OBJECTIVE: To compare complications of percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) in brain injured patients. METHOD: The records of brain injured patients who received either PEG or PRG between January 2001 and July 2008 in Busan paik hospital were reviewed retrospectively. Documented complications (infection, leakage, blockage/delayed feeding, aspiration pneumonia, tube displacement, pain, ileus, bleeding, tube fell/pulled out, bradycardia/hypotension) were recorded and compared. RESULTS: There were 44 brain injury patients with dysphagia. All patient received PEG or PRG successfully. (32 PEG, 12 PRG) The incidences of complications were 50% in both PEG group (16 in 32) and PRG group (6 in 12). In PEG group sixteen patients developed complications, 27 minor and two major. In PRG group six patients developed complications, 11 minor and one major. The most common complication of PEG was wound infection (37.9%). But there were no wound infection in PRG group. And there were no deaths in both PEG and PRG group. CONCLUSION: Both endoscopic and radiologic gastrostomy tube placements are safe and effective methods. But in high infection risk group such as old ages, DM or CRF patients who have brain injury with dysphagia, PRG is safer method than PEG.

OBJECTIVE: To determine the relationship of hand motor function recovery and Tatu's vascular territory classification of brain lesion in acute stroke. METHOD: Thirty one patients with acute cerebral infarct were included. We divided them into two groups. One had cerebral lesions supplied by the leptomeningeal branches of cerebral artery and the other by the perforating branches of cerebral artery. The leptomeningeal group was subdivided into middle cerebral artery group (LMCA) and posterior cerebral artery group (LPCA). The perforating group was again divided by perforating branch of the middle cerebral artery group (PMCA) and anterior choroidal artery group (PACoA). The diffusion weighted magnetic resonance image was used as a reference image. The hand motor recovery was scored by physical examination at admission and discharge. Score 0 was for no motion, 1 was for synergy movement, and 2 was for isolated hand movement. RESULTS: Eight patients were in LMCA group, while 3 were in LPCA group. Eight were in PMCA group, and twelve patients were in PACoA group. The distribution of the hand motor recovery at admission was score 0 (3,1,5,8, for LMCA, LPCA, PMCA, PACoA), 1 (2,1,1,4) and 2 (3,1,2,0), while at discharge, score 0 (3,0,4,4), 1 (0,0,1,5) and 2 (5,3,3,3). Hand functions significantly improved at discharge compared with those at admission in all groups. Especially in PACoA group, the significant better recovery at discharge was achieved.(p<0.05) Isolated hand movement at discharge was significantly better at the leptomeningeal group than perforating group.(p<0.05). CONCLUSION: Tatu's atlas may be helpful to predict the recovery of hand function for initial assessment of stroke rehabilitation.

OBJECTIVE: We report here on analyzing 3,128 subjects with stroke and who were discharged from the Departments of Rehabilitation Medicine of secondary or tertiary hospitals, and all the hospitals subscribed to the Online Database System developed by the Korean Society of Neurorehabilitation. METHOD: This is a retrospective analysis of the brain rehabilitation registry database for outcome of stroke outcome in the year 2006 to 2008. RESULTS: The male stroke subjects and cerebral infarction were 58.4% and 66.3%, respectively. Cerebral infarction in the middle cerebral artery territory was the most common, and the basal ganglia and cerebral cortex were the common areas for the cases of intracranial hemorrhage. The mean age of the patients was 61.7 years, and the most common ages were 45~64 years for all the stroke subjects. The subjects with cerebral hemorrhage (56.1 years) were younger than those with cerebral infarction (63.9 years). Seasonal variation was observed in the occurrence of stroke; spring (34.1%), winter (27.4%), summer (21.6%) and autumn (16.8%) in this order. There was no significant difference of the changes on the Korean version of the modified Barthel index between the patients with cerebral infarction and cerebral hemorrhage after rehabilitation. On analyzing the two groups of stroke subjects admitted before and after 100 days from stroke onset, the changes on the Korean version of the modified Barthel index and the Brunnstrom stage scores of the early admission group were higher that those of the late rehabilitation group. CONCLUSION: The above findings suggest that 1) the incidence, lesion sites and seasonality of stroke in this database system are similar to those of the worldwide data, 2) the length of hospital stay for the subjects with stroke is about 46 days and 3) early rehabilitation is more effective in improving the outcome of stroke subjects.

Aphasia is defined as "the loss of ability to communicate orally, through signs, or in writing, or the inability to understand such communications; the loss of language usage ability." Aphasia is present in 21~38% of acute stroke patients and is associated with high morbidity, mortality and expenditure. The evidence based challenges was described that occurred when carrying out systematic reviews of language therapy for aphasia following stroke. Language therapy in treating aphasia is efficacious when provided intensely for the first 3 months. There is strong evidence that computer-based aphasia therapy results in improved language skills. Constraint induced language therapy can result in improved language function and everyday communication in chronic aphasics. Treatment with rTMS may be associated with improved naming performance in patients with non-fluent, chronic aphasia. But, further investigation is required. Several placebo-controlled trials suggest that piracetam is effective in recovery from aphasia when started soon after the stroke. Drugs acting on catecholamine systems (d-amphetamine) have shown varying degrees of efficacy when combined with language therapy. Data from single-case studies, case series and an open-label study suggest that donepezil may have beneficial effects on chronic poststroke aphasia. Preliminary evidence suggests that donepezil is well tolerated and its efficacy is maintained in the long term. Significant language and communication gains have been demonstrated following the use of memantine in conjunction with constraint-induced language therapy.

Dominant hemisphere for language function is the left hemisphere, however patients experiencing aphasia followed by damage to language areas often shows good recovery in the days to weeks to even years after brain injury. According to the duration from brain injury, recovery period of language function in aphasia can be divided into three overlapping periods (acute, subacute, and chronic phase) with different underlying neural mechanisms. During subacute period of weeks to months following brain injury, reorganization of neural network through brain plasticity occurring in the both hemisphere plays a crucial role in recovery of language function. Recently, the potential use of functional neuroimaging has been raised to explain the underlying neural mechanism for language recovery, however, the brain areas and various factors affecting brain reorganization are still controversial. This article reviews the clinical evidence for recovery of language function through brain plasticity and reorganization and the factors affecting the recovery of language function in aphasic patients following brain injury.

Aphasia is an acquired language disorder caused by focal brain damage, which affect all modalities of language. Therefore, segregation of aphasia from speech disorders or modality specific problems such as dysarthria, apraxia of speech or agnosia is the first step of differential diagnosis. Even though cognitive dysfunctions affect language performance, cognitive communication disorder is also a different concept from aphasia which in confined to pure language disorders. The purpose of this study is to introduce various models and methods of evaluation on aphasia and to review of recent issues of aphasia research.

This article summarizes the era from when Paul Broca had first introduced his aphasia case study and theory in 1861 to clinical-neuroanatomical approach which was widely known until early twentieth century. The article also comprises the cognitive-neuropsychological approach which appeared after the cognitive revolution in 1956. It investigated and compared the definition, classification method and the primary research object of aphasia in the perspectives of clinical-neuroanatomical approach and cognitive-neuropsychological approach. Each approach has its own advantages and disadvantages. Therefore, it is inappropriate to only support for a certain approach but better if two approaches are incorporated together and used effectively in certain situations. In order for the best research and treatment for the aphasic patients, clinical practitioners who prefer clinical-neuroanotomical approach and researchers who prefer cognitive-neuropsychological approach should participate together to incorporate the two approaches.

Neuromuscular coordination is the process in the activation of muscle contraction patterns with appropriate forces and sequences coupled with simultaneous inhibition of other muscles to carry out desired activity. Through coordination training, engram can be developed as automatic preprogrammed multi-muscular patterns in extrapyramidal system by repetitive training millions of time, whereas control is the ability to voluntarily activate a single muscle in pyramidal system with conscious awareness. The development of coordination depends on voluntary repetition of precise performance with simple components until engram is formed. Balance training begins with therapeutic standing using a tilt table and a prone stander. Thereafter, patients with stable static posture proceed to dynamic balance training and progressive gait training using parallel bars and gait aids such as walker or cane. Balance training as a comprehensive early rehabilitation program can effectively improve balance performance. As a therapeutic modality for balance and coordination, neurologic music therapy for sensorimotor training consists of rhythmic auditory stimulation (RAS), patterned sensory enhancement, and therapeutic instrumental music performance (TIMP). RAS has been shown to increase the effect of gait training by stimulating reticulospinal tract in extrapyramidal system as the underlying mechanism. TIMP using keyboard playing has been introduced as therapeutic modality to enhance sequential and programmed coordination with precise execution and independent movement of individual fingers. Therefore, clinical application of neurologic music therapy might be considered to improve balance and coordination in patients with neurological diseases.
Acoustic Stimulation ; Brain ; Brain Diseases ; Canes ; Fingers ; Gait ; Humans ; Muscle Contraction ; Muscles ; Music ; Music Therapy ; Posture ; Walkers

A customized vestibular rehabilitation (VRT) is an important treatment modality in patients with vestibular dysfunction with gaze instability, motion-provoked vertigo, disequilibrium and gait disturbance. We discuss in this paper the patient selection criteria for VRT, rehabilitation strategies for vestibular deficits, and the factors that affect the outcome.
Gait ; Humans ; Patient Selection ; Vertigo

Balance, the ability to maintain the center of gravity over the base of support within a given sensory environment, is composed of several subcomponents and influenced by several systems (sensory, musculoskeletal, and central and peripheral nervous systems). The assessment and management of balance and posture in brain disorders are complex. To make a reasonable choice about balance scales to use, it is important to understand the balance system, to have a careful understanding about measurement tools in brain disorders and have a comprehensive way to assess balance function and dysfunction. This is a challenge for balance activity measurement tools as the most balance scales needs underlying theoretical approach behind the clinical assessment. Further research is needed to develop the theoretical construct with ecological validity, the 'hierarchy' conceptual scale and combine the individual test to the patients' level of balance ability. And assessment of the minimum detectable change in each test should be included and paid attention that is vital for clinical interpretation of scores. In conclusion, a thorough assessment into the cause of balance dysfunction in brain disorders is essential to the implementation of appropriate treatment, usually a multidisciplinary approach.
Brain ; Brain Diseases ; Brain Injuries ; Gravitation ; Postural Balance ; Posture ; Stroke ; Weights and Measures