In Japan, most residents with Hansen’s disease live in dedicated sanatoria because of an established quarantine policy, even after being cured of the primary disease. They suffer from secondary diseases and are advancing in age, and advance care planning is increasingly crucial for them to live their lives with dignity in a sanatorium. In this study, we have three aims: to understand how to promote communication about their wishes for medical treatment, care, and recuperation; to identify required assistance; and to (...) explore how to promote ACP in a sanatorium. This study is a qualitative research conducted through semi-structured interviews. The study included 57 ex-Hansen’s disease patients and 66 staff from 10 facilities. Ex-Hansen’s disease patients were expected to consider ACP, but this was in the context of uncertainty about whether a sanatorium would close and whether there would be doctors to manage their needs. They reported being confused when staff rushed to confirm their advance directives, feeling that they were not provided with enough information before being approached. Barriers to promoting ACP were found to be insufficient of team-based care and information sharing, ex-Hansen’s disease patients’ weak interest in their end of life, and their conservative thoughts. We believe that ACP can be achieved by listening to the wishes of recovered patients through regular home care visits by nurses and everyday support by care workers. Furthermore, multidisciplinary coordination is urgently needed for promoting ACP. (shrink)

Inspired by recent theorization by Dreier and Lave concerning situated perspectives on learning, I illuminate learning of international graduate students in a science lab in Japan as trajectories of participation in multi-layered activities and various mutually constituted occasions, and as crossing of multiple communities of practice. By doing so, I describe trajectories of participation as unique and multiple ways characteristic of individual participants instead of as a linear process from newcomer to old-timer or from peripheral to full participation in a (...) community of practice. Identity formation is also reformulated as discovering and constituting one’s unique self through crossing multiple communities of practice rather than merely as becoming a member in a community of practice. Further, I show that identity formation may be regarded not merely as adjusting the relationship among multiple communities within individuals, but as the practice of organizing new linkages among communities and of reconstituting communities of practice. (shrink)

As humans, we constantly change our movement strategies to adapt to changes in physical functions and the external environment. We have to walk very slowly in situations with a high risk of falling, such as walking on slippery ice, carrying an overflowing cup of water, or muscle weakness owing to aging or motor deficit. However, previous studies have shown that a normal gait pattern at low speeds results in reduced efficiency and stability in comparison with those at a normal speed. (...) Another possible strategy is to change the gait pattern from normal to step-to gait, in which the other foot is aligned with the first swing foot. However, the efficiency and stability of the step-to gait pattern at low speeds have not been investigated yet. Therefore, in this study, we compared the efficiency and stability of the normal and step-to gait patterns at intermediate, low, and very low speeds. Eleven healthy participants were asked to walk with a normal gait and step-to gait on a treadmill at five different speeds, ranging from very low to normal walking speed. The efficiency parameters and stability parameters were analyzed from the motion capture data and then compared for the two gait patterns. The results suggested that step-to gait had a more efficient gait pattern at very low speeds of 10–30 m/min, with a larger percent recovery, and was more stable at 10–60 m/min in comparison with a normal gait. However, the efficiency of the normal gait was better than that of the step-to gait pattern at 60 m/min. Therefore, step-to gait is effective in improving gait efficiency and stability when faced with situations that force us to walk slowly or hinder quick walking because of muscle weakness owing to aging or motor deficit along with a high risk of falling. (shrink)

Objective:This study aimed to investigate the effect of robot-assisted gait training therapy combined with non-invasive brain stimulation on lower limb function in patients with stroke and spinal cord injury.Data sourcesPubMed, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Web of Science were searched.Study selectionRandomized controlled trials published as of 3 March 2021. RCTs evaluating RAGT combined with NIBS, such as transcranial direct current stimulation and repetitive transcranial magnetic stimulation, for lower limb function and activities in patients with stroke and (...) SCI were included.Data extractionTwo reviewers independently screened the records, extracted the data, and assessed the risk of bias.Data synthesisA meta-analysis of five studies and risk of bias were conducted. Pooled estimates demonstrated that RAGT combined with NIBS significantly improved lower limb function [standardized mean difference = 0.52; 95% confidence interval = 0.06–0.99] but not lower limb activities. Subgroup analyses also failed to find a greater improvement in lower limb function of RAGT with tDCS compared to sham stimulation. No significant differences between participant characteristics or types of NIBS were observed.ConclusionThis meta-analysis demonstrated that RAGT therapy in combination with NIBS was effective in patients with stroke and SCI. However, a greater improvement in lower limb function and activities were not observed using RAGT with tDCS compared to sham stimulation. (shrink)

This article considers what it means to give plants a voice as witnesses to nuclear events. It examines two texts that attempt to represent the nonverbal testimony of irradiated plants through a hybrid approach of text and image: Sugihara Rieko’s Pilgrimage to the A-Bombed Trees (Hibakuju junrei, 2015) and Michael Marder and Anaïs Tondeur’s The Chernobyl Herbarium: Fragments of an Exploded Consciousness (2016). Published a year apart, both texts focus on the afterlife of nuclear catastrophes: the atomic bombing of (...) Hiroshima in 1945 and the Chernobyl nuclear disaster in 1986. Sugihara’s book is an account of the hibakujumoku – trees that survived the atomic bombing of Hiroshima and continue to produce new growth to this day. Combining maps, photographs, interviews, and short essays, Pilgrimage to the A-Bombed Trees is intended as an immersive guidebook to the nearly 170 irradiated trees located within a two-kilometer radius around Hiroshima’s ground zero. It presents these trees as “living witnesses” whose subsequent flourishing has provided human survivors with a conceptual figuration of destructive plasticity. Marder and Tondeur’s The Chernobyl Herbarium formally resembles Sugihara’s Pilgrimage to the A-Bombed Trees, and likewise combines text (a combination of short theoretical essays and personal remembrances of the Chernobyl meltdown) and images (Tondeur’s photograms of plants grown in the exclusion zone) into a slim volume that calls for a rejection of language as the sole means of bearing witness. According to Marder, Tondeur’s photograms “bring out the testimony of the plant,” and yet the same procedure renders these plant witnesses “specimens,” full of radioactivity but devoid of life (something Sugihara’s book avoids through the medium of photography). The Chernobyl Herbarium is an attempt to capture, in fragmentary form, the limits of language in the conceptualization of plant life and in the proper conceptualization of the Chernobyl disaster. Ultimately, both texts are experiments to “think the unthinkable and represent the unrepresentable,” to borrow Marder’s words, through a deep, speculative engagement with the botanical realm. As wordless testimony is given voice through human–botanical intra-action, the plasticity of plant life (its capacity to adapt and change) is highlighted, and this allows us to locate moments of phytomorphism – the attribution of vegetal qualities to the human – in these two self-proclaimed “guidebooks.”. (shrink)