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.

파킨슨병 환자에 적합한 새로운 연하장애 완화용 식품의 개발

오응석,김범근,안소영 대한노인재활의학회 2022 Geriatric rehabilitation Vol.12 No.2

Objective: Dysphagia associated with Parkinson’s disease (PD) affects the mortality and quality of life of patients with PD. Avoiding aspiration and maintaining swallowing ability are among the concerns regarding PD care. Therefore, we developed a swallowing supplement for easier swallowing and tolerability in patients with PD. Methods: Thirty patients with PD and 50 healthy controls were enrolled and their swallowing function measured using the videofluoroscopic swallowing study (VFSS) and several dysphagia scales. The Unified Parkinson’s Disease Rating Scale motor scores, Hoehn and Yahr stage, and levodopa doses were evaluated in patients with PD. The VFSS and survey were used to assess the viscosity, color, taste, nutrition, safety, and tolerability of the swallowing supplement. Results: Compared with controls, patients with PD had significantly lower total and sub-item scores of the swallowing quality of life (swal-QoL). Using commercialized yogurt, the pharyngeal delay time (PDT) and the modified penetration aspiration scale were higher in the PD group than in the control group. The swallowing supplement significantly shortened the PDT and pharyngeal transit time (PTT). Moreover, compared with commercialized yogurt, it improved pharyngeal wall coating, PTT, and aspiration in the videofluoroscopic dysphagia subscales. The survey scores were above average to good in the “easy swallowing” and “pharyngeal residual sense” items and tolerable in the remaining 6 preference items. Conclusion: The develped swallowing supplement could prevent aspiration and dysphagia omplications in patients with PD.

재생재활 관점의 항노화

민경훈 대한노인재활의학회 2022 Geriatric rehabilitation Vol.12 No.1

Anti-aging refers to treatments that delay, prevent or reverse the aging process that leads to degenerative changes causing pathological conditions in adults. The anti-aging treatment and service market can be divided into five categories: pharmaceutical approaches, regenerative medical approaches, digital therapeutics, innovative supplements and new beauty products and devices. The pharmaceutical and regenerative medical approaches are treatments for pathological conditions and the other three are anti-aging services before or after those states. Regenerative rehabilitation can further improve the treatment effects synergistically. From the perspective of rehabilitation, the basis of anti-aging treatment is exercise and physical activity. As regenerative treatments, blood products, senolytics, and cell therapy have been studied. Since the aging mechanisms are diverse, a tissue‑specific approach may be suitable rather than inhibiting all aging mechanisms by a single treatment.

항노화 치료의 임상적 근거

박정현 대한노인재활의학회 2022 Geriatric rehabilitation Vol.12 No.1

Aging is a biological process driven by the many numbers of biological and genetic pathways, which are closely related to lifespan, and are a very strong risk factor for all age-related diseases. Human life expectancy has greatly increased, but this has not been accompanied by a similar increase in their healthspan. Aging is a driving factor of various age-related diseases, including neurodegenerative diseases, cardiovascular diseases, cancer, immune system disorders, and musculoskeletal disorders. Current advances in the preventive and therapeutic strategies for these age-related degenerative diseases are still incomplete, partially because of the aging process itself. Modification of aging process itself might have profound impact on the development and progression of age-related diseases. Researches to find out medications and strategies that improve the healthspan by targeting the aging itself have now become a very hot topic in the medical researches. In this review, the status of aging research and the efforts for the development of potential pharmacological interventions for the age-related diseases, such as metformin, rapamycin, resveratrol, senolytics, as well as caloric restriction, will be briefly summarized. The feasibility, side effects, and future potential of these treatments will be also discussed, which will provide a basis to develop novel anti-aging therapeutics for improving the healthspan and preventing aging-related diseases.

치매 환자를 위한 인지재활

이주강 대한노인재활의학회 2022 Geriatric rehabilitation Vol.12 No.2

Cognitive rehabilitation refers to the rehabilitation of people with cognitive impairment. Several types of cognition-focused interventions have been described, which include cognitive training, cognitive stimulation, and cognitive rehabilitation. Patients with dementia suffer from diverse cognitive-related problems including memory impairment and from non-cognitive-related problems such as dysphagia, dysregulation of voiding and defecation, and musculoskeletal problems. Cognitive and non-cognitive-related problems affect the dementia patient’s ability to live well. It is time to re-think that people living with dementia have the right to attain and maintain maximum independence, with the assistance of comprehensive rehabilitation services. Cognitive rehabilitation should use a goal-oriented, problem-based, individualized approach to facilitate improved management of functional disability for people with dementia.

근감소증과 삼킴곤란

문현임 대한노인재활의학회 2022 Geriatric rehabilitation Vol.12 No.2

Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist, leading to dehydration and malnutrition in these subjects. ‘Sarcopenic dysphagia’ is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might also be related to poor oral health status. Moreover, the aging process is strictly associated with poor oral health status due to direct impairment of the immune system. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, frailty. Sarcopenia, dysphagia, and malnutrition are closely linked, sharing common pathophysiological pathways. Thus, the aim of the present review is to describe the correlation between dysphagia and sarcopenia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features.

Feasibility of Overground Gait Training Using an Exoskeletal Wearable Robot in Older Patients with Brain Disorders: A Case Report

최지홍,임유진,장원혁 대한노인재활의학회 2022 Geriatric rehabilitation Vol.12 No.1

We describe the effects of overground robot-assisted gait training (RAGT) with an untethered exoskeletal wearable robot in two cases of ambulatory older patients with brain disorders. An 80-year-old patient with idiopathic Parkinson’s disease (case 1) was taken through 6 sessions of overground RAGT for 3 weeks. On the other hand, an 84-year old patient with stroke (case 2) received overground RAGT for 6 sessions of overground RAGT for 2 weeks. Each overground RAGT session was conducted for 20 min. Berg balance scale (BBS) in case 1 showed a significant improvement after a 3 weeks intervention, and case 2 showed a significant improvement of Functional Ambulatory Category and BBS after an overground RAGT. In addition, there were no significant side effects in each patient during and after the overground RAGT. We demonstrated the feasibility and safety of overground RAGT with an untethered exoskeletal wearable robot in older patients with brain disorders.

Functional Improvement of Progressive Supranuclear Palsy-Like Syndrome with Bromocriptine: Three Cases

최우인,김형섭 대한노인재활의학회 2022 Geriatric rehabilitation Vol.12 No.2

Progressive supranuclear palsy (PSP)-like syndrome is a condition that mimics the neurological features of PSP, which is characterized by supranuclear vertical gaze palsy, cognitive decline, and postural instability. The syndrome is a reversible condition that can occur secondary to other diseases or drug regimens, while PSP is a non-reversible neurodegenerative disease. We present three patients who developed PSP-like syndrome after hydrocephalus following intraventricular hemorrhage. The patients showed symptoms of PSP and imaging findings known as the “hummingbird” sign. Bromocriptine alleviated the symptoms of the PSPlike syndrome, while levodopa had little effect. Midbrain atrophy with hydrocephalus after intraventricular hemorrhage may cause clinically and radiologically similar characteristics to PSP. Bromocriptine improved the physical function of the PSP-like syndrome, except for vertical gaze palsy. The pharmacodynamic pathway may have led to this result. Identifying the underlying medical disorder may lead to accurate diagnosis for geriatric patients with PSP-like syndrome.

연명의료 및 웰다잉의 현황과 전망

윤영호 대한노인재활의학회 2022 Geriatric rehabilitation Vol.12 No.1

In January 2016, at the National Assembly of the Republic of Korea, Act on decision on lifesustaining treatment for patients in hospice and palliative care or at the end of life was enacted. Interest in well-dying began to increase at a time when the elderly population has recently rapidly increased and we are about to enter a super-aging society in 2024. Tragic deaths such solitary death caring murders and accompanying suicides that are reported through the news make us sad. Currently the policy and government budget for hospice is insufficient compared to the public demand. Well-dying in a broad sense is the answer of our reality. The public interest and demand for well-dying is getting stronger day by day. If there is no national response to well-dying in a broader sense even after 10 years have passed we will face the reality of legislating euthanasia or physician-assisted suicide.

Patient Diagnosed with Acquired Hemophilia A who Developed Intramuscular Hematoma during Comprehensive Rehabilitation after Stroke: A Case Report

정연규,문현임 대한노인재활의학회 2022 Geriatric rehabilitation Vol.12 No.2

Acquired hemophilia A (AHA) is a rare but fatal disease that leads to severe bleeding by autoantibodies to endogenous factor VIII. AHA is more prevalent in elderly patients with underlying comorbidities. Pathophysiology and treatment strategies of AHA are quite different from congenital hemophilia A. AHA is difficult to diagnose early unless the clinician understands and suspects the disease. Delayed diagnosis can have devastating consequences, especially for the elderly. The main goals of the treatment are to control bleeding and eradicate autoantibodies using immunosuppressive agents. We report a case of a 76-years-old patient who bruised easily and developed intramuscular hematoma diagnosed with AHA during comprehensive rehabilitation after subacute stroke. Although intramuscular hematomas or bruises are common during stretching exercise, if intramuscular, mucosal, or submucosal bleeding of unexplained causes persists despite low-intensity rehabilitation treatment in an elderly without a personal or family history of bleeding, AHA should be suspected.