Ocular motor and vestibular dysfunction in central nervous system lymphoma.

BACKGROUND AND PURPOSE: Diagnosis of lymphoma involving the central nervous system (CNS) is challenging. This study aimed to explore the abnormal vestibular and ocular motor findings in CNS lymphoma. METHODS: A retrospective search of the medical records identified 30 patients with CNS lymphoma presenting ocular motor and vestibular abnormalities from four neurology clinics of university hospitals in South Korea (22 men, age range 14-81 years, mean 60.6 ± 15.2). The demographic and clinical features and the results of laboratory, radiological and pathological evaluation were analyzed. RESULTS: Patients presented with diplopia (13/30, 43%), vestibular symptoms (15/30, 50%) or both (2/30, 7%). In 15 patients with diplopia, abnormal ocular motor findings included ocular motor nerve palsy (n = 10, 67%), internuclear ophthalmoplegia (n = 2, 13%), external ophthalmoplegia (n = 2, 13%) and exophoria (n = 1, 7%). The vestibular abnormalities were isolated in 14 (82%) of 17 patients with vestibular symptoms and included combined unilateral peripheral and central vestibulopathy in three from lesions involving the vestibular nuclei. CNS lymphoma involved the brainstem (53%), cerebellum (33%), leptomeninges (30%), deep gray nuclei (23%) or cranial nerves (17%). Two patients showed the "double-panda" sign by involving the midbrain. CONCLUSIONS: This study expands the clinical and radiological spectra of CNS lymphoma. Neuro-ophthalmological and neuro-otological evaluation may guide the early diagnosis of CNS lymphoma.

Incidence, characteristics, and neuroanatomical substrates of vestibular symptoms in supratentorial stroke.

The incidence and characteristics of acute vestibular symptoms, responsible structures, and lateralization of the causative lesions in supratentorial stroke remain unknown. This study aimed to determine the incidence, clinical features, and anatomical correlation of acute vestibular symptoms in supratentorial stroke. We performed a prospective, multicenter, observational study that had recruited patients with supratentorial stroke from the neurology clinics of referral-based four university hospitals in Korea. All patients received a constructed neuro-otological evaluations, and neuroimaging. We analyzed the incidence of acute vestibular symptoms, abnormal ocular motor and vestibular function tests, and stroke lesions. Of 1301 patients with supratentorial stroke, 48 (3.7%) presented with acute vestibular symptoms, and 13 of them (1%) had the vestibular symptoms in isolation. In patients with acute vestibular symptoms, abnormal findings included spontaneous nystagmus (5%), impaired horizontal smooth pursuit (41%), and abnormal tilt of the subjective visual vertical (SVV) (20%). Video head impulse and caloric tests were normal in all the patients. There was no clear correlation between acute vestibular symptoms and involvement of specific vestibular cortex. In patients with unilateral stroke, there was also no lateralization of the causative lesions of acute vestibular symptoms (left vs. right; 52 vs. 48%), even in patients with vertigo (left vs. right; 58 vs. 42%). This study demonstrates that the incidence of acute vestibular symptoms in supratentorial stroke is 3.7%, with being isolated in 1%. The widespread lesions responsible for acute vestibular symptoms implicate diffuse multisensory cortical-subcortical networks in the cerebral hemispheres without a lateralization.

Erratum: Hyperventilation-Triggered Vertigo and Nystagmus in Vestibular Paroxysmia.

This corrects the article on p. 507 in vol. 16, PMID: 32657077.

Effect of low-level laser intervention on dermatitis symptoms and cytokine changes in DNCB-induced atopy mouse model: A randomized controlled trial.

The incidence of atopic dermatitis (AD) has recently increased due to various factors. Its prevalence is higher among children and teenagers than in other age groups. Numerous methods to treat AD are available, including light ray therapy, which has been proposed as an alternative therapy for the treatment of AD. The present study aimed to evaluate the curative mechanism and optimal energy level of energy irradiation from a low-level laser (LLL) toward AD. AD was induced in BALB/c mice with dinitrochlorobenzene (DNCB) solution. The mice were divided into six groups, including one normal control (n=8), one AD control (n=10) and four AD experimental groups with LLL irradiation at 2 J/cm2 (n=10), 4 J/cm2 (n=10), 6 J/cm2 (n=9) and 8 J/cm2 (n=10). Following AD induction, an LLL was applied to the four AD experimental groups for 2, 4, 6, and 8 min, for two weeks (14 times in total) at a wavelength of 650 nm and an output of 50 mW. The effects of irradiation on AD were evaluated using a scratch test, a clinical skin severity test, immunoglobulin-E (IgE) analysis and measurements of numerous cytokine levels, including interleukin (IL)-4, IL-6, tumor necrosis factor (TNF)-α, and interferon-γ (IFN-γ), tissue thickness and mast cell count. The results demonstrated that serum IgE level in all irradiated groups was significantly decreased compared with that of the AD control group, and IL-4 level was significantly decreased in all irradiated groups apart from the 8 J/cm2 LLL irradiated group. IL-6 and TNF-α levels were also significantly decreased in all irradiated groups. The results from histological analysis revealed diminished epidermal thickness and mast cell counts in irradiated mice compared with those mice in the AD control group. In summary, these findings suggested that LLL irradiation may alleviate symptoms of AD and may be useful for restoring cytokines levels and tissues features to normal levels.

Cardiogenic vertigo: characteristics and proposed diagnostic criteria.

Early identification of cardiogenic vertigo (CV) is necessary to prevent serious complications of cardiovascular diseases. However, the literature is limited to case reports without detailed clinical features or diagnostic criteria. The aim of this study was to define characteristics of CV and propose diagnostic criteria. This study included patients with CV diagnosed at Pusan National University and Keimyung University Hospitals. Demographic, clinical, laboratory, and treatment data were analyzed. Of 72 patients with clinically suspicious CV, 27 were finally included. The age ranged from 63 to 88 years (75.1 ± 7.2 years). Recurrent vertigo occurred without syncopal attacks in 52% [95% CI, 32-71], while it preceded (37% [19-58]) or followed (11% [2-29]) syncope. The patients with recurrent isolated vertigo had suffered from symptoms from 15 days to 5 years until final diagnosis (median 122 days). The vertigo lasted only for a few seconds (93% [76-99]) or a few minutes (7% [1-24]). Fourteen patients presented with spinning vertigo, and one of them showed spontaneous downbeat nystagmus during the attack. Accompanying symptoms including chest discomfort, palpitation, headache, arm twitching, and lightheadedness were found in 70% [50-86]. Between patients with and without syncope, there was no difference in clinical parameters and results of cardiac function tests. The most common cardiac abnormality during the attacks of vertigo was bradyarrhythmia (89% [71-98]). Cardiovascular diseases can develop recurrent isolated vertigo without or preceding syncope. Onset age, duration of vertigo, accompanying symptoms, and underlying cardiac diseases can aid in differentiation from other vestibular disorders. Early identification of CV would reduce morbidity and mortality associated with cardiac syncope.

Prediction of early neurological deterioration in acute minor ischemic stroke by machine learning algorithms.

OBJECTIVES: A significant proportion of patients with acute minor stroke have unfavorable functional outcome due to early neurological deterioration (END). The purpose of this study was to evaluate the applicability of machine learning algorithms to predict END in patients with acute minor stroke. PATIENTS AND METHODS: We collected clinical and neuroimaging information from patients with acute minor stroke with NIHSS score of ≤ 3. Early neurological deterioration was defined as any worsening of NIHSS score within 3 days after admission. Unfavorable functional outcome was defined as a modified Rankin Scale score of ≥ 2. We also compared clinical and neuroimaging information between patients with and without END. Four machine learning algorithms, i.e., Boosted trees, Bootstrap decision forest, Deep neural network, and Logistic Regression, were selected and trained by our dataset to predict early neurological deterioration RESULTS: A total of 739 patients were included in this study. 78 patients (10.6%) experienced END. Among 78 patients with END, 61 (78.2%) had unfavorable functional outcome at 90 days after stroke onset. On multivariate analysis, the initial NIHSS score (P = 0.003), hemorrhagic transformation (P = 0.010), and stenosis (P = 0.014) or occlusion (P = 0.004) of a relevant artery were independently associated with END. Of the four machine learning algorithms, Boosted trees, Deep neural network, and Logistic Regression can be used to predict END in patients with acute minor stroke (Boosted trees: accuracy = 0.966, F1 score = 0.8 and area under the curve = 0.934, Deep neural network :0.966, 0.8, and 0. 904, and Logistic Regression : 0.966, 0.8, and 0.885). CONCLUSIONS: This study suggests that machine learning algorithms that integrate clinical and neuroimaging information can be used to predict END in patients with acute minor stroke. Further studies based on larger, multicenter datasets are needed to predict END accurately for designing treatment strategies and obtaining favorable functional outcome.

Effects of circular gait training on balance, balance confidence in patients with stroke: a pilot study.

[Purpose] This study aimed to investigate the effects of circular gait training on balance and balance confidence in patients with stroke. [Subjects and Methods] Fifteen patients with stroke were randomly divided into either the circular gait training (CGT) group (n=8) or the straight gait training (SGT) group (n=7). Both groups had conventional therapy that adhered to the neurodevelopmental treatment (NDT) approach, for 30 min. In addition, the CGT group performed circular gait training, and the SGT group practiced straight gait training for 30 min. Each intervention was applied for 1 h, 5 days a week, for 2 weeks. Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Activities-specific Balance Confidence (ABC) scale were used to test balance and balance confidence. [Results] After the intervention, both groups showed significant increases in balance and balance confidence. Significant improvements in the balance of the CGT group compared with the SGT group were observed at post-assessment. [Conclusion] This study showed that circular gait training significantly improves balance in patients with stroke.

Comparison of pain, disorder, back performance, and psychological factors in patients with low back pain and radicular pain.

[Purpose] This study investigated the relationship between pain intensity, lumber disability, and psychological factors in patients with low back pain. [Subjects and Methods] A total of 166 outpatients (116 female, 50 male) with chronic low back pain presenting for physical therapy participated in this study. Patients were divided into two groups: those with low back pain alone and those with both low back pain and radicular pain. Pain intensity and lumbar disability were measured using a visual analogue scale and the Roland-Morris Disability Questionnaire. Psychological factors, such as self-efficiency, fear avoidance, and depression were measured using the Chronic Pain Self-efficacy Scale, Fear-Avoidance Beliefs Questionnaire, and Beck Depression Index, respectively. [Results] Patients with low back pain with radicular pain had greater pain and lumber disability and lower psychological factors compared with patients with chronic low back pain alone. [Conclusion] Our findings indicate the presence of low back pain with radicular pain is more related to pain, LBP disability index, Back performance, Self-efficiency (Pain, Function, Symptom), Fear-avoidance (body, work) and depression factors than low back pain. Considering the relationships between in pain, LBP disability index, Back performance, Self-efficiency (Pain, Function, Symptom), Fear-avoidance (body, work) and depression factors in patients with low back pain, therapeutic intervention for not only pain and dysfunction, but also psychological factors is needed.

Effects of progressive backward body weight suppoted treadmill training on gait ability in chronic stroke patients: A randomized controlled trial.

BACKGROUND AND OBJETIVE: A stroke patient with hemiplegic gait is generally described as being slow and asymmetric. Body weight-supported treadmill training and backward gait training are recent additions to therapeutic gait trainings that may help improve gait in stroke patient with hemiplegic gait. Therefore, we examined the effect of progressive backward body weight-supported treadmill training on gait in chronic stroke patients with hemiplegic gait. METHODS: Thirty subjects were divided to the experimental and control groups. The experimental group consisted of 15 patients and underwent progressive backward body weight-supported treadmill training. The control group consisted of 15 patients and underwent general treadmill gait training five times per week, for a total of four weeks. The OptoGait was used to analyze gait kinematics, and the dynamic gait index (DGI) and results of the 6-minute walk test were used as the clinical evaluation indicators. A follow-up test was carried out four weeks later to examine persistence of exercise effects. RESULTS: The experimental group showed statistically significant results in all dependent variables week four compared to the control group. However, until the eighth week, only the dependent variables, of affected step length (ASL), stride length (SL), and DGI differed significantly between the two groups. CONCLUSION: This study verified that progressive bodyweight-supported treadmill training had a positive influence on the temporospatial characteristics of gait and clinical gait evaluation index in chronic stroke patients.

Effects of phase proprioceptive training on balance in patients with chronic stroke.

[Purpose] This study aimed to investigate the effect of phase proprioceptive training on balance in patients with chronic stroke. [Subjects and Methods] Participants included 30 patients with stroke who were randomly assigned to the proprioceptive training group (n=15) or control group (n=15). Participants in the proprioceptive training group underwent proprioceptive training and received general physical therapy each for a total of 20 thirty-minute sessions, five times per week, during a period of four weeks; the control group received general physical therapy for a total of 20 sixty-minute sessions, five times per week, during a period of four weeks. [Results] All participants were evaluated with the Berg Balance Scale, Timed Up and Go (TUG) test, and Activities-specific Balance Confidence (ABC) Scale instrument before and after intervention. After training, the differences in BBS, TUG, and ABC scores in the proprioceptive group were significantly greater than those in the control group. [Conclusion] In conclusion, proprioceptive training was effective on balance ability. Therefore, proprioceptive training may be efficient when combining general physical therapy with phase proprioceptive training for patients with impairments of balance. Further research is needed to investigate proprioceptive training methods.

Perception and use of balance measures for stroke patients among physical therapists in South Korea.

[Purpose] The purpose of this study looked into physical therapists' perception and use of balance measures for stroke patients. [Subjects and Methods] Three hundred eighty two physical therapists who understood the purpose of this study, agreed on their participation in this study, were treating or treated stroke patients. A Cross-sectional study based on self-administered questionnaire that had a total of 41 questions was performed in South Korea. 382 questionnaires were used for analysis. [Results] Regarding the questions about their perception and of personal measures, 287 persons (75.1%) replied that Single Leg Stance test was the most useful. According to the data analysis on their use of balance measures, Single Leg Stance Test was used by 254 persons (66.5%, the highest percentage), Functional Reach Test by 199 (52.1%). Also, stepwise multiple regression analysis was conducted. As a result, the most influential factor was physical therapists' perception of personal measures, and their use was also influenced by their comprehensive perception of measurement and their perception of balance factors. [Conclusion] This study revealed physical therapists' perception and use of balance measures for stroke patients and showed that their perception of balance measures for stroke patients affected their use of personal measures.

A study on the physical fitness of children with juvenile rheumatoid arthritis.

[Purpose] This study was conducted to assess the physical fitness of children with juvenile rheumatoid arthritis (JRA). [Subjects and Methods] In total, 26 children with juvenile rheumatoid arthritis (JRA) and 25 healthy controls participated in this study. Using the physical fitness measurement instruments, the Inbody 720 and Quark b2, the elements of physical fitness that were assessed included muscular strength, muscular endurance, flexibility, lung capacity, and body composition. [Results] The results revealed significant differences in muscular strength, muscular endurance, lung capacity, body composition, functional ability, and health-related quality of life between the children with juvenile rheumatoid arthritis (JRA) and the control group. [Conclusion] These results suggested that children with juvenile rheumatoid arthritis (JRA) have inferior physical fitness when compared to healthy children. The present study was conducted to develop an accurate evaluation standard to assess the physical fitness of children with juvenile rheumatoid arthritis (JRA).

Effects of a standard transfer exercise program on transfer quality and activities of daily living for transfer-dependent spinal cord injury patients.

[Purpose] The objective of this study was to analyze the effect of a standard transfer exercise program on the transfer quality and activities of daily living (ADL) in wheelchair-dependent spinal cord injury patients. [Subjects and Methods] We randomly divided 22 patients into 2 groups. During the intervention period, one group received treatment with both conventional physical therapy and a standard sitting pivot transfer exercise program (experimental group, n=12) and the other group was managed solely with conventional physical therapy (control group, n=10). The standard transfer exercise program comprised of an independent and a dependent program. Exercises were conducted 30 minutes daily, 3 times per week, over a period of 6 weeks. All subjects were tested using a transfer assessment instrument (TAI) and spinal cord independence measure (SCIM) before and after the intervention. [Results] Compared to the control group, the intervention group scored higher on both the transfer assessment instrument (TAI Part 1, Part 2, TAI total score) and spinal cord independence measure tests (SCIM mobility room and toilet score; SCIM total score). [Conclusion] In conclusion, the standard transfer exercise program is an effective tool which improves transfer quality and the ability of wheelchair-dependent spinal cord injury patients to carry out their ADLs.

Comparison of the effects on dynamic balance and aerobic capacity between objective and subjective methods of high-intensity robot-assisted gait training in chronic stroke patients: a randomized controlled trial.

BACKGROUND: Robot-assisted gait training (RAGT) is effective for improving dynamic balance and aerobic capacity, but previous RAGT method does not set suitable training intensity. Recently, high-intensity treadmill gait training at 70% of heart rate reserve (HRR) was used for improving aerobic capacity and dynamic balance. PURPOSE: This study was designed to compare the effectiveness between objective and subjective methods of high-intensity RAGT for improving dynamic balance and aerobic capacity in chronic stroke. METHODS: Subjects were randomly allocated into experimental (n = 17) and control (n = 17) groups. The experimental group underwent high-intensity RAGT at 70% of HRR, whereas the control group underwent high-intensity RAGT at an RPE of 15. Both groups received their assigned training for 30 min per session, 3 days per week for 6 weeks. All subjects also received an additional 30 min of conventional physical therapy. Before and after each of the 18 sessions, the dynamic balance and aerobic capacity of all subjects were evaluated by a blinded examiner. RESULTS: After training, Berg Balance Scale (BBS) and Timed Up and Go Test scores, VO2max, and VO2max/kg were significantly increased in both groups (p < 0.05). These variables in experimental group were significantly greater than control group. However, the BBS score was not significantly different between both groups. All subjects completed high-intensity RAGT. No adverse effect of training was observed in both groups. CONCLUSION: High-intensity RAGT at 70% of HRR significantly improved dynamic balance and aerobic capacity more than RAGT at RPE of 15. These results suggest that high-intensity RAGT at 70% of HRR is safe and effective for improving dynamic balance and aerobic capacity in chronic stroke.

Effects of elastic-band resistance exercise on balance, mobility and gait function, flexibility and fall efficacy in elderly people.

[Purpose] The purpose of this study was to analyze the effects of elastic-band resistance exercise on balance, gait function, flexibility and fall efficacy in the elderly people of rural community. [Subjects and Methods] It is selected by 45 outpatients. They have come into the clinic continually to treat of physical therapy at least 1-2 times for a week. A group treated with both general physical therapy and elastic-band resistance exercise (23 patients), and the other group treated with only general physical therapy (22 patients). Elastic-band resistance exercise is composed of 8 movements of lower extremity joints. It is performed for 30 minutes during 8 weeks by 3 times for a week. It is measured and recorded at the pre and post test that sit and reach test (SRT), functional reach test (FRT), timed up and go test (TUG) for every subjects by measurement equipments. And, subjects performed for the form of performance and question as its rated scale by Berg's balance scale (BBS), dynamic gait index (DGI), activities-specific balance confidence scale (ABC). [Results] In the study, both the elastic-band exercise group and the general physical therapy group showed a significant improvement in balance, gait function, flexibility and fall efficacy. And the group with elastic-band resistance exercise showed more effectiveness than the contrast group in value of variation. [Conclusion] From this study, it was confirmed that elastic-band resistance exercise has influence on balance, gait function, flexibility and fall efficacy are working for agriculture of elderly people of rural community. Based on this result, elastic-band resistance exercise can be better instrument and easier to elderly people of rural community for the improvement in balance, gait function, flexibility and fall efficacy as it performing along with and reciprocal physical therapy.

Effect of the Schroth method of emphasis of active holding on Cobb's angle in patients with scoliosis: a case report.

[Purpose] The purpose of this study was to examine the effect of the Schroth method (three-dimensional convergence exercise) of emphasis of active holding on pain and Cobb's angle in patients with scoliosis. [Subjects and Methods] It applied the Schroth method program of emphasis of active holding individually to three subjects three time per week for 15 weeks. All subject were measured Cobb's angle and pain. [Results] After 15 weeks, pain and Cobb's angle decreased compared to values before. [Conclusion] These results demonstrate the benefit of the Schroth exercise program of emphasis of active holding on decreasing pain and Cobb's angle in patients with idiopathic scoliosis.

Effects of ankle biofeedback training on strength, balance, and gait in patients with stroke.

[Purpose] This study aimed to investigate the effects of ankle biofeedback training on muscle strength of the ankle joint, balance, and gait in stroke patients. [Subjects and Methods] Twenty-seven subjects who had had a stroke were randomly allocated to either the ankle biofeedback training group (n=14) or control group (n=13). Conventional therapy, which adhered to the neurodevelopmental treatment approach, was administered to both groups for 30 minutes. Furthermore, ankle strengthening exercises were performed by the control group and ankle biofeedback training by the experimental group, each for 30 minutes, 5 days a week for 8 weeks. To test muscle strength, balance, and gait, the Biodex isokinetic dynamometer, functional reach test, and 10 m walk test, respectively, were used. [Results] After the intervention, both groups showed a significant increase in muscle strength on the affected side and improved balance and gait. Significantly greater improvements were observed in the balance and gait of the ankle biofeedback training group compared with the control group, but not in the strength of the dorsiflexor and plantar flexor muscles of the affected side. [Conclusion] This study showed that ankle biofeedback training significantly improves muscle strength of the ankle joint, balance, and gait in patients with stroke.

The effects of Pilates exercise training on static and dynamic balance in chronic stroke patients: a randomized controlled trial.

[Purpose] The purpose of this study was to analyze the effects of Pilates exercise on static and dynamic balance in chronic stroke patients. [Subjects and Methods] Nineteen individuals with unilateral chronic hemiparetic stroke (age, 64.7 ± 6.9 years; height, 161.7 ± 7.9 cm; weight, 67.0 ± 11.1 kg) were randomly allocated to either a Pilates exercise group (PG, n=10) or a control group (CG, n=9). The PG attended 24 exercise sessions conducted over an 8-week period (3 sessions/week). Center of pressure (COP) sway and COP velocity were measured one week before and after the exercise program and compared to assess training effects. [Results] Pilates exercise positively affected both static and dynamic balance in patients with chronic stroke. For static balance, COP sway and velocity in the medial-lateral (M-L) and anterior-posterior (A-P) directions were significantly decreased in the PG after training while no significant differences were found in the CG. For dynamic balance, measured during treadmill walking, the PG showed significantly reduced COP sway and velocity in the M-L and A-P directions for both the paretic and non-paretic leg. [Conclusions] The findings provide initial evidence that Pilates exercise can enhance static and dynamic balance in patients with chronic stroke.