Aphasia, result from damage of language-dominant area of the brain, usually accompanied hemiparesis due to proximity of language centers and motor control areas. So, global aphasia without hemiparesis is a rare stroke syndrome. We report a case of right handed man with language disturbance after stroke. He showed global aphasia without hemiparesis. We use diffusion tensor image tractography (DTT) for evaluation of global aphasia without hemiparesis. DTT demonstrated that preservation of the corticospinal tract. After speech therapy, he showed improvement of language profile on K-WAB.

OBJECTIVE: Screening tests for dysphagia have been introduced to prevent complications arising from dysphagia in stroke patients. Among them, Gugging swallowing screen (GUSS) was proven as an effective screening tests for dysphagia of stroke patients in 24 hours after onset. We compared several screening tests and clinical scales including GUSS. METHOD: Subjects were 37 stroke patients 3 months after onset. GUSS, 3 oz water test, Burke dysphagia screening test (BDST) and Standardized swallowing assessment (SSA) were carried out at bedside. VFS was performed in 24 hours after other studies were done. Functional dysphagia scale (FDS) and Penetration-aspiration scale (P/A scale) were derived from VFS. Clinical scales such as American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) swallowing scale and Clinical dysphagia scale (CDS) were measured to see the correlation between GUSS and another dysphagia scales. RESULTS: GUSS had a sensitivity of 90.9% and a specificity of 69.2%. 3 oz water test had a sensitivity of 81.8% and a specificity of 76.9%. Sensitivity and specificity of BDST were respectively 90.9%, 61.5%. Sensitivity of SSA was 90.9%, specificity 61.5%. Correlation between GUSS and FDS was significant (r =-0.527, p<0.01). Correlation between GUSS and P/A scale also showed significance (r=-0.747, p<0.01). ASHA NOMS swallowing scale and GUSS showed significant correlation (r=0.432, p<0.01). CDS and GUSS showed significant correlation as well (r=-0.815, p<0.01). CONCLUSION: The screening ability of GUSS was equal to other screening tests for dysphagia of stroke patients. Correlations among GUSS and other VFS and clinical scales showed availability of GUSS as a clinical scale for dysphagia.

OBJECTIVE: To investigate the musculoskeletal cause of hemiplegic shoulder pain using ultrasonographic evaluation of hemiplegic shoulder. METHOD: Thirty-six hemiplegic patients admitted to rehabilitation department were enrolled. Ultrasonographic investigation of shoulder and physical examinations including range of motion (ROM), muscle power, spasticity and subluxation of shoulders were performed. RESULTS: Eighteen (55.6%) patients reported pain in hemiplegic shoulder. The abnormal sonographic findings, ROM, muscle power, spasticity, and subluxation of hemiplegic shoulder were not significantly different between subjects with painful hemiplegic shoulder and those without. The presence of ultrasonographic abnormality combined with focal tenderness, however, was significantly related with the painfulness of hemiplegic shoulder (p-value = 0.03). CONCLUSION: These results suggest that ultrasonographic evaluation is useful to investigate the musculoskeletal component of painful hemiplegic shoulder, when collaborated with physical examination of focal tenderness.

OBJECTIVE: To evaluate the varying effects of rehabilitation intensity classified by the number of treatment sessions on recovery of activity and function in stroke subjects. METHOD: Eighty nine subjects with stroke (51 infarction, 38 hemorrhage) had received conventional rehabilitation programs (physical therapies, occupational therapies) with 30 minutes per each therapy. They were divided into two groups; group I consisted of 42 subjects who received one session of rehabilitation therapy per day; group II consisted of 47 subjects received two sessions per day. Functional outcomes, such as K-BBS (Korean version of Berg Balance Scale), FIM (Functional Independence Measure), and MMSE-K (Korean version of Mini Mental State Examination) were assessed with two weeks interval. Data was analyzed the differences of functional outcomes assessed at the initial time of treatments (the initial) and at the time of the peak K-BBS (the second). RESULTS: Age, sex, lesion sites, the initial K-BBS, the initial FIM, and MMSE-K scores had no differences between two groups (p>0.05). There were significant differences between the initial and the second K-BBS, and the initial FIM and the second FIM in group I & II, respectively (p<0.01). In comparison for effects of rehabilitation intensity, the second K-BBS of group II were significantly higher than those of the group I (p<0.01), but there was no statistically significant difference in the second FIM between two groups (p>0.05). Also, length of stay was no significant differences between two groups. CONCLUSION: The above findings suggest that though all rehabilitation programs affect the functional improvement of stroke subjects, the daily rehabilitation training time could be more important factor for functional improvement in subjects with stroke, especially on recovery of ambulation rather than the sum of functional gain.

OBJECTIVE: Team approach for patient-specific rehabilitation for acute stroke patient is important to minimize loss of function and facilitate recovery as well as cost effectiveness. We tried to establish acute stroke rehabilitation algorithm to maximize efficiency of delivering patient-specific and comprehensive rehabilitation in acute stroke patients. METHOD: We developed the clinical algorithms through the informal consensus development process by thorough discussions within the rehabilitation team members. Before and after adoption of the rehabilitation algorithms in clinical activity, we investigated satisfaction of patients and staffs by questionnaire. In addition, length of hospitalization was assessed. RESULTS: Ten algorithms were developed on the general rehabilitation, physical, occupational, and speech therapy, dysphagia, cognitive rehabilitation, nursing care and complication, and psychosocial rehabilitation. Every algorithm was comprised to take care of patients from the acute stage of rehabilitation to long term management. After algorithms to the clinical practice, total mean score of satisfaction was significantly improved in patients and staffs (p<0.05). Mean length of stay for rehabilitation tended to decline without statistical significance. CONCLUSION: Algorithm for patient specific acute stroke rehabilitation could contribute to increase the level of satisfaction among patients and staffs.

Dysphagia is very prevalent conditions seen today by physiatrist. Central to the management of this pervasive medical condition are the issues of accurate diagnosis and maintaining control through appropriate treatment. This review article summarizes the recent knowledge accumulated on challenging therapies in dysphagia. The continuing evolution of the management of dysphagia is reflected in many articles and evidence-based information stemming from recent studies. The contributions of some of the more recent and salient studies and trials are mentioned here. Although some data to support the rationale and outcomes for the swallowing therapies currently used, a great deal more data are needed on their effects on specific populations.

Dysphagia can be caused by an anatomic abnormality or neurological dysfunction in either one or combination of all of these factors. Especially, dysphagia is one of common complications of stroke and related with the survival as well as prognosis of functional recovery of cerebrovascular accident. Irrespective of its primary causes of swallowing difficulty, the options for conservative treatment of dysphagia are adopted according to the functional status of the patient. The most important goals of the conservative management are promoting oropharyngeal transit and protecting the airway from aspiration. In this review, major non-operative therapeutic methods are illustrated: behavioral interventions including compensatory maneuvers, diet preparation, tube feeding and prostheses. Also, the clinical application of them is discussed. Each of these treatments should be applied to patients cautiously after a thorough consideration of the functional recovery and risk evaluation of aspiration. Furthermore, the nutritional requirement of patients ought to be taken into account.

In this case study with 2 chronic stroke patients, we investigated the nature of modulation of neural activities during the working memory (WM) task by transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) using functional MRI (fMRI). Two patients with chronic right hemispheric stroke participated. Patients performed the 2-back WM task within the fMRI scanner before and after tDCS application while the response data were recorded. An anodal tDCS of 1 mA over the left DLPFC was applied for 20 min within fMRI scanner. The accuracy and the recognition accuracy of WM task were improved after applying tDCS. In fMRI images, activation was decreased in the left superior temporal areas in both cases which represent increased efficiency of neural resources after applying the tDCS. The results of this study showed that the effective modulation of cortical activity by tDCS might be a determinant for behavioral changes of enhancing WM function in patients with stroke.
Humans ; Magnetic Resonance Imaging ; Memory, Short-Term ; Prefrontal Cortex ; Stroke

OBJECTIVE: This study aimed to characterize the use of medical service and medical costs of each cluster categorized by its discharge disposition pattern. METHOD: Data extracted from Electronic Data Interchange database of Korea Workers' Compensation and Welfare Service was analyzed. Among those who suffered from industrial accidents from Jan 1, 2006 to Dec 31, 2006, 422 were stroke patients. We categorized the subjects into 2 groups using k-means cluster analysis according to the discharge disposition pattern. Demographic characteristics, days of treatment, medical cost, initially admitted medical institution and disease type were analyzed in each group. RESULTS: There was no difference between the 2 groups in age, sex, type of stroke (ischemic or hemorrhagic stroke) and initially admitted medical institution. However medical cost and days of treatment were significantly different between 2 groups. CONCLUSION: K-means cluster analysis according to transferring pattern revealed a distinct group with longer hospitalization and more medical cost in injured workers. Further study is necessary to find out the characteristics of this group.
Accidents, Occupational ; Cluster Analysis ; Electronics ; Electrons ; Hospitalization ; Humans ; Korea ; Stroke ; Workers' Compensation

OBJECTIVE: To investigate the specific features of stroke patients with hip fracture, and the correlation of fracture occurrence with rehabilitation after stroke onset. METHOD: We retrospectively analyzed 181 stroke patients in a total of 892 patients who underwent an operation due to hip fracture. The assessment factors consists of age, the location of brain lesion, bone marrow density, body mass index, the presence of diabetes mellitus and anemia, laboratory findings of serum albumin, calcium and phosphate. We also analyzed subject's dominant hand side, experience of rehabilitation, and the duration between stroke onset and occurrence of hip fracture. RESULTS: Among 181 patients (56 male, 125 female), most common location of the brain lesion was the subcortex. About 70% of patients had osteoporosis, anemia and hypoalbuminemia. Among 34 hemiplegic patients, most of them had hip fracture on hemiplegic side (91.2%). The duration between stroke onset and occurrence of hip fracture of the patients who had experience of rehabilitation after stroke was longer than that of the patients without rehabilitation experience (p<0.05). CONCLUSION: Woman, osteoporosis, anemia and hypoalbuminemia are correlated with the hip fracture in stroke patient. The hip fracture of the stroke patient who did not have rehabilitation experience occurred earlier. The rehabilitation therapy including education for prevention of falling may be helpful to stroke patients with these factors.
Anemia ; Body Mass Index ; Bone Marrow ; Brain ; Calcium ; Diabetes Mellitus ; Female ; Hand ; Hip ; Humans ; Hypoalbuminemia ; Male ; Osteoporosis ; Retrospective Studies ; Serum Albumin ; Stroke