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Analysis of Diffuse Axonal Injury Using Diffusion Tensor Imaging in Traumatic Brain Injury Patients.

Hyung Jong CHOI ; Jong Gu KANG ; Seung Ho AHN ; Suk Hoon OHN ; Kwang Ik JUNG ; Woo Kyoung YOO

Brain & Neurorehabilitation.2010;3(2):111-116. doi:10.12786/bn.2010.3.2.111

Disruption of the cytoskeletal network and axonal membranes characterizes diffuse axonal injury (DAI) after traumatic brain injury. Histologic abnormalities seen in DAI hypothetically decrease the diffusion along axons and increase the diffusion in directions perpendicular to them. We tested this hypothesis by measuring the diffusion characteristics of traumatized brain tissue with use of diffusion tensor imaging (DTI). Two patients with traumatic brain injuries and five control subjects were studied with DTI. Mechanisms of change in fractional anisotropy maps of DTI were explored using an eigenvalue analysis of the diffusion tensor. Axial diffusivity (λ1) were decreased and radial diffusivity ((λ2+λ3)/2) were increased in both caudal middle frontal gyri, pars orbitalis gyri, fusiform gyri, parahippocampal gyri (patient 1), caudal middle frontal gyri, precentral gyri, middle temporal gyri (patient 2). Both axial and radial diffusivity were increased in most of the frontal lobe gyri. We applied new analytic methods for DAI in traumatic brain injury.

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Modulation of Motor Cortical Excitability Induced by Combined Visual Attention to Guide Finger Movement.

Kyung Lim JOA ; Jin Hee PARK ; Jae Jun LEE ; Tai Hyun KIM ; Han Young JUNG

Brain & Neurorehabilitation.2010;3(2):106-110. doi:10.12786/bn.2010.3.2.106

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.

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Effect of Botulinum Toxin A for Upper Limb Function in Post Stroke Spastic Hemiplegia.

Chin Wook CHUNG ; Hyun Jung CHANG ; Suk Hoon OHN ; Won Hyuk CHANG ; Peter K.W. LEE ; Yun Hee KIM

Brain & Neurorehabilitation.2010;3(2):99-105. doi:10.12786/bn.2010.3.2.99

OBJECTIVE: Botulinum Toxin A (BoNT-A) is one of the therapeutic methods for the spastic decrement of the upper limb which appears from the patient after stroke. Decrement of stiffness is announced from many studies, but the effect of functional improvement was few examined closely so far clearly. The purpose of this study is to evaluate the effects of BoNT-A for the improvement of upper limb function in post stroke spastic hemiplegia. METHOD: Eleven chronic stroke patients (mean age 44.4 years) were included and injected BoNT-A (Dysport®, Ipsen, UK) according to degree of stiffness of each individual. Motor assessment scale, Box and Block test, Peg board test, Ashworth Scale, manual muscle test, Visual analogue scale, and subject satisfaction were applied at the baseline, and 1 week, 1, 2 and 3 months after interventions. All subjects were also submitted to ongoing rehabilitation therapy. RESULTS: Motor assessment scale results were statistically significant improvements at 1, 2 and 3 months after intervention (p<0.05). Also, statistically significant decreases in muscle tone as determined by the Ashworth scale were found at 1 week, 1, 2 and 3 months after injections (p<0.05). CONCLUSION: Botulinum Toxin A could derive the functional improvements as well as the tone reduction of upper limb in post stroke spastic hemiplegia.

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Effect of Shock Wave Therapy on Upper Limb Spasticity in Chronic Stroke.

Sang Hyun KIM ; Hyun SEOK ; Sunwoo KIM

Brain & Neurorehabilitation.2010;3(2):94-98. doi:10.12786/bn.2010.3.2.94

OBJECTIVE: To investigate the effect and optimal therapeutic frequency of extracorporeal shock wave therapy (ESWT) on upper limb spasticity in chronic stroke patients. METHOD: Total 16 patients with chronic stroke were evaluated. Patients were divided into 2 groups, one group applied with 4 Hz stimulation, and the other group applied with 8 Hz stimulation. All patients were applied with sham stimulation (0 mj/cm2) at the initial time and with active stimulation (0.030 mj/cm2) 4 weeks later. Target muscles were dorsal interossei and flexor digitorum profundus. The primary outcome was the finger flexor spasticity using the modified Ashworth scale (MAS), which was serially measured before, after 1 week and after 4 week respectively. RESULTS: Before the study, the MAS of 4 Hz group was 3.90±0.87 and 8 Hz group was 3.89±0.93, which showed no significant difference. After 1 week of active stimulation, the MAS of 4 Hz group (2.90±0.81) was significantly smaller than the MAS of 8 Hz group (3.33±0.88). Treatment effects had been continued to 4 weeks. There were no complications associated with ESWT. CONCLUSION: ESWT could be used to reduce spasticity of the upper limb muscles in chronic stroke patients.

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The Cost of Brain Disorder: Individual and Social Cost.

Keewon KIM ; Jaho LEIGH ; Byung Mo OH ; Se Hee JUNG ; Kyoung Moo LEE ; Si Woon PARK ; Min Ho CHUN ; Han Young JUNG ; Il Soo KIM ; Se Hyun KIM ; Tai Ryoon HAN

Brain & Neurorehabilitation.2010;3(2):86-93. doi:10.12786/bn.2010.3.2.86

OBJECTIVE: To estimate the cost of brain disorders from individual and social aspects. METHOD: This study employed two complementary methodologies for the estimation: individual survey and collective statistics. The survey recruited 1903 disabled persons, staying at home, registered at public health center as brain disorders. They were asked about epidemiologic, clinical variables, medical cost, employment status and pre-/post-morbid incomes. Collective statistics included mortality data from the national statistical office, report on wage structure report from the ministry of labor and national health insurance statistical yearbook from the national health insurance corporation. Individual cost of brain disorders was estimated by summing direct medical cost and indirect cost from productivity loss (job loss or decreased income). Social cost also comprised direct medical cost and indirect cost; indirect cost corresponded to productivity loss due to healthcare utilization, job loss, decreased income and premature death. RESULTS: Individual cost of brain disorders was 164,041,000 Korean Won (KRW) per patient. 93.3% of the subjects of the survey who were pre-morbidly employed lost their job and the income of those who maintained employment decreased to 51.5% of original income on average. Social cost of brain disorder in 2005 was 9,901,057,327,000 KRW. Major part of social cost was due to job loss. CONCLUSION: Brain disorder imposes substantial amount of economic cost, individually and socially. Especially job loss from disability after brain disorder takes up the largest portion. The results of the study are expected to serve as a foundation for future research and healthcare policy.

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Subtypes of Spatial Neglect and Assessment.

Woo Kyoung YOO

Brain & Neurorehabilitation.2009;2(1):46-50. doi:10.12786/bn.2009.2.1.46

Spatial neglect is a cluster of symptoms characterized by a failure to orient, or react to stimuli located predominantly on the contralesional side. This could be subdivided into personal, peripersonal and extrapersonal neglect in terms of spatial frame of reference. In the perceptual point of view, one can classify into further perceptual and representational neglect. In this review, subtypes of spatial neglect were conceptualized by spatial frame of reference and perception in relationship with their neuroanatomical correlates. Furthermore, its assessment was discussed according to those subtypes.

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Neuroanatomy of Unilateral Neglect Syndrome.

Ju Kang LEE

Brain & Neurorehabilitation.2009;2(1):39-45. doi:10.12786/bn.2009.2.1.39

Unilateral spatial neglect is caused by a failure of attentional orienting mechanism. Over 90% of spatial neglect patients have right hemisphere injury. The most frequent sites of damage are right dorsal and ventral frontal cortex (Brodmann area 6, 8, 44), right inferior parietal and superior temporal cortex (Brodmann area 39, 40, 41) and subcortical nuclei (thalamus (pulvinar), putamen, caudate nucleus). Functional neuroimaging studies showed that spatial neglect is associated with lesions of dorsal fronto-parietal network which is involved in top-down control of selective attention, and right ventral fronto-parieto-temporal network which is specialized for detection of salient or unexpected stimuli. The ventral network works as a 'circuit breaker' for the dorsal system, directing attention to salient stimuli. Structural or functional disruption of both network cause unilateral spatial neglect.

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Clinical Practice Guideline for Stroke Rehabilitation in Korea.

Yun Hee KIM ; Tae Ryun HAN ; Han Young JUNG ; Min Ho CHUN ; Jongmin LEE ; Deog Young KIM ; Nam Jong PAIK ; Si Woon PARK ; Min Wook KIM ; Sung Bom PYUN ; Woo Kyoung YOO ; Young Il SHIN ; Il Soo KIM ; Soo Jeong HAN ; Dae Yul KIM ; Suk Hoon OHN ; Won Hyuk CHANG ; Kyoung Hee LEE ; Soon Uk KWON ; Byoung Woo YOON

Brain & Neurorehabilitation.2009;2(1):1-38. doi:10.12786/bn.2009.2.1.1

The clinical practice guideline for the stroke rehabilitation was formulated through both extensive review of published literature and consensus meeting of the specialists. The purposes of this study were to provide optimum practical guideline for acute and subacute stroke rehabilitation and to enhance the quality of stroke rehabilitation team in Korea. This guideline contains evidences and recommendations on the organization of post-stroke rehabilitation team, timing, evaluation, and intensity of rehabilitation, detailed management of dysphagia, neurogenic bladder and bowel, movement, shoulder problem, cognition, neglect, language, mood and complications commonly encountered in the acute and subacute period of stroke rehabilitation. Clinicians who are working in the field of stroke rehabilitation can adopt this guideline for their practice and give the feedback for further revision.

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Progress of Rehabilitation in Patients with Hypoglycemic Encephalopathy Accompanying Dysphagia and Voiding Difficulty: A Case Report.

Hannae JO ; Hee Won PARK ; Sora BAEK

Brain & Neurorehabilitation.2015;8(2):113-116. doi:10.12786/bn.2015.8.2.113

Dysphagia and voiding difficulty after hypoglycemic encephalopathy (HE) are not well described in the literature. Additionally, the effect of rehabilitation on outcomes of HE has not been discussed enough. Here we report two cases of HE, who underwent comprehensive rehabilitative management. A 76-year-old man with HE had cognitive dysfunction, dysphagia, poor standing balance, and voiding difficulty. After rehabilitation for about 20 days, the patient's swallowing, gait, and voiding function was improved remarkably, and he could eat a tolerable diet, walk independently, and void without catheterization. However, the cognitive function changed a little. A 75-year-old woman with HE had cognitive dysfunction, impaired gait, dysphagia, and voiding difficulty. After rehabilitation for one month, the patient made progress in swallowing and gait. However, the cognitive function changed a little. After rehabilitation, the recovery of swallowing and locomotor function was rapid and satisfactory in two cases, however, the progress of cognitive function was not definite.
Aged ; Catheterization ; Catheters ; Deglutition ; Deglutition Disorders* ; Diet ; Female ; Gait ; Humans ; Rehabilitation*

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Toluene-induced Encephalopathy: A Case Report.

Dae Kwon PARK ; Chang Ho HWANG

Brain & Neurorehabilitation.2015;8(2):109-112. doi:10.12786/bn.2015.8.2.109

Toluene is one of well-known neuro-toxicants. It can readily cross the blood-brain-barrier and mainly affect the central nervous system (CNS). An inhalation is the typical route of its human exposure and show a variety of symptoms involving cerebral and cerebellar dysfunction, bronchial asthma, chemical pneumonitis, toxic hepatitis, renal tubular acidosis, intestinal obstruction, and myelo-dysplastic syndrome. In this case, toluene-inhalated showed numerous CNS and systemic symptoms. Authors performed such gait analysis, gross and fine motor evaluations, computerized neurocognitive test that we noticed the impaired results. After comprehensive rehabilitation for four weeks, patient improved as much as she could carry out the independent life, and finally discharged home. Authors report the case of toluene-induced encephalopathy in Republic of Korea for the first time.
Acidosis, Renal Tubular ; Asthma ; Central Nervous System ; Cerebellar Diseases ; Drug-Induced Liver Injury ; Gait ; Humans ; Inhalation ; Intestinal Obstruction ; Pneumonia ; Rehabilitation ; Republic of Korea ; Toluene

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