Factors Affecting Stress in Chronic Stroke Patients Undergoing Rehabilitation

김성현,김대열 대한노인재활의학회 2022 Geriatric rehabilitation Vol.12 No.2

Objective: This study evaluated the stress level of chronic stroke patients and its associations with factors such as neuropathic pain, sleep disorder, and socioeconomic status were quantified. Method: Thirty chronic stroke patients aged 18 years and above who were undergoing rehabilitation were included in the study. The Adult Self-Report (K-ASR) was used to evaluate stress levels in these patients. Results: The mean K-ASR t scores were in the normal range, and only three patients (10%) had scores in the clinical range. Stress levels as indicated by the K-ASR were related to annual income (rho = -0.391, p = 0.033), neuropathic pain (rho = 0.457, p = 0.011), and sleep disorder (rho = 0.188, p = 0.041). Conclusion: Overall stress levels of chronic stroke patients were not high compared to those of the general population. In addition, we found that stress levels were strongly and significantly associated with neuropathic pain, annual income, and sleep disorder.

Post-lobectomy Pulmonary Rehabilitation on Peak Oxygen Consumption in Old Age Lung Cancer Patients

김문정,전형은,남훈,좌경림 대한노인재활의학회 2023 Geriatric rehabilitation Vol.13 No.1

Objective: We aimed to evaluate how cardiopulmonary exercise test (CPET)-based treadmill training could affect cardiopulmonary function, especially peak oxygen consumption (VO2 peak) in old age post-lobectomy patients with lung cancer. Materials: Four weeks after lobectomy, 31 post-lobectomy patients were assigned to the pulmonary rehabilitation group (N=22) and control group (N=9). Exercise capacity, including VO2 peak and the 6-min walking test, and psychological symptoms, including depression, anxiety, fatigue, sleep quality, and quality of life, were measured before and after the intervention. Results: The pulmonary rehabilitation group showed greater improvement in the cardiopulmonary function, especially VO2peak, than the control group (p < 0.0001). Psychological and quality of life parameters didn’t show statistically significant differences between groups. Conclusion: This study provided evidence that individualized, tailored pulmonary rehabilitation training is effective in improving cardiopulmonary function, especially VO2 peak, in old-age lung cancer patients who underwent lobectomy.

COVID-19 폐렴 후 폐 이식을 받은 근감소증 환자에서의 호흡재활: 증례보고 및 12개월 추적 관찰

신희태,김원,고은재 대한노인재활의학회 2023 Geriatric rehabilitation Vol.13 No.1

Sarcopenia is common in lung transplant patients and COVID-19 infection could significantly affect the degree of sarcopenia. In these patients, rehabilitation is important not only for reversal of muscle mass loss, but also for respiratory function. We report of case of 63-year old patient who received lung transplantation due to COVID-19 acute respiratory distress syndrome (ARDS). She was admitted to the intensive care unit (ICU) due to severe COVID-19 pneumonia and met the ICU-acquired weakness (ICU-AW) diagnostic criteria. She underwent pre-habilitation in the intensive care unit before lung transplantation. After surgery, pulmonary rehabilitation was performed with transfer, gait training and resistance exercise. Muscle mass, muscle strength, physical performance, and respiratory function were observed to gradually improve for 1 year after the surgery. However, even after 1 year, the patient is still included in the diagnostic criteria for sarcopenia and complains of functional limitations

The Usefulness of Non-invasive Ventilation for Acute Respiratory Failure in Elderly Patients: Case Reports

정석영,장찬웅,강성웅,김명상,최원아,조한얼 대한노인재활의학회 2023 Geriatric rehabilitation Vol.13 No.1

In this case report, we introduce on two unusual cases in which Non-invasive ventilation (NIV) was applied to elderly patients with respiratory failures. The first case needed ventilatory support because of acute respiratory failure. Although patient's situation was not “end-of-life”, but “curative”, surrogates did not agree to intubate since the patient had previously declared “do not intubate (DNI)”. The use of NIV allowed the patient to overcome the disease. The latter case, we introduce a patient with underlying tuberculosis-destroyed lung who showed dyspnea and chronic hypercapnia respiratory failure after influenza infection. This patient could manage hypercapnia and dyspnea through using NIV, and finally, she could wean the ventilator. Like our cases, if NIV can be used properly, treatment choices can be significantly expanded for patients with acute respiratory failure. We expected that these cases would widen the range of NIV use in elderly patients

Successful Rehabilitation Outcomes in a 93 Years Oldest-Old Patient after Left ACA and MCA Infarction: A Case Report

함초롬,김용욱,박종미 대한노인재활의학회 2023 Geriatric rehabilitation Vol.13 No.1

As the geriatric population grows rapidly, the incidence of stroke is high in the elderly (age > 65 years) and peaks in the oldest old (age > 85 years). However, there is conflicting evidence regarding the effectiveness of rehabilitation in the oldest old stroke patients. We report the case of a 93-year-old man with hemiplegia, cognitive impairment, aphasia, and dysphagia after acute stroke. The patient underwent rehabilitation evaluation within 48 hours of disease onset and started early mobilization. After being transferred to the Department of Rehabilitation Medicine, he underwent eccentric biased strengthening exercises and customized treatment to prevent complications. After 4 months of intensive inpatient rehabilitation, his functional level (FIM total from 25 to 51), aphasia (AQ score from 5.9 to 12.4), and dysphasia improved. He could independently walk to the toilet using an anterior walker. Although aging progression is associated with reduced effectiveness of rehabilitation treatment, our case report suggests that early multidisciplinary intensive inpatient rehabilitation may bring significant functional benefits to the oldest-old population.

노인재활 프로그램 처방

민경훈 대한노인재활의학회 2023 Geriatric rehabilitation Vol.13 No.2

Abstract As population aging accelerates, the importance of geriatric medicine and rehabilitation increases. Rehabilitation medicine is suitable for providing team therapy in several fields, focusing on functional recovery and rehabilitation of older people. This review aimed to summarize the prescription of rehabilitation programs in geriatrics as the commencement of multidisciplinary treatment. The medical fee payment system in Korea is a fee-for-service system, and the indications for treatment items are clearly summarized on the website (https:// biz.hira.or.kr/index.do?sso=ok) of HIRA (Health Insurance Review and Assessment Service). In addition, comprehensive geriatric assessment should be conducted to address various aspects of treatment. The evaluations convers regarding frailty, physical function, hand dexterity, cognition, nutrition/blood test, imaging studies of sarcopenia and osteoporosis, and control of polypharmacy.

자동화된 자세 분석 및 가상 재구축 장비를 이용한 이중 과제 능력 평가

김나영 대한노인재활의학회 2023 Geriatric rehabilitation Vol.13 No.2

Objective: Assessing motor-cognitive dual-task performance could sensitively detect changes in balance, an essential indicator of physical function in geriatric population. Posture Analysis and Virtual Reconstruction (PAViR) is a new technique to trace body posture and motion in real-time. We investigated the clinical usability of PAViR device to measure motor-cognitive dual-task performance. Methods: We recruited two age groups of healthy individuals without subjective cognitive and motor impairment: young (18 < Age < 40, N = 21) and old (Age ≥ 65, N = 28). The dual-task performance was evaluated by subtraction while single-leg standing using a PAViR device. All patients underwent comprehensive neuropsychological tests, Seoul Neuropsychological Screening Battery-Core (SNSB-C). We conducted group comparison analysis and correlation analysis between the scores on items of SNSB-C and task performance in each group. Results: Old group showed significantly lower performance (p < 0.05) in all tasks except amplitude during single task and dual task cost of amplitude, and significantly lower scores on most items of SNSB-C. In young age group, dual-task cost was significantly negatively correlated with the scores of controlled oral word association test and color word stroop test. In old age group, there was significant correlation between the score of color-word stroop test and dual-task performance as well as single task performance (p < 0.05). Conclusion: Our study showed that the degree of motor-cognitive dual-task performance could be measured by PAViR device, and it was also correlated with the different aspects of cognitive assessments depending on the age group. Further study is needed using various tasks in larger population.

Overground Bodyweight-Supporting Walking Robot as a New Rehabilitation Approach for a Patient with Femoral Neck Fracture: A Case Report

신지철 대한노인재활의학회 2023 Geriatric rehabilitation Vol.13 No.2

The Andago® robotic gait training system is widely used in stroke rehabilitation to bridge the gap between robot-assisted therapy and conventional overground gait training. To facilitate the weight-bearing and gait training rehabilitation processes, a bodyweight-supporting walking robot can be used in patients with femoral neck fractures. Thus, here we investigated whether the Andago® robotic system can be applied to femoral fracture patients postoperatively because it is capable of controlling the weight support percentage, allowing rehabilitation specialists to gradually decrease the support and increase weight-bearing with overground gait training. Gait performance, standing balance, and fall risk significantly improved even after rehabilitation and hospital discharge. Moreover, this study’s findings imply that the Andago® allows older patients, even those who undergo surgery for femoral neck fractures, to complete rehabilitation exercises without adverse events, including pain, trauma, and falls.

Gait Training Using an End-Effect Robotic Device in Elderly Patients with Spinal Cord Injury

전하라 대한노인재활의학회 2023 Geriatric rehabilitation Vol.13 No.2

Objective: The incidence of spinal cord injury (SCI) in the elderly is gradually increasing. The recovery of walking ability is a major goal in older patients with spinal cord injury (SCI). Among the various treatments aimed at regaining walking ability, robot-assisted gait training (RAGT) is a commonly used treatment tool. Several previous studies have investigated the effectiveness of RAGT for improving walking ability in patients with SCI; however, only a few studies have used end-effector-type robotic devices in patients with SCI. This study compared the effects of RAGT and conventional gait training in elderly patients with incomplete SCI. Methods: Forty-one elderly patients aged 65 years or older with incomplete SCI classified as American Spinal Injury Association Impairment Scale C or D were enrolled. The patients were classified into two groups according to the rehabilitation therapy they received: conventional gait training and RAGT. They received treatment five times a week for an average of 4.4 weeks. Sensory and lower extremity motor scores (LEMS) of the International Standards for Neurological Classification of Spinal Cord Injury, Spinal Cord Independence Measure Version III (SCIM-III), and the Walking Index for Spinal Cord Injury Version II (WISCI-II) were compared before and after the intervention. Results: The LEMS, SCIM-III, and WISCI-II showed significant improvement (p < 0.05) after gait training in both groups, but no significant difference was observed between the groups. Conclusion: The end-effector type of RAGT is as effective as conventional rehabilitation therapy in older, incomplete SCI patients.

뇌졸중 후 신체 활동 및 운동

고성화 대한노인재활의학회 2023 Geriatric rehabilitation Vol.13 No.2

Physical activity and exercise reduce the risk of mortality and recurrence after stroke and improve physical function and quality of life after stroke. Several recent studies have shown that physical activity and exercise after stroke are associated with significant improvements in physical function, including gait function, muscle strength, and balance. Many stroke rehabilitation guidelines strongly recommend physical activity and exercise after stroke, including aerobic and strength exercises. However, the actual levels of physical activity and exercise among people with stroke are lower than recommended. Therefore, all healthcare providers caring for stroke patients should be fully informed of the evidence and guidelines on the effectiveness of physical activity and exercise after stroke and apply them in clinical practice. They should also be able to educate stroke patients adequately. In addition, physical activity and exercise after stroke should be personalized and include exercise prescriptions feasible for people with stroke. As a result, patients, carers, and healthcare providers should be actively involved in ensuring that people with stroke participate in physical activity and exercise to a sufficient level.