Neural Substrate Responsible for Crossed Aphasia

Crossed aphasia (CA) refers to language impairment secondary to right hemisphere lesion. Imaging analysis on the lesion location of CA has not yet been reported in the literature. This study was proposed to analyze the most prevalent lesion site related to CA. Brain MRI of 7 stroke patients satisfying the criteria for CA were used to define Region of interest (ROIs) before overlaying the images to visualize the most overlapped area. Talairach coordinates for the most overlapped areas were converted to corresponding anatomical regions. Anatomical lesions where more than 3 patients' images were overlapped were considered significant. The overlayed ROIs of 7 patients revealed the lentiform nucleus as the most frequently involved area, overlapping in 6 patients. Our study first demonstrates the areas involved in CA by lesion mapping using brain MRI, and lentiform nucleus is the responsible neural substrate for crossed aphasia.Crossed aphasia (CA) refers to language impairment secondary to right hemisphere lesion. Imaging analysis on the lesion location of CA has not yet been reported in the literature. This study was proposed to analyze the most prevalent lesion site related to CA. Brain MRI of 7 stroke patients satisfying the criteria for CA were used to define Region of interest (ROIs) before overlaying the images to visualize the most overlapped area. Talairach coordinates for the most overlapped areas were converted to corresponding anatomical regions. Anatomical lesions where more than 3 patients' images were overlapped were considered significant. The overlayed ROIs of 7 patients revealed the lentiform nucleus as the most frequently involved area, overlapping in 6 patients. Our study first demonstrates the areas involved in CA by lesion mapping using brain MRI, and lentiform nucleus is the responsible neural substrate for crossed aphasia.OAIID:oai:osos.snu.ac.kr:snu2013-01/102/0000005165/7SEQ:7PERF_CD:SNU2013-01EVAL_ITEM_CD:102USER_ID:0000005165ADJUST_YN:YEMP_ID:A075663DEPT_CD:801CITE_RATE:1.249FILENAME:첨부된 내역이 없습니다.DEPT_NM:의학과EMAIL:[email protected]_YN:YCONFIRM:

Oropharyngeal Dysphagia in a Community-Based Elderly Cohort: the Korean Longitudinal Study on Health and Aging

This study was conducted to investigate the prevalence of dysphagia and evaluated the association of dysphagia and activities of daily living in a geriatric population residing in an independent-living facility in Korea. Korean men and women 65-yr and older living in a single, typical South Korean city (n = 415) were enrolled in the Korean Longitudinal Study on Health and Aging study. Dysphagia was assessed using the Standardized Swallowing Assessment. Data were collected on activities of daily living (ADL), instrumental ADL (IADL), and medical history and laboratory. The overall prevalence of dysphagia in the random sample was 33.7% (95% CI, 29.1-38.4), including 39.5% in men and 28.4% in women. The identified risk factors for dysphagia were men (OR, 3.6, P = 0.023), history of stroke (OR, 2.7, P = 0.042) and presence of major depressive disorder (OR, 3.0, P = 0.022). Dysphagia was associated with impairment in IADL domains of preparing meals and taking medicine (P = 0.013 and P = 0.007, respectively). This is the first published report of the prevalence of dysphagia in older community-dwelling Koreans. Dysphagia is a common problem among elderly people that limits some IADL domains.The funding for this study was provided by a grant from the Korean Health Technology R & D Project, Ministry for Health, Welfare, & Family Affairs, Republic of Korea (Grant No. A092077) and the National Research Foundation of Korea (NRF) grant funded by the Korea Government (MEST) (No. 2012-0000999) and a grant from Korea Healthcare Technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (No. A070001).OAIID:oai:osos.snu.ac.kr:snu2013-01/102/0000005165/6SEQ:6PERF_CD:SNU2013-01EVAL_ITEM_CD:102USER_ID:0000005165ADJUST_YN:YEMP_ID:A075663DEPT_CD:801CITE_RATE:1.249FILENAME:첨부된 내역이 없습니다.DEPT_NM:의학과EMAIL:[email protected]_YN:YCONFIRM:

Effect of the Presence of Brain-Derived Neurotrophic Factor Val66Met Polymorphism on the Recovery in Patients With Acute Subcortical Stroke

Objective : To investigate the effect of brain-derived neurotrophic factor (BDNF) Valmet polymorphism on the recovery after subcortical stroke, using the modified Rankin Scale (mRS). Methods : Subcortical stroke patients with copies of BDNF Valmet polymorphism (n=7) were compared to their controls (n=7) without a copy of BDNF Valmet polymorphism after matching for initial severity, location and type of stroke. The mRS scores at 1 and 3 months after discharge from the neurorehabilitation unit were compared between the groups. Results : A repeated measures ANOVA for mRS revealed significant interaction between time and group (F(2, 24) =37.2, p<0.001) and a significant effect of time (F(2, 24)=10.8, p<0.001), thereby reflecting significant differences between the Met allele (+) group and the Met allele (-) group. There was a significant difference in mRS scores at 3 months post-discharge between the two groups (p=0.01) although no difference was evident in mRS scores at 1 month post-discharge between the two groups. There were significant improvements between mRS scores on admission and mRS scores at 1 month post-discharge (p=0.02), and between mRS scores at 1 month post-discharge and mRS scores at 3 months post-discharge (p=0.004) in the Met allele (-) group. Conclusion : BDNF Valmet polymorphism may be associated with worse functional outcome in Korean patients with subcortical stroke. Therefore, BDNF Valmet polymorphism should be considered as an important prognostic factor for recovery and responses to rehabilitation therapies after stroke in Korean patients. There is a need for developing different rehabilitation strategies for the population with BDNF Valmet polymorphism. Further studies assessing different outcomes for various functional domains of stroke recovery are needed to clarify the role of BDNF Valmet polymorphism.This research was supported by SK Chemicals Co. through Seoul National University R&DB Foundation (Grant No. 800-2010095).OAIID:oai:osos.snu.ac.kr:snu2013-01/102/0000005165/4SEQ:4PERF_CD:SNU2013-01EVAL_ITEM_CD:102USER_ID:0000005165ADJUST_YN:YEMP_ID:A075663DEPT_CD:801CITE_RATE:0FILENAME:첨부된 내역이 없습니다.DEPT_NM:의학과EMAIL:[email protected]:

Effect of ultrasound treatment in experimentally induced carpal tunnel syndrome

학위논문(박사)--서울대학교 대학원 :의학과 예방의학전공,2000.Docto

요통환자의 심리적 특성과 동통행태에 대한 연구

학위논문(석사)--서울대학교 대학원 :의학과 예방의학전공,1995.Maste

Differences of Mortality and Dependence Between Stroke Unit and General Ward Care in Acute Ischemic Stroke Patients

Background: There is strong evidence for the efficacy of stroke unit (SU) care, which has become a common practice in other developed countries but is available only in a small number of centers in Korea. This late introduction of SU care in Korea can be at least partly attributed to doubts about its benefits on patient outcomes compared to general ward (GW) care in our routine practice. Methods: Based on a prospective stroke registry, we identified 1,300 acute stroke patients hospitalized in either SUs (n=195) or GWs (n=1,105) from January 2004 to June 2008. Clinical outcomes such as fatality and disability rates were compared using propensity score matching in the total cohort. Additional statistical adjustments were performed using stepwise logistic regression analyses with the backward elimination method for potential confounders. Results: The baseline characteristics did not differ significantly between patients admitted to SUs (n=195) and their matched controls (n=386). The 3-month dependency rate was 17.4% in SUs and 21.0% in GWs (p=0.31), and the case fatality rates were 1.5% and 8.0% (p&lt;0.001), respectively. Adjusted odds ratios for SU care were 0.49 for dependency (95% confidence interval [CI]=0.22-1.08) and 0.17 for death (95% CI=0.04-0.83). Conclusions: This study showed that SU care reduces fatality rates and improves functional outcomes, which indicates the need to implement more SUs in Korea.N

The Long-term Incidence of Recurrent Stroke: Single Hospital-based Cohort Study

Background: Recurrent stroke is a major cause of morbidity and mortality among stroke survivors. However, studies of the long-term prognosis after acute stroke are very rare, especially in Asia. This study aimed to provide estimates of recurrent stroke rates by age, gender, and subtype of stroke in an unselected cohort of patients hospitalized to a community-based general hospital due to acute stroke. Methods: Based on a prospective stroke registry, acute stroke patients were enrolled within 7 days of symptom onset and followed retrospectively or prospectively for up to 3 years. Information was gathered about stroke recurrence and other vascular events. The cumulative risk of recurrent stroke was calculated using the Kaplan-Meier method. Results: Two-thousand and sixty-eight patients were enrolled in this study. The cumulative risks of stroke recurrence were 2.3%, 5.5%, 8.6%, and 10.0% at 90 days and 1, 2, and 3 years, respectively. The prevalence of stroke recurrence increased with age and the presence of previous stroke history (p&lt;0.001), but not with gender or stroke subtype. Conclusions: To the best of our knowledge, this is the first cohort study of stroke recurrence in Korea. Its limitation of being a single hospital-based study warrants community- or multicenter-based cohort studies to identify high-risk groups for stroke recurrence.N

A soft wearable robotic ankle-foot-orthosis for post-stroke patients

We propose a soft robotic ankle-foot-orthosis for post-stroke patients, which is inexpensive, lightweight, easy to wear, and capable of gait assistance for rehabilitation not only in the clinic but also in daily life. The device includes a 3D-printed flexible brace and an ankle supportthat allows natural flexion and extension of the ankle but provides support in the vertical direction preventing the structure from buckling. A bi-directional tendon-driven actuator was used for assisting both dorsiflexion and plantarflexion. The device also contains a wearable gait sensing module for measuring the leg trajectory and the foot pressures in real time for feedback control. Since the device is powered by a rechargeable battery and communicates with the main controller wirelessly, it is fully untethered, making it mobile and comfortable. Using the measured sensor data and the biomechanics of the legs, the real-time gait phase is detected, and then a gait assistance algorithm for both dorsiflexion and plantarflexion provides an accurate prediction of a control phase and timing although there are variations in the gait trajectories among individuals. As a feasibility test, the walking experiment was conducted with a post-stroke patient. The result showed improvement in both gait propulsion and foot-drop prevention.OAIID:RECH_ACHV_DSTSH_NO:T201913775RECH_ACHV_FG:RR00200001ADJUST_YN:EMP_ID:A075663CITE_RATE:0DEPT_NM:의학과EMAIL:[email protected]_YN:YN

Feasibility, reliability, and validity of using accelerometers to measure physical activities of patients with stroke during inpatient rehabilitation.

Promoting physical activities is important for medical and functional recovery after stroke. Therefore, an accurate and convenient measurement of physical activities is necessary to provide feedback on functional status and effects of rehabilitative interventions. We assessed the feasibility, reliability, and validity of wearing accelerometers to monitor physical activities of stroke patients by estimating energy expenditure. This was a prospective observational quantitative study conducted in an inpatient rehabilitation unit. Twenty-four patients with subacute stroke were enrolled. They wore accelerometers on wrists and ankles for three consecutive weekdays. The feasibility was evaluated by daily wear-time. The test-retest reliability was determined by intra-class correlation coefficient. The validity was evaluated by comparing accelerometeric data to behavior mappings using Mann-Whitney U test, Spearman's rho correlation coefficient (r) and Bland-Altman plots. Average wearing time for four accelerometers was 20.99 ± 3.28 hours per day. The 3-day accelerometer recording showed excellent test-retest reliability. For sedentary activities, wrist accelerometers showed higher correlation with direct observation than ankle accelerometers. For light to moderate activities, ankle accelerometers showed higher correlation with direct observation than wrist accelerometers. Overall, combined models of accelerometers showed higher correlation with direct observation than separate ones. Wearing accelerometers for 24 h may be useful for measuring physical activities in subjects with subacute stroke in an inpatient rehabilitation unit

Muscle strength is the main associated factor of physical performance in older adults with knee osteoarthritis regardless of radiographic severity

The aim of the study is to compare factors associated with physical performance in older individuals with severe knee osteoarthritis and those with less-severe osteoarthritis. This is an ancillary cross-sectional study to a population-based cohort study focusing on Koreans age 65 years or older. The analysis included 553 subjects with information about knee pain, depressive symptoms, and comorbidities collected by self-reported questionnaire, and body weight, knee osteoarthritis severity, muscle strength, and physical measures by observer-rated tests. Stepwise logistic regression analyses were performed with physical performance as an outcome variable and the others as independent variables across radiographic knee osteoarthritis severity. In the minimal-to-moderate-severity group, muscle strength, knee pain, BMI, and age were related to poor performance (OR [CI] 0.81 [0.73-0.90], 1.12 [1.03-1.21], 0.87 [0.79-0.96], and 1.09 [1.05-1.14], respectively). In the severe group, muscle strength was the only factor significantly associated with poor performance (OR [CI] 0.72 [0.58-0.89]). Muscle strength, knee pain, and BMI were important determinants of physical performance in the older population with knee osteoarthritis. In severe knee osteoarthritis patients, muscle strength was the only significant determinant.Data collection was funded by the Independent Research Grant from Pfizer Global Pharmaceuticals (Grant no. 06-05-039) and the Grant for Developing Seongnam Health Promotion Program for the Elderly from Seongnam City Government in Korea (Grant no. 800-20050211).OAIID:oai:osos.snu.ac.kr:snu2013-01/102/0000005165/2SEQ:2PERF_CD:SNU2013-01EVAL_ITEM_CD:102USER_ID:0000005165ADJUST_YN:YEMP_ID:A075663DEPT_CD:801CITE_RATE:1.704FILENAME:첨부된 내역이 없습니다.DEPT_NM:의학과EMAIL:[email protected]: