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.

Stroke is the second leading cause of death, and the leading cause of acquired disability in adults. Survivors of stroke are at risk of a recurrent event, which is often more disabling than first-ever stroke. Recurrent strokes continue to account for 25~30% of all strokes. That represents the needs of successful secondary prevention. Appropriate secondary prevention of recurrent stroke needs rapid diagnosis and treatment and prompt identification of the underlying cardiovascular cause. Some epidemiological data suggest that a substantial proportion of strokes can be attributed to unhealthy lifestyle behaviors. This review summarizes the evidence for optimum secondary prevention of recurrent ischemic stroke as integral part of physical medicine and rehabilitation.
Adult ; Cause of Death ; Diagnosis ; Humans ; Life Style ; Physical and Rehabilitation Medicine ; Rehabilitation* ; Secondary Prevention* ; Stroke* ; Survivors

Pyogenic arthritis remain a difficult problem, despite the availability of a wide range of powerful modernantibiotics. Early and correct diagnosis is imperative to assure the prompt initiation of an effective therapeuticregimen and the prevent of late sequela. Careful clinical, laboratory and roentgenological analysis arefundamental to early and precise diagnosis. Therefore, plain roentgenogram shold not be overlooked. A radiologicaland clinical observation was made in 51 cases of pyogenic arthritis admittted to Chosun University Hospital duringthe period from January 1976 to Dec. 1983 and following results were obtained. 1. Among the 51 cases, 36 cases(70.6%) were male and 15 cases(29.4%) were females. The most prevalent age was 5 to 9 (27.6%). 2. Symptom durationless than 5 days was in 21 cases (41.2%) and more than 31 days was in 6 cases (11.7%). 3. The most common symptomon admission was pain around the involved joint and others are limitation of motion, swelling, tenderness, fever,local heating and erythema. 4. The underlying causes were composed of unknown in 21 cases(41.2%), trauma in 18cases(35.3%), infections focus in 8 cases (15.7%) and iatrogenic reasone 4 cases(7.8%) 5. The msot commonlyaffected joint was hip joint (45.1%). The other affected sites in order of frequency were knee, ankle, shoulder,S-I and elbow joint. In infants and children, hip and knee joint are commonly affected; In adults, knee joint ismost commonly affected. 6. In laboratory findings, the number of W.B.C and E.S.R were increased in 56.9%. Symptomduration more than 31 days in 5 cases were increased E.S,R only. Causative microorganism was isolated in 31 cases;the most common microorganism was Staphylococcus auterus in 22 cases. Others are B-hemolytic Streptococcus,Enterobacteriaceae species and Pseudomonas aeruginosa. 7. In 26 cases(50.9%) of the patients, roentgenographicfinding was negative. The most common radiological findig was soft tissue swelling and the others are include inorder of frequency: joint space widening, small erosions in articular cortex, subchondral osteoporosis. The comonradiological findings of symptom duration more than 31 days in 6 cases were lost of entire cortex, ankylosis andjoint space narrwoing.
Adult ; Ankle ; Ankylosis ; Arthritis ; Child ; Diagnosis ; Elbow Joint ; Erythema ; Female ; Heating ; Hip ; Hip Joint ; Hot Temperature ; Humans ; Infant ; Joints ; Knee ; Knee Joint ; Male ; Osteoporosis ; Pseudomonas aeruginosa ; Staphylococcus

Hemiplegic stroke patients may have abnormal awareness or perception of the affected limb (s). For example, patients may experience their limb as not belonging to them (asomatognosia) or attribute their own body parts to other persons (somatoparaphrenia). Disturbed sensation of limb ownership (asomatognosia, somatoparaphrenia) for the hemiplegic limb has been reported in patients with right insula lesion. We report a case of a 70-year-old right handed female who had somatoparaphrenia and neglect dyslexia after right posterior cerebral artery and posterior corpus callosal infarction. Additionally, she showed visual defect, dyschromatopsia, and hemispatial neglect
Aged ; Dyslexia ; Extremities ; Female ; Hand ; Human Body ; Humans ; Infarction ; Infarction, Posterior Cerebral Artery ; Ownership ; Perceptual Disorders ; Posterior Cerebral Artery ; Sensation ; Stroke

No abstract available.

OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on muscle spasticity of elbow and wrist affected by stroke. Methods: We studied 21 patients affected by stroke with spasticity in upper limbs. The neurological status of the stroke patients were evaluated by K-NIHSS and the evaluation of efficacy on the upper limb spasticity were based on modified Ashworth scale (MAS), modified Tardieu scale (MTS), and active elevation of upper limb. Treatment was performed 1 session/week, total 3 sessions in each patient. Patients were evaluated at baseline and 4 weeks after treatment using MAS of elbow flexor and active elevation of upper limb. Patients were monitored at baseline, after sham stimulation, and at 1, 4 weeks after ESWT using MTS of elbow flexor and wrist pronator. RESULTS: After ESWT, patients showed significant improvement in muscle tone of elbow flexor and wrist pronator after the 1st and 4th weeks compared with baseline and sham stimulation (p<0.001). The active elevation of hemiplegic upper limb was significantly increased (p<0.05). CONCLUSION: We suggest the ESWT could be a useful treatment method on upper limb spasticity in the patients of stroke. Further studies with a larger group of patients are warranted.
Elbow ; Humans ; Muscle Spasticity ; Muscles ; Salicylamides ; Shock ; Stroke ; Upper Extremity ; Wrist

OBJECTIVE: To investigate the correlation between poststroke depression (PSD) and the cognitive impairment in the patients with subacute stroke. METHOD: The subjects were 53 patients with cerebral infarction (n=28) and cerebral hemorrhage (n=25). These patients had a mean age of 64.3. The mean onset time was 2.7 months. The location of stroke was in the right hemisphere in 24 subjects, left hemisphere in 23, and bilateral in 6. The severity of PSD was evaluated by Beck Depression Inventory (BDI), Korean Geriatric Depression Scale (KGDS), and Hamilton Rating Scale for Depression (HRS-D) and the evaluation of cognitive impairments was based on Computerized Neuro-psychological Test (CNT), Mini-Mental State Examination (MMSE). The Pearson correlation was used as a measure of the strength of association between cognitive impairments and PSD. Independent t-tests were calculated to compare differences in cognitive functioning according to hemispheric involvement. RESULTS: PSD was diagnosed in 33 of 53 patients by the BDI, in 28 of 43 patients by the KGDS and in 22 of 45 patients by the HRS-D. Scores in the verbal and visual learning domains of the CNT were significantly correlated with scores on the BDI, KGDS, and HRS-D, but scores on the MMSE were unrelated to any of these measures of depression. CONCLUSION: We suggest the use of the CNT in poststroke depression patients could be a useful tool from the viewpoint of differentiation of PSD patients with or without cognitive impairment and the diagnosis for poststroke depression should be conducted by self rating and objective assessments.
Cerebral Hemorrhage ; Cerebral Infarction ; Depression ; Humans ; Learning ; Stroke

Unilateral vocal cord palsy (UVCP) is frequently observed in patients with stroke. This study aimed to evaluate the association between objective dysphonia severity and the classification of UVCP in patients with stroke by objectively and quantitatively measuring their phonetic function. We recruited patients with UVCP diagnosed using laryngoscopy after stroke.Subgroups were divided according to UVCP type, and the dysphonia severity index (DSI) and maximum phonation time (MPT) were measured to objectively evaluate dysphonia. The DSI and MPT were compared between subgroups using analysis of variance with Tukey’s honest significant difference post hoc test. In total, 103 patients with stroke and UVCP were recruited. We found that a higher UVCP severity possibly had to do with lower DSI and MPT values. We objectively confirmed that phonetic function was worse in patients with stroke with higher UVCP severity, and the DSI and MPT tests can be helpful in determining the severity and need for additional evaluation.

Acute-phase rehabilitation hospitals focus on managing disabilities, reducing sequelae and symptoms, and enhancing social reintegration, to provide patients with the highest possible independence and the best quality of life. In order to achieve these goals, it is necessary to ensure the appropriate length of hospital stays based on a consideration of disease severity and patients' potential for rehabilitation, as well as to provide multidisciplinary rehabilitation. Multidisciplinary rehabilitation has been shown to be effective in the management of complex or severe conditions. Hospitals should include rehabilitation centers (specialized rehabilitation units) for patients with complex or severe needs. Starting in acute settings, specialized rehabilitation wards provide intensive, highly specialized interventions to restore function to patients with complex rehabilitation needs. Financial resources should be allocated to rehabilitation services to implement recommendations for the delivery of medical services In Korea, the appropriate allocation of resources for rehabilitation could increase both the availability and the quality of rehabilitation services by facilitating the establishment of specialized rehabilitation units in acute settings.
Delivery of Health Care ; Humans ; Korea ; Length of Stay ; Quality of Life ; Rehabilitation Centers ; Rehabilitation* ; Resource Allocation

Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.
Cerebral Hemorrhage/*complications ; Cerebral Infarction/complications ; Female ; Humans ; Male ; Middle Aged ; Pain/etiology ; Phantom Limb/*diagnosis/etiology/therapy ; Psychomotor Performance/physiology ; Stroke/complications ; Tomography, X-Ray Computed