ABSTRACT
Objective: Dysphagia rehabilitation is an important area in geriatric nutrition due to the commonality of sarcopenic dysphagia in older adults. However, there have been no reports on the efficacy of treatment by board-certified physiatrists (BCP) in patients with sarcopenic dysphagia. This study therefore aimed to investigate whether intervention by board-certified physiatrists affects the functional prognosis of patients with sarcopenic dysphagia.Materials and Methods: Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia database between November 2019 and March 2021, 433 met the study eligibility criteria. The patients were divided into two groups based on whether or not they received intervention by a BCP. The clinical characteristics and outcomes of the two groups were compared. Statistical analyses were performed by inverse probability weighting (IPW).Results: BCPs were involved in the management of 57.0% of patients with sarcopenic dysphagia. These patients had a significantly higher increase in the Barthel index both before and after IPW correction than those not managed by a BCP (P=0.001 and P=0.016, respectively). However, sarcopenic dysphagia significantly improved in the non-BCP group before IPW correction (P<0.001), although there was no significant difference after IPW correction (P=0.301).Conclusion: BCP management was significantly associated with higher activities of daily living (ADL), but not with an improvement in sarcopenic dysphagia. To provide and manage effective rehabilitation, it is necessary to familiarize patients with the management and training of sarcopenic dysphagia rehabilitation for BCP in order to cope in regions with few rehabilitation units.
ABSTRACT
@#AIM: To evaluate the disruption degree of macular fovea structure by pre-operation SD-OCT examination and establish a new method of IMEM. Thus, to analysis the value of this method for predicting the visual functional prognosis of cataract patients complicated with idiopathic macular epiretinal membrane(IMEM)after cataract surgery alone.<p>METHODS: Totally 64 patients(80 eyes)diagnosed as cataract with IMEM, who simply underwent phaco cataract extraction combined with intraocular lens implantation were included in this study. These patients were admitted in Shenzhen Eye Hospital from October 2017 to November 2018. IMEM was divided into 4 stages based on the damage degree of macular fovea structure by pre-operative SD-OCT examination. The best corrected visual acuity(BCVA), mean retinal sensitivities(MS), central macular thickness(CMT)and the progression rate of IMEM in all the patients were compared and analyzed before and 3mo after the cataract operation.<p>RESULTS: With the IMEM grade rised, the epiretinal membranes became more obvious, the disruption of retinal layers and loss of the foveal depression became more serious on the SD-OCT image. The LogMAR BCVA of pre-operation and 3mo after cataract surgery progressively rised with the increasing of IMEM grade, and the differences were statistically significant(<i>F</i>=37.72, 26.43, <i>P</i><0.001). Otherwise, The MS of pre-operation and 3mo after cataract surgery progressively declined with the increasing of IMEM grade, and the differences were statistically significant(<i>F</i>=43.77, 28.96, <i>P</i><0.001). The change of CMT was not consistent with the progression rate of IMEM in 3mo after operation. There was no significant difference in CMT(<i>P</i>>0.05), but the progression rate of IMEM was increased significantly with the IMEM grading(χ<sup>2</sup><sub>Trend</sub>=12.59, <i>P</i><0.001).<p>CONCLUSION: The new classification method was created for IMEM by SD-OCT will help to predict the visual functional prognosis for cataract patients complicated with IMEM after cataract surgery.
ABSTRACT
PURPOSE: In order to evaluate the clinical features and visual prognosis of Leber's hereditary optic neuropathy (LHON) associated with T14484C mitochondrial DNA (mtDNA) mutation in Korean patients. METHODS: To evaluate the clinical feature of Korean LHON patients with T14484C mtDNA mutation, a retrospective chart review was performed on 14 patients who visited our clinic with the chief complaint of decreased visual acuity. RESULTS: All of the 14 patients experienced a significant decrease in visual acuity during the follow-up period. Eight of these patients (57%) showed an improvement in visual acuity of 20/50 or better in one or both eyes, and the remaining six patients (43%) showed visual acuities of 20/200 or worse in both eyes at the final follow-up. When the symptoms aggravated, ten patients (71%) showed central scotoma or cecocentral scotoma. Eleven of 12 patients (92%) who had undergone the Ishihara color vision test showed dyschromatopsia in the aggravated stage. Four patients had dyschromatopsia and three patients had central scotoma in both eyes even after visual recovery. There were no statistically significant differences in the age of onset or the nadir of visual acuity between the good visual recovery group and the non-recovery group (p > 0.05). CONCLUSIONS: Korean LHON patients with the T14484C mutation showed relatively good visual prognosis similar to those of the Caucasian or Japanese patients but with remaining dyschromatopsia or central scotoma after visual recovery.
Subject(s)
Humans , Age of Onset , Asian People , Color Vision , DNA, Mitochondrial , Eye , Follow-Up Studies , Optic Atrophy, Hereditary, Leber , Prognosis , Retrospective Studies , Scotoma , Visual AcuityABSTRACT
We report a case of Nothnagel syndrome with inattention. A 69-year-old laborer was admitted to our hospital for rehabilitation therapy complaining of gait disturbance a month after the onset of brainstem infarction. He had right oculomotor palsy, ataxia on the left side and upward movement limitation of the left eye. Magnetic resonance imaging demonstrated high signal intensity in the right tegmentum of the midbrain and the medial aspect of the right thalamus on T2-weighted and diffusion weighted images. This lesion involving nuclei in the medial aspect of the right thalamus, which is considered to be closely related with the reticular activating system, might explain his inattention. And it is suggested that the low blood flow in the right basal ganglia and parietal lobe revealed by his SPECT scan, could be related with that as well. We administered rehabilitation programs for his ataxia and inattention. Because diplopia is thought to be difficult to improve, we did not attempt to treat the patient's eye movement limitation. Three months after our intervention, he was able to walk without support. However, his inattention remained. Patients with brainstem infarction are apt to have plural impairments concurrently. In such cases, it is necessary to assess the treatment priority for each impairment adequately. Evidence based guidelines for the assessment of treatment priority would aid in this endeavor and the development of such guidelines is therefore expected.
ABSTRACT
The purpose of this study was to evaluate in aged patients with hip fracture, the degree of recovery at discharge and after discharge relative to the pre-fracture walking level, to clarify the factors involved in unsuccessful recovery. The patients were 189 patients aged 60 years and older who underwent surgery between 1988 and 1994. Patients who died within 1 year or lacked data on walking were excluded. Multiple logistic regression analysis was applied to data on the walking level before fracture, that at discharge, and the best walking level after discharge, to clarify factors involved in unsuccessful recovery. The rate of recovery to the pre-fracture level was 55.1% at discharge. Unsuccessful recovery at discharge was influenced by prior dementia, a history of cerebrovascular diseases, and an age of 85 or more years. Analysis showed an “after-discharge” recovery rate of 63.2%. Prior dementia and the residence outside one’s own home influenced unsuccessful recovery rate. These findings suggested that it is important to provide patients with such factors a more effective postoperative rehabilitation program not merely the standard rehabilitation program. In addition, a walking rehabilitation program should be offered to those who were re-hospitalized or admitted to other health care facilities.