Association between clinical risk factors and severity of dysphagia after extubation based on a videofluoroscopic swallowing study

Background/Aims@#This study aimed to evaluate the correlation between clinical risk factors of post-extubation dysphagia (PED) and the severity of impaired pharyngeal swallowing function assessed via videofluoroscopic swallowing studies (VFSSs). @*Methods@#This study was a retrospective review of medical records. Of 116 patients who were admitted to the intensive care unit and underwent VFSS, 32 who had non-neurologic disorders and experienced prolonged intubation (for more than 48 hours) were diagnosed with PED. The severity of PED was evaluated by using a functional dysphagia scale (FDS) and a penetration aspiration scale (PAS), on the basis of VFSS. @*Results@#The Simplified Acute Physiology Score 3 and total FDS score were positively correlated (r = 0.40, p = 0.02). Intubation duration was positively correlated with total PAS and FDS scores (r = 0.62, p < 0.001; r = 0.65, p < 0.001, respectively). The amounts of residue in the valleculae (RV) and pyriform sinuses (RP) were associated with intubation duration (r = 0.58, p < 0.001; r = 0.57, p < 0.001, respectively). Multivariate regression analysis revealed that intubation duration was significantly associated with the total FDS score, RV and RP subscales of the FDS, and total PAS score. @*Conclusions@#The severity of impaired swallowing function, particularly the amount of residue in the pharyngeal recesses assessed via VFSS, was strongly associated with both severity of medical illness and intubation duration. Intubation duration could be a prognostic factor for assessing impaired swallowing function on the basis of VFSS.

Effect of Family Caregiving on Depression in the First 3 Months After Spinal Cord Injury

OBJECTIVE: To investigate the effect of family caregiving on depression in the first 3 months after spinal cord injury (SCI). METHODS: A retrospective study was carried out on 76 patients diagnosed with an SCI from January 2013 to December 2016 at the Department of Physical Medicine and Rehabilitation of Kyungpook National University Hospital, Korea. Clinical characteristics including age, gender, level of injury, completeness of the injury, time since injury, caregiver information, etiology, and functional data were collected through a retrospective review of medical records. Depression was assessed using the Beck Depression Inventory (BDI). Patients with 14 or more points were classified as depressed and those with scores of 13 or less as non-depressed group. RESULTS: Of the 76 patients, 33 were in the depressed group with an average BDI of 21.27±6.17 and 43 patients included in the non-depressed group with an average BDI of 4.56±4.20. The BDI score of patients cared by unlicensed assistive personnel (UAP) was significantly higher than that of patients cared by their families (p=0.020). Univariate regression analysis showed that motor complete injury (p=0.027), UAP caregiving (p=0.022), and Ambulatory Motor Index (p=0.019) were associated with depression after SCI. Multivariate binary logistic regression analysis showed that motor completeness (p=0.002) and UAP caregiving (p=0.002) were independent risk factors. CONCLUSION: Compared with UAP, family caregivers lowered the prevalence of depression in the first 3 months after SCI.

Recommendation of Nasogastric Tube Removal in Acute Stroke Patients Based on Videofluoroscopic Swallow Study

OBJECTIVE: To evaluate the safety of nasogastric tube (NGT) removal and change to oral feeding with a food thickener for acute stroke patients in whom a videofluoroscopic swallow study (VFSS) confirmed thin liquid aspiration. METHODS: We retrospectively examined data of 199 patients with first stroke who were diagnosed with dysphagia from 2011 to 2015. Swallowing function was evaluated using VFSS. Patients included in this study were monitored for 4 weeks to identify the occurrence of aspiration pneumonia. The penetration-aspiration scale (PAS) was used to assess VFSS findings. The patients were divided into thin-liquid aspiration group (group 1, n=104) and no thin-liquid aspiration group (group 2, n=95). RESULTS: The feeding method was changed from NGT feeding to oral feeding with food thickener (group 1) and without food thickener (group 2). The PAS scores of thin and thick liquids were 6.46±0.65 and 1.92±0.73, respectively, in group 1 and 2.65±0.74 and 1.53±0.58, respectively, in group 2. Aspiration pneumonia developed in 1.9% of group 1 and 3.2% of group 2 (p=0.578), with no significant difference between the groups. CONCLUSION: We concluded that removing the NGT and changing to oral feeding with a food thickener is a safe food modification for acute stroke patients with thin liquid aspiration. Therefore, we recommend that VFSS should be conducted promptly in acute stroke patients to avoid unnecessary prolonged NGT feeding.

Quality of Life and Physical Ability Changes After Hospital-Based Cardiac Rehabilitation in Patients With Myocardial Infarction

OBJECTIVE: To evaluate the effect of hospital-based cardiac rehabilitation (CR) on quality of life (QOL) and physical ability in patients with myocardial infarction (MI). METHODS: Patients with MI who were referred to the Cardiac Health and Rehabilitation Center 2 weeks after percutaneous coronary intervention were divided into CR and non-CR groups. The CR group performed supervised exercises 3 times a week for 2 months. QOL assessment, using the 36-item Short-Form Health Survey (SF-36) and physical ability evaluation were performed at the beginning and end of CR. RESULTS: The CR group demonstrated statistically significant improvements in physical functioning (PF), physical role functioning (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social role functioning (SF), emotional role functioning (RE), mental health (MH), physical component summary (PCS), and mental component summary (MCS). The non-CR group showed improvement in RP. Secondary outcomes, including resting heart rate (RHR), maximal oxygen consumption (VO(2max)), metabolic equivalent of task (MET), maximal exercise time (ET(max)), stage 3 Borg rating of perceived exertion (3RPE), maximal Borg rating of perceived exertion (RPEmax), and stage 3 rate pressure product (3RPP), improved in the CR group. The non-CR group showed improvements in VO(2max), MET, ET(max), and 3RPE. There were significant differences in improvements in PF, RP, BP, VT, SF, MH, MCS, RHR, VO(2max), MET, ET(max), 3RPE, and 3RPP between the two groups. CONCLUSION: Male patients with MI demonstrated improvements in QOL and physical ability following hospital-based CR; the impact on the mental component was greater than that on the physical component.

Balance Assessment in Subacute Stroke Patients Using the Balance Control Trainer (BalPro)

OBJECTIVE: To demonstrate the efficacy of the balance control trainer (BCT), developed for training patients with balance problems, as a balance assessment tool in subacute stroke patients. METHODS: A prospective cross-sectional study was carried out on 38 subacute stroke patients in their first episode of a stroke, and having the ability to maintain a standing position without aid for at least 5 minutes. Patients were assessed using the BCT (BalPro) 43.7±35.7 days after stroke. The balance was assessed using the Berg Balance Scale (BBS), the Timed Up and Go Test (TUG), a 10-meter walking test (10mWT), a 6-minute walking test (6MWT), and the Korean version of the Modified Barthel Index. The correlation and validity between the BCT and various balance assessments were analyzed. RESULTS: Statistically significant linear correlations were observed between the BCT score and the BBS (r=0.698, p<0.001). A moderate to excellent correlation was seen between the BCT score and 11 of the 14 BBS items. The BCT scores and other secondary outcome parameters (6MWT r=0.392, p=0.048; TUG r=–0.471, p=0.006; 10mWT r=–0.437, p=0.012) had a moderate correlation. CONCLUSION: Balance control training using the BCT (BalPro) showed significant statistical correlation with the BBS, and could therefore be a useful additional balance assessment tool in subacute stroke patients.

Change of Brain Functional Connectivity in Patients With Spinal Cord Injury: Graph Theory Based Approach

OBJECTIVE: To investigate the global functional reorganization of the brain following spinal cord injury with graph theory based approach by creating whole brain functional connectivity networks from resting state-functional magnetic resonance imaging (rs-fMRI), characterizing the reorganization of these networks using graph theoretical metrics and to compare these metrics between patients with spinal cord injury (SCI) and age-matched controls. METHODS: Twenty patients with incomplete cervical SCI (14 males, 6 females; age, 55+/-14.1 years) and 20 healthy subjects (10 males, 10 females; age, 52.9+/-13.6 years) participated in this study. To analyze the characteristics of the whole brain network constructed with functional connectivity using rs-fMRI, graph theoretical measures were calculated including clustering coefficient, characteristic path length, global efficiency and small-worldness. RESULTS: Clustering coefficient, global efficiency and small-worldness did not show any difference between controls and SCIs in all density ranges. The normalized characteristic path length to random network was higher in SCI patients than in controls and reached statistical significance at 12%-13% of density (p<0.05, uncorrected). CONCLUSION: The graph theoretical approach in brain functional connectivity might be helpful to reveal the information processing after SCI. These findings imply that patients with SCI can build on preserved competent brain control. Further analyses, such as topological rearrangement and hub region identification, will be needed for better understanding of neuroplasticity in patients with SCI.

Effects of Balance Control Training on Functional Outcomes in Subacute Hemiparetic Stroke Patients

OBJECTIVE: To investigate the efficacy of balance control training using a newly developed balance control trainer (BalPro) on the balance and gait of patients with subacute hemiparetic stroke. METHODS: Forty-three subacute stroke patients were assigned to either a balance control training (BCT) group or a control group. The BCT group (n=23) was trained with BalPro for 30 minutes a day, 5 days a week for 2 weeks, and received one daily session of conventional physical therapy. The control group (n=20) received two sessions of conventional physical therapy every day for 2 weeks. The primary outcome was assessment with the Berg Balance Scale (BBS). Secondary outcomes were Functional Ambulation Category (FAC), the 6-minute walking test (6mWT), Timed Up and Go (TUG), the Korean version of Modified Barthel Index (K-MBI), and the manual muscle test (MMT) of the knee extensor. All outcome measures were evaluated before and after 2 weeks of training in both groups. RESULTS: There were statistically significant improvements in all parameters except MMT and FAC after 2 weeks of treatment in both groups. After training, the BCT group showed greater improvements in the BBS and the 6mWT than did the control group. CONCLUSION: Balance control training using BalPro could be a useful treatment for improving balance and gait in subacute hemiparetic stroke patients.

Validity of Quantitative Lymphoscintigraphy as a Lymphedema Assessment Tool for Patients With Breast Cancer

OBJECTIVE: To evaluate the validity of quantitative lymphoscintigraphy as a useful lymphedema assessment tool for patients with breast cancer surgery including axillary lymph node dissection (ALND). METHODS: We recruited 72 patients with lymphedema after breast cancer surgery that included ALND. Circumferences in their upper limbs were measured in five areas: 15 cm proximal to the lateral epicondyle (LE), the elbow, 10 cm distal to the LE, the wrist, and the metacarpophalangeal joint. Then, maximal circumference difference (MCD) was calculated by subtracting the unaffected side from the affected side. Quantitative asymmetry indices (QAI) were defined as the radiopharmaceutical uptake ratios of the affected side to the unaffected side. Patients were divided into 3 groups by qualitative lymphoscintigraphic patterns: normal, decreased function, and obstruction. RESULTS: The MCD was highest in the qualitative obstruction (2.76+/-2.48) pattern with significant differences from the normal (0.69+/-0.78) and decreased function (1.65+/-1.17) patterns. The QAIs of the axillary LNs showed significant differences among the normal (0.82+/-0.29), decreased function (0.42+/-0.41), and obstruction (0.18+/-0.16) patterns. As the QAI of the axillary LN increased, the MCD decreased. The QAIs of the upper limbs were significantly higher in the obstruction (3.12+/-3.07) pattern compared with the normal (1.15+/-0.10) and decreased function (0.79+/-0.30) patterns. CONCLUSION: Quantitative lymphoscintigraphic analysis is well correlated with both commonly used qualitative lymphoscintigraphic analysis and circumference differences in the upper limbs of patients with breast cancer surgery with ALND. Quantitative lymphoscintigraphy may be a good alternative assessment tool for diagnosing lymphedema after breast cancer surgery with ALND.

Delayed Onset of Acute Limb Compartment Syndrome With Neuropathy After Venoarterial Extracorporeal Membrane Oxygenation Therapy

Acute limb compartment syndrome (ALCS) is defined as compound symptoms resulting from poor oxygenation and decreased nutrition supply to muscles and nerves in a tightly confined compartment. The most common cause of ALCS is tibia fracture, followed by blunt trauma to soft tissue. However, non-traumatic causes are rare. We report an iatrogenic, non-traumatic ALCS case after venoarterial extracorporeal membrane oxygen (VA-ECMO) therapy. A 14-year-old male received VA-ECMO therapy due to cardiorespiratory failure after drowning. Although he had no symptoms during therapy, leg swelling appeared 10 hours after ECMO treatment. Two days after the leg swelling, the patient underwent a fasciotomy. Unfortunately, nerve conduction studies and electromyography showed multiple neuropathies in the lower leg. Despite 2 weeks of rehabilitation with electrical stimulation, an exercise program, and physical therapy, there was no definite change in muscle strength. To our knowledge, this is the first reported case of non-traumatic ALCS after VA-ECMO therapy in Korea.

Effect of Dominant Hand Paralysis on Quality of Life in Patients With Subacute Stroke

OBJECTIVE: To evaluate the degree to which the paralysis of a dominant hand affects quality of life (QOL) in patients with subacute stroke. METHODS: We recruited 75 patients with subacute hemiplegic stroke. Patients were divided into two groups according to the location of the lesion and the side of the dominant hand. Group 1 consisted of patients whose strokes affected the dominant hand (i.e., right hemiplegia and right dominant hand or left hemiplegia and left dominant hand). Group 2 consisted of patients whose strokes affected the non-dominant hand (i.e., left hemiplegia and right dominant hand or right hemiplegia and left dominant hand). The primary outcome measure was the Short-Form 36-Item Health Survey (SF-36), which was used to evaluate health-related QOL. Secondary outcomes were scores on the Modified Barthel Index (MBI) and Beck Depression Inventory (BDI). RESULTS: We did not find any statistically significant differences between the groups in any SF-36 domain including the summaries of physical and mental component. Similarly, the MBI and BDI scores were not significantly different between the groups. CONCLUSION: The effect of paralysis on the dominant hand and QOL in patients with subacute stroke was not significantly different from the effect of paralysis on the non-dominant hand.

Feasibility and Effects of Newly Developed Balance Control Trainer for Mobility and Balance in Chronic Stroke Patients: A Randomized Controlled Trial

OBJECTIVE: To investigate the feasibility and effects of balance training with a newly developed Balance Control Trainer (BCT) that applied the concept of vertical movement for the improvements of mobility and balance in chronic stroke patients. METHOD: Forty chronic stroke patients were randomly assigned to an experimental or a control group. The experimental group (n=20) underwent training with a BCT for 20 minutes a day, 5 days a week for 4 weeks, in addition to concurrent conventional physical therapy. The control group (n=20) underwent only conventional therapy for 4 weeks. All participants were assessed by: the Functional Ambulation Categories (FAC), 10-meter Walking Test (10mWT), Timed Up and Go test (TUG), Berg Balance Scale (BBS), Korean Modified Barthel Index (MBI), and Manual Muscle Test (MMT) before training, and at 2 and 4 weeks of training. RESULTS: There were statistically significant improvements in all parameters except knee extensor power at 2 weeks of treatment, and in all parameters except MBI which showed further statistically significant progress in the experimental group over the next two weeks (p<0.05). Statistically significant improvements on all measurements were observed in the experimental group after 4 weeks total. Comparing the two groups at 2 and 4 weeks of training respectively, 10mWT, TUG, and BBS showed statistically more significant improvements in the experimental group (p<0.05). CONCLUSION: Balance training with a newly developed BCT is feasible and may be an effective tool to improve balance and gait in ambulatory chronic stroke patients. Furthermore, it may provide additional benefits when used in conjunction with conventional therapies.

Health-Related Quality of Life in Breast Cancer Patients with Lymphedema Who Survived More than One Year after Surgery / 한국유방암학회지

PURPOSE: To identify the influence of lymphedema on health-related quality of life (HRQOL) more than 1 year after breast cancer surgery. METHODS: Ninety-six breast cancer patients who survived more than 1 year after surgery and 104 members of the general population were recruited. Patients were divided into 2 groups according to the presence of lymphedema. HRQOL was evaluated with the Short-Form 36-Item Health Survey. RESULTS: There were no statistically significant differences in any scales between groups: groups of breast cancer survivors with and without lymphedema. Compared with the general population, breast cancer survivors had lower quality of life scores in all scales, although the vitality and mental health scales did not differ from chance variation at the 5% level. CONCLUSION: In this study, the presence of lymphedema in breast cancer patients who survived over 1 year after surgery might not affect the quality of life. However quality of life of breast cancer survivors is lower than in general population except for some mental health components.

Intradialytic Exercise Programs for Hemodialysis Patients / 전남의대학술지

Although it is widely accepted that exercise is beneficial in patients with end-stage renal disease as in the general population, it is not easy to incorporate exercise programs into routine clinical practice. This review aimed to investigate the beneficial effects of exercise during hemodialysis and also to introduce various intradialytic exercise programs and their advantages as a first step in combining exercise programs into clinical practice. Aerobic and resistance exercise are beneficial not only in improving physical functioning, including maximal oxygen uptake and muscle strength, but also in improving anthropometrics, nutritional status, hematological indexes, inflammatory cytokines, depression, and health-related quality of life. However, it is not clear whether the beneficial effects of exercise are limited to only relatively healthy dialysis patients. Therefore, the effects of individualized exercise programs for elderly patients or patients with comorbid conditions need to be studied further.

Peroneal Neuropathy after Tibio-Fibular Fracture

OBJECTIVE: To investigate the injury mechanism in patients who had peroneal neuropathy after a tibio-fibular fracture and the correlation between tibio-fibular fracture location and the severity of the peroneal neuropathy by using electrodiagnosis. METHOD: Thirty-four patients with peroneal neuropathy after a tibio-fibular fracture were recruited for this study. Their medical records, radiologic and electrodiagnostic findings were investigated retrospectively. They were divided into 2 groups according to the existence of a fibular head fracture. The group of patients without the fibular head fracture was further classified according to the criteria of Orthopedic Trauma Association (OTA) classification. The differences between the two groups in the severity of the neuropathy and electrodiagnostic findings were evaluated. RESULTS: Nine cases (26.5%) had tibio-fibular fractures with a coexisting fibular-head fracture and 25 cases (73.5%) had tibio-fibular fractures without fractures in the fibular-head area. There was no statistical significance in the correlation between the existence of the fibular head fracture and the severity of the electrodiagnostic findings. Neither was there any statistically significant relationship between the site of the tibio-fibular fracture and the severity of the peroneal neuropathy (p>0.05). CONCLUSION: This study showed there were numerous cases with common peroneal neuropathy after tibiofibular fracture without a coexisting fibular-head fracture, which shows the importance of indirect nerve injury mechanisms as well as that of direct nerve injury as a cause of peroneal neuropathy. In addition, this study showed that there was no statistically significant correlation between the site of tibio-fibular fracture and the severity of peroneal neuropathy.

Intradialytic Exercise Programs for Hemodialysis Patients / 전남의대학술지

Although it is widely accepted that exercise is beneficial in patients with end-stage renal disease as in the general population, it is not easy to incorporate exercise programs into routine clinical practice. This review aimed to investigate the beneficial effects of exercise during hemodialysis and also to introduce various intradialytic exercise programs and their advantages as a first step in combining exercise programs into clinical practice. Aerobic and resistance exercise are beneficial not only in improving physical functioning, including maximal oxygen uptake and muscle strength, but also in improving anthropometrics, nutritional status, hematological indexes, inflammatory cytokines, depression, and health-related quality of life. However, it is not clear whether the beneficial effects of exercise are limited to only relatively healthy dialysis patients. Therefore, the effects of individualized exercise programs for elderly patients or patients with comorbid conditions need to be studied further.

Recommendations for Establishing Cardiac Rehabilitation Programs; Facility, Equipment and Staff: The Korean Society of Cardiac Rehabilitation (KSCR) Position Statement

The Korean Society of Cardiac Rehabilitation (KSCR) have recommended standards for establishing cardiac rehabilitation programs in terms of facility, equipment and staff. This is the first time a statement concerning these types of standards has been issued in Korea, and presents the minimal requirements for establishing cardiac rehabilitation programs. Cardiac rehabilitation facilities should contain individual spaces for patient examination, exercise stress testing, monitoring exercise training, patient education, patient preparation, storing medical records, showers and lockers, toilets, and walking tracks. Essential equipment must include at least four sets of aerobic exercise equipment such as treadmills, bicycles, arm ergometers, step machines, and floor mats, and medical equipment such as exercise stress test for ECG with gas analysis, telemetry ECG monitoring systems, sphygmomanometers, stethoscopes, pulse oximeters, glucometers, portable oxygenators, and emergency carts with defibrillators. Hospital staff should include a medical director (a physician with a subspecialty in cardiac rehabilitation), exercise physiologist, nurse specializing in cardiac rehabilitation, exercise specialist, physical therapist, and clinical nutritionist. All should have an expertise in exercise science and be trained in basic life support or advanced cardiac life support. This statement is a recommendation by KSCR and cardiac rehabilitation council of regional cardiocerebrovascular center, and set forth the standards for facilities, equipment, and staff to set up or upgrade cardiac rehabilitation programs in Korea. These recommendations should be developed as a national standard for the establishment of cardiac rehabilitation programs, and adjusted for the current situation of the Korean medical industry through nationwide and long-term research.

Correlation between Duration of Dysphagia and Magnetic Resonance Image Findings in Patients with Stroke

OBJECTIVE: To evaluate the correlation between duration of dysphagia and magnetic resonance image (MRI) findings in patients with stroke. METHOD: Ninety seven patients, who were evaluated by video fluoroscopic swallowing studies (VFSS), were recruited for 28 months. They were divided into two groups (transient group (n=52), prolonged group (n=45)) by removing time of NG tube from onset of stroke. Their MRI findings (lesion location and lesion size) were interpreted by one experienced radiologist retrospectively. RESULTS: The duration of dysphagia had statistically significant correlation with lesion size but there was no statistically significant correlation between lesion location and duration of dysphagia in patients with stroke. Compared with transient group (51.5+/-53.8 cm3), a larger lesion was found in prolonged group (95.5+/-107.7 cm3). CONCLUSION: Lesion size, not lesion location, can be a more important factor to predict early removal of NG tube in patients with stroke. More careful interventions about dysphagia are needed in patients with larger stroke lesion.

The Effect of Environmental Factors to the Mobility Disability in Independent Subjects with Stroke

OBJECTIVE: To investigate the effect of environmental factors on the ability of mobility in subjects with chronic stroke who can perform nearly independent activities of daily living (ADL). METHOD: Sixty one patients were divided into three groups (superior, middle, and inferior) by the degree of independent walking. Modified self-administered questionnaire was completed to report how well the patients encountered the environmental elements faced in community mobility. In addition, all patients were assessed to find out the difference of ADL performance, Berg balance scale (BBS), 10 m walking time (10 mWT) and patterns of 'going out' among the three groups. RESULTS: The group 1 (superior group) had shown better performance than group 2 (middle group) and group 3 (inferior group) in performance of ADL, BBS, 10 mWT. Secondly, the group 1 visited more places or destinations per day than the group 2 and 3, and they used more various transportation systems than other groups. Finally, there were significant differences in the distance dimension, the temporal dimension, terrain dimension (except for a 'getting on a elevator' component), and density dimension among the groups. CONCLUSION: Environmental factors as well as functional abilities could affect the mobility of subjects with chronic stroke. This result suggests that any kinds of compensation and the supports of social institutions are needed even in subjects of nearly independent ADL for their improvement of mobility and convenience.

The Effect of Regular Dental Examination on Prevention of Caries in Patients with Cerebral Palsy

OBJECTIVE: To evaluate the tendency of occurrence of dental caries in the primary or permanent dentition of children with cerebral palsy (CP) and attempt to determine an appropriate treatment method. METHOD: We examined 29 children with CP treated in our rehabilitation center (CP group) and 27 normal children from one of the local kindergartens (control group). We checked DMF (decayed, missing and filled teeth) and DMF ratio (DMFR) and asked them if they underwent regular dental examinations or not. RESULTS: The mean age (+/-standard deviation) of the CP and control groups was 4.75 (+/-1.99) and 4.96 (+/-0.71), respectively. The prevalence of dental caries in the CP and control groups was 69% and 44%, respectively; moreover the percentage of patients in the CP group who underwent regular dental examinations was lower, as compared to the control group. Moreover, a significant statistical relationship between dental caries and regular dental examinations was observed only in the CP group. CONCLUSION: As compared to the control group, the prevalence of dental caries in children with CP was higher, and they also underwent regular dental examinations less frequently.

The Correlation between Post-stroke Depression and Lesion Location

OBJECTIVE: To localize lesions which correlate with depression after stroke. METHOD: This study was performed in 98 stroke patients who admitted at two hospitals in Daegu in 2006. Lesions on magnetic resonance imaging were reviewed by same neuroradiologist and depression was diagnosed by same phychiatrist using DSM-III-R and ICD-10 criteria. We tried to find the correlation between the lesion location and depression. RESULTS: Depression was not related to age, sex, dominant hemisphere, underlying disease (HTN, DM, heart disease), and many lesions of interest of brain. Lesions in prefrontal area, limbic lobe, cingulate gyrus, post white matter and frontal lobe correlated significantly with depression. CONCLUSION: We found that there was a strong correlation between post stroke depression and the pathologic lesion which is frontal-subcortical circuit except basal ganglion and thalamus.