Medical applications for 3-dimensional (3D) printing are rapidly expanding and are expected to revolutionize health care. Two patients with chronic stroke participated in a training program with the 3D printing pen (3Doodler 2.0; WobbleWorks, Inc.). This training program consisted of 12 sessions for 4 weeks. The training program consisted of a 4-step protocol. In 2 patients with chronic stroke who showed impaired visuospatial function and hand function, each function improved without any serious adverse effects after completing training. This case study suggests the therapeutic potential of the 3D printing pen to improve visual-perceptual and hand functions in stroke patients.
Delivery of Health Care ; Education ; Hand ; Humans ; Printing, Three-Dimensional* ; Rehabilitation* ; Stroke*

While a variety of robot-assisted gait training systems have been widely applied for locomotor rehabilitation in stroke patients, the best supporting evidence for robot-assisted gait training systems remains unknown. The purpose of this study was to provide the best robot-assisted gait training and clinical evidence by comparing the effects of exoskeleton and end-effector type robot-assisted gait training in stroke rehabilitation. The present study underwent a review of the literature to determine the best clinical evidence of the most commonly utilized robot-assisted gait training paradigms (end-effector and exoskeleton types) in stroke gait rehabilitation. The review corroborates the compelling evidence that combined robot-assisted gait training was advantageous in stroke rehabilitation, as it offers additive special therapeutic effects that were not afforded by conventional therapy alone. Most importantly, the robot-assisted gait training paradigm provided more intensive, repetitive, accurate kinematic feedback and symmetrical gait practice, while reducing therapist labor, which is often not affordable in current stroke rehabilitation care. Both the robot-assisted gait training with either the end-effector type or exoskeleton type was beneficial for improving motor recovery, gait function, and balance in stroke patients when it was combined with the conventional physical therapy. The robot-assisted gait training should be used as an augmented gait intervention for stroke population.
Gait* ; Humans ; Rehabilitation ; Stroke* ; Therapeutic Uses

OBJECTIVE: To develop the Korean version of the Kessler Foundation Neglect Assessment Process (KF-NAP), which enables a more functional assessment of unilateral spatial neglect, by first translating it into Korean and then statistically standardizing it. METHODS: Two rehabilitation specialists translated the KF-NAP into Korean. The entire process of administering the Korean KF-NAP to 30 patients with brain disease was video-recorded. Five occupational therapists from 4 university hospitals nationwide evaluated the 30 video-recorded examination cases. We analyzed inter- and intra-reliabilities of the Korean KF-NAP using the intraclass coefficient and Pearson correlation coefficient. Internal consistency reliability of the assessment categories was also examined using Cronbach's alpha coefficient. RESULTS: For the construct validation study, the Korean KF-NAP was strongly correlated with the Albert's test and letter cancellation test (r ≥ 0.8; p < 0.05). The intraclass correlation coefficients for the first and second assessments of the Korean KF-NAP were 0.973 and 0.982, respectively, showing high reliability (p < 0.05). The intra-rater reliabilities exceeded 0.9 (p < 0.05), and Cronbach's alpha coefficient exceeded 0.8, showing internal consistency reliability. CONCLUSION: The Korean KF-NAP is a reliable and valid instrument for assessing hemispatial neglect symptoms in patients with brain diseases.
Brain Diseases ; Hospitals, University ; Humans ; Perceptual Disorders ; Rehabilitation ; Reproducibility of Results* ; Specialization ; Translating ; Translations

The aim of this study is to investigate the nutritional status in vegetative state (VS) and minimally conscious state (MCS) patients, and to identify correlation between the duration from onset and indices indicating nutritional status. This study included a total of 37 VS and MCS patients. For nutrition assessment, the body mass index (BMI), biochemical parameters such as hemoglobin, total lymphocyte count, albumin and cholesterol levels were measured. The mean BMI was 21.31 ± 2.81 kg/m2. Only 4 patients (10.81%) were classified as underweight, 24 patients (64.86%) had normal BMI, 6 patients (16.22%) were overweight, and 3 patients (8.11%) were obese. The partial correlation coefficients showed that duration from onset has a positive correlation with BMI, and a negative correlation with cholesterol level. This study suggests that regular and properly prescribed enteral feeding in VS and MCS patients would supply stable and appropriate nutrition. Further study is needed with additional nutrition assessments reflecting muscle mass.
Body Mass Index ; Cholesterol ; Enteral Nutrition ; Humans ; Lymphocyte Count ; Malnutrition ; Nutrition Assessment* ; Nutritional Status ; Overweight ; Persistent Vegetative State ; Thinness

Ramsay Hunt syndrome (RHS) is characterized by herpes zoster oticus, facial nerve palsy, and vestibulocochlear symptoms. Dysphagia caused by the involvement of multiple cranial nerves (CNs) in RHS is very rare. We encountered a rare case presented with severe dysphagia due to cranial polyneuropathy involving trigeminal nerve (CN V), facial nerve (CN VII), vestibulocochlear nerve (CN VIII), glossopharyngeal nerve (CN IX), vagus nerve (CN X), and hypoglossal nerve (CN XII) in RHS. This case report suggested that the prognosis for dysphagia in RHS seems favorable, and swallowing rehabilitation therapy could be beneficial in expediting tube removal.
Cranial Nerves ; Deglutition ; Deglutition Disorders* ; Facial Nerve ; Glossopharyngeal Nerve ; Herpes Zoster Oticus* ; Hypoglossal Nerve ; Paralysis ; Polyneuropathies* ; Prognosis ; Rehabilitation ; Trigeminal Nerve ; Vagus Nerve ; Vestibulocochlear Nerve

To evaluate oxygenation and metabolic state of the non-brainstem stroke patients after the moderate intensity exercise using arterial blood gas analysis (ABGA). Fifty-two stroke patients were recruited. All the subjects were to follow the instructions for the exercise, not suffered cardiopulmonary diseases before, and not diagnosed with brainstem disorders. They were ordered to maintain 70% heart rate of maximal heart rate during exercise and checked blood pressure, pulse rate, respiratory rate (RR), and ABGA before and after the exercise, respectively. O² saturation, PaO², PaCO², O² content, HCO³⁻, pH, and anion gap were compared between the exercise, and those data changes were performed correlation analysis into age and the time after stroke onset. The data comparison was also done into the subgroup of the severity of stroke using National Institutes of Health Stroke Scale (NIHSS). The statistically significant results were observed in the change of O² saturation, PaO², PaCO², O² content, HCO3⁻, pH, and anion gap after the exercise. The decrease of HCO³⁻ and increase of RR were proportional to age, however the data showed no correlation with the NIHSS. These results suggest relatively preserved respiratory compensation mechanism and homeostatic effect to maintain metabolic balance among the non-brainstem stroke patients.
Acid-Base Equilibrium ; Bicycling ; Blood Gas Analysis ; Blood Pressure ; Brain Stem ; Compensation and Redress ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; National Institutes of Health (U.S.) ; Oxygen ; Oxygen Consumption ; Respiratory Rate ; Stroke*

Aphasia is a major devastating symptom in stroke survivors that deteriorates patient quality of life. Various treatment methods are applied for aphasia patients after stroke. Evidence is required to assess the effectiveness of variable therapy for aphasia. Results of a meta-analysis have concluded that speech and language treatment is effective post stroke. Better outcomes are expected with high dose and high intensity speech and language therapy within tolerable ranges. Computerized and group treatments can supplement classic one to one speech and language therapy. Pharmacotherapy and non-invasive brain stimulation combined with speech and language therapy have been well-studied and better outcomes are expected, however testing in a large number of subjects is required to validate the efficacy of these combined modalities.
Aphasia* ; Brain ; Drug Therapy ; Humans ; Language Therapy ; Quality of Life ; Speech Therapy ; Stroke* ; Survivors ; Transcranial Direct Current Stimulation ; Transcranial Magnetic Stimulation

Corticobasal syndrome (CBS) is characterized by asymmetric dystonia, and myoclonus accompanied by higher cortical features including apraxia, alien limb phenomena, cortical sensory loss. Here, we report treatment course of 3 CBS patients. Asymmetric dystonia was seen in the first and second cases, a cortical sensory loss was seen in the third case and left lower limb apraxia was common in all cases. In the first and second cases, we performed an alcohol block on the obturator nerve and injected botulinum toxin into the lower leg to reduce dystonia. In the third case, patient was treated with a robotic assisted gait training, whole body therapeutic pool and gait training with laser pointer visual cueing. After appropriate treatment for patients, all 3 cases showed improvement in gait.
Apraxias ; Botulinum Toxins ; Cues ; Dystonia ; Emigrants and Immigrants ; Extremities ; Gait Apraxia ; Gait* ; Humans ; Leg ; Lower Extremity ; Myoclonus ; Nerve Block ; Neurological Rehabilitation ; Obturator Nerve ; Rehabilitation*

The objective was to identify the correlation between the sign of lower limb swelling and unilateral deep vein thrombosis (DVT) in patients with brain lesions. A total of 194 patients, between May 12th, 2011 and December 30th, 2015, who had initially elevated plasma D-dimer level (> 0.55 mg/L) and underwent enhanced DVT computed tomography (CT) were recruited in this study. The circumference of bilateral lower limbs in CT image, below 10 cm and above 15 cm from the prominence of tibial tuberosity, were measured by a single intra-observer using NIH ImageJ software. The difference of 2 cm or more between both sides was considered as significant swelling. We also evaluated patients' range of mobility and cognitive function and its relation to lower limb swelling in DVT in patients with brain lesions. Thirty-five patients were diagnosed with DVT. The presence of lower limb swelling was not statistically significant between patients with DVT and those without DVT in the proximal limb (p = 0.330) and distal limb (p = 0.405). In DVT patients (n = 35), there was no statistically significant correlation between lower limb swelling and other covariates of the patient group. There was no statistically significant correlation between lower limb circumference and DVT.
Brain* ; Cognition ; Extremities ; Humans ; Lower Extremity* ; Plasma ; Pulmonary Embolism ; Venous Thrombosis*

To investigate the influence of leukoaraiosis (LA) on the functional outcomes of subcortical stroke in the subacute phase after onset. We retrospectively analyzed 41 patients with subacute subcortical infarct at a single center from 2011 to 2015. We explored the relationship between LA severity at admission/transfer (initial evaluation) and functional outcome at the time of discharge (follow-up evaluation), as assessed using the modified Rankin Scale (mRS), Functional Ambulation Category (FAC), and modified Barthel Index (mBI). LA severity was graded as mild, moderate, or severe according to the Fazekas scale. Scores of the mRS, FAC, and mBI were compared in patients grouped based on LA severity: no LA (n = 12), mild LA (n = 19), and moderate-to-severe LA (n = 10). Significant inter-group differences were observed in all 3 scores at both the initial and follow-up evaluations. After adjustment for age, scores at follow-up evaluation were significantly different between the 2 groups. LA is related to functional outcomes of subcortical stroke in the subacute phase after onset. After adjustment for age, severe LA was correlated with poor functional outcomes in the subacute phase.
Cerebral Infarction ; Follow-Up Studies ; Humans ; Leukoaraiosis* ; Retrospective Studies ; Stroke ; Walking