OBJECTIVE: Dysphagia is a major complication of stroke and causes serious problems, such as lung aspiration. Previous reviews of dysphagia treatments for stroke were limited due to a dearth of available studies. More trials have been published recently warranting a re-examination of the evidence. The purpose of this systematic review was to examine the effectiveness of interventions for dysphagia in adults following stroke. METHODS: The PRISMA Statement with a 27-item checklist was used as a general guide to conduct and report a quality systematic review. Five electronic databases were searched for randomized controlled trials published in English between 2008 and 2017 examining the effectiveness of dysphagia interventions following stroke. The search terms were entered by combining the keywords related to dysphagia, stroke, interventions, and randomized controlled trials. RESULTS: Fifteen articles were included; the most commonly used interventions were Transcranial Magnetic Stimulation (4 articles), Neuromuscular Electrical Stimulation (4 articles), and Pharyngeal electrical stimulation (4 articles). CONCLUSION: This review provides evidence of the effectiveness of interventions for people with dysphagia following stroke, but there were some mixed results. The heterogeneity of the outcome measures as well as the mixed results highlight the need for further research.
Adult ; Checklist ; Deglutition Disorders* ; Electric Stimulation ; Humans ; Lung ; Outcome Assessment (Health Care) ; Population Characteristics ; Stroke* ; Transcranial Magnetic Stimulation

The purpose of this study was to investigate the feasibility and therapeutic effects of a novel concept hand rehabilitation device based on magnetics for subacute stroke patients with hand motor impairment. We developed an end effector type device that can induce various movements of the fingers in accordance with a magnetic field direction using electromagnets and permanent magnets. Subacute stroke patients with hand motor impairments were recruited and divided into two rehabilitation groups. Conventional rehabilitation therapies were also conducted equally in both groups. Active-assisted training of the affected hand was additionally administered for 30 minutes per day for 4 weeks using the developed equipment in the intervention group. Hand motor function and the activities of daily living were evaluated before and after the intervention. The Manual Function Test score significantly increased in the intervention group after 4 weeks of treatment (p = 0.039), and there was a significant difference in the degree of improvement between the two groups (p = 0.016). The scores of the motor Fugl-Meyer Assessment of the upper limb, the Wolf Motor Function Test score and time, and the motor Functional Independence Measure also improved in both groups (all p < 0.05). In addition, the patients in the intervention group showed greater improvements in these outcome measures than those in the control group did (all p < 0.05). An adjuvant rehabilitation therapy using a magnetic based device can be helpful to improve the hand motor function and activities of daily life in subacute stroke patients.
Activities of Daily Living ; Fingers ; Hand ; Humans ; Magnetic Fields ; Magnets ; Outcome Assessment (Health Care) ; Pilot Projects ; Rehabilitation ; Robotics ; Stroke ; Therapeutic Uses ; Upper Extremity ; Wolves

BACKGROUND AND PURPOSE: Cerebral small vessel disease (CSVD) is the most common cause of vascular dementia and a major contributor to mixed dementia. CSVD is characterized by progressive cerebral white matter changes (WMC) due to chronic low perfusion and loss of autoregulation. In addition to its antiplatelet effect, cilostazol exerts a vasodilating effect and improves endothelial function. This study aims to compare the effects of cilostazol and aspirin on changes in WMC volume in CSVD.METHODS: The comparison study of Cilostazol and aspirin on cHAnges in volume of cerebral smaLL vEssel disease white matter chaNGEs (CHALLENGE) is a double blind, randomized trial involving 19 hospitals across South Korea. Patients with moderate or severe WMC and ≥ 1 lacunar infarction detected on brain magnetic resonance imaging (MRI) are eligible; the projected sample size is 254. Participants are randomly assigned to a cilostazol or aspirin group at a 1:1 ratio. Cilostazol slow release 200 mg or aspirin 100 mg are taken once daily for 2 years. The primary outcome measure is the change in WMC volume on MRI from baseline to 104 weeks. Secondary imaging outcomes include changes in the number of lacunes and cerebral microbleeds, fractional anisotropy and mean diffusivity on diffusion tensor imaging, and brain atrophy. Secondary clinical outcomes include all ischemic strokes, all vascular events, and changes in cognition, motor function, mood, urinary symptoms, and disability.CONCLUSIONS: CHALLENGE will provide evidence to support the selection of long-term antiplatelet therapy in CSVD.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01932203
Anisotropy ; Aspirin ; Atrophy ; Brain ; Cerebral Small Vessel Diseases ; Cognition ; Dementia ; Dementia, Vascular ; Diffusion Tensor Imaging ; Homeostasis ; Humans ; Korea ; Magnetic Resonance Imaging ; Outcome Assessment (Health Care) ; Perfusion ; Sample Size ; Stroke ; Stroke, Lacunar ; White Matter

OBJECTIVE: To assess the efficacy and safety of our 4-week caregiver-mediated exercise (CME) in improving trunk control capacity, gait, and balance and in decreasing concerns about post-stroke falls when there is an increase in its efficacy. METHODS: Acute or subacute stroke survivors were assigned to either the trial group (n=35) or the control group (n=37). Changes in Modified Barthel Index (MBI), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), and Trunk Impairment Scale (TIS) scores at 4 weeks from baseline served as primary outcome measures. Correlations of primary outcome measures with changes in Fall Efficacy Scale-International (FES-I) scores at 4 weeks from baseline in the trial group served as secondary outcome measures. Treatment-emergent adverse events (TEAEs) served as safety outcome measures. RESULTS: There were significant differences in changes in MBI, FAC, BBS, TIS-T, TIS-D, TIS-C, and FES-I scores at 4 weeks from baseline between the two groups (all p < 0.0001). There were no significant (p=0.0755) differences in changes in TIS-S scores at 4 weeks from baseline between the two groups. MBI, FAC, BBS, and TIS scores showed significantly inverse correlations with FES-I scores in patients receiving CME. There were no TEAEs in our series. CONCLUSION: CME was effective and safe in improving the degree of independence, ambulation status, dynamic and static balance, trunk function, and concerns about post-stroke falls in stroke survivors.
Accidental Falls ; Caregivers ; Gait ; Humans ; Outcome Assessment (Health Care) ; Postural Balance ; Rehabilitation* ; Stroke ; Survivors ; Walking

OBJECTIVE: To investigate the psychometric properties of the activities of daily living (ADL) instrument used in the analysis of Korean Longitudinal Study of Ageing (KLoSA) dataset. METHODS: A retrospective study was carried out involving 2006 KLoSA records of community-dwelling adults diagnosed with stroke. The ADL instrument used for the analysis of KLoSA included 17 items, which were analyzed using Rasch modeling to develop a robust outcome measure. The unidimensionality of the ADL instrument was examined based on confirmatory factor analysis with a one-factor model. Item-level psychometric analysis of the ADL instrument included fit statistics, internal consistency, precision, and the item difficulty hierarchy. RESULTS: The study sample included a total of 201 community-dwelling adults (1.5% of the Korean population with an age over 45 years; mean age=70.0 years, SD=9.7) having a history of stroke. The ADL instrument demonstrated unidimensional construct. Two misfit items, money management (mean square [MnSq]=1.56, standardized Z-statistics [ZSTD]=2.3) and phone use (MnSq=1.78, ZSTD=2.3) were removed from the analysis. The remaining 15 items demonstrated good item fit, high internal consistency (person reliability=0.91), and good precision (person strata=3.48). The instrument precisely estimated person measures within a wide range of theta (−4.75 logits <θ< 3.97 logits) and a reliability of 0.9, with a conceptual hierarchy of item difficulty. CONCLUSION: The findings indicate that the 15 ADL items met Rasch expectations of unidimensionality and demonstrated good psychometric properties. It is proposed that the validated ADL instrument can be used as a primary outcome measure for assessing longitudinal disability trajectories in the Korean adult population and can be employed for comparative analysis of international disability across national aging studies.
Activities of Daily Living ; Adult* ; Aging ; Dataset ; Humans ; Longitudinal Studies* ; Outcome Assessment (Health Care) ; Psychometrics* ; Reproducibility of Results ; Retrospective Studies ; Stroke* ; Surveys and Questionnaires

PURPOSE: Ischemic stroke is rarely seen in children, but it could cause mortality and result in developmental disabilities such as motor paralysis, cognitive dysfunction, and epilepsy. In this study, the neurological outcomes of ischemic stroke in children were reviewed and the factors associated with the neurological outcomes were to be analyzed. METHODS: Medical records of patients younger than 15 years of age who were newly diagnosed with ischemic stroke between January 2006 and December 2016 in Chonnam National University Hospital were reviewed. RESULTS: This study consisted of 38 patients with ischemic stroke (male/female= 18/20, mean age=6 years 1 month±4 years 8 months). Neurological outcomes assessment was done at least 1 year after the onset of ischemic stroke. 10 patients (26.3%) had no neurological impairments. Motor paralysis was noted in 22 (57.9%), cognitive dysfunction was in 9 (23.7%), and epilepsy in 20 (52.6%). Among the possible risk factors for neurological impairments (age, sex, early seizures, characteristics of the infarcted lesions, abnormal electroencephalogram (EEG) findings), abnormalities on EEG findings were significantly associated with cognitive dysfunction (P=0.026) and the occurrence of early seizures with epilepsy (P=0.000). CONCLUSION: Neurological impairments were remained in 73.7% of children one year after ischemic stroke. Cognitive dysfunction was associated with abnormalities on EEG findings within 2 weeks after the onset of ischemic stroke and epilepsy with the occurrence of early seizures.
Child* ; Developmental Disabilities ; Electroencephalography ; Epilepsy ; Humans ; Jeollanam-do ; Medical Records ; Mortality ; Outcome Assessment (Health Care) ; Paralysis ; Risk Factors ; Seizures ; Stroke*

OBJECTIVES: Population aging has increased the burden of chronic diseases globally. mHealth is often cited as a viable solution to enhance the management of chronic conditions. In this study, we conducted a systematic review of mHealth interventions for the self-management of chronic diseases in Korea, a highly-connected country with a high chronic care burden. METHODS: Five databases were searched for relevant empirical studies that employed randomized controlled trial (RCT) or quasi-experimental methods published in English or Korean from the years 2008 to 2018. The selected studies were reviewed according to the PRISMA guidelines. The selected studies were classified using the Individual and Family Self-Management Theory conceptual framework. RESULTS: Sixteen studies met the inclusion criteria, 9 of which were targeted towards diabetes management, and 7 of which were RCTs. Other target diseases included hypertension, stroke, asthma, and others. mHealth interventions were primarily delivered through smartphone applications, mobile phones connected to a monitoring device, and short message services (SMS). Various self-management processes were applied, including providing social influence and support, and facilitating self-monitoring and goal setting. Eleven studies showed mHealth interventions to be effective in improving self-management behaviors, biomarkers, or patient-reported outcome measures associated with chronic diseases. CONCLUSIONS: While the number of identified studies was not large, none reported negative impacts of mHealth on selected outcomes. Future studies on mHealth should design interventions with a greater variety of targeted functions and should adopt more rigorous methodologies to strengthen the evidence for its effectiveness in chronic disease management.
Aging ; Asthma ; Biomarkers ; Chronic Disease ; Humans ; Hypertension ; Korea* ; Medical Informatics ; Mobile Applications ; Outcome Assessment (Health Care) ; Self Care* ; Smartphone ; Stroke ; Telemedicine*

OBJECTIVE: To assess the efficacy of a 4-week swallowing rehabilitation program combined with pyriform sinus ballooning in patients with post-stroke dysphagia (PSD). METHODS: We evaluated a total of 30 patients (n=30) with PSD who were admitted to our medical institution between May of 2014 and October of 2016. These patients were randomly assigned to either the trial group (n=15; a 20-minute conventional rehabilitation followed by a 10-minute pyriform sinus ballooning) or the control group (n=15; a 30-minute conventional rehabilitation). In these patients, the efficacy outcome measures were pharyngeal remnant, the pharyngeal transit time, the Penetration Aspiration Scale (PAS) scores and the Videofluoroscopic Dysphagia Scale (VDS) scores. We compared the differences in efficacy outcome measures at 4 weeks from baseline between the two groups. RESULTS: There were significant changes in the pharyngeal remnant, the pharyngeal transit time, the PAS scores and the VDS scores at 4 weeks from baseline between the two groups (p < 0.0001, p=0.0001, p < 0.0001, and p=0.0048, respectively). There were no treatment-emergent adverse events in our series. CONCLUSION: Our 4-week rehabilitation program combined with pyriform sinus ballooning is an effective and safe modality in patients with PSD. However, further large-scale, long-term, and multi-center studies are needed to corroborate our results.
Deglutition Disorders* ; Deglutition* ; Humans ; Larynx ; Outcome Assessment (Health Care) ; Pharynx ; Pyriform Sinus* ; Rehabilitation* ; Stroke

OBJECTIVE: To investigate the dose-related effect of trunk control training (TCT) using Trunk Stability Rehabilitation Robot Balance Trainer (TSRRBT) in chronic stroke patients with poor sitting balance. METHODS: This was a retrospective study of 38 chronic stroke patients with poor sitting balance that underwent TCT with TSRRBT. The participants were assigned either to the low-dose training (LDT) group (n=18) or to the highdose training (HDT) group (n=20). In addition to the conventional rehabilitation therapy, the LDT group received 5 sessions of TSRRBT intervention per week, whereas the HDT group received 10 sessions of TSRRBT intervention per week. The outcome measures were the scores on the Trunk Impairment Scale (TIS) and its subscales, Berg Balance Scale (BBS), Functional Ambulation Classification (FAC), and the Korean version of Modified Barthel Index (K-MBI). All outcome measures were assessed before the training and at the end of the 4-week training. RESULTS: After the 4-week intervention, TIS, BBS, FAC, and K-MBI scores showed improvement in both LDT and HDT groups. Furthermore, the improvements in TIS scores and its subscales were significantly greater in the HDT group than in the LDT group (p < 0.05). CONCLUSION: TCT using TSRRBT could be an additional treatment for the conventional rehabilitation therapy of chronic stroke patients with poor sitting balance. HDT may provide more beneficial effects on improving patients’ sitting balance than LDT.
Biofeedback, Psychology ; Classification ; Humans ; Outcome Assessment (Health Care) ; Rehabilitation ; Retrospective Studies ; Stroke* ; Video Games* ; Walking

PURPOSE: Aim of this study was to investigate whether there are ipsilateral motor deficits for visuospatial accuracy and fine movements by making a comparison between stroke patients and healthy subjects. We examined whether ipsilateral motor deficits are influenced by the level of functional movements and muscle strength of the upper and lower extremities of the affected side. METHODS: Thirty post-stroke subjects and 20 normal aged matched subjects were recruited. Outcome measures for less-affected side were the tracking task and nine-hole pegboard test. Fugl-Meyer test and motricity index were applied for the measurement of functional movements and muscle strength of affected side. RESULTS: Tracking task and nine-hole pegboard test was significantly different between control and experimental group. In terms of accuracy index according to tracking, the experimental group showed a lower accuracy index in the MCP joint than the control group. However, there were no significant difference relation between the level of motor function of the affected side and the motor deficit level of ipsilateral side. CONCLUSION: Ipsilateral motor deficits may have significant clinical implications. It needs to be noted that although many patients, families, and medical staff are focused only on motor deficits of the affected side, motor deficits of the sound side can cause difficulties in daily living movements requiring delicate movements. In addition, there was no significant correlation between the level of motor function of the affected side and motor deficits of the sound side.
Healthy Volunteers ; Humans ; Joints ; Lower Extremity ; Medical Staff ; Muscle Strength ; Outcome Assessment (Health Care) ; Paresis ; Stroke