Earticle

본 연구의 목적은 stroke 환자의 말소리를 공기역학적으로 변별하기 위한 음향학적, 기류적 파라미터들 을 측정하여 말소리에 영향을 줄 수 있는 강도와 기류율, 성대진동과 성문기류사이 관계를 분석하는 동시에 성문하압을 음향학적 에너지로 변환시키는 후두 능력 척도인 발성효율성(vocal efficiency)을 알 아봄으로써 공기역학적 측면에서 변별 정도를 제시 할 수 있는 근거내지는 단서로 활용하여 stroke 환 자의 전반적인 명료도를 연구하는데 기초적 자료로 활용하여 말메커니즘의 기능적 측면과 유기적인 상 호작용을 이해하는데 도움을 주고자 하였다.

Background: Health-related quality of life (HRQOL) is a construct of quality of life relevant to health. HRQOL can be measured multiple ways including self-perceived interpretation of one’s health status. Research has shown value in understanding self-perceived or person-centered HRQOL. Thus, these types of assessments have been integrated into health care systems, used to help patients set personal goals and to determine treatment success. The purpose of this study was to describe the group, examine the relationship between HRQOL and functional independence, and then determine the impact of standard care on the HRQOL (index and visual analog scale [VAS]). Methods: Retrospective clinical observation study. Descriptive statistics used to describe the stroke sample. Comparison was performed to explore the correlation between the EuroQol 5-Dimensions Questionnaire (EQ-5D) and the Functional Independence Measure (FIM) at admission and discharge. Paired-samples t-test was conducted to evaluate the impact of standard therapy on HRQOL on EQ-5D. Results: n=1325; mean age of 72 years (SD=13.28) and 65% females. A weak, positive correlation found at admission (r=.15, n=1325, p<.000) and discharge (r=.04, n=1325, p<.000). A paired-samples t-test revealed a statistically significant increase in HRQOL index and VAS scores (p’s<.000) overtime, with a large effect size (η2=.74 and .70), respectively. Conclusion: A weak relationship was present between HRQOL and functional independence, thus suggesting these assessments should be used independent of each other. Statistically significant change in scores suggest improvement in HRQOL overtime, supported by large effect sizes and mean scores higher than the minimal important difference range.

Virtual reality (VR)-based rehabilitation is rapidly gaining interest and has been shown to be an intervention to facilitate motor learning in bal-ance and gait rehabilitation. A review of the current literature is needed to provide an overview of the current state of knowledge of VR-based gait physiotherapy for stroke patients. A systematic literature search was performed in PubMed and Scopus. Search terms included: “virtual reality,” “stroke,” “gait,” and “physical therapy.” Articles published in a peer-reviewed journal between 2017 and 2021 were considered. The in-tervention was mainly related to the use of VR as a therapeutic modali-ty, and the outcome was gait performance. The initial search identified 329 articles. After an eligibility review, 13 articles that met the inclusion criteria were included in the study. Most of participants were in a chronic stage and were between 14 and 85 years old. The VR-based gait training ranged from nonimmersive to immersive, was mostly per-formed on a treadmill, and was usually combined with conventional physiotherapy. The duration of the program varied from 10 to 60 min, and there were about 9 to 30 sessions. VR-based gait rehabilitation has a positive effect on gait ability. The existing literature suggests that VR-based rehabilitation combined with conventional physiotherapy could improve gait ability of people with stroke, especially in the chronic stage. However, the duration of VR-based programs should be customized to suit individuals to avoid stimulation sickness. Further research is need-ed to investigate the long-term effects of this approach.

본 연구에서는 뇌졸중 환자의 어떤 의학적 요인이 간병인 부담에 영향을 미치는지 알아보기 위해 8주간의 치료 전후 환자의 신경학적 상태, 인지, 일상생활수행능력, 보행, 균형 지표와 간병인의 부담감을 측정하여 그 변화를 비교하였습니다. 간병인은 8주간의 재활 치료 기간 동안 경도-중등도의 부담감을 느끼고 있었으며, 환자의 신경학적 상태, 인지 상태가 간병인 부담과 연관이 있었습니다. 전체 환자군 및 아급성기 뇌졸중 환자군의 의학적 지표와 간병인의 부담감을 다중회귀분석 하였 을 때, 신경학적 상태와 균형 능력이 보호자 부담감에 영향을 주는 요소로 나타났습니다. 이에 입원한 뇌졸중 환자의 재활 치 료 시 간병인 부담 경감을 위해 환자의 균형 능력 향상에 중점을 둘 것을 제안합니다.

In this study, we aimed to determine which medical conditions of the stroke patients admitted for rehabilitation more than four weeks after onset affect caregiver burden. Participants diagnosed with stroke and their respective primary caregivers were enrolled and assessed after an 8-week follow-up period. The areas of evaluation for stroke patients included neurologic state, cognition, performance in daily life movements, gait, and balance, and caregivers were evaluated in the area of burden. The evaluation was conducted at the start of the rehabilitation course and eight weeks later. Patient caregivers were found to be under mild to moderate burden while providing care throughout the hospitalization period. The patient's neurologic state and cognition were correlated with caregiver burden. In the all patient and the subacute stroke patient group, multiple regression analysis confirmed that the neurologic state and balance stability were factors that influenced caregiver burden. Hence, we suggest that improvement in the patient’s balance stability be emphasized during the course of rehabilitation to mitigate caregiver burden.

The purpose of this study was to investigate to effects of temporary visual feedback training using Fresnel prism glasses on balance in hemiplegic stroke patients without neglect. 19 hemiplegic stroke patients were randomly assigned to the experimental group (n=10) and the control group (n=9). Subjects of the control group performed balance and gait training, and subjects of the experimental group performed balance and gait training with a Fresnel prism glasses for 30 minutes each. All subjects performed motor-free visual perception test (MVPT) before intervention to measure visual perception. Functional reaching test (FRT) and gait parameters were performed before and after intervention. As a result, MVPT was no significant difference between the groups (p>0.05). FRT showed significant difference between the groups (p<0.05). In gait parameters, the swing time decreased and the single support time on the affected side increased. In summarizing the results of this study, the application of temporary Fresnel prism glasses had the effect to improve the balance ability in hemiplegic stroke patients without neglect. Therefore, Fresnel prism glasses could be favorably used as an intervention tool for improving balance in hemiplegic stroke patients without neglect.

Purpose: This study aimed to investigate the relationship between trunk control and pulmonary function and respiratory muscle strength in stroke patients. Methods: This study included 30 patients who had been clinically diagnosed with strokes, and trunk control abilities were measured using the trunk impairment scale (TIS). The subjects were classified into a group with high trunk control ability (TIS score ≥ 20) and a group with low trunk control ability (TIS score < 20). The patients’ forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured. To compare the pulmonary function and respiratory muscle strength between the two groups, the measurement data were analyzed using an independent T-test, and the relationship between TIS and respiratory function was analyzed using a Pearson correlation. Results: The high trunk control ability group had significantly higher pulmonary function and respiratory muscle strength than the low trunk control ability group. Significant positive correlations were found between trunk control and FVC, FEV1, PEF, MIP, and MEP. Conclusions: This study demonstrated that trunk control affects pulmonary function and respiratory muscle strength in stroke patients.

본 연구의 목적은 뇌졸중 동물 실험 모델에서 환경 강화는 기능 회복을 향상 시키고 이로 인하여 뇌에 형 태학적, 생화학과 행동에서 특징적인 변화와 그 효과들을 소개하고, 뇌졸중 환자에 환경 강화의 적용은 재활치료 및 작업치료를 포함한 다양 치료와 전 임상 실험의 중요성을 설명하고자 한다. 이 종설 논문에서는 주로 뇌졸중 동물 실험 모델에서 환경 강화로 인한 기능적 회복에 대한 효과와 신경 친화성 물질, 특정 단백질의 발현 및 임상 적용 사례 등의 연구 결과들을 소개하였다. 마지막으로 임상에서 뇌졸중 환자에게 환경 강화의 적용 가능성과 작업치료 및 재활치료의 관점에서 설명하였다.

The purpose of this article is to present the environmental enrichment(EE) method used to improve the functional recovery and change of brain plastic in animal experimental models of stroke. In animal experimental models of stroke, the environmental enrichment is effective in altering the morphological, biochemical and behavioral characteristics of the brain and thereby improving the functional outcomes. In this review article, we address the effects of EE in achieving a functional recovery in animal experimental models of stroke, thus attempting to describe them in patients with stroke from both occupational and rehabilitation perspectives.

Hospitals have accumulated large amounts of patient data, with each hospital’s data having unique characteristics and distributions. By leveraging this vast amount of data for machine learning, we can develop predictive models, such as those for predicting long-term outcomes in ischemic stroke patients and provide valuable information for treatment decisions. However, data privacy concerns prevent hospital data from being put together on a centralized server. This study investigates the applicability of federated learning for predicting long-term outcomes in ischemic stroke patients using data from Hallym University Sacred Heart Hospital in Pyeongchon and Hallym University Sacred Heart Hospital in Chuncheon. Patient outcomes are defined as favorable if the modified Rankin Scale (mRS) score is 0-2 and poor if the mRS score is 3-6. There are two tasks: one predicting patient outcomes at 3 months after stroke and the other predicting patient outcomes at 1 year after stroke. A simple deep neural networks model is used for implementation of the prediction model and the federated learning environment. In conclusion, the federated learning models using basic FedAVG and weighted averaging FedAVG achieved 99.4%-99.9% performance of traditional centralized learning models.

Stroke is one of the main causes of death and disability in adults, and after stroke, patients are left with various symptoms such as motor paralysis, gait disturbance, sensory abnormalities, and cognitive impairment. In particular, despite receiving intensive rehabilitation treatment, 55-75% of post-stroke patients remain impaired in upper extremity function, which reduces the quality of life. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment that has the effect of adjusting cortical excitability according to frequency. This literature review was conducted to provide a more diverse clinical basis for applying rTMS to stroke patients in the future for recovery of upper extremity function. The databases of PubMed and Embase were searched using combinations of the following terms: stroke AND upper extremity AND transcranial magnetic stimulation. 10 randomized controlled trials (RCTs) that met the inclusion criteria were included in this literature review and extracted data included sample size, sample characteristics, study design, rTMS protocol, and outcome measurement. All included studies applied rTMS to M1 (primary motor cortex). 10 studies included in this literature review reported that HF-rTMS (High-frequency rTMS) or iTBS (intermittent theta-burst stimulation) to the ipsilateral M1 and LF-rTMS (Low-frequency rTMS) to the contralateral M1 resulted in significant improvements in upper extremity assessments, so this literature review suggests that rTMS is beneficial for the recovery of upper extremity function in stroke patients.

Stroke patients have limited motor function due to ankle spasticity, and various interventions are applied to solve this problem. The purpose of this study was to investigate the effects of functional electrical stimula-tion (FES) with ankle exercise on spinal cord motor neuron excitability and balance in stroke patients. Twenty-five stroke patients were divided into the three groups. For the intervention, the control group applied general physiotherapy, the experimental group I applied a sham FES with ankle exercise, and the experimental group II applied a FES with ankle exercise. All groups applied the intervention for 30 min per ses-sion, 5 times a week, for a total of 8 weeks. The functional reaching test (FRT), Timed Up and Go test was used to measure balance ability, and H-reflex was used to measure spinal motor neuron excitability. All tests were measured before and after the intervention. In the ankle exercise with FES group, spinal motor neuron excitability significantly decreased (P<0.05), and FRT was significantly increased (P<0.05). Therefore, FES with ankle exercise for stroke patients could be suggested as an effec-tive intervention for improving motor function.

Purpose: This study investigated the effects of respiratory muscle training posture on respiratory muscle activation in stroke patients and presented appropriate posture for the respiratory muscle training. Methods: Thirty-six stroke patients were assigned to either a neutral training posture (n = 13), habitual training posture (n = 12), or side bending training posture (n = 11) group. Respiratory muscle training was conducted using an inspiratory muscle trainer. Each group was asked to adopt either a neutral, habitual, or side-bending posture during respiratory muscle training, which was performed for 30 minutes per day, 10 sets, 3 times per week, for a total of 6 weeks. After each session, external intercostal muscles and sternocleidomastoid muscle activity were measured via surface electromyography. Results: The paretic or non-paretic side intercostal muscle differed significantly in the three groups, and the non-paretic side intercostal muscle was significantly decreased in the neutral training group. The non-paretic side sternocleidomastoid muscle differed significantly in the three groups, and the nonparetic side sternocleidomastoid muscle was significantly increased in the habitual training group. Conclusion: A neutral posture, where appropriate spine and trunk alignment is maintained, is a more effective posture for respiratory muscle training for improving respiratory function in stroke patients.

Purpose: This study aimed to investigate the effects of visual feedback-based step training on balance and gait abilities in patients after stroke. Methods: In this study, 30 patients after stroke were randomly assigned to two groups of 15 participants each. The experimental group received conventional physiotherapy combined with visual feedback-based step training, whereas the control group received two sessions of conventional physiotherapy. Balance and gait abilities were assessed using the Berg balance scale (BBS), timed up & go (TUG) test, and 10-meter walk test (10MWT). Within- and between-group comparisons were analyzed using paired t-tests and analysis of covariance, respectively. Results: Both groups showed significant improvements in balance and gait abilities after the intervention (p<.05). The experimental group demonstrated significantly greater improvements in the BBS, TUG, and 10MWT scores, compared with the control group (p<.05) Conclusion: These findings suggest that visual feedback-based step training is an effective intervention for improving balance and gait abilities in patients after stroke. Further studies are needed to validate its long-term effects and optimize training protocols.

The purpose of this case report is to investigate the effects of real-time feedback from virtual reality gait training on the balance and gait abilities of a patient with post-stroke left hemiplegia. A 47-year-old male diagnosed with stroke caused by left basal ganglia intracerebral hemorrhage (ICH), resulting in right hemiplegia, participated in this case study. Notably, he exhibited hemiplegic symptoms on the right side. Physical therapy interventions included 30 minutes of virtual reality-based real-time feedback gait training, followed by 30 minutes of conventional physical therapy, consisting of Bobath, proprioceptive neuromuscular facilitation (PNF), range of motion exercises, stretching exercises, upper and lower extremity strengthening exercises, overground gait training, cycling, and treadmill gait training. The patient underwent a total of 60 minutes of training per session, conducted three times a week for eight weeks, amounting to a total of 24 sessions. Balance and gait ability were evaluated before the intervention, after four weeks, and after eight weeks. For the assessment of balance, the timed up and go test (TUG) and the berg balance scale (BBS) were utilized. Gait ability was evaluated using GaitRite. Following the intervention, the patient's BBS score improved from 41 to 45 in terms of balance ability, and the TUG result improved from 22.31 seconds to 19.85 seconds. In terms of gait ability, the 10-meter walk test result improved from 22.02 seconds to 19.65 seconds. The affected step length increased from 19.00 cm to 23 cm, while the stride length increased from 34.00 cm to 39 cm. Velocity improved from 1.0 km/h to 1.4 km/h, cadence increased from 50 steps per minute to 60 steps per minute, and single limb support improved from 22.8% of the gait cycle to 25.1% gait cycle. Virtual reality-based real-time feedback gait training had a positive impact on the rehabilitation of a patient with post-stroke left hemiplegia, demonstrating improvements in both balance and gait ability. These findings suggest that further studies are necessary to explore the broader effects of virtual reality-based real-time feedback gait training in patients with post-stroke left hemiplegia.

The aim of this study was to investigate the effect of mirror therapy combined with motion observation on grip strength in patients with chronic stroke. From April 2023 to June 2023, 20 patients with chronic stroke for more than 6 months were divided into two groups of 10 people each, and general mirror therapy and mirror therapy combined with motion observation training were applied once a week for 20 minutes for 10 weeks. The collected data were analyzed for general characteristics through descriptive statistics, and Wilcoxon signed-rank test was conducted to determine the difference in change before and after intervention between the experimental and control groups. The Mann–Whitney U test was used to compare post-intervention values and changes in outcome measures between the 2 groups. The grip strength showed a significant difference (p<.05) in palm grip strength and lateral grip strength in the mirror therapy group combined with motion observation (p<.05), but there was no significant difference in the traditional mirror therapy group (p>.05). There was no significant difference in 3-point grip strength and tip pinch grip strength in both groups (p>.05). Both mirror therapy combined with motion observation and traditional mirror therapy for chronic stroke patients showed a statistically significant increase in grip strength. Based on these results, it is expected that mirror therapy combined with motion observation using a tablet PC will help stroke patients recover their grip strength in the future. It is expected that it will develop into another therapeutic intervention method for functional recovery, and various and continuous research will be needed to prove its clinical value.

The purpose of this study was to investigate the interactive effect of cognitive function and intervention on walking independence of stroke patients. Stroke patients (n=405) who admitted to convalescent reha-bilitation ward, were classified as being walking independent or depen-dent. To examine the interaction between cognitive function and inter-vention, high cognitive function (functional independence measure score ≥20) and physical therapy and occupational therapy intervention delivered in 1 day (lasting >2 hr) were defined as cognition-intervention interaction and included as independent variables. The incidence of walking independence was calculated using Kaplan–Meier curves. In-tergroup differences were estimated using log-rank test. Cox propor-tional hazards analysis was used to extract the predictors of walking in-dependence. Survival analyses using Kaplan–Meier log-rank test showed that the probability of incidence of walking independence was significantly higher in the presence of a cognition-intervention interac-tion. The results of Cox proportional hazards analysis showed that age, left versus right cerebral damage, and cognition-intervention interac-tion significantly influenced walking independence at discharge from the hospital. The hazard ratios were 0.971 per year of age, 0.544 for left versus right cerebral damage, and 1.794 for cognition-intervention inter-action. Walking independence was more likely to be achieved by stroke patients with high cognitive function who received therapy. In other words, the conditions that increase the likelihood of an effect of therapy intervention on walking independence were identified in this study.

Age-related skeletal muscle changes may impact respiratory muscle function, and low muscle mass is associated with low pulmonary func-tion in older adults. Stroke not only causes weakness in the muscles of the upper and lower limbs, but it can also affect the respiratory system. This study aimed to investigate the relationships between grip strength and pulmonary function and respiratory muscle strength in stroke pa-tients over 50 years of age. Fifty-one patients (68.69±10.40 years) who had been clinically diagnosed with ischemic or hemorrhagic stroke were included in this study. We measured these patients’ forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and hand grip strength. The data were analyzed using descriptive statistics and Pearson correlation analysis. Grip strength showed significant correlations with FVC (r=0.686, P=0.000), FEV1 (r=0.607, P=0.000), PEF (r=0.494, P=0.000), MIP (r=0.239, P=0.091), and MEP (r=0.348, P=0.012). This study demonstrated that grip strength is associated with pulmonary function and MEP in stroke patients over 50 years of age.

The purpose of this study was to investigate the effects of coordinative locomotor training (CLT) on coordination and gait in chronic stroke pa-tients. Thirteen stroke patients were randomly assigned to one of two groups: The experimental group (EG, n=7) and control group (CG, n=6). After balanced random assignment, interventions were provided to all patients in twelve 30-min sessions during a 4-week period (3 sessions a week). The EG group underwent CLT after performing the sprinter and skater patterns in four postures. The CG group was provided with con-ventional neurodevelopment treatment. The primary outcomes were measured using the gait assessment and intervention tool (GAIT) as well as G-WALK. The secondary outcomes were measured using a 10-m walk test (10 MWT) and Timed Up and Go Test. There was no sta-tistically significant difference in the mean values between the two groups. Within both groups there were significant differences in GAIT and 10MWT. There were significant differences in gait speed and stride length in the experimental group, but not in the control group. CLT showed a more positive improvement in gait and coordination after stroke than conventional rehabilitation exercise.

The progression of ischemic stroke is associated with inflammatory re-sponse, in which the nuclear factor kappa B subunit 1 (NFKB1) plays an important role. The aim of present study was to determine whether pro-moter single nucleotide polymorphism (SNP) in the NFKB1 gene was contributed to susceptibility of ischemic stroke. One hundred twen-ty-one Korean adult patients with ischemic stroke (65.7±12.1 years in age) and 291 Korean healthy controls (63.0±9.3 years in age) were re-cruited. We genotyped a promoter SNP (rs11940017, -1727, C/T) of NFKB1 gene using direct sequencing in 121 Korean ischemic stroke pa-tients and 291 control subjects. The T/C genotype of rs11940017 SNP in the codominant model (vs. the T/T genotype) (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.15–0.92; P=0.032) and the genotype contain-ing C allele (T/C and C/C) in the dominant model (vs. the T/T genotype) (OR, 0.33; 95% CI, 0.14–0.81; P=0.0068) were associated with a de-creased risk of ischemic stroke. The frequency of C allele was de-creased in ischemic stroke patients, compared with control subjects (OR, 0.31; 95% CI, 0.13–0.74; P=0.008). These results suggest that the promoter SNP (rs11940017, -1727, C/T) of NFKB1 gene may affect isch-emic stroke susceptibility in Korean population.

배경: 뇌졸중 발병 후 인지 재활에서 주의력 장애는 주요하게 다루어지는 영역이며, 신경 보상 메커니즘을 통 해 삶의 질과 정서적 기능에 영향을 끼친다. 방법: 5명의 뇌졸중 환자를 대상으로 3~4주간 개별화된 NMT 중재를 실시하였다. 다중 척도 평가(MoCA, SDS, SS-QOL)를 사용하여 주의력과 변인 간 상관관계를 분석하였다. 결과: 주의력 향상(MoCA 주의력 하위 점수 증가)은 삶의 질 향상과 유의한 정적 상관(r = 0.629, p < 0.05)을 보였다. 인지 행동의 향상은 우울 증상과 유의한 부적 상관(r = -0.845, p < 0.05)을 나타내어, 인지 기능의 향상이 우울 상태를 완화시킬 수 있음을 시사한다. 결론: 개별화된 NMT는 뇌졸중 후 주의력 결함을 개선하는 데 있어 긍정적인 영향을 미친다. 주의력은 다차원적 뇌졸중 재활의 핵심 목표로 작용하여, 주의 과정의 재구조화를 통해 전반적인 회복을 촉진하는 가능성을 보여준다.

Background: Attention deficit is a major challenge in post-stroke cognitive rehabilitation and may affect quality of life and emotional function through neural compensation mechanisms. Methods: Five stroke patients received individualized Neurologic Music Therapy (NMT) over 3–4 weeks. Multimodal assessments (MoCA, SDS, SS-QOL) were used to examine the relationship between attention and cross-domain rehabilitation outcomes. Results: Improvements in attention, reflected by higher MoCA attention subscores, were significantly associated with better quality of life (r = 0.629, p < 0.05). Cognitive gains were significantly negatively correlated with depressive symptoms (r = –0.845, p < 0.05), indicating that improved cognition may reduce depressive states. Conclusions: Personalized NMT shows efficacy in addressing post-stroke attention deficits. Attention may serve as a central target in multidimensional rehabilitation, supporting recovery through the reorganization of attentional processes.

This study aimed to evaluate the effects of side walking training (SWT) using sandbags on the balance and walking abilities of stroke patients. The participant was a 72-year-old male diagnosed with a stroke. A single-subject experimental design combining an ABC design and a crossover treatment design (single-subject alternating treatments design) was utilized. The outcome measures included the timed up and go test (TUG) and the modified functional reach test (mFRT) for assessing balance, as well as the 10-meter walk test (10MWT) and the dynamic gait index (DGI) for evaluating walking ability. The intervention consisted of SWT with sandbags applied to the affected leg, incorporating both affected and unaffected side walking. Post-intervention results showed a decrease of 6.17 seconds in TUG, an increase of 3.67 cm in mFRT, a decrease of 7.49 seconds in 10MWT, and an increase of 3 points in DGI. These findings suggest that SWT using sandbags may assist in improving the balance and walking abilities of stroke patients. Further research in this area is warranted.