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

OBJECTIVE: The aim of the study was to evaluate the effectiveness of ultrasouond-guided salivary gland injection of botulinum toxin A (BTX-A) for posterior drooling. METHOD: 11 patients with brain lesion (9 cerebral palsy, 1 hypoxic ischemic encephalopathy and 1 mental retardation) with posterior drooling (an initial PDAS score greater than 2) and related pulmonary problems were recruited. Drooling severity was measured at baseline, 4 weeks, 3 months and 6 months after botulinum toxin A injection, by using Teacher Drooling Scale (TDS), Visual Analogue Scales (VAS), Drooling Score System (DSS)-severity, frequency and Posterior Drooling/Aspiration System (PDAS). RESULTS: The TDS, DSS-severity, DSS-frequency, VAS, PDAS were significantly reduced at 4 weeks and 3 months after BTX-A injection into salivary glands compared to pre-injection (p<0.05). However, there were no significant changes at 6 months compared to pre-injection level. CONCLUSION: BTX-A injection into salivary glands may improve anterior drooling in patients with brain lesions. Furthermore BTX-A injection into salivary glands may also decrease the posterior drooling which might related to respiratory symptoms in aspiration pneumonia.
Botulinum Toxins ; Botulinum Toxins, Type A ; Brain ; Cerebral Palsy ; Humans ; Hypoxia-Ischemia, Brain ; Pneumonia, Aspiration ; Salivary Glands ; Sialorrhea ; Sorbitol ; Stress, Psychological ; Tyramine ; Weights and Measures

OBJECTIVE: To describe factors associated with the severity of post-stroke dysphagia. METHODS: We reviewed retrospectively medical records of patients having dysphagia following stroke in Seoul National University hospital from April 2002 through Dec 2009. A total of 578 patients (male and female, 331 and 247) were included. The following parameters were recorded and analyzed: patient's sex, age, type of stroke, onset of dysphagia, location of lesion and the American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale (ASHA NOMS). Using Binary logistic regression and multiple regression analysis, the relationship between dysphagia severity and other factors were analyzed. RESULTS: Their average duration between onset of stroke and the date of videofluoroscopic swallowing study (VFSS) was 32.3 +/- 18.4 days. Patients with hemorrhagic stroke (172 patients, ASHA 4.06 +/- 1.98) showed poorer swallowing function than those with ischemic stroke (406 patients, ASHA 4.49 +/- 2.02, p=0.013). Binary logistic regression analysis showed that patients who had longer duration from onset to the first study, hemorrhagic stroke, bilateral lesion and older age were at higher risk for dysphagia requiring non-oral supplements (p=0.031, 0.039, 0.042, and 0.043, respectively). Multiple regression analysis revealed that longer duration from onset to study, older age and hemorrhagic stroke were associated with the lower ASHA NOMS (p=0.006, 0.009 and 0.021, respectively). Bilateral lesion, sex, history of previous stroke and involvement of the brainstem, however, were not significant factors. CONCLUSION: Hemorrhagic stroke, longer duration from stroke onset to the initial evaluation, and older age were identified as associated factors with the poorer swallowing function after stroke. Further prospective studies will be required to evaluate the prognostic value of these characteristics.
American Speech-Language-Hearing Association ; Brain Stem ; Deglutition ; Deglutition Disorders ; Female ; Humans ; Logistic Models ; Medical Records ; Regression Analysis ; Retrospective Studies ; Stroke

OBJECTIVE: Voiding dysfunction after stroke and traumatic brain injury has been known to be a predictive factor of death or severe disability, and an important factor on hospital discharge. Thus we aim to investigate its prevalence, related factors and natural course of brain injury related voiding dysfunction for proper rehabilitation after brain injury. METHOD: Two hundred ten brain injury patients (male 130, female 80) admitted in 5 university hospitals were included. The cognitive function was assessed using the Korean version-Mini mental state examination (K-MMSE), and bladder function was evaluated with the International Prostate Symptom Score (IPSS) and voiding diary. We excluded the patients that had previous urologic and gynecologic problem. RESULTS: Overall, 43.7% of total patients had voiding difficulty and the most common symptom was nocturia (80.6%), which was followed by frequency (72.6%) and urgency (40.3%). Patients with incontinence had lower K-MMSE scores than continent patients. There was no significant difference of rate of incontinence in relation with sex, cause of brain injury, and lesion site. Prevalence of urinary symptoms decreased as the duration after brain injury was longer. The quality of life score showed a high correlation with the total IPSS score (p<0.05). CONCLUSION: The overall results demonstrate that voiding dysfunction after brain injury is influenced by onset time and cognitive function after brain injury.
Brain ; Brain Injuries ; Female ; Hospitals, University ; Humans ; Nocturia ; Prevalence ; Prostate ; Quality of Life ; Stroke ; Urinary Bladder

OBJECTIVE: Cognitive dysfunction is an important factor on functional recovery after stroke. This study investigated the relationship between functional outcome and cognitive status during rehabilitation after stroke. METHOD: This retrospective study included 80 patients with rehabilitation program after first-ever stroke. The independent variables were mini-mental status examination (MMSE) and computerized neurocognitive function test (CNT). The dependent variables were modified Barthel index (MBI), Berg balance scale (BBS), National Institute of Health Stroke Scale (NIHSS) and discharge destination. The correlation analysis was applied. RESULTS: Mean interval from onset to rehabilitation program was 29.5 days and duration of inpatient rehabilitation program was 31.1 days. Mean score of initial MMSE was 20.5 and CNT showed abnormal performance in at least one of the domain specific tests in all patients. The scores of MMSE, MBI, NIHSS and BBS were improved after rehabilitation program (p<0.05). Cognitive improvement contributing to the functional recovery were significant in the early participants in rehabilitation and in older patients (p<0.05). The home-discharge group demonstrated higher scores in executive function tests (p<0.001). Visual attention, visual working memory and reasoning revealed significant correlation with the MBI score at discharge. CONCLUSION: The results of present study suggest that cognitive function, especially attention and working memory, is a predictor of functional outcome after stroke rehabilitation.
Cognition ; Executive Function ; Humans ; Inpatients ; Memory, Short-Term ; Recovery of Function ; Retrospective Studies ; Stroke

OBJECTIVE: To investigate the effect of regular exercise program on cognitive function in chronic cerebral hypoperfused rat. METHOD: Forty-eight male Sprague-Dawley rats were used. Chronic cerebral hypoperfusion was induced by bilateral common carotid arteries occlusion (BCCAO). All rats were randomly divided into 4 groups: normal rats (group A); normal rats with regular exercise program (group B); BCCAO rats (group C); BCCAO rats with regular exercise program (group D). Regular exercise program was composed of daily 30-minute treadmill exercise for 4 weeks. Cognitive function was evaluated by Morris water maze (MWM) test. The activities of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) were checked. The neurons were microscopically analyzed on Hematoxylin-Eosin and Cresyl violet stains. RESULTS: After regular exercise program, there was significant difference in the escape latency among 4 groups in hidden platform trial of MWM test (p<0.05). There was significant difference in the number of crossings among 4 groups in probe trial of MWM test (p<0.05). The activities of SOD of group A and group D were significantly higher than those of group C, respectively (p<0.05). Histopathological study displayed the formation of apoptotic cell bodies and pyknotic cells in group C and group D. There were more normal neurons in group D than group C. CONCLUSION: Regular treadmill exercise was helpful in improving cognitive function in chronic cerebral hypoperfused rat. Therefore, regular exercise program would be one of the useful strategies for treating chronic neurodegenerative diseases.
Animals ; Benzoxazines ; Carotid Artery, Common ; Cognition ; Dementia ; Humans ; Male ; Malondialdehyde ; Maze Learning ; Neurodegenerative Diseases ; Neurons ; Rats ; Rats, Sprague-Dawley ; Superoxide Dismutase ; United Nations ; Viola

Despite modern society's advancement in health care, family members remain the primary long term caregivers of individuals with chronic disease and disability. Recently, there has been growing interest in difficulties families experience providing care for a person with a brain injury. Because family members play a critical role in the long-term neurorehabilitation, reducing family members' careburden is very important for a patient as well as their family members. Therefore, understanding about family issues in neurorehabilitaiotn is necessary for health professionals who meet and treat them. This study investigated what is the most common issue which family members of neurorehabilitation patients, using the checklist about difficulties of family experience after a brain injury. The family members of 111 neurorehabilitation inpatients reported their experience about difficulties of caring patients. Five major family issues in neurorehabilitation are needs of clear explanation of the patient's condition and prognosis, financial problem, fear of recurrence, needs of information about social services and needs of information about community resource. Social isolation, frustration due to decreased personal time, increased stress and decreased quality of life, patient's poor motivation of treatment, patient's changed personality, adjustment problem after discharged from hospital are also family concerned about. Interventions designed to meet family caregivers' needs in these issues should be implemented. Recommendations for family support services are offered.
Brain Injuries ; Caregivers ; Checklist ; Chronic Disease ; Delivery of Health Care ; Frustration ; Health Occupations ; Humans ; Inpatients ; Motivation ; Prognosis ; Quality of Life ; Recurrence ; Social Isolation ; Social Work

Brain Injury employment of persons with disabilities and vocational rehabilitation, vocational evaluation difficult, but through a professional in the field of positive results can be obtained. In addition to the brain for people with disabilities if they utilize a variety of schemes to obtain professional help. For example, sheltered workshop, enclaves employment, homebound employment, reserved employment, work activity centers; Sheltered employment, Supported employment, Transition is that employment. Brain Injury Rehabilitation for people with disabilities, first to build job skills assessment system, brain injury rehabilitation services for people with disabilities to strengthen vocational and medical rehabilitation, vocational rehabilitation, and the Indians and an occupation requiring.
Brain ; Brain Injuries ; Disabled Persons ; Employment ; Employment, Supported ; Humans ; Occupations ; Rehabilitation, Vocational ; Sheltered Workshops