Publications by authors named "Seong-Hoon Lim"

86 Publications

Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures.

Ann Rehabil Med 2021 Jun 30;45(3):225-259. Epub 2021 Jun 30.

Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries.

Methods: Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method.

Results: A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost.

Conclusion: This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.
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http://dx.doi.org/10.5535/arm.21110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273721PMC
June 2021

Clinical Characteristics and Predictors of In-Hospital Mortality in Patients With Cardiogenic Shock: Results From the RESCUE Registry.

Circ Heart Fail 2021 Jun 15;14(6):e008141. Epub 2021 Jun 15.

Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center (J.H.Y., K.H.C., T.K.P., J.M.L., Y.B.S., J.-Y.H., S.-H.C., H.-C.G.), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: In the current era of mechanical circulatory support, limited data are available on prognosis of cardiogenic shock (CS) caused by various diseases. We investigated the characteristics and predictors of in-hospital mortality in Korean patients with CS.

Methods: The RESCUE study (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With CS) is a multicenter, retrospective, and prospective registry of patients that presented with CS. Between January 2014 and December 2018, 1247 patients with CS were enrolled from 12 major centers in Korea. The primary outcome was in-hospital mortality.

Results: In-hospital mortality rate was 33.6%. The main causes of shock were ischemic heart disease (80.7%), dilated cardiomyopathy (6.1%), myocarditis (3.2%), and nonischemic ventricular arrhythmia (2.5%). Vasopressors were used in 1081 patients (86.7%). The most frequently used vasopressor was dopamine (63.4%) followed by norepinephrine (57.3%). An intraaortic balloon pump was used in 314 patients (25.2%) and extracorporeal membrane oxygenator in 496 patients (39.8%). In multivariable analysis, age ≥70years (odds ratio [OR], 2.73 [95% CI, 1.89-3.94], <0.001), body mass index <25 kg/m (OR, 1.52 [95% CI, 1.08-2.16], =0.017), cardiac arrest at presentation (OR, 2.16 [95% CI, 1.44-3.23], <0.001), vasoactive-inotrope score >80 (OR, 3.55 [95% CI, 2.54-4.95], <0.001), requiring continuous renal replacement therapy (OR, 4.14 [95% CI, 2.88-5.95], <0.001), mechanical ventilator (OR, 3.17 [95% CI, 2.16-4.63], <0.001), intraaortic balloon pump (OR, 1.55 [95% CI, 1.07-2.24], =0.020), and extracorporeal membrane oxygenator (OR, 1.85 [95% CI, 1.25-2.76], =0.002) were independent predictors for in-hospital mortality.

Conclusions: The in-hospital mortality of patients with CS remains high despite the high utilization of mechanical circulatory support. Age, low body mass index, cardiac arrest at presentation, amount of vasopressor, and advanced organ failure requiring various support devices were poor prognostic factors for in-hospital mortality. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02985008.
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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.120.008141DOI Listing
June 2021

The Long-Term Functional Effect of Thrombectomy on Patients with Middle Cerebral Artery Occlusion Who Exhibit Moderate to Severe Disability.

Medicina (Kaunas) 2021 May 19;57(5). Epub 2021 May 19.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea.

: Endovascular thrombectomy (EVT is an emerging gold standard treatment for acute cerebral infarction and may allow functional improvement after subacute cerebral infarction. However, the long-term functional benefits of EVT in patients with moderate to severe disability remain unclear. We investigated the effects of EVT on the activities of daily living (ADL), handicap, gait, and eating in patients with middle cerebral artery (MCA) occlusion who exhibited moderate to severe disability (score of 3-5 on the modified Rankin scale (mRS)) due to stroke, up to six months after onset. : This retrospective longitudinal case-control study assessed 45 patients with MCA occlusion who exhibited moderate to severe disability (mRS score ≥ 3): 15 underwent EVT and 30 served as controls. Clinical assessments were conducted at two weeks (12-16 days), four weeks (26-30 days), and six months (180-210 days) after stroke onset. Functional assessments comprised the Korean version of the modified Barthel index (MBI), mRS, functional ambulation category (FAC), and dysphagia outcome severity scale (DOSS) to assess disability, handicap, gait, and eating. : The MBI, mRS, FAC, and DOSS scores all improved significantly (all < 0.05) in the EVT group, compared to the controls. : EVT has favorable effects on performing routine ADL, the handicap itself, walking, and eating. Therefore, EVT is recommended for patients with acute MCA occlusion, including those with severe disability at the initial assessment.
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http://dx.doi.org/10.3390/medicina57050509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161388PMC
May 2021

Could DOAC Be a Better Choice Than Warfarin in Low Compliance Patients with Fontan Procedure?

Medicina (Kaunas) 2021 May 10;57(5). Epub 2021 May 10.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.

After the Fontan procedure, thromboembolic events need to be prevented. We present a young patient with a history of Fontan procedure and poor adherence to warfarin who developed systemic thromboembolism. He was changed to maintenance dabigatran, which is one of the available direct oral anticoagulants (DOACs). A 20-year-old man was diagnosed with cerebral infarct, pulmonary thromboembolism (PTE), and renal infarcts. He was prescribed warfarin to prevent thromboembolic events after the Fontan procedure. Based on his poor adherence to warfarin, we decided to change the anticoagulant therapy from warfarin to dabigatran 150 mg bid. One month later, his pulmonary thromboembolism regressed. Our case report showed a young adult with low compliance to warfarin who developed cerebral, pulmonary, and renal thromboembolic events. Thus, in our opinion, the change from warfarin to a DOAC was necessary for further prevention and treatment of PTE. A change from warfarin to a DOAC should be considered in patients with poor compliance who are at high risk of thromboembolic events, for example, after the Fontan procedure.
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http://dx.doi.org/10.3390/medicina57050465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151865PMC
May 2021

Alteration of White Matter in Patients with Central Post-Stroke Pain.

J Pers Med 2021 May 15;11(5). Epub 2021 May 15.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea.

A stroke may be followed by central post-stroke pain (CPSP), which is characterized by chronic neuropathic pain. The exact mechanism has not yet been fully uncovered. We investigated alterations in the white matters in patients with CPSP, compared with stroke patients without CPSP and normal controls. Our retrospective cross-sectional, case-control study participants were assigned to three groups: CPSP (stroke patients with CPSP ( = 17)); stroke control (stroke patients without CPSP ( = 26)); and normal control (normal subjects ( = 34)). The investigation of white matter for CPSP was focused on the values of fiber numbers (FN) and fractional anisotrophy (FA) for spinothalamic tract (STT), anterior thalamic radiation (ATR), superior thalamic radiation (STR) and posterior thalamic radiation (PTR), and corticospinal tract (CST) was measured. The FA for the STT and STR of the CPSP group were lower than those for the stroke control and normal control groups. The FA of CST and ATR did not differ between the CPSP and stroke groups, but both differed from the normal control. The FA of PTR in the stroke control group differed from the normal control group, but not from the CPSP group. The FN of CST, STT, ATR, and STR for the CPSP and stroke control groups did not differ from each other, but both differed from those of normal controls. FN of PTR did not differ between the CPSP and normal control groups. The alterations in the spinothalamic tract and superior thalamic radiation after stroke would play a role in the pathogenesis of CPSP.
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http://dx.doi.org/10.3390/jpm11050417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156708PMC
May 2021

Is Lateropulsion Really Related with a Specific Lesion of the Brain?

Brain Sci 2021 Mar 10;11(3). Epub 2021 Mar 10.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

Lateropulsion (pusher syndrome) is an important barrier to standing and gait after stroke. Although several studies have attempted to elucidate the relationship between brain lesions and lateropulsion, the effects of specific brain lesions on the development of lateropulsion remain unclear. Thus, the present study investigated the effects of stroke lesion location and size on lateropulsion in right hemisphere stroke patients. The present retrospective cross-sectional observational study assessed 50 right hemisphere stroke patients. Lateropulsion was diagnosed and evaluated using the Scale for Contraversive Pushing (SCP). Voxel-based lesion symptom mapping (VLSM) analysis with 3T-MRI was used to identify the culprit lesion for SCP. We also performed VLSM controlling for lesion volume as a nuisance covariate, in a multivariate model that also controlled for other factors contributing to pusher behavior. VLSM, combined with statistical non-parametric mapping (SnPM), identified the specific region with SCP. Lesion size was associated with lateropulsion. The precentral gyrus, postcentral gyrus, inferior frontal gyrus, insula and subgyral parietal lobe of the right hemisphere seemed to be associated with the lateropulsion; however, after adjusting for lesion volume as a nuisance covariate, no lesion areas were associated with the SCP scores. The size of the right hemisphere lesion was the only factor most strongly associated with lateropulsion in patients with stroke. These results may be useful for planning rehabilitation strategies of restoring vertical posture and understanding the pathophysiology of lateropulsion in stroke patients.
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http://dx.doi.org/10.3390/brainsci11030354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000189PMC
March 2021

Correlation Between Duration From Injury and Bone Mineral Density in Individuals With Spinal Cord Injury.

Ann Rehabil Med 2021 Feb 9;45(1):1-6. Epub 2021 Feb 9.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

Objective: To investigate the correlation between bone mineral density (BMD) and duration of injury in individuals with spinal cord injury (SCI).

Methods: Patients with SCI who visited the outpatient department between January 2009 and January 2019 were enrolled. Patients' most recent dual energy X-ray absorptiometry images were reviewed. According to the 2007 International Society for Clinical Densitometry guidelines, vertebrae with a local structural change were excluded when deriving spine BMD. If one or no vertebra is suitable for evaluation, spine BMD was judged as "improper for assessment". Correlation analysis was performed between duration from injury and BMD Z-scores of the hip and spine.

Results: Among 83 individuals with SCI, the spines of 44 were judged as improper for assessment. The correlation analysis showed a significant negative relationship between the duration from injury and femur neck BMD (r=-0.40, p<0.01) and total proximal femur BMD (r=-0.39, p<0.01). However, no significant correlation was found between the duration from injury and spine BMD Z-score.

Conclusion: The duration of SCI correlated with hip BMD, but not with spine BMD. Further, more than half of the individuals with SCI could not undergo spinal assessment due to local structural changes. Therefore, spine BMD measurement is not an appropriate method for predicting future fracture risk in those with SCI.
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http://dx.doi.org/10.5535/arm.20169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960953PMC
February 2021

Graded motor imagery training as a home exercise program for upper limb motor function in patients with chronic stroke: A randomized controlled trial.

Medicine (Baltimore) 2021 Jan;100(3):e24351

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Purpose: Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke.

Methods: This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI).

Results: Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05).

Conclusions: The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.
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http://dx.doi.org/10.1097/MD.0000000000024351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837923PMC
January 2021

Effect of Brain Lesions on Voluntary Cough in Patients with Supratentorial Stroke: An Observational Study.

Brain Sci 2020 Sep 10;10(9). Epub 2020 Sep 10.

Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

Patients with stroke are known to manifest a decreased cough force, which is associated with an increased risk of aspiration. Specific brain lesions have been linked to impaired reflexive coughing. However, few studies have investigated whether specific stroke lesions are associated with impaired voluntary cough. Here, we studied the effects of stroke lesions on voluntary cough using voxel-based lesion-symptom mapping (VLSM). In this retrospective cross-sectional study, the peak cough flow was measured in patients who complained of weak cough ( = 39) after supratentorial lesions. Brain lesions were visualized via magnetic resonance imaging (MRI) at the onset of stroke. These lesions were studied using VLSM. The VLSM method with non-parametric mapping revealed that lesions in the sub-gyral frontal lobe and superior longitudinal and posterior corona radiata were associated with a weak cough flow. In addition, lesions in the inferior parietal and temporal lobes and both the superior and mid-temporal gyrus were associated with a weak peak cough flow during voluntary coughing. This study identified several brain lesions underlying impaired voluntary cough. The results might be useful in predicting those at risk of poor cough function and may improve the prognosis of patients at increased risk of respiratory complications after a stroke.
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http://dx.doi.org/10.3390/brainsci10090627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564773PMC
September 2020

Effects of Age on Long-Term Functional Recovery in Patients with Stroke.

Medicina (Kaunas) 2020 Sep 7;56(9). Epub 2020 Sep 7.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

Age might be a determinant that limits functional recovery in patients with stroke. Here, we investigated the effect of age on functional recovery within 30 months after stroke onset. This retrospective longitudinal study enrolled 111 patients with first-ever stroke. Functional recovery was assessed at 2 weeks and at 1, 6, and 30 months after stroke onset using the modified Barthel Index (MBI), modified Rankin Score (mRS), functional ambulation category (FAC), muscle strength, and Mini-Mental State Examination (MMSE). A generalized estimating equation analysis was performed. With the MBI, function improved until 6 months after stroke onset in patients aged <70 years and until 1 month after stroke onset in patients ≥70 years. At 30 months after stroke, there was no significant change of MBI in patients aged <70 years, whereas there was a significant decline in older patients. With the mRS and FAC, function improved until 30 months after stroke onset in patients aged <70 years and until 1 month after stroke onset in older patients. Motor deficit, assessed using the Medical Research Council (MRC), improved significantly until 6 months after stroke onset in patients aged <70 years. There was a significant improvement in cognition (assessed using the MMSE) until 6 months after stroke onset in patients aged <70 years and until 1 month after stroke onset in older patients. Long-term functional recovery occurred for up to 30 months after stroke. Patients aged ≥70 years showed functional decline between 6 and 30 months after onset. These findings could be useful when measuring functional recovery after stroke.
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http://dx.doi.org/10.3390/medicina56090451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558871PMC
September 2020

Twelve Weeks of Strengthening Exercise for Patients with Rheumatoid Arthritis: A Prospective Intervention Study.

J Clin Med 2020 Aug 29;9(9). Epub 2020 Aug 29.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

Rheumatoid arthritis (RA) patients may benefit from exercise for several reasons. However, whole-limb strengthening exercises for such patients remain poorly studied. We hypothesized that systemic strength training that includes the upper and lower extremities would improve strength per se and enhance the quality of life. Here, we investigated the effects of 12 weeks of upper- and lower-limb strengthening exercise on the strength and quality of life of RA patients using the International Classification of Functioning, Disability, and Health model. This was a prospective, interventional controlled trial. Forty female RA patients were recruited and assigned to two groups not based on willingness to exercise, with 20 patients in the exercise group and 20 in the control group. All patients in the exercise group received once-weekly training sessions of 60 min over 12 weeks. All participants were assessed before and after the 12-week intervention period. We measured the hand grip strength and isometric quadriceps contraction, the cross-sectional area of the rectus femoris (CSA-RF) (via ultrasonography), and performed the 30 s sit-to-stand test and the 6 min walk test (6MWT). We derived the Borg scale score after the 6MWT and assessed the extent of social participation and quality of life using a Korean version of the 36-Item Short Form Health Survey (SF-36). A total of 35 subjects completed the experiment (18 in the exercise group, 17 in the control group). After the 12-week intervention period, the lower-limb strength and the CSA-RF were significantly increased in the exercise group. The activity level did not change significantly in either group. The exercise group exhibited significant improvements in the SF-36 mental health domain scores. Thus, strengthening exercise is useful for patients with RA.
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http://dx.doi.org/10.3390/jcm9092792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564491PMC
August 2020

Outcome Analysis of the Effects of Helmet Therapy in Infants with Brachycephaly.

J Clin Med 2020 Apr 19;9(4). Epub 2020 Apr 19.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea.

Brachycephaly has several potential deleterious effects, including malocclusion, sleep apnea, and abnormal posture. Nevertheless, the research regarding helmet therapy as a treatment strategy for brachycephaly is limited. Herein, we aimed to analyze the factors influencing the effects of helmet therapy in infants with brachycephaly. We retrospectively reviewed the records of 207 infants aged 3-14 months with a cranial index (CI) >90% who received helmet therapy between May 2016 and October 2019 and complied with the treatment protocol well. We used a multiple regression analysis to determine which factors affected the duration of therapy and a Jonckheere-Terpstra test to establish differences in the duration of helmet therapy according to age and severity. We identified brachycephaly severity ( < 0.001), asymmetry ( < 0.001), and age ( < 0.001) as factors affecting the duration of therapy. Helmet therapy might be effective for infants with moderate to severe brachycephaly, assuming good protocol compliance. In addition, younger treatment initiation age and less severe and less asymmetric brachycephaly significantly shorten the treatment duration.
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http://dx.doi.org/10.3390/jcm9041171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230218PMC
April 2020

Body composition of school-aged children with disabilities.

Pediatr Int 2020 Aug;62(8):962-969

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Background: Children with disabilities are more likely to have problems related to growth and development than typically developing children. This study aimed to compare the growth and body composition indices of children with disabilities with those of typically developing children.

Methods: Students from two elementary schools and one special school were recruited. Height, bodyweight, fat mass, fat-free mass, skeletal muscle mass, and percentage body fat (PBF) were measured. Raw data and proportions of classifications (under, within, and over range) according to the reference value were analyzed.

Results: In total, 355 typically developing children, and 73 children with disabilities participated. Fat-free mass was significantly lower in students with disabilities than in typically developing students (32.14 ± 5.82 versus 28.71 ± 5.92, P < 0.05). Compared with typically developing students, students with disabilities showed tendencies of lower ranges of body mass index (BMI) and fat mass index (FMI). The proportion of under, within, or over ranges of FFMI (fat-free mass index) was significantly different between the two groups. Among the factors, age, gender, and disability, disability significantly influenced FFMI in school-aged children. The proportion of three ranges of BMI, PBF, FMI were significantly different among the age groups in students with disabilities (P = 0.006, P = 0.0001, and P = 0.001, respectively). Younger children had significantly greater proportions of under range in BMI, PBF, and FMI.

Conclusions: Disability significantly affects FFMI, which represents muscle mass. Therefore, it is crucial to make efforts to increase physical activity and to improve nutrition in rehabilitative intervention strategies.
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http://dx.doi.org/10.1111/ped.14248DOI Listing
August 2020

Neglected Odontoid Fracture During Growth.

Ann Rehabil Med 2020 Feb 29;44(1):99-100. Epub 2020 Feb 29.

Department of Rehabilitation Medicine, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

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http://dx.doi.org/10.5535/arm.2020.44.1.99DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7056324PMC
February 2020

Optimal Strategy for Antiplatelet Therapy After Endovascular Revascularization for Lower Extremity Peripheral Artery Disease.

JACC Cardiovasc Interv 2019 12 13;12(23):2359-2370. Epub 2019 Nov 13.

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

Objectives: The aim of this study was to investigate the optimal strategy for antiplatelet therapy in patients with lower extremity peripheral artery disease (PAD) after endovascular revascularization.

Background: The optimal strategy for antiplatelet therapy in patients with PAD after endovascular revascularization has not been established.

Methods: From March 2008 to February 2013, 693 patients with lower extremity PAD treated with different antiplatelet therapies, such as mono-antiplatelet therapy (MAPT) and dual-antiplatelet therapy (DAPT), of various durations after endovascular revascularization were analyzed. They were classified into 2 groups (DAPT <6 months or MAPT vs. DAPT ≥6 months). The primary outcomes were major adverse cardiovascular events and major adverse limb events. The safety outcome was major bleeding.

Results: During 5-year follow-up, major adverse cardiovascular events occurred less frequently in the DAPT ≥6-month group than the DAPT <6-month or MAPT group (17.3% vs. 31.3%; hazard ratio: 0.44; 95% confidence interval: 0.30 to 0.65; p < 0.001). Major adverse limb events also occurred less frequently in the DAPT ≥6-month group than the DAPT <6-month or MAPT group (21.5% vs. 43.7%; hazard ratio: 0.42; 95% CI: 0.30 to 0.58; p < 0.001). However, major bleeding events were infrequent, with no signal toward harm with DAPT ≥6 months. Results were consistent after inverse probability-weighted adjustment and propensity score matching.

Conclusions: Following endovascular revascularization for lower extremity PAD, DAPT ≥6 months was associated with decreased 5-year major adverse cardiovascular events and major adverse limb events.
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http://dx.doi.org/10.1016/j.jcin.2019.08.006DOI Listing
December 2019

The effect of white matter integrity on functional outcome in central pontine demyelination.

J Phys Ther Sci 2019 Aug 9;31(8):698-701. Epub 2019 Aug 9.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea: 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea.

[Purpose] Central pontine demyelination is a common osmotic demyelination syndrome. Typically, central pontine demyelination shows high signal intensity with demyelination in the mid-pons. Despite severe imaging findings, patients usually recover. This study investigated the integrity of the corticospinal tract (CST) and corticoreticular pathway (CRP) in patients at 12 months after the onset of central pontine demyelination. [Participants and Methods] This retrospective cross-sectional observational study assessed two patients with central pontine demyelination, who were ultimately able to walk without using an aid or orthosis and to use both hands but with mild residual symptoms. All participants underwent diffusion tensor imaging (DTI) at 12 months after onset. [Results] Both patients had mild ataxia at 12 months after onset. The integrity of the CST was restored in both cases, while the integrity of the CRP recovered partially. [Conclusion] The integrity of the CST and CRP at 12 months after the onset of central pontine demyelination was similar in both cases as well as the recovery status of the hand function and ambulation. These results may be useful in planning therapy for patients with central pontine demyelination.
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http://dx.doi.org/10.1589/jpts.31.698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698467PMC
August 2019

Degeneration of the Inferior Cerebellar Peduncle After Middle Cerebral Artery Stroke: Another Perspective on Crossed Cerebellar Diaschisis.

Stroke 2019 10 26;50(10):2700-2707. Epub 2019 Aug 26.

Department of Rehabilitation Medicine, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul (Y.K.).

Background and Purpose- Deafferentation of the cortico-ponto-cerebellar pathway has been proposed as a key mechanism of crossed cerebellar diaschisis. Although the cerebellum receives afferent stimuli from both cortico-ponto-cerebellar and spinocerebellar pathways, evidence on whether spinocerebellar deafferentation contributes to a hypofunctional cerebellum is lacking. Therefore, we aimed to determine whether changes in the spinocerebellar pathway occur after middle cerebral artery stroke. Methods- Twenty-three patients admitted to our inpatient rehabilitation facility and 23 age-matched healthy controls were retrospectively enrolled. Patients' functional ambulation category was determined and the Medical Research Council muscle scale test of the lower limb muscles was performed at admission and discharge. The fractional anisotropy (FA) values of the corticospinal tract and the inferior cerebellar peduncle (ICP), as the final route of the dorsal spinocerebellar pathway, were compared between the groups. The FA laterality indices of the ICP and corticospinal tract were calculated as follows: (FA-FA)/(FA+FA). Pearson correlation analysis and multivariate linear regression models were used to determine the associations between the FA laterality indices and ambulatory function. Results- The FAs of the corticospinal tract and ICP were lower in the patient group than in the control group. The FA laterality index of the corticospinal tract was not correlated with the functional ambulation category or Medical Research Council muscle scale score at admission or discharge. The FA laterality index of the ICP at the pontomedullary junction was positively correlated with the functional ambulation category and Medical Research Council muscle scale scores of all hemiplegic lower limb muscles at admission and discharge. The FA laterality index of the ICP at the pontomedullary junction was independently associated with the functional ambulation category according to the multivariate regression models. Conclusions- ICP degeneration occurs in the subacute and early chronic phase of middle cerebral artery stroke. The lower FA laterality index of the ICP was indicative of poorer ambulatory and lower limb function.
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http://dx.doi.org/10.1161/STROKEAHA.119.025723DOI Listing
October 2019

Is the modified Mann Assessment of Swallowing Ability useful for assessing dysphagia in patients with mild to moderate dementia?

J Clin Neurosci 2019 Dec 12;70:169-172. Epub 2019 Aug 12.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address:

Dysphagia is an important causative factor of aspiration pneumonia among the elderly, particularly in patients with dementia. The modified Mann Assessment of Swallowing Ability (mMASA) is commonly used as a physician-administered screening protocol for assessing dysphagia due to its merits as a clinical test that does not involve special equipment or radiation exposure. The present study investigated whether the mMASA would reflect the dysphagia state as estimated by videofluoroscopic swallowing study (VFSS) findings and cognitive function in patients with dementia. This study included 25 subjects with mild to moderate dementia. In all subjects, swallowing function was evaluated with the mMASA and VFSS and cognitive function was evaluated using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Global Deterioration Scale (GDS), and Clinical Dementia Rating (CDR) scales. The Spearman correlation and linear regression tests were conducted with the mMASA values and other tests for swallowing and cognition. The mMASA values were correlated with the Penetration-Aspiration Scale (PAS) of the VFSS as well as scores on the MMSE, MoCA, GDS, and CDR. In addition, the Judgment and Problem Solving and Community Affairs subscales of the CDR were correlated with mMASA values. The assessments of dysphagia using the mMASA were consistent with the VFSS findings and were reflected by cognitive function. Taken together, the present findings suggest that the mMASA would be useful for the routine evaluation of swallowing function in patients with mild to moderate dementia for the detection of dysphagia.
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http://dx.doi.org/10.1016/j.jocn.2019.08.031DOI Listing
December 2019

Association Between the Severity of Dysphagia and Various Parameters of the Cervical Spine; Videofluoroscopic Analysis in Neutral and Retraction Position of the Normal Volunteers.

Spine (Phila Pa 1976) 2020 Jan;45(2):103-108

Department of Rehabilitation, Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea.

Study Design: Videoflurographic swallowing study in asymptomatic volunteers.

Objective: The purpose of this study was to investigate the relationship between the severity of dysphagia and various parameters of the subjects.

Summary Of Background Data: Occipitocervical fixation is associated with several potential complications. Malalignment of craniovertebral junction and associated dysphagia have been well described in the literature. However, there has been little attention given to investigate the association between the degree of swallowing dysfunction and various patient's parameters.

Methods: Thirty-nine healthy asymptomatic volunteers, 18 males and 21 females, were enrolled in this study. Based on videofluorographic swallowing study (VFSS), two scoring systems of swallowing dysfunction (dysphagia rating scale [DRS], dysphagia outcome and severity scale [DOSS]) were measured in neutral and retraction position. Multiple linear regression analysis was performed to evaluate the relationship between the degree of swallowing dysfunction and various factors of the subjects such as radiological and clinical parameters.

Results: There was statistically significant correlation between DRS and DOSS (r = -0.354, P < 0.05). Multiple regression analysis showed that there was a significant association of the dysphagia severity (DRS and DOSS) with the percentile change of the narrowest oropharyngeal diameter (OD) (%dn OD) (r = 0.121, P < 0.01 and r = 0.020, P < 0.01, respectively). Percentile change of OD (neutral and retraction position) was positively associated with the difference of C0-2 angle (r = 1.676, P < 0.01). None of the other variables such as age, sex, C0-1 angle, C1-2 angle, and C2-7 angle were significantly associated with the degree of dysphagia or %dn OD.

Conclusion: This study demonstrated that the severity of dysphagia is significantly associated with the percentile change of OD and the C0-2 angle has considerable effect on the OD after O-C fusion. Therefore, C0-2 angle could be the most critical radiological parameter not only for predicting the stricture of oropharyngeal space but also for preventing postoperative dysphagia.

Level Of Evidence: 4.
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http://dx.doi.org/10.1097/BRS.0000000000003185DOI Listing
January 2020

Association of Lesion Location With Long-Term Recovery in Post-stroke Aphasia and Language Deficits.

Front Neurol 2019 24;10:776. Epub 2019 Jul 24.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Recovery from post-stroke aphasia is important for performing the activities of daily life, returning to work, and quality of life. We investigated the association between specific brain lesions and the long-term outcome of four dimensions of aphasia: fluency, comprehension, naming, and repetition 12 months after onset in patients with stroke. Our retrospective cross-sectional observational study investigated the relationship between the Korean version of the Western Aphasia Battery scores in 31 stroke patients 1 year after the onset of stroke and stroke lesion location. Brain lesions were assessed using voxel-based lesion symptom mapping (VLSM) in conjunction with magnetic resonance imaging. Damage to the Rolandic cortex, Heschl's gyrus, the posterior corona radiata, supramarginal cortex, superior longitudinal fasciculus, superior temporal gyrus, and insula was associated with a low total AQ score. Lesions in the inferior triangularis and inferior operculum of the frontal cortex, supramarginal cortex, and insula were associated with a poor fluency outcome. Damage to the parietal cortex, angular cortex, temporal middle cortex, sagittal stratum, and temporal superior cortex was associated with poor recovery of comprehension skills. Lesions in the angular cortex, supramarginal cortex, posterior corona radiata, superior longitudinal fasciculus, internal capsule, temporal superior cortex, and temporal middle cortex were associated with poor recovery of naming in patients with stroke. Damage to the superior temporal cortex, posterior corona radiata, and superior longitudinal fasciculus was associated with poor recovery of repetition component. We identified specific brain lesions associated with long-term outcomes in four dimensions of aphasia, in patients with post-stroke aphasia. Our findings may be useful for advancing understanding for the pathophysiology of aphasia in stroke patients.
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http://dx.doi.org/10.3389/fneur.2019.00776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668327PMC
July 2019

The effects of repetitive transcranial magnetic stimulation on body weight and food consumption in obese adults: A randomized controlled study.

Brain Stimul 2019 Nov - Dec;12(6):1556-1564. Epub 2019 Jul 25.

Department of Family Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93-6 Ji-dong, Paldal-gu, Suwon, Kyonggi-do, 442-723, Republic of Korea.

Background: Although some studies have reported significant reductions in food cravings following the single-session of repetitive transcranial magnetic stimulation (rTMS), there is little research on the effects of multi-session of rTMS on food consumption and body weight in obese subjects.

Objective: We conducted 4-week randomized, sham-controlled, single-blind, parallel-group trial to examine the effect of rTMS on body weight in obese adults.

Methods: Forty-three obese patients (body mass index [BMI] ≥25 kg/m) aged between 18 and 70 years were randomized to the sham or real treatment group (21 in the TMS group and 22 in the sham treatment group). A total of 8 sessions of rTMS targeting the left dorsolateral prefrontal cortex (DLPFC) was provided over a period of 4 weeks. The primary outcome measure was weight change in kilograms from baseline to 4 weeks. Secondary endpoints included changes in anthropometric measures, cardiovascular risk factors, food intake, and appetite.

Results: Participants in the rTMS group showed significantly greater weight loss from baseline following the 8 session of rTMS (-2.75 ± 2.37 kg vs. 0.38 ± 1.0 kg, p < 0.01). Consistent with weight loss, there was a significant reduction in fat mass and visceral adipose tissue at week 4 in the rTMS group compared with the control group (p < 0.01). After the 8 sessions of rTMS, the TMS group consumed fewer total kilocalories and carbohydrates per day than the control group (p < 0.05).

Conclusions: 8 sessions of HF rTMS delivered to the left DLPFC were effective in inducing weight loss and decreasing food intake in obese patients.

Trial Registration: Clinical trial registered with the Clinical Trials Registry at http://cris.cdc.go.kr (KCT0002548).
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http://dx.doi.org/10.1016/j.brs.2019.07.020DOI Listing
February 2020

The Role of Regular Physical Therapy on Spasticity in Children With Cerebral Palsy.

Ann Rehabil Med 2019 Jun 28;43(3):289-296. Epub 2019 Jun 28.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

Objective: To investigate the effect of physical therapy (PT) intervention on spasticity in patients with cerebral palsy (CP), and to assess the degree of deterioration of spasticity when regular PT is interrupted in those patients.

Methods: We recruited 35 children with spastic CP who visited our hospital for PT, and whose Modified Tardieu Scale (MTS) scores were serially recorded including before and after a 10-day public holiday time frame period. The outcome measures were the angle of range of motion (ROM) of dorsiflexion of the ankle joint (R1 and R2) in the knee flexion and extension positions as assessed using the MTS.

Results: The range of dorsiflexion of the ankle joint (R1 and R2) after the holiday period was significantly decreased as compared with that measured ROM noted before the holiday period, regardless of the knee position, age, or gross motor function. The dynamic component of the MTS (R2-R1) showed a slight decrease in the knee flexion position.

Conclusion: Interruption of regular PT aggravated spasticity and decreased ankle joint ROM in children with spastic CP. Our findings suggest that regular PT in the care continuum for children with CP is crucial for the maintenance of ROM in the spastic ankle joints.
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http://dx.doi.org/10.5535/arm.2019.43.3.289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637053PMC
June 2019

Normative Data on Grip Strength in a Population-Based Study with Adjusting Confounding Factors: Sixth Korea National Health and Nutrition Examination Survey (2014-2015).

Int J Environ Res Public Health 2019 06 25;16(12). Epub 2019 Jun 25.

Department of Rehabilitation Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.

We investigated population-based data on grip strength, analyzed for demographic factors, and proposed a formula to estimate grip strength that could be generalized to a population with different anthropometric and background characteristics. : This study used a complex, stratified, multistage probability cluster survey with a representative sample of the population. Select household Korean participants ( = 6577) over age 10 who were able to perform daily tasks without issue were included. Grip strength was measured in both hands, alternately, three times using a digital grip strength dynamometer. : There was a curvilinear relationship between grip strength and age, and grip strength was higher in males than females ( = 0.001). Hand preference significantly affected grip strength ( = 0.001). Weight and height were positively correlated with strength in both hands ( = 0.001), but waist circumference was negatively correlated with strength in both hands ( = 0.001). The intensity of occupational labor did significantly affect grip strength in both hands ( = 0.001). The formulas for estimating grip strength of each hand are presented as main results. To determine normative data on grip strength, we may consider factors such as occupations with different physical demands, underlying medical conditions, anthropometric characteristics, and unmodifiable factors such as age and sex.
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http://dx.doi.org/10.3390/ijerph16122235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616518PMC
June 2019

When does spasticity in the upper limb develop after a first stroke? A nationwide observational study on 861 stroke patients.

J Clin Neurosci 2019 Aug 11;66:144-148. Epub 2019 May 11.

Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Republic of Korea.

This study investigated the time taken for upper extremity spasticity to develop and its regional difference after first-ever stroke onset in a nationwide multicenter study in South Korea. The retrospective observational study included 861 individuals with post-stroke spasticity in the upper limbs. Spasticity in the upper extremity joints was defined as a modified Ashworth Scale score ≥1. The median time to develop upper limb spasticity after stroke onset was 34 days. 12% of post-stroke spasticity cases developed between 2 months and 3 months and 13% developed after 3 months from onset. At the time of diagnosis of spasticity, most patients showed only a slight increase in muscle tone, which was observed most frequently in the elbow, followed by the wrist, and fingers. Younger stroke survivors were more spastic, and the severity of spasticity increased with time. Approximately half of the patients with post-stroke spasticity developed spasticity during the first month. However, post-stroke spasticity can develop more than 3 months after stroke onset. Therefore, it is important to assess spasticity, even in the chronic state.
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http://dx.doi.org/10.1016/j.jocn.2019.04.034DOI Listing
August 2019

Corticospinal Tract Integrity and Long-Term Hand Function Prognosis in Patients With Stroke.

Front Neurol 2019 15;10:374. Epub 2019 Apr 15.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

The restoration of hand function is an important goal for patients with stroke. This study investigated the relationship between corticospinal tract (CST) integrity and the functional status of the hand in patients with stroke 6 months after onset and evaluated which of the following values would be useful for predicting hand function: fiber number (FN), fractional anisotropy (FA) at the mid-pons, and FA at the pontomedullary junction. The present retrospective cross-sectional observational study assessed 44 patients with stroke who were able to walk without using a walking aid or orthosis. The final hand function results were classified into three groups: no recovery (unable to grasp), partial recovery (able to grasp, unable to oppose), and full recovery (able to grasp and oppose). All subjects underwent diffusion tensor imaging (DTI) at 6 months after stroke onset. Values for FA at the mid-pons and pontomedullary junction and CST FN were measured. The normalization ratio for FN and FA was calculated using the following formula: data for affected hand/data for non-affected hand. The normalized FN, FA (mid-pons), and FA (pontomedullary junction) DTI values differed significantly. The FA (mid-pons) value for the full recovery group was higher than those for the other groups. The FA (mid-pons) value for the partial recovery group was higher than that for the no recovery group. The normalized FA (mid-pons) value differed significantly among all three groups. The present study showed that CST integrity (at 6 months after onset) in patients with chronic stroke was related to functional hand status. In addition, the mid-pons FA value was more predictive of functional restoration of the hand than the FN or FA value at the pontomedullary junction. These results may be useful in predicting the functional restoration of the hand and understanding the functional prognosis of stroke.
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http://dx.doi.org/10.3389/fneur.2019.00374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476282PMC
April 2019

Crossed Cerebellar Diaschisis Has an Adverse Effect on Functional Outcome in the Subacute Rehabilitation Phase of Stroke: A Case-Control Study.

Arch Phys Med Rehabil 2019 07 13;100(7):1308-1316. Epub 2019 Mar 13.

Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea. Electronic address:

Objective: To investigate whether crossed cerebellar diaschisis (CCD) is associated with functional outcome in the subacute rehabilitation phase of stroke.

Design: Retrospective case-control study.

Setting: Hospital-based cohort.

Participants: The study enrolled participants who underwent brain single-photon emission computed tomography (N=48). Patients with CCD were identified (n=24). Twenty-four controls were selected for each case-patient by matching age, stroke type (ischemic or hemorrhagic), lesion laterality, and lesion location.

Intervention: Not applicable.

Main Outcome Measures: The functional ambulation category (FAC), modified Barthel Index (MBI), and Mini-Mental State Examination (MMSE) were administered at the initial (initiation of rehabilitation therapy) and the follow-up (4wk after rehabilitation therapy) assessments.

Results: The CCD group had lower MMSE, FAC, MBI, and MMSE scores at the initial assessment (P=.032, .016, and .001, respectively) and lower FAC and MBI scores at the follow-up assessment, than the non-CCD group (P=.001 and .036, respectively). Although CCD was not associated with cognitive impairment, nonambulatory status, and dependent activities of daily living (ADL) at the initial assessment (P=.538, .083, and >.99, respectively), the CCD group had a higher risk of cognitive impairment (adjusted odds ratio [aOR]=4.044; 95% confidence interval [CI], 1.071-15.270; P=.039), nonambulatory status (aOR=7.000; 95% CI, 1.641-29.854; P=.009) and dependent ADL (aOR=13.500; 95% CI, 1.535-118.692; P=.019) at the follow-up assessment.

Conclusions: CCD is associated with severe functional impairment and may have an adverse effect on functional outcomes related to cognition, ambulatory function, and ADL during the subacute rehabilitation phase of stroke. This suggests that CCD may be a valuable predictor of functional outcome in the subacute rehabilitation phase of stroke.
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http://dx.doi.org/10.1016/j.apmr.2019.01.026DOI Listing
July 2019

Sinking Skin Flap Syndrome or Syndrome of the Trephined: A Report of Two Cases.

Ann Rehabil Med 2019 Feb 28;43(1):111-114. Epub 2019 Feb 28.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Decompressive craniectomy (DC) is commonly performed in patients with intracranial hypertension or brain edema due to traumatic brain injury. Infrequently, neurologic deteriorations accompanied by sunken scalp may occur after DC. We report two patients with traumatic subdural hemorrhage who had neurologic deteriorations accompanied by sunken scalp after DC. Neurologic function improved dramatically in both patients after cranioplasty. Monitoring for neurologic deterioration after craniectomy is advised. For patients showing neurologic deficit with a sunken scalp, early cranioplasty should be considered.
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http://dx.doi.org/10.5535/arm.2019.43.1.111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6409664PMC
February 2019

Physical Activity of Workers in a Hospital.

Int J Environ Res Public Health 2019 02 13;16(4). Epub 2019 Feb 13.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea.

: This study aims to evaluate the physical activity of healthcare personnel and the affecting factors of physical activity (PA) in a hospital using an accelerometer device (Actigraph wGT3X-BT). : A total of 63 subjects (22 physicians, 19 nurses, and 23 supporting staff) participated and wore an accelerometer for seven days. Among the outputs, the mean counts for a minute, time spent for light, moderate, and vigorous intensity PA, and step count were extracted. As a secondary study, 16 subjects continued for one more week after feedback on their PA of the previous week and counseling to encourage PA. : Most of (62/63) the participants fulfilled the recommended amount of PA, which is more than 300 min of moderate to vigorous physical activity (MVPA). Physicians showed significantly less PA than nurses or supporting staffs: Mean counts per minute (210.4 vs. 476.0 and 441.8 respectively), time in MVPA per week (904.7 min vs. 1471.3 min and 1451.0 min), and step counts per week (69,029 vs. 87,119 and 84,700) ( < 0.001). Nurses and supporting staff were not statistically different. There was no significant difference in the PA of workers in the hospital regarding gender and marital status. However, the average calorie expenditure of the child raising group was significantly higher. There was no statistically significant difference in PA before and after counseling. No participants reported a vigorous degree of exercise intensity over the study period. : Most of the healthcare personnel met the recommended PA, however, only 57% (36/63) recalled having engaged in MVPA during the study period. The group of physicians showed less PA compared to nurses or supporting staff. Single check-up and counseling were not found to increase PA.
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http://dx.doi.org/10.3390/ijerph16040532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406875PMC
February 2019

Therapeutic effect of repetitive transcranial magnetic stimulation on non-lesional focal refractory epilepsy.

J Clin Neurosci 2019 May 31;63:130-133. Epub 2019 Jan 31.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address:

The effects of repetitive transcranial magnetic stimulation (rTMS) on epilepsy remain unclear. This study was performed to investigate the effects of low-frequency rTMS on non-lesional focal epilepsy. This was a prospective open-label longitudinal study with four patients with multi-drug-resistant non-lesional focal epilepsy and no control group. The patients received daily doses of 900 pulses of 0.5-Hz stimulation for 10 days over the epileptic foci in neocortical areas determined by electrical source analysis. The outcomes were measured in terms of seizure reduction. The incidences of seizures were measured at baseline (4 weeks), intervention (2 weeks), and follow up (8 weeks). Seizure reduction was observed in three of four subjects. The effects of rTMS persisted over a follow-up period of 8 weeks. One of the four patients did not respond to rTMS and showed no seizure reduction. The low frequency rTMS would be an effective treatment for non-lesional focal refractory epilepsy, may be an adjunctive treatment with conventional medical treatment for refractory epilepsy. These results are therefore useful for planning treatment strategies for patients with refractory epilepsy, as well as for treatment of epilepsy.
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http://dx.doi.org/10.1016/j.jocn.2019.01.025DOI Listing
May 2019

Which brain lesions produce spasticity? An observational study on 45 stroke patients.

PLoS One 2019 24;14(1):e0210038. Epub 2019 Jan 24.

Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Spasticity is an important barrier that can hinder the restoration of function in stroke patients. Although several studies have attempted to elucidate the relationship between brain lesions and spasticity, the effects of specific brain lesions on the development of spasticity remain unclear. Thus, the present study investigated the effects of stroke lesions on spasticity in stroke patients. The present retrospective longitudinal observational study assessed 45 stroke patients using the modified Ashworth Scale to measure muscle spasticity. Each patient was assessed four times: initially (within 2 weeks of stroke) and at 1, 3, and 6 months after the onset of stroke. Brain lesions were analyzed using voxel-based lesion symptom mapping (VLSM) with magnetic resonance imaging images. Spasticity developed to a certain degree within 3 months in most stroke patients with spasticity. The VLSM method with non-parametric mapping revealed that lesions in the superior corona radiata, posterior limb of the internal capsule, posterior corona radiata, thalamus, putamen, premotor cortex, and insula were associated with the development of upper-limb spasticity. Additionally, lesions of the superior corona radiata, posterior limb of the internal capsule, caudate nucleus, posterior corona radiata, thalamus, putamen, and external capsule were associated with the development of lower-limb spasticity. The present study identified several brain lesions that contributed to post-stroke spasticity. Specifically, the involvement of white matter tracts and the striatum influenced the development of spasticity in the upper and lower limbs of stroke patients. These results may be useful for planning rehabilitation strategies and for understanding the pathophysiology of spasticity in stroke patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210038PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345431PMC
September 2019
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