Annals of Rehabilitation Medicine.2017;41(5):899-901. doi:10.5535/arm.2017.41.5.899
Annals of Rehabilitation Medicine
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Annals of Rehabilitation Medicine.2017;41(5):776-785. doi:10.5535/arm.2017.41.5.776
OBJECTIVE: To compare swallowing function between healthy subjects and patients with pharyngeal dysphagia using high resolution manometry (HRM) and to evaluate the usefulness of HRM for detecting pharyngeal dysphagia. METHODS: Seventy-five patients with dysphagia and 28 healthy subjects were included in this study. Diagnosis of dysphagia was confirmed by a videofluoroscopy. HRM was performed to measure pressure and timing information at the velopharynx (VP), tongue base (TB), and upper esophageal sphincter (UES). HRM parameters were compared between dysphagia and healthy groups. Optimal threshold values of significant HRM parameters for dysphagia were determined. RESULTS: VP maximal pressure, TB maximal pressure, UES relaxation duration, and UES resting pressure were lower in the dysphagia group than those in healthy group. UES minimal pressure was higher in dysphagia group than in the healthy group. Receiver operating characteristic (ROC) analyses were conducted to validate optimal threshold values for significant HRM parameters to identify patients with pharyngeal dysphagia. With maximal VP pressure at a threshold value of 144.0 mmHg, dysphagia was identified with 96.4% sensitivity and 74.7% specificity. With maximal TB pressure at a threshold value of 158.0 mmHg, dysphagia was identified with 96.4% sensitivity and 77.3% specificity. At a threshold value of 2.0 mmHg for UES minimal pressure, dysphagia was diagnosed at 74.7% sensitivity and 60.7% specificity. Lastly, UES relaxation duration of <0.58 seconds had 85.7% sensitivity and 65.3% specificity, and UES resting pressure of <75.0 mmHg had 89.3% sensitivity and 90.7% specificity for identifying dysphagia. CONCLUSION: We present evidence that HRM could be a useful evaluation tool for detecting pharyngeal dysphagia.
Deglutition Disorders* ; Deglutition* ; Diagnosis ; Esophageal Sphincter, Upper ; Healthy Volunteers* ; Humans ; Manometry* ; Pharynx ; Relaxation ; ROC Curve ; Sensitivity and Specificity ; Tongue
Deglutition Disorders* ; Deglutition* ; Diagnosis ; Esophageal Sphincter, Upper ; Healthy Volunteers* ; Humans ; Manometry* ; Pharynx ; Relaxation ; ROC Curve ; Sensitivity and Specificity ; Tongue
Clinical Predictors of Oro-esophageal Tube Feeding Success in Brain Injury Patients With Dysphagia.
Annals of Rehabilitation Medicine.2017;41(5):769-775. doi:10.5535/arm.2017.41.5.769
OBJECTIVE: To identify possible clinical predictors of intermittent oro-esophageal (OE) tube feeding success, and evaluate the clinical factors associated with OE tube treatment. METHODS: A total of 135 dysphagic patients were reviewed, who received OE tube treatment and were hospitalized in the department of rehabilitation medicine between January 2005 and December 2014. The 76 eligible cases enrolled were divided into two groups, based on the OE tube training success. Clinical factors assessed included age, cause of brain lesion, gag reflex, cognitive function and reasons for OE tube training failure. RESULTS: Of the 76 cases enrolled, 56 study patients were assigned to the success group, with the remaining 20 in the failure group. There were significant differences between these two groups in terms of age, gag reflex, ability to follow commands, and the score of Korean version of Mini-Mental Status Examination (K-MMSE). Location of the brain lesion showed a borderline significance. Multivariable analysis using logistic regression revealed that age, cause of brain lesion, gag reflex, and K-MMSE were the main predictors of OE tube training success. CONCLUSION: A younger age, impaired gag reflex and higher cognitive function (specifically a K-MMSE score ≥19.5) are associated with an increased probability of OE tube training success in dysphagic patients.
Brain Injuries* ; Brain* ; Cognition ; Deglutition Disorders* ; Enteral Nutrition* ; Humans ; Logistic Models ; Multivariate Analysis ; Reflex ; Rehabilitation
Brain Injuries* ; Brain* ; Cognition ; Deglutition Disorders* ; Enteral Nutrition* ; Humans ; Logistic Models ; Multivariate Analysis ; Reflex ; Rehabilitation
Life Space Assessment in Stroke Patients.
Annals of Rehabilitation Medicine.2017;41(5):761-768. doi:10.5535/arm.2017.41.5.761
OBJECTIVE: To evaluate the reliability of the practical life space in post-stroke patients using the Korean version of the Life-Space Assessment (K-LSA) questionnaire and to assess the relationships between the K-LSA and physical function, daily activity, quality of life, and post-stroke depression. METHODS: The LSA questionnaire was translated into Korean, and the translated version was authorized by the author of the LSA questionnaire. In a cross-sectional study, the performance of the K-LSA was evaluated in 34 stroke patients (20 males and 14 females; mean age 65.11±2.39 years) who were receiving physical and occupational therapy at the outpatient clinic in the rehabilitation medicine department of a university medical center at the time of evaluation. Performances were assessed twice by one examiner at a 2-week interval to test the reliability. The patients were evaluated using the Functional Ambulation Category (FAC) scale, Functional Independence Measure (FIM) scale, and mobility subscale of the FIM to assess their relationships with the K-LSA. They were also evaluated using the EuroQol 5 Dimensions questionnaire (EQ-5D) and Geriatric Depression Scale (GDS) to determine the relationship with quality of life and post-stroke depression. RESULTS: Test-retest reliability at the first (62.20±32.14) and second (63.15±32.22) assessment was 0.993 (p<0.01). The K-LSA showed significant correlations with the FAC (r=0.848, p<0.01), FIM (r=0.765, p<0.01), mobility category of the FIM (r=0.764, p<0.01), GDS (r=-0.657, p<0.01), and EQ-5D (r=0.506, p<0.01). CONCLUSION: This study suggests that the practical life space of post-stroke patients, assessed by the K-LSA, has a significant correlation with patients' functional mobility, independence in daily activity, quality of life, and depression.
Academic Medical Centers ; Ambulatory Care Facilities ; Cross-Sectional Studies ; Depression ; Female ; Humans ; Male ; Occupational Therapy ; Quality of Life ; Rehabilitation ; Reproducibility of Results ; Stroke* ; Walking
Academic Medical Centers ; Ambulatory Care Facilities ; Cross-Sectional Studies ; Depression ; Female ; Humans ; Male ; Occupational Therapy ; Quality of Life ; Rehabilitation ; Reproducibility of Results ; Stroke* ; Walking
Risk Factors and Functional Impact of Medical Complications in Stroke.
Annals of Rehabilitation Medicine.2017;41(5):753-760. doi:10.5535/arm.2017.41.5.753
OBJECTIVE: To determine the incidence and risk factors for medical complications in Korean patients suffering from stroke and the impact of such complications on post-stroke functional outcomes. METHODS: We assessed patients enrolled in a prospective cohort study. All recruited patients had suffered a first acute stroke episode and been admitted to nine university hospitals in Korea between August 2012 and June 2015. We analyzed patient and stroke characteristics, comorbidities, prevalence of post-stroke medical complications, and functional outcomes at time of discharge and 3, 6, and 12 months after stroke onset. RESULTS: Of 10,625 patients with acute stroke, 2,210 (20.8%) presented with medical complications including bladder dysfunction, bowel dysfunction, sleep disturbance, pneumonia, and urinary tract infection. In particular, complications occurred more frequently in older patients and in patients with hemorrhagic strokes, more co-morbidities, severe initial motor impairment, or poor swallowing function. In-hospital medical complications were significantly correlated with poor functional outcomes at all time points. CONCLUSION: Post-stroke medical complications affect functional recovery. The majority of complications are preventable and treatable; therefore, the functional outcomes of patients with stroke can be improved by providing timely, appropriate care. Special care should be provided to elderly patients with comorbid risk factors.
Aged ; Cohort Studies ; Comorbidity ; Deglutition ; Hospitals, University ; Humans ; Incidence ; Korea ; Pneumonia ; Prevalence ; Prospective Studies ; Rehabilitation ; Risk Factors* ; Stroke* ; Urinary Bladder ; Urinary Tract Infections
Aged ; Cohort Studies ; Comorbidity ; Deglutition ; Hospitals, University ; Humans ; Incidence ; Korea ; Pneumonia ; Prevalence ; Prospective Studies ; Rehabilitation ; Risk Factors* ; Stroke* ; Urinary Bladder ; Urinary Tract Infections
The Factors Associated With Health-Related Quality of Life in Stroke Survivors Age 40 and Older.
Annals of Rehabilitation Medicine.2017;41(5):743-752. doi:10.5535/arm.2017.41.5.743
OBJECTIVE: To evaluate the association between clinical and socio-demographic status and health-related quality of life (HR-QoL) in stroke survivors age 40 and older in the Korean population. METHODS: The relationship between stroke and HR-QoL was investigated using data from the Korea National Health and Nutrition Examination Survey (KNHANES), conducted from 2007–2012. The total number of respondents was 24,050 and 757 stroke survivors were included. Specifically, we investigated factors associated with the lowering of HR-QoL in a group of Korean adult stroke patients age 40 and older after adjusting for socio-demographic factors, anthropometric measurements, and clinical comorbidities. Adjusted effects of covariates on EuroQol-visual analog scales (EQ-VAS) scores were estimated with a complex-samples general linear model and multivariate-adjusted odds ratios of the lowest quintile versus highest quintile of the EQ-VAS scores in the stroke group were estimated with a complex-samples logistic regression model. RESULTS: Socio-demographic, anthropometric factors, and clinical comorbidities significantly differed between the stroke and non-stroke groups, except regarding gender and residential area. The EQ-VAS was significantly lower in the stroke than non-stroke group. Anxiety/depression problems significantly lowered EQ-VAS, as did low education level, smoking, mobility and usual activities problems. Also, aging in 1-year increments and cardiovascular disease had a significant effect on lower EQ-VAS in stroke survivors. CONCLUSION: People with a stroke have significantly lower HR-QoL than healthy subjects. Therefore, managing depression, smoking, or cardiovascular disease and maintenance of physical function may be priority goals in improving HR-QoL after a stroke.
Adult ; Aging ; Cardiovascular Diseases ; Comorbidity ; Depression ; Education ; Healthy Volunteers ; Humans ; Korea ; Linear Models ; Logistic Models ; Nutrition Surveys ; Odds Ratio ; Quality of Life* ; Smoke ; Smoking ; Stroke* ; Surveys and Questionnaires ; Survivors* ; Visual Analog Scale ; Weights and Measures
Adult ; Aging ; Cardiovascular Diseases ; Comorbidity ; Depression ; Education ; Healthy Volunteers ; Humans ; Korea ; Linear Models ; Logistic Models ; Nutrition Surveys ; Odds Ratio ; Quality of Life* ; Smoke ; Smoking ; Stroke* ; Surveys and Questionnaires ; Survivors* ; Visual Analog Scale ; Weights and Measures
Annals of Rehabilitation Medicine.2017;41(5):734-742. doi:10.5535/arm.2017.41.5.734
OBJECTIVE: To determine the frequency and characteristics of vascular cognitive impairment (VCI) in patients with subacute stroke who underwent inpatient rehabilitation and to analyze whether cognitive function can predict functional assessments after rehabilitation. METHODS: We retrospectively reviewed the medical records of patients who were admitted to our rehabilitation center after experiencing a stroke between October 2014 and September 2015. We analyzed the data from 104 patients who completed neuropsychological assessments within 3 months after onset of a stroke. RESULTS: Cognitive impairment was present in 86 out of 104 patients (82.6%). The most common impairment was in visuospatial function (65, 62.5%) followed by executive function (63, 60.5%), memory (62, 59.6%), and language function (34, 32.6%). Patients with impairment in the visuospatial and executive domains had poor scores of functional assessments at both admission and discharge (p<0.05). A multivariate analysis revealed that age (β=−0.173) and the scores on the modified Rankin Scale (β=−0.178), Korean version of the Modified Barthel Index (K-MBI) (β=0.489) at admission, and Trail-Making Test A (TMT-A) (β=0.228) were related to the final K-MBI score at discharge (adjusted R²=0.646). CONCLUSION: In our study, VCI was highly prevalent in patients with stroke. TMT-A scores were highly predictive of their final K-MBI score. Collectively, our results suggest that post-stroke executive dysfunction is a significant and independent predictor of functional outcome.
Cognition ; Cognition Disorders* ; Executive Function ; Humans ; Inpatients* ; Medical Records ; Memory ; Multivariate Analysis ; Neurobehavioral Manifestations ; Rehabilitation Centers ; Rehabilitation* ; Retrospective Studies ; Stroke*
Cognition ; Cognition Disorders* ; Executive Function ; Humans ; Inpatients* ; Medical Records ; Memory ; Multivariate Analysis ; Neurobehavioral Manifestations ; Rehabilitation Centers ; Rehabilitation* ; Retrospective Studies ; Stroke*
Subcortical Aphasia After Stroke.
Annals of Rehabilitation Medicine.2017;41(5):725-733. doi:10.5535/arm.2017.41.5.725
OBJECTIVE: To evaluate the types and severity of subcortical aphasia after stroke and to determine the predictors of the degree of aphasic impairment. METHODS: Medical records of 38 patients with post-stroke subcortical aphasia (19 males; mean age, 61.7±13.8 years) were reviewed retrospectively with respect to the following tests: the Korean version of the Western Aphasia Battery (K-WAB), the Korean version of the Modified Barthel Index (K-MBI), and the Fugl-Meyer Index (FMI). The severity of aphasia was evaluated by the aphasia quotient (AQ) and the language quotient (LQ). RESULTS: Anomic aphasia was the most frequent type of aphasia (n=15, 39.5%), and the lesion most frequently observed in subcortical aphasia was located in the basal ganglia (n=19, 50.0%). Patients with lesions in the basal ganglia exhibited the lowest scores on the FMI for the upper extremities (p=0.04). Severity of aphasia was significantly correlated with the K-MBI (Pearson correlation coefficient: γ=0.45, p=0.01 for AQ and γ=0.53, p=0.01 for LQ) and FMI scores for the lower extremities (γ=0.43, p=0.03 for AQ and γ=0.49, p=0.05 for LQ). In a multivariate logistic regression analysis, K-MBI remained the only explanatory variable closely associated with aphasia severity. CONCLUSION: This study showed the general characteristics of post-stroke subcortical aphasia, and it revealed that K-MBI was an associated and explanatory factor for aphasia severity.
Anomia ; Aphasia* ; Basal Ganglia ; Cerebrovascular Disorders ; Humans ; Language Tests ; Logistic Models ; Lower Extremity ; Male ; Medical Records ; Retrospective Studies ; Stroke* ; Upper Extremity
Anomia ; Aphasia* ; Basal Ganglia ; Cerebrovascular Disorders ; Humans ; Language Tests ; Logistic Models ; Lower Extremity ; Male ; Medical Records ; Retrospective Studies ; Stroke* ; Upper Extremity
Flaccid Leg Paralysis Caused by a Thoracic Epidural Catheterization: A Case Report.
Annals of Rehabilitation Medicine.2013;37(3):453-458. doi:10.5535/arm.2013.37.3.453
We report a case of a 44-year-old patient with paralysis of the left leg who had a thoracic epidural catheterization after general anesthesia for abdominal surgery. Sensory losses below T10 and motor weakness of the left leg occurred after the surgery. Magnetic resonance image study demonstrated a well-defined intramedullary linear high signal intensity lesion on T2-weighted image and low-signal intensity on T1-weighted image in the spinal cord between T9 and L1 vertebral level, and enhancements of the spinal cord below T8 vertebra and in the cauda equina. Electrodiagnostic examination revealed lumbosacral polyradiculopathy affecting nerve roots below L4 level on left side. We suggest that the intrinsic spinal cord lesion and nerve root lesion can be caused by an epidural catheterization with subsequent local anesthetic injection.
Analgesia, Epidural ; Anesthesia, General ; Catheterization ; Catheters ; Cauda Equina ; Humans ; Leg ; Magnetic Resonance Spectroscopy ; Paralysis ; Polyradiculopathy ; Spinal Cord ; Spinal Cord Injuries ; Spine
Analgesia, Epidural ; Anesthesia, General ; Catheterization ; Catheters ; Cauda Equina ; Humans ; Leg ; Magnetic Resonance Spectroscopy ; Paralysis ; Polyradiculopathy ; Spinal Cord ; Spinal Cord Injuries ; Spine
Vernet Syndrome by Varicella-Zoster Virus.
Annals of Rehabilitation Medicine.2013;37(3):449-452. doi:10.5535/arm.2013.37.3.449
Vernet syndrome involves the IX, X, and XI cranial nerves and is most often attributable to malignancy, aneurysm or skull base fracture. Although there have been several reports on Vernet's syndrome caused by fracture and inflammation, cases related to varicella-zoster virus are rare and have not yet been reported in South Korea. A 32-year-old man, who complained of left ear pain, hoarse voice and swallowing difficulty for 5 days, presented at the emergency room. He showed vesicular skin lesions on the left auricle. On neurologic examination, his uvula was deviated to the right side, and weakness was detected in his left shoulder. Left vocal cord palsy was noted on laryngoscopy. Antibody levels to varicella-zoster virus were elevated in the serum. Electrodiagnostic studies showed findings compatible with left spinal accessory neuropathy. Based on these findings, he was diagnosed with Vernet syndrome, involving left cranial nerves, attributable to varicella-zoster virus.
Aneurysm ; Cranial Nerves ; Deglutition ; Ear ; Emergencies ; Herpesvirus 3, Human ; Inflammation ; Laryngoscopy ; Neurologic Examination ; Republic of Korea ; Shoulder ; Skin ; Skull Base ; Uvula ; Vocal Cord Paralysis ; Voice
Aneurysm ; Cranial Nerves ; Deglutition ; Ear ; Emergencies ; Herpesvirus 3, Human ; Inflammation ; Laryngoscopy ; Neurologic Examination ; Republic of Korea ; Shoulder ; Skin ; Skull Base ; Uvula ; Vocal Cord Paralysis ; Voice
Country
Republic of Korea
Publisher
Korean Academy of Rehabilitation Medicine
ElectronicLinks
http://www.e-arm.org/Editor-in-chief
Moon Suk Bang
edit@e-arm.org
Abbreviation
Ann Rehabil Med
Vernacular Journal Title
ISSN
2234-0645
EISSN
2234-0653
Year Approved
2007
Current Indexing Status
Currently Indexed
Start Year
Description
Annals of Rehabilitation Medicine aims to share up-to-date knowledge dedicated to the advancement of care and to enhance the function and quality of life of persons with various disabilities and chronic illnesses. Its scope includes all aspects of physical medicine and rehabilitation including clinical practice, experimental and applied research, and education. Research areas covered by this journal include rehabilitation of brain disorders, rehabilitation of spinal cord injury, electro-diagnosis, pain, pediatric rehabilitation, geriatric rehabilitation, cardiopulmonary rehabilitation, sports and musculoskeletal rehabilitation, cancer rehabilitation, cognitive rehabilitation, robotic rehabilitation, neuro-modulation, neuroimaging, orthotics & prosthetics, physical modalities, clinical trials, quality of life issues, and basic researches and other emerging fields in rehabilitation medicine.
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