Publications by authors named "Sung-Bom Pyun"

58 Publications

Clinical Factors Associated with Balance Function in the Early Subacute Phase after Stroke.

Am J Phys Med Rehabil 2021 Jul 27. Epub 2021 Jul 27.

Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Republic of Korea Brain Convergence Research Center, Korea University, Seoul, Republic of Korea Department of Biomedical Sciences, Korea University, Seoul, Republic of Korea.

Objective: To investigate the key factors of balance function in the early subacute phase after stroke.

Design: Ninety-four stroke patients were included. Multiple variables were evaluated, including demographic factors, clinical variables (stroke type; lesion site; Korean Mini-Mental State Examination [MMSE]; motor strength of the hip, knee, and ankle joints; Fugl-Meyer Assessment of lower extremity [FMA-LE]); neurophysiologic variables (amplitude ratio of somatosensory evoked potential [SEP] of the tibial nerves), and laterality index of fractional anisotropy (FA-LI) of the corticospinal tract using diffusion tensor imaging. Balance function was measured using the Berg balance scale (BBS).

Results: The BBS score was significantly negatively correlated with age and FA-LI and positively correlated with MMSE; FMA-LE; motor strength of the affected hip, knee, and ankle joint; and SEP amplitude ratio (p < 0.05). The abnormal SEP group and poor integrity of the corticospinal tract group showed significantly decreased BBS scores. In multivariable logistic regression analysis, age, FMA-LE score, and ankle plantar flexion strength were significantly associated with balance function (odds ratios: 0.919, 1.181, and 15.244, respectively, p < 0.05).

Conclusion: Higher age, severe initial motor impairment, and strength of the affected lower extremity muscles, especially the ankle plantar flexor, are strongly associated with poor balance function early after stroke.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PHM.0000000000001856DOI Listing
July 2021

Neuroanatomical correlates of poststroke complex regional pain syndrome: a voxel-based lesion symptom-mapping study.

Sci Rep 2021 Jun 22;11(1):13093. Epub 2021 Jun 22.

Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.

Complex regional pain syndrome (CRPS) is a common poststroke complication. However, the neural substrates associated with CRPS remain unclear. We investigated the neural correlates associated with poststroke CRPS using voxel-based lesion‒symptom mapping (VLSM) analysis. Among 145 patients with ischemic stroke, 35 were diagnosed with CRPS and categorized into the poststroke CRPS group, and the remaining 110 into the control group. We compared the clinical characteristics between the groups. VLSM analysis was performed to identify the brain region associated with the development of poststroke CRPS. The clinical findings suggested that the poststroke CRPS group had lower muscle strength; lower scores on Fugl‒Meyer assessment, Manual Function Test, Mini-Mental Status Examination; and higher incidence of absent somatosensory evoked potentials in the median nerve than the control group. The head of the caudate nucleus, putamen, and white matter complexes in the corona radiata were significantly associated with poststroke CRPS development in ischemic stroke patients. These results facilitate an understanding of poststroke CRPS pathophysiology. Monitoring patients with lesions in these structures may aid the prevention and early treatment of poststroke CRPS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-92564-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219671PMC
June 2021

Design and Evaluation of Korean Electropalatography (K-EPG).

Sensors (Basel) 2021 May 31;21(11). Epub 2021 May 31.

Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea.

Recently, the development of medical rehabilitation technology has resulted in an increased interest in speech therapy equipment. In particular, research on articulation therapy for communication disorders is being actively conducted. The existing methods for the diagnosis and treatment of speech disorders, such as traditional tactile perception tests and methods based on the empirical judgment of speech therapists, have many limitations. Moreover, the position and contact force of the tongue are key factors in speech disorders with regards to articulation. This is a very important factor in the distinction of Korean characters such as lax, tense and aspirated consonants. In this study, we proposed a Korean-electropalatography (EPG) system to easily measure and monitor the position and contact force of the tongue during articulation treatment and diagnosis. In our proposed K-EPG system, a sensor was fabricated using an AgCl electrode and biocompatible silicon. Furthermore, the measured signal was analyzed by implementing a bio-signal processing module and monitoring program. In particular, the bio-signal was measured by inserting the device into the palate of an experimental healthy test group (four subjects). Through these experiments, we confirmed that our K-EPG system could be applied to clinical treatment in speech therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/s21113802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198145PMC
May 2021

Repetitive Transcranial Magnetic Stimulation on the Supplementary Motor Area Changes Brain Connectivity in Functional Dysphagia.

Brain Connect 2021 06 29;11(5):368-379. Epub 2021 Mar 29.

BK21 Graduate Program, Department of Biomedical Sciences and Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Republic of Korea.

Previous studies arguing that functional dysphagia could be explained by underlying neurobiological mechanisms are insufficient to explain brain regions that functionally interact in patients with functional dysphagia. Therefore, we investigated functional connectivity changes associated with functional dysphagia after applying facilitatory repetitive transcranial magnetic stimulation (rTMS) on the supplementary motor area (SMA). A patient with severe long-lasting functional dysphagia and 15 healthy controls participated in this study. A facilitatory 5 Hz rTMS protocol was applied to the patient's SMA. We performed functional magnetic resonance imaging (fMRI) using volitional swallowing tasks to investigate neural network changes before rTMS (pre-rTMS), immediately after rTMS, and 3 months later. The pre-rTMS fMRI results of the patient showed extensive overactivation in the left-lateralized regions related to volitional swallowing compared with the healthy controls. Following rTMS, dysphagia symptoms partially improved. The patient showed positive connectivity with the bilateral cerebellum in the bilateral SMA seeds before rTMS treatment. Furthermore, left-lateralized overactivation was washed out immediately after completion of rTMS, and connectivity between the left SMA and left precentral gyrus recovered 3 months after rTMS treatment. Our findings confirm that functional dysphagia might be a neurobiological manifestation caused by maladaptive functional connectivity changes in brain structures related to swallowing. Furthermore, noninvasive brain modulation with rTMS over the SMA may facilitate functional connectivity changes between the cortical and subcortical regions. Accordingly, these changes will allow control of the movements related to swallowing and may lead to improved clinical symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/brain.2020.0818DOI Listing
June 2021

Automatic Pharyngeal Phase Recognition in Untrimmed Videofluoroscopic Swallowing Study Using Transfer Learning with Deep Convolutional Neural Networks.

Diagnostics (Basel) 2021 Feb 13;11(2). Epub 2021 Feb 13.

Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea.

Background: Video fluoroscopic swallowing study (VFSS) is considered as the gold standard diagnostic tool for evaluating dysphagia. However, it is time consuming and labor intensive for the clinician to manually search the recorded long video image frame by frame to identify the instantaneous swallowing abnormality in VFSS images. Therefore, this study aims to present a deep leaning-based approach using transfer learning with a convolutional neural network (CNN) that automatically annotates pharyngeal phase frames in untrimmed VFSS videos such that frames need not be searched manually.

Methods: To determine whether the image frame in the VFSS video is in the pharyngeal phase, a single-frame baseline architecture based the deep CNN framework is used and a transfer learning technique with fine-tuning is applied.

Results: Compared with all experimental CNN models, that fine-tuned with two blocks of the VGG-16 (VGG16-FT5) model achieved the highest performance in terms of recognizing the frame of pharyngeal phase, that is, the accuracy of 93.20 (±1.25)%, sensitivity of 84.57 (±5.19)%, specificity of 94.36 (±1.21)%, AUC of 0.8947 (±0.0269) and Kappa of 0.7093 (±0.0488).

Conclusions: Using appropriate and fine-tuning techniques and explainable deep learning techniques such as grad CAM, this study shows that the proposed single-frame-baseline-architecture-based deep CNN framework can yield high performances in the full automation of VFSS video analysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/diagnostics11020300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918932PMC
February 2021

Development of a categorical naming test in Korean: Standardization and clinical application for patients with stroke.

PLoS One 2021 19;16(2):e0247118. Epub 2021 Feb 19.

Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea.

Purpose: The purpose of this study was to develop and standardize a new categorical naming test, titled the Categorical Naming Test (CNT), for stroke patients, and to investigate its validity and clinical usefulness for patients with stroke.

Materials And Methods: The CNT was developed based on semantic category, imageability, and psycholinguistic factors such as word frequency and word length. The test materials included two main semantic categories (living objects and artificial objects) comprising 60 items. We standardized the CNT on 221 healthy adults and administered the CNT to 112 stroke patients.

Results: Internal consistency and concurrent validity of the test were high. The mean total CNT scores varied significantly according to participants' age, sex, and education. Among healthy controls, the scores for naming living objects were significantly higher than those for artificial objects. The analysis of stroke patients showed that the total CNT score revealed a statistically significant difference based on the patients' lesion laterality and presence of aphasia, after controlling for age, sex, and education. However, the categorical scores achieved by comparing the naming scores for living and artificial objects showed no significant differences according to lesion laterality, stroke type, and presence of aphasia.

Conclusion: The CNT is a newly developed version of an overt naming task with high internal consistency validity for stroke patients in Korea. The newly developed CNT can prove useful in evaluating naming ability in stroke patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247118PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895370PMC
August 2021

Effects of aging on brain networks during swallowing: general linear model and independent component analyses.

Sci Rep 2021 01 13;11(1):1069. Epub 2021 Jan 13.

Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea.

Swallowing disorders occur more frequently in older adults. However, the effects of the aging process on neural activation when swallowing are unclear. We aimed to identify neural regions activated during swallowing and evaluate changes in neural activation and neural networks with aging. Using a general linear model (GLM) and independent component (IC) analyses, blood oxygen level-dependent (BOLD) signals were observed in the lateral precentral gyrus, postcentral gyrus, anterior insular cortices, supramarginal gyri, and medial frontal gyrus during swallowing. The right thalamus and anterior cingulate gyri were found to be active areas by GLM and IC analyses, respectively. In the correlational analyses, age was negatively correlated with BOLD signals of the lateral precentral gyri, postcentral gyri, and insular cortices in swallowing tasks. Additionally, correlation analyses between ICs of all participants and age revealed negative correlations in the right supramarginal gyrus, both anterior cingulate cortices, putamen, and cerebellum. In the network analysis, the BOLD signal positively correlated with age in the default mode network (DMN), and was negatively correlated in the lateral precentral gyri, postcentral gyri, and insular cortices. The amplitude of low-frequency fluctuations was significantly decreased in the DMN and increased in swallowing-related areas during swallowing tasks. These results suggest that aging has negative effects on the activation of swallowing-related regions and task-induced deactivation of the DMN. These changes may be used to detect early functional decline during swallowing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-79782-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806781PMC
January 2021

Shape and Volumetric Differences in the Corpus Callosum between Patients with Major Depressive Disorder and Healthy Controls.

Psychiatry Investig 2020 Sep 17;17(9):941-950. Epub 2020 Sep 17.

Brain Convergence Research Center, Korea University Anam Hospital, Seoul, Republic of Korea.

Objective: This study aimed to investigate the morphometric differences in the corpus callosum between patients with major depressive disorder (MDD) and healthy controls and analyze their relationship to gray matter changes.

Methods: Twenty female MDD patients and 21 healthy controls (HCs) were included in the study. To identify the difference in the regional gray matter concentration (GMC), VBM was performed with T1 magnetic resonance imaging. The shape analysis of the corpus callosum was processed. Diffusion tensor imaging (DTI) fiber-tracking was performed to identify the regional tract pathways in the damaged corpus callosal areas.

Results: In the shape analysis, regional shape contractions in the rostrum and splenium were found in the MDD patients. VBM analysis showed a significantly lower white matter concentration in the genu and splenium, and a significantly lower GMC in the frontal, limbic, insular, and temporal regions of the MDD patients compared to the HCs. In DTI fiber-tracking, the fibers crossing the damaged areas of the genu, rostrum, and splenium were anatomically connected to the areas of lower GMC in MDD patients.

Conclusion: These findings support that major depressive disorder may be due to disturbances in multiple neuronal circuits, especially those associated with the corpus callosum.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.30773/pi.2020.0157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538242PMC
September 2020

Clinical and neuroimaging factors associated with aphasia severity in stroke patients: diffusion tensor imaging study.

Sci Rep 2020 07 30;10(1):12874. Epub 2020 Jul 30.

Brain Convergence Research Center, Korea University College of Medicine, Seoul, Korea.

This study investigated factors associated with aphasia severity at both 2 weeks and 3 months after stroke using demographic and clinical variables, brain diffusion tensor imaging (DTI) parameters, and lesion volume measurements. Patients with left hemisphere stroke were assessed at 2 weeks (n = 68) and at 3 months (n = 20) after stroke. Demographic, clinical, and neuroimaging data were collected; language functions were assessed using the Western Aphasia Battery. For neuroimaging, DTI parameters, including the laterality index (LI) of fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity, mean diffusivity and fibre density (FD) of the arcuate fasciculus (AF), and lesion volume, were measured. Lesion volume, cortical involvement, and the National Institutes of Health Stroke Scale score significantly predicted aphasia severity at 2 weeks after stroke, whereas the aphasia quotient and presence of depression during the early subacute stage were significant predictors at 3 months after stroke. According to Pearson correlation, LI-AD and LI-FD were significantly correlated with the aphasia quotient 2 weeks after ischaemic stroke, and the LI-FA was significantly correlated with the aphasia quotient 2 weeks after haemorrhagic stroke, suggesting that the extent and mechanism of AF injuries differ between ischaemic and haemorrhagic strokes. These differences may contribute to aphasia severity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-69741-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393375PMC
July 2020

Enforced format change to medical education webinar during the coronavirus disease 2019 pandemic.

Korean J Med Educ 2020 06 28;32(2):101-102. Epub 2020 May 28.

Department of Physiology, Korea University College of Medicine, Seoul, Korea.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3946/kjme.2020.158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272379PMC
June 2020

Shape Deformation in the Brainstem of Medication-Naïve Female Patients with Major Depressive Disorder.

Psychiatry Investig 2020 May 15;17(5):465-474. Epub 2020 May 15.

Brain Convergence Research Center, Korea University, Seoul, Republic of Korea.

Objective: Although neuroimaging studies have shown volumetric reductions, such as the anterior cingulate, prefrontal cortices, and hippocampus in patients with major depressive disorder (MDD), few studies have investigated the volume of or shape alterations in the subcortical regions and the brainstem. We hypothesized that medication-naïve female adult patients with MDD might present with shape and volume alterations in the subcortical regions, including the brainstem, compared to healthy controls (HCs).

Methods: A total of 20 medication-naïve female patients with MDD and 21 age-matched female HCs, underwent 3D T1-weighted structural magnetic resonance scanning. We analyzed the volumes of each subcortical region and each brainstem region, including the midbrain, pons, and medulla oblongata. We also performed surface-based vertex analyses on the subcortical areas and brainstem.

Results: Female patients with MDD showed non-significant volumetric differences in the subcortical regions, whole brainstem, and each brainstem region compared to the HCs. However, in the surface-based vertex analyses, significant shape contractions were observed in both cerebellar peduncles located on the lateral wall of the posterior brainstem [threshold-free cluster enhancement, corrected for family-wise error (FWE) at p<0.05] in patients with MDD.

Conclusion: We revealed shape alterations in the posterior brainstem in female patients with MDD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.30773/pi.2020.0025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265019PMC
May 2020

Reliability and Validity of the Comprehensive Limb and Oral Apraxia Test: Standardization and Clinical Application in Korean Patients With Stroke.

Ann Rehabil Med 2019 Oct 31;43(5):544-554. Epub 2019 Oct 31.

Department of Speech Pathology, Daegu University, Gyeongsan, Korea.

Objective: To develop and standardize the Limb and Oral Apraxia Test (LOAT) for Korean patients and investigate its reliability, validity, and clinical usefulness for patients with stroke.

Methods: We developed the LOAT according to a cognitive neuropsychological model of limb and oral praxis. The test included meaningless, intransitive, transitive, and oral praxis composed of 72 items (56 items on limb praxis and 16 items on oral praxis; maximum score 216). We standardized the LOAT in a nationwide sample of 324 healthy adults. Intra-rater and inter-rater reliability and concurrent validity tests were performed in patients with stroke. We prospectively applied the LOAT in 80 patients and analyzed the incidence of apraxia. We also compared the clinical characteristics between the apraxia and non-apraxia groups.

Results: The internal consistency was high (Cronbach's alpha=0.952). The inter-rater and intra-rater reliability and concurrent validity were also high (r=0.924-0.992, 0.961-0.999, and 0.830, respectively; p<0.001). The mean total, limb, and oral scores were not significantly different according to age and education (p>0.05). Among the 80 patients with stroke, 19 (23.8%) had limb apraxia and 21 (26.3%) had oral apraxia. Left hemispheric lesions and aphasia were significantly more frequently observed in the limb/oral apraxia group than in the non-apraxia group (p<0.001).

Conclusion: The LOAT is a newly developed comprehensive test for limb and oral apraxia for Korean patients with stroke. It has high internal consistency, reliability, and validity and is a useful apraxia test for patients with stroke.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5535/arm.2019.43.5.544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835135PMC
October 2019

Effects and safety of combined rTMS and action observation for recovery of function in the upper extremities in stroke patients: A randomized controlled trial.

Restor Neurol Neurosci 2019 ;37(3):219-230

Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea.

Background: Repetitive transcranial magnetic stimulation (rTMS) modulates cortical excitability and facilitates motor learning to improve motor recovery after stroke. Action observation (AO) therapy effectively facilitates physical training for motor memory formation.

Objective: To compare the effectiveness of rTMS alone with that of combined rTMS and AO for the functional recovery of upper extremity function in subacute stroke patients and to verify the safety of the interventions.

Methods: The present study was a prospective, randomized controlled trial involving subacute unilateral stroke patients. In total, 22 patients were randomly assigned to 2 groups: the trial group (rTMS with AO) and the control group (rTMS alone). Both groups received 1 Hz rTMS (intensity: 120% of resting motor threshold; rMT) over the contralesional primary motor cortex for 20 minutes on 10 consecutive days. Trial group received rTMS while watching a video of 5 different complex hand movements. The functional parameters were the Brunnstrom stage, Fugl-Meyer assessment (FMA) score of the upper extremity, Manual Function Test (MFT) score, and grip power. The following motor evoked potential (MEP) parameters were recorded from the abductor pollicis brevis muscle: rMT, latency, and amplitude. Both parameters were measured before and after the 2 week intervention.

Results: After the 2 week trial, the total FMA and MFT scores were significantly improved in both groups, but the MFT subscores of hand motor function and grip power were significantly improved in the combination therapy group only. In contrast, the changes (Δ) of FMA, MFT, grip power test, and MEP outcomes were not significantly different between the 2 groups. No adverse events or complications were reported.

Conclusions: Distal upper extremity function, as measured by MFT and grip power, was improved after rTMS and AO in combination. The combination of rTMS with AO may be applied safely to improve upper extremity function after stroke.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/RNN-180883DOI Listing
April 2020

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2019.04.034DOI Listing
August 2019

Prediction of functional outcome and discharge destination in patients with traumatic brain injury after post-acute rehabilitation.

Int J Rehabil Res 2019 Sep;42(3):256-262

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

As the survival rate of traumatic brain injury increases, the burden of care for patients with traumatic brain injury is emerging as a socioeconomic issue and the discharge destination is one of the important outcome measures in the post-acute rehabilitation unit. To investigate the predictors of functional outcome and discharge destination in patients with traumatic brain injury after post-acute rehabilitation. A retrospective review was performed on 86 patients who were admitted to the rehabilitation unit between January 2010 and June 2017. Multiple regression analysis was used as a statistical method to identify the factors affecting Modified Barthel Index and discharge destination. The number of days from traumatic brain injury onset to rehabilitation unit admission (odds ratio = 0.959, P = 0.049), brain surgery for traumatic brain injury management (odds ratio = 0.160, P = 0.021), initial Glasgow Coma Scale score (odds ratio = 1.269, P = 0.022) and Mini-Mental State Examination score at admission (odds ratio = 1.245, P < 0.001) were the predictive factors for higher Modified Barthel Index after rehabilitation. Underlying vascular risk factors (odds ratio = 0.138, P = 0.015), Modified Barthel Index score after rehabilitation (odds ratio = 1.085, P < 0.001) and deductible-free insurance (odds ratio = 0.211, P = 0.032) were the predictive factors of home discharge. The functional outcome of patients with traumatic brain injury after rehabilitation was related to the severity of initial injury, cognitive function at admission and rehabilitation timing. The discharge destination after rehabilitation was related to functional outcome, insurance issues and underlying vascular risk factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MRR.0000000000000353DOI Listing
September 2019

Reduced axial diffusivity and increased mode and T2 signals in cerebral white matter of chronic obstructive pulmonary disease using tract-based spatial statistics.

Neuroradiology 2019 Jul 2;61(7):795-801. Epub 2019 Feb 2.

Brain Convergence Research Center, Korea University College of Medicine, Seoul, South Korea.

Purpose: Chronic obstructive pulmonary disease (COPD) is considered to be a multi-systemic disease involving pathological changes in the brain. This study investigated how diffusion tensor imaging (DTI) parameters in patients with non-hypoxemic COPD differ from those in controls. Moreover, we tried to examine whether the mode of anisotropy (MO) reflects early changes in white matter (WM) integrity in COPD.

Methods: DT images were obtained from 13 male COPD patients and 13 age- and sex-matched healthy controls. Raw DT images were processed using an automated tract-based spatial statistics (TBSS) pipeline. DTI scalars of fractional anisotropy (FA); axial, radial, and mean diffusivities (AD, RD, and MD, respectively); MO; and raw T2 signal (S0) were statistically compared between COPD patients and controls. TBSS methods were used for analysis.

Results: In patients with COPD, decreased AD was observed in the temporal stem (TS), corticospinal tract (CST), thalamus, subiculum, crus cerebri, and midbrain. Increased MO values were found in the corpus callosum, CST, internal capsule, cerebellar peduncle (CP), and medial lemniscus (ML). Additionally, increased S0 was found in the TS, CP, pons, and cerebellar tonsil (threshold-free cluster enhancement to a family-wise error rate of p < 0.05).

Conclusion: The results revealed decreased AD and increased MO scalars in COPD patients compared with the controls, although there were no differences in FA, RD, and MD scalars. Decreased AD and increased MO scalars may reflect early changes in WM integrity in COPD patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00234-019-02178-0DOI Listing
July 2019

Re: The Efficacy of Bedside Respiratory Muscle Training in Patients with Stroke: .

Am J Phys Med Rehabil 2019 07;98(7):e76-e77

Department of Physical Medicine and Rehabilitation Korea University Anam Hospital Korea University College of Medicine Seoul, Korea. Department of Physical Medicine and Rehabilitation Korea University Anam Hospital Korea University College of Medicine Seoul, Korea. and Brain Convergence Research Center Korea University Anam Hospital Korea University College of Medicine Seoul, Korea.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PHM.0000000000001089DOI Listing
July 2019

Changes in the regional shape and volume of subcortical nuclei in patients with tinnitus comorbid with mild hearing loss.

Neuroradiology 2018 Nov 11;60(11):1203-1211. Epub 2018 Sep 11.

Department of Otolaryngology, School of Medicine, Kangwon National University, Kangwondaehak-gil 1, Chuncheon, Kangwon-do, 24341, Republic of Korea.

Purpose: Tinnitus, the perception of sound without an external source, is a prevalent disease, but its underlying mechanism has not been fully elucidated. Recent studies have suggested the involvement of subcortical nuclei in tinnitus generation. We investigated changes in the local shape and volume of subcortical nuclei in relation to tinnitus.

Methods: The participants included 53 patients with tinnitus and 52 age- and gender-matched normal controls. Individual 3D T1-weighted structural images were obtained using 3-T magnetic resonance imaging. Surface-based vertex analysis (SVA) was performed with automated segmentation of the bilateral caudate nuclei, putamina, nucleus accumbens, thalami, pallidum, hippocampi, amygdalae, and brainstem. The scalar distances from the mean surface and volumes of 15 nuclei were compared between the tinnitus and control groups and correlated with tinnitus handicap score (THI) and tinnitus duration.

Results: SVA revealed regional contractions in the accessory basal and lateral nuclei of the right amygdala and expansions in the left medial and right ventral posterior nuclei and lateral dorsal nucleus of both thalami. The surface distances of the right nucleus accumbens were positively correlated with tinnitus duration, while those of the left nucleus accumbens and left hippocampus were negatively correlated with THI.

Conclusion: Regional atrophy of the amygdala may indicate self-modulation of emotional response regulation to diminish tinnitus-related emotional distress. Thalamic regional expansion may signify dysfunctional auditory gating in the thalamus, where inhibition of the tinnitus signal at the thalamus level is disrupted due to abnormal changes in the limbic system, ultimately leading to the tinnitus percept.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00234-018-2093-2DOI Listing
November 2018

Validation of Korean Version of Coma Recovery Scale-Revised (K-CRSR).

Ann Rehabil Med 2018 Aug 31;42(4):536-541. Epub 2018 Aug 31.

Department of Physical and Rehabilitation Medicine, Inha University College of Medicine, Incheon, Korea.

Objective: To determine the validity and reliability of the Korean version of the Coma Recovery Scale-Revised (K-CRSR) for evaluation of patients with a severe brain lesion.

Methods: With permission from Giacino, the developer of the Coma Recovery Scale Revised (CRSR), the scale was translated into Korean and back-translated into English by a Korean physiatrist highly proficient in English, and then verified by the original developer. Adult patients with a severe brain lesion following traumatic brain injury, stroke, or hypoxic brain injury were examined. To assess the inter-rater reliability, all patients were tested with K-CRSR by two physiatrists individually. To determine intra-rater reliability, the same test was re-administered by the same physiatrists after three days.

Results: Inter-rater reliability (k=0.929, p<0.01) and intra-rater reliability (k=0.938, p<0.01) were both high for total K-CRSR scores. Inter- and intra-rater agreement rates were very high (94.9% and 97.4%, respectively). The total K-CRSR score was significantly correlated with K-GCS (r=0.894, p<0.01), demonstrating sufficient concurrent validity.

Conclusion: K-CRSR is a reliable and valid instrument for the assessment of patients with brain injury by trained physiatrists. This scale is useful in differentiating patients in minimally conscious state from those in vegetative state.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5535/arm.2018.42.4.536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129706PMC
August 2018

Efficacy of Bedside Respiratory Muscle Training in Patients With Stroke: A Randomized Controlled Trial.

Am J Phys Med Rehabil 2018 10;97(10):691-697

From the Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea (H-JY); and Brain Convergence Research Center, Korea University College of Medicine, Seoul, South Korea (S-BP).

Objective: Inspiratory and expiratory muscles are important for effective respiratory function. This study aimed to investigate the efficacy of bedside respiratory muscle training on pulmonary function and stroke-related disabilities in stroke rehabilitation.

Design: Patients with stroke (N = 40) in a rehabilitation unit were randomly assigned to either the intervention group (n1 = 20) or the control group (n2 = 20). Both groups participated in a conventional stroke rehabilitation program. During the study period, the intervention group received bedside respiratory muscle training twice a day for 3 wks. The respiratory muscle training consisted of (1) a breath stacking exercise, (2) inspiratory muscle training, and (3) expiratory muscle training. The primary outcomes were measures of pulmonary function: forced vital capacity, forced expiratory volume in 1 sec, and peak flow. Secondary outcomes were stroke-related disabilities assessed using the National Institutes of Health Stroke Scale, Modified Barthel Index, Berg Balance Scale, Fugl-Meyer Assessment, the Korean Mini-Mental State Examination, and pneumonia incidence.

Results: Pulmonary function was significantly improved in the intervention group after 3 wks of respiratory muscle training (P < 0.05). This improvement in pulmonary function was independent of the improvement in stroke-related disabilities.

Conclusion: Three weeks of respiratory muscle training had significant effects on pulmonary function in stroke survivors.

To Claim Cme Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Appreciate the respiratory function changes that occur in patients following a stroke; (2) Describe appropriate inspiratory and expiratory muscle training techniques to improve pulmonary function in patients following a stroke; (3) Enhance ability to implement inpatient; and (4) Determine appropriate respiratory training programs for patients following stroke.

Level: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PHM.0000000000000933DOI Listing
October 2018

Complex Regional Pain Syndrome of Non-hemiplegic Upper Limb in a Stroke Patient: A Case Report.

Ann Rehabil Med 2018 Feb 28;42(1):175-179. Epub 2018 Feb 28.

Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea.

Complex regional pain syndrome (CRPS) type I in stroke patients is usually known to affect the hemiplegic upper limb. We report a case of CRPS presented in an ipsilesional arm of a 72-year-old female patient after an ischemic stroke at the left middle cerebral artery territory. Clinical signs such as painful range of motion and hyperalgesia of her left upper extremity, swollen left hand, and dystonic posture were suggestive of CRPS. A three-phase bone scintigraphy showed increased uptake in all phases in the ipsilesional arm. Diffusion tensor tractography showed significantly decreased fiber numbers of the corticospinal tract and the spinothalamic tract in both unaffected and affected hemispheres. Pain and range of motion of the left arm of the patient improved after oral steroids with a starting dose of 50 mg/day.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5535/arm.2018.42.1.175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852221PMC
February 2018

Current Clinical Applications of Diffusion-Tensor Imaging in Neurological Disorders.

J Clin Neurol 2018 Apr 28;14(2):129-140. Epub 2018 Feb 28.

Brain Convergence Research Center, Korea University, Seoul, Korea.

Diffusion-tensor imaging (DTI) is a noninvasive medical imaging tool used to investigate the structure of white matter. The signal contrast in DTI is generated by differences in the Brownian motion of the water molecules in brain tissue. Postprocessed DTI scalars can be used to evaluate changes in the brain tissue caused by disease, disease progression, and treatment responses, which has led to an enormous amount of interest in DTI in clinical research. This review article provides insights into DTI scalars and the biological background of DTI as a relatively new neuroimaging modality. Further, it summarizes the clinical role of DTI in various disease processes such as amyotrophic lateral sclerosis, multiple sclerosis, Parkinson's disease, Alzheimer's dementia, epilepsy, ischemic stroke, stroke with motor or language impairment, traumatic brain injury, spinal cord injury, and depression. Valuable DTI postprocessing tools for clinical research are also introduced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3988/jcn.2018.14.2.129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897194PMC
April 2018

Neuroanatomical Mechanism of Cerebellar Mutism After Stroke.

Ann Rehabil Med 2017 Dec 28;41(6):1076-1081. Epub 2017 Dec 28.

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

Cerebellar mutism (CM) is a rare neurological condition characterized by lack of speech due to cerebellar lesions. CM is often reported in children. We describe a rare case of CM after spontaneous cerebellar hemorrhage. The patient showed mutism, irritability, decreased spontaneous movements and oropharyngeal apraxia. Diffusion tensor imaging revealed significant volume reduction of medial frontal projection fibers from the corpus callosum. In Tracts Constrained by UnderLying Anatomy (TRACULA) analysis, forceps major and minor and bilateral cingulum-angular bundles were not visualized. Cerebello-frontal pathway reconstructed from the FMRIB Software Library showed continuity of fibers, with decreased number of fibers on qualitative analysis. These results suggest that cerebello-frontal disconnection may be a neuroanatomical mechanism of CM. Damage of brain network between occipital lobe, cingulate and cerebellum caused by hemorrhage may also have role in the mechanism of CM in our case.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5535/arm.2017.41.6.1076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5773428PMC
December 2017

Comparison of Clinical Characteristics Between Patients With Different Causes of Vocal Cord Immobility.

Ann Rehabil Med 2017 Dec 28;41(6):1019-1027. Epub 2017 Dec 28.

Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.

Objective: To analyze the clinical characteristics between neurogenic and non-neurogenic cause of vocal cord immobility (VCI).

Methods: The researchers retrospectively reviewed clinical data of patients who underwent laryngeal electromyography (LEMG). LEMG was performed in the bilateral cricothyroid and thyroarytenoid muscles. A total of 137 patients were enrolled from 2011 to 2016, and they were assigned to either the neurogenic or non-neurogenic VCI group, according to the LEMG results. The clinical characteristics were compared between the two groups and a subgroup analysis was done in the neurogenic group.

Results: Among the 137 subjects, 94 patients had nerve injury. There were no differences between the neurogenic and non-neurogenic group in terms of demographic data, underlying disease except cancer, and premorbid events. In general characteristics, cancer was significantly higher in the neurogenic group than non-neurogenic group (p=0.001). In the clinical findings, the impaired high pitched 'e' sound and aspiration symptoms were significantly higher in neurogenic group (p=0.039 for impaired high pitched 'e' sound; p=0.021 for aspiration symptoms), and sore throat was more common in the non-neurogenic group (p=0.014). In the subgroup analysis of neurogenic group, hoarseness was more common in recurrent laryngeal neuropathy group than superior laryngeal neuropathy group (p=0.018).

Conclusion: In patients with suspected vocal cord palsy, impaired high pitched 'e' sound and aspiration symptoms were more common in group with neurogenic cause of VCI. Hoarseness was more frequent in subjects with recurrent laryngeal neuropathy. Thorough clinical evaluation and LEMG are important to differentiate underlying cause of VCI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5535/arm.2017.41.6.1019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5773422PMC
December 2017

Relationship Between Cognitive Function and Dysphagia After Stroke.

Ann Rehabil Med 2017 Aug 31;41(4):564-572. Epub 2017 Aug 31.

Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.

Objective: To investigate the characteristics of cognitive deficits in patients with post-stroke dysphagia, and to analyze the relationships between cognitive dysfunction and severity of dysphagia in supratentorial stroke.

Methods: A total of 55 patients with first-ever supratentorial lesion stroke were enrolled retrospectively, within 3 months of onset. We rated dysphagia from 0 (normal) to 4 (severe) using the dysphagia severity scale (DSS) through clinical examinations and videofluoroscopic swallowing studies (VFSS). The subjects were classified either as non-dysphagic (scale 0) or dysphagic (scale 1 to 4). We compared general characteristics, stroke severity and the functional scores of the two groups. We then performed comprehensive cognitive function tests and investigated the differences in cognitive performance between the two groups, and analyzed the correlation between cognitive test scores, DSS, and parameters of oral and pharyngeal phase.

Results: Fugl-Meyer motor assessment, the Berg Balance Scale, and the Korean version of the Modified Barthel Index showed significant differences between the two groups. Cognitive test scores for the dysphagia group were significantly lower than the non-dysphagia group. Significant correlations were shown between dysphagia severity and certain cognitive subtest scores: visual span backward (p=0.039), trail making tests A (p=0.042) and B (p=0.002), and Raven progressive matrices (p=0.002). The presence of dysphagia was also significantly correlated with cognitive subtests, in particular for visual attention and executive attention (odds ratio [OR]=1.009; 95% confidence interval [CI], 1.002-1.016; p=0.017). Parameters of premature loss were also significantly correlated with the same subtests (OR=1.009; 95% CI, 1.002-1.016; p=0.017).

Conclusion: Our results suggest that cognitive function is associated with the presence and severity of post-stroke dysphagia. Above all, visual attention and executive functions may have meaningful influence on the oral phase of swallowing in stroke patients with supratentorial lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5535/arm.2017.41.4.564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608663PMC
August 2017

Sonography of Carpal Tunnel Syndrome According to Pathophysiologic Type: Conduction Block Versus Axonal Degeneration.

J Ultrasound Med 2017 May 4;36(5):993-998. Epub 2017 Mar 4.

Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.

Objectives: The purpose of this study was to investigate sonographic findings according to the pathophysiologic type in patients with carpal tunnel syndrome.

Methods: We retrospectively reviewed the records of 80 patients (148 hands) with carpal tunnel syndrome. Patients were classified into 3 groups according to electrophysiologic findings: (1) conduction block and conduction delay; (2) axonal degeneration; and (3) mixed. We used sonographic evaluations to assess the cross-sectional area at the distal wrist crease and the distal forearm and the wrist-to-forearm ratio of the median nerve.

Results: Patients with axonal degeneration had significantly larger cross-sectional areas and wrist-to-forearm ratios than those with a conduction block (P < .05). The increased wrist-to-forearm ratio correlated with a reduced amplitude of the sensory nerve action potential, which reflects the degree of axonal degeneration.

Conclusions: The cross-sectional area and wrist-to-forearm ratio were associated with the pathophysiologic type of carpal tunnel syndrome, with larger nerve swellings seen in patients with axonal degeneration compared with those with demyelinating lesions. In addition to helping in the localization of the nerve lesion, sonography may indicate the type of nerve lesion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7863/ultra.16.05019DOI Listing
May 2017

Amusia After Right Temporoparietal Lobe Infarction: A Case Report.

Ann Rehabil Med 2016 Oct 31;40(5):933-937. Epub 2016 Oct 31.

Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.; Brain Convergence Research Center, Korea University Anam Hospital, Seoul, Korea.

Which brain regions participate in musical processing remains controversial. During singing and listening a familiar song, it is necessary to retrieve information from the long-term memory. However, the precise mechanism involved in musical processing is unclear. Amusia is impaired perception, understanding, or production of music not attributable to disease of the peripheral auditory pathways or motor system. We report a case of a 36-year-old right-handed man who lost the ability to discriminate or reproduce rhythms after a right temporoparietal lobe infarction. We diagnosed him as an amusic patient using the online version of Montreal Battery of Evaluation of Amusia (MBEA). This case report suggests that amusia could appear after right temporoparietal lobe infarction. Further research is needed to elucidate the dynamic musical processing mechanism and its associated neural structures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5535/arm.2016.40.5.933DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108721PMC
October 2016

A Further Step to Develop Patient-Friendly Implementation Strategies for Virtual Reality-Based Rehabilitation in Patients With Acute Stroke.

Phys Ther 2016 Oct 5;96(10):1554-1564. Epub 2016 May 5.

B. Yoon, PT, OT, PhD, Department of Physical Therapy, College of Health Sciences, Korea University 145, Anam-ro, Seongbuk-go, Seoul 136-701, Republic of Korea.

Background: Virtual reality (VR)-based rehabilitation is gaining attention as a way to promote early mobilization in patients with acute stroke. However, given the motor weakness and cognitive impairment associated with acute stroke, implementation strategies for overcoming patient-perceived difficulty need to be developed to enhance their motivation for training.

Objective: The purpose of this study was to explore patient-perceived difficulty and enjoyment during VR-based rehabilitation and the factors affecting those experiences.

Design: An exploratory mixed-method design was used in this study.

Methods: Eight individuals with acute stroke participated in 2 training modes of VR-based rehabilitation (ie, workout and game modes) 20 to 30 minutes per day for 5 to 8 sessions. A visual analog scale was used to assess patient-perceived difficulty and enjoyment at every session. Then semistructured interviews were conducted to explore the factors affecting those experiences.

Results: Levels of difficulty and enjoyment varied depending on the training mode and participants' phases of recovery. Five major factors were identified as affecting those varied experiences: (1) ease of following the directions, (2) experience of pain, (3) scores achieved, (4) novelty and immediate feedback, and (5) self-perceived effectiveness.

Conclusions: Levels of difficulty and enjoyment during VR-based rehabilitation differed depending on the phases of recovery and training mode. Therefore, graded implementation strategies for VR-based rehabilitation are necessary for overcoming patient-perceived difficulty and enhancing enjoyment. Ease of following the directions might be best considered in the very early stage, whereas multisensory feedback may be more necessary in the later stage. Health professionals also should find a way for patients to avoid pain during training. Feedback, such as knowledge of results and performance, should be used appropriately.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2522/ptj.20150271DOI Listing
October 2016

A comparison of carpal tunnel syndrome between digital and paper textbook users in elementary schools.

Work 2016 Mar;53(4):909-15

Gachon University, Incheon, Republic of Korea.

Background: There are advantages to using digital textbooks, but also health concerns yet to be evaluated.

Objective: This study examines the use of digital textbooks' effects on carpal tunnel, considered one of the potential health risks in students using digital textbooks.

Methods: Data were obtained from 43 elementary school students in the sixth grade, selected from two groups who had used digital and paper textbooks, respectively. To assess carpal tunnel function, this study performed median motor nerve and median sensory nerve conduction studies.

Results: There were no statistically significant differences between the groups, indicating that there were no functional differences related to carpal tunnel syndrome between the groups.

Conclusion: Usage of digital textbook is expanding nationwide in the Republic of Korea. There is no short-term risk of carpal tunnel syndrome in this population of elementary school students.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/WOR-162278DOI Listing
March 2016

Neural substrates of lower extremity motor, balance, and gait function after supratentorial stroke using voxel-based lesion symptom mapping.

Neuroradiology 2016 Jul 10;58(7):723-31. Epub 2016 Mar 10.

Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Inchon-Ro 73, Seongbuk-Gu, Seoul, 02841, Republic of Korea.

Introduction: Stroke impairs motor, balance, and gait function and influences activities of daily living. Understanding the relationship between brain lesions and deficits can help clinicians set goals during rehabilitation. We sought to elucidate the neural substrates of lower extremity motor, balance, and ambulation function using voxel-based lesion symptom mapping (VLSM) in supratentorial stroke patients.

Methods: We retrospectively screened patients who met the following criteria: first-ever stroke, supratentorial lesion, and available brain magnetic resonance imaging (MRI) data. MRIs of 133 stroke patients were selected for VLSM analysis. We generated statistical maps of lesions related to lower extremity motor (lower extremity Fugl-Meyer assessment, LEFM), balance (Berg Balance Scale, BBS), and gait (Functional Ambulation Category, FAC) using VLSM.

Results: VLSM revealed that lower LEFM scores were associated with damage to the bilateral basal ganglia, insula, internal capsule, and subgyral white matter adjacent to the corona radiata. The lesions were more widely distributed in the left than in the right hemisphere, representing motor and praxis function necessary for performing tasks. However, no associations between lesion maps and balance and gait function were established.

Conclusion: Motor impairment of the lower extremities was associated with lesions in the basal ganglia, insula, internal capsule, and white matter adjacent to the corona radiata. However, VLSM revealed no specific lesion locations with regard to balance and gait function. This might be because balance and gait are complex skills that require spatial and temporal integration of sensory input and execution of movement patterns. For more accurate prediction, factors other than lesion location need to be investigated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00234-016-1672-3DOI Listing
July 2016
-->