Relationship between Swallowing Function, Diet Level and Pulmonary Function in Post-Stroke Patients / 대한연하장애학회지

Objective@#To identify the relationship between dysphagia, dietary level, and pulmonary function in post-stroke patients. @*Methods@#Thirty-six post-stroke patients with dysphagia, who were hospitalized from June 2017 to October 2017 in the Department of Rehabilitation Medicine at a tertiary hospital, were analyzed retrospectively. The video-fluoroscopic swallowing study (VFSS) and videofluoroscopic dysphagia scale (VDS) were used to assess dysphagia. The vital capacity (VC) and peak cough flow (PCF) were used to assess the pulmonary function. Upon admission, the patients were divided into three groups according to their dietary level (tube feeding, dysphagia diet, and general diet). The correlation between dysphagia and pulmonary function was analyzed using an independent t-test test with the optimal points, and the relationship between the diet level and pulmonary function was evaluated using a one-way analysis of the variance. @*Results@#Significant correlations between the pulmonary function and sub-items of VDS were found in “oral transit time” with VC, “vallecullar residue” and “aspiration” with PCF, and “triggering of pharyngeal swallow”, “VDS total score” with VC and PCF. The dietary levels upon admission had a significant correlation with VC and PCF. The VC among groups divided according to three diet levels showed statistically significant differences. @*Conclusion@#This study revealed the relationship between the pulmonary function and dysphagia in post-stroke patients. Moreover, the pulmonary function correlated with dietary level, even though it was not confirmed that it affected dietary levels. The clinical importance of the pulmonary function in post-stroke patients with dysphagia should be emphasized. In addition, a large-scale study is needed to determine the correlation between the pulmonary function and swallowing difficulty

Significance of Hypokalemia in Functional Outcomes of Patients with Subacute Stroke

This retrospective case-control study aimed to the effect of hypokalemia on the functional outcomes of patients with subacute stroke. A total of 96 post-stroke hemiplegic patients admitted to an inpatient clinic of the department of rehabilitation medicine between March 2014 and February 2018 were recruited. Serum potassium level was assessed at the time of admission, and the patients with hypokalemia on admission or within 7 days after onset were classified into the hypokalemic group. Functional assessments using the Hemispheric Stroke Scale (HSS), Functional Ambulation Category (FAC), Functional Independence Measure for locomotion, and Mini Mental Status Examination were performed. The primary outcome was the change in functional score during rehabilitation. No significant intergroup differences in baseline characteristics were found except hospital stay duration and use of diuretics. FAC recovery (0.91 vs. 1.66, p = 0.001), HSS lower extremity and total motor scores (0.37 vs. 1.10, p = 0.01; 0.83 vs. 2.18, p = 0.02, respectively) were significantly lower in the hypokalemic group. Pearson correlation analysis of the initial serum potassium level and functional recovery revealed significant correlations with the FAC or HSS lower extremity and total motor scores (p = 0.001, p = 0.01, and p = 0.04, respectively).

Motor Recovery after Seizure Induced by Repetitive Transcranial Magnetic Stimulation

Despite the low incidence, seizures induced by repetitive transcranial magnetic stimulation (rTMS) have been studied as they may cause neurological and functional regression. Seizures may predict poor outcomes in stroke patients, with no reports of improved neurological status after seizures. This is the first Korean report of a seizure induced by rTMS, and the first report in the literature of prompt motor recovery following a seizure induced by high-frequency rTMS of the primary motor cortex in a stroke patient. A 43-year-old man with left hemiplegia due to infarction in the right basal ganglia was enrolled 10 sessions of rTMS (each session consisted of 15 trains, with each train consisting of 5 seconds of stimulation at 20 Hz and 90% of resting motor threshold for each session followed by 55 seconds of rest). The self-limited seizure occurred within 5 seconds after the 10th session. It lasted for 60 seconds, with generalized tonic features in all four extremities and the trunk and loss of consciousness followed by prompt improvement in left hand muscle strength and coordination. Though the seizure is known to usually cause neurologic regression, this case showed neurologic improvement after rTMS even after the rTMS-induced seizure.

Relationship Between Swallowing Function and Maximum Phonation Time in Patients With Parkinsonism

OBJECTIVE: To identify the relationship between maximum phonation time (MPT) and swallowing function, as well as the elements of swallowing, in order to provide a rationale for speech therapy in patients with Parkinsonism manifesting dysphagia. METHODS: Thirty patients with Parkinsonism who underwent speech evaluation and videofluoroscopic swallowing study (VFSS) were recruited. The MPT, the longest periods of sustained pronunciation of /aa/, was evaluated. The VFSS was evaluated using Penetration Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and Videofluoroscopic Dysphagia Scale (VDS). The relationship between dysphagia scales and MPT was analyzed using Pearson correlation. The difference in VDS variables between subgroups (Parkinson disease or Parkinsonian syndrome, independent or dependent ambulation, and normal or abnormal MPT) and the difference in MPT between subgroups based on the VDS variables were analyzed using the independent t-test. RESULTS: Bolus formation and laryngeal elevation functions were significantly higher in the normal MPT group compared with the impaired group. In the VDS variables, patients with intact bolus formation, oral transit time, pharyngeal swallow triggering, and laryngeal elevation showed significantly longer MPTs compared with the impaired groups. In addition, MPT was significantly correlated with the VDS and modestly correlated with the NIH-SSS, but not the PAS, suggesting that phonatory function is related to the oropharyngeal swallowing function, but not directly to the aspiration itself. CONCLUSION: The correlation between MPT and several swallowing-related elements was identified, indicating an interactive correlation between swallowing and phonation. This result justifies voice therapy as a treatment for dysphagia in patients with Parkinsonism.

The Effect of Treadmill Exercise on Gait Efficiency During Overground Walking in Adults With Cerebral Palsy

OBJECTIVE: To investigate the effect of treadmill walking exercise as a treatment method to improve gait efficiency in adults with cerebral palsy (CP) and to determine gait efficiency during overground walking after the treadmill walking exercise. METHODS: Fourteen adults with CP were recruited in the experimental group of treadmill walking exercise. A control group of 7 adults with CP who attended conventional physical therapy were also recruited. The treadmill walking exercise protocol consisted of 3-5 training sessions per week for 1-2 months (total 20 sessions). Gait distance, velocity, VO2, VCO2, O2 rate (mL/kg.min), and O2 cost (mL/kg.m) were assessed at the beginning and at the end of the treadmill walking exercise. The parameters were measured by KB1-C oximeter. RESULTS: After the treadmill walking exercise, gait distance during overground walking up to 6 minutes significantly increased from 151.29+/-91.79 to 193.93+/-79.01 m, and gait velocity increased from 28.09+/-14.29 to 33.49+/-12.69 m/min (p<0.05). Energy efficiency evaluated by O2 cost during overground walking significantly improved from 0.56+/-0.36 to 0.41+/-0.18 mL/kg.m (p<0.05), whereas O2 rate did not improve significantly after the treadmill walking exercise. On the other hand, gait velocity and O2 cost during overground walking were not significantly changed in the control group. CONCLUSION: Treadmill walking exercise improved the gait efficiency by decreased energy expenditure during overground walking in adults with CP. Therefore, treadmill walking exercise can be an important method for gait training in adults with CP who have higher energy expenditure.