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To investigate whether patterns of dysphagia and swallowing laterality differ according to the location of brain lesions in patients with stroke.
Patients with stroke >20 years of age were enrolled in this study. A videofluoroscopic swallowing study (VFSS) including the anterior-posterior view was used to assess swallowing. Patterns of swallowing were classified into three types according to the width of barium sulfate flow while passing the pharyngoesophageal segment: right-side-dominant flow, left-side-dominant flow, and no laterality in flow. Laterality was defined when the width of one side was twice or more the width of the other side.
A total of 92 patients who underwent swallowing function evaluations by VFSS were enrolled from Sep-tember 2012 to May 2013. Of these, 72 patients had supratentorial lesions (group I) and 20 patients had infratento-rial lesions (group II). Only 10 patients (13.9%) in group I and three patients (15.0%) in group II showed laterality. Of these 13 patients, laterality occurred on the left side regardless of the side of the brain lesion. No relationships were found between swallowing laterality and location of stroke or motor weakness.
The results suggest that swallowing laterality was not prevalent among patients with stroke and that lesion side, location of the brain lesion, or motor weakness did not influence swallowing laterality. Although stroke can cause symptoms of dysphagia, it is difficult to conclude that stroke has a crucial impact on swallowing laterality.
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To investigate the prognosis of patients with stroke and urinary retention resistant to alpha blockers and cholinergic agents.
Post-void residual urine volume (PVR) was measured in 33 patients with stroke (14 men and 19 women) who were admitted to the department of rehabilitation medicine of our hospital within 30 days after stroke onset. An alpha-blocker and cholinergic agent were administered to patients with PVR >100 mL. If urinary retention had not improved despite the maximum drug doses, the patient was diagnosed with drug-resistant urinary retention. We retrospectively reviewed patient's charts, including PVR at discharge and prognostic factors for PVR.
Ten patients (30.3%) could not void or their PVR was >400 mL at discharge (45.7±15.4 days after onset) after rehabilitation. Twelve patients (36.4%) could void, and their PVR was 100-400 mL. PVR was consistently <100 mL in 11 patients (33.3%). These measurements correlated with the Korean version of the Modified Barthel Index score, Functional Ambulation Category, and the presence of a communication disorder.
The results show that 22 patients (66.7%) had incomplete bladder emptying or required catheterization at discharge. Outcomes correlated with functional status, walking ability, and the presence of a communication disorder. Patients with urinary retention and poor general condition require close observation to prevent complications of urinary retention.
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To investigate whether virtual reality (VR) training will help the recovery of cognitive function in brain tumor patients.
Thirty-eight brain tumor patients (19 men and 19 women) with cognitive impairment recruited for this study were assigned to either VR group (n=19, IREX system) or control group (n=19). Both VR training (30 minutes a day for 3 times a week) and computer-based cognitive rehabilitation program (30 minutes a day for 2 times) for 4 weeks were given to the VR group. The control group was given only the computer-based cognitive rehabilitation program (30 minutes a day for 5 days a week) for 4 weeks. Computerized neuropsychological tests (CNTs), Korean version of Mini-Mental Status Examination (K-MMSE), and Korean version of Modified Barthel Index (K-MBI) were used to evaluate cognitive function and functional status.
The VR group showed improvements in the K-MMSE, visual and auditory continuous performance tests (CPTs), forward and backward digit span tests (DSTs), forward and backward visual span test (VSTs), visual and verbal learning tests, Trail Making Test type A (TMT-A), and K-MBI. The VR group showed significantly (p<0.05) better improvements than the control group in visual and auditory CPTs, backward DST and VST, and TMT-A after treatment.
VR training can have beneficial effects on cognitive improvement when it is combined with computer-assisted cognitive rehabilitation. Further randomized controlled studies with large samples according to brain tumor type and location are needed to investigate how VR training improves cognitive impairment.
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