Objective: To verify the pharyngeal width at rest as a measurement that could be used to assess changes in the degree of dysphagia over time in stroke patients. Methods: In a cohort of stroke patients, we performed serial measurements of the pharyngeal width at the midpoints of the second (C2) and third (C3) cervical vertebral bodies using lateral neck X-rays while the patients were at rest. The JOSCYL width, a parameter named after the first initial of each developers’ surname and defined as the average value of the upper and lower pharyngeal widths, was used to formulate the JOSCYL scale, which was calculated as the JOSCYL width × 100eck circumference. All patients also underwent serial videofluoroscopic swallowing studies (VFSSs). The Spearman correlation analysis was used to detect correlations between the serial VFSS results, JOSCYL widths, and JOSCYL scale values. Results: Over time, we observed significant positive and negative correlations of change in the JOSCYL width and scale with changes in the Penetration-Aspiration Scale and the Dysphagia Outcome and Severity Scale scores, respectively. Conclusion The JOSCYL width and JOSCYL scale clearly reflected changes in dysphagia in stroke patients over time. These parameters may provide an easier method for evaluating whether post-stroke dysphagia has been alleviated.

Traumatic brain injury is a main cause of long-term neurological disability, and many patients suffer from cognitive impairment for a lengthy period. Cognitive impairment is a fatal malady to that limits active rehabilitation, and functional recovery in patients with traumatic brain injury. In severe cases, it is impossible to assess cognitive function precisely, and severe cognitive impairment makes it difficult to establish a rehabilitation plan, as well as evaluate the course of rehabilitation. Evaluation of cognitive function is essential for establishing a rehabilitation plan, as well as evaluating the course of rehabilitation. We report a case of the analysis of electroencephalography with global synchronization index and low-resolution brain electromagnetic tomography applied, for evaluation of cognitive function that was difficult with conventional tests, due to severe cognitive impairment in a 77-year-old male patient that experienced traumatic brain injury.
Aged ; Brain ; Brain Injuries ; Cognition Disorders ; Cognition ; Electroencephalography ; Humans ; Magnets ; Male ; Rehabilitation

No abstract available.
Humans ; Retinoschisis*

OBJECTIVE: To develop a new tool for aspiration risk prediction based on pharyngeal width at rest in older adults with symptoms of aspiration. METHODS: Lateral cervical spine roentgenograms were obtained from 33 older adult patients who complained of dysphagia and from 33 healthy, age-matched controls. Pharyngeal width at rest was measured at two points. We named the average of these two pharyngeal widths ‘JOSCYL Width’, calculated ‘JOSCYL Scale’, and compared these parameters between dysphagia and control groups. Correlations of individual JOSCYL Width and JOSCYL Scale, with Penetration Aspiration Scale (PAS) and Dysphagia Outcome and Severity Scale (DOSS) scores were analyzed for the dysphagia group. To determine optimal cutoff points for predicting aspiration, a receiver operating characteristic curve analysis was performed on JOSCYL Width and JOSCYL Scale. RESULTS: Both JOSCYL Width and JOSCYL Scale of the dysphagia group were larger than those of the control group (p<0.001). The correlation between JOSCYL Width and severity of dysphagia was significant for the dysphagia group (PAS p=0.007; DOSS p=0.012). The correlation between JOSCYL Scale and the severity of dysphagia was also significant for the dysphagia group (PAS p=0.009; DOSS p=0.011). Optimal cutoffs for JOSCYL Width and JOSCYL Scale for predicting aspiration were 20.0 mm and 5.9, respectively. CONCLUSION: JOSCYL Width and JOSCYL Scale can be new indicators for predicting aspiration in older adults. They are both precise and easy to use.
Adult ; Aged ; Deglutition Disorders ; Dioctyl Sulfosuccinic Acid ; Humans ; Pharynx ; ROC Curve ; Spine

BACKGROUND: Loss of skin elasticity due to redundancy of the upper eyelid (dermatochalasis) and falling of the upper eyelid border to a lower position (blepharoptosis) are often the earliest signs of facial aging. Upper eyelid blepharoplasty is an effective procedure to establish a good eyelid position, and is the most common facial cosmetic procedure [1]. When performing upper eyelid blepharoplasty, eyelid symmetry is essential for a satisfactory surgical outcome. Even if not possible, every surgeon tries to achieve complete symmetry when performing aesthetic eyelid surgery [2]. Several previous studies by surgeons with > 10 years of experience reported how preoperative incision markings should be made to achieve satisfactory surgical outcomes and excellent surgical results for upper eyelid blepharoplasty [3-7]. However, none of these studies investigated naturally occurring asymmetry when applying a preoperative design for upper blepharoplasty incision markings. During the preoperative design step, we noticed certain asymmetric tendencies. We therefore characterised these differences to ensure a more effective preoperative design for upper blepharoplasty incision markings for both eyelids. METHODS: This retrospective study examined 22 patients who underwent bilateral upper blepharoplasty surgery resulting from senile dermatochalasis and/or blepharoptosis. The initial preoperative incision design markings were drawn with the patient sitting upright. Then, with the patient in a supine position, preoperative design photographs were taken. We measured medial canthal excision angle (MCA), maximal lid excision height (MLH), maximal lid excision width (MLW), peak point angle, and peak point distance and compared measurements between both upper eyelids designs using Image J software. RESULTS: The mean MCA for the right side (30.68 ± 10.16°) was significantly different to that for the left side (35.39 ± 13.82°; p < 0.001). The mean MLH for the right side (1.17 ± 0.24 cm) was significantly different to that for the left side (1.24 ± 0.25 cm; p = 0.002). The mean MLW for the right side (0.72 ± 0.19 cm) was significantly different to that for the left side (0.77 ± 0.21 cm; p = 0.011). The mean peak point angle for the right side (15.67 ± 5.09°) was significantly different to that for the left side (18.11 ± 5.49°; p = 0.001). The mean peak point distance for the right side (2.41 ± 0.31°) was significantly different to that for the left side (2.22 ± 0.28 cm; p = 0.001). CONCLUSION: In upper blepharoplasty, the preoperative incision marking design measurements of the left side were significantly greater than those of the right side. The symmetry can therefore be maximised by including the asymmetries in the preoperative design.

PURPOSE: To investigate retinal nerve fiber layer (RNFL) thickness using swept source (SS)-optical coherence tomography (OCT) in healthy Koreans and to evaluate the effects of age on the distributional variability of thickness. METHODS: We performed a retrospective review of 309 normal eyes presenting for examination of peripapillary nerve fiber layer thickness measured by SS-OCT (DRI OCT-1, Atlantis SS-OCT, Topcon, Tokyo, Japan) from July 2014 to February 2016. The patients were between the ages of 20 and 79 without systemic or ocular disease. The patients were divided into 3 age groups of 20 to 39 years (85 eyes), 40 to 59 years (140 eyes), and 60 to 79 years (84 eyes). The groups were matched based on average RNFL thickness and quadrant and 12 o'clock position RNFL thickness. RESULTS: The average RNFL thickness of the inferior quadrant was the thickest of the layers and revealed a bimodal distribution. In the three groups, the thicknesses of the average RNFL, quadrant, and 12 o'clock RNFL decreased with age. There was significant difference in the measurements (p < 0.05) of quadrant RNFL thickness except that in the nasal quadrant (p = 0.068). CONCLUSIONS: The thickness of the circumpapillary retinal nerve fiber layer measured by SS-OCT differs according to age and analysis of normal values by age can be useful in the diagnosis of disease.
Diagnosis ; Humans ; Nerve Fibers* ; Reference Values ; Retinaldehyde* ; Retrospective Studies ; Tomography, Optical Coherence*

PURPOSE: To investigate retinal nerve fiber layer (RNFL) thickness using swept source (SS)-optical coherence tomography (OCT) in healthy Koreans and to evaluate the effects of age on the distributional variability of thickness. METHODS: We performed a retrospective review of 309 normal eyes presenting for examination of peripapillary nerve fiber layer thickness measured by SS-OCT (DRI OCT-1, Atlantis SS-OCT, Topcon, Tokyo, Japan) from July 2014 to February 2016. The patients were between the ages of 20 and 79 without systemic or ocular disease. The patients were divided into 3 age groups of 20 to 39 years (85 eyes), 40 to 59 years (140 eyes), and 60 to 79 years (84 eyes). The groups were matched based on average RNFL thickness and quadrant and 12 o'clock position RNFL thickness. RESULTS: The average RNFL thickness of the inferior quadrant was the thickest of the layers and revealed a bimodal distribution. In the three groups, the thicknesses of the average RNFL, quadrant, and 12 o'clock RNFL decreased with age. There was significant difference in the measurements (p < 0.05) of quadrant RNFL thickness except that in the nasal quadrant (p = 0.068). CONCLUSIONS: The thickness of the circumpapillary retinal nerve fiber layer measured by SS-OCT differs according to age and analysis of normal values by age can be useful in the diagnosis of disease.
Diagnosis ; Humans ; Nerve Fibers* ; Reference Values ; Retinaldehyde* ; Retrospective Studies ; Tomography, Optical Coherence*

PURPOSE: To determine whether the simultaneous recording of photopic electroretinography (ERG) and flash visual evoked potential (VEP) can predict the postoperative outcome in diabetic cases where massive vitreous hemorrhage precludes fundus observation. METHODS: The photopic ERG and flash VEP were recorded simultaneously on 20 eyes of 20 normal subjects, and 23 eyes of 23 patients who were diagnosed with Grade IV vitreous hemorrhage d/t diabetic retinopathy. Of the 23 patients, fellow eyes were diagnosed with proliferative diabetic retinopathy and they underwent pars plana vitrectomy after the test. Three groups were analyzed the responses of photopic ERG and flash VEP. Best corrected visual acuity was also checked before and after the surgery. After the 8 weeks after the vitrectomy, two groups were formed, based on the outcome of surgery and these two groups were analyzed the preoperative response of photopic ERG and flash VEP. RESULTS: When comparing the groups between proliferative diabetic retinopathy and normal eyes, Grade IV vitreous hemorrhage and fellow eyes, there was a statistically significant (p < 0.05) difference in a wave amplitude, a wave implicit time, b wave amplitude, b wave implicit time of photopic ERG and P2 peak time of flash VEP. In addition, a wave amplitude of photopic ERG showed the best predictive ability (area under receiver operating characteristic [AUROC] curve value of 0.88) when comparing improved visual acuity group to the unimproved visual acuity group. CONCLUSIONS: Simultaneous recordings of photopic ERG and flash VEP showed the decreased function of retina and optic pathway on eyes with vitreous hemorrhage precluding inspection of the fundus. In addition, preoperative photopic ERG and flash VEP can safely predict the outcome of vitrectomy in dense vitreous hemorrhage of diabetics.
Diabetic Retinopathy* ; Electroretinography* ; Evoked Potentials, Visual* ; Humans ; Retina ; ROC Curve ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage*

“Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” is the 3rd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 2nd edition published in 2014. Forty-two specialists in stroke rehabilitation from 21 universities and 4 rehabilitation hospitals and 4 consultants participated in this update. The purpose of this CPG is to provide optimum practical guidelines for stroke rehabilitation teams to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. The recent two CPGs from Canada (2015) and USA (2016) and articles that were published following the 2nd edition were used to develop this 3rd edition of CPG for stroke rehabilitation in Korea. 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. 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. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” consists of ‘Chapter 1; Introduction of Stroke Rehabilitation’, ‘Chapter 2; Rehabilitation for Stroke Syndrome, ‘Chapter 3; Rehabilitation for Returning to the Society’, and ‘Chapter 4; Advanced Technique for Stroke Rehabilitation’. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” will provide direction and standardization for acute, subacute and chronic stroke rehabilitation in Korea.
Canada ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

PURPOSE: To evaluate diagnostic ability of macular ganglion cell complex (mGCC), macular ganglion cell inner plexiform layer (mGCIPL) measurements in glaucoma using swept source deep range imaging optical coherence tomography (DRI OCT-1, Topcon Co., Tokyo, Japan). METHODS: From August of 2014 to July of 2015, 109 eyes of 109 subjects were assessed for the average thickness and sectional thickness of both mGCC and mGCIPL to determine whether there exists any significant difference among advanced stage glaucoma group, early stage glaucoma group and normal group in Swept source OCT. Comparisons were also made between the above measurements and circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements in their diagnostic accuracy, sensitivity, and specificity. RESULTS: The diagnostic ability of mGCC based-mean thickness value (area under the curve [AUC] = 0.78/0.99) in detecting early stage glaucoma group as well as advanced stage group was not significantly different from that of cpRNFL thickness measurement. However, there was a significant difference in thickness between mGCIPL (AUC = 0.70) and cpRNFL in early stage glaucoma groups (p = 0.018). The sensitivities and specificities of mGCC were 0.95/0.97, and those of mGCIPL were 0.92/0.97, respectively. CONCLUSIONS: The two swept source OCT based methods measuring retinal ganglion cell layer thickness appeared to have a good diagnostic accuracy, high sensitivity and specificity in detecting glaucomatous eyes. Nevertheless, of the two methods, mGCC thickness measurement was more efficient in detecting early glaucomatous changes.
Ganglion Cysts* ; Glaucoma* ; Nerve Fibers ; Retinal Ganglion Cells ; Retinaldehyde ; Sensitivity and Specificity ; Tomography, Optical Coherence*