Cerebral concussion and mild traumatic brain injury (TBI) have been used interchangeably, although the two terms have different definitions. Traumatic axonal injury (TAI) is a more severe subtype of TBI than concussion or mild TBI. Regarding the evidence of TAI lesions in patients with concussion or mild TBI, since the 1960’s, several studies have reported on TAI in patients with concussion who showed no radiological evidence of brain injury by autopsy. However, conventional CT and MRI are not sensitive to detection of axonal injury in concussion or mild TBI, therefore, previously, diagnosis of TAI in live patients with concussion or mild TBI could not be demonstrated. With the development of diffusion tensor imaging (DTI) in the 1990’s, in 2002, Arfanakis et al. reported on TAI lesions in live patients with mild TBI using DTI for the first time. Subsequently, hundreds of studies have demonstrated the usefulness of DTI in detection of TAI and TAI lesions in patients with concussion or mild TBI. In Korea, the term “TAI” has rarely been used in the clinical field while diffuse axonal injury and concussion have been widely used. Rare use of TAI in Korea appeared to be related to slow development of DTI analysis techniques in Korea. Therefore, we think that use of DTI analysis techniques for diagnosis of TAI should be facilitated in Korea.
Autopsy ; Axons* ; Brain Concussion* ; Brain Injuries* ; Diagnosis ; Diffuse Axonal Injury ; Diffusion Tensor Imaging ; Humans ; Korea ; Magnetic Resonance Imaging

Neurological deficits commonly associated with anterior choroidal artery infarction (AChAI) include hemiplegia, hemisensory loss, and homonymous hemianopsia, while neuropsychological and perceptual deficits are uncommon. Prominent cognitive function impairment has rarely been reported. Here, we report a case of AChAI with prominent cognitive function impairment without motor deterioration. In contrast to the typical clinical features of AChAI, near complete and rapid motor recovery was observed, while cognitive impairment persisted despite rehabilitation therapy.
Cerebral Infarction* ; Hemianopsia ; Hemiplegia ; Internal Capsule ; Rehabilitation

The objective was to investigate the effects of the intensive inpatient rehabilitation treatment during subacute phase to reduce disabilities at chronic phase in patients with first-ever stroke. This study presents interim results of the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO). Stroke patients who transferred to the rehabilitation department during the 1st hospitalization were classified into the intensive rehabilitation group, and the other stroke patients were classified into the nonintensive rehabilitation group. Disability grade at subacute phase and 6 months after stroke was defined using the Korean modified Barthel Index (K-MBI). The change of disability grade at chronic phase was analyzed by the intensive inpatient rehabilitation treatment. A total of 5,380 first-ever stroke patients were included in this analysis. Among these 5,380 patients, 1,162 and 4,218 patients were classified into the intensive rehabilitation group and the non-intensive rehabilitation group, respectively. The proportion of patients to improve the disability grade at 6 months after stroke was significantly higher in the intensive rehabilitation group than the non-intensive rehabilitation group with severe functional impairment at subacute phase (p < 0.05). This study revealed that the intensive inpatient rehabilitation treatment during subacute stage could significantly improve the disability grade at chronic phase in first-ever stroke patients.
Cohort Studies* ; Hospitalization ; Humans ; Inpatients* ; Rehabilitation* ; Stroke*

Activity and participation after stroke can be increased by neurorehabilitation of upper extremity. As the technology advances, a robot-assisted restorative therapy with/without a brain-machine interface (BMI) is suggested as a promising therapeutic option. Understanding the therapeutic point of view about robots and BMIs can be linked to the patient-oriented usability of the devices. The therapeutic turning point concept of robot-assisted rehabilitation with BMIs, basics of robotics for stroke and upper extremity weakness and consequent neuroplasticity/motor recovery are reviewed.
Brain-Computer Interfaces* ; Humans ; Neuronal Plasticity ; Rehabilitation ; Robotics ; Stroke* ; Upper Extremity*

The aim of this study was to investigate prevalence and risk factors associated with spasticity at 3 months after a first-ever stroke in Korean patients. This cohort study included consecutive patients with first-ever stroke who were admitted to 9 participated hospitals in different areas of Korea. The Modified Ashworth Scale (MAS), which defines spasticity as MAS > 1 in any of the examined joints was used to assess patients 3 months after stroke occurrence. The prevalence of spasticity was 7.3% (339 of 4,658 patients), 3 months after stroke onset. Spasticity was more frequent in upper extremity (6.7%) than lower extremity (4.3%). Severity of spasticity was as follows: 63.1%: MAS I, 23.3%: MAS I+, 9.4%: MAS II, 2.6%: MAS III, and 1.4%: MAS IV. Stroke type (hemorrhagic) (p < 0.05) were identified as correlated risk factors. Patients with spasticity scored higher with National Institute of Health Stroke Scale (NIHSS) and lower with modified Rankin Scale (mRS) than non-spastic patients (p < 0.001). This study showed 7.3% prevalence of spasticity in Korean first-ever stroke patients at 3 months, and identified those who carried higher risks of developing spasticity who would particularly benefit from preventive or therapeutic strategies. It would contribute to assessing spasticity in patients with first-ever stroke in Korea.
Cohort Studies* ; Humans ; Joints ; Korea* ; Lower Extremity ; Muscle Spasticity* ; Prevalence* ; Rehabilitation* ; Risk Factors ; Stroke* ; Upper Extremity

To reveal test discrepancies between early bedside swallowing screening test (BSST) and standard videofluoroscopic swallowing study (VFSS) and thereby to achieve an evaluation standard for post-stroke dysphagia which prevent aspiration pneumonia or unnecessary diet restrictions. Consecutive 252 first-ever stroke patients admitted to stroke unit of 1 tertiary university hospital from May 2009 to May 2010. BSST was performed within 3 days after onset and VFSS within 2 weeks after BSST. The findings between BSST and VFSS were compared. BSST and VFSS were performed in 186 patients. Of the 116 patients who passed BSST, aspiration was newly detected in VFSS in 16 patients (14%). Diet recommendation was changed in 95 of the 186 patients (51%) after VFSS, with 28% (n = 52) being changed to a more conservative level compared to the recommendation based on initial BSST. The data support the need for reassessment using VFSS even when BSST is performed in the acute stage of stroke.
Deglutition Disorders* ; Deglutition* ; Diet ; Humans ; Mass Screening* ; Pneumonia, Aspiration ; Prospective Studies* ; Stroke

OBJECTIVE: To investigate the neuroanatomical correlation of conduction aphasia by analyzing neuroimage data of patients who were diagnosed as conduction aphasia after stroke. METHOD: Nine patients with conduction aphasia after stroke were retrospectively reviewed with their medical records. Language functions of patients were assessed by Korean-version Western Aphasia Battery (K-WAB). Stroke lesions were assessed by brain computed tomography or magnetic resonance images taken within 1 month after onset of stroke. RESULTS: The stroke subtypes were cerebral infarction in 5 patients and intracranial hemorrhage in 4 patients. The lesions were located in left hemisphere in 8 subjects and right hemisphere in 1 subject. The left hemispheric lesion were located in the insula and superior temporal lobe in 3, the inferior parietal lobe in 2, the corona radiate in 1, the basal ganglia in 1 patient and both corona radiata and basal ganglia in 1. The right hemispheric lesion was located in the inferior parietal and superior temporal lobe. CONCLUSION: 6 of 9 patients with conduction aphasia had brain lesions in the path of arcuate fasciculus in the left hemisphere, however, 3 of 9 patients showed other brain lesions. These findings suggested that conduction aphasia could be caused by heterogeneous brain lesions. The characteristic features of conduction aphasia according to diverse brain lesions may need further investigation.

OBJECTIVE: To investigate the effect of taping therapy on hemiplegic shoulder subluxation. METHOD: Sixty patients were randomly assigned to three groups. In study group, two parts of the first tape was shaped as letter Y and were attached from humeral insertion of deltoid muscle to extension line of the clavicle midline, following anterior and middle deltoid line, respectively, with 125% elasticity. And two parts of the second tape as same as the first tape were attached horizontally from head of greater tubercle to medial border of scapular, following supraspinatus and infraspinatus muscles, respectively, with 125% elasticity. The placebo group was applied by the tape with 100% and 150% elasticity and control group was not applied. The effects of strapping were evaluated by using visual analogue scale (VAS), passive range of movement (ROM), vertical distance (VD) and horizontal distance (HD) on radiologic findings of plain anteroposterior (AP) view and lateral distance (LD) on shoulder ultrasonography at entry (day 0), 1 and 2 days later. RESULTS: Repeated measured analysis of variances indicated that the study group showed corrective effect in the VAS (p<0.05). The control and placebo groups showed no significant change in any parameters of distance measurements and clinical findings. In every group, spasticity, MMT and Brunnstrom stage were not changed during study. CONCLUSION: The taping therapy with 125% elasticity may be helpful for patients with hemiplegic shoulder to reduce pain.

OBJECTIVE: The purpose of this study is to find the change in post-stroke cognitive function during subacute phase, and to investigate factors associated with this change. METHOD: The cognitive function was evaluated using Mini-Mental Status Examination (MMSE) at the beginning of rehabilitation (mean 23.1 ± 12.6 days after onset) and discharge (mean 88.1 ± 29.8 days after onset) in 56 stroke patients. At the same time functional status was also evaluated using modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS) and modified Barthel Index (MBI). Then we compared the improvements of MMSE scores between two time period according to age, sex, stroke profile, and initial functional status. We also determined the correlation between cognitive and functional gain. RESULTS: MMSE scores improved from rehabilitation start to discharge (3.14 ± 5.4, p = 0.000). MMSE scores improved more when patients were male, older than 65 years, and had hemorrhagic and cortical lesions (p<0.05). And, MMSE scores improved more when patients had a higher functional level initially (mRS≤2, NIHSS≤1, MBI≥75), (p<0.05) and improvement of MMSE score was significantly correlated with initial MBI score (r = 0.351, p<0.05). CONCLUSION: Cognitive function recovered during subacute phase of stroke, and improvement of cognitive function at this phase were associated with sex, age, stroke profiles, initial functional status. These results would provide us an information to plan cognitive rehabilitation in these patients.

Apraxias are deficits of higher motor behavior that are not primarily caused by sensorimotor dysfunction, or communication problems, or dementia. A patient with apraxia does not know what to do, because the plan of action is disrupted, or in other cases, the patient knows what to do but not how to do it. A variety of forms of apraxia originate from lesions of different levels and structures of the motor system, reflecting its complexity. The multifarious types of apraxia differentially affect the activities of daily living and hence show marked differences in the prognosis of recovery and the need of treatment. Therefore, objective diagnosis and appropriate treatment of the different types of apraxia are of foremost clinical importance. In this paper, we reviewed the current literature on the assessment and treatment of apraxia.