Brain & NeuroRehabilitation最新文献

Percutaneous endoscopic gastrostomy (PEG) is considered in patients with insufficient oral intake who need enteral feeding or therapeutic gastric decompression. PEG tube feeding is generally superior to nasogastric tube feeding in terms of patients' comfort, long-term use, and feeding efficiency. Patient selection for PEG, the proper endoscopic insertion technique, early recognition of complications, and appropriate management are important for patient care. During preparation, adequate management of anticoagulation and antithrombotic agents are important to prevent bleeding, and prophylactic antibiotics prevent wound infection. Most complications are minor; however, major complications that require surgical correction or are life-threatening may occur, such as wound infection, bleeding, buried bumper syndrome, colocutaneous fistula, perforation, volvulus, and injuries to other organs. This review presents practical guidelines for the selection and preparation of patients, endoscopic insertion methods, and complication management strategies.

Malnutrition is associated with increased mortality and poor functional recovery after stroke. Most guidelines for stroke rehabilitation strongly recommend nutritional screening for malnutrition. Nutritional status after stroke is related to long-term outcomes, and nutritional supplementation is recommended for stroke patients with malnutrition and those at risk of malnutrition. However, routine nutritional supplementation in stroke patients, regardless of nutritional status, is not correlated with improved functional outcomes, and nutritional supplementation is not recommended if the nutritional status is adequate. Nutritional supplementation with protein, amino acids, vitamins, and minerals positively affects recovery after stroke, with improvements seen in motor function, cognition, activities of living, and mood. However, the evidence is insufficient due to the small number of studies and the lack of well-designed randomized controlled studies. Therefore, nutritional supplementation for stroke patients in rehabilitation should not be uniform, and individual nutritional interventions based on an assessment of the patient's nutritional status should be provided.

Many stroke survivors live with disabilities in the community. This study aimed to investigate the causes and trends of disabilities among community-dwelling stroke survivors. A total of 1547 community-dwelling stroke survivors ≥ 19 years were identified using the Korea National Health and Nutrition Examination Survey (KNHANES) database from 2007 to 2018. We analyzed the causes and trends of disabilities in strokes survivors using complex-samples procedures. During 2007-2018, 38.0% of stroke survivors were found to have disabilities. Stroke itself was the most common cause of disabilities (21.3%). Musculoskeletal (back or neck problems, 7.0%; arthritis, 5.7%; and leg pain excluding arthritis, 2.3%), sensory (visual problems, 3.6%; and auditory problems, 1.4%), and medical problems (diabetes 2.6%; hypertension, 2.3%; heart disease, 1.5%) accounted for the rest of the other causes of disabilities. Upon analyzing the trends, we found that both the proportion of stroke survivors with disabilities and that of stroke survivors with stroke-related disabilities decreased from KNHANES IV (2007-2009) to V (2010-2012). After 2010-2012, the proportion of both groups stayed constant. The burden of disabilities in non-hospitalized stroke survivors has decreased but still remains high. Attention is warranted because many other problems than a stroke can cause disabilities in community-dwelling stroke survivors.

Anarthria is a complete loss of speech. It usually results from lesions in bilateral neural substrates that control articulation. Recently, lateralized cortical control of speech articulation in the dominant hemisphere has been reported. However, anarthria by non-dominant hemispheric lesion has not been reported yet. Here we report a rare case of transient anarthria caused by right hemispheric infarction after brain surgery in a right-handed patient. This report suggests that anarthria could be caused by a lesion not related to language lateralization. This report is expected to contribute to studies on neural correlates of anarthria lesions.

This study aims to investigate the relationship between ipsilesional upper extremity (UE) motor function and the integrity of the subregions of the corpus callosum in hemiparetic stroke patients with motor deficits of the dominant or non-dominant ipsilesional side. Twenty participants with unilateral UE deficits after stroke were included. Each of the 10 participants had lesions on the left and right sides. The ipsilesional UE function was assessed with the Jebsen-Taylor hand function test (JHFT), the 9-hole peg test (9HPT), and grip and pinch strength tests. Fractional anisotropy (FA) was calculated for the integrity of the 5 subregions of the corpus callosum. Pearson's correlation analysis was conducted to investigate the relationship between UE function and the integrity of the callosal subregions. The results of JHFT and 9HPT showed a significant correlation with the FA value of the corpus callosum I projecting to the frontal lobe in the left lesion group (p < 0.05). There was no correlation between the ipsilesional UE motor function and the FA value of the ulnar subregion in the right lesion group (p > 0.05). These results showed that the motor deficits of the ipsilesional UE correlated with the integrity of callosal fiber projection to the prefrontal area when the ipsilesional side was non-dominant.

We investigated the diffusion tensor image (DTI) parameters of superior longitudinal fasciculus (SLF) and inferior fronto-occipital fasciculus (IFOF), and their relationships with hemispatial neglect. Thirteen patients with first-ever ischemic stroke who had the right hemispheric lesion were included. Neglect was assessed using the Albert test and figure discrimination test of Motor-free Visual Perception Test 3 (MVPT-3). The SLF and IFOF were separated by diffusion tensor tractography (DTT) and tract volume (TV) was calculated. We measured the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values in the total area, seed region of interest (ROI), and target ROI, respectively. Among thirteen patients, seven demonstrated signs of hemispatial neglect on neglect test. Tractography reconstruction showed significantly low TV of the right IFOF in patients with hemispatial neglect. FA values of the right SLF and the right IFOF were significantly lower in neglect patients. ADC values were not significantly different in two groups. This study suggests that damage of SLF and IFOF is associated with hemispatial neglect in right hemispheric stroke patients. DTI may be useful for predicting the severities of hemispatial neglect using values such as TV and FA of each tract.

Neurological disorders can change patients' nutritional status by directly or indirectly affecting dietary intake through mechanisms such as dysphagia, movement disorders, cognitive impairment, and depression. Malnutrition contributes to complications, resulting in delayed rehabilitation and increased morbidity and mortality. It is important to prevent malnutrition in patients with neurological disorders and to improve their nutritional status by identifying nutritional deterioration at an early stage and implementing appropriate nutritional interventions. This review examines the nutritional screening and assessment process in patients with neurological disorders, with a particular focus on stroke patients undergoing rehabilitation. Nutritional assessment, the first step of clinical nutrition management, identifies nutritional problems and their causes, signs, and symptoms through an overall evaluation including anthropometric measurements, dietary assessments, biochemical assessment, nutrition-related physical examinations, and functional assessment data. Based on the assessment, a nutritional intervention plan is established. By synthesizing the assessment results of selected subjective and objective indicators, nutritional screening tools to screen patients at risk of malnutrition and nutritional assessment tools to diagnose malnutrition were developed. It is important to use those tools with a clear understanding of their characteristics and scope.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory central nervous system disease that is driven by antibodies of the immunoglobulin G1 class. MOGAD has recently been recognized as an autoimmune disease; therefore, little is known about its rehabilitation. Here, we present a case of MOGAD that showed significant recovery after rehabilitation. A 58-year-old woman developed weakness in all extremities, dysarthria, and dysphagia. She visited the neurology department, and early brain and spine magnetic resonance imaging showed multifocal high intensity in the subcortical and periventricular white matter and the cervical cord. The patient's serum tested positive for anti-MOG antibodies. She was diagnosed with MOGAD and received intravenous steroid pulse therapy. After pharmacologic therapy, the patient was transferred to the rehabilitation department. Initially, her Functional Independence Measure (FIM) motor score was 26, allowing her to stand independently for only a few seconds. After 5 weeks of rehabilitation involving physical therapy, occupational therapy, and balance training, her FIM motor score improved to 60. However, 4 months after discharge, the disease relapsed with symptoms of motor weakness in all extremities, and steroid treatment was initiated. On the second admission, her FIM motor score was 42, but after continuous multidisciplinary rehabilitation, it improved to 76. Computerized cognitive therapy improved her cognitive function, from a Korean version of the Mini-Mental State Examination score of 23 on the first admission to 30 on final discharge. Since MOGAD is a relapsing disease, a favorable outcome can be achieved with continuous monitoring and multidisciplinary, symptom-specific rehabilitation.

Myoclonus is an abrupt arrhythmic condition with shock-like movements that can be triggered by sensory stimuli, affecting the trunk or limbs during voluntary movement. Since motor symptoms are often not easily treatable, various pharmacological treatment options have been suggested. We report a case of using intrathecal baclofen (ITB) therapy in a patient with hypoxic brain injury (HBI), leading to the alleviation of myoclonus. A 29-year-old woman repeatedly presented with generalized myoclonus and multiple joint contractures at both upper and lower limbs after resuscitation. She cried during intractable myoclonus events, making it difficult for her to maintain a good sleep pattern. Due to the persistent status of multiple joint contractures and intractable myoclonus, we offered an ITB trial to control her symptoms. After ITB, her total scores on the Unified Myoclonus Rating Scale progressively improved as the doses of baclofen increased. Therefore, ITB therapy should be considered as a substantial option in the management of intractable myoclonus in patients with HBI to prevent various complications and improve the quality of life.

[This corrects the article e15 in vol. 14.].