Telehealth Interventions to Support Self-Management in Stroke Survivors: A Systematic Review.

Telehealth (TH) intervention is a method to optimize self-management (SM) support in stroke survivors. Objectives of this study included identifying the TH-SM intervention's focus and SM support components, the TH delivery type, and the TH-SM support effects on stroke survivors. Five databases were searched for the years 2005-2020 to identify TH-SM support interventions for stroke survivors. Randomized controlled trials and quasi-experimental, one-group re-post study designs were included. Ten studies were reviewed. TH-SM support focused on post-stroke depression, obesity management, participation, functional mobility, and activities of daily living. The TH delivery type most used in selected studies was messaging. Regarding the SM support components, the education component was used in all studies, and psychological support and lifestyle advice and support were used in 8 out of 10 studies. TH-SM intervention had positive effects in terms of goal achievement for SM behavior, emotional state, and mobility of clinical outcomes, and TH acceptance in stroke survivors. Although the TH-SM-supported intervention effects were not found consistently in all outcomes, this review discovered a positive effect on various SM-related outcomes. In addition, TH delivery types and SM support components showed the possibility of various options to be considered for intervention. Therefore, we suggest that TH-SM supported intervention is a positive alternative for SM support in stroke survivors.

Immediate effect of a wearable foot drop stimulator to prevent foot drop on the gait ability of patients with hemiplegia after stroke.

The purpose of this study was to compare the effects of a foot drop stimulator (FDS) and ankle-foot orthosis (AFO) on the gait ability of patients with hemiplegia after stroke. This study recruited 10 patients with hemiplegia after stroke. All patients performed gait under two conditions (AFO and FDS gait). Gait parameters were measured with the GAITRite® system to analyze the spatial and temporal parameters of the patients' gaits. No significant differences in cadence, velocity, swing time, stance time, or step length of the affected or less-affected limbs were found between the two conditions (all, p > .05). These findings demonstrate that AFO and FDS have a similar effect on the gait ability of patients with hemiplegia after stroke.

Effect of Neuromuscular Electrical Stimulation on Masseter Muscle Thickness and Maximal Bite Force Among Healthy Community-Dwelling Persons Aged 65 Years and Older: A Randomized, Double Blind, Placebo-Controlled Study.

AIM: This study investigated the effect of neuromuscular electrical stimulation (NMES) on masseter muscle thickness and maximal bite force among healthy community-dwelling elderly persons older than 65 years. MATERIALS AND METHODS: A total of 40 participants were randomly assigned to the experimental and placebo groups. In the experimental group, NMES was applied to both masseter muscles, and electrical signals were gradually increased until the participants felt a grabbing sensation (range 6.0-7.5 mA) in the masseter muscle. The placebo group, in contrast, underwent NMES in the same manner and procedure as the experimental group with less electrical intensity (0.5 mA). All interventions were administered five times a week for six weeks, 20 min per day. The outcomes were masseter muscle thickness assessed using ultrasound and maximal bite force using a bite force meter. The level of significance was set as p < 0.05. RESULTS: The experimental group showed a significant increase in both masseter muscle thickness and maximal bite force as compared with the placebo group (p = 0.002 and 0.019, respectively). Moreover, the degree of change in the masseter muscle thickness and maximal bite force significantly increased in the experimental and placebo groups (p < 0.001, both). CONCLUSIONS: This study demonstrated that NMES could be an effective modality for increasing masseter muscle thickness and maximal bite force in healthy older adults.

Effects of resistive jaw opening exercise in stroke patients with dysphagia: A double- blind, randomized controlled study.

BACKGROUND: The resistive jaw opening exercise (RJOE) was suggested as a potential remedial treatment for patients with dysphagia. However, clinical evidence is insufficient. OBJECTIVE: To investigate the effect of RJOE on hyoid bone movement, aspiration, and oral intake level in stroke patients with dysphagia. METHODS: Forty stroke patients with dysphagia were randomly allocated into either the experimental group (n= 20) or placebo group (n= 20). The experimental group performed RJOE using a portable device, while the placebo group performed RJOE using a sham device with fewer loads. Intervention was conducted 5 times a week for 4 weeks. Hyoid bone movement was analyzed by two-dimensional analysis of anterior and superior motion based on a videofluoroscopic swallowing study. Aspiration was assessed using a penetration-aspiration scale (PAS), and oral intake level was assessed using the functional oral intake scale (FOIS). RESULTS: Both groups showed statistically significant differences in hyoid movement, PAS, and FOIS scale (p< 0.05). However, after the intervention, there was no significant difference between the two groups except for the liquid type of PAS. Effect sizes (Cohen's d) were 0.9 and 0.7, 0.6 and 0.6, and 1.1 for the anterior and superior movement of the hyoid bone, semisolid and liquid type of PAS, and FOIS scale respectively. CONCLUSIONS: This study suggests that RJOE helps in hyoid movement, aspiration reduction, and oral intake in patients with dysphagia after stroke.

The effect of neuromuscular electrical stimulation with different electrode positions on swallowing in stroke patients with oropharyngeal dysphagia: A randomized trial.

OBJECTIVE: To examine the effects of neuromuscular electrical stimulation (NMES) on oropharyngeal swallowing function according to 2 types of placement, acting as assistance and as resistance, in stroke patients with dysphagia. METHODS: Thirty-eight stroke patients with dysphasia were randomly assigned to the suprahyoid group (SMG), or infrahyoid muscle group (IMG); 26 patients completed the intervention and were included in the analysis. In the SMG, the electrodes were placed on the region between the jaw and the hyoid bone, whereas in the IMG, the electrodes were placed on the region below the hyoid for the targeted infrahyoid muscles. Both groups received NMES for 30 min/d, 5 d/wk, for 4 weeks and conventional dysphagia therapy. Swallowing function was measured using the Videofluoroscopic Dysphagia Scale and Penetration-Aspiration Scale based on videofluoroscopic swallowing study. Oral dietary intake was measured using the Functional Oral Intake Scale. RESULTS: Both groups showed significant improvements in oropharyngeal function and level of functional oral intake, but there was no significant difference between the two groups. However, the SMG showed a more reduced penetration-aspiration, compared with the IMG. CONCLUSIONS: Altogether, these data demonstrate that 2 types of NMES placements have a similar effect on improving swallowing function and oral diet intake in patients with dysphagia.

Effects of lingual strength training on oropharyngeal muscles in South Korean adults.

BACKGROUND: Lingual strength training (LST) has been reported to positively affect the activation of submental muscles, as well as to increase lingual muscle strength. However, there is little evidence to support its effectiveness. OBJECTIVES: This study aimed to investigate the effect of LST on the strength and thickness of oropharyngeal muscles in healthy adults. METHODS: The study included 30 subjects who were assigned to the experimental (n = 15) and the control groups (n = 15). The experimental group performed LST based on tongue-to-palate resistance exercise method. LST was categorised as isometric and isotonic exercise. The intervention was performed five times a week for 6 weeks. The control group did not receive any intervention. The lingual strength was measured using the Iowa Oral Performance Instrument. Changes in the thickness of the mylohyoid and the digastric muscles and the lingual were assessed ultrasonographically. RESULTS: After the intervention, the thickness of the mylohyoid and the digastric muscles in the experimental group was significantly greater than that in the control group (P = 0.037 and 0.042). CONCLUSION: This study demonstrated that LST increases the thickness and the strength of oropharyngeal muscles. Therefore, LST is a useful option in patients with dysphagia or in elderly patients prone to swallowing dysfunction.

Effects of modified constraint-induced movement therapy on upper extremity function and occupational performance of stroke patients.

[Purpose] The purpose of this research was to examine the effectiveness of modified constraint-induced movement therapy (mCIMT) on the upper extremity function and occupational performance of stroke patients. [Participants and Methods] An experimental study was carried out on two groups of 7 participants selected by a specific criterion. The experimental group received the mCIMT as well as the conventional rehabilitation therapy (CRT) for 5 days per week over a 2 week period. The control group received only the CRT. Outcome measures included the Manual Function Test (MFT), Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM). [Results] Average amount of changes in the MAL and COPM is different in statistical analysis between the mCIMT and the CRT groups before and after the intervention. The mCIMT group showed significant improvements on MFT, MAL, and COPM before and after the intervention. [Conclusion] We suggest that the mCIMT improves the upper extremity function and occupational performance of stroke patients better than the CRT alone.

Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: A randomized pilot study.

BACKGROUND: Recently, chin tuck against resistance exercise (CTAR) has been reported as a remedial treatment for pharyngeal dysphagia. However, the clinical evidence of the effect is still lacking. OBJECTIVE: This study investigated the effect of CTAR on the swallowing function in patients with dysphagia following subacute stroke. METHODS: The patients were randomly assigned to an experimental (n = 11) or a control group (n = 11). The experimental group performed CTAR using the CTAR device. The control group received only conventional dysphagia treatment. Both groups received training on five days a week, for four weeks. The swallowing function was measured using functional dysphagia scale (FDS) and penetration-aspiration scale (PAS), based on a videofluoroscopic swallowing study (VFSS). RESULTS: The experimental group showed more improvements in the oral cavity, laryngeal elevation/epiglottic closure, residue in valleculae, and residue in pyriform sinuses of FDS and PAS compared to the control group (p < 0.05, all). CONCLUSIONS: This study demonstrated that CTAR is effective in improving the pharyngeal swallowing function in patients with dysphagia after stroke. Therefore, we recommend CTAR as a new remedial training alternative to HLE.

Effects of resistance expiratory muscle strength training in elderly patients with dysphagic stroke.

BACKGROUND: Recently, resistance expiratory muscle strength training (EMST) has been reported as a remedial treatment for dysphagia. OBJECTIVE: To investigate the effect of resistance EMST on the swallowing function in stroke patients with oropharyngeal dysphagia. METHODS: Forty-two stroke patients with dysphagia were randomly assigned to two groups: an experimental group (n = 13) and a placebo group (n = 13). The experimental group performed EMST using a portable EMST device, while the placebo group performed EMST using a sham EMST device with no loading. The intervention was performed 5 days per week for 4weeks, in five sets of 5 breaths through the device for a total of 25 breaths per day. Both groups underwent conventional dysphagia treatment for 30 minutes/day, 5 days/week, for 4 weeks. Videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study (VFSS) were assessed to analyze the oropharyngeal swallowing function. RESULTS: The experimental group showed more improvement in pharyngeal phase of the VDS (p = 0.018 and 0.006, respectively) and PAS compared to the placebo group (p = 0.014). CONCLUSIONS: We suggest that EMST could improve the effects of dysphagia observed in post-stroke elderly patients based on swallowing function.

Effects of mental practice combined with electromyogram-triggered electrical stimulation for upper extremity function in stroke patients.

[Purpose] To investigate the effect of mental practice combined with electromyogram-triggered electrical stimulation (MP-EMG ES) on the upper extremity of stroke patients. [Subjects and Methods] Participants were randomly assigned to experimental group or control group. The experimental group received MP-EMG ES plus conventional rehabilitation therapy for 5 days per week for 4 weeks. The control group received only conventional rehabilitation therapy. Outcome measure included the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL). [Results] Experimental group showed more improved in the FMA, MAL-AOU, MAL-QOM compared with the control group. [Conclusion] These results suggest that MP-EMG ES improves the upper extremity of subacute stroke patients better than conventional rehabilitation therapy alone.

The expression and correlation of Hsp 70 and Hsp 27 in serous middle ear effusion fluids of pediatric patients-a preliminary study.

OBJECTIVES: Several cytokines and innate immune-associated molecules are present in middle ear effusions, but damage-associated molecular patterns (DAMPs) in middle ear effusion have not been studied. Therefore, we evaluated the role of heat shock proteins (Hsps) in the development of otitis media with effusion (OME). METHODS: Serous middle ear effusions from 22 pediatric patients who were diagnosed with OME and underwent ventilation tube insertion from June 2015 to March 2017 were evaluated in our study. The levels of Hsp 90, 70, 27, IL-8, and TNF-α in effusion fluids were evaluated by enzyme-linked immunosorbent assays. The associations between the levels of these molecules and the degree of tympanic membrane inflammation were statistically evaluated. Finally, the relationships among these molecules were also evaluated. RESULTS: Hsp 70 and Hsp 27 were detected in all middle ear effusions, but Hsp 90 was detected in only five effusion fluid samples. IL-8 was also detected in all middle ear effusions, but TNF-α was detected in only four effusion fluid samples. When we compared the degree of tympanic membrane inflammation with the levels of Hsp 70, Hsp 27, and IL-8, which were detected in all effusion fluids, we could not find statistical significance. However, Hsp 70, Hsp 27, and IL-8 were significantly associated with each other (p < 0.05). CONCLUSIONS: Hsp 70 and Hsp 27 were expressed in middle ear effusions. Furthermore, the levels of Hsp 70 and Hsp 27 were positively correlated with each other, and were also positively associated with the neutrophil chemoattractant, IL-8. Our findings suggested that Hsp 70 and Hsp 27 might be involved in the pathophysiology of pediatric OME.

Effects of observation of hand movements reflected in a mirror on cortical activation in patients with stroke.

[Purpose] The purpose of this study was to examine what changes occur in brain waves when patients with stroke receive mirror therapy intervention. [Subjects and Methods] The subjects of this study were 14 patients with stroke (6 females and 8 males). The subjects were assessed by measuring the alpha and beta waves of the EEG (QEEG-32 system CANS 3000). The mirror therapy intervention was delivered over the course of four weeks (a total of 20 sessions). [Results] Relative alpha power showed statistically significant differences in the F3, F4, O1, and O2 channels in the situation comparison and higher for hand observation than for mirror observation. Relative beta power showed statistically significant differences in the F3, F4, C3, and C4 channels. [Conclusion] This study analyzed activity of the brain in each area when patients with stroke observed movements reflected in a mirror, and future research on diverse tasks and stimuli to heighten activity of the brain should be carried out.

Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial.

OBJECTIVE: This study aimed to investigate the effect of expiratory muscle strength training (EMST) on swallowing-related muscle strength in community-dwelling elderly individuals. BACKGROUND: Expiratory muscle strength training is an intervention for patients with oropharyngeal dysphagia. This training is associated with respiration, coughing, speech and swallowing, and its effectiveness has been proven in previous studies. However, the effects of EMST on elderly individuals and evidence are still lacking. MATERIALS AND METHODS: This study included 24 community-dwelling senior citizens aged ≥65 years (12 men and 12 women). The experimental group trained at the 70% threshold value of the maximum expiratory pressure using an EMST device 5 days per week for 4 weeks and comprised five sets of five breaths through the device for 25 breaths per day. The placebo group trained with a resistance-free sham device. Post-intervention, muscle strength of the bilateral buccinator and the orbicularis oris muscles (OOM) was measured using the Iowa Oral Performance Instrument. Surface electromyography was used to measure activation of the suprahyoid muscles (SM). RESULTS: After intervention, the strength of the buccinator and the OOM in the experimental group showed statistically significant improvement. There was also statistically significant activation of the SM. In the placebo group, the strength of the orbicularis oris muscle alone improved. No statistically significant differences between groups were found for the strength of the buccinator and the OOM and the activation of the SM. CONCLUSION: EMST had a positive effect on swallowing-related muscle strength in elderly participants.

Facial nerve stimulation in the narrow bony cochlear nerve canal after cochlear implantation.

OBJECTIVES/HYPOTHESIS: To evaluate the correlation between a narrow bony cochlear nerve canal (BCNC) and facial nerve stimulation (FNS) after cochlear implantation (CI) and their underlying mechanisms and to predict the risk of FNS preoperatively. STUDY DESIGN: Retrospective cohort study. METHODS: A total of 64 pediatric cases that underwent CI were included. Among them, 32 cases experienced FNS after CI, and another 32 cases were selected from 817 pediatric implantees by stratified random sampling. The width of the BCNC, the status of the cochlear nerve (CN) and the internal auditory canal (IAC), T level, and C level were compared and analyzed. Strategies for eliminating FNS were also analyzed. RESULTS: The FNS group showed a narrower BCNC (1.09 ± 0.52 mm) than the control group (1.99 ± 0.61 mm; P < .01), a lower CN/facial nerve ratio (0.32 ± 0.36) than the control group (1.34 ± 0.76; P < .01), and narrower IAC diameter (4.06 ± 1.71 mm) than the control group (5.66 ± 1.36 mm; P < .01). The FNS group also showed higher T level (165.7 ± 28.3 µA) than the control group (142.2 ± 21.2 µA; P < .01). Adjustment of the C levels and/or pulse width and switching off offending electrodes were attempted to eliminate FNS, with a 75.0% success rate. The FNS group still showed low Categories of Auditory Performance scores (3.00 ± 1.90) compared with the control group (5.94 ± 1.41, P < .01) after adjustment. CONCLUSIONS: A narrow BCNC could be a cause of FNS after CI. Therefore, careful selection of the side for CI and programming strategies are required to reduce FNS. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1433-1439, 2016.

Comparison of Muscle Activation while Performing Tasks Similar to Activities of Daily Livings with and without a Cock-up Splint.

[Purpose] This study investigated changes in the activation of the main elbow muscle while performing tasks similar to activities of daily living (ADL) with and without a cock-up splint. [Methods] Sixteen participants performed a simulated feeding task and picked up light and heavy cans in the Jebsen-Taylor hand function test. The activation of the biceps brachii, the triceps brachii, and the brachioradialis with and without the cock-up splint was measured using a BTS FreeEMG 300 wireless electromyography system (BTS, Inc., Milan, Italy). [Results] The activation of the biceps brachii and the brachioradialis was significantly higher while performing the simulated feeding task with the cock-up splint than without the splint. While picking up the light and heavy cans, the activation of the brachioradialis was significantly decreased by wearing the cock-up splint. In the heavy cans task, the activation of the triceps brachii was significantly higher with the cock-up splint than without the splint. [Conclusion] This study showed that diverse muscles' activation was increased or decreased when wearing the cock-up splint while performing tasks similar to ADL. The results of this study can be used as an educational resource for therapists teaching patients about splint application and splint compliance in ADL.

Prognosis of Ramsay Hunt syndrome presenting as cranial polyneuropathy.

OBJECTIVES/HYPOTHESIS: Ramsay Hunt syndrome is known to be accompanied with cranial polyneuropathy very occasionally. We reviewed our experience to analyze the clinical manifestations and prognosis of these cases. STUDY DESIGN: Retrospective review. METHODS: Eleven patients with Ramsay Hunt syndrome presenting as cranial polyneuropathy between 1999 and 2009 were included in this study retrospectively. All patients were treated with systemic steroids and antiviral agents. Assessment of recovery from facial nerve palsy (FNP) using the House-Brackmann (HB) grading system was performed, and the follow-up period was 4 to 28 months. RESULTS: The patient numbers for the initial degree of FNP were five for HB grade II, one for grade III, two for grade IV, and three for grade V. The cochleovestibular nerve was involved in 10 cases, and hearing loss was observed in nine patients. Other involved cranial nerves were IX in seven cases, X in five cases, V in three cases, and III/XII in one case each. Antiviral agents and steroids were administered within 3 days after the onset of symptoms for about 1 to 2 weeks in most cases. After the treatment the degree of FNP improved to HB grade I or II in nine of 11 patients (81.8%). Symptoms of other cranial nerves also improved in most patients, whereas recovery for hearing loss showed poor results. CONCLUSIONS: Ramsay Hunt syndrome associated with cranial polyneuropathy has a good prognosis for FNP and other cranial nerve palsies with a combination therapy of antiviral agents and steroids, but not for recovery of hearing loss.

Assessment of allergic rhinitis websites in Korea.

OBJECTIVES: The internet has become an important source of medical information and a great amount of information related to allergic rhinitis (AR) is available on the internet. However, the quality of this information is still a matter of debate. Therefore, this study was conducted to assess the AR-related information on Korean websites. METHODS: The key word "allergic rhinitis" was entered into 4 popular search engines, and this led to identifying 40 websites. After being categorized according to authorship, the informational value of these websites was evaluated using 4 different assessment tools such as the Journal of the American Medical Association (JAMA) benchmarks, the DISCERN questionnaire, the Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update and the Health On the Net (HON) code. RESULTS: The 40 websites containing AR-related information were categorized according to their authorship as Western physician: 20, Oriental physician: 14, commercial: 1, and others: 5. The mean citation frequencies of the JAMA benchmarks and the ARIA 2008 Update concepts was 1.23 out of 4 and 4.33 out of 8, respectively, while the mean DISCERN score was 1.92 out of 5. When the websites were evaluated based on the type of authorship, the mean citation frequencies of the ARIA 2008 Update concepts were Western physician: 5.35, Oriental physician: 2.64. Additionally, three websites authored by Western physicians and 13 authored by Oriental physicians contained unreliable information. Among these 16 websites, only 3 websites met the requirements for the HON code "Justification". CONCLUSION: AR-related information available on Korean websites is of variable quality and not all of the information provided is justifiable. Thus, performing surveillance of the medical information on these websites is necessary. Furthermore, common criteria that can be used to evaluate the websites created by both Western and Oriental physicians are also needed.