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Min I, Woo H, Kim JY, Kim TL, Lee Y, Chang WK, Jung SH, Lee WH, Oh BM, Han TR, Seo HG. Inter-rater and Intra-rater Reliability of the Videofluoroscopic Dysphagia Scale with the Standardized Protocol. Dysphagia 2024; 39:43-51. [PMID: 37204525 DOI: 10.1007/s00455-023-10590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
This study aimed to develop a standardized protocol for the assessment of videofluoroscopic dysphagia scale (VDS) and to demonstrate the inter-rater and intra-rater reliability of the VDS by applying the new standard protocol. A standardized protocol for the VDS was developed by dysphagia experts, including the original developer. To identify the reliability of the VDS using the protocol, 60 patients who underwent videofluoroscopic swallowing study (VFSS) for various etiologies were recruited retrospectively from three tertiary medical centers. Ten randomly selected cases were duplicated to evaluate the intra-rater reliability. Six physicians evaluated the VFSS data sets. Intraclass correlation coefficients were calculated for inter-rater and intra-rater reliability of the VDS score, and Gwet's kappa values for each VDS item were calculated. The inter-rater and intra-rater reliability of the total VDS score was 0.966 and 0.896, respectively. Notably, the evaluators' experience did not appear to have a significant impact on the reliability (physiatrists: 0.933/0.869, residents: 0.922/0.922). The reliability was consistent across different centers and dysphagia etiologies. The inter-rater and intra-rater reliability of the oral and pharyngeal sub-scores were 0.953/0.861 and 0.958/0.907, respectively. The inter-rater agreement of individual items ranged from 0.456 to 0.929, and nine items demonstrated good to very good level of agreement. Assessment of dysphagia using the VDS with the standard protocol showed excellent inter-rater and intra-rater reliabilities regardless of the evaluator's experience, VFSS equipment, and dysphagia etiologies. The VDS can be a useful assessment scale in the quantitative analysis of dysphagia based on VFSS findings.
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Affiliation(s)
- Ingi Min
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Hyeonseong Woo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jae Yoon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Tae-Lim Kim
- National Traffic Injury Rehabilitation Hospital, 260, Jungang-ro, Yangpyeong-gun, Gyeonggi-do, Republic of Korea
| | - Yookyung Lee
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110, Deokan-Ro, Gwangmyeong-Si, Gyeonggi-do, Republic of Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Songnam, Gyeonggi-do, 13620, Republic of Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, Republic of Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- National Traffic Injury Rehabilitation Hospital, 260, Jungang-ro, Yangpyeong-gun, Gyeonggi-do, Republic of Korea
- Institute On Aging, Seoul National University, Seoul, Republic of Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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Park J, Lee SH, Shin D, Kim Y, Kim YS, Seong MY, Lee JJ, Seo HG, Cho WS, Ro YS, Kim Y, Oh BM. Multiplexed Quantitative Proteomics Reveals Proteomic Alterations in Two Rodent Traumatic Brain Injury Models. J Proteome Res 2024; 23:249-263. [PMID: 38064581 DOI: 10.1021/acs.jproteome.3c00544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
In many cases of traumatic brain injury (TBI), conspicuous abnormalities, such as scalp wounds and intracranial hemorrhages, abate over time. However, many unnoticeable symptoms, including cognitive, emotional, and behavioral dysfunction, often last from several weeks to years after trauma, even for mild injuries. Moreover, the cause of such persistence of symptoms has not been examined extensively. Recent studies have implicated the dysregulation of the molecular system in the injured brain, necessitating an in-depth analysis of the proteome and signaling pathways that mediate the consequences of TBI. Thus, in this study, the brain proteomes of two TBI models were examined by quantitative proteomics during the recovery period to determine the molecular mechanisms of TBI. Our results show that the proteomes in both TBI models undergo distinct changes. A bioinformatics analysis demonstrated robust activation and inhibition of signaling pathways and core proteins that mediate biological processes after brain injury. These findings can help determine the molecular mechanisms that underlie the persistent effects of TBI and identify novel targets for drug interventions.
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Affiliation(s)
- Junho Park
- Department of Pharmacology, School of Medicine, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea
- Proteomics Research Team, CHA Future Medicine Research Institute, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea
- Research Institute for Basic Medical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Dongyoon Shin
- Proteomics Research Team, CHA Future Medicine Research Institute, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea
| | - Yeongshin Kim
- Department of Life Science, School of Medicine, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea
| | - Young Sik Kim
- Proteomics Research Team, CHA Future Medicine Research Institute, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea
| | - Min Yong Seong
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin Joo Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Youngsoo Kim
- Proteomics Research Team, CHA Future Medicine Research Institute, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea
- Department of Life Science, School of Medicine, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Institute of Aging, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul 03080, Republic of Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- National Traffic Injury Rehabilitation Hospital, 260 Jungang-ro, Yangpyeong-gun 12564, Gyeonggi-do, Republic of Korea
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Kim E, Yun SJ, Oh BM, Seo HG. Changes of neural coupling between cognitive and motor networks associated with dual-task performance in Parkinson's disease. Neurol Sci 2023:10.1007/s10072-023-07255-0. [PMID: 38153677 DOI: 10.1007/s10072-023-07255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/02/2023] [Indexed: 12/29/2023]
Abstract
BACKGOUND Although cognitive control is essential for efficient gait, the associations between cognitive and motor networks regarding gait in individuals with Parkinson's disease (PD) remain to be determined. Herein, we enrolled 28 PD and 28 controls to compare internetwork coupling among cognitive and motor networks and examine its relationship with single- and dual-task gait performance in PD. METHODS The dorsal attention network (DAN), left and right frontoparietal control networks (FPNs), sensorimotor network, and lateral motor network were identified using resting-state functional magnetic resonance imaging data. The time taken to complete a 10-m walk test during cognitive or physical dual-tasks in PD was calculated representing gait performance. RESULTS We observed that the internetwork couplings between the DAN and motor networks and between the motor networks decreased whereas those between the left FPN and DAN and motor networks increased in PD compared to controls using a permutation test. There was no significant correlation between the internetwork couplings and single- and dual-task gait performance in PD. Nevertheless, improved cognitive dual-task performance showed a positive correlation with the DAN and left FPN coupling and a negative correlation with the DAN and lateral motor network coupling in a good performance group. The opposite relationship was observed in the poor cognitive dual-task performance group. CONCLUSION Our findings suggest a neural mechanism of cognitive control on gait to compensate for reduced goal-directed attention in PD who maintain cognitive dual-task performance.
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Affiliation(s)
- Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Institute On Aging, Seoul National University, 1, Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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Lee MY, Son M, Lee HH, Kang MG, Yun SJ, Seo HG, Kim Y, Oh BM. Proteomic discovery of prognostic protein biomarkers for persisting problems after mild traumatic brain injury. Sci Rep 2023; 13:19786. [PMID: 37957236 PMCID: PMC10643618 DOI: 10.1038/s41598-023-45965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Some individuals with mild traumatic brain injury (mTBI), also known as concussion, have neuropsychiatric and physical problems that last longer than a few months. Symptoms following mTBI are not only impacted by the kind and severity of the injury but also by the post-injury experience and the individual's responses to it, making the persistence of mTBI particularly difficult to predict. We aimed to identify prognostic blood-based protein biomarkers predicting 6-month outcomes, in light of the clinical course after the injury, in a longitudinal mTBI cohort (N = 42). Among 420 target proteins quantified by multiple-reaction monitoring-mass spectrometry assays of blood samples, 31, 43, and 15 proteins were significantly associated with the poor recovery of neuropsychological symptoms at < 72 h, 1 week, and 1 month after the injury, respectively. Sequential associations among clinical assessments (depressive symptoms and cognitive function) affecting the 6-month outcomes were evaluated. Then, candidate biomarker proteins indirectly affecting the outcome via neuropsychological symptoms were identified. Using the identified proteins, prognostic models that can predict the 6-month outcome of mTBI were developed. These protein biomarkers established in the context of the clinical course of mTBI may have potential for clinical application.
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Affiliation(s)
- Min-Yong Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Minsoo Son
- Interdisciplinary Program of Bioengineering, Seoul National University College of Engineering, Seoul, Korea
- Mass Spectrometry Technology Access Center, McDonnell Genome Institute, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Youngsoo Kim
- Interdisciplinary Program of Bioengineering, Seoul National University College of Engineering, Seoul, Korea.
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.
- Department of Biomedical Science, School of Medicine, CHA University, Seongnam-si, Kyeonggi-do, Korea.
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea.
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.
- Institute on Aging, Seoul National University, Seoul, Korea.
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Seo HG, Yun SJ, Farrens A, Johnson C, Reinkensmeyer DJ. A Systematic Review of the Learning Dynamics of Proprioception Training: Specificity, Acquisition, Retention, and Transfer. Neurorehabil Neural Repair 2023; 37:744-757. [PMID: 37864458 PMCID: PMC10847967 DOI: 10.1177/15459683231207354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
OBJECTIVE We aimed to identify key aspects of the learning dynamics of proprioception training including: 1) specificity to the training type, 2) acquisition of proprioceptive skills, 3) retention of learning effects, and 4) transfer to different proprioceptive skills. METHODS We performed a systematic literature search using the database (MEDLINE, EMBASE, Cochrane Library, and PEDro). The inclusion criteria required adult participants who underwent any training program that could enhance proprioceptive function, and at least 1 quantitative assessment of proprioception before and after the intervention. We analyzed within-group changes to quantify the effectiveness of an intervention. RESULTS In total, 106 studies with 343 participant-outcome groups were included. Proprioception-specific training resulted in large effect sizes with a mean improvement of 23.4 to 42.6%, nonspecific training resulted in medium effect sizes with 12.3 to 22% improvement, and no training resulted in small effect sizes with 5.0 to 8.9% improvement. Single-session training exhibited significant proprioceptive improvement immediately (10 studies). For training interventions with a midway evaluation (4 studies), trained groups improved by approximately 70% of their final value at the midway point. Proprioceptive improvements were largely maintained at a delayed follow-up of at least 1 week (12 studies). Finally, improvements in 1 assessment were significantly correlated with improvements in another assessment (10 studies). CONCLUSIONS Proprioceptive learning appears to exhibit several features similar to motor learning, including specificity to the training type, 2 time constant learning curves, good retention, and improvements that are correlated between different assessments, suggesting a possible, common mechanism for the transfer of training.
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Affiliation(s)
- Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Mechanical and Aerospace Engineering, University of California at Irvine, California, USA
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Andria Farrens
- Department of Mechanical and Aerospace Engineering, University of California at Irvine, California, USA
| | - Christopher Johnson
- Department of Biomedical Engineering, University of California at Irvine, California, USA
| | - David J. Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, University of California at Irvine, California, USA
- Department of Biomedical Engineering, University of California at Irvine, California, USA
- Department of Anatomy and Neurobiology, University of California at Irvine, California, USA
- Department of Physical Medicine and Rehabilitation, University of California at Irvine, California, USA
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Lim J, Lee JC, Jang EG, Choi SY, Seo KH, Lee SY, Park D, Oh BM, Seo HG, Ryu JS. Kinematic mechanism of the rehabilitative effect of 4-channel NMES: post-hoc analysis of a prospective randomized controlled study. Sci Rep 2023; 13:13445. [PMID: 37596323 PMCID: PMC10439227 DOI: 10.1038/s41598-023-40359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
The sequential 4-channel neuromuscular electrical stimulation (NMES), based on the normal contractile sequences of swallowing-related muscles, is a new rehabilitative treatment. The objective of this study was to explore the mechanism of the rehabilitative effect of the 4-channel NMES using kinematic analysis of videofluoroscopic swallowing study (VFSS) data. For this post-hoc analysis, we included a subset of participants from the prospective randomized controlled study on the clinical effectiveness of the sequential 4-channel NMES compared with that of the conventional 2-channel NMES. Seventeen subjects (11 and six in the 4- and 2-channel NMES groups, respectively) were eligible for the kinematic analysis of VFSS data. The hyoid bone movement was analyzed by evaluating the distance and time parameters with four peak points (A, B, C, D). The 4-channel NMES group showed significant improvement in vertical distances (A-C), horizontal distance (A-B, A-C), time interval (A-B-C) and total time, compared with their pretreatment data. The 2-channel NMES group showed significant improvements in time interval (A-B); however, the Euclidean distance (A-D) and mean velocity of the Euclidean distance (A-C) were significantly decreased. When the two groups were directly compared, the 4-channel group showed significantly greater improvement in horizontal distance (A-B), Euclidean distance (A-D), time interval (A-B-C), and mean velocity the Euclidean distance (A-D). The results in this study suggest that the sequential 4-channel NMES might lead to the physiologic circular movement of the hyoid bone during swallowing, and therefore be an effective treatment for dysphagia.Trial registration: Clinicaltrials.gov, registration number: NCT03670498.
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Affiliation(s)
- Jiwoon Lim
- Department of Rehabilitation Medicine, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Jun Chang Lee
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Eun Gyeong Jang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sun Young Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Kyoung-Ho Seo
- Department of Rehabilitation Medicine, Seongnam Citizen's Medical Center, Seongnam-si, South Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, South Korea
| | - Donghwi Park
- Department of Rehabilitation Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, South Korea.
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Yun SJ, Hyun SE, Oh BM, Seo HG. Fully immersive virtual reality exergames with dual-task components for patients with Parkinson's disease: a feasibility study. J Neuroeng Rehabil 2023; 20:92. [PMID: 37464349 PMCID: PMC10355082 DOI: 10.1186/s12984-023-01215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Dual-task training in Parkinson's disease (PD) improves spatiotemporal gait parameters, cognition, and quality of life. Virtual reality (VR) has been used as a therapeutic tool for patients to participate in activities in a safe environment, engage in multisensory experiences, and improve motivation and interest in rehabilitation. This study aimed to investigate the feasibility of fully immersive VR exergames with dual-task components in patients with PD. METHODS We developed VR exergames (go/no-go punch game, go/no-go stepping game, and number punch game) to improve habitual behavior control using motor-cognitive dual-task performance in patients with PD. The participants underwent 10 sessions 2-3 times a week, consisting of 30 min per session. The Unified Parkinson's Disease Rating Scale, Timed Up and Go test (TUG) under single- and dual-task (cognitive and physical) conditions, Berg balance scale (BBS), Stroop test, trail-making test, and digit span were evaluated before and after intervention. The Simulator Sickness Questionnaire (SSQ) was used to assess VR cybersickness. Usability was assessed using a self-reported questionnaire. RESULTS Twelve patients were enrolled and completed the entire training session. The mean age of participants was 73.83 ± 6.09 years; mean disease duration was 128.83 ± 76.96 months. The Hoehn and Yahr stages were 2.5 in seven patients and 3 in five patients. A significant improvement was observed in BBS and Stroop color-word test (p = 0.047 and p = 0.003, respectively). TUG time and dual-task interferences showed positive changes, but these changes were not statistically significant. The median SSQ total score was 28.05 (IQR: 29.92), 13.09 (IQR: 11.22), and 35.53 (IQR: 52.36) before, after the first session, and after the final session, respectively; the differences were not significant. Overall satisfaction with the intervention was 6.0 (IQR: 1.25) on a 7-point Likert-type scale. CONCLUSIONS Fully immersive VR exergames combined with physical and cognitive tasks may be used for rehabilitation of patients with PD without causing serious adverse effects. Furthermore, the exergames using dual-task components improved executive function and balance. Further development of VR training content may be needed to improve motor and dual-task performances. Trial registration NCT04787549 ( https://clinicaltrials.gov/ct2/show/NCT04787549 ).
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Affiliation(s)
- Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Eun Hyun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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Yang S, Park JW, Min K, Lee YS, Song YJ, Choi SH, Kim DY, Lee SH, Yang HS, Cha W, Kim JW, Oh BM, Seo HG, Kim MW, Woo HS, Park SJ, Jee S, Oh JS, Park KD, Jin YJ, Han S, Yoo D, Kim BH, Lee HH, Kim YH, Kang MG, Chung EJ, Kim BR, Kim TW, Ko EJ, Park YM, Park H, Kim MS, Seok J, Im S, Ko SH, Lim SH, Jung KW, Lee TH, Hong BY, Kim W, Shin WS, Lee YC, Park SJ, Lim J, Kim Y, Lee JH, Ahn KM, Paeng JY, Park J, Song YA, Seo KC, Ryu CH, Cho JK, Lee JH, Choi KH. Clinical Practice Guidelines for Oropharyngeal Dysphagia. Ann Rehabil Med 2023; 47:S1-S26. [PMID: 37501570 PMCID: PMC10405672 DOI: 10.5535/arm.23069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one's physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. METHODS Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. RESULTS Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. CONCLUSION This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Yoon Se Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Jin Song
- Department of Occupational Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Hee Choi
- Department Audiology and Speech-Language Pathology, Daegu Catholic University, Gyoungsan, Korea
| | - Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Seung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Won Kim
- Department of Otolaryngology, Inha University College of Medicine, Incheon, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hee-Soon Woo
- Department of Occupational Therapy, School of Medicine, Wonkwang University, Iksan, Korea
| | - Sung-Jong Park
- Department of Speech Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ju Sun Oh
- Department of Rehabilitation Medicine, Seoul Medical Center, Seoul, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Ju Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Sungjun Han
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - DooHan Yoo
- Department of Occupational Therapy, Konyang University, Daejeon, Korea
| | - Bo Hae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hyun Haeng Lee
- Deptartment of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Gu Kang
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hanaro Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Hee Lee
- Department of Gastroenterology, Konyang University College of Medicine, Daejeon, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woojeong Kim
- Deptartment of Nutrition & Food Control, Gangnam Severance Hospital, Seoul, Korea
| | - Weon-Sun Shin
- Deptartment of Food & Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Jeonghyun Lim
- Department of Food Service & Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Youngkook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Young Paeng
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - JeongYun Park
- Department of Clinical Nursing, University of Ulsan, Seoul, Korea
| | - Young Ae Song
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Cheon Seo
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea
| | - Chang Hwan Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kang KM, Kim KM, Kim IS, Kim JH, Kang H, Ji SY, Dho YS, Oh H, Park HP, Seo HG, Kim SM, Choi SH, Park CK. Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging for Language Mapping in Brain Tumor Surgery: Validation With Direct Cortical Stimulation and Cortico-Cortical Evoked Potential. Korean J Radiol 2023; 24:553-563. [PMID: 37271209 DOI: 10.3348/kjr.2022.1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging-derived tractography (DTI-t) contribute to the localization of language areas, but their accuracy remains controversial. This study aimed to investigate the diagnostic performance of preoperative fMRI and DTI-t obtained with a simultaneous multi-slice technique using intraoperative direct cortical stimulation (DCS) or corticocortical evoked potential (CCEP) as reference standards. MATERIALS AND METHODS This prospective study included 26 patients (23-74 years; male:female, 13:13) with tumors in the vicinity of Broca's area who underwent preoperative fMRI and DTI-t. A site-by-site comparison between preoperative (fMRI and DTI-t) and intraoperative language mapping (DCS or CCEP) was performed for 226 cortical sites to calculate the sensitivity and specificity of fMRI and DTI-t for mapping Broca's areas. For sites with positive signals on fMRI or DTI-t, the true-positive rate (TPR) was calculated based on the concordance and discordance between fMRI and DTI-t. RESULTS Among 226 cortical sites, DCS was performed in 100 sites and CCEP was performed in 166 sites. The specificities of fMRI and DTI-t ranged from 72.4% (63/87) to 96.8% (122/126), respectively. The sensitivities of fMRI (except for verb generation) and DTI-t were 69.2% (9/13) to 92.3% (12/13) with DCS as the reference standard, and 40.0% (16/40) or lower with CCEP as the reference standard. For sites with preoperative fMRI or DTI-t positivity (n = 82), the TPR was high when fMRI and DTI-t were concordant (81.2% and 100% using DCS and CCEP, respectively, as the reference standards) and low when fMRI and DTI-t were discordant (≤ 24.2%). CONCLUSION fMRI and DTI-t are sensitive and specific for mapping Broca's area compared with DCS and specific but insensitive compared with CCEP. A site with a positive signal on both fMRI and DTI-t represents a high probability of being an essential language area.
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Affiliation(s)
- Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Min Kim
- Department of Neurosurgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | | | - Joo Hyun Kim
- Department of Clinical Science, MR, Philips Healthcare Korea, Seoul, Korea
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - So Young Ji
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun-Sik Dho
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Kim E, Lee WH, Seo HG, Nam HS, Kim YJ, Kang MG, Bang MS, Kim S, Oh BM. Deciphering Functional Connectivity Differences Between Motor Imagery and Execution of Target-Oriented Grasping. Brain Topogr 2023; 36:433-446. [PMID: 37060497 DOI: 10.1007/s10548-023-00956-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/20/2023] [Indexed: 04/16/2023]
Abstract
This study aimed to delineate overlapping and distinctive functional connectivity in visual motor imagery, kinesthetic motor imagery, and motor execution of target-oriented grasping action of the right hand. Functional magnetic resonance imaging data were obtained from 18 right-handed healthy individuals during each condition. Seed-based connectivity and multi-voxel pattern analyses were employed after selecting seed regions with the left primary motor cortex and supplementary motor area. There was equivalent seed-based connectivity during the three conditions in the bilateral frontoparietal and temporal areas. When the seed region was the left primary motor cortex, increased connectivity was observed in the left cuneus and superior frontal area during visual and kinesthetic motor imageries, respectively, compared with that during motor execution. Multi-voxel pattern analyses revealed that each condition was differentiated by spatially distributed connectivity patterns of the left primary motor cortex within the right cerebellum VI, cerebellum crus II, and left lingual area. When the seed region was the left supplementary motor area, the connectivity patterns within the right putamen, thalamus, cerebellar areas IV-V, and left superior parietal lobule were significantly classified above chance level across the three conditions. The present findings improve our understanding of the spatial representation of functional connectivity and its specific patterns among motor imagery and motor execution. The strength and fine-grained connectivity patterns of the brain areas can discriminate between motor imagery and motor execution.
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Affiliation(s)
- Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung Seok Nam
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jae Kim
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Institute of Bioengineering, Seoul National University, Seoul, Republic of Korea.
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea.
- Institute on aging, Seoul National University, Seoul, Republic of Korea.
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Kim E, Kim H, Yun SJ, Kang MG, Shin HI, Oh BM, Seo HG. Effects of gait training on structural brain changes in Parkinson's disease. Restor Neurol Neurosci 2023:RNN221295. [PMID: 37066925 DOI: 10.3233/rnn-221295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Gait training may lead to functional brain changes in Parkinson's disease (PD); however, there is a lack of studies investigating structural brain changes after gait training in PD. OBJECTIVE To investigate structural brain changes induced by 4 weeks of gait training in individuals with PD. METHODS Diffusion tensor imaging and structural T1 images were acquired in PD group before and after robot-assisted gait training or treadmill training, and in healthy control group. Tract-based spatial statistics and tensor-based morphometry were conducted to analyze the data. The outcome of gait training was assessed by gait speed and dual-task interference of cognitive or physical tests of the 10-meter walking test representing gait automaticity. The associations between structural brain changes and these outcomes were investigated using correlation analysis. RESULTS A total of 31 individuals with PD (68.5±8.7 years, the Hoehn & Yahr stage of 2.5 or 3) and 28 healthy controls (66.6±8.8 years) participated in this study. Compared to the controls, PD group at baseline showed a significant increased fractional anisotropy (FA) in the right forceps minor and bilateral brainstem and reduced radial diffusivity (RD) in the right superior longitudinal fasciculus, as well as the expanded structural volumes in the several brain areas. After gait training, FA increased in the left internal capsule and it decreased in the left cerebellar Crus I, while the structural volume did not change. The increased FA in the left internal capsule positively correlated with the baseline gait speed and negatively correlated with gait speed improvement; moreover, the decreased FA in the left cerebellum Crus I negatively correlated with the baseline gait speed during the cognitive task. CONCLUSIONS Gait training induces white matter changes in the brain of individuals with PD, which suggests the improvement of brain structural pathology to mitigate the impact of neurodegenerative consequences.
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Affiliation(s)
- Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heejae Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Iee Shin
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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12
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Jung JS, Jeon H, Oh BM, Seo HG. Clinical and Swallowing Characteristics Related With Respiratory Infection in Parkinsonism Patients. Ann Rehabil Med 2023; 47:138-146. [PMID: 37137571 PMCID: PMC10164519 DOI: 10.5535/arm.22152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE To investigate the clinical and swallowing characteristics related to respiratory infection in patients with parkinsonism. METHODS One hundred and forty-two patients with parkinsonism who underwent videofluoroscopic swallowing studies (VFSS) were enrolled in this study. The initial clinical and VFSS characteristics were compared between patients with and without a history of respiratory infection in the past year. A multivariate logistic regression model was applied to identify clinical and swallowing characteristics related to respiratory infections. RESULTS Patients with respiratory infections were older (74.75±10.20 years vs. 70.70±8.83 years, p=0.037), had a higher Hoehn and Yahr (H&Y) stage (stage IV-V, 67.9% vs. 49.1%; p=0.047), and were more likely to have a diagnosis of idiopathic Parkinson's disease (IPD) (67.9% vs. 41.2%, p=0.011) than those without respiratory infections. Among VFSS findings, bolus formation, premature bolus loss, oral transit time, pyriform sinus residues, pharyngeal wall coatings, and penetration/aspiration were significantly worse in patients with respiratory infections (p<0.05). Regarding clinical characteristics, higher H&Y stage (odds ratio [OR], 3.174; 95% confidence interval [CI], 1.226-8.216; p=0.017) and diagnosis of IPD (OR, 0.280, 95% CI, 0.111-0.706; p=0.007) were significantly related to respiratory infections in the multivariate analysis. Among VFSS findings, pyriform sinus residue (OR, 14.615; 95% CI, 2.257-94.623; p=0.005) and premature bolus loss (OR, 5.151; 95% CI, 1.047-25.338; p=0.044) were also significantly associated with respiratory infection. CONCLUSION This study suggests that disease severity, diagnosis, pyriform sinus residue, and premature bolus loss observed in VFSS are associated with respiratory infection in patients with parkinsonism.
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Affiliation(s)
- Ji Su Jung
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Heewon Jeon
- Department of Rehabilitation Medicine, Seongbuk Seoul Convalescent Hospital, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Institute on Aging, Seoul National University, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Lee HJ, Wi S, Park S, Oh BM, Seo HG, Lee WH. Exploratory Investigation of the Effects of Tactile Stimulation Using Air Pressure at the Auricular Vagus Nerve on Heart Rate Variability. Ann Rehabil Med 2023; 47:68-77. [PMID: 36599294 PMCID: PMC10020049 DOI: 10.5535/arm.22119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/04/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To explore the effects of tactile stimulation using air pressure at the auricular branch of the vagus nerve on autonomic activity in healthy individuals. METHODS Three types of tactile stimulation were used in this study: continuous low-amplitude, continuous high-amplitude, and pulsed airflow. The tactile stimulations were provided to the cymba concha to investigate autonomic activity in 22 healthy participants. The mean heart rate (HR) and parameters of HR variability, including the standard deviation of R-R intervals (SDNN) and root mean square of successive R-R interval differences (RMSSD) were compared at baseline, stimulation, and recovery periods. RESULTS Two-way repeated measures ANOVA indicated a significant main effect of time on HR (p=0.001), SDNN (p=0.003), and RMSSD (p<0.001). These parameters showed significant differences between baseline and stimulation periods and baseline and recovery periods in the post-hoc analyses. There were no significant differences in the changes induced by stimulation type and the interaction between time and stimulation type for all parameters. One-way repeated measures ANOVA showed that HR, SDNN, and RMSSD did not differ significantly among the three time periods during sham stimulation. CONCLUSION Parasympathetic activity can be enhanced by auricular tactile stimulation using air pressure, targeting the cymba concha. Further studies are warranted to investigate the optimal stimulation parameters for potential clinical significance.
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Affiliation(s)
- Hyun Jeong Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soohyun Wi
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Sungwoo Park
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea.,Institute on Aging, Seoul National University, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Seo HG, Staerz A, Kim DS, LeBeau JM, Tuller HL. Tuning Surface Acidity of Mixed Conducting Electrodes: Recovery of Si-Induced Degradation of Oxygen Exchange Rate and Area Specific Resistance. Adv Mater 2023; 35:e2208182. [PMID: 36461730 DOI: 10.1002/adma.202208182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Indexed: 06/17/2023]
Abstract
Metal oxides are an important class of functional materials, and for many applications, ranging from solid oxide fuel/electrolysis cells, oxygen permeation membranes, and oxygen storage materials to gas sensors (semiconducting and electrolytic) and catalysts, the interaction between the surface and oxygen in the gas phase is central. Ubiquitous Si-impurities are known to impede this interaction, commonly attributed to the formation of glassy blocking layers on the surface. Here, the surface oxygen exchange coefficient (kchem ) is examined for Pr0.1 Ce0.9 O2-δ (PCO), a model mixed ionic electronic conductor, via electrical conductivity relaxation measurements, and the area-specific resistance (ASR) by electrochemical impedance spectroscopy. It is demonstrated that even low silica levels, introduced by infiltration, depress kchem by a factor 4000, while the ASR increases 40-fold and we attribute this to its acidity relative to that of PCO. The ability to fully regenerate the poisoned surface by the subsequent addition of basic Ca- or Li-species is further shown. This ability to not only recover Si-poisoned surfaces by tuning the relative surface acidity of an oxide surface, but subsequently outperform the pre-poisoned response, promises to extend the operating life of materials and devices for which the catalytic oxygen/solid interface reaction is central.
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Affiliation(s)
- Han Gil Seo
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Anna Staerz
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Dennis S Kim
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - James M LeBeau
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Harry L Tuller
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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Kim MY, Park JY, Leigh JH, Kim YJ, Nam HS, Seo HG, Oh BM, Kim S, Bang MS. Exploring user perspectives on a robotic arm with brain-machine interface: A qualitative focus group study. Medicine (Baltimore) 2022; 101:e30508. [PMID: 36086771 PMCID: PMC10980453 DOI: 10.1097/md.0000000000030508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/05/2022] [Indexed: 11/27/2022] Open
Abstract
Brain-machine Interface (BMI) is a system that translates neuronal data into an output variable to control external devices such as a robotic arm. A robotic arm can be used as an assistive living device for individuals with tetraplegia. To reflect users' needs in the development process of the BMI robotic arm, our team followed an interactive approach to system development, human-centered design, and Human Activity Assistive Technology model. This study aims to explore the perspectives of people with tetraplegia about activities they want to participate in, their opinions, and the usability of the BMI robotic arm. Eight people with tetraplegia participated in a focus group interview in a semistructured interview format. A general inductive analysis method was used to analyze the qualitative data. The 3 overarching themes that emerged from this analysis were: 1) activities, 2) acceptance, and 3) usability. Activities that the users wanted to do using the robotic arm were categorized into the following 5 activity domains: activities of daily living (ADL), instrumental ADL, health management, education, and leisure. Participants provided their opinions on the needs and acceptance of the BMI technology. Participants answered usability and expected standards of the BMI robotic arm within 7 categories such as accuracy, setup, cost, etc. Participants with tetraplegia have a strong interest in the robotic arm and BMI technology to restore their mobility and independence. Creating BMI features appropriate to users' needs, such as safety and high accuracy, will be the key to acceptance. These findings from the perspectives of potential users should be taken into account when developing the BMI robotic arm.
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Affiliation(s)
- Moon Young Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Traffic Rehabilitation Research Institute, National Traffic Rehabilitation Hospital, Yangpyeong-gun, Gyeonggi-do, Republic of Korea
| | - Jung Youn Park
- Department of Health and Welfare, Yuhan University, Gyeongin-ro, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Traffic Rehabilitation Research Institute, National Traffic Rehabilitation Hospital, Yangpyeong-gun, Gyeonggi-do, Republic of Korea
| | - Yoon Jae Kim
- Interdisciplinary Program for Bioengineering, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Hyung Seok Nam
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Medical and Biological Engineering, Seoul National University, Seoul, Republic of Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kim E, Seo HG, Seong MY, Kang MG, Kim H, Lee MY, Yoo RE, Hwang I, Choi SH, Oh BM. An exploratory study on functional connectivity after mild traumatic brain injury: Preserved global but altered local organization. Brain Behav 2022; 12:e2735. [PMID: 35993893 PMCID: PMC9480924 DOI: 10.1002/brb3.2735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/26/2022] [Accepted: 07/20/2022] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION This study aimed to investigate alterations in whole-brain functional connectivity after a concussion using graph-theory analysis from global and local perspectives and explore the association between changes in the functional network properties and cognitive performance. METHODS Individuals with mild traumatic brain injury (mTBI, n = 29) within a month after injury, and age- and sex-matched healthy controls (n = 29) were included. Graph-theory measures on functional connectivity assessed using resting state functional magnetic resonance imaging data were acquired from each participant. These included betweenness centrality, strength, clustering coefficient, local efficiency, and global efficiency. Multi-domain cognitive functions were correlated with the graph-theory measures. RESULTS In comparison to the controls, the mTBI group showed preserved network characteristics at a global level. However, in the local network, we observed decreased betweenness centrality, clustering coefficient, and local efficiency in several brain areas, including the fronto-parietal attention network. Network strength at the local level showed mixed-results in different areas. The betweenness centrality of the right parahippocampus showed a significant positive correlation with the cognitive scores of the verbal learning test only in the mTBI group. CONCLUSION The intrinsic functional connectivity after mTBI is preserved globally, but is suboptimally organized locally in several areas. This possibly reflects the neurophysiological sequelae of a concussion. The present results may imply that the network property could be used as a potential indicator for clinical outcomes after mTBI.
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Affiliation(s)
- Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Yong Seong
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Heejae Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Yong Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.,National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
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17
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Nam HS, Lee WH, Seo HG, Smuck MW, Kim S. Evaluation of Motion Segment Size as a New Sensor-based Functional Outcome Measure in Stroke Rehabilitation. J Int Med Res 2022; 50:3000605221122750. [PMID: 36129970 PMCID: PMC9511330 DOI: 10.1177/03000605221122750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate a novel parameter, motion segment size (MSS), in stroke patients with upper limb impairment and validate its clinical applicability by correlating results with a standard clinical task-based functional evaluation tool. Methods In this cross-sectional study, patients with hemiplegia and healthy controls equipped with multiple inertial measurement unit (IMU) sensors performed Action Research Arm Test (ARAT) and activities of daily living (ADL) tasks. Acceleration of the wrist and Euler angles of each upper limb segment were measured. The average and maximum MSS, accumulated motion, total performance time, and average motion speed (AMS) were extracted for analysis. Results Data from nine patients and 10 controls showed that the average MSS of forearm supination/pronation and elbow flexion/extension during full ARAT tasks showed a significant difference between patients and controls and a significant correlation with ARAT scores. Conclusions We suggest that MSS may provide clinically relevant information regarding upper limb functional status in stroke patients.
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Affiliation(s)
- Hyung Seok Nam
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.,Wearable Health Lab, Division of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA, USA.,Department of Rehabilitation Medicine, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, UAE
| | - Woo Hyung Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Matthew W Smuck
- Wearable Health Lab, Division of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA, USA
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.,Institute of Bioengineering, Seoul National University, Seoul, Korea
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18
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Hwang W, Kang SM, Lee SY, Seo HG, Park YG, Kwon BS, Lee KJ, Kim DY, Kim HS, Lee SU. Efficacy and Safety of Botulinum Toxin Type A (NABOTA) for Post-stroke Upper Extremity Spasticity: A Multicenter Phase IV Trial. Ann Rehabil Med 2022; 46:163-171. [PMID: 36070998 PMCID: PMC9452292 DOI: 10.5535/arm.22061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/05/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To evaluate the efficacy and safety of Daewoong botulinum toxin type A (NABOTA) after its launch in South Korea. Methods This prospective, multicenter, open-label phase IV clinical trial included 222 patients with stroke. All patients visited the clinic at baseline and at weeks 4, 8, and 12 after injection of upto 360 units of NABOTA into the wrist, elbow, and finger flexor muscles at the first visit. The primary outcome was the change in Modified Ashworth Scale (MAS) score for the wrist flexor muscles between baseline and week 4. The secondary outcomes were the changes in MAS, Disability Assessment Scale (DAS), and Caregiver Burden Scale (CBS) scores between baseline and each visit, and the Global Assessment Scale (GAS) score at week 12. Results There was a statistically significant decrease in the MAS score for the wrist flexors between baseline and week 4 (−0.97±0.66, p<0.001). Compared with baseline, the MAS, DAS and CBS scores improved significantly during the study period. The GAS was rated as very good or good by 86.8% of physicians and by 60.0% of patients (or caregivers). The incidence of adverse events was 14.4%, which is smaller than that in a previous trial. Conclusion NABOTA showed considerable efficacy and safety in the management of upper limb spasticity in stroke patients.
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Kim TL, Byun SJ, Seong MY, Oh BM, Park SJ, Seo HG. Fracture risk and impact of osteoporosis in patients with Parkinson's disease: a nationwide database study. J Bone Miner Metab 2022; 40:602-612. [PMID: 35347431 DOI: 10.1007/s00774-022-01322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) showed an increased risk of fractures in previous studies and a high prevalence of osteoporosis is reportedly a potential contributor. We conducted a nationwide database study on the risk of fractures and the impact of osteoporosis on patients with PD compared to controls. MATERIALS AND METHODS Using a nationwide database in South Korea, we identified incident patients with PD in 2004-2006 and selected four age- and sex-matched controls. We checked the occurrence rates of overall and hip fractures and plotted Kaplan-Meier curves and a Cox proportional hazards model to determine risk. We also conducted stratified analyses according to the presence or absence of osteoporosis. RESULTS We identified 9126 patients with PD and 35,601 controls. Patients with PD had a greater probability of fractures throughout the study period in Kaplan-Meier curves, and an increased risk of overall (aHR 1.35, 95% CI 1.297-1.405) and hip (aHR 1.814, 95% CI 1.66-1.983) fractures in a Cox proportional hazards model. In the stratified analysis, the increased risk of overall fracture (aHR 1.333, 95% CI 1.273-1.396 and aHR 1.412, 95% CI 1.301-1.532, respectively) and hip fracture (aHR 1.773, 95% CI 1.604-1.96 and aHR 2.008, 95% CI 1.657-2.434, respectively) due to PD was similar between patients with and without osteoporosis. DISCUSSION Patients with PD, with or without osteoporosis, are more likely to experience fractures, especially hip fractures. There seems to be no interaction between PD and osteoporosis in regard to the occurrence of fractures, and therefore no effect modification by osteoporosis.
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Affiliation(s)
- Tae-Lim Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Songnam, Republic of Korea
| | - Min Yong Seong
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Gyeonggi-do, Republic of Korea
- Institute of Aging, Seoul National University, Seoul, Republic of Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Songnam, Republic of Korea.
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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20
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Kim KM, Kim SM, Kang H, Ji SY, Dho YS, Choi YD, Kwak GH, Kim BE, Oh H, Park HP, Kang KM, Choi SH, Kwon YN, Lee ST, Seo HG, Park CK. Preservation of language function by mapping the arcuate fasciculus using intraoperative corticocortical evoked potential under general anesthesia in glioma surgery. J Neurosurg 2022; 137:1-9. [PMID: 35303703 DOI: 10.3171/2022.1.jns212658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative language mapping under general anesthesia is imperative for brain tumor surgery because awake surgery is not always feasible. Monitoring corticocortical evoked potential (CCEP) is known to be a useful method for tracking neuronal connectivity and localizing functional areas. The authors evaluated the clinical benefit of intraoperative CCEP monitoring for language function preservation in patients undergoing glioma surgery. METHODS Between January 2019 and June 2021, the authors performed a total of 29 consecutive glioma surgeries using CCEP monitoring under general anesthesia because of a risk of speech impairment; these were analyzed. Language area mapping was implemented by the anterior language area to posterior language area CCEP method for arcuate fasciculus mapping, and tumor resection was performed while avoiding the localized language areas. Language function before and after surgery was evaluated by the Controlled Oral Word Association Test (COWAT). RESULTS Intraoperative CCEP was successfully monitored in 25 patients (86.2%), and a valid signal was undetectable in the other 4 patients. Language function evaluation was possible before and after surgery in a total of 20 patients. Overall, the preservation rate of language function was 65.0%, and the deterioration rate was 35.0% after tumor resection with CCEP monitoring. Among those 8 patients with preoperative COWAT scores ≥ 18, 5 patients (62.5%) successfully preserved their language function, with COWAT scores > 18 after tumor resection. Among the 12 patients with preoperative deteriorated language function (COWAT score < 18), 8 patients (66.7%) showed improvement or preserved language function after surgery. CONCLUSIONS Intraoperative CCEP monitoring of the arcuate fasciculus is an acceptable technology for the preservation of language function under general anesthesia in glioma surgery in patients in whom awake surgery is not feasible.
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Affiliation(s)
- Kyung Min Kim
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Sung-Min Kim
- 2Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Ho Kang
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - So Young Ji
- 3Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam
| | - Yun-Sik Dho
- 4Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju
| | - Young-Doo Choi
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Gil Ho Kwak
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Bo Eun Kim
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Hyongmin Oh
- 5Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Hee-Pyoung Park
- 5Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Koung Mi Kang
- 6Department of Radiology, Seoul National University College of Medicine, Seoul; and
| | - Seung Hong Choi
- 6Department of Radiology, Seoul National University College of Medicine, Seoul; and
| | - Young Nam Kwon
- 2Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Soon-Tae Lee
- 2Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Han Gil Seo
- 7Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chul-Kee Park
- 1Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
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Kim H, Kim E, Yun SJ, Kang MG, Shin HI, Mo B, Seo HG. Robot-assisted gait training with auditory and visual cues in Parkinson's disease: a randomized controlled trial. Ann Phys Rehabil Med 2021; 65:101620. [PMID: 34896605 DOI: 10.1016/j.rehab.2021.101620] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robot-assisted gait training (RAGT) may have beneficial effects on Parkinson's disease (PD); however, the evidence to date is inconsistent. OBJECTIVES This study compared the effects of RAGT and treadmill training (TT) on gait speed, dual-task gait performance, and changes in resting-state brain functional connectivity in individuals with PD. METHODS In this prospective, single-center, randomized controlled trial with a parallel two-group design, 44 participants were randomly allocated to undergo 12 sessions (3 times per week for 4 weeks) of RAGT or TT. The primary outcome was gait speed on the 10-m walk test (10mWT) under comfortable walking conditions. Secondary outcomes included dual-task interference on gait speed, balance, disability scores, fear of falling, freezing of gait, and brain functional connectivity changes. All clinical outcomes were measured before (T0), immediately after (T1), and 1 month after treatment (T2). RESULTS The mean (SD) age of the participants was 68.1 (8.1) years, and mean disease duration 108.0 (61.5) months. The groups did not significantly differ on the 10mWT (T0-T1, p=0.726, Cohen's d=0.133; T0-T2, p=0.778, Cohen's d=0.121). We observed a significant time-by-group interaction (F=3.236, p=0.045) for cognitive dual-task interference, controlling for confounders. After treatment, coupling was decreased to a greater extent with RAGT than TT between the visual and dorsal attention networks (p=0.015), between bilateral fronto-parietal networks (p=0.043), and between auditory and medial temporal networks (p=0.018). Improvement in cognitive dual-task interference was positively correlated with enhanced visual and medial temporal network coupling overall (r=0.386, p=0.029) and with TT (r=0.545, p=0.024) but not RAGT (r=0.151, p=0.590). CONCLUSIONS RAGT was not superior to intensity-matched TT on improving gait functions in individuals with PD but may be beneficial in improving gait ability under cognitive dual-task conditions. The therapeutic mechanism and key functional connectivity changes associated with improvement may differ between treatment strategies.
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Affiliation(s)
- Heejae Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min-Gu Kang
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Hyun Iee Shin
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Byung Mo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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22
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Abstract
ABSTRACT Coronavirus disease 2019 might have an impact on patients with Parkinson disease because of the neuroinvasive potential. Herein, we report the case of a patient with Parkinson disease who developed severe and prolonged oropharyngeal dysphagia after a coronavirus disease 2019 infection. A 73-yr-old male patient with Parkinson disease was diagnosed with coronavirus disease 2019 and admitted to a tertiary care hospital. Before hospitalization, he was assessed at Hoehn and Yahr stage 4 and showed no symptoms of dysphagia. After admission, the patient gradually recovered; however, he was fed through a nasogastric tube. A videofluoroscopic swallowing study revealed a severe oropharyngeal dysphagia with a severely delayed oral phase. Therefore, he underwent percutaneous gastrostomy tube insertion. After discharge, although he received swallowing therapy for 4 mos, he still had severe dysphagia, which made him dependent on enteral feeding. We speculate that the impact of coronavirus disease 2019 on dopaminergic and nondopaminergic mechanisms could lead to the development of dysphagia in this patient. The present case suggests that clinicians must have a high index of suspicion without dismissing the possibility of dysphagia and subsequent aspiration pneumonia in coronavirus disease 2019 patients with Parkinson disease.
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Kim A, Yun SJ, Sung KS, Kim Y, Jo JY, Cho H, Park K, Oh BM, Seo HG. Exercise Management Using a Mobile App in Patients With Parkinsonism: Prospective, Open-Label, Single-Arm Pilot Study. JMIR Mhealth Uhealth 2021; 9:e27662. [PMID: 34463635 PMCID: PMC8441602 DOI: 10.2196/27662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/17/2021] [Accepted: 07/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background Patients with parkinsonism have higher inactivity levels than the general population, and this results in increased comorbidities. Although exercise has benefits for motor function and quality of life (QOL) in patients with parkinsonism, these patients face many barriers to exercise participation, such as lack of motivation, fatigue, depression, and time constraints. Recently, the use of mobile apps has been highlighted as a remote exercise management strategy for patients with chronic diseases. Objective This study aimed to evaluate the effects of home-based exercise management with a customized mobile app on the exercise amount, physical activity, and QOL of patients with parkinsonism. Methods This was a prospective, open-label, single-arm pilot study. The therapist installed the app in the smartphones of the participants and educated them on how to use the app. The therapist developed an individualized multimodal exercise program that consisted of stretching, strengthening, aerobic, balance and coordination, and oral-motor and vocal exercises. Participants were encouraged to engage in an 8-week home-based exercise program delivered through a customized app. The alarm notifications of the app provided reminders to exercise regularly at home. The primary outcome was the exercise amount. The secondary outcomes were assessed using the International Physical Activity Questionnaire (IPAQ), Parkinson’s Disease Questionnaire-39 (PDQ-39), and Geriatric Depression Scale (GDS). The usability of the customized app was assessed using a self-report questionnaire. Results A total of 21 participants with parkinsonism completed the intervention and assessment between September and December 2020 (mean age: 72 years; women: 17/21, 81%; men: 4/21, 19%). The participants reported a significant increase in the total amount of exercise (baseline: mean 343.33, SD 206.70 min/week; 8-week follow-up: mean 693.10, SD 373.45 min/week; P<.001) and in the amount of each exercise component, including stretching, strengthening, balance and coordination, and oral-motor and vocal exercise after 8 weeks. Analysis of the secondary outcomes revealed significant improvements in the IPAQ (P=.006), PDQ-39 (P=.02), and GDS (P=.04) scores. The usability of the program with the mobile app was verified based on the positive responses such as “intention to use” and “role expectation for rehabilitation.” Conclusions Exercise management with a customized mobile app may be beneficial for improving exercise adherence, physical activity levels, depression management, and QOL in patients with parkinsonism. This remotely supervised technology-based, reinforcing, and multimodal exercise management strategy is recommended for use in patients with parkinsonism. In addition, this program proved useful as an alternative exercise management strategy during the COVID-19 pandemic when patients with Parkinson disease were less physically active than before and showed aggravation of symptoms. However, additional clinical trials are needed to evaluate the efficacy of this exercise program in a large population and to confirm its disease-modifying effects.
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Affiliation(s)
- Aram Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwan-Sik Sung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeonju Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ju Young Jo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hanseul Cho
- College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyudong Park
- School of Information Convergence, Kwangwoon University, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Institute on Aging, Seoul National University, Seoul, Republic of Korea.,National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Kang M, Seo HG, Chung E, Lee HH, Yun SJ, Keam B, Kim TM, Kwon SK, Oh B. Effects of percutaneous injection laryngoplasty on voice and swallowing problems in cancer-related unilateral vocal cord paralysis. Laryngoscope Investig Otolaryngol 2021; 6:800-806. [PMID: 34401505 PMCID: PMC8356886 DOI: 10.1002/lio2.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/15/2021] [Accepted: 07/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unilateral vocal cord paralysis may result from nerve compression by tumors or direct nerve injuries during tumor resections, which can cause dysphonia or dysphagia, and reduced quality of life. OBJECTIVES This prospective, single-group study aimed to investigate the effect of percutaneous injection laryngoplasty on voice and swallowing function in patients with cancer-related unilateral vocal cord paralysis. METHODS Patients underwent percutaneous injection laryngoplasty with hyaluronic acid under local anesthesia. Stroboscopy and videofluoroscopic swallowing study were conducted to evaluate the voice- and swallowing-related outcome measures, respectively. The participants were evaluated before injection laryngoplasty, as well as after two weeks and three months. RESULTS Injection laryngoplasty significantly improved the glottal gap, vocal fold position, Maximum Phonation Time, and Voice Handicap Index-10. Post-hoc analysis using Bonferroni correction showed that the improvements occurred within two post-treatment weeks and remained at three post-treatment months. In the subgroup analysis, the patients who underwent injection laryngoplasty within 8 weeks from onset showed significantly higher improvements in the videofluoroscopic dysphagia scale and swallowing function than the patients who received the procedure after 8 weeks or more. CONCLUSION Percutaneous injection laryngoplasty improves glottal closure and voice in patients with cancer-related unilateral vocal cord paralysis. Early injection laryngoplasty may lead to greater benefits on swallowing function. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Min‐Gu Kang
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
- Department of Physical Medicine and RehabilitationDong‐A University College of MedicineBusanRepublic of Korea
| | - Han Gil Seo
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Eun‐Jae Chung
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University HospitalSeoulRepublic of Korea
| | - Hyun Haeng Lee
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University HospitalSeoulRepublic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Bhumsuk Keam
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
| | - Tae Min Kim
- Department of Rehabilitation MedicineKonkuk University HospitalSeoulRepublic of Korea
| | - Seong Keun Kwon
- Department of Physical Medicine and RehabilitationDong‐A University College of MedicineBusanRepublic of Korea
- Department of Otorhinolaryngology‐Head and Neck SurgerySeoul National University College of MedicineSeoulRepublic of Korea
- Cancer Research InstituteSeoul National UniversitySeoulRepublic of Korea
| | - Byung‐Mo Oh
- Department of Rehabilitation MedicineSeoul National University HospitalSeoulRepublic of Korea
- Department of Rehabilitation MedicineSeoul National University College of MedicineSeoulRepublic of Korea
- Institute on Aging, Seoul National UniversitySeoulRepublic of Korea
- National Traffic Injury Rehabilitation HospitalYangpyeongRepublic of Korea
- Neuroscience Research Institute, Seoul National University College of MedicineSeoulRepublic of Korea
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Yun SJ, Seo HG. Changes in Epidemiological Trends and Rehabilitation Usage in Neurological Diseases in Korea: Parkinson's Disease. Brain Neurorehabil 2021; 14:e12. [PMID: 36743428 PMCID: PMC9879503 DOI: 10.12786/bn.2021.14.e12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 11/08/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by typical motor symptoms such as resting tremor, bradykinesia, and rigidity, as well as non-motor manifestations, including psychiatric symptoms, autonomic dysfunction, and cognitive impairment. These symptoms induce a marked impact on functional independence in daily activities and quality of life in PD patients. Recent guidelines recommend adequate rehabilitation education and treatment from the early stages of PD, and rehabilitation has become part of standard care for PD. In Korea, the number of patients with PD has more than tripled over 15 years, from 39,265 in 2004 to 125,607 in 2019. However, the rehabilitation usage of PD patients has not changed remarkably, and it remains suboptimal in Korea compared to several developed countries, which have advanced and disseminated guidelines and implemented specialized care delivery systems for PD over the past 20 years. Additional efforts are warranted to provide adequate rehabilitation therapies for PD patients in Korea.
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Affiliation(s)
- Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Bang YM, Song Y, Yun SJ, Seo HG, Chang WH. Associated Factors on Quality of Life in Patients with Parkinson's Disease. Brain Neurorehabil 2021; 14:e13. [PMID: 36743433 PMCID: PMC9879496 DOI: 10.12786/bn.2021.14.e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/04/2021] [Accepted: 07/06/2021] [Indexed: 11/08/2022] Open
Abstract
The objective of this study is to investigate the clinical and demographic factors that influence the quality of life in patients with Parkinson's disease (PD). This is a cross-sectional observational study of 47 patients in 2 hospitals with PD. All participants were asked to complete a disease-specific quality of life (QoL) questionnaire (PDQ-39). We gave a structured questionnaire interview and did a complete neurological examination on the same day. Additionally, we measured depression and dependency with the Geriatric Depression Scale-Short Form (GDS-SF) and the Korean version of the Modified Barthel Index (K-MBI). The PDQ-39 had a significant relationship with each motor part of the Unified Parkinson's Disease Rating Scale, the Korean Mini-Mental State Examination (K-MMSE), the GDS-SF, and the K-MBI (p < 0.05). The factors that independently contributed to the PDQ-39 scores were K-MMSE, GDS-SF, and K-MBI (p < 0.05). Factors having the greatest influence on the PDQ-39 were K-MBI, K-MMSE, and GDS-SF in that order. In addition, the mobility item in the K-MBI was independently a significant relating factor in the PDQ-39 (p < 0.05). These results demonstrated that dependency, especially with the mobility issue, was the greatest influence on the QoL in patients with PD.
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Affiliation(s)
- Yu Min Bang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoojin Song
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Seo KH, Jang J, Jang EG, Park Y, Lee SY, Kim BR, Park D, Park S, Hwang H, Kim NH, Oh BM, Seo HG, Lee JC, Ryu JS. Clinical effectiveness of the sequential 4-channel NMES compared with that of the conventional 2-channel NMES for the treatment of dysphagia in a prospective double-blind randomized controlled study. J Neuroeng Rehabil 2021; 18:90. [PMID: 34059092 PMCID: PMC8165767 DOI: 10.1186/s12984-021-00884-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 05/20/2021] [Indexed: 12/17/2022] Open
Abstract
Background To date, conventional swallowing therapies and 2-channel neuromuscular electrical stimulation (NMES) are standard treatments for dysphagia. The precise mechanism of 2-channel NMES treatment has not been determined, and there are controversies regarding the efficacy of this therapy. The sequential 4-channel NMES was recently developed and its action is based on the normal contractile sequence of swallowing-related muscles. Objective To evaluate and compare the rehabilitative effectiveness of the sequential 4-channel NMES with that of conventional 2-channel NMES. Methods In this prospective randomized case–control study, 26 subjects with dysphagia were enrolled. All participants received 2- or 4-channel NMES for 2–3 weeks (minimal session: 7 times, treatment duration: 300–800 min). Twelve subjects in the 4-channel NMES group and eleven subjects in the 2-channel NMES group completed the intervention. Initial and follow-up evaluations were performed using the videofluoroscopic dysphagia scale (VDS), the penetration-aspiration scale (PAS), the MD Anderson dysphagia inventory (MDADI), the functional oral intake scale (FOIS), and the Likert scale. Results The sequential 4-channel NMES group experienced significant improvement in their VDS (oral, pharyngeal, and total), PAS, FOIS, and MDADI (emotional, functional, and physical subsets) scores, based on their pretreatment data. VDS (oral, pharyngeal, and total) and MDADI (emotional and physical subsets) scores, but not PAS and FOIS scores, significantly improved in the 2-channel NMES group posttreatment. When the two groups were directly compared, the 4-channel NMES group showed significant improvement in oral and total VDS scores. Conclusions The sequential 4-channel NMES, through its activation of the suprahyoid and thyrohyoid muscles, and other infrahyoid muscles mimicking physiological activation, may be a new effective treatment for dysphagia. Trial registration: clinicaltrial.gov, registration number: NCT03670498, registered 13 September 2018, https://clinicaltrials.gov/ct2/show/NCT03670498?term=NCT03670498&draw=2&rank=1. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00884-6.
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Affiliation(s)
- Kyoung-Ho Seo
- Department of Rehabilitation Medicine, Seongnam Citizen's Medical Center, Seongnam-si, South Korea
| | - Joonyoung Jang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Eun Gyeong Jang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Yulhyun Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju-do, South Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, South Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea
| | - Sungwon Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Hyeoncheol Hwang
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-Si, South Korea
| | - Nam Hun Kim
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-Si, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jun Chang Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea.
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Kim SH, Yun SJ, Dang QK, Chee Y, Chung SG, Oh BM, Kim K, Seo HG. Measurement and Correction of Stooped Posture during Gait Using Wearable Sensors in Patients with Parkinsonism: A Preliminary Study. Sensors (Basel) 2021; 21:s21072379. [PMID: 33808057 PMCID: PMC8038058 DOI: 10.3390/s21072379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022]
Abstract
Stooped posture, which is usually aggravated during walking, is one of the typical postural deformities in patients with parkinsonism. However, the degree of stooped posture is difficult to quantitatively measure during walking. Furthermore, continuous feedback on posture is also difficult to provide. The purpose of this study is to measure the degree of stooped posture during gait and to investigate whether vibration feedback from sensor modules can improve a patient's posture. Parkinsonian patients with stooped posture were recruited for this study. Two wearable sensors with three-axis accelerometers were attached, one at the upper neck and the other just below the C7 spinous process of the patients. After being calibrated in the most upright posture, the sensors continuously recorded the sagittal angles at 20 Hz and averaged the data at every second during a 6 min walk test. In the control session, the patients walked with the sensors as usual. In the vibration session, sensory feedback was provided through vibrations from the neck sensor module when the sagittal angle exceeded a programmable threshold value. Data were collected and analyzed successfully in a total of 10 patients. The neck flexion and back flexion were slightly aggravated during gait, although the average change was <10° in most patients in both measurement sessions. Therefore, it was difficult to evaluate the effect of sensory feedback through vibration. However, some patients showed immediate response to the feedback and corrected their posture during gait. In conclusion, this preliminary study suggests that stooped posture could be quantitatively measured during gait by using wearable sensors in patients with parkinsonism. Sensory feedback through vibration from sensor modules may help in correcting posture during gait in selected patients.
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Affiliation(s)
- Se Hoon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (S.H.K.); (S.J.Y.); (S.G.C.); (B.-M.O.); (K.K.)
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (S.H.K.); (S.J.Y.); (S.G.C.); (B.-M.O.); (K.K.)
| | - Quoc Khanh Dang
- MKS Instruments Korea, 543 Beonji, Daedeok Techno Valley, Yongsan-dong, Yuseong-gu, Daejeon 34028, Korea;
- School of Electrical Engineering, Biomedical Engineering, College of Engineering, University of Ulsan, Ulsan 44610, Korea;
| | - Youngjoon Chee
- School of Electrical Engineering, Biomedical Engineering, College of Engineering, University of Ulsan, Ulsan 44610, Korea;
| | - Sun Gun Chung
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (S.H.K.); (S.J.Y.); (S.G.C.); (B.-M.O.); (K.K.)
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (S.H.K.); (S.J.Y.); (S.G.C.); (B.-M.O.); (K.K.)
- National Traffic Injury Rehabilitation Hospital, Yangpyeong-gun 12564, Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (S.H.K.); (S.J.Y.); (S.G.C.); (B.-M.O.); (K.K.)
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (S.H.K.); (S.J.Y.); (S.G.C.); (B.-M.O.); (K.K.)
- Correspondence: ; Tel.: +82-2-2072-1659; Fax: +82-2-743-7473
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Won JH, Byun SJ, Oh BM, Kim HJ, Park SJ, Seo HG. Corrigendum to "Pneumonia risk and its associated factors in Parkinson's disease: A national database study" [Journal of the Neurological Sciences, Volume 415, 15 August 2020, 116949]. J Neurol Sci 2021; 424:117431. [PMID: 33858603 DOI: 10.1016/j.jns.2021.117431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jun Hee Won
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Big Data Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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Yun SJ, Lee HH, Lee WH, Lee SH, Oh BM, Seo HG. Effect of robot-assisted gait training on gait automaticity in Parkinson disease: A prospective, open-label, single-arm, pilot study. Medicine (Baltimore) 2021; 100:e24348. [PMID: 33592882 PMCID: PMC7870221 DOI: 10.1097/md.0000000000024348] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/17/2020] [Accepted: 12/27/2020] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Gait automaticity is reduced in patients with Parkinson disease (PD) due to impaired habitual control. The aim of this study was to investigate the effect of robot-assisted gait training (RAGT) on gait automaticity as well as gait speed and balance in patients with PD.This study was a prospective, open-label, single-arm, pilot study. We planned to recruit 12 patients with idiopathic PD. Participants received 12 sessions of RAGT using exoskeleton-type robotic device. Sessions were 45-minute each, 3 days a week, for 4 consecutive weeks using an exoskeleton-type gait robot. The primary outcome was the percentage of dual-task interference measured by the 10-Meter Walk Test (10MWT) under single and dual-task (cognitive and physical) conditions. Secondary outcomes were the Berg Balance Scale and Korean version of the Falls Efficacy Scale-International. All measures were evaluated before treatment (T0), after treatment (T1), and 1-month post-treatment (T2).Twelve patients were enrolled and 1 dropped out. Finally, 11 patients with idiopathic PD were analyzed. The mean age of 11 patients (5 males) was 66.46 ± 5.66 years, and disease duration was 112.91 ± 50.19 months. The Hoehn and Yahr stages were 2.5 in 8 patients and 3 in 3 patients. Linear mixed-effect model analysis showed a significant change over time only in single-task gait speed of the 10MWT (P = .007), but not in dual-task gait speed, dual-task interferences, and Korean version of the Falls Efficacy Scale-International. Cognitive dual-task interference significantly increased (P = .026) at T1, but not at T2 (P = .203). No significant changes were observed for physical dual-task interference at T1 and T2. Single-task gait speed of the 10MWT was significantly increased at T1 (P = .041), but not at T2 (P = .445). There were no significant changes in the dual-task gait speed of 10MWT. A significant improvement was observed in Berg Balance Scale score at T1 and T2 (P = .004 and P = .024, respectively).In this pilot study, despite improvement in walking speed and balance, gait automaticity in patients with PD was not improved by RAGT using an exoskeleton-type robot. Additional therapeutic components may be needed to improve gait automaticity using RAGT in patients with PD.
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Affiliation(s)
- Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
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Lee WH, Lim MH, Seo HG, Oh BM, Kim S. Hyoid kinematic features for poor swallowing prognosis in patients with post-stroke dysphagia. Sci Rep 2021; 11:1471. [PMID: 33446787 PMCID: PMC7809117 DOI: 10.1038/s41598-020-80871-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/29/2020] [Indexed: 01/25/2023] Open
Abstract
Identification of prognostic factors for swallowing recovery in patients with post-stroke dysphagia is crucial for determining therapeutic strategies. We aimed at exploring hyoid kinematic features of poor swallowing prognosis in patients with post-stroke dysphagia. Of 122 patients who experienced dysphagia following ischemic stroke, 18 with poor prognosis, and 18 age- and sex-matched patients with good prognosis were selected and retrospectively reviewed. Positional data of the hyoid bone during swallowing were obtained from the initial videofluoroscopic swallowing study after stroke onset. Normalized hyoid profiles of displacement/velocity and direction angle were analyzed using functional regression analysis, and maximal or mean values were compared between the good and poor prognosis patient groups. Kinematic analysis showed that maximal horizontal displacement (P = 0.031) and velocity (P = 0.034) in forward hyoid motions were significantly reduced in patients with poor prognosis compared to those with good prognosis. Mean direction angle for the initial swallowing phase was significantly lower in patients with poor prognosis than in those with good prognosis (P = 0.0498). Our study revealed that reduced horizontal forward and altered initial backward motions of the hyoid bone during swallowing can be novel kinematic features indicating poor swallowing prognosis in patients with post-stroke dysphagia.
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Affiliation(s)
- Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Min Hyuk Lim
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Gyeonggi-do, 12564, Republic of Korea.
- Institute of Aging, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
- Neuroscience Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University College of Medicine, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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Seo HG, Byun SJ, Oh BM, Park SJ. Ten-Year Relative Survival From the Diagnosis of Parkinson's Disease: A Nationwide Database Study. J Am Med Dir Assoc 2020; 22:1757-1761. [PMID: 33340454 DOI: 10.1016/j.jamda.2020.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/08/2020] [Accepted: 11/14/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Varying early survival rates have been reported across studies on patients with Parkinson's disease (PD). In this study, we reported the 10-year relative survival rate of patients with PD using a nationwide database. DESIGN This was a population-based cohort study. SETTING AND PARTICIPANTS We identified incident PD cases from 2004 to 2006 using the PD registration codes from the National Health Insurance Service database covering the entire South Korean population. METHODS Relative survival up to 10 years was evaluated by adjusting all-cause survival for expected survival, estimated from population life tables and matched by sex, age, and year of diagnosis. RESULTS Of the 10,159 patients with PD, 4675 (46.0%) patients survived 10 years after diagnosis. Relative survival rates decreased with time after diagnosis (0.972 after 1 year, 0.772 after 5 years, and 0.588 after 10 years). Ten-year relative survival gradually decreased with age at diagnosis. Men had a lower relative survival rate than women 2 years post diagnosis, and if they were older than 60 years. CONCLUSIONS AND IMPLICATIONS Patients diagnosed with PD are expected to have a lower 10-year relative survival. In the real world, patients with PD might have lower survival than the general population even in the early disease stage. Our results suggest further efforts to prevent premature mortality among patients with PD.
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Affiliation(s)
- Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; National Traffic Injury Rehabilitation Hospital, Yangpyeong, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
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Kang MG, Yun SJ, Shin HI, Kim E, Lee HH, Oh BM, Seo HG. Correction to: Effects of robot-assisted gait training in patients with Parkinson’s disease: study protocol for a randomized controlled trial. Trials 2020; 21:438. [PMID: 32460875 PMCID: PMC7254688 DOI: 10.1186/s13063-020-04437-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Kang MG, Yun SJ, Lee SY, Oh BM, Lee HH, Lee SU, Seo HG. Effects of Upper-Extremity Rehabilitation Using Smart Glove in Patients With Subacute Stroke: Results of a Prematurely Terminated Multicenter Randomized Controlled Trial. Front Neurol 2020; 11:580393. [PMID: 33240205 PMCID: PMC7680863 DOI: 10.3389/fneur.2020.580393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Although there have been many trials and interventions for reducing upper-extremity impairment in stroke survivors, it remains a challenge. A novel intervention is needed to provide high-repetition task-specific training early after stroke. Objective: This study aimed to investigate the effect of smart glove training (SGT) for upper-extremity rehabilitation in patients with subacute stroke. Methods: A prospective, multicenter, randomized, controlled study was conducted in patients with upper-extremity hemiparesis with Brunnstrom stage for arm 2–5 in the subacute phase after stroke. Eligible participants were randomly allocated to the SGT group or the control group. The SGT group underwent 30 min of standard occupational therapy plus 30 min of upper-extremity training with smart glove. The control group underwent standard occupational therapy for 30 min plus upper-extremity self-training (homework tasks at bedside) for 30 min. All participants underwent each intervention 5 days/week for 2 consecutive weeks. They were evaluated before, immediately after, and 4 weeks after the intervention. The primary outcome measure was the change in the score of the Fugl-Meyer assessment of the upper extremity (FMA-UE). Results: Twenty-three patients were enrolled. Repeated-measures analysis of covariance after controlling for age and disease duration showed significant time × group interaction effects in the FMA-UE, FMA-distal, and FMA-coordination/speed (p = 0.018, p = 0.002, p = 0.006). Repeated-measures analysis of variance showed significant time × group interaction effects in the FMA-UE, FMA-distal, and Box and Block Test (p = 0.034, p = 0.010, p = 0.046). Mann-Whitney U-test showed a statistically higher increase in the FMA-UE and FMA-distal in the SGT group than in the control group (p = 0.023, p = 0.032). Conclusion: Upper-extremity rehabilitation with a smart glove may reduce upper-extremity impairment in patients with subacute stroke. Clinical Trial Registration: ClinicalTrials.gov (NCT02592759).
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Affiliation(s)
- Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Yun SJ, Kang MG, Yang D, Choi Y, Kim H, Oh BM, Seo HG. Cognitive Training Using Fully Immersive, Enriched Environment Virtual Reality for Patients With Mild Cognitive Impairment and Mild Dementia: Feasibility and Usability Study. JMIR Serious Games 2020; 8:e18127. [PMID: 33052115 PMCID: PMC7593866 DOI: 10.2196/18127] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/12/2020] [Accepted: 09/16/2020] [Indexed: 01/16/2023] Open
Abstract
Background Cognitive training using virtual reality (VR) may result in motivational and playful training for patients with mild cognitive impairment and mild dementia. Fully immersive VR sets patients free from external interference and thus encourages patients with cognitive impairment to maintain selective attention. The enriched environment, which refers to a rich and stimulating environment, has a positive effect on cognitive function and mood. Objective The aim of this study was to investigate the feasibility and usability of cognitive training using fully immersive VR programs in enriched environments with physiatrists, occupational therapists (OTs), and patients with mild cognitive impairment and mild dementia. Methods The VR interface system consisted of a commercialized head-mounted display and a custom-made hand motion tracking module. We developed the virtual harvest and cook programs in enriched environments representing rural scenery. Physiatrists, OTs, and patients with mild cognitive impairment and mild dementia received 30 minutes of VR training to evaluate the feasibility and usability of the test for cognitive training. At the end of the test, the usability and feasibility were assessed by a self-report questionnaire based on a 7-point Likert-type scale. Response time and finger tapping were measured in patients before and after the test. Results Participants included 10 physiatrists, 6 OTs, and 11 patients with mild cognitive impairment and mild dementia. The mean scores for overall satisfaction with the program were 5.75 (SD 1.00) for rehabilitation specialists and 5.64 (SD 1.43) for patients. The response time of the dominant hand in patients decreased after the single session of cognitive training using VR, but this was not statistically significant (P=.25). There was no significant change in finger tapping in either the right or left hand (P=.48 and P=.42, respectively). None of the participants reported headaches, dizziness, or any other motion sickness after the test. Conclusions A fully immersive VR cognitive training program may be feasible and usable in patients with mild cognitive impairment and mild dementia based on the positive satisfaction and willingness to use the program reported by physiatrists, OTs, and patients. Although not statistically significant, decreased response time without a change in finger tapping rate may reflect a temporary increase in attention after the test. Additional clinical trials are needed to investigate the effect on cognitive function, mood, and physical outcomes.
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Affiliation(s)
- Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dongseok Yang
- Department of Computer Engineering, Dankook University, Gyeonggi, Republic of Korea
| | - Younggeun Choi
- Department of Computer Engineering, Dankook University, Gyeonggi, Republic of Korea
| | - Heejae Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Kim HK, Leigh JH, Lee YS, Choi Y, Kim Y, Kim JE, Cho WS, Seo HG, Oh BM. Decreasing Incidence and Mortality in Traumatic Brain Injury in Korea, 2008-2017: A Population-Based Longitudinal Study. Int J Environ Res Public Health 2020; 17:ijerph17176197. [PMID: 32859061 PMCID: PMC7504501 DOI: 10.3390/ijerph17176197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/16/2022]
Abstract
Traumatic brain injury (TBI), a global public health concern, may lead to death and major disability. While various short-term, small-sample, and cross-sectional studies on TBI have been conducted in South Korea, there is a lack of clarity on the nationwide longitudinal TBI trends in the country. This retrospective study investigated the epidemiological TBI trends in South Korea, using a population-based dataset of the National Health Insurance (2008–2017). The crude and age adjusted TBI incidence and mortality values were calculated and stratified by age, sex, and TBI diagnosis. The age-adjusted incidence per 100,000 people increased until 2010 and showed a decreasing trend (475.8 cases in 2017) thereafter; however, a continuously decreasing age-adjusted mortality trend was observed (42.9 cases in 2008, 11.3 in 2017). The crude incidence rate increased continually in those aged >70 years across all the TBI diagnostic categories. The mortality per 100,000 people was significantly higher among participants aged ≥70 years than in the other age groups. We observed changing trends in the TBI incidence, with a continuously decreasing overall incidence and a rapidly increasing incidence and high mortality values in older adults. Our findings highlight the importance of active TBI prevention in elderly people.
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Affiliation(s)
- Han-Kyoul Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (H.-K.K.); (J.-H.L.); (Y.S.L.); (Y.C.); (H.G.S.)
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yang-Pyeong 12564, Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (H.-K.K.); (J.-H.L.); (Y.S.L.); (Y.C.); (H.G.S.)
- Department of Rehabilitation Medicine, Workers’ Compensation and Welfare Incheon Hospital, Incheon 21417, Korea
| | - Ye Seol Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (H.-K.K.); (J.-H.L.); (Y.S.L.); (Y.C.); (H.G.S.)
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yang-Pyeong 12564, Korea
| | - Yoonjeong Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (H.-K.K.); (J.-H.L.); (Y.S.L.); (Y.C.); (H.G.S.)
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yang-Pyeong 12564, Korea
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul 03080, Korea;
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul 03080, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 03080, Korea; (J.E.K.); (W.-S.C.)
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 03080, Korea; (J.E.K.); (W.-S.C.)
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (H.-K.K.); (J.-H.L.); (Y.S.L.); (Y.C.); (H.G.S.)
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea; (H.-K.K.); (J.-H.L.); (Y.S.L.); (Y.C.); (H.G.S.)
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yang-Pyeong 12564, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute on Aging, Seoul National University, Seoul 03080, Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-2072-2619
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Lee SH, Jung BK, Song H, Seo HG, Chai JY, Oh BM. Neuroprotective Effect of Chronic Intracranial Toxoplasma gondii Infection in a Mouse Cerebral Ischemia Model. Korean J Parasitol 2020; 58:461-466. [PMID: 32871641 PMCID: PMC7462801 DOI: 10.3347/kjp.2020.58.4.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022]
Abstract
Toxoplasma gondii is an obligate intracellular protozoan parasite that can invade various organs in the host body, including the central nervous system. Chronic intracranial T. gondii is known to be associated with neuroprotection against neurodegenerative diseases through interaction with host brain cells in various ways. The present study investigated the neuroprotective effects of chronic T. gondii infection in mice with cerebral ischemia experimentally produced by middle cerebral artery occlusion (MCAO) surgery. The neurobehavioral effects of cerebral ischemia were assessed by measurement of Garcia score and Rotarod behavior tests. The volume of brain ischemia was measured by triphenyltetrazolium chloride staining. The expression levels of related genes and proteins were determined. After cerebral ischemia, corrected infarction volume was significantly reduced in T. gondii infected mice, and their neurobehavioral function was significantly better than that of the uninfection control group. Chronic T. gondii infection induced the expression of hypoxia-inducible factor 1-alpha (HIF-1α) in the brain before MCAO. T. gondii infection also increased the expression of vascular endothelial growth factor after the cerebral ischemia. It is suggested that chronic intracerebral infection of T. gondii may be a potential preconditioning strategy to reduce neural deficits associated with cerebral ischemia and induce brain ischemic tolerance through the regulation of HIF-1α expression.
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Affiliation(s)
- Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul 05505, Korea
| | - Bong-Kwang Jung
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07653, Korea
| | - Hyemi Song
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07653, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, 03080 Seoul, Korea
| | - Jong-Yil Chai
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07653, Korea.,Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, 03080 Seoul, Korea
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Kim WS, Kwon BS, Seo HG, Park J, Paik NJ. Low-Frequency Repetitive Transcranial Magnetic Stimulation Over Contralesional Motor Cortex for Motor Recovery in Subacute Ischemic Stroke: A Randomized Sham-Controlled Trial. Neurorehabil Neural Repair 2020; 34:856-867. [PMID: 32807013 DOI: 10.1177/1545968320948610] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Low-frequency repetitive transcranial magnetic stimulation (rTMS) over the contralesional motor cortex (M1) has demonstrated beneficial effects on motor recovery, but evidence among patients with subacute stroke is lacking. We aimed to investigate whether 1-Hz rTMS over the contralesional M1 versus sham rTMS could improve arm function in patients with subacute ischemic stroke when combined with rehabilitative motor training. METHODS In total, 77 patients who were within 90 days after their first-ever ischemic stroke were enrolled and randomly allocated to either real (n = 40) or sham rTMS (n = 37). We delivered 1-Hz 30-minute active or sham rTMS before each daily 30-minute occupational therapy sessions over a 2-week period. The primary endpoint was changes in the Box and Block Test (BBT) score immediately after the end of treatment (EOT). Secondary analyses assessed changes in Fugl-Meyer assessment, Finger Tapping Test (FTT), Brunnstrom stage, and grip strength. CLINICAL TRIAL REGISTRATION ClinialTrials.gov (NCT02082015). RESULTS Changes in BBT immediately after the end of treatment did not differ significantly between the 2 groups (P = .267). Subgroup analysis according to cortical involvement revealed that real rTMS resulted in improvements in BBT at 1 month after EOT (17.4 ± 9.8 real vs 10.9 ± 10.3 sham; P = .023) and Brunnstrom stage of the hand immediately after EOT (0.6 ± 0.5 real vs 0.2 ± 0.5 sham; P = .023), only in the group without cortical involvement. CONCLUSION The effects of real and sham rTMS did not differ significantly among patients within 3 months poststroke. The location of stroke lesions should be considered for future clinical trials.
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Affiliation(s)
- Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Ilsandong-gu, Goyang, South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jihong Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
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Kim DY, Oh HM, Bok SK, Chang WH, Choi Y, Chun MH, Han SJ, Han TR, Jee S, Jung SH, Jung HY, Jung TD, Kim MW, Kim EJ, Kim HS, Kim YH, Kim Y, Kim DY, Kim DY, Kim DK, Ko SH, Ko MH, Lee JK, Lee J, Lee SJ, Lee SG, Lim SH, Oh BM, Paik NJ, Park KD, Park SW, Park GY, Park JH, Park YG, Pyun SB, Ryu B, Seo HG, Shin YI, Sohn MK, Yang SN, Don Yoo S, Yoo WK. KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson's Disease. Brain Neurorehabil 2020; 13:e17. [PMID: 36744191 PMCID: PMC9879460 DOI: 10.12786/bn.2020.13.e17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/09/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022] Open
Abstract
Clinical consensus statements (CCSs) aim to improve care for patients with Parkinson's disease (PD) and reduce the variability of rehabilitation methods in clinical practice. A literature search was conducted to find available evidence on the rehabilitation of patients with PD and to determine the scope of CCSs. The selection of PD rehabilitation domains and key questions was done using the modified Delphi method in 43 expert panels. These panels achieved a consensus on 11 key questions regarding rehabilitation assessment and goal setting, gait and balance, activities of daily living, and swallowing and communication disorders. After the completion of an agreement procedure, 11 key consensus statements were developed by the consensus panel. These statements addressed the needs of rehabilitation as a continuum in patients with PD. They included the appropriate rehabilitation initiation time, assessment items, rehabilitation contents, and complication management. This agreement can be used by physiatrists, rehabilitation therapists, and other practitioners who take care of patients with PD. The consensus panel also highlighted areas where a consensus could not be reached. The development of more focused CCS or clinical practice guidelines that target specific rehabilitation approaches is considered the next needed step.
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Affiliation(s)
| | - Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Hyun Mi Oh
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Soo-Kyung Bok
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yongmin Choi
- Department of Rehabilitation Medicine, School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo Jeong Han
- Department of Rehabilitation, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Tai-Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han Young Jung
- Department of Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Min Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Eun Joo Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hyoung Seop Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yongwook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine & Rehabilitation, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan, Korea
| | - Sam-Gyu Lee
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byungju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University, College of Medicine, Seoul, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine & Rehabilitation, Hallym University College of Medicine, Chuncheon, Korea
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Choi JS, Bang H, Lee GJ, Seo HG, Oh BM, Han TR. Epiglottic Retroflexion is a Key Indicator of Functional Recovery of Post-stroke Dysphagia. Ann Rehabil Med 2020; 44:1-10. [PMID: 32130834 PMCID: PMC7056332 DOI: 10.5535/arm.2020.44.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/09/2019] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate the longitudinal changes of swallowing kinematics based on videofluoroscopic swallowing studies (VFSSs) in subacute stroke patients grouped according to the method of dietary intake. Methods Sixty-nine subacute stroke patients who had taken at least 2 successive VFSSs were included. Subjects were allocated into 3 groups according to the degree of swallowing function recovery—not improved group (tube feeding recommended to patients at both studies), improved group (tube feedings recommended initially to patients and oral feeding recommended at follow-up study), and well-maintained group (oral feeding at both studies recommended to patients). Initial VFSS was performed during the subacute stage of stroke, 1 to 12 weeks after the onset of stroke, and follow-up VFSS was performed at least once. Kinematic variables were calculated by two-dimensional motion analysis of multiple structures, including the hyoid bone, epiglottis, and vocal cord. Changes of kinematic variables were analyzed in serial VFSSs. Results At the initial VFSS, the well-maintained group showed significantly larger angles of epiglottic folding than the not improved group, while at the follow-up VFSS, the improved and the well-maintained groups showed significantly larger epiglottic folding angles than the not improved group. The distribution of epiglottic folding angles was in a dichotomous pattern, and each cluster was related to the swallowing function. Conclusion This study showed that improved epiglottic folding angles are associated with the recovery of the swallowing process and suitability for oral feeding among various kinematic variables in subacute stroke patients.
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Affiliation(s)
- Ji Soo Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Bang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Background and Purpose- The aim of this study was to explore clinical and radiological prognostic factors for long-term swallowing recovery in patients with poststroke dysphagia and to develop and validate a prognostic model using a machine learning algorithm. Methods- Consecutive patients (N=137) with acute ischemic stroke referred for swallowing examinations were retrospectively reviewed. Dysphagia was monitored in the 6 months poststroke period and then analyzed using the Kaplan-Meier method and Cox regression model for clinical and radiological factors. Bayesian network models were developed using potential prognostic factors to classify patients into those with good (no need for tube feeding or diet modification for 6 months) and poor (tube feeding or diet modification for 6 months) recovery of swallowing function. Results- Twenty-four (17.5%) patients showed persistent dysphagia for the first 6 months with a mean duration of 65.6 days. The time duration of poststroke dysphagia significantly differed by tube feeding status, clinical dysphagia scale, sex, severe white matter hyperintensities, and bilateral lesions at the corona radiata, basal ganglia, or internal capsule (CR/BG/IC). Among these factors, tube feeding status (P<0.001), bilateral lesions at CR/BG/IC (P=0.001), and clinical dysphagia scale (P=0.042) were significant prognostic factors in a multivariate analysis using Cox regression models. The tree-augmented network classifier, based on 10 factors (sex, lesions at CR, BG/IC, and insula, laterality, anterolateral territory of the brain stem, bilateral lesions at CR/BG/IC, severe white matter hyperintensities, clinical dysphagia scale, and tube feeding status), performed better than other benchmarking classifiers developed in this study. Conclusions- Initial dysphagia severity and bilateral lesions at CR/BG/IC are revealed to be significant prognostic factors for 6-month swallowing recovery. The prediction of 6-month swallowing recovery was feasible based on clinical and radiological factors using the Bayesian network model. We emphasize the importance of bilateral subcortical lesions as prognostic factors that can be utilized to develop prediction models for long-term swallowing recovery.
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Affiliation(s)
- Woo Hyung Lee
- From the Department of Biomedical Engineering, Seoul National University College of Medicine, Republic of Korea (W.H.L., M.H.L., S.K.)
| | - Min Hyuk Lim
- From the Department of Biomedical Engineering, Seoul National University College of Medicine, Republic of Korea (W.H.L., M.H.L., S.K.)
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Republic of Korea (H.G.S., M.Y.S., B.-M.O.)
| | - Min Yong Seong
- Department of Rehabilitation Medicine, Seoul National University Hospital, Republic of Korea (H.G.S., M.Y.S., B.-M.O.)
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Republic of Korea (H.G.S., M.Y.S., B.-M.O.)
| | - Sungwan Kim
- From the Department of Biomedical Engineering, Seoul National University College of Medicine, Republic of Korea (W.H.L., M.H.L., S.K.).,Institute of Bioengineering, Seoul National University, Republic of Korea (S.K.)
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Won J, Byun SJ, Oh BM, Park SJ, Seo HG. Pneumonia Risk and Related Factors in Patients with Parkinson Disease: A National Database Study. Arch Phys Med Rehabil 2019. [DOI: 10.1016/j.apmr.2019.10.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Choi JS, Seo HG, Oh BM, Choi H, Cheon GJ, Lee SU, Lee SH. 18 F-FDG uptake in denervated muscles of patients with peripheral nerve injury. Ann Clin Transl Neurol 2019; 6:2175-2185. [PMID: 31588693 PMCID: PMC6856607 DOI: 10.1002/acn3.50899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/08/2019] [Accepted: 09/01/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We aimed to investigate the clinical significance of increased uptake in 18 F-fluorodeoxyglucose positron emission tomography in patients with peripheral nerve lesions. METHODS We selected patients with unilateral peripheral nerve lesions confirmed with electromyography who had undergone 18 F-fluorodeoxyglucose positron emission tomography covering the lesions. In the denervated muscles and their contralateral corresponding pairs, a mean (SUVmean) and maximum standardized uptake value (SUVmax) were obtained from 18 F-fluorodeoxyglucose positron emission tomography images. We analyzed the difference in these values between the denervated and normal muscles. The lesion-to-normal ratio of the SUVmean (LNRmean) between each muscle pair was also obtained. Subgroup analysis was performed to find whether these three parameters were related to severity, abundance of abnormal spontaneous activity, and etiology. RESULTS Twenty-three patients with 38 denervated muscles were included. Compared to their normal counterparts, the denervated muscles showed significantly higher SUVmax (1.33 ± 0.49 vs. 1.10 ± 0.37, n = 38, P < 0.001) and SUVmean (0.91 ± 0.31 vs. 0.77 ± 0.28, n = 38, P < 0.001). The muscles with severe neuropathy showed significantly higher LNRmean than those with mild neuropathy (1.30 ± 0.36, n = 19 vs. 1.11 ± 0.24, n = 19; P = 0.046), and the muscles with traumatic neuropathy showed significantly higher LNRmean than those with nontraumatic neuropathy (1.32 ± 0.28, n = 13 vs. 1.14 ± 0.33, n = 23; P = 0.015). INTERPRETATION Denervated muscles with peripheral nerve injury showed higher uptake than normal muscles in 18 F-fluorodeoxyglucose positron emission tomography, and this was associated with severity and etiology.
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Affiliation(s)
- Ji Soo Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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Lee WH, Kim E, Seo HG, Oh BM, Nam HS, Kim YJ, Lee HH, Kang MG, Kim S, Bang MS. Target-oriented motor imagery for grasping action: different characteristics of brain activation between kinesthetic and visual imagery. Sci Rep 2019; 9:12770. [PMID: 31484971 PMCID: PMC6726765 DOI: 10.1038/s41598-019-49254-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/21/2019] [Indexed: 02/05/2023] Open
Abstract
Motor imagery (MI) for target-oriented movements, which is a basis for functional activities of daily living, can be more appropriate than non-target-oriented MI as tasks to promote motor recovery or brain-computer interface (BCI) applications. This study aimed to explore different characteristics of brain activation among target-oriented kinesthetic imagery (KI) and visual imagery (VI) in the first-person (VI-1) and third-person (VI-3) perspectives. Eighteen healthy volunteers were evaluated for MI ability, trained for the three types of target-oriented MIs, and scanned using 3 T functional magnetic resonance imaging (fMRI) under MI and perceptual control conditions, presented in a block design. Post-experimental questionnaires were administered after fMRI. Common brain regions activated during the three types of MI were the left premotor area and inferior parietal lobule, irrespective of the MI modalities or perspectives. Contrast analyses showed significantly increased brain activation only in the contrast of KI versus VI-1 and KI versus VI-3 for considerably extensive brain regions, including the supplementary motor area and insula. Neural activity in the orbitofrontal cortex and cerebellum during VI-1 and KI was significantly correlated with MI ability measured by mental chronometry and a self-reported questionnaire, respectively. These results can provide a basis in developing MI-based protocols for neurorehabilitation to improve motor recovery and BCI training in severely paralyzed individuals.
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Affiliation(s)
- Woo Hyung Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung Seok Nam
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yoon Jae Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Hospital, 120-1 Hwayang-dong, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Institute of Bioengineering, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Lee SH, Jung HY, Yun SJ, Oh BM, Seo HG. Upper Extremity Rehabilitation Using Fully Immersive Virtual Reality Games With a Head Mount Display: A Feasibility Study. PM R 2019; 12:257-262. [PMID: 31218794 DOI: 10.1002/pmrj.12206] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/12/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Rehabilitation therapy using a virtual reality (VR) system for stroke patients has gained attention. However, few studies have investigated fully immersive VR using a head-mount display (HMD) for upper extremity rehabilitation in stroke patients. OBJECTIVE To investigate the feasibility, preliminary efficacy, and usability of a fully immersive VR rehabilitation program using a commercially available HMD for upper-limb rehabilitation in stroke patients. DESIGN A feasibility study. SETTING Two rehabilitation centers. PARTICIPANTS Twelve stroke patients with upper extremity weakness. INTERVENTIONS Five upper extremity rehabilitation tasks were implemented in a virtual environment, and the participants wore an HMD (HTC Vive) and trained with appropriate tasks. Participants received a total of 10 sessions two to three times a week, consisting of 30 minutes per session. MAIN OUTCOME MEASURES Both patient participation and adverse effects of VR training were monitored. Primary efficacy was assessed using functional outcomes (Action Research Arm Test, Box and Block Test, and modified Barthel Index), before and after the intervention. Usability was assessed using a self-reported questionnaire. RESULTS Three patients discontinued VR training, and nine patients completed the entire training sessions and there were no adverse effects due to motion sickness. The patients who received all sessions showed significant functional improvement in all outcome measures after training (P < .05 for all measures). The overall satisfaction was 6.3 ± 0.8 on a 7-point Likert scale in all participants. CONCLUSIONS A fully immersive VR rehabilitation program using an HMD for rehabilitation of the upper extremities following stroke is feasible and, in this small study, no serious adverse effects were identified. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Seung Hak Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Incheon Workers Compensation Hospital, Incheon, Republic of Korea
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Hae-Yoon Jung
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Incheon Workers Compensation Hospital, Incheon, Republic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Kim E, Seo HG, Lee HH, Lee SH, Choi SH, Cho WS, Wagner AK, Oh BM. Altered White Matter Integrity after Mild to Moderate Traumatic Brain Injury. J Clin Med 2019; 8:jcm8091318. [PMID: 31461987 PMCID: PMC6780936 DOI: 10.3390/jcm8091318] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 12/14/2022] Open
Abstract
(1) Background: White matter changes among individuals with mild-to-moderate traumatic brain injury (TBI) may be sensitive imaging markers reflecting functional impairment, particularly in the context of post-concussion syndrome. The objective of this study was to examine the altered white matter integrity in mild-to-moderate TBI patients compared with age-matched normal controls. (2) Methods: Diffusion tensor imaging data from 15 individuals with TBI and 15 control subjects were retrospectively obtained. We investigated and compared white matter integrity in both groups, with regard to fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD) and examined the relationship with cognitive dysfunction and impaired balance in patients. (3) Results: In comparison with controls, the TBI patients had significantly decreased FA as well as increased RD, in the right corticospinal tract. Decreased RD was observed in the left cerebellar area near the middle cerebellar peduncle. Decreased AD was observed in the left inferior cerebellar peduncle, showing positive correlation with poor balance control. We observed decreased FA and increased AD in the left superior longitudinal fasciculus showing positive and negative correlation, respectively, with cognitive function in the TBI group. (4) Conclusions: Altered white matter integrity in mild-to-moderate TBI cases may be indicative of cognitive dysfunction and impaired balance.
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Affiliation(s)
- Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul 03080, Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 03080, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburg, PA 15260, USA
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea.
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Abstract
BACKGROUND Despite the importance of understanding penetration-aspiration (PA) in patients with stroke, the pathophysiology of PA remains unclear. OBJECTIVES This study aimed to investigate the temporal characteristics of PA in post-stroke patients in terms of the timing of the PA event and hyolaryngeal incoordination. METHODS Fifty-eight swallows (38 stroke patients), showing PA when swallowing a thin liquid, were included. The timing of PA was classified kinematically as before or during the swallow. The movement sequence of vertical laryngeal elevation, horizontal hyoid excursion, and epiglottic rotation were compared with healthy controls. Spatiotemporal measurements, videofluoroscopic dysphagia scale parameters were compared between subgroups. RESULTS Thirteen swallows (22.4%) were classified as PA before the swallow and 45 were classified as PA during the swallow (77.6%). Among the PA during the swallow, 26 (57.8%) swallows exhibited abnormal sequences of hyolaryngeal movements and 19 (42.2%) swallows showed normal sequences of hyolaryngeal movements compared with healthy controls. The onset time of horizontal hyoid excursion (P = 0.028), the time to maximal horizontal hyoid excursion (P = 0.010), and maximal epiglottic rotation (P = 0.030) were significantly more delayed in the PA during the swallow group than in the PA before the swallow group. In the swallows with abnormal sequential movements, the onset of horizontal hyoid excursion occurred significantly later than the onset of epiglottic rotation (P < 0.001). Pyriform sinus residue was observed significantly more often in the swallows with abnormal sequences (P = 0.030) than in the swallows with normal sequences. CONCLUSIONS The timing of PA can be classified as before and during the swallow with significantly different temporal characteristics. The horizontal movement of hyoid is the most important factor associated with the pathophysiology of PA in stroke patients.
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Affiliation(s)
- Yeo Hyung Kim
- Department of Rehabilitation Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung Seok Nam
- Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Jeon I, Jung GP, Seo HG, Ryu JS, Han TR, Oh BM. Proportion of Aspiration Pneumonia Cases Among Patients With Community-Acquired Pneumonia: A Single-Center Study in Korea. Ann Rehabil Med 2019; 43:121-128. [PMID: 31072078 PMCID: PMC6509581 DOI: 10.5535/arm.2019.43.2.121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/10/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the proportion of aspiration pneumonia cases among patients with community-acquired pneumonia in Korea. Methods This retrospective study included patients with community-acquired pneumonia who had been admitted to the emergency department of a university-affiliated tertiary hospital in Gyeonggi Province, Korea between January 1, 2016 and December 31, 2016. Among these patients, those with aspiration pneumonia were identified using ICD-10 codes (J69.*). Patients with recurrent pneumonia were excluded, as were those who were immunocompromised. The proportion of cases of aspiration pneumonia was calculated, and the characteristics and clinical outcomes of patients with aspiration pneumonia and non-aspiration pneumonia were compared. Results The proportion of aspiration pneumonia cases among patients with community-acquired pneumonia was 14.2%. Patients with aspiration pneumonia were significantly more likely to be older (p<0.001) and male (p<0.001), and to have a higher confusion, uremia, respiratory rate, blood pressure, and age ≥65 years (CURB-65) score (p<0.001) as compared to patients with non-aspiration pneumonia. They were also more likely to require admission to the intensive care unit (p<0.001) and a longer hospital stay (p<0.001). Conclusion Aspiration pneumonia accounts for 14.2% of all cases of community-acquired pneumonia in Korea. These data may contribute to the establishment of healthcare strategies for managing aspiration pneumonia among Korean adults.
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Affiliation(s)
- Inpyo Jeon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gwang Pyo Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
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Nam HS, Lee WH, Seo HG, Kim YJ, Bang MS, Kim S. Inertial Measurement Unit Based Upper Extremity Motion Characterization for Action Research Arm Test and Activities of Daily Living. Sensors (Basel) 2019; 19:s19081782. [PMID: 31013966 PMCID: PMC6514920 DOI: 10.3390/s19081782] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 01/26/2023]
Abstract
In practical rehabilitation robot development, it is imperative to pre-specify the critical workspace to prevent redundant structure. This study aimed to characterize the upper extremity motion during essential activities in daily living. An IMU-based wearable motion capture system was used to access arm movements. Ten healthy subjects performed the Action Research Arm Test (ARAT) and six pre-selected essential daily activities. The Euler angles of the major joints, and acceleration from wrist and hand sensors were acquired and analyzed. The size of the workspace for the ARAT was 0.53 (left-right) × 0.92 (front-back) × 0.89 (up-down) m for the dominant hand. For the daily activities, the workspace size was 0.71 × 0.70 × 0.86 m for the dominant hand, significantly larger than the non-dominant hand (p ≤ 0.011). The average range of motion (RoM) during ARAT was 109.15 ± 18.82° for elbow flexion/extension, 105.23 ± 5.38° for forearm supination/pronation, 91.99 ± 0.98° for shoulder internal/external rotation, and 82.90 ± 22.52° for wrist dorsiflexion/volarflexion, whereas the corresponding range for daily activities were 120.61 ± 23.64°, 128.09 ± 22.04°, 111.56 ± 31.88°, and 113.70 ± 18.26°. The shoulder joint was more abducted and extended during pinching compared to grasping posture (p < 0.001). Reaching from a grasping posture required approximately 70° elbow extension and 36° forearm supination from the initial position. The study results provide an important database for the workspace and RoM for essential arm movements.
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Affiliation(s)
- Hyung Seok Nam
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 03080, Korea.
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea.
| | - Woo Hyung Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea.
| | - Yoon Jae Kim
- Interdisciplinary Program for Bioengineering, Seoul National University Graduate School, Seoul 08826, Korea.
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul 03080, Korea.
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 03080, Korea.
- Institute of Medical and Biological Engineering, Seoul National University, Seoul 03080, Korea.
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Abstract
BACKGROUND The gold standard in dysarthria assessment involves subjective analysis by a speech-language pathologist (SLP). We aimed to investigate the feasibility of dysarthria assessment using automatic speech recognition. METHODS We developed an automatic speech recognition based software to assess dysarthria severity using hidden Markov models (HMMs). Word-specific HMMs were trained using the utterances from one hundred healthy individuals. Twenty-eight patients with dysarthria caused by neurological disorders, including stroke, traumatic brain injury, and Parkinson's disease were participated and their utterances were recorded. The utterances of 37 words from the Assessment of Phonology and Articulation for Children test were recorded in a quiet control booth in both groups. Patients were asked to repeat the recordings for evaluating the test-retest reliability. Patients' utterances were evaluated by two experienced SLPs, and the consonant production accuracy was calculated as a measure of dysarthria severity. The trained HMMs were also employed to evaluate the patients' utterances by calculating the averaged log likelihood (aLL) as the fitness of the spoken word to the word-specific HMM. RESULTS The consonant production accuracy reported by the SLPs strongly correlated (r = 0.808) with the aLL, and the aLL showed excellent test-retest reliability (intraclass correlation coefficient, 0.964). CONCLUSION This leads to the conclusion that dysarthria assessment using a one-word speech recognition system based on word-specific HMMs is feasible in neurological disorders.
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Affiliation(s)
- Seung Hak Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, Incheon Workers' Compensation Hospital, Incheon, Korea
| | - Minje Kim
- Department of Intelligent Systems Engineering, Indiana University, Bloomington, IN, USA
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Gangpyo Lee
- Department of Rehabilitation Medicine, Incheon Workers' Compensation Hospital, Incheon, Korea
| | - Ja Ho Leigh
- Department of Rehabilitation Medicine, Incheon Workers' Compensation Hospital, Incheon, Korea
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
- Institute of Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea.
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