1.NeuroRehabilitation after Hypoxic-ischemic Encephalopathy.
Brain & Neurorehabilitation 2014;7(1):16-20
The number of survivors after hypoxic-ischemic encephalopathy has been increasing due to recent progress in medical system and care. Impairment after injury ranges from mild memory deficit to vegetative state or death. Cognitive impairment is particularly common in the survivors, because the hippocampus and medial temporal lobe are vulnerable to ischemic insult. Medication and cognitive rehabilitation should be initiated to minimize the impact of various cognitive deficits. Instead of Glasgow-Pittsburgh Cerebral Performance Categories, which is insensitive to functional change, standardized functional assessment tools should also be used in research as well as in rehabilitation settings.
Brain Injuries
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Hippocampus
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Humans
;
Hypoxia-Ischemia, Brain*
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Memory Disorders
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Mild Cognitive Impairment
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Persistent Vegetative State
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Rehabilitation
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Survivors
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Temporal Lobe
2.Endocrinologic Complications after Traumatic Brain Injury.
Brain & Neurorehabilitation 2012;5(2):52-57
The endocrinologic complications such as adrenal insufficiency and hypopituitarism are common after traumatic brain injury (TBI) portending poor rehabilitation outcome. Anterior pituitary dysfunction presents as hypothyroidism, hypogonadism, growth hormone deficiency, adrenal insufficiency and hyperprolactinemia, whereas posterior pituitary dysfunction includes syndrome of inappropriate antidiuretic hormone and central diabetes insipidus. Careful history taking and physical examination are essential to detect these abnormalities early. Laboratory tests such as serum/urine sodium and osmolality, thyroid hormone, testosterone, estradiol, cortisol, prolactin, growth hormone or IGF-1 are also necessary. Screening of endocrinologic functions is recommended especially in patients with moderate or severe TBI, skull base fracture or diffuse axonal injury 3 to 6 months after injury. Further studies are needed to reveal the effect of early correction of endocrinologic abnormality on long-term functional outcome.
Adrenal Insufficiency
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Brain Injuries
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Diabetes Insipidus, Neurogenic
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Diffuse Axonal Injury
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Endocrine System Diseases
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Estradiol
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Growth Hormone
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Humans
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Hydrocortisone
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Hyperprolactinemia
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Hypogonadism
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Hypopituitarism
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Hypothyroidism
;
Insulin-Like Growth Factor I
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Mass Screening
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Osmolar Concentration
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Physical Examination
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Prolactin
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Skull Base
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Sodium
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Testosterone
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Thyroid Gland
;
Treatment Outcome
3.Nutrition Management in Patients With Traumatic Brain Injury: A Narrative Review
Brain & Neurorehabilitation 2022;15(1):e4-
Traumatic brain injury (TBI) is a major cause of long-term physical and psychological disability and death. In patients with TBI, undernutrition is associated with an increased mortality rate, more infectious complications, and worse neurologic outcomes. Therefore, timely and effective nutritional therapy is particularly crucial in the management of TBI to improve patients’ prognoses. This narrative review summarizes the issues encountered in clinical practice for patients with neurotrauma who receive acute and post-acute inpatient rehabilitation services, and it comprehensively incorporates a wide range of studies, including recent clinical practice guidelines (CPGs), with the aim of better understanding the current evidence for optimal nutritional therapy focused on TBI patients. Recent CPGs were reviewed for 6 topics: 1) hypermetabolism and variation in energy expenditure in patients with TBI, 2) delayed gastric emptying and intolerance to enteral nutrition, 3) decisionmaking on the route and timing of access in patients with TBI who are unable to maintain volitional intake (enteral nutrition versus parenteral nutrition), 4) decision-making on the enteral formula (standard or immune-modulating formulas), 5) glycemic control, and 6) protein support. We also identified areas that need further research in the future.
7.Validity and Reliability of the Korean Version of the MD Anderson Dysphagia Inventory for Head and Neck Cancer Patients.
Chan Hyuk KWON ; Yeo Hyung KIM ; Jae Hyeon PARK ; Byung Mo OH ; Tai Ryoon HAN
Annals of Rehabilitation Medicine 2013;37(4):479-487
OBJECTIVE: To translate the MD Anderson Dysphagia Inventory (MDADI) which is a self-administered questionnaire that assesses effect of dysphagia on the quality of life for patients with head and neck cancer, into Korean and to verify the validity and reliability of the Korean version of MDADI. METHODS: We performed 6 steps for the cross-cultural adaptation which consisted of translation, synthesis, back translation, review by an expert committee, cognitive debriefing, and final proof reading. A total of 34 dysphagia patients with head and neck cancers from Seoul National University Hospital answered the translated version of the questionnaire for the pre-testing. The patients answered the same questionnaire 2 weeks later to verify the test-retest reliability. RESULTS: One patient was excluded at second survey because he changed his feeding strategy. Overall, 33 patients completed the study. Linguistic validations were achieved by each step of cross-cultural adaptation. We gathered statistically strong construct validity (Spearman rho for subdomain scores to total score correlation range from 0.852 to 0.927), internal consistency for subdomains (Cronbach's alpha coefficients range from 0.785 to 0.889) and test-retest reliability (intra-class correlation coefficient range from 0.820 to 0.955) CONCLUSION: The Korean version of the MDADI achieved linguistic validations and demonstrated good construct validity and reliability. It can be a useful tool for screening and treatment planning for the dysphagia of patients with head and neck cancers.
Deglutition Disorders
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Head
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Head and Neck Neoplasms
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Humans
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Linguistics
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Mass Screening
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Neck
;
Quality of Life
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Reproducibility of Results
;
Surveys and Questionnaires
8.Bilateral femoral neuropathy after vaginal delivery: A case report.
Seung Pyo CHOI ; Byung Mo OH ; Wonsik AHN
Korean Journal of Anesthesiology 2009;57(2):228-232
Epidural analgesia is frequently used for the management of labor pain in parturients. The neurologic complications of epidural analgesia are rare, but they are catastrophic when they occur. We report here on a case of bilateral femoral neuropathy in a vaginal delivery patient with epidural analgesia. The patient complained of weakness of both thighs and numbness around both knees. Neurologic examination and electromyographic study revealed that they occurred due to the delivery itself. The patient had not fully recovered at eight weeks after delivery. The declining incidence of postpartum femoral neuropathy may reflect a reduced duration of labor in accordance with modern obstetric practice, and particularly the more frequent use of Caesarean delivery. The exact etiology of postpartum femoral neuropathy is unknown, and the possible factors are direct compression of nerves that are proximal within the pelvis by either the fetal head or birthing instruments, or this malady is the result of pressure induced ischemia at the level of the inguinal ligament when the pregnant woman is in the lithotomy position.
Analgesia, Epidural
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Female
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Femoral Neuropathy
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Head
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Humans
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Hypesthesia
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Incidence
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Ischemia
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Knee
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Labor Pain
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Ligaments
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Neurologic Examination
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Parturition
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Pelvis
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Postpartum Period
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Pregnancy
;
Pregnant Women
;
Thigh
9.Kinematic Changes in Swallowing After Surgical Removal of Anterior Cervical Osteophyte Causing Dysphagia: A Case Series.
Hyeonghui JEONG ; Han Gil SEO ; Tai Ryoon HAN ; Chun Kee CHUNG ; Byung Mo OH
Annals of Rehabilitation Medicine 2014;38(6):865-870
This retrospective case series included five patients who underwent surgical resection of the cervical anterior osteophyte due to dysphagia. Videofluoroscopic swallowing studies (VFSSs) were performed before and after surgery on each patient, and kinematic analysis of the video clips from the VFSS of a 5-mL liquid barium swallow was carried out. Functional oral intake improved after surgery in 3/4 patients who had required a modified diet before surgery. Kinematic analysis showed increases in the maximal hyoid vertical movement length (13.16+/-5.87 to 19.09+/-4.77 mm, p=0.080), hyoid movement velocities (170.24+/-84.71 to 285.53+/-104.55 mm/s, p=0.043), and upper esophageal sphincter opening width (3.97+/-0.42 to 6.39+/-1.32 mm, p=0.043) after surgery. In conclusion, improved upper esophageal sphincter opening via enhancement of hyoid movement after cervical anterior osteophyte resection may be the kinetic mechanism of improved swallowing function.
Barium
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Deglutition Disorders*
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Deglutition*
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Diet
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Esophageal Sphincter, Upper
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Humans
;
Hyoid Bone
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Osteophyte*
;
Retrospective Studies
10.Effect of Magnetic Stimulation in Spinal Cord on Limb Angiogenesis and Implication: A Pilot Study.
Dohong LEE ; Jaewon BEOM ; Byung Mo OH ; Kwan Sik SEO
Annals of Rehabilitation Medicine 2012;36(3):311-319
OBJECTIVE: To investigate the effect of repetitive magnetic stimulation (rMS) of the spinal cord on limb angiogenesis in healthy rats and explore its implication for the treatment of lymphedema. METHOD: Twelve adult male Sprague-Dawley rats were divided into four groups as follows: sham rMS followed by tissue harvest 5 minutes later (group 1, n=2), 1 Hz rMS and tissue harvest 5 minutes later (group 2, n=3), 20 Hz rMS and tissue harvest 5 minutes later (group 3, n=3), 20 Hz rMS and tissue harvest 30 minutes later (group 4, n=4). Animals were treated with 20-minute rMS with 120% of the motor threshold on their left side of upper lumbar spinal cord. Expression of angiogenic factors, that is, Akt, phospho-Akt (pAkt), endothelial nitric oxide synthase (eNOS), phospho-eNOS (p-eNOS) were measured by western blot. Bilateral hindlimb muscles (quadriceps and gastrocnemius) were harvested. RESULTS: Expression of Akt in left quadriceps increased in group 4 compared with group 2 and 3 (3.4 and 5.3-fold each, p=0.026). Expression of eNOS in left plus right quadriceps markedly increased in group 3 and 4 compared with group 1 and 2 (p=0.007). Expressions of eNOS, Akt and p-eNOS, pAkt in gastrocnemius were not comparable between four groups (p>0.05). CONCLUSION: Repetitive magnetic stimulation of the spinal cord may exert an angiogenic effect closely linked to lymphangiogenesis. It has clinical implication for the possible therapy of lymphedema caused by breast, cervical or endometrial cancer operation. Future studies with the specific lymphatic endothelial cell markers are required to confirm the effect of rMS on lymphangiogenesis.
Adult
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Angiogenesis Inducing Agents
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Animals
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Blotting, Western
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Breast
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Endometrial Neoplasms
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Endothelial Cells
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Extremities
;
Female
;
Hindlimb
;
Humans
;
Lymphangiogenesis
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Lymphedema
;
Magnetics
;
Magnets
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Male
;
Muscles
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Nitric Oxide Synthase Type III
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Pilot Projects
;
Rats
;
Rats, Sprague-Dawley
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Salicylamides
;
Spinal Cord