A customized vestibular rehabilitation (VRT) is an important treatment modality in patients with vestibular dysfunction with gaze instability, motion-provoked vertigo, disequilibrium and gait disturbance. We discuss in this paper the patient selection criteria for VRT, rehabilitation strategies for vestibular deficits, and the factors that affect the outcome.
Gait ; Humans ; Patient Selection ; Vertigo

OBJECTIVE: To understand the neural generator of double-peak potentials and the change of latency and amplitude of double peaks with aging. METHOD: In 50 healthy subjects made up of groups of 10 people per decade from the age of 20 to 60, orthodromic sensory nerve conduction studies were performed on the median nerves using submaximal stimulation. Various stimulus durations and interstimulation distances were used to obtain each double peak in the different age groups. The latency and amplitude of the second peak were measured. Statistical analyses included one-way ANOVA and correlation tests. p-values<0.05 were considered significant. RESULTS: When the cathode moved in a proximal direction, the interpeak intervals increased. Second peak amplitudes decreased, and second peak latencies were delayed with aging (p<0.05). In some older people, second peaks were not obtained. CONCLUSION: Our experiments indicate that the double-peak response represented the two stimulation sites under the cathode and anode. The delayed latency and decreased amplitude of the second peak that occurs with aging represented peripheral nerve degeneration in aging, which starts at the distal nerve.
Aging ; Electrodes ; Humans ; Median Nerve ; Nerve Degeneration ; Neural Conduction ; Peripheral Nerves

To evaluate the effectiveness of the human umbilical cord blood (HUCB) transplantation for the treatment of intrinsic sphincter deficiency (ISD), we analyzed the short term effects of HUCB mononuclear cell transplantation in rats with induced-ISD. ISD was induced in rats by electro-cauterization of periurethral soft tissue with HUCB mononuclear cell injection after 1 week. The sphincter function measured by mean leak point pressure was significantly improved in the experimental group compared to the control group at 4 weeks. (91.75+/-18.99 mmHg vs. 65.02+/-22.09 mmHg, P=0.001). Histologically, the sphincter muscle was restored without damage while in the control group it appeared markedly disrupted with atrophic muscle layers and collagen deposit. We identified injected HUCB cells in the tissue sections by Di-I signal and Prussian blue staining. HUCB mononuclear cell injection significantly improved urethral sphincter function, suggesting its potential efficacy in the treatment of ISD.
Animals ; Cells, Cultured ; Cord Blood Stem Cell Transplantation/*methods ; Humans ; Leukocytes, Mononuclear/*transplantation ; Rats ; Rats, Sprague-Dawley ; Treatment Outcome ; Urinary Incontinence, Stress/diagnosis/*physiopathology/*surgery ; Urologic Surgical Procedures/*methods

The thalamus, located between the cerebrum and midbrain, is a nuclear complex connected to the cerebral cortex that influences motor skills, cognition, and mood. The thalamus is composed of 50-60 nuclei and can be divided into four areas according to vascular supply. In addition, it can be divided into five areas according to function. Many studies have reported on a thalamic infarction causing motor or sensory changes, but few have reported on behavioral and executive aspects of the ophthalmoplegia of the thalamus. This study reports a rare case of a paramedian thalamus infarction affecting the dorsomedial area of the thalamus, manifesting as oculomotor nerve palsy, an abnormal behavioral change, and executive dysfunction. This special case is presented with a review of the anatomical basis and function of the thalamus.
Cerebral Cortex ; Cerebrum ; Cognition ; Executive Function ; Infarction* ; Mesencephalon ; Motor Skills ; Oculomotor Nerve Diseases ; Ophthalmoplegia ; Thalamus

OBJECTIVE: To evaluate the effect of multiple sensory stimulation on cortical excitability by using transcranial magnetic stimulation (TMS). METHOD: Thirteen right handed young adults without neurological deficit were enrolled. Cortical excitability was tested by measuring recruitment of motor evoked potentials [recruitment curve (RC)], intracortical inhibition (ICI), and intracortical facilitation (ICF) at the abductor pollicis brevis of the dominant hand in two different conditions: (1) group A: active thumb and index finger pinch movement while observing the congruent finger movement in a screen with 0.2 Hz bell sound for 30 minutes, (2) group B: the same active finger movement in a dark screen with the same bell sound for 30 minutes. All of these procedures were done with a randomized crossover design. RESULTS: The amplitude of MEP and the slope of all RC (140%,160% of the resting motor threshold) of group A showed increment after visually-guided finger movement and the level of ICI showed decrement after visually guided finger movement (p<0.05), but there was no change in the level of ICF (p>0.05) in group A. In group B, the amplitude of MEP and the levels of ICI, ICF showed no significant changes following finger movement with no visual guidance (p>0.05), but the slope of RC with 140% showed increment (p<0.05). CONCLUSION: These findings suggest that cortical excitability can be enhanced by simple repetitive motor practice. The congruent sensori-motor stimulations lead to corresponding additional effect on cortical excitability, presumably by recruitment of remote motor neurons.

OBJECTIVE: The objective of present study was to identify the rehabilitation outcome measures currently used in Korea. METHOD: The survey was conducted by e-mail questionnaire to 165 department of rehabilitation medicine in hospitals of Korea. Non-responders were sent a second copy of the questionnaire if they did not answer within 1 week. Data from the returned questionnaires were entered into a Microsoft Excel and subjected to descriptive and simple quantitative analysis. RESULTS: A total of 99 (60%) responses were received. Of these, 95% units collected some outcome assessment measure as part of routine clinical practice. Korean version of Modified Barthel Index (K-MBI) (80%) was the most popular global outcome measures. The Korean version of Berg Balance Scale (K-BBS) (53%) was used most frequently for balance assessment. Upper extremity function was checked with hand grip strength test (70%) and Box and block test (67%) most commonly. Korean version of Mini Mental State Examination (K-MMSE) was the most popular cognitive function test (75%). PARADISE Korean version-Western Aphasia Battery (PARADISE K-WAB) was the most popular language test (67%). Sixty-three (67%) units used outcome results for discussion and goal setting. Seventy-eight (78%) units responded that they would use a standardized outcome measures if there is an agreed standardized outcome measures lists (80%) and support of money and time (43%). CONCLUSION: The survey demonstrated that quite widespread use of outcome assessments in routine clinical rehabilitation within Korea. There is also an agreement for need of common 'basket' of recommended instruments for rehabilitation.
Aphasia ; Coat Protein Complex I ; Electronic Mail ; Hand ; Hand Strength ; Korea ; Language Tests ; Outcome Assessment (Health Care) ; Treatment Outcome ; Upper Extremity ; Surveys and Questionnaires

OBJECTIVE: The objective of present study was to identify the rehabilitation outcome measures currently used in Korea. METHOD: The survey was conducted by e-mail questionnaire to 165 department of rehabilitation medicine in hospitals of Korea. Non-responders were sent a second copy of the questionnaire if they did not answer within 1 week. Data from the returned questionnaires were entered into a Microsoft Excel and subjected to descriptive and simple quantitative analysis. RESULTS: A total of 99 (60%) responses were received. Of these, 95% units collected some outcome assessment measure as part of routine clinical practice. Korean version of Modified Barthel Index (K-MBI) (80%) was the most popular global outcome measures. The Korean version of Berg Balance Scale (K-BBS) (53%) was used most frequently for balance assessment. Upper extremity function was checked with hand grip strength test (70%) and Box and block test (67%) most commonly. Korean version of Mini Mental State Examination (K-MMSE) was the most popular cognitive function test (75%). PARADISE Korean version-Western Aphasia Battery (PARADISE K-WAB) was the most popular language test (67%). Sixty-three (67%) units used outcome results for discussion and goal setting. Seventy-eight (78%) units responded that they would use a standardized outcome measures if there is an agreed standardized outcome measures lists (80%) and support of money and time (43%). CONCLUSION: The survey demonstrated that quite widespread use of outcome assessments in routine clinical rehabilitation within Korea. There is also an agreement for need of common 'basket' of recommended instruments for rehabilitation.
Aphasia ; Coat Protein Complex I ; Electronic Mail ; Hand ; Hand Strength ; Korea ; Language Tests ; Outcome Assessment (Health Care) ; Treatment Outcome ; Upper Extremity ; Surveys and Questionnaires

Dysphagia can cause aspiration pneumonia, a critical condition that increases the risk of morbidity and mortality in immunosuppressed patients. The facial nerve plays an important role in oropharyngeal swallowing. Here, we present a rare case of a leukemia patient with bilateral facial palsy and dysphagia, detected by a videofluoroscopic swallowing study (VFSS), which revealed oropharyngeal phase dysfunction. Severe drooling was observed due to poor lip sealing in the oral phase. The tongue movement was normal, but the patient had difficulty controlling dense food between his teeth and tongue, and under the tongue. In the pharyngeal phase, decreased elevation and closure of the larynx were observed. Penetration and aspiration were observed during liquid tests, however there was no cough. This case highlights the fact that the facial nerve plays an important role in the oropharyngeal phase of swallowing. VFSS should be preferentially considered to rule out aspiration pneumonia in bilateral facial palsy with suspected dysphagia.

Objective: Patients recovering from moderate-to-severe coronavirus disease 2019 (COVID-19) reportedly have dysphagia or difficulty in swallowing. The current study compares the differences in dysphagia characteristics arising from COVID-19 pneumonia and aspiration pneumonia. We further identify factors affecting the severity of dysphagia. Methods: Fifty-four patients diagnosed with COVID-19 pneumonia with dysphagia and 44 patients with aspiration pneumonia were referred for a videofluoroscopic swallowing study (VFSS) since they presented with signs and symptoms of dysphagia. The electronic medical records were reviewed to compare the dysphagia characteristics of the patients. Results: Intensive care unit (ICU) admission, intubation, tracheostomy, and a diagnosis of Acute Respiratory Distress Syndrome (ARDS) after admission were more common in patients with COVID-19 pneumonia (P＜0.001 for other variables and P=0.007 for tracheostomy) than in patients with aspiration pneumonia. Compared to patients with aspiration pneumonia, the COVID-19 patients had a significantly higher total modified videofluoroscopic dysphagia scale (mVDS) score, indicating more severe dysphagia (P=0.038). Among the mVDS sub-scores, tracheal aspiration was significantly higher in the COVID-19 pneumonia group (P＜0.001). In logistic regression analysis, age (P=0.034), COVID-19 (P=0.001), ICU admission (P=0.012), tracheostomy (P=0.029), and ARDS diagnosis after admission (P=0.036) were significantly associated with tracheal aspiration. After adjusting for age, sex, comorbidities, and clinical variables, COVID-19 was still significantly associated with worse tracheal aspiration scores (P=0.042). Conclusion Patients with COVID-19 pneumonia showed more severe dysphagia than subjects with aspiration pneumonia. This is particularly related to tracheal aspiration, as revealed by the VFSS. The dysphagia also correlated with a greater incidence of ICU admission, intubation, tracheostomy, and ARDS diagnosis in the COVID-19 pneumonia group.