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Clinical Practice Guideline for Stroke Rehabilitation in Korea 2012.

Ueon Woo RAH ; Yun Hee KIM ; Suk Hoon OHN ; Min Ho CHUN ; Min Wook KIM ; Woo Kyoung YOO ; Sung Bom PYUN ; Young Hee LEE ; Joo Hyun PARK ; Min Kyun SOHN ; Seong Jae LEE ; Yang Soo LEE ; Jongmin LEE ; Sam Gyu LEE ; Yoon Ghil PARK ; Si Woon PARK ; Ju Kang LEE ; Seong Eun KOH ; Don Kyu KIM ; Myoung Hwan KO ; Yong Wook KIM ; Seung Don YOO ; Eun Joo KIM ; Seong Hoon LIM ; Byung Mo OH ; Ki Deok PARK ; Won Hyuk CHANG ; Hyoung Seop KIM ; Se Hee JUNG ; Myung Jun SHIN

Brain & Neurorehabilitation.2014;7(Suppl 1):S1-S75. doi:10.12786/bn.2014.7.Suppl1.S1

"Clinical Practice Guideline for Stroke Rehabilitation in Korea 2012" is a 2nd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 1st edition published in 2009. After 1st stroke rehabilitation CPG, many studies concerning stroke rehabilitation have been published and the necessity for update has been raised. The Korea Centers for Disease Control and Prevention supported the project "Development of Clinical Practice Guideline for Stroke Rehabilitation" in 2012. Thirty-two specialists in stroke rehabilitation from 18 universities and 3 rehabilitation hospitals and 10 consultants participated in this project. The scope of this CPG included both ischemic and hemorrhagic stroke from the acute to chronic stages. The purpose of this CPG is to provide guidelines for doctors and therapists to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. "Clinical Practice Guideline for Stroke Rehabilitation in Korea 2012" consists of 'Chapter 1; Introduction of Stroke Rehabilitation', 'Chapter 2; Rehabilitation for Stroke Syndrome, 'Chapter 3; Rehabilitation for Return to the Society', and 'Chapter 4; Advanced Technique for Stroke Rehabilitation'. Both the adaptation and de novo development methods were used to develop this 2nd edition of CPG. The appraisal of foreign CPGs was performed using 'Korean appraisal of guidelines for research and evaluation II' (K-AGREE II); moreover, four CPGs from Scotland (2010), Austrailia (2010), USA (2010), Canada (2010) were chosen for adaptation. For de novo development, articles that were published following the latest foreign CPGs were searched from the database system, PubMed, Embase, and Cochrane library. Literatures were assessed in the aspect of subjects, study design, study results' consistency, language and application possibility in the Korean society. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. GPP (Good Practice Point) was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised.
Canada ; Centers for Disease Control and Prevention (U.S.) ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

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Posterior Reversible Encephalopathy Syndrome (PRES) in a Chronic Alcoholic Patient after Having Steam Bath: A Case Report.

Hyoung Seop KIM ; Ja Young CHOI ; Mi Ri SEO

Brain & Neurorehabilitation.2014;7(1):66-70. doi:10.12786/bn.2014.7.1.66

Posterior reversible encephalopathy syndrome (PRES) is a rare disorder that is associated with hypertensive crises. In this article, we present a 59-year-old male patient with posterior reversible encephalopathy syndrome (PRES) caused by an acute hypertensive crisis after entering a steam bath in alcohol intoxicated status. In our case, oxidative stress resulting from alcohol metabolism may have lead to blood brain barrier (BBB) breakdown, serving as an aggravating factor in PRES. Thus we must always consider the possibility of PRES when treating chronic alcoholic patients with abnormal neurologic symptoms.
Alcoholics* ; Blood-Brain Barrier ; Humans ; Hypertension ; Male ; Metabolism ; Middle Aged ; Neurologic Manifestations ; Oxidative Stress ; Posterior Leukoencephalopathy Syndrome* ; Steam Bath* ; Steam*

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Mirror Writing after Thalamic Hemorrhagic Stroke: A Case Report.

Jin Kyu YANG ; Jong Bum PARK ; So Young JOO ; Deog Young KIM

Brain & Neurorehabilitation.2014;7(1):61-65. doi:10.12786/bn.2014.7.1.61

Mirror-writing is the process of reversing individual letter and composing word sequence in opposite direction. Unintentional mirror writing has been observed in young children learning to write and interpreted as the manifestation of different cognitive impairments. It is very rare that normal right-handed adult shows mirror writing. However, the acquired "mirror writing" may be shown in left hemispheric stroke, neurodegenerative disease, and diffuse cerebral disorders. To explain this event, some assumption have been indicated such as the motor, the visual dominance, the supplementary motor area, the visio-spatial, the visual word-form, the hemispatial factor or directional and the reflected graphemic representation hypotheses. It is reported that the lesions which causes the "Mirror-writing" are the parietal lobe, basal ganglia, thalamus and right supplementary motor area, etc. We reported a case of "mirror-writing" with left thalamic hemorrhagic stroke.
Adult ; Basal Ganglia ; Child ; Functional Laterality* ; Humans ; Learning ; Neurodegenerative Diseases ; Parietal Lobe ; Stroke* ; Thalamus

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Association between Location of Brain Lesion and Clinical Factors and Findings of Videofluoroscopic Swallowing Study in Subacute Stroke Patients.

Woo Hyun JEON ; Gun Woong PARK ; Jae Hyun LEE ; Ho Joong JEONG ; Young Joo SIM

Brain & Neurorehabilitation.2014;7(1):54-60. doi:10.12786/bn.2014.7.1.54

OBJECTIVE: To investigate whether patterns of dysphagia were associated with the location of the brain lesion and clinical factors in subacute stroke patients. METHOD: One hundred and seventy-eight first-ever subacute stroke patients who underwent videofluoroscopic swallowing study (VFSS) from January 2006 to April 2012 were enrolled in the present study. Swallowing-related parameters were assessed by VFSS. The location of brain lesions were classified into the cortical, subcortical, and brain stem. The degree of cognitive impairment and the independency of activities of daily living were assessed by the Korean version of mini-mental status examination and Korean version of modified Barthel index (K-MBI). Aphasia and hemineglect were assessed by Korean version of Western aphasia battery and line bisection test. These data were collected via retrospective chart review. RESULTS: A reduced laryngeal elevation and prolonged pharyngeal delay time were associated with brain stem lesion. Other swallowing parameters were not associated with lesion topology. Pyriform sinus residue was associated with the presence of aphasia and low K-MBI scores. Prolonged pharyngeal delay time was associated with the patient's age, type of stroke and brain stem lesion. CONCLUSION: Pyriform sinus residue was associated with clinical factors such as aphasia and K-MBI scores rather than with the location of brain lesion. However, reduced laryngeal elevation and prolonged pharyngeal delay time were predominant in brain stem lesions.
Activities of Daily Living ; Aphasia ; Brain Stem ; Brain* ; Deglutition Disorders ; Deglutition* ; Humans ; Pyriform Sinus ; Retrospective Studies ; Stroke*

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Functional Outcomes of Patients with Severe MCA Infarction after Decompressive Craniectomy.

Kyeong Woo LEE ; Sang Beom KIM ; Jong Hwa LEE ; Min Ah KIM ; Jae Won RI ; Jin Gee PARK

Brain & Neurorehabilitation.2014;7(1):48-53. doi:10.12786/bn.2014.7.1.48

OBJECTIVE: To compare the functional outcomes between surgical treatment and conservative medical treatment for severe middle cerebral artery (MCA) infarction. METHOD: This is comparative analysis of prospectively documented data with 25 patients have malignant MCA infarction. Ten patients in Group A (male 7, female 3) received surgical treatment such as decompressive craniectomy, and fifteen patients in Group B (male 10, female 5) received conservative medical treatment. We defined MCA infarction as "severe" when it concerned both the deep and superficial areas of the MCA or when the Functional Independence Measure (FIM) was lower to 75 on admission to our department. Functional status was measured using modified Rankin Scale (mRS), FIM, Motricity Index (MI) and Trunk Control Test (TCT). All evaluations were measured at baseline and 90 days after stroke. RESULTS: Mean age were 55.0 +/- 8.6 and 58.7 +/- 12.3 in Group A and B. Rt. MCA infarction were 4 in Group A and 5 in Group B. Lt. MCA infarction were 5 in Group A and 10 in Group B. Baseline functional status between two groups was not significantly different. Each group showed functional improvement according to the time. When compared changes between two groups, arm Motricity Index, K-MMSE, mRS and FIM were no significant difference between two groups. Leg segments of MI and TCT was significantly improved in Group A more than B at 90 days after baseline evaluation (p<0.05). CONCLUSION: Decompressive craniectomy improved motor function of affected leg and trunk in patients with severe MCA infarction more than conservative medical treatment alone.
Arm ; Decompressive Craniectomy* ; Female ; Humans ; Infarction ; Infarction, Middle Cerebral Artery* ; Leg ; Middle Cerebral Artery ; Prospective Studies ; Stroke

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Effects of Robot-assisted Upper Limb Training on Hemiplegic Patients.

Han Gil SEO ; Jaewon BEOM ; Byung Mo OH ; Tai Ryoon HAN

Brain & Neurorehabilitation.2014;7(1):39-47. doi:10.12786/bn.2014.7.1.39

OBJECTIVE: To investigate the effects of short-term robot-assisted upper limb training on hemiplegic patients compared to conventional physical therapy. METHOD: This study was a prospective, single-blinded, randomized controlled trial. Eighteen hemiplegic patients due to brain lesions were randomly assigned to: (1) robot-assisted upper limb training and conventional upper limb physical therapy for 30 min a day, respectively (Robot group); or (2) conventional upper limb physical therapy for 30 min twice a day (Conventional group). All interventions were provided for 2 weeks, 5 times a week. Each patient was evaluated at pre- and post-treatment by the Fugl-Meyer assessment-upper extremity (FMA-UE), Jebsen hand function test (JHFT), grip power, modified Barthel index-upper extremity (MBI-UE), line bisection test, and Albert test. RESULTS: The Robot group showed significant improvement in FMA-UE (pre: 13.22 +/- 14.20, post: 21.67 +/- 15.84; p = 0.018), MBI-UE (pre: 14.33 +/- 7.42, post: 16.56 +/- 6.95; p = 0.041), and line bisection test (pre: 25.15 +/- 34.48, post: 14.93 +/- 28.38; p = 0.043). The Conventional group showed significant improvement only in MBI-UE (pre: 9.22 +/- 6.06, post: 15.56 +/- 6.19; p = 0.008). The improvement in MBI-UE was larger in the Conventional group than Robot group (6.33 +/- 3.28 vs. 2.22 +/- 2.49; p = 0.014). CONCLUSION: This study suggests that short-term robot-assisted upper limb training may improve upper limb function in hemiplegic patients. However, proper physical therapy may be needed to transfer improved upper limb function to activity of daily living. In addition, goal-directed reaching tasks using a robot are expected to be a treatment option for hemineglect.
Brain ; Extremities ; Hand ; Hand Strength ; Hemiplegia ; Humans ; Perceptual Disorders ; Prospective Studies ; Rehabilitation ; Robotics ; Upper Extremity*

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Upper Extremity Rehabilitation using Virtual Reality after Stroke.

Jeonghun KU ; Hyungjun IM ; Youn Joo KANG

Brain & Neurorehabilitation.2014;7(1):30-38. doi:10.12786/bn.2014.7.1.30

There is limited evidence regarding the use of virtual reality (VR) and interactive video gaming for improving arm function because there are few such commercial devices and little relevant research. However, evidence of the greater effectiveness of upper extremity VR training over that of conventional therapy after stroke has recently grown due to the adoption of various therapeutic devices. VR applications are novel and potent technologies for upper extremity rehabilitation after stroke because the interface technologies, augmented reality technologies, and various sensorimotor feedback techniques are rapidly advancing. Going forward, VR technology should be designed to provide the possibility of intense functional repetitive practice for patients. The combination of VR with robotic devices, neuromodulation, mirror therapy, and telerehabilitation may synergistically improve upper extremity function after stroke. In severely injured patients, robotic interfaces should be considered, the level of difficulty should be fitted appropriately to the severity of the deficits, and the fact that it is difficult to train patients repeatedly and effectively in a real-world environment should be considered. Further research should be conducted on the application of VR programs in larger populations, VR involving various training paradigms, VR at different exercise levels, and the long-term sustained effects of VR. In addition, synergistically enhanced effects of combining other treatments and feedback paradigms with well-designed interfaces should be investigated.
Arm ; Feedback, Sensory ; Humans ; Rehabilitation* ; Stroke* ; Upper Extremity*

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Optimal Strategies of Upper Limb Motor Rehabilitation after Stroke.

Myung Jun SHIN ; Sang Hun KIM ; Chang Hyung LEE ; Yong Il SHIN

Brain & Neurorehabilitation.2014;7(1):21-29. doi:10.12786/bn.2014.7.1.21

The purpose of this review is to provide a comprehensive approach for optimal strategies of upper limb motor rehabilitation after stroke. Stroke is a common, serious, and disabling global health-care problem. Optimal organization of rehabilitation for stroke patients has been extensively documented. However, between 30% and 66% of individuals with stroke do not obtain satisfactory motor recovery of the affected upper limb with rehabilitative interventions. The recovery of the affected upper extremity depends on intensity, task progression, and repetition to neural plasticity, namely, the ability of central nervous system cells to modify their structure and function in response to external stimuli. Recently, constraint-induced movement therapy, motor imagery, action observation, or mirror therapy has emerged as interesting options as add-on interventions to standard physical therapies. In this review, we will discuss to establish a framework by which several promising interventions for neural plasticity.
Central Nervous System ; Humans ; Neuronal Plasticity ; Plastics ; Rehabilitation* ; Stroke* ; Upper Extremity*

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NeuroRehabilitation after Hypoxic-ischemic Encephalopathy.

Ja Ho LEIGH ; Byung Mo OH

Brain & Neurorehabilitation.2014;7(1):16-20. doi:10.12786/bn.2014.7.1.16

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 ; Hippocampus ; Humans ; Hypoxia-Ischemia, Brain* ; Memory Disorders ; Mild Cognitive Impairment ; Persistent Vegetative State ; Rehabilitation ; Survivors ; Temporal Lobe

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Common Complications after Hypoxic-ischemic Encephalopathy.

Seong Hoon LIM

Brain & Neurorehabilitation.2014;7(1):10-15. doi:10.12786/bn.2014.7.1.10

Hypoxic-ischemic encephalopathy (HIE) is one of the major disease for neuro-rehabilitation, as well as one of the important impairment. HIE typically shows global deterioration of brain function with relative preservation of brain stem reflexes, and topographic pattern of damage; the CA1 hippocampal cells, cerebellar Purkinje cells, neocortical neurons in layers 3, 5, 6 and basal ganglia. The characteristics of patho-mechanism including persistent vegetative state, seizure, autonomic dysfunction and secondary Parkinsonism are causative factors of several complications. Management of these complications sometimes curative, but more often re-adaptive and palliative. Understanding and proper rehabilitation of complications will be one of the most important therapeutic strategies for patients with HIE.
Basal Ganglia ; Brain ; Brain Stem ; Humans ; Hypoxia-Ischemia, Brain* ; Neurons ; Parkinson Disease, Secondary ; Persistent Vegetative State ; Purkinje Cells ; Reflex ; Rehabilitation ; Seizures

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