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Cha S, Chang WK, Lee K, Han K, Paik NJ, Kim WS. Prevalence and impact of depression and anxiety among older myocardial infarction survivors: A nationwide cohort study. J Affect Disord 2024; 354:408-415. [PMID: 38479513 DOI: 10.1016/j.jad.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/19/2024] [Accepted: 03/09/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Depression and anxiety may be significant prognostic factors after myocardial infarction (MI). Thus, we investigated depression and anxiety prevalence among older MI survivors and their impact on mortality, stroke, and recurrent MI. METHODS This population-based cohort study used the Korean National Health Insurance Service database for data concerning individuals aged 66 years who participated in the National Screening Program from 2009 to 2016. Overall, 11,721 individuals with MI history and 58,605 age- and sex-matched controls were included and followed up until 2019. The presence of depression and anxiety was assessed 2 years before and after participation in the program. Mortality and major adverse outcomes, defined as a composite outcome comprising mortality, stroke, and recurrent MI, were analyzed. RESULTS Depression and anxiety prevalence among MI survivors was 20.4 % and 30.3 %, respectively. Crude odds ratios for depression and anxiety, compared with the control group, were 1.207 (1.148-1.269) and 1.078 (1.032-1.126), respectively. During the follow-up, individuals with depression, anxiety, or both showed increased hazard ratios (HRs) for mortality and major adverse outcomes; after adjustments, their HRs were 1.442 (1.182-1.759), 1.129 (0.960-1.328), and 1.498 (1.263-1.776), respectively, for mortality and 1.505 (1.289-1.758), 1.158 (1.021-1.314), and 1.530 (1.337-1.751), respectively, for major adverse outcomes. LIMITATIONS Although this was a nationwide cohort study, the MI, depression, and anxiety diagnoses were based on diagnostic codes. CONCLUSIONS Higher depression and anxiety prevalence was observed among older MI survivors. Depression and anxiety occurrence correlated with increased adverse clinical outcomes after adjustments.
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Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyuna Lee
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Feng W, Paik NJ. Challenges and solutions to optimize stroke recovery trial enrollment and execution. Lancet Reg Health Eur 2024; 38:100844. [PMID: 38476743 PMCID: PMC10928267 DOI: 10.1016/j.lanepe.2024.100844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
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Cho HM, Kim H, Jang J, Cha S, Chang WK, Jung BK, Park DS, Jee S, Ko SH, Shin JH, Choi JS, Kim WS, Paik NJ. Attitude Toward Virtual Rehabilitation and Active Video Games Among Therapists in Korea: A Nationwide Survey. Brain Neurorehabil 2024; 17:e4. [PMID: 38585030 PMCID: PMC10990844 DOI: 10.12786/bn.2024.17.e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/08/2023] [Accepted: 12/20/2023] [Indexed: 04/09/2024] Open
Abstract
In this study, we conducted a survey targeting 191 physical therapists (PTs) and 159 occupational therapists (OTs) in South Korea to explore attitudes toward virtual rehabilitation. Utilizing the Korean version of the ADOPT VR by Glegg et al., OT exhibited significantly more experience with virtual reality (VR) and active video games (AVG) than PT. Therapists with VR/AVG experience scored significantly higher in most categories, and the scores in each category were significantly correlated with the Behavioral Intention category, reflecting the willingness to use VR/AVG. The biggest barriers identified were insufficient funds and setup assistance for the equipment. Differences in responses between the groups with and without VR/AVG experience were most prominent in terms of lack of interest and funding. Therapists' attitudes, perceptions, and intentions toward VR/AVG are crucial factors in the establishment and implementation of VR/AVG; thus, the results of this study provide valuable evidence for future policies related to VR/AVG in rehabilitation medicine.
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Affiliation(s)
- Hee-Mun Cho
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyunji Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jihui Jang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bong-Keun Jung
- Department of Mechanical Engineering, Seoul National University College of Engineering, Seoul, Korea
| | - Dae-Sung Park
- Department of Physical Therapy, Konyang University, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan, Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Ji Soo Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Shoaib Z, Chang WK, Lee J, Lee SH, Phillips V Z, Lee SH, Paik NJ, Hwang HJ, Kim WS. Investigation of Neuromodulatory Effect of Anodal Cerebellar Transcranial Direct Current Stimulation on the Primary Motor Cortex Using Functional Near-Infrared Spectroscopy. Cerebellum 2024; 23:56-66. [PMID: 36633829 DOI: 10.1007/s12311-023-01511-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
Cerebellar brain inhibition (CBI), a neural connection between the cerebellum and primary motor cortex (M1), has been researched as a target pathway for neuromodulation to improve clinical outcomes in various neurological diseases. However, conflicting results of anodal cerebellar transcranial direct current stimulation (acb-tDCS) on M1 excitability indicate that additional investigation is required to examine its precise effect. This study aimed to gather evidence of the neuromodulatory effect of acb-tDCS on the M1 using functional near-infrared spectroscopy (fNIRS). Sixteen healthy participants were included in this cross-over study. Participants received real and sham acb-tDCS randomly, with a minimum 1-week washout period between them. The anode and cathode were placed on the right cerebellum and the right buccinator muscle, respectively. Stimulation lasted 20 min at an intensity of 2 mA, and fNIRS data were recorded for 42 min (including a 4-min baseline before stimulation and an 18-min post-stimulation duration) using eight channels attached bilaterally on the M1. acb-tDCS induced a significant decrease in oxyhemoglobin (HbO) concentration (inhibitory effect) in the left (contralateral) M1, whereas it induced a significant increase in HbO concentration (excitatory effect) in the right (ipsilateral) M1 compared to sham tDCS during (p < 0.05) and after stimulation (p < 0.01) in a group level analysis. At the individual level, variations in response to acb-tDCS were observed. Our findings demonstrate the neuromodulatory effects of acb-tDCS on the bilateral M1 in terms of neuronal hemodynamics.
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Affiliation(s)
- Zeshan Shoaib
- Department of Electronics and Information Engineering, Korea University, Sejong City, South Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jongseung Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Stephanie Hyeyoung Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Zephaniah Phillips V
- Global Health Technology Research Center, College of Health Science, Korea University, Seoul, South Korea
| | - Seung Hyun Lee
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Han-Jeong Hwang
- Department of Electronics and Information Engineering, Korea University, Sejong City, South Korea.
- Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong City, South Korea.
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Ye DH, Chun MH, Park YG, Paik NJ, Lee SU, Yoo SD, Kim DY. A Randomized, Double-Blind, Active Control, Multicenter, Phase 3 Study to Evaluate the Efficacy and Safety of Liztox ® versus Botox ® in Post-Stroke Upper Limb Spasticity. Toxins (Basel) 2023; 15:697. [PMID: 38133201 PMCID: PMC10748261 DOI: 10.3390/toxins15120697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
Botulinum toxin type A (BTX-A) injection is a commonly used therapeutic intervention for upper limb spasticity in stroke patients. This study was designed as a randomized, active-drug-controlled, double-blind, multicenter, phase 3 clinical trial to evaluate the safety and efficacy of Liztox® in comparison to onabotulinum toxin A (Botox®) for individuals with post-stroke upper limb spasticity. The primary outcome was the alteration in wrist flexor muscle tone from the initial assessment to the fourth week, evaluated using the modified Ashworth scale (MAS). Secondary outcomes included MAS score changes for the wrist at weeks 8 and 12 from baseline; MAS score changes for finger and elbow flexors; and changes in the Disability Assessment Scale (DAS), Subject's Global Assessment (SGA), the Investigator's Global Assessment (IGA), and Caregiver Burden Scale (CBS) at weeks 4, 8, and 12 from baseline. The MAS score for wrist flexor spasticity decreased by -1.14 ± 0.59 in the Liztox® group and -1.22 ± 0.59 in the Botox® group from baseline to week 4. The difference [97.5% confidence interval (CI)] between the test and control groups was 0.08 [-∞, 0.26], confirming the non-inferiority of the test group compared to the control group. Furthermore, there were consistent improvements in the IGA, SGA, and CBS scores across all assessment intervals, with no statistically significant variances detected between the two groups. No safety-related concerns were reported during the study. In conclusion, Liztox® injection proved to be a secure and efficacious intervention for managing upper extremity spasticity in post-stroke patients.
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Affiliation(s)
- Dong Hyun Ye
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea;
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea;
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea;
- Department of Medicine (AgeTech-Service Convergence Major), Kyung Hee University, Seoul 05278, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
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Shim M, Choi GY, Paik NJ, Lim C, Hwang HJ, Kim WS. Altered Functional Networks of Alpha and Low-Beta Bands During Upper Limb Movement and Association with Motor Impairment in Chronic Stroke. Brain Connect 2023; 13:487-497. [PMID: 34269616 DOI: 10.1089/brain.2021.0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Impaired movement after stroke is closely associated with altered brain functions, and thus the investigation on neural substrates of patients with stroke can pave a way for not only understanding the underlying mechanisms of neuropathological traits, but also providing an innovative solution for stroke rehabilitation. The objective of this study was to precisely investigate altered brain functions in terms of power spectral and brain network analyses. Methods: Altered brain function was investigated by using electroencephalography (EEG) measured while 34 patients with chronic stroke performed movement tasks with the affected and unaffected hands. The relationships between functional brain network indices and Fugl-Meyer Assessment (FMA) scores were also investigated. Results: A stronger low-beta event-related desynchronization was found in the contralesional hemisphere for both affected and unaffected movement tasks compared with that of the ipsilesional hemisphere. More efficient whole-brain networks (increased strength and clustering coefficient, and prolonged path length) in the low-beta frequency band were revealed when moving the unaffected hand compared with when moving the affected hand. In addition, the brain network indices of the contralesional hemisphere indicated higher efficiency and cost-effectiveness than those of the ipsilesional hemisphere in both the alpha and low-beta frequency bands. Moreover, the alpha network indices (strength, clustering coefficient, path length, and small-worldness) were significantly correlated with the FMA scores. Conclusions: Efficient functional brain network indices are associated with better motor outcomes in patients with stroke and could be useful biomarkers to monitor stroke recovery during rehabilitation.
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Affiliation(s)
- Miseon Shim
- Institute of Industrial Technology, Korea University, Sejong, Republic of Korea
- Department of Electronics and Information Engineering, Korea University, Sejong, Republic of Korea
| | - Ga-Young Choi
- Department of Electronics and Information Engineering, Korea University, Sejong, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Chaiyoung Lim
- Bundang Rusk Rehabilitation Specialty Hospital, Seongnam-si, Republic of Korea
| | - Han-Jeong Hwang
- Department of Electronics and Information Engineering, Korea University, Sejong, Republic of Korea
- Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Baek S, Kim WS, Park YH, Jung YS, Chang WK, Kim G, Paik NJ. Korean Version of the Longer-Term Unmet Needs After Stroke Questionnaire. Ann Rehabil Med 2023; 47:367-376. [PMID: 37907228 PMCID: PMC10620493 DOI: 10.5535/arm.23044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE : To translate the 22-item Longer-term Unmet Needs after Stroke (LUNS) questionnaire, validate it in the Korean stroke population, and assess the reliability of face-to-face and telephone surveys. METHODS : Sixty-six adult patients with stroke from Seoul National University Bundang Hospital and Kangwon National University Hospital were involved in the validation. Participants were interviewed twice using the LUNS Korean version: first, a face-to-face survey for validation, and second, a telephone survey for test-retest reliability. Participants completed the Frenchay Activities Index (FAI) and Short Form 12 (SF-12) Mental and Physical Component Summary (MCS and PCS) scores at the first interview. For concurrent validity, the differences in health status (FAI, SF-12 MCS and PCS) between the groups that reported unmet needs and those that did not were analyzed for each item. Cohen's kappa and percentage of agreement between the first and second administrations were calculated for each item to determine the test-retest reliability. RESULTS : The average age of the participants was 61.2±12.8 years and 74.2% were male. Fifty-seven patients were involved in the second interview. Depending on the unmet needs, SF-12 MCS, PCS, and FAI were significantly different in 12 of 22 items. In the test-retest reliability test, 12 items had a kappa of 0.6 or higher, and two had a kappa of <0.4. CONCLUSION : The LUNS instrument into Korean (LUNS-K) is a reliable and valid instrument for assessing unmet health needs in patients with stroke. In addition, telephone surveys can be considered reliable.
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Affiliation(s)
- Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yul-Hyun Park
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Public Health Care, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Sun Jung
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Gowun Kim
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Cho HM, Cha S, Sohn MK, Jee S, Chang WK, Kim WS, Paik NJ. Investigation of the efficacy of low-frequency repetitive transcranial magnetic stimulation on upper-limb motor recovery in subacute ischemic stroke without cortical involvement: a protocol paper for a multi-center, double-blind randomized controlled trial. Front Neurol 2023; 14:1216510. [PMID: 37693768 PMCID: PMC10491015 DOI: 10.3389/fneur.2023.1216510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction The incidence of stroke is increasing steadily due to factors such as population aging. Approximately 80% of stroke survivors have motor disorders affecting their daily lives. Repetitive transcranial magnetic stimulation (rTMS) has been reported to maximize functional recovery after stroke along with exercise intervention in upper limb rehabilitation treatment. However, whether rTMS affects the recovery of upper limb function in patients with stroke remains unclear. Therefore, in this trial, we will investigate the efficacy of low-frequency rTMS in patients with subcortical and brainstem ischemic stroke. Methods This study has been designed as a multi-center, double-blind, randomized controlled trial to compare the efficacy of low-frequency rTMS over the contralesional M1 with sham stimulation. Overall, 88 participants will be allocated to the intervention or control group in a 1:1 ratio, with stratification according to their initial upper extremity Fugl-Meyer assessment (UE-FMA) score. The participants will receive either 30 min of real rTMS (intervention group) or sham rTMS (control group), followed by 30 min of occupational therapy for 10 consecutive workdays. All the participants will receive the same amount of rehabilitation therapy throughout the intervention period. Evaluations will be performed at baseline (T0), at the end of treatment (T1), and 4 weeks after the end of treatment (T2), including the box and block test (BBT), UE-FMA, Korean version of the Modified Barthel Index, and NIH Stroke Scale scores, Finger tapping test, Brunnstrom stage, modified Ashworth scale, and grip strength. The primary outcome will be the change in the BBT score between T0 and T2. Conclusion This study will provide evidence on the efficacy of low-frequency rTMS in motor function recovery of the upper limb in patients with subacute, subcortical, and brainstem ischemic stroke. Clinical trial registration ClinicalTrials.gov, identifier [NCT05535504].
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Affiliation(s)
- Hee-Mun Cho
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Chang WK, Lim H, Park SH, Lim C, Paik NJ, Kim WS, Ku J. Effect of immersive virtual mirror visual feedback on Mu suppression and coherence in motor and parietal cortex in stroke. Sci Rep 2023; 13:12514. [PMID: 37532803 PMCID: PMC10397282 DOI: 10.1038/s41598-023-38749-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023] Open
Abstract
We investigated the activation pattern of the motor cortex (M1) and parietal cortex during immersive virtual reality (VR)-based mirror visual feedback (MVF) of the upper limb in 14 patients with chronic stroke and severe upper limb hemiparesis and in 21 healthy controls. Participants performed wrist extension with unaffected wrists (dominant side in controls). In the MVF condition, movement of the affected hand was synchronized with that of the unaffected hand. In the no-MVF condition, only the movement of unaffected hand was shown. Mu suppression in bilateral M1 and parietal cortex and mu coherence were analyzed. In patients with stroke, MVF induced significant mu suppression in both the ipsilesional M1 and parietal lobes (p = 0.006 and p = 0.009, respectively), while mu suppression was observed in the bilateral M1 (p = 0.003 for ipsilesional and p = 0.041 for contralesional M1, respectively) and contralesional parietal lobes in the controls (p = 0.036). The ipsilesional mu coherence between the M1 and parietal cortex in patients with stroke was stronger than controls, regardless of MVF condition (p < 0.001), while mu coherence between interhemispheric M1 cortices was significantly weaker in patients with stroke (p = 0.032). Our findings provide evidence of the neural mechanism of MVF using immersive VR in patients with stroke.
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Affiliation(s)
- Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyunmi Lim
- Department of Biomedical Engineering, College of Medicine, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu, Republic of Korea
| | - Seo Hyun Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chaiyoung Lim
- Bundang Rusk Rehabilitation Speciality Hospital, Seongnam, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Jeonghun Ku
- Department of Biomedical Engineering, College of Medicine, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu, Republic of Korea.
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu, Republic of Korea.
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Choi GY, Chang WK, Shim M, Kim N, Jang JH, Kim WS, Hwang HJ, Paik NJ. Electroencephalography Network Indices as Biomarkers of Upper Limb Impairment in Chronic Stroke. J Vis Exp 2023. [PMID: 37522717 DOI: 10.3791/64753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Alteration of electroencephalography (EEG) signals during task-specific movement of the impaired limb has been reported as a potential biomarker for the severity of motor impairment and for the prediction of motor recovery in individuals with stroke. When implementing EEG experiments, detailed paradigms and well-organized experiment protocols are required to obtain robust and interpretable results. In this protocol, we illustrate a task-specific paradigm with upper limb movement and methods and techniques needed for the acquisition and analysis of EEG data. The paradigm consists of 1 min of rest followed by 10 trials comprising alternating 5 s and 3 s of resting and task (hand extension)-states, respectively, over 4 sessions. EEG signals were acquired using 32 Ag/AgCl scalp electrodes at a sampling rate of 1,000 Hz. Event-related spectral perturbation analysis associated with limb movement and functional network analyses at the global level in the low-beta (12-20 Hz) frequency band were performed. Representative results showed an alteration of the functional network of low-beta EEG frequency bands during movement of the impaired upper limb, and the altered functional network was associated with the degree of motor impairment in chronic stroke patients. The results demonstrate the feasibility of the experimental paradigm in EEG measurements during upper limb movement in individuals with stroke. Further research using this paradigm is needed to determine the potential value of EEG signals as biomarkers of motor impairment and recovery.
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Affiliation(s)
- Ga-Young Choi
- Department of Electronics and Information Engineering, Korea University
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Miseon Shim
- Department of Electronics and Information Engineering, Korea University
| | - Nuri Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Ji-Hee Jang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital;
| | - Han-Jeong Hwang
- Department of Electronics and Information Engineering, Korea University; Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University;
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital
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Kim DY, Ryu B, Oh BM, Kim DY, Kim DS, Kim DY, Kim DK, Kim EJ, Lee HY, Choi H, Kim HS, Lee HH, Kim HJ, Oh HM, Seok H, Park J, Park J, Park JG, Kim JM, Lee J, Shin JH, Lee JK, Oh JS, Park KD, Kim KT, Chang MC, Chun MH, Kim MW, Kang MG, Song MK, Choi M, Ko MH, Kim NY, Paik NJ, Jung SH, Yoon SY, Lim SH, Lee SJ, Yoo SD, Lee SH, Yang SN, Park SW, Lee SY, Han SJ, Lee SJ, Bok SK, Ohn SH, Im S, Pyun SB, Hyun SE, Kim SH, Ko SH, Jee S, Kwon S, Kim TW, Chang WH, Chang WK, Yoo WK, Kim YH, Yoo YJ, Kim YW, Shin YI, Park YG, Choi YH, Kim Y. Clinical Practice Guideline for Stroke Rehabilitation in Korea-Part 1: Rehabilitation for Motor Function (2022). Brain Neurorehabil 2023; 16:e18. [PMID: 37554256 PMCID: PMC10404807 DOI: 10.12786/bn.2023.16.e18] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
This clinical practice guideline (CPG) is the fourth edition of the Korean guideline for stroke rehabilitation, which was last updated in 2016. The development approach has been changed from a consensus-based approach to an evidence-based approach using the Grading of Recommendations Assessment Development and Evaluation (GRADE) method. This change ensures that the guidelines are based on the latest and strongest evidence available. The aim is to provide the most accurate and effective guidance to stroke rehabilitation teams, and to improve the outcomes for stroke patients in Korea. Fifty-five specialists in stroke rehabilitation and one CPG development methodology expert participated in this development. The scope of the previous clinical guidelines was very extensive, making it difficult to revise at once. Therefore, it was decided that the scope of this revised CPG would be limited to Part 1: Rehabilitation for Motor Function. The key questions were selected by considering the preferences of the target population and referring to foreign guidelines for stroke rehabilitation, and the recommendations were completed through systematic literature review and the GRADE method. The draft recommendations, which were agreed upon through an official consensus process, were refined after evaluation by a public hearing and external expert evaluation.
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Affiliation(s)
- Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Byungju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| | - Da-Sol Kim
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Deog Young Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Don-Kyu Kim
- Department of Physical and Rehabilitation Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Eun Joo Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hoo Young Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Hyoseon Choi
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Hyoung Seop Kim
- Department of Physical medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Hyun Mi Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Hyun Seok
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University College of Medicine, Asan, Korea
| | - Jihye Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihyun Park
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Gee Park
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jong Moon Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gachon University, Gil Medical Center, Incheon, Korea
| | - Ju Sun Oh
- Department of Physical medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gachon University, Gil Medical Center, Incheon, Korea
| | - Kyoung Tae Kim
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| | - Min Wook Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Gu Kang
- Department of Rehabilitation Medicine, Daegu Workers’ Compensation Hospital, Daegu, Korea
| | - Min-Keun Song
- Department of Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Na Young Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seo Yeon Yoon
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, Dankook University College of Medicine, Seoul, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Soo Jeong Han
- Department of Rehabilitation Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sook Joung Lee
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo-Kyung Bok
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Chuncheon, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Sung Eun Hyun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Hoon Kim
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - SuYeon Kwon
- Department of Rehabilitation Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Chuncheon, Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeun Jie Yoo
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Wook Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University College of Medicine, Asan, Korea
| | - Youngkook Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kwon S, Cha S, Kim J, Han K, Paik NJ, Kim WS. Trends in the incidence and prevalence of dysphagia requiring medical attention among adults in South Korea, 2006-2016: A nationwide population study. PLoS One 2023; 18:e0287512. [PMID: 37379287 DOI: 10.1371/journal.pone.0287512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/07/2023] [Indexed: 06/30/2023] Open
Abstract
The prevalence of dysphagia is increasing, resulting in socioeconomic burden, but previous reports have only been based on a limited populations. Therefore, we aimed to investigate the nationwide incidence and prevalence of dysphagia requiring medical attention to provide adequate information for healthcare planning and resource allocation. In this nationwide retrospective cohort study, the data of adults aged ≥20 years recorded from 2006 to 2016 were sourced from the Korean National Health Insurance Service database. Medical claim codes based on ICD-10-CM were used to define dysphagia and possible causes. The annual incidence and prevalence of dysphagia were calculated. Cox regression was used to estimate dysphagia risk in people with possible dysphagia etiology. Survival analysis was performed to estimate the mortality and hazard ratio of dysphagia. The crude annual incidence of dysphagia increased continuously from 7.14 in 2006 to 15.64 in 2016. The crude annual prevalence of dysphagia in 2006 was 0.09% and increased annually to 0.25% in 2016. Stroke (odds ratio [OR]: 7.86, 95% confidence interval [CI]: 5.76-6.68), neurodegenerative disease (OR: 6.20, 95% CI: 5.76-6.68), cancer (OR: 5.59, 95% CI: 5.17-6.06), and chronic obstructive pulmonary disease (OR: 2.94, 95% CI: 2.71-3.18) were associated with a high risk of dysphagia. The mortality in the dysphagia group was 3.12 times higher than that in the non-dysphagia group (hazard ratio: 3.12, 95% CI: 3.03-3.23). The incidence and prevalence of dysphagia requiring medical attention are increasing annually. The increasing trend was conspicuous in the geriatric population. The presence of stroke, neurodegenerative disease, cancer, and chronic obstructive pulmonary disease is associated with a high risk of dysphagia. Therefore, adequate screening, diagnosis, and management of dysphagia in the older population must be emphasized in geriatric healthcare.
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Affiliation(s)
- SuYeon Kwon
- Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, School of Medicine, Seoul, Republic of Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Junsik Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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Feng W, Plow EB, Paik NJ. Transcranial Magnetic Stimulation for Poststroke Motor Recovery: What We Have Learned. Stroke 2023. [PMID: 37345547 DOI: 10.1161/strokeaha.123.043536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Affiliation(s)
- Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC (W.F.)
| | - Ela B Plow
- Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Rehabilitation Hospitals, OH (E.B.P.)
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea (N.-J.P.)
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Kwon S, Kim G, Cha S, Han K, Paik NJ, Kim WS. Incidence of dysphagia requiring medical attention in various types of cancers: A nationwide population-based cohort study. Support Care Cancer 2023; 31:309. [PMID: 37115351 DOI: 10.1007/s00520-023-07778-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/25/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE Most previous reports on dysphagia in cancer have focused on specific cancer types, particularly head and neck cancer. Therefore, we aimed to investigate the incidence of dysphagia in patients with various cancers using a nationwide database in South Korea. METHODS This was a retrospective cohort study using the National Health Insurance Service database. Claim codes were used for the selection criteria and operational definitions. The total population data from 2010 to 2015 were extracted. The crude incidence of dysphagia was calculated per 1,000 person-years. The multivariate adjusted Cox proportional hazards regression was used to determine the effects of different cancers on the incidence of dysphagia. RESULTS People with cancer had a lower income and suffered from a higher risk of comorbidities compared to people without cancer. The risk of dysphagia increased in all types of cancers, particularly in the oral cavity and pharynx (hazard ratio [HR]: 20.65, 95% confidence interval [CI]: 17.73-24.06), esophagus (HR: 18.25, 95% CI: 15.66-21.26), larynx (HR: 12.87, 95% CI: 10.33-16.02), and central nervous system (HR: 12.42, 95% CI: 10.33-14.94). CONCLUSIONS The risk of dysphagia was significantly higher in the cancer group than in the non-cancer group. As the survival of cancer patients is improving with the development of new treatments, more attention should be paid to dysphagia in the management of cancer. Prompt and appropriate multidisciplinary interventions for dysphagia are necessary to improve the recovery and quality of life in cancer patients.
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Affiliation(s)
- SuYeon Kwon
- Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, School of Medicine, Seoul, Republic of Korea
| | - Gowun Kim
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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15
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Cha S, Chang WK, Cho HM, Han K, Paik NJ, Kwon S, Kim WS. Dysphagia Requiring Medical Attention in Parkinson's Disease: A Korean Population-Based Study. J Korean Med Sci 2023; 38:e114. [PMID: 37069809 PMCID: PMC10111039 DOI: 10.3346/jkms.2023.38.e114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/31/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) experience both motor and non-motor symptoms, including dysphagia. Although PD is closely associated with dysphagia, the prevalence or risk of dysphagia in PD is unclear, especially in Asian countries. METHODS The prevalence of PD and dysphagia with PD in the general population was analyzed using the Korean National Health Insurance Service (NHIS) database. The prevalence per 100,000 persons of PD and dysphagia with PD from 2006 to 2015 was analyzed in the general population aged ≥ 40 years. Patients newly diagnosed with PD between 2010 and 2015 were compared with those without PD. RESULTS The prevalence of PD and dysphagia in patients with PD increased continuously during the study period and was highest in the ninth decade of life. The percentage of patients with dysphagia in patients with PD increased with age. Patients with PD showed an adjusted hazard ratio of 3.132 (2.955-3.320) for dysphagia compared to those without PD. CONCLUSION This nationwide study showed increasing trends in the prevalence of PD and dysphagia among patients with PD in Korea between 2006 and 2015. The risk of dysphagia was three times higher in patients with PD than that in those without PD, highlighting the importance of providing particular attention.
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Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Mun Cho
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sohyun Kwon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Angerhöfer C, Vermehren M, Colucci A, Nann M, Koßmehl P, Niedeggen A, Kim WS, Chang WK, Paik NJ, Hömberg V, Soekadar SR. The Berlin Bimanual Test for Tetraplegia (BeBiTT): development, psychometric properties, and sensitivity to change in assistive hand exoskeleton application. J Neuroeng Rehabil 2023; 20:17. [PMID: 36707885 PMCID: PMC9881328 DOI: 10.1186/s12984-023-01137-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Assistive hand exoskeletons are promising tools to restore hand function after cervical spinal cord injury (SCI) but assessing their specific impact on bimanual hand and arm function is limited due to lack of reliable and valid clinical tests. Here, we introduce the Berlin Bimanual Test for Tetraplegia (BeBiTT) and demonstrate its psychometric properties and sensitivity to assistive hand exoskeleton-related improvements in bimanual task performance. METHODS Fourteen study participants with subacute cervical SCI performed the BeBiTT unassisted (baseline). Thereafter, participants repeated the BeBiTT while wearing a brain/neural hand exoskeleton (B/NHE) (intervention). Online control of the B/NHE was established via a hybrid sensorimotor rhythm-based brain-computer interface (BCI) translating electroencephalographic (EEG) and electrooculographic (EOG) signals into open/close commands. For reliability assessment, BeBiTT scores were obtained by four independent observers. Besides internal consistency analysis, construct validity was assessed by correlating baseline BeBiTT scores with the Spinal Cord Independence Measure III (SCIM III) and Quadriplegia Index of Function (QIF). Sensitivity to differences in bimanual task performance was assessed with a bootstrapped paired t-test. RESULTS The BeBiTT showed excellent interrater reliability (intraclass correlation coefficients > 0.9) and internal consistency (α = 0.91). Validity of the BeBiTT was evidenced by strong correlations between BeBiTT scores and SCIM III as well as QIF. Wearing a B/NHE (intervention) improved the BeBiTT score significantly (p < 0.05) with high effect size (d = 1.063), documenting high sensitivity to intervention-related differences in bimanual task performance. CONCLUSION The BeBiTT is a reliable and valid test for evaluating bimanual task performance in persons with tetraplegia, suitable to assess the impact of assistive hand exoskeletons on bimanual function.
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Affiliation(s)
- Cornelius Angerhöfer
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Mareike Vermehren
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Annalisa Colucci
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Marius Nann
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Koßmehl
- Kliniken Beelitz GmbH, Paracelsusring 6A, Beelitz-Heilstätten, 14547 Beelitz, Germany
| | - Andreas Niedeggen
- Kliniken Beelitz GmbH, Paracelsusring 6A, Beelitz-Heilstätten, 14547 Beelitz, Germany
| | - Won-Seok Kim
- grid.412480.b0000 0004 0647 3378Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620 Seongnam-si, Republic of Korea
| | - Won Kee Chang
- grid.412480.b0000 0004 0647 3378Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620 Seongnam-si, Republic of Korea
| | - Nam-Jong Paik
- grid.412480.b0000 0004 0647 3378Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Gyeonggi-do 13620 Seongnam-si, Republic of Korea
| | - Volker Hömberg
- SRH Gesundheitszentrum Bad Wimpfen GmbH, Bad Wimpfen, Germany
| | - Surjo R. Soekadar
- grid.6363.00000 0001 2218 4662Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Neurowissenschaftliches Forschungszentrum (NWFZ), Charité-Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117 Berlin, Germany
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Song K, Choi S, Shin JH, Lee H, Paik NJ. Digital Biomarkers for Diagnosis of Muscle Disorders Using Stimulated Muscle Contraction Signal. IEEE Trans Neural Syst Rehabil Eng 2023; PP. [PMID: 37028069 DOI: 10.1109/tnsre.2023.3250641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
We propose a digital biomarker related to muscle strength and muscle endurance (DB/MS and DB/ME) for the diagnosis of muscle disorders based on a multi-layer perceptron (MLP) using stimulated muscle contraction. When muscle mass is reduced in patients with muscle-related diseases or disorders, measurement of DBs that are related to muscle strength and endurance is needed to suitably recover damaged muscles through rehabilitation training. Furthermore, it is difficult to measure DBs using traditional methods at home without an expert; moreover, the measuring equipment is expensive. Additionally, because traditional measurements depend on the subject's volition, we propose a DB measurement technique that is unaffected by the subject's volition. To achieve this, we employed an impact response signal (IRS) based on multi-frequency electrical stimulation (MFES) using an electromyography sensor. The feature vector was then extracted using the signal. Because the IRS is obtained from stimulated muscle contraction, which is caused by electrical stimulation, it provides biomedical information about the muscle. Finally, to estimate the strength and endurance of the muscle, the feature vector was passed through the DB estimation model learned through the MLP. To evaluate the performance of the DB measurement algorithm, we collected the MFES-based IRS database for 50 subjects and tested the model with quantitative evaluation methods using the reference for the DB. The reference was measured using torque equipment. The results were compared with the reference, indicating that it is possible to check for muscle disorders which cause decreased physical performance using the proposed algorithm.
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Affiliation(s)
- Kwangsub Song
- Research and Development Center of Exosystems, Seongnam, Republic of Korea
| | - Sangui Choi
- Research and Development Center of Exosystems, Seongnam, Republic of Korea
| | - Jin-Hong Shin
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hooman Lee
- Research and Development Center of Exosystems, Seongnam, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Platz T, Paik NJ, Good D, Sandrini G. Editorial: COVID-19: the neurorehabilitation perspective. Front Neurol 2023; 14:1189295. [PMID: 37188303 PMCID: PMC10175765 DOI: 10.3389/fneur.2023.1189295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- Thomas Platz
- BDH-Klinik Greifswald, Institute for Neurorehabilitation and Evidence-Based Practice, An-Institut, University of Greifswald, Greifswald, Germany
- Neurorehabilitation Research Group, University Medical Centre, Greifswald, Germany
- Special Interest Group Clinical Pathways, World Federation for Neurorehabilitation, North Shields, United Kingdom
- *Correspondence: Thomas Platz
| | - Nam-Jong Paik
- Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - David Good
- Penn State Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Giorgio Sandrini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Cho HM, Kim H, Jang J, Cha S, Chang WK, Jung BK, Park DS, Jee S, Ko SH, Shin JH, Kim WS, Paik NJ. Attitude Toward Telerehabilitation Among Physical and Occupational Therapists in Korea: A Brief Descriptive Report. Brain Neurorehabil 2023; 16:e8. [PMID: 37033001 PMCID: PMC10079478 DOI: 10.12786/bn.2023.16.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
The attitude toward telerehabilitation (TR) among therapists (191 physical therapists and 159 occupational therapists) in Korea was surveyed. The survey consisted of 15 questions in the following 8 domains: awareness(AW), attitude (AT), perceived usefulness (PU), perceived behavioral control (PBC), self-efficacy (SE), facilitating conditions (FC), barriers (B), and behavioral intention (BI). Therapists with experience in TR responded with higher scores in all domains except B, regardless of their specialty. The most perceived barriers to TR were unmatched insurance fees and a lack of technical support. Experience with TR was a major factor in attitude and behavior intention toward TR.
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Affiliation(s)
- Hee-Mun Cho
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyunji Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jihee Jang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bong-Keun Jung
- Department of Mechanical Engineering, Seoul National University College of Engineering, Seoul, Korea
| | - Dae-Sung Park
- Department of Physical Therapy, Konyang University, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan, Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Colucci A, Vermehren M, Cavallo A, Angerhöfer C, Peekhaus N, Zollo L, Kim WS, Paik NJ, Soekadar SR. Brain-Computer Interface-Controlled Exoskeletons in Clinical Neurorehabilitation: Ready or Not? Neurorehabil Neural Repair 2022; 36:747-756. [PMID: 36426541 PMCID: PMC9720703 DOI: 10.1177/15459683221138751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The development of brain-computer interface-controlled exoskeletons promises new treatment strategies for neurorehabilitation after stroke or spinal cord injury. By converting brain/neural activity into control signals of wearable actuators, brain/neural exoskeletons (B/NEs) enable the execution of movements despite impaired motor function. Beyond the use as assistive devices, it was shown that-upon repeated use over several weeks-B/NEs can trigger motor recovery, even in chronic paralysis. Recent development of lightweight robotic actuators, comfortable and portable real-world brain recordings, as well as reliable brain/neural control strategies have paved the way for B/NEs to enter clinical care. Although B/NEs are now technically ready for broader clinical use, their promotion will critically depend on early adopters, for example, research-oriented physiotherapists or clinicians who are open for innovation. Data collected by early adopters will further elucidate the underlying mechanisms of B/NE-triggered motor recovery and play a key role in increasing efficacy of personalized treatment strategies. Moreover, early adopters will provide indispensable feedback to the manufacturers necessary to further improve robustness, applicability, and adoption of B/NEs into existing therapy plans.
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Affiliation(s)
- Annalisa Colucci
- Clinical Neurotechnology Laboratory, Neurowissenschaftliches Forschungszentrum (NWFZ), Department of Psychiatry and Neurosciences, Charité Campus Mitte (CCM), Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Mareike Vermehren
- Clinical Neurotechnology Laboratory, Neurowissenschaftliches Forschungszentrum (NWFZ), Department of Psychiatry and Neurosciences, Charité Campus Mitte (CCM), Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Alessia Cavallo
- Clinical Neurotechnology Laboratory, Neurowissenschaftliches Forschungszentrum (NWFZ), Department of Psychiatry and Neurosciences, Charité Campus Mitte (CCM), Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Cornelius Angerhöfer
- Clinical Neurotechnology Laboratory, Neurowissenschaftliches Forschungszentrum (NWFZ), Department of Psychiatry and Neurosciences, Charité Campus Mitte (CCM), Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Niels Peekhaus
- Clinical Neurotechnology Laboratory, Neurowissenschaftliches Forschungszentrum (NWFZ), Department of Psychiatry and Neurosciences, Charité Campus Mitte (CCM), Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Loredana Zollo
- Unit of Advanced Robotics and Human-Centred Technologies (CREO Lab), University Campus Bio-Medico of Rome, Roma RM, Italy
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Surjo R. Soekadar
- Clinical Neurotechnology Laboratory, Neurowissenschaftliches Forschungszentrum (NWFZ), Department of Psychiatry and Neurosciences, Charité Campus Mitte (CCM), Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany,Surjo R. Soekadar, Charité Universitatsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany.
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Brady MC, Ali M, VandenBerg K, Williams LJ, Williams LR, Abo M, Becker F, Bowen A, Brandenburg C, Breitenstein C, Bruehl S, Copland DA, Cranfill TB, Pietro-Bachmann MD, Enderby P, Fillingham J, Lucia Galli F, Gandolfi M, Glize B, Godecke E, Hawkins N, Hilari K, Hinckley J, Horton S, Howard D, Jaecks P, Jefferies E, Jesus LMT, Kambanaros M, Kyoung Kang E, Khedr EM, Pak-Hin Kong A, Kukkonen T, Laganaro M, Lambon Ralph MA, Charlotte Laska A, Leemann B, Leff AP, Lima RR, Lorenz A, MacWhinney B, Shisler Marshall R, Mattioli F, Maviş İ, Meinzer M, Nilipour R, Noé E, Paik NJ, Palmer R, Papathanasiou I, Patricio B, Pavão Martins I, Price C, Prizl Jakovac T, Rochon E, Rose ML, Rosso C, Rubi-Fessen I, Ruiter MB, Snell C, Stahl B, Szaflarski JP, Thomas SA, van de Sandt-Koenderman M, van der Meulen I, Visch-Brink E, Worrall L, Harris Wright H. Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis. Int J Stroke 2022; 17:1067-1077. [PMID: 35422175 PMCID: PMC9679795 DOI: 10.1177/17474930221097477] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/01/2022] [Indexed: 09/19/2023]
Abstract
BACKGROUND Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. AIM We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. METHODS MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. RESULTS 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. CONCLUSIONS We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.
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Affiliation(s)
| | - Marian C Brady
- Marian C Brady, NMAHP Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
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Lee J, Chun MH, Ko YJ, Lee SU, Kim DY, Paik NJ. Safety and efficacy of MT10107 in post-stroke upper limb spasticity treatment: A phase I randomized controlled trial. Medicine (Baltimore) 2022; 101:e31367. [PMID: 36343044 PMCID: PMC9646656 DOI: 10.1097/md.0000000000031367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Botulinum toxin type A injection is widely used treatment option for the treatment of upper limb spasticity in stroke patients. The purpose of this study was to explore the safety and efficacy of MT10107, a new botulinum toxin type A, in patients with post-stroke upper limb spasticity. METHODS A prospective, randomized, double-blind, active drug-controlled, multi-center, phase I clinical trial. Thirty patients with post-stroke upper limb spasticity were received either MT10107 or onabotulinumtoxinA. Primary endpoint was change of modified Ashworth scale (MAS) score for wrist flexor from baseline to week 4. The secondary endpoints were changes of MAS scores for elbow and finger flexors, response rate, Disability Assessment Scale (DAS), and global assessment of treatment. The safety endpoints such as adverse events, vital signs, physical examination, and laboratory test were evaluated. The outcome measures were evaluated from baseline to week 4. RESULTS The primary endpoints were -1.07 ± 0.70 and -1.23 ± 0.56 for the MT10107 and onabotulinumtoxinA groups, respectively. The intergroup difference of change between the 2 groups was 0.17 (95% confidence interval -0.31 to 0.64, P = .5769). In secondary endpoints, both groups showed a significant improvement in both MAS and DAS. There was no significant between-group difference in all secondary endpoints and safety measures. CONCLUSION The safety and efficacy of MT10107 showed no significant difference compared to onabotulinumtoxinA in post-stroke upper limb spasticity treatment.
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Affiliation(s)
- Junekyung Lee
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Jin Ko
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Cha S, Chang WK, Cho HM, Jung YS, Kang M, Paik NJ, Kim WS. The effect of a telephone-based intervention on physical activity after stroke. PLoS One 2022; 17:e0276316. [PMID: 36264990 PMCID: PMC9584526 DOI: 10.1371/journal.pone.0276316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/05/2022] [Indexed: 11/18/2022] Open
Abstract
Despite the effectiveness of telephone-based interventions for medical adherence and improved blood pressure, studies on the effect of such interventions on physical activity (PA) are needed. Therefore, we investigated the impact of a telephone-based intervention on PA in patients with subacute stroke. This pre-post study included patients who participated in an education program for stroke rehabilitation before being discharged to home, with a modified Rankin scale (mRS) score of ≤ 3. Patients hospitalized in 2020 (intervention group) received a nurse-led telephone-based intervention with a PA measurement once monthly during the 3 months after discharge. Those hospitalized in 2019 (historical controls) only received a PA measurement 3 months after discharge. Physical activity was assessed via a questionnaire by phone. In addition, demographics, medical history, smoking, mRS scores, and Patient Health Questionnaire-9 data were collected. The study included 139 participants (73 in intervention, 66 in control). The intervention group had a higher proportion of patients with mRS of 0-1 and a shorter length of hospital stay than the historical controls. Three months post-discharge, a significantly higher proportion of participants were physically active in the intervention group (48 [71.6%] vs. control group, 25 [34.7%]). In addition, the intervention group had a significantly higher median energy expenditure (924 vs. 297 MET-min/week) than the control group. The OR of the intervention for achieving 'physically active' individuals was 4.749 (95% CI, 2.313-9.752) before and 5.222 (95% CI, 1.892-14.419) after adjusting for possible confounders. A telephone-based intervention improved PA three months after stroke. Further studies with larger sample size and long-term follow-up are needed.
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Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Mun Cho
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun-Sun Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Miji Kang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
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Cha S, Grace SL, Han K, Kim B, Paik NJ, Kim WS. Editor's Choice - Effect of Physical Activity and Tobacco Use on Mortality and Morbidity in Patients with Peripheral Arterial Disease After Revascularisation: A Korean Nationwide Population Based Cohort Study. Eur J Vasc Endovasc Surg 2022; 64:417-426. [PMID: 35671938 DOI: 10.1016/j.ejvs.2022.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 05/16/2022] [Accepted: 05/29/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the effects of physical activity (PA) and tobacco use on adverse clinical outcomes after revascularisation for peripheral arterial disease (PAD) in the Western Pacific region, where PAD cases and tobacco use are among the highest in the world. METHODS This was a retrospective cohort study using the Korean National Health Insurance Service (NHIS) database and included patients who had received revascularisation for PAD between 2010 and 2015. They were categorised as active or inactive based on the number of days per week they engaged in PA and as current or non-tobacco users (self report). The primary outcome was all cause mortality. Secondary outcomes included major adverse outcome (a composite of all cause mortality, myocardial infarction, and stroke) and major adverse limb event (MALE, a composite of amputation and recurrent revascularisation). RESULTS The relatively healthy cohort comprised 8 324 patients (mean age 64.7 years; 76.9% male) following revascularisation for PAD. Among them, 32.7% were inactive and 26.4% were tobacco users. Active patients had better outcomes than inactive patients (all cause mortality adjusted hazard ratio [adjHR] 0.766; 95% CI 0.685 - 0.855, major adverse outcome adjHR 0.795; 95% CI 0.719 - 0.878, MALE adjHR 0.858; 95% CI 0.773 - 0.953). Tobacco users had poorer outcomes than non-users (all cause mortality adjHR 1.279; 95% CI 1.124 - 1.456, major adverse outcome adjHR 1.263; 95% CI 1.124 - 1.418, MALE adjHR 1.291; 95% CI 1.143 - 1.458). CONCLUSION Even after receiving revascularisation for PAD, a sizable proportion of patients were physically inactive and used tobacco, leading to adverse clinical outcomes such as death, cardiovascular morbidity, and amputation in Korea. These modifiable risk factors should be addressed systematically, and a comprehensive approach including supervised exercise programmes and tobacco cessation is needed in patients with PAD.
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Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sherry L Grace
- York University & the University Health Network, Toronto, Canada
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Cha S, Jeong B, Choi M, Kwon S, Lee SH, Paik NJ, Kim WS, Han CE. White matter tracts involved in subcortical unilateral spatial neglect in subacute stroke. Front Neurol 2022; 13:992107. [PMID: 36247754 PMCID: PMC9561922 DOI: 10.3389/fneur.2022.992107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundUnilateral spatial neglect (USN) is common and associated with poor motor and cognitive outcomes as well as impaired quality of life following stroke. Traditionally, the neural substrates underlying USN have been thought to be cortical areas, such as the posterior parietal cortex. However, patients with stroke involving only subcortical structures may also present with USN. While only a few studies have reported on USN in subcortical stroke, the involvement of white matter tracts related to brain networks of visuospatial attention is one possible explanation for subcortical neglect. Therefore, this study aimed to investigate which specific white matter tracts are neural substrates for USN in patients with subcortical stroke.MethodsTwenty-two patients with subcortical stroke without cortical involvement who were admitted to the Department of Rehabilitation Medicine at Seoul National University Bundang Hospital were retrospectively enrolled. Nine subjects were subclassified into a “USN(+)” group, as they had at least two positive results on three tests (the Schenkenberg line bisection test, Albert's test, and house drawing test) and a score of 1 or higher on the Catherine Bergego scale. The remaining 13 subjects without abnormalities on those tests were subclassified into the “USN(–)” group. Stroke lesions on MRI were manually drawn using MRIcron software. Lesion overlapping and atlas-based analyses of MRI images were conducted. The correlation was analyzed between the overlapped lesion volumes with white matter tracts and the severity of USN (in the Albert test and the Catherine Bergego scale).ResultsLesions were more widespread in the USN(+) group than in the USN(–) group, although their locations in the right hemisphere were similar. The atlas-based analyses identified that the right cingulum in the cingulate cortex, the temporal projection of the superior longitudinal fasciculus, and the forceps minor significantly overlapped with the lesions in the USN(+) group than in the USN(–) group. The score of the Catherine Bergego scale correlated with the volume of the involved white matter tracts.ConclusionIn this study, white matter tracts associated with USN were identified in patients with subcortical stroke without any cortical involvement. Our study results, along with previous findings on subcortical USN, support that USN may result from damage to white matter pathways.
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Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - ByeongChang Jeong
- Department of Electronics and Information Engineering, Korea University, Sejong, South Korea
- Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, South Korea
| | - Myungwon Choi
- Department of Electronics and Information Engineering, Korea University, Sejong, South Korea
| | - Sohyun Kwon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Stephanie Hyeyoung Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Won-Seok Kim
| | - Cheol E. Han
- Department of Electronics and Information Engineering, Korea University, Sejong, South Korea
- Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, South Korea
- *Correspondence: Cheol E. Han
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Lim CY, Ko MJ, Lee JW, Bok SK, Paik NJ, Nam YG, Kwon BS. Efficacy and safety of EXOWALK® on electromechanical-assisted gait training: study protocol for randomized controlled trial. Trials 2022; 23:729. [PMID: 36056399 PMCID: PMC9438256 DOI: 10.1186/s13063-022-06660-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background High-intensity repetitive task-specific practice might be the most effective strategy to promote motor recovery after stroke, and electromechanical-assisted gait training represents one of the treatment options. However, there is still difficulty in clarifying the difference between conventional gait training and electromechanically assisted gait training. Methods The study is a multicenter, randomized, parallel-group clinical trial for stroke patients. Three clinical research centers in Korea (Dongguk University Ilsan Hospital, Chungnam National University Hospital, and Seoul National University Bundang Hospital) will participate in the clinical trial and 144 stroke patients will be registered. Enrolled patients are assigned to two groups, an experimental group and a control group, according to a randomization table. In addition, patients are treated for half an hour (one session) five times a week for 4 weeks. Both groups carry out basic rehabilitation (central nervous system development therapy and strength exercise) and the experimental group executes robotic walking rehabilitation treatment, and the control group executes conventional gait rehabilitation treatment. The primary endpoint variable is the Functional Ambulation Category (FAC) that determines the degree of independent walking and is measured before, after, and after 4 weeks of treatment. Secondary endpoint variables are 11 variables that take into account motor function and range, measured at the same time as the primary endpoint variable. Discussion There are still insufficient data on the effectiveness of electromechanical-assisted gait training for stroke patients and large-scale research is lacking. Thus, the research described here is a large-scale study of stroke patients that can supplement the limitations mentioned in other previous studies. In addition, the clinical studies described here include physical epidemiological analysis parameters that can determine walking ability. The results of this study can lead to prove the generalizable effectiveness and safety of electromechanical-assisted gait training with EXOWALK®. Trial registration Clinical Research Information Service (CRIS), Republic of Korea KCT0003411, Registered on 30 October 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06660-8.
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Affiliation(s)
- Chi-Yeon Lim
- Department of Biostatistics, School of Medicine, Dongguk University, Goyang, South Korea
| | | | | | - Soo Kyung Bok
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chungnam, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yeon Gyo Nam
- Dongguk University Posture Science Institute, Dongguk University College of Medicine, Goyang, South Korea
| | - Bum Sun Kwon
- Dongguk University Posture Science Institute, Dongguk University College of Medicine, Goyang, South Korea. .,Department of Rehabilitation Medicine, Dongguk University College of Medicine, Goyang, South Korea.
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Leigh JH, Kim WS, Sohn DG, Chang WK, Paik NJ. Transitional and Long-Term Rehabilitation Care System After Stroke in Korea. Front Neurol 2022; 13:786648. [PMID: 35432175 PMCID: PMC9008335 DOI: 10.3389/fneur.2022.786648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Stroke is one of the leading causes of mortality and disability in Korea. Patients who experience stroke require adequate management throughout the acute to subacute and chronic stages. Many patients with long-term functional issues require rehabilitative management even in the chronic stage. A comprehensive rehabilitation and care model for patients who experience stroke is necessary to effectively manage their needs during rehabilitation and allocate medical resources throughout the stages, thus ensuring reduced unmet needs and improved post-stroke quality of life. In Korea, the government and medical specialists are working on re-organizing the rehabilitation care model, including standardized triage and discharge planning after acute stroke treatment, and establishing systematic transitional and long-term rehabilitation care plans. This review briefly introduces the general rehabilitation triage after acute stroke and describes the current transitional and continuous care systems available for these patients in Korea. We also present the issues faced in transitional and long-term care plans of the current system and the efforts invested in resolving them and promoting long-term care in stroke cases.
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Affiliation(s)
- Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong-gun, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong-Gyun Sohn
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
- Medical Rehabilitation Center, Korea Workers' Compensation Welfare Service Incheon Hospital, Incheon, South Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Jee S, Jeong M, Paik NJ, Kim WS, Shin YI, Ko SH, Kwon IS, Choi BM, Jung Y, Chang W, Sohn MK. Early Supported Discharge and Transitional Care Management After Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:755316. [PMID: 35370909 PMCID: PMC8965290 DOI: 10.3389/fneur.2022.755316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the available evidence on early supported discharge (ESD) and transitional care (TC) delivery service in patients with cerebrovascular disease. Methods A systematic literature search was conducted to collect all available evidence on the use of ESD and TC services. We included cluster-randomized pragmatic trials or randomized controlled trials (RCTs) that recruited patients with stroke or transient ischemic attack to receive either conventional care or any care service intervention that included rehabilitation or support provided by professional medical personnel with the aim of accelerating and supporting home discharge. Relevant data were electronically searched through international databases (Cochrane Library, EMBASE, and PubMed) and incorporated into a summary grid to investigate research outcomes and provide a narrative synthesis. Furthermore, we compared the outcomes in terms of length of hospital stay, patient and caregiver outcomes, and mortality through meta-analysis. Results We identified and included a total of 20 publications of various original randomized studies. There were 18 studies conducted in western countries and 2 in eastern countries. The meta-analysis revealed a tendency that ESD or TC could decrease the length of hospital stay more than the usual care [standardized mean difference (SMD) -0.13; 95% confidence interval (CI) -0.31 to 0.04 days; P = 0.14]. Moreover, there was a tendency that ESD resulted in better activities of daily living (ADL) than usual care (SMD 0.29; 95% CI -0.04 to 0.61; P = 0.08). Patient outcome based on modified Rankin scale (mRS) score (SMD -0.11; 95% CI -0.38 to 0.17; P = 0.45] and mortality (odds ratio 0.80; 95% CI 0.56-1.17; P = 0.25) did not reveal any significant difference. The Caregiver Strain Index revealed no difference. Conclusion We did not find a large effect size for the use of TC and ESD. When implementing the TC and ESD model from western to Asian countries, services should be prepared and implemented in accordance with national medical rehabilitation pathways for cerebrovascular disease.
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Affiliation(s)
- Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea
| | - Minah Jeong
- Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, South Korea
| | - Bo Mi Choi
- Department of Public Health and Medical Services, Chungnam National University Hospital, Daejeon, South Korea
| | - Yunsun Jung
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Wonkee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital and Chungnam National University College of Medicine, Daejeon, South Korea
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Chang WK, Park J, Lee JY, Cho S, Lee J, Kim WS, Paik NJ. Functional Network Changes After High-Frequency rTMS Over the Most Activated Speech-Related Area Combined With Speech Therapy in Chronic Stroke With Non-fluent Aphasia. Front Neurol 2022; 13:690048. [PMID: 35222235 PMCID: PMC8866644 DOI: 10.3389/fneur.2022.690048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 01/12/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) to the lesional hemisphere requires prudence in selecting the appropriate stimulation spot. Functional near-IR spectroscopy (fNIRS) can be used in both selecting the stimulation spot and assessing the changes of the brain network. This study aimed to evaluate the effect of HF-rTMS on the most activated spot identified with fNIRS and assess the changes of brain functional network in the patients with poststroke aphasia. METHODS A total of five patients received HF-rTMS to the most activated area on the lesional hemisphere, followed by 30 min of speech therapy for 10 days. The Korean version of the Western aphasia battery (K-WAB) and fNIRS evaluation were done 1 day before the treatment, 1 day and 1 month after the last treatment session. Changes of K-WAB and paired cortical interaction and brain network analysis using graph theory were assessed. RESULTS Aphasia quotient in K-WAB significantly increased after the treatment (P = 0.043). The correlation analysis of cortical interactions showed increased connectivity between language production and processing areas. Clustering coefficients of the left hemisphere were increased over a sparsity range between 0.45 and 0.58 (0.015 < p < 0.031), whereas the clustering coefficients of the right hemisphere, decreased over a sparsity range 0.15-0.87 (0.063 < p < 0.095). The global efficiency became lower over a network sparsity range between 0.47 and 0.75 (0.015 < p < 0.063). CONCLUSION Improvement of language function and changes of corticocortical interaction between language-related cortical areas were observed after HF-rTMS on the most activated area identified by fNIRS with combined speech therapy in the patients with poststroke aphasia.
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Affiliation(s)
| | | | | | | | | | | | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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Kim KT, Chang WK, Jung YS, Jee S, Sohn MK, Ko SH, Shin YI, Leigh JH, Kim WS, Paik NJ. Unmet Needs for Rehabilitative Management in Common Health-Related Problems Negatively Impact the Quality of Life of Community-Dwelling Stroke Survivors. Front Neurol 2022; 12:758536. [PMID: 35002922 PMCID: PMC8733320 DOI: 10.3389/fneur.2021.758536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 12/07/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose: Community-dwelling stroke survivors have various unmet needs for rehabilitative management, but there is a lack of in-depth investigations on common health problems after stroke. Moreover, the association between unmet needs and health-related quality of life (HRQoL) has not been thoroughly investigated. This study aimed to investigate the unmet needs for rehabilitative management in common problems after stroke and their associations with HRQoL among community-dwelling stroke survivors. Methods: A face-to-face cross-sectional survey was conducted among community-dwelling stroke survivors visiting outpatient clinics of rehabilitation departments between June and October 2020 in three university-affiliated hospitals. Unmet needs for common problems after stroke were assessed across eight domains based on the post-stroke checklist: spasticity, dysphagia, communication, cognition, ambulation, pain/discomfort, anxiety/depression, and self-care. HRQoL was measured using the EuroQoL-5D three level (EQ-5D). The prevalence of unmet needs for rehabilitative management and their associations with the EQ-5D index were analyzed. Results: Among the 239 participants who responded to the survey, 63% (n = 150) were men. The mean age was 63 ± 13 years, and the mean duration of stroke onset was 55.6 months. Overall, 49% reported at least one unmet need, and the most frequently reported unmet needs were anxiety/depression (20.9%), self-care (20.9%), and pain/discomfort (18.0%). The highest proportion of unmet needs was in the anxiety/depression, communication, and cognition domains. Patients with unmet needs for cognition and pain/discomfort showed a significantly lower EQ-5D index, even after adjusting for age, sex, and modified Rankin scale scores. The total number of unmet needs was significantly correlated with a lower EQ-5D index (Pearson's r = -0.329, p < 0.001) in the multivariate linear regression model. Conclusions: Unmet rehabilitative needs are prevalent among community-dwelling stroke survivors, and the proportion of unmet needs was high among non-physical domains such as anxiety/depression. The number of unmet needs is an independent negative predictor of HRQoL. Systematic approaches to identify unmet needs and provide appropriate rehabilitative management are required in long-term stroke survivors.
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Affiliation(s)
- Kyoung Tae Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.,Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yun-Sun Jung
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chugnam National University Hospital, Daejeon, South Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chugnam National University Hospital, Daejeon, South Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea.,National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Choi GY, Han CH, Lee HT, Paik NJ, Kim WS, Hwang HJ. An artificial neural-network approach to identify motor hotspot for upper-limb based on electroencephalography: a proof-of-concept study. J Neuroeng Rehabil 2021; 18:176. [PMID: 34930380 PMCID: PMC8686235 DOI: 10.1186/s12984-021-00972-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background To apply transcranial electrical stimulation (tES) to the motor cortex, motor hotspots are generally identified using motor evoked potentials by transcranial magnetic stimulation (TMS). The objective of this study is to validate the feasibility of a novel electroencephalography (EEG)-based motor-hotspot-identification approach using a machine learning technique as a potential alternative to TMS. Methods EEG data were measured using 63 channels from thirty subjects as they performed a simple finger tapping task. Power spectral densities of the EEG data were extracted from six frequency bands (delta, theta, alpha, beta, gamma, and full) and were independently used to train and test an artificial neural network for motor hotspot identification. The 3D coordinate information of individual motor hotspots identified by TMS were quantitatively compared with those estimated by our EEG-based motor-hotspot-identification approach to assess its feasibility. Results The minimum mean error distance between the motor hotspot locations identified by TMS and our proposed motor-hotspot-identification approach was 0.22 ± 0.03 cm, demonstrating the proof-of-concept of our proposed EEG-based approach. A mean error distance of 1.32 ± 0.15 cm was measured when using only nine channels attached to the middle of the motor cortex, showing the possibility of practically using the proposed motor-hotspot-identification approach based on a relatively small number of EEG channels. Conclusion We demonstrated the feasibility of our novel EEG-based motor-hotspot-identification method. It is expected that our approach can be used as an alternative to TMS for motor hotspot identification. In particular, its usability would significantly increase when using a recently developed portable tES device integrated with an EEG device.
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Affiliation(s)
- Ga-Young Choi
- Department of Electronics and Information Engineering, Korea University, Sejong, 30019, Republic of Korea
| | - Chang-Hee Han
- Department of Software, College of Software Convergence, Dongseo University, Busan, 47011, South Korea
| | - Hyung-Tak Lee
- Department of Electronics and Information Engineering, Korea University, Sejong, 30019, Republic of Korea.,Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, 30019, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, 13620, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, 13620, Republic of Korea.
| | - Han-Jeong Hwang
- Department of Electronics and Information Engineering, Korea University, Sejong, 30019, Republic of Korea. .,Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, 30019, South Korea.
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Affiliation(s)
- Annie J Hill
- School of Health and Rehab Sciences, The University of Queensland and Surgical, Treatment and Rehabilitation Service, Metro North Health, Herston, QLD, Australia
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Swathi Kiran
- Speech, Language and Hearing Sciences, College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, United States
| | - Paolo Tonin
- Department of Neurorehabilitation, Sant'Anna Institute, Crotone, Italy
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Chang WK, Kim WS, Sohn MK, Jee S, Shin YI, Ko SH, Ock M, Kim HJ, Paik NJ. Korean Model for Post-acute Comprehensive rehabilitation (KOMPACT): The Study Protocol for a Pragmatic Multicenter Randomized Controlled Study on Early Supported Discharge. Front Neurol 2021; 12:710640. [PMID: 34566853 PMCID: PMC8455937 DOI: 10.3389/fneur.2021.710640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Early supported discharge (ESD) is a transitional care model aimed at facilitating post-acute stroke patients' discharge to home. Previous studies have demonstrated that ESD provides equivalent patient and caregiver outcomes with superior cost-effectiveness compared to conventional rehabilitation (CR). This study intends to examine the feasibility of ESD in Korea. Methods and Analysis: This study is designed as a multicenter assessor-blinded, randomized controlled trial. Ninety post-acute stroke patients with mild to moderate disability (modified Rankin Scale 1–3) will be recruited from three university hospitals (30 patients per hospital) in Korea and allocated to either the ESD group or the CR group in a 1:1 ratio. Patients in the ESD group will receive individualized discharge planning and goal setting, a 4-week home-based rehabilitation program, and liaison service to community-based resources by a multidisciplinary team. Patients in the CR group will receive rehabilitation practices according to their current hospital policy. Outcomes: The primary outcome is the Korean version of the modified Barthel Index, and the primary endpoint was post-onset 3 months. Clinical outcomes, patient/caregiver reported outcomes, and socioeconomic outcomes will be measured at baseline, 1 month after discharge, 2 months after discharge, and 3 months after onset. Discussion: The efficacy and cost-effectiveness of ESD can vary according to the healthcare system and sociocultural aspects. To establish ESD as an alternative transitional care model for post-acute stroke patients in Korea, its feasibility needs to be examined in prior. This study will add evidence on the applicability of ESD in Korea. Ethical Considerations: The study protocol was reviewed and approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB number B-2012/654-308). The study protocol was registered at ClinicalTrials.gov (Identifier NCT04720820). Disseminations will include submission to peer-reviewed journals and presentations at conferences.
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Affiliation(s)
- Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chugnam National University Hospital, Daejeon, South Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Chugnam National University Hospital, Daejeon, South Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Choi YH, Kim DH, Paik NJ, Park J. Long-term analgesic effects of peripheral nerve block in patients with central post-stroke pain: A retrospective series. Pain Pract 2021; 21:843-849. [PMID: 33991164 DOI: 10.1111/papr.13031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Central post-stroke pain (CPSP) has a detrimental effect on the quality of life of post-stroke patients. However, no definitive and effective method has been established yet for the treatment of CPSP. OBJECTIVE We aimed to examine the applicability of single-injection peripheral nerve blocks (PNBs) for the treatment of CPSP. SUBJECTS In this retrospective study, we included 22 patients (mean age = 56.3 years; 13 men and 9 women) diagnosed with CPSP who visited an outpatient rehabilitation clinic in Seoul National University Bundang Hospital between December 2018 and April 2020. METHODS The patients underwent ultrasound-guided single-injection PNB (lidocaine + epinephrine [1: 200,000]) according to the primary site of pain. The level of pain (measured using a numeric rating scale) was recorded before and after the PNB, and the occurrence of adverse events were also measured. The primary outcome of this study was the amount of pain reduction after PNB. Secondary outcome measures obtained 1 month after the PNB included the pain reduction rate 1 month after the PNB, the patient-reported satisfaction and effectiveness regarding the PNB, intention for re-injection, and the patients' willingness to recommend this procedure to others. RESULTS The mean pain reduction after PNB was 3.3 ± 2.8. PNB was associated with pain reduction that persisted for greater than 1 month in 68% (15/22) of the patients. Thirteen of 22 patients reported a pain reduction of 50% or more. The mean pain reduction rate was 43.6%. Of the 22 patients, 13 were willing to undergo a second round of treatment with PNB. Nine of them underwent the procedure. No adverse events were observed in this study. CONCLUSIONS Our study provides preliminary data suggesting that PNB could be an effective and feasible method to treat CPSP.
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Affiliation(s)
- Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital Seoul, Seoul, South Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jihong Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Oh K, Park J, Jo SH, Hong SJ, Kim WS, Paik NJ, Park HS. Improved cortical activity and reduced gait asymmetry during poststroke self-paced walking rehabilitation. J Neuroeng Rehabil 2021; 18:60. [PMID: 33849557 PMCID: PMC8042685 DOI: 10.1186/s12984-021-00859-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background For patients with gait impairment due to neurological disorders, body weight-supported treadmill training (BWSTT) has been widely used for gait rehabilitation. On a conventional (passive) treadmill that runs at a constant speed, however, the level of patient engagement and cortical activity decreased compared with gait training on the ground. To increase the level of cognitive engagement and brain activity during gait rehabilitation, a self-paced (active) treadmill is introduced to allow patients to actively control walking speed, as with overground walking. Methods To validate the effects of self-paced treadmill walking on cortical activities, this paper presents a clinical test with stroke survivors. We hypothesized that cortical activities on the affected side of the brain would also increase during active walking because patients have to match the target walking speed with the affected lower limbs. Thus, asymmetric gait patterns such as limping or hobbling might also decrease during active walking. Results Although the clinical test was conducted in a short period, the patients showed higher cognitive engagement, improved brain activities assessed by electroencephalography (EEG), and decreased gait asymmetry with the self-paced treadmill. As expected, increases in the spectral power of the low γ and β bands in the prefrontal cortex (PFC), premotor cortex (PMC), and supramarginal gyrus (SG) were found, which are possibly related to processing sensory data and planning voluntary movements. In addition, these changes in cortical activities were also found with the affected lower limbs during the swing phase. Since our treadmill controller tracked the swing speed of the leg to control walking speed, such results imply that subjects made substantial effort to control their affected legs in the swing phase to match the target walking speed. Conclusions The patients also showed reduced gait asymmetry patterns. Based on the results, the self-paced gait training system has the potential to train the symmetric gait and to promote the related cortical activities after stroke. Trial registration Not applicable
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Affiliation(s)
- Keonyoung Oh
- Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Jihong Park
- Department of Rehabilitation, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Seong Hyeon Jo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Seong-Jin Hong
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.
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Kim WS, Paik NJ. Safety Review for Clinical Application of Repetitive Transcranial Magnetic Stimulation. Brain Neurorehabil 2021; 14:e6. [PMID: 36742107 PMCID: PMC9879417 DOI: 10.12786/bn.2021.14.e6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/09/2021] [Indexed: 11/08/2022] Open
Abstract
Studies using repetitive transcranial magnetic stimulation (rTMS) in healthy individuals and those with neuropsychiatric diseases have rapidly increased since the 1990s, due to the potential of rTMS to modulate the cortical excitability in the brain depending on the stimulation parameters; therefore, the safety considerations for rTMS use are expected to become more important. Wassermann published the first safety guidelines for rTMS from the consensus conference held in 1996, and Rossi and colleague then published the second safety guidelines from the multidisciplinary consensus meeting held in Siena, Italy in 2008, on behalf of the International Federation of Clinical Neurophysiology. More than 10 years after the second guidelines, the updated third safety guidelines were recently published in 2021. The general safety guidelines for conventional rTMS have not substantially changed. Because the most frequently used rTMS protocol is conventional (low- and high-frequency) rTMS in research and clinical settings, we focus on reviewing safety issues when applying conventional rTMS with a focal cortical stimulation coil. The following issues will be covered: 1) possible adverse events induced by rTMS; 2) checklists to screen for any precautions and risks before rTMS; 3) safety considerations for dosing conventional rTMS; and 4) safety considerations for using rTMS in stroke and traumatic brain injury.
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Affiliation(s)
- Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Kim J, Sin M, Kim WS, Min YS, Kim W, Park D, Paik NJ, Cho K, Park HS. Corrigendum: Remote Assessment of Post-Stroke Elbow Function Using Internet-Based Telerobotics: A Proof-of-Concept Study. Front Neurol 2021; 11:640537. [PMID: 33613427 PMCID: PMC7890069 DOI: 10.3389/fneur.2020.640537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jonghyun Kim
- School of Mechanical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Minki Sin
- Department of Medical Assistant Robot, Daegu Research Center, Korea Institute of Machinery and Materials, Daegu, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Woojin Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Daegeun Park
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyujin Cho
- School of Mechanical and Aerospace Engineering, Seoul National University, Seoul, South Korea
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Neurorehabilitation Engineering Lab., Korea Advanced Institute of Science and Technology, Daejeon, South Korea
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Kim J, Sin M, Kim WS, Min YS, Kim W, Park D, Paik NJ, Cho K, Park HS. Remote Assessment of Post-Stroke Elbow Function Using Internet-Based Telerobotics: A Proof-of-Concept Study. Front Neurol 2020; 11:583101. [PMID: 33343489 PMCID: PMC7744560 DOI: 10.3389/fneur.2020.583101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/30/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose: Upper limb hemiparesis is the most common impairment in stroke survivors, and adequate assessment is crucial for setting the rehabilitation strategy and monitoring the effect of treatment. However, adequate timely assessments are difficult due to the limited accessibility to clinics for stroke survivors. We designed this study to investigate whether teleassessments for motor impairments of the spastic elbow (i.e., passive range of motion (PROM), muscle strength, and spasticity) are feasible in stroke survivors. Methods: To implement a telerobotic system for remote assessment with physical interaction, we constructed a system with a master robot interacting with a doctor (assessor) and a slave robot interacting with the elbow of a subject with stroke. The master robot is operated by the doctor, where the torque and the speed are transferred to the slave robot via the Internet, and the reaction of the patient's elbow to the slave robot's movement is measured with a torque sensor, then finally transferred back to the master robot. An intercontinental remote assessment, which is considered one of the worst possible scenarios, was used as a clinical test to strictly check the feasibility. For the clinical tests, the examiner for the teleassessment was located at a lab in the National Institutes of Health (NIH, Bethesda, MD, USA) while the stroke patients were located at Seoul National University Bundang Hospital (Bundang, Kyeonggido, South Korea). Results: In total, 12 stroke patients' elbows (age range, 28–74; M:F = 6:6) were tested. For the PROM, the absolute difference between two assessments (in-person vs. remote) was 5.98 ± 3.51° on average (range, 0–11.2). The agreements for the strength and the spasticity of elbow flexor between in-person and remote assessments were substantial (k = 0.643) and fair (k = 0.308), respectively. No adverse events were observed during or immediately after the telerobotic assessment. Conclusions: Internet-based telerobotic remote assessment for motor impairment of spastic elbow in stroke using our system is feasible even in the worst setting, with too long of a distance and a delayed communication network.
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Affiliation(s)
- Jonghyun Kim
- School of Mechanical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Minki Sin
- Department of Medical Assistant Robot, Daegu Research Center, Korea Institute of Machinery and Materials, Daegu, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Woojin Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Daegeun Park
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyujin Cho
- School of Mechanical and Aerospace Engineering, Seoul National University, Seoul, South Korea
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Neurorehabilitation Engineering Lab., Korea Advanced Institute of Science and Technology, Daejeon, South Korea
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Lim JY, Oh MK, Park J, Paik NJ. Does Measurement of Corticospinal Tract Involvement Add Value to Clinical Behavioral Biomarkers in Predicting Motor Recovery after Stroke? Neural Plast 2020; 2020:8883839. [PMID: 33354207 PMCID: PMC7735861 DOI: 10.1155/2020/8883839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 11/07/2020] [Accepted: 11/20/2020] [Indexed: 01/03/2023] Open
Abstract
Background The prediction of motor recovery after stroke is an important issue, and various prediction models have been proposed using either clinical behavioral or neurological biomarkers. This study sought to identify the effects of clinical behavioral biomarkers combined with corticospinal tract (CST) injury measurement on the prediction of motor recovery after stroke. Methods The region of interest was drawn on the normalized brain magnetic resonance imaging scans of patients with first-ever unilateral hemispheric stroke, and the degree of CST injury was calculated in a total of 67 such subjects. Patients who had initial minor deficits and showed a ceiling effect on motor recovery were excluded. To predict the follow-up Fugl-Meyer assessment (FMA) scores, correlation and regression analyses were performed using various clinical behavioral biomarkers, including age, sex, lesion location, and initial FMA scores and CST injury measurements. Results Only the initial FMA-upper extremity (UE) score was statistically correlated with the follow-up FMA-UE score at ≥2 months after the onset (adjusted R 2 = 0.626), and the relationship between CST injury and follow-up FMA-UE score was unclear (n = 53). Hierarchical clustering between the initial and follow-up FMA-UE scores showed three clusters. After exclusion of a cluster with an initial FMA-UE ≥ 35, the prediction of the follow-up FMA-UE score was possible by incorporating the initial FMA-UE score and CST injury measurements (n = 39). However, the explanatory power decreased (adjusted R 2 = 0.445), and the unique contribution of the CST injury (10.1%) was lower than that of the initial FMA-UE score (26.7%). With respect to the FMA-lower extremity score, CST injury was not related to recovery. Conclusions Motor recovery of the upper and lower extremities after stroke could be predicted using the initial FMA score. CST injury was significant for the prediction of motor recovery of the upper extremity in patients with severe initial motor deficits (FMA-UE < 35); however, its portion of prediction of motor recovery was low. The prediction of poststroke motor recovery using the initial motor deficit was not improved by the addition of CST injury measurements.
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Affiliation(s)
- Jong Youb Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, 95, Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea
| | - Mi-Kyoung Oh
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Jihong Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
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Kim WS, Kwon BS, Seo HG, Park J, Paik NJ. Low-Frequency Repetitive Transcranial Magnetic Stimulation Over Contralesional Motor Cortex for Motor Recovery in Subacute Ischemic Stroke: A Randomized Sham-Controlled Trial. Neurorehabil Neural Repair 2020; 34:856-867. [PMID: 32807013 DOI: 10.1177/1545968320948610] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Low-frequency repetitive transcranial magnetic stimulation (rTMS) over the contralesional motor cortex (M1) has demonstrated beneficial effects on motor recovery, but evidence among patients with subacute stroke is lacking. We aimed to investigate whether 1-Hz rTMS over the contralesional M1 versus sham rTMS could improve arm function in patients with subacute ischemic stroke when combined with rehabilitative motor training. METHODS In total, 77 patients who were within 90 days after their first-ever ischemic stroke were enrolled and randomly allocated to either real (n = 40) or sham rTMS (n = 37). We delivered 1-Hz 30-minute active or sham rTMS before each daily 30-minute occupational therapy sessions over a 2-week period. The primary endpoint was changes in the Box and Block Test (BBT) score immediately after the end of treatment (EOT). Secondary analyses assessed changes in Fugl-Meyer assessment, Finger Tapping Test (FTT), Brunnstrom stage, and grip strength. CLINICAL TRIAL REGISTRATION ClinialTrials.gov (NCT02082015). RESULTS Changes in BBT immediately after the end of treatment did not differ significantly between the 2 groups (P = .267). Subgroup analysis according to cortical involvement revealed that real rTMS resulted in improvements in BBT at 1 month after EOT (17.4 ± 9.8 real vs 10.9 ± 10.3 sham; P = .023) and Brunnstrom stage of the hand immediately after EOT (0.6 ± 0.5 real vs 0.2 ± 0.5 sham; P = .023), only in the group without cortical involvement. CONCLUSION The effects of real and sham rTMS did not differ significantly among patients within 3 months poststroke. The location of stroke lesions should be considered for future clinical trials.
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Affiliation(s)
- Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Ilsandong-gu, Goyang, South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jihong Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
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Kang SM, Kim SH, Han KD, Paik NJ, Kim WS. Physical activity after ischemic stroke and its association with adverse outcomes: A nationwide population-based cohort study. Top Stroke Rehabil 2020; 28:170-180. [PMID: 32726190 DOI: 10.1080/10749357.2020.1799292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sufficient physical activity (PA) is highly recommended to improve the prognosis after stroke. However, there have been only a few studies evaluating the changes in PA level after stroke. AIMS We aimed to identify the changes in PA level between before and after stroke, and to determine the association between PA and adverse outcomes. METHODS This observational, retrospective cohort study was performed using the Nationwide Health Insurance Service (NHIS) database in South Korea. Subjects between the ages of 20 to 80 years, who had a first-ever ischemic stroke from 2010 to 2013, were included. Subjects were divided into either the "sufficient" or "insufficient" subgroups, depending on the result of the self-reported PA questionnaire. Adverse outcomes, including all-cause mortality, stroke recurrence, and myocardial infarction (MI), were collected from a post-stroke health checkup to 2017. RESULTS Of the 34,243 subjects with ischemic stroke, only 21.24% had sufficient PA level after stroke. Among those with insufficient PA level, only 17.34% improved their PA level after stroke. Subjects with sufficient PA level after stroke, regardless of their PA level prior to stroke, showed a lower risk of composite adverse outcomes (adjusted Hazard Ratio [HR], 95% CI: 0.85, 0.80-0.90). Subjects who went from insufficient to sufficient PA level (HR 0.87, 95% CI: 0.81-0.93) showed a significantly lower risk of composite adverse outcomes. CONCLUSIONS Achieving a sufficient PA level after ischemic stroke appears to significantly reduce major adverse events. Further effort is needed to promote the PA level after ischemic stroke.
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Affiliation(s)
- Seong-Min Kang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sun-Hyung Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Kyung-Do Han
- Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Gyeonggi Regional Cardiocerebrovascular Center, Seongnam-si, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Gyeonggi Regional Cardiocerebrovascular Center, Seongnam-si, South Korea
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Lee J, Chun MH, Ko YJ, Lee SU, Kim DY, Paik NJ, Kwon BS, Park YG. Efficacy and Safety of MT10107 (Coretox) in Poststroke Upper Limb Spasticity Treatment: A Randomized, Double-Blind, Active Drug-Controlled, Multicenter, Phase III Clinical Trial. Arch Phys Med Rehabil 2020; 101:1485-1496. [PMID: 32497599 DOI: 10.1016/j.apmr.2020.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of MT10107 (Coretox) with those of onabotulinum toxin A (Botox) in patients with poststroke upper limb spasticity DESIGN: Prospective, randomized, double-blind, active drug-controlled, multicenter, phase III clinical trial. SETTING Seven university hospitals in the Republic of Korea. PARTICIPANTS Patients (N=220) with poststroke upper limb spasticity. INTERVENTIONS All participants received a single injection of either MT10107 (Coretox group) or onabotulinum toxin A (Botox group). MAIN OUTCOME MEASURES The primary outcome was change in wrist flexor spasticity from baseline to week 4, which was assessed using the modified Ashworth scale (MAS). The secondary outcomes were MAS scores for wrist, elbow, and finger flexors; percentage of treatment responders (response rate); Disability Assessment Scale (DAS) score, and global assessment of treatment. Safety was evaluated based on adverse events, vital signs, physical examination findings, and laboratory test results. The efficacy and safety were evaluated at 4, 8, and 12 weeks postintervention. RESULTS The primary outcome was found to be -1.32±0.69 and -1.40±0.69 for the Coretox and Botox groups, respectively. MT10107 showed a non-inferior efficacy compared with onabotulinum toxin A, as the 95% confidence interval for between-group differences was -0.10 to 0.27 and the upper limit was less than the non-inferiority margin of 0.45. Regarding the secondary outcomes, MAS scores for all muscles and DAS scores showed a significant improvement at all time points in both groups, with no significant between-group difference. No significant between-group differences were observed regarding response rate, global assessment of treatment, and safety measures. CONCLUSIONS MT10107 showed no significant difference in efficacy and safety compared with onabotulinum toxin A in poststroke upper limb spasticity treatment.
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Affiliation(s)
- Junekyung Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul.
| | - Young Jin Ko
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim DY, Oh HM, Bok SK, Chang WH, Choi Y, Chun MH, Han SJ, Han TR, Jee S, Jung SH, Jung HY, Jung TD, Kim MW, Kim EJ, Kim HS, Kim YH, Kim Y, Kim DY, Kim DY, Kim DK, Ko SH, Ko MH, Lee JK, Lee J, Lee SJ, Lee SG, Lim SH, Oh BM, Paik NJ, Park KD, Park SW, Park GY, Park JH, Park YG, Pyun SB, Ryu B, Seo HG, Shin YI, Sohn MK, Yang SN, Don Yoo S, Yoo WK. KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson's Disease. Brain Neurorehabil 2020; 13:e17. [PMID: 36744191 PMCID: PMC9879460 DOI: 10.12786/bn.2020.13.e17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/09/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022] Open
Abstract
Clinical consensus statements (CCSs) aim to improve care for patients with Parkinson's disease (PD) and reduce the variability of rehabilitation methods in clinical practice. A literature search was conducted to find available evidence on the rehabilitation of patients with PD and to determine the scope of CCSs. The selection of PD rehabilitation domains and key questions was done using the modified Delphi method in 43 expert panels. These panels achieved a consensus on 11 key questions regarding rehabilitation assessment and goal setting, gait and balance, activities of daily living, and swallowing and communication disorders. After the completion of an agreement procedure, 11 key consensus statements were developed by the consensus panel. These statements addressed the needs of rehabilitation as a continuum in patients with PD. They included the appropriate rehabilitation initiation time, assessment items, rehabilitation contents, and complication management. This agreement can be used by physiatrists, rehabilitation therapists, and other practitioners who take care of patients with PD. The consensus panel also highlighted areas where a consensus could not be reached. The development of more focused CCS or clinical practice guidelines that target specific rehabilitation approaches is considered the next needed step.
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Affiliation(s)
| | - Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Hyun Mi Oh
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Soo-Kyung Bok
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yongmin Choi
- Department of Rehabilitation Medicine, School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo Jeong Han
- Department of Rehabilitation, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Tai-Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han Young Jung
- Department of Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Min Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Eun Joo Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hyoung Seop Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yongwook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine & Rehabilitation, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan, Korea
| | - Sam-Gyu Lee
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byungju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University, College of Medicine, Seoul, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine & Rehabilitation, Hallym University College of Medicine, Chuncheon, Korea
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Kim G, Kim WS, Kim TW, Lee YS, Lee H, Paik NJ. Home-based rehabilitation using smart wearable knee exercise device with electrical stimulation after anterior cruciate ligament reconstruction: A study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e20256. [PMID: 32443364 PMCID: PMC7254399 DOI: 10.1097/md.0000000000020256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Rehabilitation after anterior cruciate ligament (ACL) reconstruction is critical to patient outcome. Despite its importance; however, hospital-based rehabilitation is limited, with barriers, including distance and cost. With recent technological advancements, wearable devices have actively been used to address these barriers. In this study, we propose a randomized controlled trial protocol investigating the efficacy and feasibility of home-based rehabilitation after ACL reconstruction using a smart wearable device providing electrical stimulation that allows knee exercise. METHODS AND ANALYSIS This is a protocol proposal for a prospective, single-center, randomized, controlled study. We plan to recruit adults discharged after ACL reconstruction; the recruited subjects will be randomly allocated to 1 of 2 groups, using a computer-generated randomization method: the intervention (n = 20) or control group (n = 20). The intervention group will receive a 6-week home-based rehabilitation program using smart wearable device. The control group will undergo a 6-week self-exercise program as normal. The following outcomes will be assessed at baseline, 2 weeks, and 6 weeks post the 6-week intervention program: quadriceps strength of the affect side as measured by a dynamometer (primary outcome); range of motion; root mean square of quadriceps muscle using surface electromyography; knee function using questionnaire; quality of life; subject's satisfaction score using questionnaire; frequency and duration of exercise; and knee pain. An intention-to-treat analysis will be conducted for the primary outcome. DISCUSSION This study is a prospective, single-center, randomized, controlled study. This study aims to research the feasibility and efficacy of a 6-week, structured home-based rehabilitation program for patients after ACL reconstruction using a smart wearable device. The findings of this study will help to establish a home-based rehabilitation program to better recovery in patients with ACL reconstruction. TRIAL REGISTRATION NUMBER This protocol was registered in ClinicalTrials.gov, under the number NCT04079205.
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Affiliation(s)
- Gowun Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Hooman Lee
- EXOSYSTEMS Inc., Seongnam-si, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si
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Lee SH, Kim WS, Park J, Kim J, Paik NJ. Effects of anodal transcranial direct current stimulation over the contralesional hemisphere on motor recovery in subacute stroke patients with severe upper extremity hemiparesis: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e19495. [PMID: 32243365 PMCID: PMC7220659 DOI: 10.1097/md.0000000000019495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Upper extremity motor impairment is one of the major sequelae of stroke, resulting in limitations of activities of daily living. Recently, contralesional cortical activation has been reported to be important for motor recovery in stroke patients with severe upper extremity hemiparesis due to the extensive corticospinal tract involvement. We therefore designed this study to investigate the effects of contralesional anodal transcranial direct current stimulation (tDCS), which induces cortical activation, in stroke patients with severe upper extremity motor impairment. METHODS AND ANALYSIS We will recruit patients with subacute stroke (<3 months after onset) with unilateral upper extremity weakness who meet the following criteria: Shoulder Abduction and Finger Extension (SAFE) score below 8, Fugl-Meyer Assessment for upper extremity (FMA-UE) score ≤25, and absent motor evoked potential (MEP) response on the affected extensor carpi radialis muscle. Subjects will be randomly allocated to either the intervention (n = 18) or the control group (n = 18). The intervention group will undergo 10 sessions of robotic arm rehabilitation with simultaneous anodal tDCS over the contralesional premotor area, whereas the control group will receive sham tDCS during the same sessions. One daily session consists of 25 minutes.The primary outcome measure of this study is the Fugl-Meyer Assessment score of the upper extremity; the secondary outcome measures are the Korean version of the Modified Barthel Index, the Brunnstrom stage of the affected arm and hand, the Box and Block Test, the Modified Ashworth Scale, the Manual Muscle Power Test, and the patient's encephalographic laterality index. DISCUSSION Findings of this study will help to establish an individualized tDCS protocol according to the stroke severity and to find out the EEG parameters to predict the better recovery in subacute stroke patients with severe upper extremity hemiparesis. ETHICS AND DISSEMINATION The study was approved by the Seoul National University Bundang Hospital Institutional Review Board (IRB No. B-1806-475-006) and will be carried out in accordance with the approved guidelines. The results of the trial will be submitted for publication in a peer-reviewed journal.
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Kim SH, Cha S, Kang S, Han K, Paik NJ, Kim WS. High prevalence of physical inactivity after heart valve surgery and its association with long-term mortality: A nationwide cohort study. Eur J Prev Cardiol 2020; 28:749-757. [PMID: 33611453 DOI: 10.1177/2047487320903877] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
AIMS Physical activity (PA) and systematic efforts, such as cardiac rehabilitation, are recommended by several national guidelines for those who have received heart valve surgery. However, only a few studies have demonstrated real-world situations, such as changes in the PA level after heart valve surgery, and their effects on long-term outcomes. We designed this study to investigate the changes in PA after heart valve surgery and their associations with mortality using nationwide representative data. METHODS This study was performed using the Korean National Health Insurance Service database. We included patients who received heart valve surgery from 2009 to 2015 and underwent regular health checkups before and after surgery. Subjects were grouped according to their PA level before and after the surgery. Information on all-cause mortality was obtained until 31 December 2016, with a maximum follow-up period of 5 years. RESULTS Of the 6587 subjects, 3258 (49.5%) were physically inactive after surgery. Among patients who were physically active (n = 3070), 1196 (39.0%) became inactive after surgery. The postoperative 'inactive' group showed higher mortality than the 'active' group (hazard ratio (HR): 1.41, 95% confidence interval (CI): 1.08-1.83). The 'inactive/inactive' group showed the highest risk of mortality (HR: 1.69, 95% CI: 1.19-2.40) compared with the 'active/active' group. CONCLUSIONS Insufficient PA level after heart valve surgery is associated with higher risk of mortality. However, maintaining sufficient PA after heart valve surgery may be challenging for many patients. Therefore, systematic efforts, such as cardiac rehabilitation, should be considered in those who received heart valve surgery.
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Affiliation(s)
- Sun-Hyung Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seongmin Kang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Gyeonggi Regional Cardiocerebrovascular Center, Seongnam, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Gyeonggi Regional Cardiocerebrovascular Center, Seongnam, Korea
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Abstract
Hemispatial neglect is a common impairment after stroke. It is associated with poor functional and social outcomes. Therefore, an adequate intervention is imperative for the successful management of hemispatial neglect. However, the clinical use of various interventions is limited in real clinical practice. Prism adaptation therapy is one of the most evidence-based rehabilitation modalities to treat hemispatial neglect. To overcome any possible shortcoming that may occur with prism therapy, we developed a new system using immersive virtual reality and depth-sensing camera to create a virtual prism adaptation therapy (VPAT). To validate the VPAT system, we designed an experimental protocol investigating the behavioral errors and changes in cortical activation via the VPAT system. Cortical activation was measured by functional near infrared spectroscopy (fNIRS). The experiment consisted of four phases. All four included clicking, pointing or rest applied to right-handed healthy people. Clicking versus pointing was used for investigating the cortical region related with the gross motor task, and pointing with VPAT versus pointing without VPAT was used for investigating the cortical region associated with visuospatial perception. The preliminary results from four healthy participants showed that pointing errors by the VPAT system was similar to the conventional prism adaptation therapy. Further analysis with more participants and fNIRS data, as well as a study in patients with stroke may be required.
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Affiliation(s)
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital;
| | - Seo Hyun Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Jihong Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital;
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Brady MC, Ali M, VandenBerg K, Williams LJ, Williams LR, Abo M, Becker F, Bowen A, Brandenburg C, Breitenstein C, Bruehl S, Copland DA, Cranfill TB, Pietro-Bachmann MD, Enderby P, Fillingham J, Galli FL, Gandolfi M, Glize B, Godecke E, Hawkins N, Hilari K, Hinckley J, Horton S, Howard D, Jaecks P, Jefferies E, Jesus LMT, Kambanaros M, Kang EK, Khedr EM, Kong APH, Kukkonen T, Laganaro M, Ralph MAL, Laska AC, Leemann B, Leff AP, Lima RR, Lorenz A, MacWhinney B, Marshall RS, Mattioli F, Maviş I, Meinzer M, Nilipour R, Noé E, Paik NJ, Palmer R, Papathanasiou I, Patricio BF, Martins IP, Price C, Jakovac TP, Rochon E, Rose ML, Rosso C, Rubi-Fessen I, Ruiter MB, Snell C, Stahl B, Szaflarski JP, Thomas SA, van de Sandt-Koenderman M, van der Meulen I, Visch-Brink E, Worrall L, Wright HH. RELEASE: a protocol for a systematic review based, individual participant data, meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia. Aphasiology 2020; 34:137-157. [PMID: 37560459 PMCID: PMC7614912 DOI: 10.1080/02687038.2019.1643003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Speech and language therapy (SLT) benefits people with aphasia following stroke. Group level summary statistics from randomised controlled trials hinder exploration of highly complex SLT interventions and a clinically relevant heterogeneous population. Creating a database of individual participant data (IPD) for people with aphasia aims to allow exploration of individual and therapy-related predictors of recovery and prognosis. AIM To explore the contribution that individual participant characteristics (including stroke and aphasia profiles) and SLT intervention components make to language recovery following stroke. METHODS AND PROCEDURES We will identify eligible IPD datasets (including randomised controlled trials, non-randomised comparison studies, observational studies and registries) and invite their contribution to the database. Where possible, we will use meta- and network meta-analysis to explore language performance after stroke and predictors of recovery as it relates to participants who had no SLT, historical SLT or SLT in the primary research study. We will also examine the components of effective SLT interventions. OUTCOMES AND RESULTS Outcomes include changes in measures of functional communication, overall severity of language impairment, auditory comprehension, spoken language (including naming), reading and writing from baseline. Data captured on assessment tools will be collated and transformed to a standardised measure for each of the outcome domains. CONCLUSION Our planned systematic-review-based IPD meta- and network meta-analysis is a large scale, international, multidisciplinary and methodologically complex endeavour. It will enable hypotheses to be generated and tested to optimise and inform development of interventions for people with aphasia after stroke. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018110947).
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Affiliation(s)
- Marian C. Brady
- Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK
| | - Myzoon Ali
- Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK
| | - Kathryn VandenBerg
- Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK
| | - Linda J. Williams
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Louise R. Williams
- Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Frank Becker
- University of Oslo, Oslo, and Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
| | - Audrey Bowen
- Division of Neuroscience & Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Caitlin Brandenburg
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Caterina Breitenstein
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Stefanie Bruehl
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - David A. Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | | | - Marie di Pietro-Bachmann
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Pamela Enderby
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Federica Lucia Galli
- Neurorehabilitation Clinic, Neurological Sciences Department, Marche Polytechnic University, Ancona, Italy
| | - Marialuisa Gandolfi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Bertrand Glize
- EA 4136 Handicap Activity Cognition Health, University of Bordeaux and Department of Physical Medicine and Rehabilitation, CHU de Bordeaux, France
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Neil Hawkins
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Katerina Hilari
- Division of Language and Communication Science, City, University of London, London, UK
| | - Jacqueline Hinckley
- Department of Speech-Language Pathology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Simon Horton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David Howard
- School of Education Communication and Language Sciences, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Petra Jaecks
- Faculty of Linguistics and Literary Studies, Bielefeld University, Bielefeld, Germany
| | | | - Luis M. T. Jesus
- School of Health Sciences (ESSUA) and Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal
| | - Maria Kambanaros
- Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Eun Kyoung Kang
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Eman M. Khedr
- Department of Neurology, Assiut University Hospital, Assiut, Egypt
| | - Anthony Pak-Hin Kong
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
| | - Tarja Kukkonen
- ENT/Department of Phoniatry, Tampere University Hospital, Tampere, Finland
| | - Marina Laganaro
- Faculty of Psychology and Educational Science, University of Geneva, Geneva, Switzerland
| | | | - Ann Charlotte Laska
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Béatrice Leemann
- Neurorééducation, Département des Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alexander P. Leff
- Department of Brain Repair and Rehabilitation, Institute of Neurology, UCL, London, UK
| | - Roxele R. Lima
- Department of Speech Language Pathology, Educational Association Bom Jesus – IELUSC, Santa Catarina, Brazil
| | - Antje Lorenz
- Institut für Psychologie, Humboldt University Berlin, Berlin, Germany
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - Flavia Mattioli
- Neuropsychology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - ilknur Maviş
- Department of Speech and Language Therapy, Anadolu University, Eskişehir, Turkey
| | - Marcus Meinzer
- UQ Centre for Clinical Research, The University of Queensland, Hertston, Australia
| | - Reza Nilipour
- Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Rebecca Palmer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ilias Papathanasiou
- Department of Speech and Language Therapy, Technological Educational Institute of Western Greece, Patras, Greece
| | - Brigida F. Patricio
- Speech Therapy Department of Health School of Polytechnic Institute of Porto, Porto, Portugal
| | - Isabel Pavão Martins
- Laboratório de Estudos de Linguagem, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal
| | - Cathy Price
- Wellcome Centre for Human Neuroimaging, UCL, London, UK
| | - Tatjana Prizl Jakovac
- Department of Speech and Language Pathology, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia
| | - Elizabeth Rochon
- Department of Speech-Language Pathology and Rehabilitation Sciences Institute, University of Toronto, and Toronto Rehabilitation Institute, Toronto, Canada
| | - Miranda L. Rose
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Charlotte Rosso
- Institut du Cerveau et del la Moelle épinière, Sorbonne University, APHP, Urgences Cérébro-Vasculaires, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Ilona Rubi-Fessen
- RehaNova Rehabilitation Hospital and Department of Special Education and Rehabilitation, University of Cologne, Cologne, Germany
| | - Marina B. Ruiter
- Sint Maartenskliniek, Rehabilitation Centre and Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
| | - Claerwen Snell
- Warrington Hospital, Warrington and Halton NHS Foundation Trust, Warrington, UK
| | - Benjamin Stahl
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jerzy P. Szaflarski
- UAB Epilepsy Centre, Department of Neurology, University of Alabama at Birmingham, AL, USA
| | - Shirley A. Thomas
- Division of Rehabilitation & Ageing; School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Ineke van der Meulen
- Rijndam rehabilitation Rotterdam and Erasmus University Medical Center, Rotterdam, Netherlands
| | - Evy Visch-Brink
- Department of Neurology and Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Cha S, Kim WS, Paik NJ. Reply to Wakabayashi Regarding “Sarcopenia is an Independent Risk Factor for Dysphagia in Community-Dwelling Older Adults”. Dysphagia 2019; 34:608-609. [DOI: 10.1007/s00455-019-09998-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/05/2019] [Indexed: 11/25/2022]
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