Dysphagia and Decannulation Following Tracheostomy in Children / 대한연하장애학회지

Dysphagia is a common problem in children with a tracheostomy tube. Such children are at risk of malnutrition, developmental problems, increased medical complications, and pose an increased burden on their caregivers. Therefore, proper evaluation and dysphagia rehabilitation are necessary for children with a tracheostomy tube.Also, as many such children experience serious complications, it is necessary to consider decannulation as early as possible, soon after the indication for tracheostomy placement is resolved. Decannulation should be performed safely as per the appropriate protocol.

Rehabilitation in a Patient with Sarcopenic Dysphagia on Venovenous Extracorporeal Membrane Oxygenation Support Following COVID-19 Infection: A Case Report / 대한연하장애학회지

Sarcopenic dysphagia is a complication of coronavirus disease 2019 (COVID-19). This report describes the approach to rehabilitation in a 65-year-old man with sarcopenic dysphagia who contracted severe COVID-19 and underwent awake venovenous extracorporeal membrane oxygenation (vv-ECMO). He started active rehabilitation while receiving vv-ECMO and underwent a course of comprehensive inpatient rehabilitation lasting 115 days. The sarcopenic dysphagia improved, and he regained physical functional independence without any complications at hospital discharge.

Delirium After Traumatic Brain Injury: Prediction by Location and Size of Brain Lesion

Objective@#To examine (1) the location of brain lesion that would predict post-traumatic delirium and (2) the association between volume of brain lesion and occurrence of delirium in patients with traumatic brain injury (TBI). @*Methods@#A retrospective study was conducted by reviewing medical records of 68 TBI patients, categorized into two groups: the delirious group (n=38) and non-delirious group (n=30). The location and volume of TBI were investigated with the 3D Slicer software. @*Results@#The TBI region in the delirious group mainly involved the frontal or temporal lobe (p=0.038). All 36 delirious patients had brain injury on the right side (p=0.046). The volume of hemorrhage in the delirious group was larger by about 95 mL compared to the non-delirious group, but this difference was not statistically significant (p=0.382). @*Conclusion@#Patients with delirium after TBI had significantly different injury site and side, but not lesion size compared to patients without delirium.

Association Between Length of Stay in the Intensive Care Unit and Sarcopenia Among Hemiplegic Stroke Patients

Objective@#To discuss the association between the length of stay at the intensive care unit (ICU) and sarcopenia among hemiplegic stroke patients. @*Methods@#This study evaluated 66 hemiplegic stroke patients with history of ICU admission using handgrip strength and bioelectrical impedance analysis to obtain height-adjusted appendicular skeletal muscle mass. The diagnosis of sarcopenia was made according to the muscle mass based on the Asian Working Group for Sarcopenia. The patients were divided into sarcopenic and non-sarcopenic groups. The two groups were statistically analyzed, and the significant factors with differences were studied. A multivariate logistic regression analysis was performed to examine the association between length of stay in the ICU and sarcopenia, after adjusting for potential confounders. @*Results@#Among 66 hemiplegic patients with an ICU admission history, 12 patients were diagnosed with sarcopenia. Sarcopenia patients showed lower scores on the Korean version of the Modified Barthel Index and the Korean version of the Mini-Mental State Examination. Additionally, patients with sarcopenia had a longer length of stay in the ICU, and univariate and multivariate analyses confirmed that the ICU length of stay was significantly related to sarcopenia (adjusted odds ratio=1.187; 95% confidence interval, 1.019–1.382; p=0.028). @*Conclusion@#The length of stay in the ICU was significantly associated with sarcopenia in hemiplegic stroke patients.

Spatiotemporal Gait Parameter Comparison for Parkinson's Disease, Multiple System Atrophy, and Other Parkinsonism Diseases

The aim of this study was to compare and quantify the spatiotemporal and gait parameters obtained by foot pressure analysis during the gait in a group of Parkinson's disease (PD) patients compared with other Parkinsonism diseases, especially multiple system atrophy (MSA). Thirty-seven out of ninety-three patients who visited the center of neurology or rehabilitation with features of Parkinsonism were recruited. Spatiotemporal gait parameters were collected using gait analysis system. The results did not differ in terms of the stride length, step width, double stance phase, stride time, cadence, velocity, gait line and single support line differences, anterior-posterior position of center of pressure, and maximal gait line velocity; the lateral symmetry showed a significant difference between the PD and the MSA groups (p < 0.05). The study evaluated the differences in terms of spatiotemporal parameters between the PD and MSA along with other Parkinsonism diseases; it showed that the PD patients had a gait tendency to deviate laterally compared to the MSA patients. The result suggests conducting the gait foot pressure analysis might help distinguish PD from other Parkinsonism diseases in early stage, aiding the early decision for the treatment plans.

Factors Affecting Activities of Daily Living in Severely Disabled Stroke Patients

To investigate factors which affect the activities of daily living (ADL) in severely disabled stroke patients. Medical records of 64 post-stroke patients were reviewed retrospectively. All patients had had rehabilitation for 3 months, and their ADL was assessed using the Korean version of Modified Barthel Index at the time of admission and after 3 months. We also investigated age, onset duration of stroke and the Korean version of Mini-Mental State Examination (K-MMSE) at the time of admission. The ability to roll over, sit, sit to stand, transfer, ambulation, climbing stairs, sitting balance and standing balance were evaluated at the time of admission and after 3 months, either. The factors affecting ADL were K-MMSE and functional ability, such as the ability to roll over, come to sit, sit to stand, sitting and standing balance. The most important factors were the level of K-MMSE and the ability to come to sit. The ability to sit up and the K-MMSE score are the independent factors that can predict the ADL after rehabilitation in severely disabled stroke patient.

Neuromyopathy caused by long term colchicine therapy

Colchicine-induced neuromyopathy is an extremely rare complication, and can develop in the setting of acute overdose or chronic administration in therapeutic doses. A 72-year-old man presented with proximal muscle weakness and myalgia. He had angina pectoris and Behçet’s disease, leading to the treatment of colchicine (1.2 mg daily for about 6 years), cyclosporine, methylprednisolone, simvastatin, and aspirin. A biceps brachii muscle biopsy was performed and electron microscopic examination revealed scattered autophagic vacuoles. He was initially treated with steroid pulse therapy. However, muscle weakness did not improve. After the discontinuation of colchicine, muscle power and myalgia improved steadily. There should be heightened awareness of colchicine-induced neuromyopathy because that clinical suspicion is the most important diagnostic clue, and termination of colchicine is the only treatment.

Gastrointestinal Stromal Tumor of the Stomach Presenting as a Perigastric Abscess

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. A 77-year-old man was referred for the evaluation of general weakness and leukocytosis. Computed tomography showed a 9.5×6.5-cm cavitary lesion with an air-fluid level near the stomach, which was thought to be a perigastric abscess. Upper endoscopy revealed a fistula on the greater curvature at the mid body of the stomach. The margin of the fistula opening was clearly demarcated, and yellow turbid fluid oozing from the fistula was seen. Laparoscopic wedge resection was performed at the perforated area of the stomach. Immunohistochemistry revealed CD117 expression. A diagnosis of intermediate-risk GIST was made. No recurrence was identified within 18 months after the operation. The final diagnosis was perforated gastric GIST communicating with the gastric lumen and presenting as an intra-abdominal abscess.

Nutritional Assessment in Vegetative and Minimally Conscious Patients

The aim of this study is to investigate the nutritional status in vegetative state (VS) and minimally conscious state (MCS) patients, and to identify correlation between the duration from onset and indices indicating nutritional status. This study included a total of 37 VS and MCS patients. For nutrition assessment, the body mass index (BMI), biochemical parameters such as hemoglobin, total lymphocyte count, albumin and cholesterol levels were measured. The mean BMI was 21.31 ± 2.81 kg/m2. Only 4 patients (10.81%) were classified as underweight, 24 patients (64.86%) had normal BMI, 6 patients (16.22%) were overweight, and 3 patients (8.11%) were obese. The partial correlation coefficients showed that duration from onset has a positive correlation with BMI, and a negative correlation with cholesterol level. This study suggests that regular and properly prescribed enteral feeding in VS and MCS patients would supply stable and appropriate nutrition. Further study is needed with additional nutrition assessments reflecting muscle mass.

Electron Microscopy Pathology of ADSSL1 Myopathy

No abstract available.

Lymphedema Associated With Primary Amyloidosis: A Case Study

We reported on a 60-year-old man presenting lymphedema of both lower extremities and scrotum for 3 years with unknown cause. We took a computed tomography scan of the lower extremities as a follow-up. There were diffuse subcutaneous edema in both lower extremities and multiple enlarged lymph nodes along the para-aortic and bilateral inguinal areas. For further evaluation, biopsy of an enlarged inguinal lymph node was taken, yielding a diagnosis of primary amyloidosis. A treatment of chemotherapy for amyloidosis was recommended for him. To our knowledge, this is the first report of lymphedema presenting with primary amyloidosis in Asia. This case suggests that primary amyloidosis could be one of the differential diagnoses in patients with lymphedema in the lower extremities.

Falls in Korean Polio Survivors: Incidence, Consequences, and Risk Factors

Falls and fall-related injuries are important issue among polio survivors. The purpose of this study was to determine the incidence of, and consequences and factors associated with falls among Korean polio survivors. A total of 317 polio survivors participated in this study. All participants completed a questionnaire including fall history, symptoms related to post-polio syndrome and other information through a telephone interview. Among them, 80 participants visited our clinic for additional physical measurements and tests. Of the 317 respondents, 68.5% reported at least one fall in the past year. Of the fallers, 42.5% experienced at least one fall during one month. Most falls occurred during ambulation (76.6%), outside (75.2%) and by slipping down (29.7%). Of fallers, 45% reported any injuries caused by falls, and 23.3% reported fractures specifically. Female sex, old age, low bone mineral density, the presence of symptoms related to post-polio syndrome (PPS), poor balance confidence, short physical performance battery and weak muscle strength of knee extensor were not significantly associated with falls. Only leg-length discrepancy using spine-malleolar distance (SMD) was a significant factor associated with falls among Korean polio survivors. Our findings suggest that malalignment between the paralytic and non-paralytic limb length should be addressed in polio survivors for preventing falls.

Obesity and Pulmonary Function in Polio Survivors

OBJECTIVE: To examine the correlation between obesity and pulmonary function in polio survivors. METHODS: This study was conducted based on a questionnaire survey and physical examination. The questionnaire included gender, age, paralyzed regions, physical activity levels, and accompanying diseases. The physical examination included measuring body mass index, waist circumference, muscle power, total fat amount, body fat percentage, and lean body mass. In addition, pulmonary function was tested based on forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), ratio of FEV1 to FVC, and chest circumference. Five university hospitals and a local health clinic participated in this study. RESULTS: Pearson and partial correlation coefficients that used data collected from 73 polio survivors showed that obesity had a negative correlation with pulmonary function. CONCLUSION: This study found that pulmonary function has a negative correlation with obesity for polio survivors. Therefore, it is necessary to develop specialized exercise programs to help polio survivors reduce their weight and strengthen their respiratory muscles.

Post-Polio Syndrome and Risk Factors in Korean Polio Survivors: A Baseline Survey by Telephone Interview

OBJECTIVE: To obtain information on the socioeconomic, medical, and functional status of polio survivors, and to use these results as the preliminary data for establishing the middle-aged cohort of polio survivors. METHODS: The subjects were recruited based on the medical records of multiple hospitals and centers. They were assessed through a structured questionnaire over the phone. Post-poliomyelitis syndrome (PPS) was identified according to the specified diagnostic criteria. Differences between polio survivors with or without PPS were evaluated, and the risk factors for PPS were analyzed by the odds ratio (OR). RESULTS: Majority of polio survivors were middle-aged and mean age was 51.2+/-8.3 years. A total of 188 out of 313 polio survivors met the adopted criteria for PPS based on the symptoms, yielding a prevalence of 61.6%. Mean interval between acute poliomyelitis and the development of PPS was 38.5+/-11.6 years. Female gender (OR 1.82; confidence interval [CI] 1.09-3.06), the age at onset of poliomyelitis (OR 1.75; CI 1.05-2.94), the use of orthoses or walking aids (OR 2.46; CI 1.44-4.20), and the history of medical treatment for paralysis, pain or gait disturbance (OR 2.62; CI 1.52-4.51) represented independent risk factors for PPS. CONCLUSION: We found that the majority of Korean polio survivors entered middle age with many medical, functional, and social problems. Female gender, early age of onset of poliomyelitis, the use of orthoses or walking aids, and the history of medical treatment for paralysis, pain or gait disturbance were identified as the significant risk factors for PPS. A comprehensive and multidisciplinary plan should be prepared to manage polio survivors considering their need for health care services and the risk factors for late effects, such as PPS.

Risk Factor of Visuospatial Neglect: A Study of Association Between Visuospatial Neglect and Anemia

OBJECTIVE: To investigate the correlation between visuospatial neglect and anemia in patients with right cerebral infarction, as well as to identify the risk factor of neglect and furnish preliminary data on rehabilitation management. METHODS: The line bisection test and Albert test were conducted on subjects with right cerebral infarction in order to analyze neglect severity. Multiple linear regression analysis was conducted to investigate correlation between neglect severity and hemoglobin and hematocrit level. Logistic regression analysis was applied to identify the risk factor of neglect. RESULTS: Visuospatial neglect was observed in 33 subjects out of 124. Hemoglobin and hematocrit were not directly correlated with visuospatial neglect severity, whereas infarct size was directly correlated. Subjects with visuospatial neglect were characterized by a large infarct size, a low score in the Mini-Mental State Examination and long hospital stay. CONCLUSION: In this study, visuospatial neglect was found to be uncorrelated with anemia. It implies that emphasis should be placed on the early detection of anemia and neglect in patients with left hemiplegia, the formulation of respective therapeutic plans and improvement of prognosis. The study found that the possibility of a visuospatial neglect occurrence increases with infarct size. In this regard, it is required that visuospatial neglect was detected and treated in the earliest possible stage, notwithstanding the difficulty that lies in the precise measurement of the severity.

Long Term Improvement of Dysphagia in Lateral Medullary Infarction: A Case Report / 이화의대지

This report concerns a male patient suffered from refractory dysphagia after subarachnoid hemorrhage. A 49-year-old man admitted with severe headache followed by mental change. Imaging studies revealed that subarachnoid hemorrhage was located in basal cistern, and demonstrated ruptured vertebral dissecting aneurysm. After operation, the patient recovered well except severe dysphagia. Initial VFSS showed aspiration in fluid trial, penetration in semisolid bolus, and large amount of pharyngeal residue with poor relaxation of upper esophageal sphincter. For about 5 months, his symptom and several follow-up VFSS findings did not show marked improvement by various treatments. On magnetic resonance imaging for further evaluation of his brain lesion, an old infarction in right lateral side of medulla was found. He kept dysphagia rehabilitation more than one year, and his symptom improved to the level of oral feeding at last.

Improvement of the Working Memory and Naming by Transcranial Direct Current Stimulation

OBJECTIVE: To investigate the effects of transcranial direct current stimulation (tDCS) applied over the prefrontal cortex on the improvement of verbal, visuospatial working memory and naming in healthy adults. METHOD: Thirty two healthy adults (15 males and 17 females, mean age 37.3+/-13.0 years) were enrolled in this study. The subjects were divided into four groups randomly. They underwent sham or anodal tDCS over the left or right prefrontal cortex, for 20 minutes at a direct current of 1 mA. Before and immediately after tDCS, the subjects performed the Korean version of the mini-mental state exam (K-MMSE) and stroop test (color/word/interference) for the screening of cognitive function. For working memory and language evaluation, the digit span test (forward/backward), the visuospatial attention test in computer assisted cognitive program (CogPack(R)) and the Korean-Boston Naming Test (K-BNT) were assessed before tDCS, immediately after tDCS, and 2 weeks after tDCS. RESULTS: The stroop test (word/interference), backward digit span test and K-BNT were improved in the left prefrontal tDCS group compared with that of the sham group (p<0.05). The stroop test (interference) and visuospatial attention test were in the right prefrontal tDCS group compared with that of the sham group (p<0.05). Their improvement lasted for 2 weeks after stimulation. CONCLUSION: tDCS can induce verbal working memory improvement and naming facilitation by stimulating the left prefrontal cortex. It can also improve the visuospatial working memory by stimulating the right prefrontal cortex. Further studies which are lesion and symptom specific tDCS treatment for rehabilitation of stroke can be carried out.

Extracorporeal Shock Wave Therapy in Myofascial Pain Syndrome of Upper Trapezius

OBJECTIVE: To evaluate the effect of extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome of upper trapezius with visual analogue scale (VAS) and pressure threshold by digital algometer. METHOD: Twenty-two patients diagnosed with myofascial pain syndrome in upper trapezius were selected. They were assigned to treatment and standard care (control) groups balanced by age and sex, with eleven subjects in each group. The treated group had done four sessions of ESWT (0.056 mJ/mm2, 1,000 impulses, semiweekly) while the control group was treated by the same protocol but with different energy levels applied, 0.001 mJ/mm2. The VAS and pressure threshold were measured twice: before and after last therapy. We evaluated VAS of patients and measured the pressure threshold by using algometer. RESULTS: There were two withdrawals and the remaining 20 patients were three men and 17 women. Age was distributed with 11 patients in their twenties and 9 over 30 years old. There was no significant difference of age, sex, pre-VAS and pre-pressure threshold between 2 groups (p>0.05) found. The VAS significantly decreased from 4.91+/-1.76 to 2.27+/-1.27 in the treated group (p<0.01). The control group did not show any significant changes of VAS score. The pressure threshold significantly increased from 40.4+/-9.94 N to 61.2+/-12.16 N in the treated group (p<0.05), but there was no significant change in the control group. CONCLUSION: ESWT in myofascial pain syndrome of upper trapezius is effective to relieve pain after four times therapies in two weeks. But further study will be required with more patients, a broader age range and more males.

Analysis of Stroke Patients with Hip Fracture

OBJECTIVE: To investigate the specific features of stroke patients with hip fracture, and the correlation of fracture occurrence with rehabilitation after stroke onset. METHOD: We retrospectively analyzed 181 stroke patients in a total of 892 patients who underwent an operation due to hip fracture. The assessment factors consists of age, the location of brain lesion, bone marrow density, body mass index, the presence of diabetes mellitus and anemia, laboratory findings of serum albumin, calcium and phosphate. We also analyzed subject's dominant hand side, experience of rehabilitation, and the duration between stroke onset and occurrence of hip fracture. RESULTS: Among 181 patients (56 male, 125 female), most common location of the brain lesion was the subcortex. About 70% of patients had osteoporosis, anemia and hypoalbuminemia. Among 34 hemiplegic patients, most of them had hip fracture on hemiplegic side (91.2%). The duration between stroke onset and occurrence of hip fracture of the patients who had experience of rehabilitation after stroke was longer than that of the patients without rehabilitation experience (p<0.05). CONCLUSION: Woman, osteoporosis, anemia and hypoalbuminemia are correlated with the hip fracture in stroke patient. The hip fracture of the stroke patient who did not have rehabilitation experience occurred earlier. The rehabilitation therapy including education for prevention of falling may be helpful to stroke patients with these factors.

Polymorphism of the Glutamate Transporter Protein EAAT2 and Migraine Transformation into Chronic Daily Headache

BACKGROUND AND PURPOSE: The progression of migraine into chronic daily headache involves multiple risk factors, but the main contributor is not known. Glutamate is the major excitatory neurotransmitter in central sensitization, which is an important process in the pathogenesis of migraine transformation. The glutamate transporter protein excitatory amino acid transporter 2 (EAAT2) is the primary modulator of glutamatergic neurotransmission, and genetic polymorphisms of its gene, EEAT2, have been identified. The aim of this study was to determine the effect of EAAT2 polymorphisms on migraine transformation into chronic daily headache. METHODS: We included 74 migraine patients with episodic attack (M-E) and 59 migraine patients with chronic daily headache (M-CDH). After amplifying EAAT2 by polymerase chain reaction, we assessed its genotype frequencies based on restriction fragment length polymorphisms. We reclassified all migraine patients into two groups according to their EAAT2 genotype, either with the A allele (n=62) or without it (n=71), and compared the clinical variables between the two groups. RESULTS: The genotype frequencies of EAAT2 polymorphisms did not differ between the M-E and M-CDH groups. Comparison between EEAT2 genotypes revealed that the frequency of analgesic usage was significantly higher among migraine patients with the A allele (12.9+/-1.6 days/month) than in those without the A allele (8.1+/-1.2 days/month; p=0.019). The other clinical variables of migraine did not differ between the two groups. CONCLUSIONS: The results suggest that EEAT2 polymorphism contributes to the tendency toward frequent analgesic usage in migraine patients. This implies a potential genetic influence on the progression of migraine into chronic daily headache through the development of medication-overuse headache.