• Physical Therapy Korea
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• v.24 no.1
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• pp.71-78
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• 2017

Background: Muscle weakness and impaired trunk muscle control are common in stroke patients. The bridging exercise (BE) is generally used for trunk stabilization and improving the overall function of stroke patients. The effectiveness of the BE with hip adductor contraction (BEHA) in facilitating trunk muscle activation has been well studied in healthy adults. However, the impact of BEHA in sub-acute stroke patients has not yet been investigated. Objects: The purpose of this study was to determine the effects of BEHA on the electromyography (EMG) activities and the asymmetry of the rectus abdominis (RA), external oblique (EO) and internal oblique (IO) abdominal muscles. Methods: Twenty participants with sub-acute stroke (11 males and 9 females) were recruited. Each participant was asked to perform bridging exercises for five seconds under three different conditions: BE in a neutral position (BEN), BEHA with a large ball (BEHAL) and BEHA with a small ball (BEHAS). The EMG amplitudes of the bilateral RA, EO and IO and the asymmetry of the EMG activity between the sound and affected sides were compared among the conditions. The significance level was set at ${\alpha}=.05$. Results: The EMG activities of RA, EO and IO were significantly greater during BEHAL and BEHAS than during BEN (p<.05); the asymmetry of the RA, EO and IO decreased significantly during BEHAL and BEHAS compared to BEN (p<.05). However, no measured variables showed any significant differences between BEHAL and BEHAS (p>.05). Conclusion: This study compared the EMG activities of the RA, EO and IO on both sides and the asymmetry of the RA, EO and IO during BEN, BEHAL and BEHAS. Our findings suggest that BEHA was more effective for individuals with hemiplegic stroke at facilitating and normalizing abdominal muscle control than BEN.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.313-320
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• 2014

Objective : The purpose of this study is to demonstrate the technical feasibility and clinical efficacy of emergent carotid angioplasty and stenting (CAS) for acute stroke due to athero-thrombotic occlusion of the cervical internal carotid artery (ICA). Methods : Review of medical records identified 17 patients who underwent emergent CAS for treatment of athero-thrombotic occlusion of the cervical ICA with acute stroke between 2009 and 2013. Eleven patients (64.7%) presented with concomitant intracranial artery occlusion, which was treated primarily by mechanical thrombectomy after CAS. Results : Successful revascularization of the cervical ICA with emergent CAS was achieved in all patients. After CAS, intracranial recanalization with Thrombolysis in Cerebral Infarction ${\geq}2b$ flow was achieved in four of the 11 patients (36.4%). The overall recanalization rate (cervical ICA and intracranial artery) was 10 of 17 patients (58.8%). Symptomatic intracranial hemorrhage occurred in two patients (11.8%), resulting in death. Ten patients (58.8%) showed improvement (decrease in NIHSS score of ${\geq}4$ points) at seven days after recanalization. Nine patients (52.9%) showed a favorable outcome ($mRS{\leq}2$) at the last follow-up. A favorable outcome ($mRS{\leq}2$) was obtained in four of the six patients with isolated cervical ICA occlusion (4/6, 66.7%) and five of 11 patients with intracranial tandem occlusion (5/11, 45.5%). Conclusion : Emergent CAS for acute stroke due to athero-thrombotic occusion of the cervical ICA showed a good technical feasibility and favorable clinical outcome.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.627-634
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• 2017

Objective : Few studies have reported the outcome of mechanical thrombectomy with Solitaire stent retrival (MTSR) in subtypes of acute ischemic stroke. The purpose of this study was to evaluate the efficacy and result of MTSR in acute cardioembolic stroke. Methods : Twenty consecutive patients with acute cardioembolic stroke were treated by MTSR. The angiographic outcome was assessed by thrombolysis in cerebral infarction (TICI) grade. TICI grade 2a, 2b, or 3 with a measurable thrombus that was retrieved was considered as a success when MTSR was performed in the site of primary vessel occlusion, and TICI grade 2b or 3 was considered as a success when final result was reported. Clinical and radiological results were compared between two groups divided on the basis of final results of MTSR. Persistent thrombus compression sign on angiogram was defined as a stenotic, tapered arterial lumen whenever temporary stenting was performed. The clinical outcomes were assessed by the modified Rankin Scale (mRS) at 3 months. Results : The failure rate of MTSR was 20% (4/20) and other modalities, such as permanent stenting, were needed. Final successful recanalization (TICI grade 2b or 3) was 80% when other treatments were included. The rate of good outcome ($mRS{\leq}2$) was 35% at the 3-month follow-up. Failure of MTSR was significantly correlated with persistent thrombus compression sign (p=0.001). Conclusion : Some cases of cardioembolic stroke are resistant to MTSR and may need other treatment modalities. Careful interpretation of angiogram may be helpful to the decision.

• Physical Therapy Rehabilitation Science
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• v.8 no.4
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• pp.187-193
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• 2019

Objective: The aim of this preliminary study was to investigate the effects of virtual reality combined with balance training on upper limb function, balance, and activities of daily living (ADL) in persons with acute stroke. Design: Randomized controlled trial. Methods: Fourteen acute stroke survivors were recruited and randomly assigned into two groups: the experimental group (n=7) and the control group (n=7). Both groups performed the conventional rehabilitation therapy for 30 minutes a day, 5 times a week, for 4 weeks. Additionally, the experimental group conducted the virtual reality training for 30 minutes on an unstable surface during each session, whereas the control group performed balance training for 30 minutes on a stable surface. All measurements were performed before and one day after intervention. Upper limb function, balance, and ADL were assessed using the Manual Function Test (MFT), the Berg Balance Scale (BBS), and the Korean version of the Modified Barthel Index (K-MBI), respectively. Results: Both groups showed significant improvements in MFT, BBS, K-MBI after intervention (p<0.05). There were no significant differences between the experimental and control groups with respect to MFT, BBS, and K-MBI after intervention. The experimental group showed a greater decrease in fall risk (BBS<45) after intervention than the control group (p<0.05). Conclusions: These findings suggest that virtual reality combined with balance training has a better effect on balance improvement than virtual reality training alone in persons with acute stroke.

• PNF and Movement
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• v.15 no.3
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• pp.267-279
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• 2017

Purpose: The aim of the investigation was to identify the effects of purposeful activities combined with music on upper extremity function, motivation, and mood in acute stroke patients. Methods: For the study, 19 acute stroke inpatients were recruited at a general hospital in Korea. The patients were allocated between an experimental group (n=9) and a control group (n=10). The experimental group performed purposeful activities with their preferred music, and the control group carried out purposeful activities without music. The 2 groups received the treatments 30 min per day, 5 days per week, for 4 weeks. Measurements were taken before and after intervention, including a manual function test (MFT) for measuring upper extremity function, a volitional questionnaire (VQ) for assessing motivation, and the Beck depression inventory (BDI) and Beck anxiety inventory (BAI) for assessing mood. Results: In post-treatment measurement, both groups showed greater MFT, VQ, and BDI scores than in pre-treatment. Significantly greater VQ and BDI changes were represented in the experimental group as compared to the control group. Conclusion: Based on the findings of this study, purposeful activities combined with music have a positive effect on motivation and depression in acute stroke patients.

• Journal of Korean Academy of Nursing
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• v.44 no.3
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• pp.280-293
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• 2014

Purpose: The study was done to develop an evidence-based enteral nutrition (EN) protocol for effective nutritional support for dysphagia in patients with acute stroke, and to evaluate effects of this protocol on clinical outcomes. Methods: A methodological study was used to develop the EN protocol and a quasi-experimental study to verify the effectiveness of the protocol. The preliminary EN protocol was drawn by selecting recommendations from previous well-designed EN guidelines, and then developing additional recommendations based on high-quality evidence. Content validation was assessed by an expert group, and clinical applicability by care providers and patients. The scale-level content validity index of the final EN protocol was 0.99. Assessment was done of differences in percentage of caloric goals achieved and presence of undernutrition, aspiration pneumonia, and gastrointestinal (GI) complications after application of the EN protocol. Results: In the EN protocol group, the percentage of caloric goals achieved ($R^2=.24$, p=.001) and the reduction of GI complications (p=.045) were significantly improved, but the presence of undernutrition (p=.296) and aspiration pneumonia (p=.601) did not differ from the usual care group. Conclusion: Results indicate that the new EN protocol for dysphagia in patients with acute stroke significantly increased their nutritional intake and reduced GI complications.

• Journal of Magnetics
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• v.19 no.4
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• pp.353-356
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• 2014

The aim of the present study was to examine whether mental practice (MP) in conjunction with repetitive transcranial magnetic stimulation (rTMS) can improve the upper limb function of sub-acute stroke patients. This study was conducted with 32 subjects who were diagnosed with hemiparesis by stroke. The experimental group consisted of 16 members upon each of whom was performed MP in conjunction with rTMS, whreas the control group consisted of 16 members upon each of whom was performed MP and sham rTMS. Both groups received traditional physical therapy for 30 minutes a day, 5 days a week, for 6 weeks; additionally, they received mental practice for 15 minutes a day. The experimental group was instructed to perform rTMS, and the control group was instructed to apply sham rTMS for 15 minutes. A motor cortex excitability analysis was performed by motor evoked potentials (MEPs), and upper limb function was evaluated by Fugl-Meyer Assessment (FMA) and the Box and Block test (BBT). Results showed that the amplitude, latency, FMA, and BBT of the experimental group and the latency, FMA, and BBT of the control group were significantly improved after the experiment (p<0.05). Significant differences were found between the groups in amplitude and latency after the experiment (p<0.05). The results showed that MP in conjunction with rTMS is more effective in improving upper limb function than MP alone.

• Journal of Korean Medical Science
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• v.33 no.53
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• pp.343.1-343.8
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• 2018

Background: Linkage of public healthcare data is useful in stroke research because patients may visit different sectors of the health system before, during, and after stroke. Therefore, we aimed to establish high-quality big data on stroke in Korea by linking acute stroke registry and national health claim databases. Methods: Acute stroke patients (n = 65,311) with claim data suitable for linkage were included in the Clinical Research Center for Stroke (CRCS) registry during 2006-2014. We linked the CRCS registry with national health claim databases in the Health Insurance Review and Assessment Service (HIRA). Linkage was performed using 6 common variables: birth date, gender, provider identification, receiving year and number, and statement serial number in the benefit claim statement. For matched records, linkage accuracy was evaluated using differences between hospital visiting date in the CRCS registry and the commencement date for health insurance care in HIRA. Results: Of 65,311 CRCS cases, 64,634 were matched to HIRA cases (match rate, 99.0%). The proportion of true matches was 94.4% (n = 61,017) in the matched data. Among true matches (mean age 66.4 years; men 58.4%), the median National Institutes of Health Stroke Scale score was 3 (interquartile range 1-7). When comparing baseline characteristics between true matches and false matches, no substantial difference was observed for any variable. Conclusion: We could establish big data on stroke by linking CRCS registry and HIRA records, using claims data without personal identifiers. We plan to conduct national stroke research and improve stroke care using the linked big database.

• The Journal of Korean Medicine
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• v.21 no.3
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• pp.51-56
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• 2000

To assess the relationship between the severity of stenosis in MCA territory and the differentiation of syndromes in oriental medical aspects, the general characteristics, the scores of stroke-pattern identification, and the findings of MRA were compared in 18 acute cerebral infarction patientshospitalized in Dept. of Internal Medicine, Pundang CHA Oriental Medicine Hospital from 1998 sep. 1 to 1999 sep. 31. We compared the scores of stroke-pattern identification with the severity of stenosis by Kruskall-Wallis test, and analyzed the relationship by Pearson correlation test. The P value under 0.05 was regarded as significant. The results are as follows: The incidence of stenosis(mild to complete occlusion) was 83.3%. There were significant difference of the mean scores according to the severity of stenosis in Yin deficiency pattern. We could also observe a strong relationship between the severity of stenosis and Yin deficiency pattern, whose Pearson correlation coefficient was 0.655 (P<0.05). These results showed that Yin deficiency pattern could be a major cause of cerebral infarction.

• International Journal of Arrhythmia
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• v.17 no.1
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• pp.41-45
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• 2016

Atrial fibrillation (AF) can occur in acute coronary syndrome (ACS), which is a serious medical condition and may require the use of antiplatelet agents in addition to anticoagulants for stroke prevention. Recently, novel or non-vitamin K antagonist oral anticoagulants (NOACs) have been increasingly used for stroke prevention in patients with AF instead of traditional OACs. The duration of treatment or treatment with a stepwise approach (e.g. triple, double, or monotherapy) is determined depending on the clinical setting and the balance between the risks of ischemic stroke and bleeding. However, some concerns and controversies in the use of NOACs in patients with AF and ACS need to be addressed. Here, the current management for NOAC therapy in patients with ACS and AF will be reviewed based on recently published guidelines.