Anatomical Correlates of Neuropsychological Deficits Among Patients With the Cerebellar Stroke

Shin, Min A,Park, Oak Tae,Shin, Joon-Ho Korean Academy of Rehabilitation Medicine 2017 Annals of Rehabilitation Medicine Vol.41 No.6

<P><B>Objective</B></P><P>To investigate the anatomical correlates of the neuropsychological deficits in patients with the cerebellar stroke.</P><P><B>Methods</B></P><P>We screened patients who were admitted to the National Rehabilitation Center with the cerebellar stroke between October 2012 and November 2016. The patients with the cerebellar stroke who underwent neuropsychological testing for which the Seoul Neuropsychological Screening Battery (SNSB) or the SNSB-II were enrolled. The neuropsychological function capacities were compared in accordance with the stroke type (hemorrhagic vs. ischemic) and the location (right/left anterior, right/left posterior intermediate, right/left posterior lateral lobe, and vermis). Mean z-scores were computed to compare the patient performances with the population averages.</P><P><B>Results</B></P><P>Twenty-six patients (15 with ischemic stroke and 11 with hemorrhagic stroke) with a mean age of 54.8±16.6 years were assessed 8.8±9.2 months after the stroke. Differences in the neuropsychological functioning according to the stroke type were not observed. All of the numerical subtests of the stroke patients showed significantly poorer performances compared with the population averages (mean z-score <0), and some of the subtests revealed abnormal performances in attention-, visuospatial function-, memory-, and frontal/executive function-related tasks (mean z-score <−1). The patients with the presence of a lesion in the right posterior intermediate lobe of the cerebellum showed a poorer performance in the subtests evaluating the executive function including the Korean-version Stroop Test (p=0.04), the Digit Symbol Coding Test (p=0.01), and the Korean-version Trail Making Test (p=0.02) compared with the patients without that lesion.</P><P><B>Conclusion</B></P><P>The present study confirms that the cerebellar stroke affects the neuropsychological functioning which is associated with the anatomical site of stroke.</P>

The Characteristics of Cognitive Impairment and Their Effects on Functional Outcome After Inpatient Rehabilitation in Subacute Stroke Patients

Park, Soo Ho,Sohn, Min Kyun,Jee, Sungju,Yang, Shin Seung Korean Academy of Rehabilitation Medicine 2017 Annals of Rehabilitation Medicine Vol.41 No.5

<P><B>Objective</B></P><P>To determine the frequency and characteristics of vascular cognitive impairment (VCI) in patients with subacute stroke who underwent inpatient rehabilitation and to analyze whether cognitive function can predict functional assessments after rehabilitation.</P><P><B>Methods</B></P><P>We retrospectively reviewed the medical records of patients who were admitted to our rehabilitation center after experiencing a stroke between October 2014 and September 2015. We analyzed the data from 104 patients who completed neuropsychological assessments within 3 months after onset of a stroke.</P><P><B>Results</B></P><P>Cognitive impairment was present in 86 out of 104 patients (82.6%). The most common impairment was in visuospatial function (65, 62.5%) followed by executive function (63, 60.5%), memory (62, 59.6%), and language function (34, 32.6%). Patients with impairment in the visuospatial and executive domains had poor scores of functional assessments at both admission and discharge (p<0.05). A multivariate analysis revealed that age (β=−0.173) and the scores on the modified Rankin Scale (β=−0.178), Korean version of the Modified Barthel Index (K-MBI) (β=0.489) at admission, and Trail-Making Test A (TMT-A) (β=0.228) were related to the final K-MBI score at discharge (adjusted R<SUP>2</SUP>=0.646).</P><P><B>Conclusion</B></P><P>In our study, VCI was highly prevalent in patients with stroke. TMT-A scores were highly predictive of their final K-MBI score. Collectively, our results suggest that post-stroke executive dysfunction is a significant and independent predictor of functional outcome.</P>

Transcranial Motor Evoked Potentials of Lower Limbs Can Prognosticate Ambulation in Hemiplegic Stroke Patients

Hwang, Pyoungsik,Sohn, Min Kyun,Jee, Sungju,Lee, Hyunkeun Korean Academy of Rehabilitation Medicine 2016 Annals of Rehabilitation Medicine Vol.40 No.3

<P><B>Objective</B></P><P>To examine the association between motor evoked potentials (MEPs) in lower limbs and ambulatory outcomes of hemiplegic stroke patients.</P><P><B>Methods</B></P><P>Medical records of hemiplegic patients with the first ever stroke who received inpatient rehabilitation from January 2013 to May 2014 were reviewed. Patient who had diabetes, quadriplegia, bilateral lesion, brainstem lesion, severe musculoskeletal problem, and old age over 80 years were excluded. MEPs in lower limbs were measured when they were transferred to the Department of Rehabilitation Medicine. Subjects were categorized into three groups (normal, abnormal, and absent response) according to MEPs findings. Berg Balance Scale (BBS) and Functional Ambulation Category (FAC) at initial and discharge were compared among the three groups by one-way analysis of variance (ANOVA). Correlation was determined using a linear regression model.</P><P><B>Results</B></P><P>Fifty-eight hemiplegic patients were included. BBS and FAC at discharge were significantly (ANOVA, p<0.001) different according to MEPs findings. In linear regression model of BBS and FAC using stepwise selection, patients' age (p<0.01), BBS at admission (p<0.01), and MEPs (p<0.01) remained significant covariates. In regression assumption model of BBS and FAC at admission, MEPs and gender were significant covariates.</P><P><B>Conclusion</B></P><P>Initial MEPs of lower limbs can prognosticate the ambulatory outcomes of hemiplegic patients.</P>

Facilitation of Corticospinal Excitability According to Motor Imagery and Mirror Therapy in Healthy Subjects and Stroke Patients

Kang, Youn Joo,Ku, Jeonghun,Kim, Hyun Jung,Park, Hae Kyung Korean Academy of Rehabilitation Medicine 2011 Annals of Rehabilitation Medicine Vol.35 No.6

<P><B>Objective</B></P><P>To delineate the changes in corticospinal excitability when individuals are asked to exercise their hand using observation, motor imagery, voluntary exercise, and exercise with a mirror.</P><P><B>Method</B></P><P>The participants consisted of 30 healthy subjects and 30 stroke patients. In healthy subjects, the amplitudes and latencies of motor evoked potential (MEP) were obtained using seven conditions: (A) rest; (B) imagery; (C) observation and imagery of the hand activity of other individuals; (D) observation and imagery of own ipsilateral hand activity; (E) observation and imagery of the hand activity of another individual with a mirror; (F) observation and imagery of own symmetric ipsilateral hand activity (thumb abduction) with a mirror; and (G) observation and imagery of own asymmetric ipsilateral hand activity (little finger abduction) with a mirror. In stroke patients, MEPs were obtained in the A, C, D, E, F conditions.</P><P><B>Results</B></P><P>In both groups, increment of the percentage MEP amplitude (at rest) and latency decrement of MEPs were significantly higher during the observation of the activity of the hand of another individual with a mirror and during symmetric ipsilateral hand activity on their own hand with a mirror than they were without a mirror. In healthy subjects, the increment of percentage MEP amplitude and latency decrement were significantly higher during the observation of the symmetric ipsilateral hand activity with a mirror compared to the observation of the activity of the asymmetric ipsilateral hand with a mirror of their own hand.</P><P><B>Conclusion</B></P><P>In both groups, corticospinal excitability was facilitated by viewing the mirror image of the activity of the ipsilateral hand. These findings provide neurophysiological evidence supporting the application of various mirror imagery programs during stroke rehabilitation.</P>

Comparison of the Effects of Cardiac Rehabilitation Between Obese and Non-obese Patients After Acute Myocardial Infarction

Lim, Seung-Kyu,Han, Jae-Young,Choe, Yu-Ri Korean Academy of Rehabilitation Medicine 2016 Annals of Rehabilitation Medicine Vol.40 No.5

<P><B>Objective</B></P><P>To evaluate the effects of cardiac rehabilitation (CR) on functional capacity in obese and non-obese patients who have suffered acute myocardial infarction (AMI).</P><P><B>Methods</B></P><P>Overall, 359 patients who have suffered AMI, and were referred for CR after percutaneous coronary intervention from 2010 to 2015 and underwent an exercise tolerance test before and after phase II CR were included in this study. The patients were divided into two groups: obese group with body mass index (BMI) ≥25 kg/m<SUP>2</SUP> (n=170; age, 54.32±9.98 years; BMI, 27.52±2.92 kg/m<SUP>2</SUP>) and non-obese group with BMI <25 kg/m<SUP>2</SUP> (n=189; age, 59.12±11.50 years; BMI 22.86±2.01 kg/m<SUP>2</SUP>). The demographic characteristics and cardiopulmonary exercise capacity of all patients were analyzed before and after CR.</P><P><B>Results</B></P><P>There were significant changes in resting heart rate (HR<SUB>rest</SUB>) before and after CR between the obese and non-obese groups (before CR, p=0.028; after CR, p=0.046), but other cardiopulmonary exercise capacity before and after CR was not different between the groups. HR<SUB>rest</SUB> (p<0.001), maximal metabolic equivalents (METs, p<0.001), total exercise duration (TED, p<0.001), and maximal oxygen consumption (VO<SUB>2max</SUB>, p<0.001) improved significantly in the obese and non-obese groups after CR. No difference in the change in the cardiopulmonary exercise capacity rate was detected between the groups.</P><P><B>Conclusion</B></P><P>CR may improve functional capacity in patients who suffered AMI regardless of their obesity.</P>

Risk Factors and Functional Impact of Medical Complications in Stroke

Kim, Bo-Ram,Lee, Jongmin,Sohn, Min Kyun,Kim, Deog Young,Lee, Sam-Gyu,Shin, Yong-Il,Oh, Gyung-Jae,Lee, Yang-Soo,Joo, Min Cheol,Han, Eun Young,Kim, Yun-Hee Korean Academy of Rehabilitation Medicine 2017 Annals of Rehabilitation Medicine Vol.41 No.5

<P><B>Objective</B></P><P>To determine the incidence and risk factors for medical complications in Korean patients suffering from stroke and the impact of such complications on post-stroke functional outcomes.</P><P><B>Methods</B></P><P>We assessed patients enrolled in a prospective cohort study. All recruited patients had suffered a first acute stroke episode and been admitted to nine university hospitals in Korea between August 2012 and June 2015. We analyzed patient and stroke characteristics, comorbidities, prevalence of post-stroke medical complications, and functional outcomes at time of discharge and 3, 6, and 12 months after stroke onset.</P><P><B>Results</B></P><P>Of 10,625 patients with acute stroke, 2,210 (20.8%) presented with medical complications including bladder dysfunction, bowel dysfunction, sleep disturbance, pneumonia, and urinary tract infection. In particular, complications occurred more frequently in older patients and in patients with hemorrhagic strokes, more co-morbidities, severe initial motor impairment, or poor swallowing function. In-hospital medical complications were significantly correlated with poor functional outcomes at all time points.</P><P><B>Conclusion</B></P><P>Post-stroke medical complications affect functional recovery. The majority of complications are preventable and treatable; therefore, the functional outcomes of patients with stroke can be improved by providing timely, appropriate care. Special care should be provided to elderly patients with comorbid risk factors.</P>

Energy Expenditures for Activities of Daily Living in Korean Young Adults: A Preliminary Study

Cho, Kye Hee,Song, Woojin,Kim, Jungsoo,Jung, Eun Ji,Jang, Joonyoung,Im, Sang Hee,Kim, MinYoung Korean Academy of Rehabilitation Medicine 2016 Annals of Rehabilitation Medicine Vol.40 No.4

<P><B>Objective</B></P><P>To investigate the energy expenditure (EE) of Korean young adults based on activities refined to a deskbound lifestyle.</P><P><B>Methods</B></P><P>Sixty-four healthy office workers aged between 25 and 46 years participated in this study. EE was expressed as metabolic equivalent of task (MET). Participants were evaluated in terms of their EE during physical activities of sleeping (n=22), typing (n=37), folding laundry (n=34), dishwashing (n=32), studying (n=18), mopping (n=35), walking (n=33), stair climbing (n=23), and running (n=29). Volume of oxygen consumption was measured by indirect calorimetry K4b<SUP>2</SUP> (COSMED). The results were compared to the established Compendium MET.</P><P><B>Results</B></P><P>The MET of activities were: sleeping, 1.24±0.43; typing, 1.35±0.25; folding laundry, 1.58±0.51; dishwashing, 2.20±0.51; studying, 2.11±0.90; mopping, 2.72±0.69; walking at 4 km/hr, 3.48±0.65; stair climbing of five stories, 6.18±1.08; and running at 8 km/hr, 7.57±0.57. The values of typing and mopping were similar to those in the Compendium, whereas those of sleeping, folding laundry, dishwashing, studying, walking, stair climbing and running were different.</P><P><B>Conclusion</B></P><P>To our knowledge, this estimation of EE in MET during activities of daily living is the first data of young adults in Korea. These data could be used as a reference to modify the guidelines of physical activities for the age group examined in this study.</P>

Needs for Medical and Rehabilitation Services in Adults With Cerebral Palsy in Korea

Park, Myung Woo,Kim, Won Sep,Bang, Moon Suk,Lim, Jae Young,Shin, Hyung-Ik,Leigh, Ja-Ho,Kim, Keewon,Kwon,, Bum Sun,Jang, Soong-Nang,Jung, Se Hee Korean Academy of Rehabilitation Medicine 2018 Annals of Rehabilitation Medicine Vol.42 No.3

<P><B>Objective</B></P><P> To investigate medical comorbidities and needs for medical and rehabilitation services of adults with cerebral palsy (CP) in Korea.</P><P><B>Methods</B></P><P>This was a prospective cross-sectional study. One hundred fifty-four adults with CP were enrolled in the study between February 2014 and December 2014. Information was obtained from participants regarding functional status, demographic and socioeconomic data, medical problems, and requirements for and utilization of medical and rehabilitation services.</P><P><B>Results</B></P><P>The participants included 93 males and 61 females with a mean age of 40.18±9.15 years. The medical check-up rate of adults with CP was lower than that of healthy adults and the total population with disabilities (53.2% vs. 58.6% vs. 70.4%). A quarter of the subjects failed to visit the hospital during the past year, and the main reason was the financial burden. Due to a cost burden and lack of knowledge, more than one-third of the subjects had unmet needs for rehabilitation services; the majority reported needs for rehabilitation services, such as physical therapy for pain management.</P><P><B>Conclusion</B></P><P>The medical check-up rate was lower in the adults with CP, even though their medical comorbidities were not less than those of healthy people. Several non-medical reasons hindered them from receiving proper medical and rehabilitation services. Such barriers should be managed effectively.</P>

The Effect of Electric Cortical Stimulation after Focal Traumatic Brain Injury in Rats

Yoon, Yong-Soon,Yu, Ki Pi,Kim, Hyojoon,Kim, Hyoung-ihl,Kwak, Soo Hyun,Kim, Bong Ok Korean Academy of Rehabilitation Medicine 2012 Annals of Rehabilitation Medicine Vol.36 No.5

<P><B>Objective</B></P><P>To evaluate the effects of electric cortical stimulation in the experimentally induced focal traumatic brain injury (TBI) rat model on motor recovery and plasticity of the injured brain.</P><P><B>Method</B></P><P>Twenty male Sprague-Dawley rats were pre-trained on a single pellet reaching task (SPRT) and on a Rotarod task (RRT) for 14 days. Then, the TBI model was induced by a weight drop device (40 g in weight, 25 cm in height) on the dominant motor cortex, and the electrode was implanted over the perilesional cortical surface. All rats were divided into two groups as follows: Electrical stimulation (ES) group with anodal continuous stimulation (50 Hz and 194 µs duration) or Sham-operated control (SOC) group with no electrical stimulation. The rats were trained SPRT and RRT for 14 days for rehabilitation and measured Garcia's neurologic examination. Histopathological and immunostaining evaluations were performed after the experiment.</P><P><B>Results</B></P><P>There were no differences in the slice number in the histological analysis. Garcia's neurologic scores & SPRT were significantly increased in the ES group (p<0.05), yet, there was no difference in RRT in both groups. The ES group showed more expression of c-Fos around the brain injured area than the SOC group.</P><P><B>Conclusion</B></P><P>Electric cortical stimulation with rehabilitation is considered to be one of the trial methods for motor recovery in TBI. However, more studies should be conducted for the TBI model in order to establish better stimulation methods.</P>

The Impact of Acute Phase Domain-Specific Cognitive Function on Post-stroke Functional Recovery

Park, Jihong,Lee, Gangpyo,Lee, Shi-Uk,Jung, Se Hee Korean Academy of Rehabilitation Medicine 2016 Annals of Rehabilitation Medicine Vol.40 No.2

<P><B>Objective</B></P><P>To assess whether the cognitive function in the acute stage evaluated by domain-specific neuropsychological assessments would be an independent predictor of functional outcome after stroke.</P><P><B>Methods</B></P><P>Forty patients underwent 4 domain-specific neuropsychological examinations about 3 weeks after the onset of stroke. The tests included the Boston Naming Test (BNT), the construction recall test (CRT), the construction praxis test (CPT), and the verbal fluency test (VFT). The Korean version of Modified Barthel Index (K-MBI) at 3 months and the modified Rankin Scale (mRS) at 6 months were investigated as functional outcome after stroke. Functional improvement was assessed using the change in K-MBI during the first 3 months and subjects were dichotomized into 'good status' and 'poor status' according to mRS at 6 months. The domain-specific cognitive function along with other possible predictors for functional outcome was examined using regression analysis.</P><P><B>Results</B></P><P>The z-score of CPT (p=0.044) and CRT (p<0.001) were independent predictors for functional improvement measured by the change in K-MBI during the first 3 months after stroke. The z-score of CPT (p=0.049) and CRT (p=0.048) were also independent predictors of functional status at post-stroke 6 months assessed by mRS.</P><P><B>Conclusion</B></P><P>Impairment in visuospatial construction and memory within one month after stroke can be an independent prognostic factor of functional outcome. Domain-specific neuropsychological assessments could be considered in patients with stroke in the acute phase to predict long-term functional outcome.</P>