Relationship between Generalized Sarcopenia and the Severity of Dysphagia after a Stroke / 대한연하장애학회지

Objective@#Patients who have suffered a stroke may experience dysphagia, which could raise the risk of aspiration pneumonia and death. This is also a complication prevalent in older adults with various comorbidities. This study aimed at investigating the association between head lifting strength and dysphagia, particularly in each of the two phases of dysphagia, namely the oral and the pharyngeal phase, in stroke patients. @*Methods@#We prospectively recruited 64 patients within six months of their first-ever stroke. Head lifting strength, handgrip strength, and calf circumference were measured. The severity of dysphagia was evaluated using the videofluoroscopic dysphagia scale (VDS). Partial correlation and multiple linear regression analyses were applied to examine the association between head lifting strength and dysphagia. @*Results@#The subjects were comprised of 31 men and 33 women with a mean age of 63 years. The median National Institute of Health Stroke Scale (NIHSS) score was 5.5 (interquartile range 4.0-8.0). Based on the penetration-aspiration scale, 46 participants had dysphagia without aspiration and 18 had dysphagia with aspiration. The head lifting strength in the non-aspiration group was higher compared with the aspiration group. The head lifting strength was significantly correlated with the VDS-pharyngeal phase (r=−0.715) and the penetration-aspiration scale (r=−0.662). In the multiple linear regression analysis, head lifting strength was independently associated with pharyngeal-phase dysphagia (P＜0.001). @*Conclusion@#Head lifting strength is significantly associated with the severity of dysphagia in the pharyngeal phase.

Hemidystonia after Pontine Hemorrhage Successfully Treated with Pharmacotherapy and Intensive Rehabilitation: a Case Report

Dystonia is a movement disorder characterized by involuntary contraction of muscles resulting in repetitive or twisting movements. Dystonia is generally caused by basal ganglia dysfunction.Recent studies have reported an association between dystonia and brainstem disorders. However, the pathological mechanism is uncertain, and detailed management strategies are limited. Here, we report a case of hemidystonia with abnormal posture and impaired proprioception after pontine hemorrhage that was effectively treated with pharmacotherapy combined with early intensive comprehensive rehabilitation. A 45-year-old man presented with abnormal posture and dystonic movement in the right hand and foot after a pontine hemorrhagic stroke. Pharmacotherapy with clonazepam and benztropine was administered, and comprehensive rehabilitation programs were implemented intensively from the early stages of symptom onset. After 3 months, the patient was able to walk independently, go up and down a few stairs without the use of a handrail, and was able to perform activities of daily living with minimal assistance.