Inpatient Stroke Rehabilitation Outcomes in Korea Derived from the Korean Brain Rehabilitation Centers’ Online Database System for the Years 2007 to 2011

좌경림,편성범,나은우,박주현,김연희,전민호,백남종,유승돈,이삼규,박시운,한태륜,임성훈,정한영 대한의학회 2015 Journal of Korean medical science Vol.30 No.5

The purpose of this report was to provide information for patients receiving inpatient rehabilitation after stroke and to identify the possible factors influencing functional outcome after inpatient rehabilitation. Stroke patients (n = 5,212) who were discharged from the Departments of Rehabilitation Medicine (RM) of university hospitals and rehabilitation hospitals from 2007 through 2011 were participants. Prevalence, age, transfer time after onset, length of stay (LOS), functional status at admission and discharge were analyzed. In all stroke subjects, cerebral infarctions (67%) were more common than hemorrhages. Cerebral infarctions in the middle cerebral artery territory were most common, while the basal ganglia and cerebral cortex were the most common areas for hemorrhagic stroke. The LOS decreased from 45 to 28 days. Transfer time after onset decreased from 44 to 30 days. Shorter transfer time after onset was correlated with better discharge functional status and shorter LOS. Initial functional status was correlated with discharge functional status. In ischemic stroke subtypes, cerebellar and brainstem strokes predicted better outcomes, while strokes with more than one territory predicted poorer outcomes with more disabilities. In hemorrhagic stroke subtypes, initial and discharge functional status was the lowest for cortical hemorrhages and highest for brainstem hemorrhages. This report shows that LOS and transfer time after onset has been decreased over time and initial functional status and shorter transfer after onset are predictors of better functional outcome at discharge.

급성 뇌경색 치료를 위한 혈전 용해제 사용 후 발생한 척수 경막하 혈종-증례보고-

좌경림,정한영,김창환,신용식,김상현,이준호,김명옥 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.6

Spinal subdural hematoma (SDH) is a rare cause of acute spinal cord compression. In most cases, these lesions are observed in association with lumbar puncture or spinal anesthesia, coagulation defect, or an underlying vascular malformation. The use of anticoagulant drug is recommended in managing deep vein thrombosis, acute myocardiac infarct, or acute cerebral infarct. But the risk of bleeding in major organs still exists and is increased by the use of multiple anticoagulants and the intensity of anticoagulation. The risk of spinal hematoma is increased in anticoagulated patients who undergo lumbar puncture or spinal anesthesia. But to dates, there are extremely rare cases of spontaneous spinal SDH occurring in patients with anticoagulant therapy when spinal instrumentation is not also being used. With reviewing some of literatures, we present a case of acute spontaneous spinal SDH developed whilereceiving anticoagulant therapy for treating acute cerebral infarct.

당뇨병성 다발신경병증 환자에서 A파의 발현

좌경림,이준호,김소헌,김창환 대한근전도전기진단의학회 2010 대한근전도 전기진단의학회지 Vol.12 No.1

목적: 전기연접전달이나 외발사에 의해 발생되는A파가 당뇨병성 신경병증에서 증가되는지를 조사하여 당뇨병성 신경병증과의 연관성을 알아보고자 하였다. 방법: 정상 지원자 21명과 73명의 당뇨병 환자를 대상으로 상, 하지의 운동과 감각신경 전도검사를 시행하였다. A파는 척골과 경골운동 신경에서 발현한 것을 조사하였다. 정상대조군과 상, 하지의 신경전도검사를 기준으로 당뇨병은 있으나 신경전도검사에서 정상군과 비정상군으로 나눈 후 세 군 사이에서 A파의 발현 정도를 비교하였다. 결과: 척골신경 전도검사에서 정상군과 당뇨병성 신경병증 유무에 따른 두 군들 사이에서A파의 발현빈도는 통계적으로 유의한 차이는 보이지 않았다. 그러나 경골신경의A파 발현빈도는 당뇨병성 신경병증 군에서 다른 두 군에 비해 유의미하게 증가되었다 (p<0.05). 결론:A 파 발현이 당뇨병성 신경병증 환자의 상지에 비해 하지에서 증가하는 소견을 보여A파 발현 증가는 당뇨병성 신경병의 진행과 관련성이 있다고 생각된다.

Concomitant Acute Transverse Myelitis and Sensory Motor Axonal Polyneuropathy in Two Children: Two Case Reports

정형,좌경림,김효상,김창환,정한영,김명옥 대한재활의학회 2015 Annals of Rehabilitation Medicine Vol.39 No.1

Acute transverse myelitis (ATM) is an upper motor neuron disease of the spinal cord, and concomitant association of peripheral polyneuropathy, particularly the axonal type, is rarely reported in children. Our cases presented with ATM complicated with axonal type polyneuropathy. Axonal type polyneuropathy may be caused by acute motor-sensory axonal neuropathy (AMSAN) or critical illness polyneuropathy and myopathy (CIPNM). These cases emphasize the need for nerve and muscle biopsies to make the differential diagnosis between AMSAN and CIPNM in patients with ATM complicated with axonal polyneuropathy.

Dysphagia after Multiple Lower Cranial Nerves Palsy Induced by Inflammatory Lesion: A Case Report

박찬혁,김창환,좌경림,정한영,김명옥,김지원 대한근전도전기진단의학회 2018 대한근전도 전기진단의학회지 Vol.20 No.1

Speech and swallowing disorder is frequently observed in stroke, brain injury, tumors, and radiation therapy. A 65-year-old woman was admitted to otolaryngology department due to dysphagia and hoarseness. These symptoms occurred two weeks after upper respiratory infection (URI). She was diagnosed with inflammatory multiple lower cranial nerves by Videofluroscopic Swallowing Study (VFSS), MRI, and neurophysiologic examinations. Shaker’s exercise for dysphagia has been performed, and the dysphagia has improved after two months. However the hoarseness persisted, and this has been improved with thyroplasty. Dysphagia by unilateral inflammatory multiple lower cranial nerve palsy would be a rare complication of URI, and we experienced a case of multiple lower cranial neuropathy with successful management.

The Correlation between Modified Ashworth Scale and Biceps T-reflex and Inter-rater and Intra-rater Reliability of Biceps T-reflex

민지홍,신용일,좌경림,고성화,신명준,장재혁,고현윤 대한재활의학회 2012 Annals of Rehabilitation Medicine Vol.36 No.4

Objective To establish a correlation between the modified Ashworth scale (MAS) and amplitude and latency of T-reflex and to demonstrate inter-rater and intra-rater reliability of the T-reflex of the biceps muscle for assessing spasticity after stroke. Method A total of 21 patients with hemiplegia and spasticity after ischemic stroke were enrolled for this study. The spasticity of biceps muscle was evaluated by an occupational therapist using the MAS. The mean value of manual muscle test of biceps muscles was 2.3±0.79. Latency and amplitude of T-reflex were recorded from biceps muscles by two physicians. The onset latency and peak to peak amplitude of the mean of 5 big T-reflex were measured. The examinations were carried out by two physicians at the same time to evaluate the inter-rater reliability. Further, one of the physicians performed the examination again after one week to evaluate the intra-rater reliability. The correlations between MAS and T-reflex, and the intra- and inter-rater reliability of biceps T-reflex were established by calculating the Spearman correlation coefficients and the intra-class correlation coefficients (ICCs).Results Amplitude of the biceps T-reflex increased with increasing level of MAS (rs=0.464 and 0.573, respectively, p<0.01). ICCs of latency and amplitude of biceps T-reflex were 0.914 and 0.822. The Spearman correlation coefficients of latency and amplitude of biceps T-reflex were 0.937 and 0.635, respectively (p<0.01). Conclusion Biceps T-reflex demonstrates a good quantitative measurement and correlation tool with MAS for spasticity, and also shows acceptable inter- and intra-rater reliability, which can be used for patients with spasticity after stroke.

Effect of a Caregiver’s Education Program on Stroke Rehabilitation

홍상은,김창환,김이진,좌경림,김태현,김상근,한희준,이의창,정한영 대한재활의학회 2017 Annals of Rehabilitation Medicine Vol.41 No.1

Objective To evaluate effects of caregiver’s education program on their satisfaction, as well as patient functional recovery, performed in addition to daily conventional rehabilitation treatment.Methods Three hundred eleven subjects diagnosed with first-onset stroke and transferred to the Department of Physical Medicine and Rehabilitation of Inha University Hospital were surveyed. In 2015, caregivers attended an education program for acute and subacute stroke patients. Patients who received an additional rehabilitation therapy were assigned to the experimental group (n=81), whereas the control group (n=100) consisted of transfer cases in 2014 with only conventional treatment. The experimental group was classified by severity using the Korean version of the National Institutes of Health Stroke Scale (K-NIHSS), which was administered to all 181 subjects, in addition to, the Korean version of the Mini Mental Status Examination (K-MMSE), a Modified Barthel Index (K-MBI), and the Berg Balance Scale (K-BBS). Caregiver satisfaction and burden before and after education programs were assessed using the Canadian Occupational Performance Measure (COPM), as well as family burden and caregiver burnout scales.Results No significant intergroup difference was observed between initial K-NIHSS, K-MMSE, K-BBS, K-MBI scores, and times from admission to transfer. Those with moderate or severe strokes under the experimental condition showed a more significant improvement than the control group as determined by the K-NIHSS and K-BBS, as well as tendential K-MMSE and K-MBI score increases. Satisfaction was significantly greater for family members and formal caregivers of patients with strokes of moderate severity in the experimental group.Conclusion The caregiver’s education program for stroke subjects had a positive outcome on patients’ functional improvement and caregiver satisfaction. The authors believe that the additional rehabilitation therapy with the education program aids patients to achieve functional improvements for an optimal return to social life.

Superior Effects of High-Intensity Interval Training Compared to Conventional Therapy on Cardiovascular and Psychological Aspects in Myocardial Infarction

최하윤,한희준,최지원,정한영,좌경림 대한재활의학회 2018 Annals of Rehabilitation Medicine Vol.42 No.1

Objective To evaluate the effect of high-intensity interval training (HIIT) on psychological symptoms, activity states, and cardiovascular functions in patients with myocardial infarction (MI) of low and moderate risk stratification. Methods This prospective study randomly allocated 44 patients with MI to 18 sessions of HIIT or conventional moderate-intensity continuous training (MICT). Outcome measures were assessed at baseline and after 18 sessions. Results Post-exercise cardiovascular and functional states, maximal oxygen uptake (VO2max), metabolic equivalents (METs), 6-Minute Walking Test (6MWT), and Korean Activity Scale/Index (KASI) scores were significantly improved in the HIIT group compared to those in the MICT group after 18 exercise sessions. In particular, VO2max was significantly (p<0.005) improved in the HIIT group (7.58 mL/kg/min) compared to that in the MICT group (2.42 mL/kg/min). In addition, post-exercise psychological states (i.e., scores of Fatigue Severity Scale [FSS] and depression items of the Hospital Anxiety and Depression Scale [HADS_D]) were significantly improved in the HIIT group compared to those in the MICT group after 18 exercise sessions. HADS-D was improved by 1.89 in the HIIT group compared to decrement of 0.47 in the MICT group. FSS was improved by 6.38 in the HIIT group compared to decrement of 0.77 in the MICT group (p<0.005). Conclusion This study demonstrates that HIIT can improve cardiac function, psychological, and activity states in low and moderate risk MI patients. Compared to conventional MICT, HIIT can improve cardiovascular functions, activity states, depression, and fatigue more effectively.

An Objective Assessment Scale for “Come-to-Sit” Using a Specifi cally Designed Jacket in Stroke Patients

이준호,김명옥,정한영,이재우,좌경림,김재홍,김명종,허두항,장은주 대한재활의학회 2012 Annals of Rehabilitation Medicine Vol.36 No.1

Objective To compare an objective assessment scale for “come-to-sit” in stroke patients with the previously established subjective assessment scales of “performance-based assessment” and the “ability for basic movement scale”. Method A specifically designed jacket was used to determine the objective degree of assistance needed for patients to perform the task. While patients were sitting up, the investigator evaluated the amount of assistance needed in a fully dependent state (A) and with maximal eff ort (B). Using this measure, we obtained an objective scale, {(A-B)/A} ×100. In addition, patients were tested in two starting positions: hemiplegic-side lying and soundside lying. We then compared the objective scale with subjective scales and other parameters related to functional outcomes. Results For both starting positions, the objective assessment scale showed high correlation with the previously established subjective scales (p<0.01). Only the hemiplegic-side lying-to-sit objective scale showed a signifi cant correlation with the parameters used to assess functional outcomes (p<0.05). In terms of Brunnström stages, only the leg stage showed a signifi cant correlation with the objective “come-to-sit” scale (p<0.01). Conclusion The objective scale was comparable to established subjective assessment scales when used by an expert. The hemiplegic-side lying-to-sit maneuver had a high correlation with patient’s functional recovery. Specifi cally, balance and lower extremity function appear to be important factors in the “come-to-sit” activity.

The Successful Treatment of Combined Local and Systemic Steroids in a Patient with Brachial Plexus Neuritis: A Case report

이현성,김창범,김은석,김명옥,좌경림,박찬혁,김창환 대한근전도전기진단의학회 2020 대한근전도 전기진단의학회지 Vol.22 No.2

Brachial plexus neuritis (BPN), also known as Parsonage-Turner syndrome, is an uncommon neurological disorder that can manifest with acute extreme upper arm pain followed by patchy muscle paralysis. There is no evidence supporting any recommended treatments for BPN from randomized trials. Non-randomized studies have supported the effectiveness of early administration of high-dose oral corticosteroids during the painful phase. We present a case of a 41-year-old-female with a history of acute left lateral shoulder pain and shoulder girdle weakness who was diagnosed with acute BPN. To reduce the risk of complications arising from high-dose oral steroid administration, we used an ultrasound-guided brachial plexus blockade combined with low-dose oral steroids. The combined treatment approach successfully restored shoulder function and effectively alleviated pain while avoiding complications associated with systemic steroid administration.