Effect of Low Frequency Cerebellar Repetitive Transcranial Magnetic Stimulation on Balance Impairment in Patients With Cerebral Infarction.

OBJECTIVE: To investigate the effect of low frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) on balance impairment in patients with cerebral infarction. METHODS: Thirty-two patients were randomly divided into two groups: rTMS group (n=16) and control (n=16). In the rTMS group, treatment was performed five times per week for 2 weeks (10 sessions), and in the control group, a sham coil was used with the sound and sensation of scalp similar to the rTMS coil. Patients in both groups underwent a conventional rehabilitation program. Berg Balance Scale (BBS) was used as the primary outcome measurement. Timed Up and Go test (TUG), 10-m walk test (10mWT), and Activity-specific Balance Confidence scale (ABC) were used as the secondary outcome measurement. All scales were measured at baseline (T0), after 10 sessions of rTMS (T1), and at 4 weeks after treatment completion (T2) by therapists with over 5 years of clinical experience. RESULTS: There were significant improvements between T0 and T1, and between T0 and T2, for all assessed items in the rTMS group. Whereas there were significant improvements between T0 and T1, and between T0 and T2, for the BBS and 10mWT in the control group. TUG (-4.87±5.05 vs. -0.50±2.97 seconds) and ABC score (8.10±8.33 vs. 0.16±0.97) were observed significant differences in comparison of the changes from T0 to T1 between the two group. BBS score (4.40±3.66 vs. 1.88±3.14), TUG (-4.87±4.56 vs. -0.62±2.96 seconds) and ABC score (8.22±7.70 vs. -0.09±0.86) differed significantly from T0 to T2 between the two groups. CONCLUSION: Our findings suggest that low-frequency cerebellar rTMS is helpful for improving balance in patients with cerebral infarction, and maybe a beneficial treatment for these patients.

Manual function of the unaffected upper extremity can affect functional outcome after stroke.

Traditionally, motor deficits of ipsilesional side, generally considered as the unaffected side, have been investigated less and the influence of the impairment is unknown. To evaluate the association between the manual function test (MFT) of nonparetic limb and poststroke functional outcome. We conducted a retrospective analysis of 71 hemiplegic patients with stroke. MFT on both sides was routinely measured at admission and 1 month later after admission by an experienced occupational therapist. The parameters of functional outcome after stroke were measured with the total score of functional independence measure (FIM) and the self-care subscore of FIM. Age, initial cognitive function, and MFT of the affected hand and unaffected hand were each significant factors for independently predicting short-term functional outcome after stroke. Linear regression analysis showed that initial MFT score of unaffected side is a significant predictor for 1 month follow-up subscore FIM (P<0.0001) and total FIM score (P<0.0001). Our findings suggests that initial MFT score of the nonparetic side has a significant correlation with functional outcome. Therefore, it is important to conduct MFT on the nonparetic side as well as the paretic side. Furthermore, it is necessary to undergo rehabilitation therapy on the nonparetic side.

Sleep disturbances negatively affect balance and gait function in post-stroke patients.

BACKGROUND: Impaired gait function after stroke contributes strongly to overall patient disability. Recently, sleep disturbance was reported to negatively affect functional recovery after stroke. OBJECTIVE: The aim of this study was to identify the impact of sleep disturbance on balance and gait function in stroke patients. METHODS: We retrospectively reviewed 140 patients with first-ever stroke. The patients were divided into two groups according to the presence of sleep disturbances, and differences in characteristics, such as demographic information, lesion factors, initial balance, and gait function. Lesion volume was measured on magnetic resonance images. Linear regression analyses were performed to examine predictors of balance and gait function after a 1-month rehabilitation program. RESULTS: Of the 140 patients, 35 had sleep disturbance (25%). The patients with sleep disturbance were older than those without. Patients who had sleep disturbance had worse balance and gait function. BBS and FAC were also predicted by the initial BBS and sleep disturbance. The 10-m velocity was strongly associated with initial BBS, onset duration, and the presence of sleep disturbance. CONCLUSIONS: Our study showed that sleep disturbances negatively affected functional outcomes, especially balance and gait function. Therefore, sleep problems should be controlled to improve outcomes in stroke patients.

Lesions Responsible for Delayed Oral Transit Time in Post-stroke Dysphagia.

INTRODUCTION: Some stroke patients show oral phase dysphagia, characterized by a markedly prolonged oral transit time that hinders oral feeding. The aim of this study was to clarify the clinical characteristics and lesions responsible for delayed swallowing. METHODS: We reviewed 90 patients with stroke. The oral processing time plus the postfaucial aggregation time required to swallow semisolid food was assessed. The patients were divided into two groups according to oral transit time, and we analyzed the differences in characteristics such as demographic factors, lesion factors, and cognitive function. Logistic regression analyses were performed to examine the predictors of delayed oral transit time. Lesion location and volume were measured on brain magnetic resonance images. We generated statistic maps of lesions related to delayed oral phase in swallowing using voxel-based lesion symptom mapping (VLSM). RESULTS: The group of patients who showed delayed oral transit time had significantly low cognitive function. Also, in a regression model, delayed oral phase was predicted with low K-MMSE (Korean version of the Mini Mental Status Exam). Using VLSM, we found the lesion location to be associated with delayed oral phase after adjusting for K-MMSE score. Although these results did not reach statistical significance, they showed the lesion pattern with predominant distribution in the left frontal lobe. CONCLUSION: Delayed oral phase in post-stroke patients was not negligible clinically. Patients' cognitive impairments affect the oral transit time. When adjusting it, we found a trend that the lesion responsible for delayed oral phase was located in the left frontal lobe, though the association did not reach significance. The delay might be related to praxis function.

Therapeutic effect of acupuncture point injection with placental extract in knee osteoarthritis.

OBJECTIVE: This study evaluated the effectiveness of acupuncture point injection (API) with placental extract on pain reduction and joint function in patients with knee osteoarthritis (OA). METHODS: Fifty-two patients with knee OA, with an average age of 64, and having a symptom duration of more than 3 months were studied in this report. Placental extract was injected weekly into acupuncture point ST35, BL23, BL24 and BL25 for 5 weeks; 8 mL of placental extract into ST35 on the affected side, and 1 mL of placental extract to BL23, BL24 and BL25 bilaterally. RESULTS: After a five-week treatment of API with placental extract, pain was substantially decreased in patients of all Kellgren-Lawrence (KL) grades. Improvement of knee joint swelling was also apparent. Decrease of pain and joint swelling improved daily working productive time among patients of all KL grades. CONCLUSION: Study results imply that API with placental extract is a potentially useful therapy to control pain and maintain joint functions in knee OA patients.

Complex regional pain syndrome type 1 relieved by acupuncture point injections with placental extract.

This is a case report of a female patient who developed complex regional pain syndrome in the left upper limb after a traumatic injury to the distal part of the left forearm. The pain was immediate and resistant to oral analgesics and continued transcutaneous electrical nerve stimulation. Five months after the injury, the patient presented to our clinic with severe pain, swelling, redness, cold sensation of the left hand, and loss of function from the left hand up to the left shoulder. Acupuncture points LI5, LU2, SI10, HT1, GB21, and SI11 (which are localized in the joints or in the muscles responsible for the movement of the left upper limb) were selected for the application of the placental extract. Injection of placental extract into the acupuncture points resulted in dramatic pain relief, swelling remission, motor recovery, temperature normalization, and disappearance of redness in this patient with complex regional pain syndrome type 1.