Annals of Rehabilitation Medicine-ARM最新文献

Objective: To investigate the clinical and swallowing characteristics related to respiratory infection in patients with parkinsonism.

Methods: One hundred and forty-two patients with parkinsonism who underwent videofluoroscopic swallowing studies (VFSS) were enrolled in this study. The initial clinical and VFSS characteristics were compared between patients with and without a history of respiratory infection in the past year. A multivariate logistic regression model was applied to identify clinical and swallowing characteristics related to respiratory infections.

Results: Patients with respiratory infections were older (74.75±10.20 years vs. 70.70±8.83 years, p=0.037), had a higher Hoehn and Yahr (H&Y) stage (stage IV-V, 67.9% vs. 49.1%; p=0.047), and were more likely to have a diagnosis of idiopathic Parkinson's disease (IPD) (67.9% vs. 41.2%, p=0.011) than those without respiratory infections. Among VFSS findings, bolus formation, premature bolus loss, oral transit time, pyriform sinus residues, pharyngeal wall coatings, and penetration/aspiration were significantly worse in patients with respiratory infections (p<0.05). Regarding clinical characteristics, higher H&Y stage (odds ratio [OR], 3.174; 95% confidence interval [CI], 1.226-8.216; p=0.017) and diagnosis of IPD (OR, 0.280, 95% CI, 0.111-0.706; p=0.007) were significantly related to respiratory infections in the multivariate analysis. Among VFSS findings, pyriform sinus residue (OR, 14.615; 95% CI, 2.257-94.623; p=0.005) and premature bolus loss (OR, 5.151; 95% CI, 1.047-25.338; p=0.044) were also significantly associated with respiratory infection.

Conclusion: This study suggests that disease severity, diagnosis, pyriform sinus residue, and premature bolus loss observed in VFSS are associated with respiratory infection in patients with parkinsonism.

Objective: To assess the relationships between phase angle and muscle mass, strength, and physical function in patients with heart failure.

Methods: This study used a cross-sectional design. The analysis included 51 patients with heart failure. The Short Physical Performance Battery, one-leg standing time, handgrip strength, phase angle, and skeletal muscle index were measured. To identify explanatory variables of phase angle, hierarchical multiple regression analysis was performed.

Results: Handgrip strength was found to be an explanatory variable of phase angle independent of age, sex, and body mass index. This model was able to explain 30.4% of the model variance for phase angle.

Conclusion: In patients with heart failure, improving muscle strength rather than muscle mass or physical function might be more important for improving phase angle. Handgrip strength is an important outcome for improving prognosis in patients with heart failure.

Objective: To investigate the relationship between Trunk Impairment Scale (TIS) and lumbar spine bone mineral density (BMD) in subacute stroke patients.

Methods: Twenty-three subacute male stroke patients under the age of 65 were prospectively enrolled to exclude both postmenopausal and senile effects on BMD. The TIS, Berg Balance Scale, the Korean version of the Modified Barthel Index, and manual muscle test were measured at admission and 3 months after stroke onset. BMD of the bilateral lower extremities and lumbar vertebrae was measured by dual-energy X-ray absorptiometry 3 months after stroke onset.

Results: TIS at baseline (TIS_B) and TIS at 3 months after stroke (TIS_3m) showed significant correlations with lumbar BMD (TIS_B, r=0.522; TIS_3m, r=0.517). Through multiple regression analysis, the TIS_B was associated with lumbar BMD (adjusted R2=0.474). However, BMD of the bilateral lower extremities was not correlated with any clinical measurements except body mass index.

Conclusion: We found a relationship between TIS_B and lumbar BMD in subacute young male stroke patients. Stroke patients with poor trunk control in the early subacute stage would have low BMD of vertebral bones at 3 months. The TIS can be useful for estimating bone fragility in the lumbar vertebrae of subacute stroke patients.

Objective: To define the effect of the inspiratory method and cough timing on peak cough flow (PCF).

Methods: We investigated the effect of measurement conditions on PCF in healthy subjects (n=10). We then compared obstructive and restrictive pulmonary diseases (n=20) to assess for similar results in respiratory diseases. The PCF was measured under four conditions: before coughing, without maneuver 1 or with maneuver 2 a temporary respiratory pause (4-6 seconds) after rapid inspiration, and without maneuver 3 or with maneuver 4 a temporary respiratory pause after slow inspiration. After the measurements were completed, the PCF between the four conditions was compared for each subject group, and the effect size was calculated.

Results: PCF of maneuvers 1 and 3 were significantly higher than maneuver 4 in healthy subjects (476.34±102.05 L/min and 463.44±107.14 L/min vs. 429.54±116.83 L/min, p<0.01 and p<0.05, respectively) and patients with restrictive pulmonary disease (381.96±145.31 L/min, 354.60±157.36 L/min vs. 296.94±137.49 L/min, p<0.01 and p<0.05, respectively). In obstructive pulmonary disease, maneuver 1 was significantly higher than maneuver 4 (327.42±154.73 L/min vs. 279.48±141.10 L/min, p<0.05). The largest effect sizes were shown by maneuvers 4 and 1.

Conclusion: PCF depends on changes in inspiratory speed before coughing and on temporary respiratory pauses after maximal inspiration. It will become necessary to unify the measurement methods for coughing strength and present appropriate coughing methods.

Objective: To systematically translate the Duchenne muscular dystrophy Functional Ability Self-Assessment Tool (DMDSAT) into Korean and verify the reliability and validity of the Korean version (K-DMDSAT).

Methods: The original DMDSAT was translated into Korean by two translators and two pediatric physiatrists. A total of 88 patients with genetically confirmed Duchenne muscular dystrophy (DMD) participated in the study. They were evaluated using the K-DMDSAT once as a self-assessment and once by an interviewer. The interviewer evaluated the K-DMDSAT again 1 week later using a test-retest approach. The intraclass correlation coefficient (ICC) was used to verify the interrater and test-retest reliabilities. Pearson correlation analysis between the K-DMDSAT and the Brooke or Vignos scales were used to assess validity.

Results: The total score and all domains of the K-DMDSAT showed excellent interrater and test-retest reliability, with an ICC for total scores of 0.985 and 0.987, respectively. All domains had an ICC >0.90. From the Pearson correlation analysis, the total K-DMDSAT score was significantly correlated with the Vignos and Brooke scales (r=0.918 and 0.825, respectively; p<0.001), and each domain of K-DMDSAT showed significant correlation with either the Vignos or Brooke scales.

Conclusion: DMDSAT was systematically translated into Korean, and K-DMDSAT was verified to have excellent reliability and validity. K-DMDSAT can help clinicians easily describe and categorize various functional aspects of patients with DMD through the entire disease progression.

Objective: To evaluate the feasibility and usability of cost-effective complex upper and lower limb robot-assisted gait training in patients with stroke using the GTR-A, a foot-plate based end-effector type robotic device.

Methods: Patients with subacute stroke (n=9) were included in this study. The enrolled patients received 30-minute robot-assisted gait training thrice a week for 2 weeks (6 sessions). The hand grip strength, functional ambulation categories, modified Barthel index, muscle strength test sum score, Berg Balance Scale, Timed Up and Go Test, and Short Physical Performance Battery were used as functional assessments. The heart rate was measured to evaluate cardiorespiratory fitness. A structured questionnaire was used to evaluate the usability of robot-assisted gait training. All the parameters were evaluated before and after the robot-assisted gait training program.

Results: Eight patients completed robot-assisted gait training, and all parameters of functional assessment significantly improved between baseline and posttraining, except for hand grip strength and muscle strength test score. The mean scores for each domain of the questionnaire were as follows: safety, 4.40±0.35; effects, 4.23±0.31; efficiency, 4.22±0.77; and satisfaction, 4.41±0.25.

Conclusion: Thus, the GTR-A is a feasible and safe robotic device for patients with gait impairment after stroke, resulting in improvement of ambulatory function and performance of activities of daily living with endurance training. Further research including various diseases and larger sample groups is necessary to verify the utility of this device.

Objective: To explore the effects of tactile stimulation using air pressure at the auricular branch of the vagus nerve on autonomic activity in healthy individuals.

Methods: Three types of tactile stimulation were used in this study: continuous low-amplitude, continuous high-amplitude, and pulsed airflow. The tactile stimulations were provided to the cymba concha to investigate autonomic activity in 22 healthy participants. The mean heart rate (HR) and parameters of HR variability, including the standard deviation of R-R intervals (SDNN) and root mean square of successive R-R interval differences (RMSSD) were compared at baseline, stimulation, and recovery periods.

Results: Two-way repeated measures ANOVA indicated a significant main effect of time on HR (p=0.001), SDNN (p=0.003), and RMSSD (p<0.001). These parameters showed significant differences between baseline and stimulation periods and baseline and recovery periods in the post-hoc analyses. There were no significant differences in the changes induced by stimulation type and the interaction between time and stimulation type for all parameters. One-way repeated measures ANOVA showed that HR, SDNN, and RMSSD did not differ significantly among the three time periods during sham stimulation.

Conclusion: Parasympathetic activity can be enhanced by auricular tactile stimulation using air pressure, targeting the cymba concha. Further studies are warranted to investigate the optimal stimulation parameters for potential clinical significance.

Objective: To examine the usefulness and feasibility of modified thread carpal tunnel release (TCTR) by comparing the results of using pre-existing commercial thread with those of a newly developed thread (Smartwire-01).

Methods: A total of 17 cadaveric wrists were used in the study. The modified TCTR method was practiced by two different experts. Pre-existing commercial surgical dissecting thread (Loop&ShearTM) was used for five wrists and the newly developed Smartwire-01 was used for twelve wrists. The gross and microanatomy of the specimens were evaluated by a blinded anatomist.

Results: Both types of thread were able to cut the TCL similarly. Gross anatomy and histologic findings showed that there was no significant difference between the two types of threads. However, the practitioners felt that it was easier to cut the TCL using the newly-developed thread.

Conclusion: TCTR using Smartwire-01 was as effective as pre-existing Loop&ShearTM, with better user experiences.

Objective: To assess the impact of a "one-stop", multi-modal, hospital-associated-home-based prehabilitation model, helmed by a small core team, on newly diagnosed gastrointestinal and urological cancer patients planned for surgery.

Methods: This is a retrospective study in a tertiary public hospital, involving all newly diagnosed gastrointestinal and urological cancer patients planned for surgery. The primary outcome measure was the 6-minute walk test (6MWT). Other outcomes included physical, psychological and quality-of-life measures, and patient satisfaction surveys, taken at baseline, pre-operatively (post-prehabilitation), and at 3 months post-operatively.

Results: When comparing the baseline to pre-operatively (post-prehabilitation), there was a statistically significant improvement in the 6MWT (21.52 m, p<0.001), 30-Second Sit to Stand test (STS) (1.08 repetitions, p<0.001), Timed Up and Go test (TUG) (0.83 seconds, p=0.014) and Hospital Anxiety and Depression Scale (HADS) (total score 1.77, p<0.001). These were sustained (6MWT: 0.22, p=0.964; STS: 0.08 repetitions, p=0.863; TUG: 0.04 seconds, p=0.939) or further improved (HADS total score 2.06, p=0.003) at 3 months post-operatively. There was also a statistically significant improvement in the EuroQol-5 dimension health score (health-related quality-of-life measure) from baseline to 3 months post-operatively (7.04 points, p=0.001), with more than 90% overall patient satisfaction reported.

Conclusion: Prehabilitation applied via our model resulted in significant improvements in functional capacity, psychological and quality-of-life outcomes, sustained at 3 months post-operatively, and is a feasible and effective approach that is well-received by our patients.