Citations
To identify the factors that could predict the functional outcome in patients with the axonal type of Guillain-Barre syndrome (GBS).
Two hundred and two GBS patients admitted to our university hospital between 2003 and 2014 were reviewed retrospectively. We defined a good outcome as being "able to walk independently at 1 month after onset" and a poor outcome as being "unable to walk independently at 1 month after onset". We evaluated the factors that differed between the good and poor outcome groups.
Twenty-four patients were classified into the acute motor axonal neuropathy type. There was a statistically significant difference between the good and poor outcome groups in terms of the GBS disability score at admission, and GBS disability score and Medical Research Council sum score at 1 month after admission. In an electrophysiologic analysis, the good outcome group showed greater amplitude of median, ulnar, deep peroneal, and posterior tibial nerve compound muscle action potentials (CMAP) and greater amplitude of median, ulnar, and superficial peroneal sensory nerve action potentials (SNAP) than the poor outcome group.
A lower GBS disability score at admission, high amplitude of median, ulnar, deep peroneal, and posterior tibial CMAPs, and high amplitude of median, ulnar, and superficial peroneal SNAPs were associated with being able to walk at 1 month in patients with axonal GBS.
Citations
To investigate the association of family history of stroke with functional outcomes in stroke patients in Korea.
A case-control study was conducted. A total of 170 patients who were admitted to a rehabilitation unit were included. Risk factors for stroke such as age, sex, diabetes mellitus, hypertension, atrial fibrillation, smoking, high blood cholesterol and homocysteine level, obesity, and family history of stroke were taken into account. Stroke subtypes were the following: large vessel infarct, small vessel infarct, embolic infarct, subarachnoid hemorrhage, and intracranial hemorrhage. Stroke severity as assessed with the National Institutes of Health Stroke Scale (NIHSS), functional outcomes using the Korean version of the Modified Barthel index (K-MBI), Functional Independence Measurement (FIM), and cognitive function using the Korean version of Mini-Mental State Examination (K-MMSE) were assessed at admission and discharge.
Subjects with a family history of stroke were more likely to have an ischemic stroke (90.7%) than were those without a family history (70.9%). The K-MBI, FIM, NIHSS, and K-MMSE scores did not show significant differences between patients with or without family history.
Family history of stroke was significantly associated with ischemic stroke, but not with functional outcomes. Other prognostic factors of stroke were not distributed differently between patients included in this study with or without a family history of stroke.
Citations
Method: Initial and follow up electrodiagnostic data of 100 patients who had been diagnosed as spina bifida were obtained retrospectively. Electrophysiological diagnosis and neurological level were investigated by the findings of needle electromyography. Each patients were divided into no change, improvement and deterioration group according to follow up study. The change of urodynamic study findings and clinical findings were also investigated. The recent functional outcomes and the presence of complications were evaluated by recent outpatient record.
Results: 56 patients had no change, 15 patients had improvement and 29 patients had deterioration electrophysiologically. The initial electrodiagnostic findings were associated with the functional outcomes in patients with spina bifida (p＜0.05). However, neurological level by electrodiagnostic findings cannot predict functional outcomes except ambulation activities. The change of electrodiagnostic findings of follow up study were related with the change of clinical findings statistically (p＜ 0.05).
Conclusion: Follow up electrodiagnostic study as well as initial study is necessary for the evaluation of the change of neurological states in the patients with spina bifida.
Method: Subjects were 23 stroke patients who admitted to rehabilitation wards. Volitional Questionnaire (VQ) for assessing patients' motivation, personal and environmental variables, modified Barthel index (MBI), Beck depression inventory (BDI), minimental status examination (MMSE) and neurobehavioral cognitive status examination (NCSE), visual reaction time (VRT) and auditory reaction time (ART) were obtained at 1 week after admission, and then MBI was measured again after 4 weeks.
Results: VQ score was not related to the personal and environmental variables, but significantly related to BDI, MMSE, NCSE, VRT, ART, follow up score of MBI 4 weeks later and MBI gain.
Conclusion: Motivation was more associated with neuropsychological status than personal or environmental factors and significant factor of functional outcome. Therefore, physicians and physiotherapists should attempt to promote motivation of their patients during rehabilitation. (J Korean Acad Rehab Med 2003; 27: 309-313)
Method: Medical records of 119 hospitalized patients with cancer who received the consultation base rehabilitation program from January 1999 to December 2000, were reviewed. Karnofsky Performance Status scale (KPSS) was used as a functional measurement.
Results: The most common primary cancer referred for the consultation base rehabilitation program was a lung cancer (16.8%), followed by brain cancer (10.9%) and hepatic cancer (9.2%). Spine was the most common metastatic site (72.7%). Strengthening (47.2%) and range of motion exercises (39.6%) were commonly prescribed rehabilitative procedures in the cancer patients with no metastasis and bracing (45.5%) was the most common cause for consultation in the cancer patients with metastasis. A significant functional improvement was observed between the initial (mean=58.4%) and final assessments (mean=65.2%) on KPSS (p＜0.01) in the cancer patients with no metastasis. However, the cancer patients with metastasis did not show a significant functional improvement.
Conclusion: Significant functional gains were observed in cancer patients who received the consultation base rehabilitation program. (J Korean Acad Rehab Med 2003; 27: 260-264)
Objective: To know the usefulness of the Modified Mini- Mental State Exam (3MS) as a screening test of cognitive function after stroke and the relationship between the 3MS with clock drawing task (CDT) and the 3MS with visual scan task (VST) in view of visual neglect and functional outcome.
Method: We studied 17 patients with unilateral hemisphere stroke [7 right hemisphere stroke (RHS), 10 left hemisphere stroke (LHS)] who have a mean age of 59.4 years and a mean hospital stay of 34.3 days on final examination. None of them had the previous history of mental illness or the previous stroke attack. We performed the MMSE, 3MS, VST and CDT at the first week of onset of stroke and at discharge.
Results: 1) 3MS was a valuable screening test of cognitive function like MMSE (p＜0.05) in both RHS and LHS groups. 2) VST was a valuable screening method of unilateral neglect in patients with normal 3MS (p＜0.05). 3) CDT was also valuable screening method of unilateral neglect in patients with normal 3MS (p＜0.05). 4) 3MS with CDT showed no significant correlation with FIM score (p＞0.05).
Conclusion: We think that 3MS is a valuable screening test of cognitive function after stroke. VST and CDTs are valuable screening tools in estimating unilateral neglect after stroke. But 3MS with CDT is not well correlated with functional outcome. (J Korean Acad Rehab Med 2002; 26: 237-242)
Objective: To investigate the functional outcome with regard to cognitive deficits in patients with aneurysmal subarachnoid hemorrhage (SAH).
Method: Two hundred thirty-four patients who underwent surgical procedure for aneurysmal SAH were enrolled. Medical records of the patients were reviewed.
Results: Mental confusion (52.1%) was more common symptom than the motor (20.3%) and language (30.9%) impairment in patients with aneurysmal SAH. Neurological grade at admission (Hunt and Hess grade), cerebral vasospasm, and mental confusion were major prognostic factors. In terms of functional outcome, patients with mental confusion showed lower Functional Independence Measure (FIM) scores at admission and on discharge, lower FIM gain and FIM efficiency, and longer hospital stay with statistical significance than those without confusion.
Conclusion: The patients with cognitive deficits achieved poor functional outcome in the patients with aneurysmal SAH. More attention to cognitive impairment is necessary to achieve better rehabilitation goal.
Objective: To identify the clinical characteristics of the patients with hypoxic-hypotensive brain injury (HBI) and to compare the prognosis of HBI with patients with traumatic brain injury (TBI).
Method: Six patients with HBI and sixteen patients with TBI, who had been comatose for more than 8 hours, were enrolled. The functional status was evaluated by the Functional Independence Measure (FIM) score.
Results: The causes of HBI were: two respiratory arrest, three cardiac arrest, and one hypotensive shock. Most patients had memory disturbance, confusion, spasticity, contracture of joints, and weakness after the HBI. Other problems included dysphagia, ataxia or tremor, dementia, and concomitant medical problems. Among these clinical features, confusion and spasticity were serious obstacles in rehabilitation. The HBI patients had lower initial and discharge total FIM score, total FIM gain, total FIM efficacy, cognitive FIM efficacy, and motor FIM efficacy than the TBI patients. The HBI patients had a poor outcome due to more widespread brain damage, medical complications, and delayed rehabilitation treatments as compared with TBI patients.
Conclusion: We concluded that HBI patients had more diffuse and severe deficit than TBI patients.
Objective: To investigate incidence, characteristics, and risk factors of insomnia and to compare the functional outcomes between insomnia and non-insomnia group in rehabilitation patients.
Method: Sixty nine consecutive admissions between May and June, 1999 have been evaluated. The St. Mary's Hospital Sleep Questionnaire were employed and medical records of the patients have been reviewed.
Results: Incidence of insomnia was 60.9%. The most common type of insomnia was difficulty in maintaining sleep during the night (interrupted type). 66.9% of the total patients with insomnia had recognizable causal factors. The common factors influencing insomnia were somatic symptoms, environmental, and psychological factors. On discharge, lower FIM gain was noted in insomnia group even though statistical significance was not found.
Conclusion: Since sleep disturbances have been common to the rehabilitation patients, and may influence functional outcome, early diagnosis and therapeutic intervention may be needed.
Objectives: To investigate the correlation of the initial Computerized Tomography(CT) findings of the brain and the functional outcome, and to suggest the initial CT findings as a functional outcome predictor in the traumatic brain injured(TBI) patients.
Methods: Thirty-nine TBI patients were included in this study. Subjects were divided into groups of non-focal or focal TBI, and with or without a depressed skull fracture according to their initial brain CT findings.
Results: The non-focal TBI patients were not significantly different from focal TBI patients in the days from onset to rehabilitation, rehabilitation stay, and initial FIM score. However their outcome in FIM gain and FIM efficiency significantly worse than focal TBI patients. The TBI patients with a depressed skull fracture were not significantly different from the patients without a depressed skull fracture in the days from onset to rehabilitation, rehabilitation stay, and intial FIM score. However their outcomes were significantly worse than patients without a depressed skull fractrue in FIM efficiency.
Conclusion: The initial brain CT findings were generally useful for the prediction of functional outcomes in TBI patients.
Objective: The purposes of this study were to estimate the incidence and complications of the tracheostomy and after decannulation, and to compare the functional outcomes between tracheostomy and non-tracheostomy groups in the severe traumatic brain injury (TBI) patients.
Method: One hundred and fifteen severe TBI patients were included in this study and the functional outcomes were measured by the Functional Independence Measure (FIM) scores retrospectively.
Results: The incidence of tracheostomy was 45.2% and the average duration of tracheostmy was 69.7 days. Twenty seven complications associated with the tracheostomy (51.9%) were reported and a pneumonia was the most common complication. Fourteen complications (26.9%) were reported after the decannulation and a tracheal granuloma was the most common complication. Complications mostly occurred during the first two weeks of tracheostomy. The duration of rehabilitation treatment for the patients with tracheostomy was longer than the patients without tracheostomy. TBI patients with tracheostomy had significantly lower initial and discharge FIM scores, FIM gain, and FIM efficiency than the patients without tracheostomy.
Conclusion: The complications of tracheostomy were mostly occurred early in the acute stage. Functional outcomes were lower in severe TBI patients with tracheostomy, thus early comprehensive and aggressive rehabilitation treatments would be necessary.
Hydrocephalus occurs frequently after stroke and has been reported to affect the functional outcome. We investigated 77 stroke patients retrospectively to evaluate whether or not hydrocephalus affects the functional outcome. The patients were divided into three groups: Group 1, 20 patients without hydrocephalus; Group 2, 28 patients with early onset hydrocephalus; Group 3, 29 patients with delayed onset hydrocephalus. Functional status was evaluated by 3 functional indices, Mini-Mental Status Examination(MMSE), Barthel index, and PULSES profile. These 3 functional indices were compared between pre- and post-rehabilitation stages in Groups 1 and 2, and compared among pre-rehabilitation, post-hydrocephalus, and post-rehabilitation stages in Group 3.
Significant functional improvements were shown in the post-rehabilitation stage in Groups 1 and 2 (P<0.05). In Group 3, the functional improvements were shown in the post-rehabilitation stage when compared to the pre-rehabilitation stage, but without statistical significance. However, significant functional improvements were demonstrated in the post-rehabilitation stage compared to the post-hydrocephalus stage in Group 3 (P<0.05). In comparing the three groups, the final functional outcome was found to be best in Group 1 and worst in Group 3.
We suggest that the time from the onset of hydrocephalus to diagnosis and management is more important than the presence of hydrocephalus itself in the stroke patient in respect to functional outcome.
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