Objective
Survivors of critical illness commonly experience persistent physical, cognitive, and psychological impairments, collectively known as post-intensive care syndrome. Although intensive care unit (ICU) rehabilitation is now recognized as an important part of recovery after critical illness, rehabilitation practices remain inconsistent, and clinical practice guidelines adapted to the Korean healthcare context have not been available.
Methods
These clinical practice guidelines were developed de novo by a multidisciplinary panel comprising critical care physicians, rehabilitation specialists, nurses, and allied health professionals. The panel prioritized 15 key clinical questions addressing adult, pediatric, and neonatal ICU (NICU) rehabilitation. Systematic literature searches were conducted in Medline via PubMed, Embase, the Cochrane Library, and KoreaMed, and the final searches for all 15 questions were completed by November 30, 2024. The certainty of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Final recommendations were approved through a structured consensus process requiring at least 70% panel agreement.
Results
The panel issued 15 recommendations across major rehabilitation domains, including early structured rehabilitation, criteria for withholding or discontinuing therapy, adjunctive modalities, rehabilitation frequency, inspiratory muscle training, swallowing rehabilitation, cognitive and occupational therapy, nutritional support, neonatal and pediatric ICU rehabilitation, and post-ICU follow-up care. Thirteen recommendations were conditional, whereas two were strong, mainly because they addressed patient safety.
Conclusion
These guidelines provide evidence-informed recommendations for rehabilitation in critically ill patients across adult, pediatric, and NICUs in Korea. They are designed to standardize practice, improve patient safety, support patient-centered functional recovery beyond survival, and identify priorities for future research.

Objective
Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia.
Methods
Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology.
Results
Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended.
Conclusion
This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Citations

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  K.V. Shishin, I.Yu. Nedoluzhko, N.S. Semenova, A.V. Pyatakova, I.A. Pavlov, E.A. Grishina, V.V. Tsvirkun
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• Dysphagia Screening in Residential Long-Term Care Settings in the Republic of Ireland: A Cross-Sectional Survey
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• Cough Suppression Therapy in Patients With Chronic Refractory Cough and Oropharyngeal Dysphagia
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  Mohan Li, Shan Jiang, Jiaojiao Li, Xiling Chen, Lan Ma, Qihao Guo, Yuehui Wang, Lan Luo, Liping An, Yonghua Wu, Wei Huang, Ludan Yuan, Lin Wang, Xiping Ding, Xujing Zhao, Zhongyuan Zhang, Hongyu Zhang, Yin Wu, Rong Yang, Yang Liu, Jian Cao, Xiaohong Liu
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• A dysphagia és a neglektszindróma kapcsolata a rehabilitáció során
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• Clinical and Economic Impact in Dysphagia Management: A Preliminary Economic Evaluation for the WeanCare-Dysphameal Approach
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Objective
To investigate the comprehensive outcomes in aphasic patients, including their cognitive and functional status after ischemic or hemorrhagic stroke. It also aimed to clarify whether aphasia is a prognostic factor for cognitive and functional improvements in stroke patients.
Methods
Sixty-seven ischemic or hemorrhagic stroke patients in the subacute stage who had been diagnosed with aphasia using the Korean version of Frenchay Aphasia Screening Test (K-FAST) were included in the study. Forty-six stroke patients without aphasia were used as controls. All patients were examined with the Korean version of the Western Aphasia Battery (K-WAB). Cognitive and functional assessments of the patients including the Korean version of Mini-Mental State Examination (K-MMSE), and the Korean version of Modified Barthel Index (K-MBI) were performed during admission and 4 weeks after the initial assessments.
Results
The initial and follow-up total K-MMSE and K-MBI scores were significantly lower in aphasic patients than in non-aphasic controls. The K-WAB scores highly correlated with the total K-MMSE scores at the follow-up stage in all aphasic stroke patients. The K-WAB scores moderately correlated with the follow-up scores of the K-MBI in ischemic stroke patients but not in hemorrhagic stroke patients.
Conclusion
Aphasia influences the cognitive and functional status of stroke patients and has a greater impact on cognitive improvement. Aphasia severity can be one of the prognostic factors for cognitive status in aphasic patients with stroke.

Citations

• Possibilities of functional outcome prediction in patients with acute ischemic stroke, who did not receive reperfusion therapy
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  Russian neurological journal.2025; 30(1): 16.     CrossRef
• Factors influencing the choice of rehabilitation measures for a disabled person with consequences of acute stroke
  Olga I. Khokhlova, Elena M. Vasilchenko, Yana A. Denisova
  Medical and Social Expert Evaluation and Rehabilitation.2025; 28(1): 39.     CrossRef
• The effectiveness of drug therapy in the rehabilitation of patients with post-stroke aphasia
  S.V. Kotov, E.V. Isakova, M.M. Shcherbakova, V.A. Zenina
  S.S. Korsakov Journal of Neurology and Psychiatry.2024; 124(11): 132.     CrossRef
• The Effect of Rehabilitation without Specific Cognitive Rehabilitation on the Improvement of Cognitive Functions in Stroke Patients: Evaluation with Risk Factors
  İlker Fatih SARI, Evren ER, İlker İLHANLI, Fazıl KULAKLI, Nurçe ÇİLESİZOĞLU YAVUZ
  Medical Records.2023; 5(2): 277.     CrossRef
• A Novel Telerehabilitation Approach for Cognitive-Language Therapy in Chronic Stroke Subjects With Aphasia: Neurocognitive Intervention Through Neurorehabilitation Exercises and Assessments
  Francesco Infarinato, Paola Romano, Francesco Adinolfi, Marco Franceschini, Roberta Ginocchi, Michela Goffredo, Marco Ottaviani, Marianna Valente, Sanaz Pournajaf
  IEEE Robotics & Automation Magazine.2023; 30(1): 84.     CrossRef
• Comparing the brain–behaviour relationship in acute and chronic stroke aphasia
  Natalie Busby, Argye E Hillis, Lisa Bunker, Chis Rorden, Roger Newman-Norlund, Leo Bonilha, Erin Meier, Emily Goldberg, Gregory Hickok, Grigori Yourganov, Julius Fridriksson
  Brain Communications.2023;[Epub]     CrossRef
• A Comparative Analysis of Functional Status and Mobility in Stroke Patients with and without Aphasia
  Zbigniew Guzek, Wioletta Dziubek, Małgorzata Stefańska, Joanna Kowalska
  Journal of Clinical Medicine.2022; 11(12): 3478.     CrossRef
• Cross-validation of predictive models for functional recovery after post-stroke rehabilitation
  Silvia Campagnini, Piergiuseppe Liuzzi, Andrea Mannini, Benedetta Basagni, Claudio Macchi, Maria Chiara Carrozza, Francesca Cecchi
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• Current view on post‐stroke dementia
  Jakub Droś, Aleksandra Klimkowicz‐Mrowiec
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• Cognitive and psychoemotional impairment dynamics in patients with hemorrhagic hemispheric stroke at the early rehabilitation stage
  Svitlana Medvedkova, Anastasiia Dronova
  Ukrains'kyi Visnyk Psykhonevrolohii.2021; (Volume 29,): 27.     CrossRef

Objective
To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on neurological and functional recovery in patients with central cord syndrome (CCS) involving the upper extremities between the treated and non-treated sides of the treated group and whether the outcomes are comparable to that of the untreated control group.
Methods
Nineteen CCS patients were treated with high-frequency (20 Hz) rTMS over the motor cortex for 5 days. The stimulation side was randomly selected, and all the subjects received conventional occupational therapy during the rTMS-treatment period. Twenty CCS patients who did not receive rTMS were considered as controls. Clinical assessments, including those by the International Standard for Neurological Classification of Spinal Cord Injury, the Jebsen-Taylor Hand Function Test, and the O'Connor Finger Dexterity Test were performed initially and followed up for 1 month after rTMS treatment or 5 weeks after initial assessments.
Results
The motor scores for upper extremities were increased and the number of improved cases was greater for the treated side in rTMS-treated patients than for the non-treated side in rTMS-treated patients or controls. The improved cases for writing time and score measured on the Jebsen-Taylor Hand Function Test were also significantly greater in number on the rTMS-treated side compared with the non-treated side and controls. There were no adverse effects during rTMS therapy or the follow-up period.
Conclusion
The results of the application of high-frequency rTMS treatment to CCS patients suggest that rTMS can enhance the motor recovery and functional fine motor task performance of the upper extremities in such individuals.

Citations

• Therapeutic efficacy of repetitive transcranial magnetic stimulation on gait and limb balance function in patients with lower limb dysfunction post-cerebral infarction: a systematic review and meta-analysis
  De-mei Jia, Xuan Li, Bin-cang Zhang, Bing-ran Zhang, Qiu-juan Zhang, Ming-wei Liu, Lin-ming Zhang
  BMC Neurology.2025;[Epub]     CrossRef
• Stimulation Parameters Used During Repetitive Transcranial Magnetic Stimulation for Motor Recovery and Corticospinal Excitability Modulation in SCI: A Scoping Review
  Nabila Brihmat, Didier Allexandre, Soha Saleh, Jian Zhong, Guang H. Yue, Gail F. Forrest
  Frontiers in Human Neuroscience.2022;[Epub]     CrossRef
• rTMS induces analgesia and modulates neuroinflammation and neuroplasticity in neuropathic pain model rats
  Roberta Ströher Toledo, Dirson João Stein, Paulo Roberto Stefani Sanches, Lisiane Santos da Silva, Helouise Richardt Medeiros, Felipe Fregni, Wolnei Caumo, Iraci L.S. Torres
  Brain Research.2021; 1762: 147427.     CrossRef
• Research on Assisting Clinicians to Operate rTMS Precisely Based on the Coil Magnetic Field Spatial Distribution With Magnetic Resonance Imaging Navigation
  Shijun Li, Yi Wang, ShengJie Li, Yanwei Lv, Lei Zhang, Jun Zou, Lin Ma
  Frontiers in Neuroscience.2019;[Epub]     CrossRef
• Effects of Combined Upper Limb Robotic Therapy in Patients With Tetraplegic Spinal Cord Injury
  Joo Hwan Jung, Hye Jin Lee, Duk Youn Cho, Jung-Eun Lim, Bum Suk Lee, Seung Hyun Kwon, Hae Young Kim, Su Jeong Lee
  Annals of Rehabilitation Medicine.2019; 43(4): 445.     CrossRef