Factors Associated to Returning Home in the First Year after Stroke

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Changes in Language Function and Recovery-Related Prognostic Factors in First-Ever Left Hemispheric Ischemic Stroke

OBJECTIVE: To investigate longitudinal changes in language function in left-hemispheric ischemic stroke patients as well as factors that influence language recovery until 1 year after stroke onset. METHODS: We analyzed data from 235 patients with first-ever left-hemispheric ischemic stroke. All patients completed the Korean version of the Frenchay Aphasia Screening Test (K-FAST) at 7 days (T1), 3 months (T2), 6 months (T3), and 1 year (T4) after stroke onset. Repeated measures analysis of variance (ANOVA) was used to investigate changes in language function between time points. Subgroup analysis was performed according to the K-FAST scores at T1. Stroke lesion volume was assessed using diffusion tensor images, and involvement of language-related brain regions was examined. Multiple regression analysis was used to analyze factors influencing improvement of K-FAST score. RESULTS: The K-FAST scores at T1, T2, T3, and T4 differed significantly (p<0.05). In the subgroup analysis, only the severe group showed continuous significant improvement by 1 year. Factors that negatively influenced improvement of language function were the age at onset, initial National Institutes of Health Stroke Scale (NIHSS) score, and initial K-FAST score, whereas education level and stroke lesion volume positively affected recovery. Involvement of language-related brain regions did not significantly influence long-term language recovery after ischemic stroke. CONCLUSION: Recovery of language function varied according to the severity of the initial language deficit. The age at stroke onset, education level, initial severity of aphasia, initial NIHSS score, and total stroke lesion volume were found to be important factors for recovery of language function.ope

Determining the cut-off score for the Modified Barthel Index and the Modified Rankin Scale for assessment of functional independence and residual disability after stroke

Assessment of functional independence and residual disability is very important for measuring treatment outcome after stroke. The modified Rankin Scale (mRS) and the modified Barthel Index (MBI) are commonly used scales to measure disability or dependence in activities of daily living (ADL) of stroke survivors. Lack of consensus regarding MBI score categories has caused confusion in interpreting stroke outcomes. The purpose of this study was to identify the optimal corresponding MBI and modified Rankin scale (mRS) grades for categorization of MBI. The Korean versions of the MBI (K-MBI) and mRS were collected from 5,759 stroke patients at 3 months after onset of stroke. The sensitivity and specificity were calculated at K-MBI score cutoffs for each mRS grade to obtain optimally corresponding K-MBI scores and mRS grades. We also plotted receiver operating characteristic (ROC) curves of sensitivity and specificity and determined the area under the curve (AUC). The K-MBI cutoff points with the highest sum of sensitivity and specificity were 100 (sensitivity 0.940; specificity 0.612), 98 (sensitivity 0.904; specificity 0.838), 94 (sensitivity 0.885; specificity 0.937), 78 (sensitivity 0.946; specificity, 0.973), and 55 (sensitivity 937; specificity 0.986) for mRS grades 0, 1, 2, 3, and 4, respectively. From this result, the K-MBI cutoff score range for each mRS grade can be obtained. For mRS grade 0, the K-MBI cutoff score is 100, indicating no associated score range. For mRS grades 1, 2, 3, 4, and 5, the K-MBI score ranges is from 99 to 98, 97 to 94, 93 to 78, 77 to 55, and under 54, respectively.The AUC for the ROC curve was 0.791 for mRS grade 0, 0.919 for mRS grade 1, 0.970 for mRS grade 2, 0.0 for mRS grade 3, and 0.991 for mRS grade 4. The K-MBI cutoff score ranges for representing mRS grades were variable; mRS grades 0, 1, and 2 had narrow K-MBI score ranges, while mRS grades 3, 4, and 5 exhibited broad K-MBI score ranges. mRS grade seemed to sensitively differentiate mild residual disability of stroke survivors, whereas K-MBI provided more specific information of the functional status of stroke survivors with moderate to severe residual impairment.ope

Factors Associated with Changes in Functional Independence after Six Months of Ischemic Stroke

The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from −4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.ope

요양병원의 언어치료 현황

Objectives: To examine and compare the present situations of long-term care facilities regarding the services of speech and language therapy (SLT). Methods: Phone interviews across Korea were conducted with 1,233 hospitals that were established before October 2013 and were still operating as of March 2014. Whether the long-term care facilities were providing SLT services was examined and analyzed according to the region, the size of the facilities, existence of certification from an institution, and the presence of physiatrists. Furthermore, the working conditions of staff providing SLT including speech and language therapists were thoroughly examined. Results: The SLT services were dependent on regional factors. More than half of the facilities did not include SLT as a part of their services. Also, the use of SLT varied according to the size of the facilities. Bigger hospitals tended to have a higher percentage of language therapy implementation. Institutions certified by the Ministry of Health and Welfare of Korea and the Korea Institute for Healthcare Accreditation were more likely to provide SLT services. SLT services were provided more often when a physiatrist was present. Workers providing SLT differed depending on the region. Speech and language therapists were more likely to work full-time rather than part-time. Conclusion: This study shows the present state and availability of SLT at long-term care facilities, emphasizing the necessity of the service, and providing the basis for future studies.ope

Effect of Repetitive Transcranial Magnetic Stimulation in Post-stroke Patients with Severe Upper-Limb Motor Impairment

Repetitive transcranial magnetic stimulation (rTMS) has been known to improve the motor function through modulation of excitability in the cerebral cortex. However, most studies with rTMS were limited to post-stroke patients with mild to moderate motor impairments. The effect of rTMS on severe upper-limb motor impairment remains unclear. Therefore, this study investigated the effects of rTMS on the upper extremity function in post-stroke patients with severe upper-limb motor impairment. Subjects were divided into 3 groups, low-, high-frequency rTMS and control group were received stimulation 10 times for 2 weeks. The motor scale of Fugl-Meyer Assessment (FMA) and cortical excitability on the unaffected hemisphere were measured before and after performing 10 rTMS sessions. The motor scale of upper extremity FMA (UE-FMA) and shoulder component of the UE-FMA were significantly improved in both low- and high-frequency rTMS groups. However, no significant improvement was observed in the wrist and hand components. No significant differences were noted in low- and high-frequency rTMS groups. The amplitude of motor evoked potential on the unaffected hemisphere showed a significant decrease in the low- and high-frequency stimulation groups. rTMS may be helpful in improving upper extremity motor function even in post-stroke patients with severe upper-limb motor impairment.ope

우리나라 언어치료사의 핵심역량

Objectives: This study was aimed to survey what are perceived to be the core capacities of speech-language pathologists (SLPs). Methods: One hundred and fifty SLPs were surveyed with a questionnaire of 43 items based on the occupational and internal capacities by O*NET. We investigated the importance and performance/possession standards of the capacities, and explored the differences of capacities depending on the organization, experience and education. In addition, the priorities of SLPs in Korea and those in the United States were compared. Results: Firstly, importance of core capacities was rated higher than performance/possession standards for all 43 capacities. Secondly, when examining the discrepancies of SLP capacities in different organizations, the importance of 6 capacities and the performance/possession standards of 7 capacities were the highest for SLPs in hospital. Thirdly, when examining the discrepancies by experience, the importance of 2 capacities and the performance/possession standards of 7 capacities were the highest for those with 5 or more years of experience. Fourthly, when examining the discrepancies by education, the importance of 3 capacities and the performance/possession standards of 6 capacities were greater for those with degrees in graduate school or higher education. Fifthly, in comparing the priorities of SLP in Korea and those in the United States, the 13 capacities in Korea were relatively higher.ope

KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson's Disease

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.ope

ffect of Clonidine on Spasticity in Patients with Spinal Cord Injury

Objective : Spasticity has been reported to be one of the common complications in patients with spinal cord injury. The purposes of this study were to investigate the proper dosage, the therapeutic and undesirable effects of clonidine with combined used of baclofen for the management of spasticity. Method : A prospective study was performed for 17 patients with spinal cord injury who did not improve spasticity with 80 mg baclofen administration. The degree of spasticity was assessed in the more-affected knee by modified Ashworth scale, pendulum test at pre-treatment and at 7 days after receiving clonidine. We also investigated the complications and subjective satisfaction. Results : Seven of 13 patients with spinal cord injury showed subjective improvement in spasticity. We found significant improvement in the relaxation index by pendulum test after administration of more than 0.3 mg of clonidine. There was no significant difference between the subgroups depending on the extent of spinal cord injury. We didn't find any serious complication in adjuvant clonidine therapy. Conclusion : Adjuvant clonidine therapy can be effective in spasticity of spinal cord injured patients without serious complication.ope

Quantitative Assessment of Intention Tremor after Brain Injury Using Tri-axial Accelerometry

Objective: The aims of this study were to assess intention tremor severity caused by brain injury using tri-axial accelerometry and also to determine the reliability and the correlation with clinical measurements. Method: Twenty two patients with intention tremor caused by brain injury were included. The quantitative measurement of tremor was performed using tri-axial accelerometry during finger to nose test. The dominant frequency and amplitude of tremor were acquired using Fast Fourier transformation analysis. The severity of tremor was also clinically rated by clinical rating scale for tremor, hand writing test, figure drawing test, pouring water test. The correlation between clinical measurement and tri-axial acce-lerometry measurement, and the inter-rater reliability were assessed. Results: The tri-axial accelerometry measurement showed good inter-rater reliability. The mean dominant frequency was 3.10 Hz. The amplitudes at dominant frequency were significantly correlated with clinical rating scale for tremor, pouring water test (p＜0.05) but not with hand writing test, figure drawing test. Conclusion: Quantitative measurement of intention tremor using tri-axial accelerometry may be very useful to assess the tremor severity caused by brain injury.ope