OBJECTIVE: To evaluate the effects of heel-opened ankle foot orthosis (HOAFO) on hemiparetic gait after stroke, especially on external foot rotation, and to compare the effects of HOAFO with conventional plastic-AFO (pAFO) and barefoot during gait. METHODS: This cross-over observational study involved 15 hemiparetic patients with external rotation of the affected foot. All subjects were able to walk independently, regardless of their usual use of a single cane, and had a less than fair-grade in ankle dorsiflexion power. Each patient was asked to walk in three conditions with randomized sequences: 1) barefoot, 2) with a pAFO, and 3) with an HOAFO. Their gait patterns were analyzed using a motion analysis system. RESULTS: Fifteen patients consisted of nine males and six females. On gait analysis, hip and foot external rotation were significantly greater in pAFO (-3.35degrees and -23.68degrees) than in barefoot and HOAFO conditions (p<0.05). Wearing an HOAFO resulted in significant decreases in hip (0.78degrees, p=0.04) and foot (-17.99degrees, p<0.01) external rotation compared with pAFO; although there was no significant difference between HOAFO and barefoot walking. Walking speed and percentage of single limb support were significantly greater for HOAFO than in barefoot walking. CONCLUSION: HOAFO was superior to pAFO in reducing hip and foot external rotation during the stance phase in patients with post-stroke hemiparesis. HOAFO may, therefore, be useful in patients with excessive external rotation of the foot during conventional pAFO.
Animals ; Ankle ; Canes ; Extremities ; Female ; Foot ; Foot Orthoses ; Foot Rot ; Gait ; Hip ; Humans ; Male ; Orthotic Devices ; Paresis ; Stroke ; Walking

PURPOSE: To evaluate the clinical characteristic of retinal nerve fiber layer (RNFL) and The clinical types of glaucoma according to optic disc appearances. METHODS: Sixty eyes in 60 patients with glaucoma were evaluated retrospectively. Complete ophthalmologic examination, optical coherent tomography (OCT), automated perimetry, stereoscopic optic disc photography and RNFL photography were performed. We classified optic disc pattern into focal, myopic, generalized enlargement, senile sclerotic, and normal appearance types. RESULTS: In 60 eyes with glaucoma, 15 eyes were adult-onset primary open-angle glaucoma (Adult-onset POAG), 22 eyes were normal-tension glaucoma (NTG), 10 eyes were juvenile-onset open-angle glaucoma (JPOAG), and 13 eyes were secondary glaucoma. JPOAG patients were significantly more detected in association with myopic optic disc type (P<0.05). OCT- measured temporal RNFL thickness in focal optic disc pattern were significantly lower than that in myopic optic disc pattern (P<0.05). Age was significantly correlated with temporal RNFL thickness in our study subjects (P<0.036, r=-0.272). CONCLUSIONS: Our study revealed that JPOAG patients may have a relationship with myopic optic disc type. OCT-measured RNFL thickness of glaucoma patients particularly in the temporal quadrant may be related to age.
Glaucoma ; Glaucoma, Open-Angle ; Humans ; Nerve Fibers* ; Photography ; Retinaldehyde* ; Retrospective Studies ; Visual Field Tests

Numerous studies have reported that physical activity and exercise training has beneficial effects in not only healthy elderly individuals, but also patients with mild cognitive impairment and dementia. Although various types of exercise appear to present positive effect for cognitive function, there is no definite exercise guideline as treatment or disease modifying strategies in dementia. The purpose of current article is to review the literatures related to the effect of exercise on cognitive function and to suggest the therapeutic exercise strategies in patients with dementia. Further prospective, longitudinal investigations using this exercise guideline should be warranted to prove the beneficial effects of exercise on cognitive function in patients with dementia.
Aged ; Dementia ; Humans ; Mild Cognitive Impairment ; Motor Activity

BACKGROUND: The aim of this study is to test if adjuvant hydrotherapy with viscosupplement is beneficial on management of pain, stiffness, function, and mental relaxation in knee osteoarthritis (OA). METHODS: Nineteen patients with OA were randomly assigned to hydrotherapy or control groups. All patients received viscosupplement injections once a week for 3 weeks. Hydrotherapy group (n=9) had a spa containing green tea, 3 days a week for 2 weeks. The control group (n=10) received only injections. All patients were assessed at baseline and after the third injection. All were assessed for pain (visual analog scale, VAS), pain severity, and functional status (Western Ontario and McMaster Universities osteoarthritis index, WOMAC), emotional status, quality of life (Euro quality of life health-related quality of life inventory five dimension, EQ-5D), and relative spectral power of alpha waves in electroencephalography (EEG). RESULTS: Both groups reported a statistically significant reduction of pain at the end of treatment and detailed assessment of pain, and function in WOMAC and the relative power of alpha in electroencephalogram showed statistical significant difference only in the hydrotherapy group. However, there were no significant intergroup differences, except for VAS score. CONCLUSION: Adjuvant 2-week hydrotherapy to viscosupplement might have a modest role in the management of pain and functional disability and the mental relaxation in patients with knee OA. Larger, randomized controlled trials with intervention of long term period to determine efficacy in treating knee OA are warranted.
Electroencephalography ; Humans ; Hydrotherapy* ; Knee ; Ontario ; Osteoarthritis ; Osteoarthritis, Knee* ; Quality of Life ; Relaxation* ; Tea ; Viscosupplements

The purpose of this study was to develop children-friendly comic books and animation for dietary education of 3rd or 4th grade elementary students. Through a literature review on current dietary problems and dietary education for children, 15 educational themes were chosen on both healthy eating and safe dietary life. Comic books and animation were developed based on the themes by the brainstorming and help of professional animators, and they were applied and evaluated in the field. The developed comic books and animation, with its own characters, proved to be of high quality and effective educational materials for children's healthy and safe eating. Compared with the reference group, the tested group has shown a significant improvement in dietary knowledge and attitude (p < 0.05). And both parents (level of understanding 4.29, level of interest 4.49, level of usefulness 4.46, level of design satisfaction 3.95 in 5-point Likert scale) and children (level of understanding 4.63, level of interest 4.57, level of usefulness of 1st comic book 4.44, 2nd comic book 4.49, level of design satisfaction 4.06, level of usefulness for knowledge pages 4.22 in 5-point Likert scale) have shown high levels of interests and satisfaction. Therefore, these materials could be utilized as effective educational materials for elementary students in school lunch time, extra-curricular activities, or after school programs.
Child ; Eating ; Humans ; Lunch ; Parents

OBJECTIVE: To confirm functional improvement in brain tumor patients after 4-week conventional rehabilitation therapy, to compare the cognitive impairment of brain tumor patients with subacute stroke patients using computerized neuropsychological testing, and to determine the effects on functional outcomes of daily activity. METHODS: From April 2008 to December 2012, 55 patients (29 brain tumor patients and 26 subacute stroke patients) were enrolled. All patients were assessed with a computerized neuropsychological test at baseline. Motricity Index, Korean version of Mini Mental Status Examination, and Korean version of Modified Barthel Index scores were assessed at the beginning and end of 4-week rehabilitation. Conventional rehabilitation therapy was applied to both groups for 4 weeks. RESULTS: Functional outcomes of all patients in both groups significantly improved after 4-week rehabilitation therapy. In brain tumor patients, the initial Motricity Index, cognitive dysfunction, and visual continuous performance test correction numbers were strong predictors of initial daily activity function (R2=0.778, p<0.01). The final Motricity Index and word-black test were strong predictors of final daily activity function (R2=0.630, p<0.01). In patients with subacute stroke, the initial Motricity index was an independent predictor of initial daily activity function (R2=0.245, p=0.007). The initial daily activity function and color of color word test were strong predictors of final daily activity function (R2=0.745, p<0.01). CONCLUSION: Conventional rehabilitation therapy induced functional improvement in brain tumor patients. Objective evaluation of cognitive function and comprehensive rehabilitation including focused cognitive training should be performed in brain tumor patients for improving their daily activity function.
Brain Neoplasms* ; Brain* ; Humans ; Neuropsychological Tests ; Rehabilitation* ; Stroke*

OBJECTIVE: To investigate the effect of dual-task training on the recovery of balance ability and cognitive function in patients with subacute stroke. METHODS: Twenty patients (12 males and eight females; average age, 59.70 years) with subacute stroke were enrolled in this study. All participants were randomly assigned to one of two groups, the dual-task group (n=10) or the control group (n=10). The dual task was simultaneous balance and cognitive training using the BioRescue. All patients were evaluated with posturographic parameters and the Berg Balance Scale for balance ability, a computerized neuropsychological test and the Korean version of the Mini-Mental State Examination for cognitive function, the Fugl-Meyer Assessment for motor function, and the Korean-Modified Barthel Index for activities of daily living (ADL) function before and after 4 weeks of rehabilitation. RESULTS: The dual-task group showed significant improvements in the pressure of the weight distribution index (WDI), surface area, and length of the stability index during the eyes-open condition; surface area of the limit of stability (LOS) on the hemiparetic and intact sides, and the auditory continuous performance test and backward visual span test after rehabilitation. Although no significant difference was observed for the changes in balance ability or cognitive, motor, and ADL functions between the groups, changes in the WDI pressure during the eyes-open condition and in the area ratio of LOS (hemiparetic/intact) showed a tendency to improve in the dual-task group. CONCLUSION: Our findings suggest that dual-task training could be as effective as conventional balance training for improving balance and cognition in subacute post-stroke patients.
Activities of Daily Living ; Cognition* ; Female ; Humans ; Male ; Neuropsychological Tests ; Rehabilitation ; Stroke

OBJECTIVE: To investigate the effect of virtual reality on the recovery of cognitive impairment in stroke patients. METHOD: Twenty-eight patients (11 males and 17 females, mean age 64.2) with cognitive impairment following stroke were recruited for this study. All patients were randomly assigned to one of two groups, the virtual reality (VR) group (n=15) or the control group (n=13). The VR group received both virtual reality training and computer-based cognitive rehabilitation, whereas the control group received only computer-based cognitive rehabilitation. To measure, activity of daily living cognitive and motor functions, the following assessment tools were used: computerized neuropsychological test and the Tower of London (TOL) test for cognitive function assessment, Korean-Modified Barthel index (K-MBI) for functional status evaluation, and the motricity index (MI) for motor function assessment. All recruited patients underwent these evaluations before rehabilitation and four weeks after rehabilitation. RESULTS: The VR group showed significant improvement in the K-MMSE, visual and auditory continuous performance tests (CPT), forward digit span test (DST), forward and backward visual span tests (VST), visual and verbal learning tests, TOL, K-MBI, and MI scores, while the control group showed significant improvement in the K-MMSE, forward DST, visual and verbal learning tests, trail-making test-type A, TOL, K-MBI, and MI scores after rehabilitation. The changes in the visual CPT and backward VST in the VR group after rehabilitation were significantly higher than those in the control group. CONCLUSION: Our findings suggest that virtual reality training combined with computer-based cognitive rehabilitation may be of additional benefit for treating cognitive impairment in stroke patients.
Cognition ; Female ; Humans ; London ; Male ; Neuropsychological Tests ; Stroke ; Verbal Learning

OBJECTIVE: To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on recovery of the swallowing function in patients with a brain injury. METHOD: Patients with a brain injury and dysphagia were enrolled. Patients were randomly assigned to sham, and low and high frequency stimulation groups. We performed rTMS at 100% of motor evoked potential (MEP) threshold and a 5 Hz frequency for 10 seconds and then repeated this every minute in the high frequency group. In the low frequency group, magnetic stimulation was conducted at 100% of MEP threshold and a 1 Hz frequency. The sham group was treated using the same parameters as the high frequency group, but the coil was rotated 90degrees to create a stimulus noise. The treatment period was 2 weeks (5 days per week, 20 minutes per session). We evaluated the Functional Dysphagia Scale (FDS) and the Penetration Aspiration Scale (PAS) with a videofluoroscopic swallowing study before and after rTMS. RESULTS: Thirty patients were enrolled, and mean patient age was 68.2 years. FDS and PAS scores improved significantly in the low frequency group after rTMS, and American Speech-Language Hearing Association National Outcomes Measurements System Swallowing Scale scores improved in the sham and low frequency groups. FDS and PAS scores improved significantly in the low frequency group compared to those in the other groups. CONCLUSION: We demonstrated that low frequency rTMS facilitated the recovery of swallowing function in patients with a brain injury, suggesting that rTMS is a useful modality to recover swallowing function.
Brain ; Brain Injuries ; Deglutition ; Deglutition Disorders ; Evoked Potentials, Motor ; Hearing ; Humans ; Magnetics ; Magnets ; Noise ; Salicylamides ; Transcranial Magnetic Stimulation

BACKGROUND AND PURPOSE: To investigate whether transcranial direct-current stimulation (tDCS) can improve cognition in stroke patients. METHODS: Forty-five stroke patients (20 males and 25 females, average age: 62.7 years) with cognitive dysfunction were included in this prospective, double-blinded, randomized case-control study. All patients were right-handed and the mean elapsed time after stroke was 39.3 days. Three different treatments groups were used: (1) anodal stimulation of the left anterior temporal lobe, (2) anodal stimulation of the right anterior temporal lobe, and (3) sham stimulation. tDCS was delivered for 30 minutes at 2 mA with 25 cm2 electrodes, five times/week, for a total of 3 weeks, using a Phoresor II Auto Model PM 850 (IOMED(R)). The evaluation of cognitive impairment was based on a Computerized Neuropsychological Test (CNT), Korean Mini-Mental State Examination (K-MMSE). The Korean version of the Modified Barthel Index (K-MBI) was used to assess activities of daily living functionality. These evaluations were conducted in all patients before and after treatment. RESULTS: Each group included 15 patients. Pre-treatment evaluation showed no significant differences between the three groups for any of the parameters. There was significant improvement in the verbal learning test on the CNT in the left anodal stimulation group (P < 0.05). There were, however, no significant differences in the K-MMSE or K-MBI scores among the three groups. CONCLUSIONS: These results demonstrated the beneficial effects of anodal tDCS on memory function. Thus, tDCS can successfully be used as a treatment modality for patients with cognitive dysfunction after stroke.
Activities of Daily Living ; Case-Control Studies ; Cognition* ; Electrodes ; Female ; Humans ; Male ; Memory ; Neuropsychological Tests ; Prospective Studies ; Stroke* ; Temporal Lobe ; Verbal Learning