대한연하장애학회지 창간 10주년 기념호를 발간하며

Sung Bom Pyun 대한연하장애학회 2020 대한연하장애학회지 Vol.10 No.1

The Author Reply Re: Lateralization of Cognitive Functions in Aphasia after Right Brain Damage

Sung Bom Pyun 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.4

Not available

Reliability and Validity of the Comprehensive Limb and Oral Apraxia Test: Standardization and Clinical Application in Korean Patients With Stroke

Sung-Bom Pyun,Yu Mi Hwang,Soo Yung Jo,Ji-Wan Ha 대한재활의학회 2019 Annals of Rehabilitation Medicine Vol.43 No.5

Objective To develop and standardize the Limb and Oral Apraxia Test (LOAT) for Korean patients and investigate its reliability, validity, and clinical usefulness for patients with stroke. Methods We developed the LOAT according to a cognitive neuropsychological model of limb and oral praxis. The test included meaningless, intransitive, transitive, and oral praxis composed of 72 items (56 items on limb praxis and 16 items on oral praxis; maximum score 216). We standardized the LOAT in a nationwide sample of 324 healthy adults. Intra-rater and inter-rater reliability and concurrent validity tests were performed in patients with stroke. We prospectively applied the LOAT in 80 patients and analyzed the incidence of apraxia. We also compared the clinical characteristics between the apraxia and non-apraxia groups. Results The internal consistency was high (Cronbach’s alpha=0.952). The inter-rater and intra-rater reliability and concurrent validity were also high (r=0.924–0.992, 0.961–0.999, and 0.830, respectively; p<0.001). The mean total, limb, and oral scores were not significantly different according to age and education (p>0.05). Among the 80 patients with stroke, 19 (23.8%) had limb apraxia and 21 (26.3%) had oral apraxia. Left hemispheric lesions and aphasia were significantly more frequently observed in the limb/oral apraxia group than in the non-apraxia group (p<0.001). Conclusion The LOAT is a newly developed comprehensive test for limb and oral apraxia for Korean patients with stroke. It has high internal consistency, reliability, and validity and is a useful apraxia test for patients with stroke.

Shape and Volumetric Differences in the Corpus Callosum between Patients with Major Depressive Disorder and Healthy Controls

Sekwang Lee,Sung-Bom Pyun,Kwan Woo Choi,Woo-Suk Tae 대한신경정신의학회 2020 PSYCHIATRY INVESTIGATION Vol.17 No.9

Objective This study aimed to investigate the morphometric differences in the corpus callosum between patients with major depressive disorder (MDD) and healthy controls and analyze their relationship to gray matter changes. Methods Twenty female MDD patients and 21 healthy controls (HCs) were included in the study. To identify the difference in the regional gray matter concentration (GMC), VBM was performed with T1 magnetic resonance imaging. The shape analysis of the corpus callosum was processed. Diffusion tensor imaging (DTI) fiber-tracking was performed to identify the regional tract pathways in the damaged corpus callosal areas. Results In the shape analysis, regional shape contractions in the rostrum and splenium were found in the MDD patients. VBM analysis showed a significantly lower white matter concentration in the genu and splenium, and a significantly lower GMC in the frontal, limbic, insular, and temporal regions of the MDD patients compared to the HCs. In DTI fiber-tracking, the fibers crossing the damaged areas of the genu, rostrum, and splenium were anatomically connected to the areas of lower GMC in MDD patients. Conclusion These findings support that major depressive disorder may be due to disturbances in multiple neuronal circuits, especially those associated with the corpus callosum.

Persistent dysarthria after cefazolin-induced status epilepticus.

Lee, Yuna,Pyun, Sung-Bom,Park, Eun Kyung,Youn, Sung Won Taylor Francis 2009 Brain injury Vol.23 No.10

<P>BACKGROUND: Cefazolin is a well-known antibiotic associated with seizures. However, intrathecal cefazolin-induced status epilepticus (SE) is very rare and resultant persistent dysarthria has not been previously reported. CASE REPORT: A 66-year-old woman underwent epidural adhesiolysis due to lumbar spinal stenosis and 500 mg of cefazolin was infused through the thecal puncture site during the procedure. SE developed abruptly 40 minutes later and it persisted for 3 days. Severe dysarthria, dysphagia and cognitive dysfunction developed after the cessation of SE. Although the patient's other symptoms showed much improvement after rehabilitation, the dysarthria did not improve after intense speech therapy for 8 months. The brain MRI showed no abnormal findings, but the 2-[(18)F]fluoro-2-deoxy-D-glucose positron emission tomography ((18)F-FDG PET) of the brain demonstrated hypometabolic areas in the bilateral inferior frontal gyrus and the primary motor cortex, representing the oromotor area. CONCLUSION: Although the exact mechanism underlying the dysarthria is unknown, the dysfunction of the inferior frontal network for speech production revealed by the brain FDG-PET, including the motor speech area (Broca's area), left insula and bilateral primary and premotor cortex representing the oromotor area, might have been responsible for the persistent dysarthria in this patient.</P>

Effectiveness of Non-invasive Brain Stimulation in Dysphagia Subsequent to Stroke: A Systemic Review and Meta-analysis.

Yang, Seung Nam,Pyun, Sung-Bom,Kim, Hyun Jung,Ahn, Hyeong Sik,Rhyu, Byung Joo Springer-Verlag 2015 Dysphagia Vol.30 No.4

<P>The objective of this study is to assess the efficacy and safety of non-invasive brain stimulation (NIBS) in patients with dysphagia subsequent to stroke. A systematic search of the literature published by Medline (January 1, 1976 through June 21, 2013), EMBASE (January 1, 1985 through June 21, 2013), and the Cochrane Library (January 1, 1987 through June 21, 2013) was conducted for all relevant articles related to NIBS, dysphagia, and cerebrovascular disorders (CVD). Two reviewers (S.N.Y and S.B.P) independently evaluated the eligibility of retrieved data according to the selection criteria and assessed methodological quality of the studies using the 'assessing risk of bias' table recommended in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.0.2). Six randomized controlled trials (59 intervention groups and 55 placebo groups) were identified as addressing the use of NIBS for dysphagia after CVD and were included in the meta-analysis. The function scale score improvement of dysphagia in patients treated with NIBS was statistically significant compared with that of patients who underwent sham stimulation (standardized mean difference = 1.08, 95 % confidence intervals = 0.29-1.88, p = 0.008; I (2) = 72 %). A subgroup analysis based on the type of intervention (three repetitive transcranial magnetic stimulation (rTMS) studies and three transcranial direct current stimulation (tDCS) studies) revealed a statistically significant beneficial effect of NIBS compared with sham stimulation in the rTMS group, but not in the tDCS group. When the results were examined based on intervention site (ipsilesional vs. contralesional site stimulation), no statistically significant difference was noted between two groups. No complications of NIBS were reported in this analysis.</P>

Efficacy of Bedside Respiratory Muscle Training in Patients With Stroke: A Randomized Controlled Trial

Yoo, Hyun-Joon,Pyun, Sung-Bom Wolters Kluwer Health, Inc. All rights reserved. 2018 AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITA Vol.97 No.10

<P>Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.</P>

Effect of Age on Cortical Activation during Swallowing: An fMRI Study

문현임,정유진,최선영,태우석,Sung-Bom Pyun 대한연하장애학회 2016 대한연하장애학회지 Vol.6 No.1

Objective: Understanding the neural functional organization of swallowing in the elderly is essential when diagnosing and treating older adults with swallowing difficulties. While brain-imaging studies in young adults have implicated multiple cortical regions in swallowing, only a few investigations were performed on older subjects. In this study, we aimed to compare neural activation in regions for swallowing between healthy young and older adults and to better understand neural control of deglutition, complex sensory-motor process which occurs as a result of old age. Method: Fifteen young and fifteen older healthy individuals without a swallowing problem were examined with functional magnetic resonance imaging (fMRI) during voluntary saliva swallowing. Functional image data was obtained with a T2 gradient-echo, echo planar imaging (EPI) pulse sequence optimized for blood-oxygen level dependent (BOLD) contrast. Two samples t-test was conducted to perform group comparison (younger adults versus older adults) for the areas in which the activation was larger for the swallowing condition than the non-swallow condition. Result: Both groups showed activations in areas involved in the motor control and execution. In both groups, main regions of activation included bilateral prefrontal cortex, primary somatosensory cortex, insula, basal ganglia, and cerebellum. Between-group comparisons revealed statistically stronger activations in the prefrontal cortex and middle temporal gyrus of older adults during swallowing. Conclusion: This study provides evidence that swallowing requires larger and more widespread areas of neural control in older adults group, especially in prefrontal cortex and inferior frontal gyrus. These findings suggest that more demanding swallowing tasks are necessary for elderly patients because of their inefficient neural network due to their age.

Characteristics of Acquired Phonological Dyslexia in Korean

Hyesuk Cho(조혜숙),Sung-Bom Pyun(편성범) 한국언어청각임상학회 2015 Communication Sciences and Disorders Vol.20 No.4

본 연구에서는 뇌손상 환자를 대상으로 한국어 후천성 음운성 실독증의 특성을 파악하고 뇌손상 영역과의 관계성을 알아보았다. 방법: 정상인 30명, 뇌손상 환자 6명이 연구에 참가하였다. 읽기의 언어심리학적 모델에 기반하여 단어 읽기의 구성 요소인 철자, 음운, 의미 처리 중 어느 요소에서 수행이 저하되는지를 체계적으로 평가하였다. 또한 단어/비단어 소리내어 읽기를 실시하여 음운성 실독증의 핵심 특성인 비단어 읽기 손상이 나타나는지를 알아보았다. 철자처리는 연구 참가자들이 철자와 단어의 시각적 형태를 인지할 수 있는지 알아보기 위하여 실시되었다. 음운처리과제는 말소리의 분석 및 조작 능력, 의미처리과제는 의미지식이 얼마나 보존되어 있는지를 알아보기 위하여 실시되었다. 결과: 정상집단과 환자집단 간에 철자, 의미처리, 단어/비단어 소리내어 읽기에서 모두 유의미한 집단 간 차이가 있었다. 환자집단은 음운처리 과제는 거의 수행하지 못한 반면 철자와 의미처리는 상대적으로 좋은 결과를 보였다. 환자집단 내에서 단어와 비단어의 읽기 수행이 유의미한 차이를 보여 음운성 실독증의 특성을 확인하였다. 논의 및 결론: 본 연구에서는 페리실비안 영역에 손상이 있는 환자를 대상으로 철자, 음운, 의미 평가과제를 실시한 결과 음운처리능력의 저하, 단어에 비해 손상된 비단어 읽기의 패턴이 관찰되었다. 이는 후천성 음운성 실독증 선행연구와 일치하는 결과로서 한국어 실독증에서도 음운성 실독증의 패턴이 나타나며 이와 실비안열 주변 언어영역과의 관련성을 확인하였다. The purpose of the current study was to identify characteristics of acquired phonological dyslexia in Korean patients with brain damage and relationship between those characteristics and brain lesions. Methods: Thirty normal controls and six brain-damaged patients participated in the study. Assessment tasks of orthographic, phonological, and semantic processing were developed based on the cognitive model of single word reading and were administered to participants to evaluate reading ability. Orthographic processing assessment was performed to evaluate whether participants recognized letters and visual word forms. Phonological tasks assessed the ability to segment and manipulate sounds in words. A semantic task was performed in order to examine if semantic knowledge was preserved. Reading aloud task of words/nonwords was also performed with the intention of identifying characteristics of phonological dyslexia. Results: There was a significant difference in orthographic, semantic, and reading aloud performance between the normal control group and patient group. The patient group showed relatively preserved orthographic and semantic processing although most of them were not able to perform the phonological tasks. Significant differences between word and nonword reading aloud in patients indicated features of phonological dyslexia. Conclusion: Orthographic, phonological, and semantic tasks were administered to participants with perisylvian lesion. Our results showed impaired phonological processing and nonword reading compared to relatively preserved performance on orthographic, semantic tasks and word reading. These results are consistent with previous studies on phonological dyslexia, and characteristics of acquired phonological dyslexia in the Korean language were associated with perisylvian language areas.

Lateralization of Cognitive Functions in Aphasia after Right Brain Damage

Ha, Ji-Wan,Pyun, Sung-Bom,Hwang, Yu Mi,Sim, Hyunsub Yonsei University College of Medicine 2012 Yonsei medical journal Vol.53 No.3

<P><B>Purpose</B></P><P>The lateralization of cognitive functions in crossed aphasia in dextrals (CAD) has been explored and compared mainly with cases of aphasia with left hemisphere damage. However, comparing the neuropsychological aspects of CAD and aphasia after right brain damage in left-handers (ARL) could potentially provide more insights into the effect of a shift in the laterality of handedness or language on other cognitive organization. Thus, this case study compared two cases of CAD and one case of ARL.</P><P><B>Materials and Methods</B></P><P>The following neuropsychological measures were obtained from three aphasic patients with right brain damage (two cases of CAD and one case of ARL); language, oral and limb praxis, and nonverbal cognitive functions (visuospatial neglect and visuospatial construction).</P><P><B>Results</B></P><P>All three patients showed impaired visuoconstructional abilities, whereas each patient showed a different level of performances for oral and limb praxis, and visuospatial neglect.</P><P><B>Conclusion</B></P><P>Based on the analysis of these three aphasic patients' performances, we highlighted the lateralization of language, handedness, oral and limb praxis, visuospatial neglect and visuospatial constructive ability in aphasic patients with right brain damage.</P>