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[Purpose] The purpose of this study was to examine whether changes in muscle synergy could affect gait stability or muscle activity by comparing muscle activity before and after prolonged walking. [Subjects and Methods] Twelve healthy male subjects walked on a treadmill for 10 min as a warm-up. Data were recorded from the participants during the first and last 1 min during 90 min of walking at 4.5 km/h. Electromyographic (EMG) activity was recorded for 7 leg muscles, and patterns of coordination were determined by principal component analysis (PCA). The patterns of activity within the anatomic muscle groups were additionally determined by repeating PCA. iEMG was calculated using the mean EMG for each cycle step during the 1 min walking periods. The largest Lyapunov exponent was calculated to quantify each subject’s inherent local dynamic stability. [Results] The patterns for each of the 7 muscles showed no change between the start and end periods. However, the end period showed a higher co-activation of the triceps surae, lower iEMG of the medial gastrocnemius, and a smaller largest Lyapunov exponent of the mediolateral and anteroposterior directions than those observed during the start period. [Conclusion] The increase in triceps surae co-activation may be associated with gait stability.

Background While in an acute hospital setting, it is challenging for clinicians to make discharge decisions due to the multifactorial process and individual patient characteristics. Objective To evaluate and develop a scoring system utilizing the Japan Rehabilitation Database (JRD) to identify acute stroke patients with a high possibility of discharge to home. Design Retrospective observational cohort study. Setting Thirty‐seven acute hospitals in Japan. Participants A total of 10 270 patients admitted to the acute hospitals with stroke were identified. The inclusion criteria were (1) admission within 3 days of onset and (2) admission from home. Exclusion criteria were (1) incomplete data and (2) death in hospital. A total of 4216 patients were included in the study. Intervention Not applicable. Main Outcome Measurements Discharge destination from acute care hospital, that is, home versus other locations. Results In the multivariate logistic regression, age, stroke type, Barthel Index on admission, modified Rankin scale on admission, the National Institutes of Health Stroke Scale on admission, and extent of paralysis were retained. When the cutoff point was 33, the scoring system showed a sensitivity of 80.4% and specificity of 80.3%. The area under curve (AUC) was 0.88. On evaluating the predictive performance, the model showed a sensitivity of 78.2% and a specificity of 78.5% with an AUC = 0.86. Conclusions We developed a point system to identify acute stroke patients with a high possibility of discharge to home using the JRD. This point system may provide useful information for clinicians to plan the discharge of acute stroke patients.

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