Brain Oscillations and Their Implications for Neurorehabilitation

지성주 대한뇌신경재활학회 2021 뇌신경재활 Vol.14 No.1

Neural oscillation is rhythmic or repetitive neural activities, which can be observed at all levels of the central nervous system (CNS). The large-scale oscillations measured by electroencephalography have long been used in clinical practice and may have a potential for the usage in neurorehabilitation for people with various CNS disorders. The recent advancement of computational neuroscience has opened up new opportunities to explore clinical application of the results of neural oscillatory activity analysis to evaluation and diagnosis; monitoring the rehab progress; prognostication; and personalized rehabilitation planning in neurorehabilitation. In addition, neural oscillation is catching more attention to its role as a target of noninvasive neuromodulation in neurological disorders.

뇌졸중 환자에서 흔한 수면 문제 및 수면 관리

지성주,전현규 대한뇌신경재활학회 2016 뇌신경재활 Vol.9 No.1

Sleep related breathing disorders comprises disorders related abnormal pattern and status of the gas exchange during sleep. It has been reported that abnormal sleep pattern could results in an autonomic dysfunction during sleep and ends up to increase possibility to induce stroke and cardiovascular disease associated with atherosclerosis. Stroke is a disorder, which could cause death and critical disability in the adulthood. Sleep related breathing disorders and stroke has causal relationship in each other, which could influence on recovery to each other. Systematic evaluation and management for sleep disorder after stroke might have clinical importance. This review will comprise of topics about sleep related disorders in stroke patients including epidemiology, relationship between stroke and sleep disorder, diagnosis, and management of frequent sleep disorder.

The Effects of Shoulder Slings on Balance in Patients With Hemiplegic Stroke

손민균,지성주,황평식,전유미,이현근 대한재활의학회 2015 Annals of Rehabilitation Medicine Vol.39 No.6

Objective To investigate the effects of a shoulder sling on balance in patients with hemiplegia. Methods Twenty-seven hemiplegic stroke patients (right 13, left 14) were enrolled in this study. The subjects’ movement in their centers of gravity (COGs) during their static and dynamic balance tests was measured with their eyes open in each sling condition−without a sling, with Bobath’s axillary support (Bobath sling), and with a simple arm sling. The percent times in quadrant, overall, anterior/posterior, and medial/lateral stability indexes were measured using a posturography platform (Biodex Balance System SD). Functional balance was evaluated using the Berg Balance Scale and the Trunk Impairment Scale. All balance tests were performed with each sling in random order. Results The COGs of right hemiplegic stroke patients and all hemiplegic stroke patients shifted to, respectively, the right and posterior quadrants during the static balance test without a sling (p<0.05). This weight asymmetry pattern did not improve with either the Bobath or the simple arm sling. There was no significant improvement in any stability index during either the static or the dynamic balance tests in any sling condition. Conclusion The right and posterior deviations of the hemiplegic stroke patients’ COGs were maintained during the application of the shoulder slings, and there were no significant effects of the shoulder slings on the patients’ balance in the standing still position.

Quantitative Muscle Ultrasonography in Carpal Tunnel Syndrome

이혜원,지성주,박수호,안승찬,임준호,손민균 대한재활의학회 2016 Annals of Rehabilitation Medicine Vol.40 No.6

Objective To assess the reliability of quantitative muscle ultrasonography (US) in healthy subjects and to evaluate the correlation between quantitative muscle US findings and electrodiagnostic study results in patients with carpal tunnel syndrome (CTS). The clinical significance of quantitative muscle US in CTS was also assessed. Methods Twenty patients with CTS and 20 age-matched healthy volunteers were recruited. All control and CTS subjects underwent a bilateral median and ulnar nerve conduction study (NCS) and quantitative muscle US. Transverse US images of the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were obtained to measure muscle cross-sectional area (CSA), thickness, and echo intensity (EI). EI was determined using computer-assisted, grayscale analysis. Inter-rater and intra-rater reliability for quantitative muscle US in control subjects, and differences in muscle thickness, CSA, and EI between the CTS patient and control groups were analyzed. Relationships between quantitative US parameters and electrodiagnostic study results were evaluated. Results Quantitative muscle US had high inter-rater and intra-rater reliability in the control group. Muscle thickness and CSA were significantly decreased, and EI was significantly increased in the APB of the CTS group (all p<0.05). EI demonstrated a significant positive correlation with latency of the median motor and sensory NCS in CTS patients (p<0.05). Conclusion These findings suggest that quantitative muscle US parameters may be useful for detecting muscle changes in CTS. Further study involving patients with other neuromuscular diseases is needed to evaluate peripheral muscle change using quantitative muscle US.

비디오투시조영검사를 통한 침습/흡인에 따른 음성의 음향적 분석

강영애,지성주,구본석 대한이비인후과학회 2017 대한이비인후과학회지 두경부외과학 Vol.60 No.9

Background and Objectives The present study aimed to investigate the effects of penetration/aspiration (P/A) on voice acoustic parameters. Subjects and Method Twenty-seven patients were analyzed with the videofluoroscopic swallowing study (VFSS) and then divided into two groups based on the modified Penetration and Aspiration Scale results. Ten patients (5 males and 5 females) were included in the Non-P/A group, and 17 patients (12 males and 5 females) in the P/A group. Stroke was the major cause of swallowing disorders. Three sustained /a/ vowels recorded in pre- and post-VFSS were analyzed. Mann-Whitney U-test was used to compare acoustic values before and after VFSS, and the receiver operating characteristics (ROC) curve with combination of significant parameters was also conducted. Results Among acoustic parameters, the length of analyzed sample (p=0.010), number of segments computed (p=0.018), total number detected pitch periods (p=0.017), and second formant (p=0.013) in pre- and post-VFSS were significantly different between Non-P/A and P/A groups. In the P/A group after VFSS, the means of these significant parameters decreased. According to ROC combined with four significant parameters, the probability of predicting P/A condition was 84% (p=0.005), the sensitivity was 80%, and the specificity was 80%. Conclusion Voice acoustic analysis can reflect voice changes by penetration/aspiration and the combination of significant parameters can also detect swallowing disorders. Therefore, voice analysis can be a reliable screening tool for patients with swallowing disorders. Korean J Otorhinolaryngol-Head Neck Surg 2017;60(9):454-62

Effect of Transcranial Direct Current Stimulation on Postural Stability and Lower Extremity Strength in Hemiplegic Stroke Patients

손민균,지성주,김영욱 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.6

Objective To evaluate the effect of anodal transcranial direct current stimulation (tDCS) over the lesioned leg motor cortex, which can enhance the strength and coordination of the contralateral lower extremity and furthermore, enhance the postural stability of the hemiplegic subject.Methods Anodal or sham stimulation on the lesioned cortex of a lower extremity was delivered to 11 ambulatory hemiplegic patients. The stimulation intensity was 2 mA. All subjects took part in two 10-minute tDCS sessions consisting of anodal stimulation and sham stimulation. The interval period between real and sham stimulation was 48 hours. The order was counter-balanced among the subjects. Before and after each stimulation session, static postural stability was evaluated with eyes opened and closed. Also, the isometric strength of the hemiplegic side of the treated knee was measured before and after each stimulation session. Repeated measure ANOVA was used to determine the statistical significance of improvements in postural stability and strength.Results There was significant improvement for overall stability index with eyes opened and closed after anodal tDCS (p<0.05). Isometric strength of the lesioned quadriceps tended to increase after anodal tDCS (p<0.05). Postural stability and quadriceps strength were not changed after sham stimulation.Conclusion Anodal tDCS has potential value in hemiplegic stroke patients to improve balance and strengthen the affected lower extremity.

연하장애가 없는 입원 노인에게 식이의 변화에 따른 연하기능 확인의 필요성

조강희,지성주,최민우,Cho, Kang-hee,Jee, Sung-ju,Choi, Min-woo 한국식품과학회 2015 식품과학과 산업 Vol.48 No.3

견봉하 삼각근하 점액낭 주사 시 맹검 접근법과 초음파 하 접근법의 비교

조강희,지성주,황선홍,이혜진 대한재활의학회 2010 Annals of Rehabilitation Medicine Vol.34 No.2

Objective: To evaluate the accuracy and effect of ultrasonography guided subacromial subdeltoid (SASD) bursa injection on the shoulder pain and function compared to blind technique. Method: Twenty-eight patients diagnosed as SASD bursitis were administered with SASD injection of corticosteroids randomly by either blind or US guided technique and then assessed by ultrasonography to confirm the accuracy. Shoulder pain and function were evaluated by visual analog scale with Hawkin’s impingement test, active range of motion (ROM) of the shoulder, University of California-Los Angeles (UCLA) shoulder rating scale before and 1 week after the injection. Results: The accuracy of SASD injection using blind technique was 42.8%, however, US-guided injection showed 100% accuracy, significantly higher than blind technique (p<0.05). We could find significant improvement in pain with Hawkin’s impingement test, active ROM of the shoulder, UCLA shoulder rating scale 1 week after injection in both groups. But there were no significant differences between the groups. In eight patients, failure was observed: four in the suprascapularis tendon, three in the deltoid muscle, and one in the subcutaneous tissue without side effects. Conclusion: Ultasonography guided injection into SASD bursa improved the accuracy of injection. However the injection method and the success of injection did not affect to the pain and shoulder function. (J Korean Acad Rehab Med 2010; 34: 209-213) Objective: To evaluate the accuracy and effect of ultrasonography guided subacromial subdeltoid (SASD) bursa injection on the shoulder pain and function compared to blind technique. Method: Twenty-eight patients diagnosed as SASD bursitis were administered with SASD injection of corticosteroids randomly by either blind or US guided technique and then assessed by ultrasonography to confirm the accuracy. Shoulder pain and function were evaluated by visual analog scale with Hawkin’s impingement test, active range of motion (ROM) of the shoulder, University of California-Los Angeles (UCLA) shoulder rating scale before and 1 week after the injection. Results: The accuracy of SASD injection using blind technique was 42.8%, however, US-guided injection showed 100% accuracy, significantly higher than blind technique (p<0.05). We could find significant improvement in pain with Hawkin’s impingement test, active ROM of the shoulder, UCLA shoulder rating scale 1 week after injection in both groups. But there were no significant differences between the groups. In eight patients, failure was observed: four in the suprascapularis tendon, three in the deltoid muscle, and one in the subcutaneous tissue without side effects. Conclusion: Ultasonography guided injection into SASD bursa improved the accuracy of injection. However the injection method and the success of injection did not affect to the pain and shoulder function. (J Korean Acad Rehab Med 2010; 34: 209-213)

Change of Swallowing in Patients With Head and Neck Cancer After Concurrent Chemoradiotherapy

권세희,구본석,지성주 대한재활의학회 2016 Annals of Rehabilitation Medicine Vol.40 No.6

Objective To evaluate the functional characteristics of swallowing and to analyze the parameters of dysphagia in head and neck cancer patients after concurrent chemoradiotherapy (CCRT). Methods The medical records of 32 patients with head and neck cancer who were referred for a videofluoroscopic swallowing study from January 2012 to May 2015 were retrospectively reviewed. The patients were allocated by duration after starting CCRT into early phase (<1 month after radiation therapy) and late phase (>1 month after radiation therapy) groups. We measured the modified penetration aspiration scale (MPAS) and American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale (ASHA-NOMS). The oral transit time (OTT), pharyngeal delay time (PDT), and pharyngeal transit time (PTT) were recorded to assess the swallowing physiology. Results Among 32 cases, 18 cases (56%) were of the early phase. In both groups, the most common tumor site was the hypopharynx (43.75%) with a histologic type of squamous cell carcinoma (75%). PTT was significantly longer in the late phase (p=0.03). With all types of boluses, except for soup, both phases showed a statistically significant difference in MPAS results. The mean ASHA-NOMS level for the early phase was 5.83±0.78 and that for the late phase was 3.79±1.80, with statistical significance (p=0.01). The PTT and ASHA-NOMS level showed a statistically significant correlation (correlation coefficient=–0.52, p=0.02). However, it showed no relationship with the MPAS results.Conclusion The results of our study suggest that in the late phase that after CCRT, the OTT, PDT, and PTT were longer than in the early phase and the PTT prolongation was statistically significant. Therefore, swallowing therapy targeting the pharyngeal phase is recommended after CCRT.

Motor Unit Number Estimation and Motor Unit Action Potential Analysis in Carpal Tunnel Syndrome

손민균,황선열,지성주,김영재,신현대 대한재활의학회 2011 Annals of Rehabilitation Medicine Vol.35 No.6

Objective To evaluate the clinical signifi cance of motor unit number estimation (MUNE) and quantitative analysis of motor unit action potential (MUAP) in carpal tunnel syndrome (CTS) according to electrophysiologic severity,ultrasonographic measurement and clinical symptoms. Method We evaluated 78 wrists of 45 patients, who had been diagnosed with CTS and 42 wrists of 21 healthy controls. Median nerve conduction studies, amplitude and duration of MUAP, and the MUNE of the abductor pollicis brevis were measured. The cross sectional area (CSA) of the median nerve at the pisiform and distal radioulnar joint level was determined by high resolution ultrasonography. Clinical symptom of CTS was assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). Results The MUNE, the amplitude and the duration of MUAP of the CTS group were signifi cantly diff erent from those found in the control group. The area under the ROC curve was 0.944 for MUNE, 0.923 for MUAP amplitude and 0.953 for MUAP duration. MUNE had a negative correlation with electrophysiologic stage of CTS, amplitude and duration of MUAP, CSA at pisiform level, and the score of BCTQ. The amplitude and duration of MUAP had a positive correlation with the score of BCTQ. The electrophysiologic stage was correlated with amplitude but not with the duration of MUAP. Conclusion MUNE, amplitude and duration of MUAP are useful tests for diagnosis of CTS. In addition, the MUNE serves as a good indicator of CTS severity.