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The purpose of this study is to investigate predictors of crossed cerebellar diaschisis (CCD), and the effects of CCD on functional outcomes including motor function, activities of daily living, cognitive function, and ambulation 6 months after onset in patients with intracerebral hemorrhage (ICH).
A total of 74 patients experiencing their first ICH were recruited. If the asymmetric index was more than 10% using single photon emission computed tomography (SPECT), a diagnosis of CCD was confirmed. Clinical factors were retrospectively assessed by reviewing medical records. Radiologic factors encompassed the concomitance of intraventricular hemorrhage, side and location of the lesion, and hemorrhage volume. Functional outcomes were evaluated using the Fugl-Meyer Assessment, the Korean version of the Mini-Mental State Examination, the Korean version of the Modified Barthel Index, and measurement of the Functional Ambulatory Category at the time of SPECT measurement and 6 months post-ICH.
Lesion location, especially in the basal ganglia (odds ratio [OR]=6.138, p=0.011), and hemorrhagic volume (OR=1.055, p=0.046) were independent predictors for CCD according to multivariate logistic regression analysis. In addition, the presence of CCD was significantly related to the improvement in Fugl-Meyer Assessment score after 6 months (adjusted R2=0.152, p=0.036).
Lesion location and hemorrhagic volume were the predisposing factors for CCD, and the CCD was associated with poor motor recovery over 6 months in patients with hemorrhagic stroke.
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To identify predictors for depressive mood in geriatric patients after traumatic brain injury (TBI).
A retrospective review of patients' medical charts was performed in TBI patients who were older than 60 years and referred to the Department of Rehabilitation Medicine at Severance Hospital in 2002–2016. The patients were classified into two groups based on the Geriatric Depression Scale (GDS): non-depressive group (0≤GDS≤16) and depressive group (17≤GDS≤30). Data was collected on demographic, socioeconomic, comorbidities, and trauma-related factors, as well as the pathophysiology of TBI, localization of lesion, post-traumatic complications, functional level, and cognitive and linguistic function. Significant variables from univariate analysis were analyzed using logistic regression.
Forty-two patients were included, of whom 64.3% displayed a depressive mood. Patients in the depressive group had higher comorbidity scores (p=0.03), lower Functional Independence Measure (FIM) totals (p=0.03) and FIM motor (p=0.03) scores, higher modified Rankin Scale scores (p=0.04), and frequently had a bilateral or left side brain lesion (p=0.002). Higher comorbidity scores (odds ratio [OR], 1.764; 95% confidence interval [CI], 1.047–2.971), bilateral lesions (OR, 13.078; 95% CI, 1.786–95.780), and left side lesions (OR, 46.074; 95% CI, 3.175–668.502) were independently associated with a depressive mood in the multiple logistic regression analysis.
The risk of depressive mood in geriatric patients after TBI is associated with comorbidity, functional limitation, and the horizontal distribution of brain lesions. The most significant determining factors were comorbidity and the horizontal distribution of brain lesions. Early detection of risk factors is important to prevent and manage depressive mood in geriatric patients after TBI.
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To assess the risk factors for delirium in patients admitted to a rehabilitation unit for acute or subacute neurological or musculoskeletal disorders.
We reviewed the medical records of 537 patients admitted to a rehabilitation unit and selected 398 patients in the acute or subacute stage of various neurological or musculoskeletal disorders. Among them, patients who had suffered from delirium were categorized into the delirium group (n=65), and the other patients were categorized into the non-delirium group (n=333). As potential risk factors for delirium, the patients' diagnosis, underlying disease, demographic data, hospital stay duration, surgery, and laboratory findings were reviewed, and the differences between the two groups with respect to independent risk factors were analyzed.
The average age in the delirium group was higher; the hospital stay and pre-transfer periods were longer. A large proportion of the patients were admitted for musculoskeletal disorders, and many patients had diabetes mellitus, dementia, and depression as underlying diseases. Laboratory tests revealed increases in the white blood cells (WBC), glucose, blood urea nitrogen (BUN), total bilirubin, aspartate transaminase (AST), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels in the delirium group, while the hemoglobin, calcium, phosphorus, protein, albumin, and potassium levels were decreased. Depression, musculoskeletal disorders, traumatic brain injury, elevated WBC, BUN, AST, and CRP levels, and decreased potassium and phosphorus levels were identified as independent risk factors for delirium.
Risk factors treatable before delirium onset were identified in rehabilitation patients in acute and subacute stages of various disorders. Early diagnosis and prevention of these risk factors could decrease delirium occurrence and increase rehabilitation effectiveness.
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To identify predictive factors of depressive mood in patients with isolated cerebellar stroke.
A retrospective chart review was performed in patients who had experienced their first isolated cerebellar stroke during 2002–2014. The patients were classified into two groups by the Geriatric Depression Scale (GDS) (non-depressive group, 0≤GDS≤16; depressive group, 17≤GDS≤30). Data on demographic and socioeconomic factors, comorbidities, functional level, cognitive and linguistic function, and stroke characteristics were collected. Significant variables in univariate analysis were analyzed using logistic regression.
Fifty-two patients were enrolled, of whom 55.8% had depressive mood, were older (p=0.021), and had higher hypertension rates (p=0.014). Cognitive and linguistic functions did not differ between the two groups. The depressive group had higher ischemic stroke rates (p=0.035) and showed a dominant right posterior cerebellar hemisphere lesion (p=0.028), which was independently associated with depressive mood in the multiple logistic regression analysis (odds ratio, 5.081; 95% confidence interval, 1.261–20.479).
The risk of depressive mood after cerebellar stroke was increased in patients at old age, with a history of hypertension, ischemic stroke, and lesion of the right posterior cerebellar hemisphere. The most significant determining factor was stroke lesion of the right posterior cerebellar hemisphere. Early detection of risk factors is important to prevent and manage depressive mood after cerebellar stroke.
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To evaluate the effect of post-stroke depression (PSD) on rehabilitation outcome and to investigate the risk factors of PSD, especially, the role of caregivers type (family or professional) in subacute stroke patients.
Two hundred twenty-six stroke patients were enrolled retrospectively. All the subjects' basic characteristics, Korean version of the Beck Depression Inventory (K-BDI), Korean version of the Modified Barthel Index (K-MBI), and the modified Rankin Scale (mRS) were recorded when the patient was transferred into the Department of Rehabilitation Medicine and at the time of discharge. The results were statistically analyzed by using SPSS ver. 20.0.
The patients' K-BDI score showed a significantly negative association with K-MBI at discharge (β=-0.473, p<0.001) and a significantly positive association with the mRS score at discharge (β=0.316, p<0.001). Patients with lesions on the left hemisphere (odds ratio [OR], 3.882; 95% confidence interval [CI], 1.726-8.733) and professional caregiver support (OR, 0.028; 95% CI, 0.012-0.065) had a higher rate of depression.
Depression was prevalent in stroke patients, and it had a negative effect on patients' functional outcome. Patients who had a lesion on the right hemisphere had less depression. The type of caregiver was related to the incidence of subacute PSD, and family caregivers were found to lower the frequency of stroke patients' depression.
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Method: The subjects were 529 patients, who were admitted at the Kyung Hee Medical Center from January 2000 to February 2001. Data collection was done through chart reviews, telephone interviews, and mail. Main measures included smoking status, alcohol use, and obesity. Chisquare test and multiple logistic regression were used to determine sociodemographic differences in these measures.
Results: At 1 year after stroke, 11.2% of patients still smoked, 31.4% of patients were obese, and 13% drank excessively. Younger patients and patients with high blood pressure were more likely to smoke. Younger patients were more likely to drink excessively. Women, patients with diabetes, and those living in the metropolitan areas were more likely to be obese.
Conclusion: Different behavioral risk factors were associated with specific sociodemographic groups within the stroke population. After stroke, high-risk groups should continue to be targeted to prevent stroke recurrence. (J Korean Acad Rehab Med 2003; 27: 500-506)
Objective: This is a study to evaluate relationships between the occurrence of lymphedema and clinicopathologic factors in postmastectomy patients.
Method: We studied 448 patients who underwent breast cancer surgery during the periods from January 1998 to December 2000, of which 69 patients developed lymphedema during the follow up period. We investigated the medical records of these follow-up patients. The general characteristics were tested by a chi-square test and student t-test and the possible risk factors were comparatively analyzed on these patients by a multiple logistic regression analysis.
Results: The incidence of lymphedema was significantly high with higher stages (p＜0.05). The incidence of lymphedema was significantly high in higher N staging, but not in higher T staging. Patients who received radiation therapy also showed higher incidence rates (p＜0.05). Patients who underwent Patey procedure showed higher incidence than those who underwent Auchincloss procedure. With increasing age, more lymphedema developed (p＜0.05).
Conclusion: These results suggest that the stage of tumor, state of lymph node metastasis, methods of surgical treatment, use of irradiation, and patient's age are the possible risk factors for the development of lymphedema. These risk factors might be useful as clinical indices for the prevention of postmastectomy lymphedema. So, we have to exert our efforts to minimize the development of lymphedema. (J Korean Acad Rehab Med 2002; 26: 475-479)
Objective: The purpose of this study was to investigate the prevalence of and risk factors for carpal tunnel syndrome in a rural population in Korea.
Method: Among the 1004 residents in a rural district who participated in the health examination, 450 (165 male, 285 female) adults aged between 30 and 79 years were randomly selected. Hand symptom questionnaire and electrodiagnostic studies were used to diagnose and classify carpal tunnel syndrome. General characteristics, female-related factors, work-related factors and anthropometric measurements were compared between normal and carpal tunnel syndrome group to identify the risk factors for carpal tunnel syndrome.
Results: Subjects with carpal tunnel syndrome were 76 (16.9%), symptom only subjects were 168 (37.3%), asymptomatic slowing 27 (6.0%) and peripheral polyneuropathy were 16 (3.6%). Age, farming, body mass index and wrist depth width ratio were associated with risk of carpal tunnel syndrome and odds ratio were 1.03 (95% confidence interval 1.01∼1.07), 2.62 (95% confidence interval 1.17∼5.86), 2.24 (95% confidence interval 1.14∼4.40) and 3.13 (95% confidence interval 1.64∼5.96), each.
Conclusion: These data suggest that the prevalence of carpal tunnel syndrome is high in a rural population and physical factors like wrist shape and body mass index, occupation and aging are associated with risk of carpal tunnel syndrome.
Objective: This study was done to evaluate the risk factors associated with recurrence after first-ever stroke.
Method: We retrospectively studied 256 first-ever stroke patients treated in Dong-Eui hospital from March 1997 to February 1998. Telephone or out-patient interviews were performed with these patients regarding stroke recurrence and treatment for hypertension and diabetes mellitus. These were divided into two groups, those with recurrence and those without. Evaluated risk factors for stroke recurrence were the following: history of diabetes mellitus, hypertension, heart disease, smoking, alcohol drinking, and transient ischemic attack; clinical findings at admission of hypertension, diabetes mellitus, hyperlipidemia, heart disease, type and location of stroke; treatment compliance for diabetes mellitus and hypertension after discharge.
Results: The recurrence rate after first-ever stroke was 12.9%. In univariate analysis, significant risk factors for stroke recurrence were history of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge (p＜0.05). In multivariate analysis, significant risk factors for stroke recurrence were atrial fibrillation at admission (odds ratio=3.43) and non-compliance with therapy for hypertension after discharge (odds ratio=7.51)(p＜0.05).
Conclusion: History of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge are considered to be important factors for recurrence of stroke. So treatment and education for those factors associated with stroke recurrence are needed during rehabilitation program.
Objective: The present study evaluated the characteristics and natural history of stroke patients.
Method: Seven hundred and sixty seven consecutive patients admitted through acute care facility were reviewed. All medical records including age, case fatality, risk factors and radiological findings including CT or MRI were reviewed. To investigate the activities of daily living (ADL) of stroke patients, follow-up study was done in 303 patients through telephone interview or direct contact. Stroke was subdivided into cerebral infarct, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH).
Results: The proportion of stroke subtypes were infarct (45.9%), ICH (34.7%) and SAH (19.4%). The recurrence rate of stroke was higher in the infarct patient. Higher percentage of fatality was noted in the SAH patient. Higher incidence of hemorrhage was still observed compared to western country. Hypertension is the major risk factors for all stroke subtypes. But among hypertensive individuals, only 29% patients controlled the hypertension. Fifty-eight percent of stroke patients regained independent ADL.
Conclusion: The result of this study shows the clinical pictures of stroke patients. Further research was needed to investigate the trends of stroke and control of risk factors and attention must be paid to the patients who is dependent in ADL.
Objective: The purposes of this study were 1) to evaluate the effectiveness of follow-up urologic evaluation of neurogenic bladder in patients with spinal cord injury, 2) to define risk factors causing upper urinary tract complications, and 3) to evaluate changes of the vesicoureteral reflux grade on follow-up study.
Method: Urodynamic studys, ultrasonographys, and voiding cystourethrographys of 90 patients with spinal cord injury who admitted to the bladder clinic of National Rehabilitation Hostpital were evaluated. Of the 90 patients, twenty four patients (27%) had upper urinary tract complication (vesicoureteral reflux or hydronephrosis). The risk factors of upper urinary tract complication were compared. The patients who had vesicoureteral reflux were devided into two main groups: conservative medical treatment group (oxybutynin, atropine intravesical instillation and intermittent catheterization) and primary surgical treatment group, and then the changes of the vesicoureteral reflux grade on follow-up study were evlauated.
Results: 1) The incidence of upper urinary tract complication was 27% for all patients. After bladder clinic evaluation, the patients who were recommended the change of the voiding mothods were 24%, and 58% of the patients were need management to decrease maximal detrusor pressure.
2) Maximal bladder capacity by clinical voiding chart recording (≤250 ml), bladder wall deformity (≥trabeculation grade 2), leak point pressure (≥40 cmH20), and maximal detrusor pressure (≥90 cmH2O) were significantly different between patients with upper urinary tract complication and patients without that. 3) In the eight vesicoureteral reflux patients, five of six patients were cured or improved with conservative treatment and two patients were cured with surgical treatment.
Conclusion: The periodic follow-up evaluation of neurogenic bladder of spinal cord injured patients was important to prevent upper urinary tract deterioration. The factors related upper urinary tract complication were clinical bladder capacity, leak point pressure, bladder wall deformity (trabeculation) and maximal detrusor pressure.
Objective: To observe the prognostic value of brainstem auditory evoked potentials (BAEP) for prediction of cerebral palsy (CP) in the high-risk neonates.
Method: Eighty-one high-risk neonates were subjected to take the history of illness, neurological examination, developmental assessment, BAEP study within one month after birth. They had been checked for detection and management of the CP in period of 12 to 56 months after birth. Associating factors were observed about their gestational age at birth, 1-minute Apgar score, history of asphyxia and/or intubation, and hyperbilirubinemia and/or exchange transfusion.
Results: Abnormal BAEP findings were seen in 38 of 81 (46.9%) high-risk neonates and 6 of 81 (7.4%) were diagnosed as a CP. Five of 6 CPs and 42 of 75 non-CPs had been abnormal in BAEP study. Neonatal BAEP study showed 83.3% sensitivity, 44% specificity, 98.4% false positive and 2.9% false negative in predicting CP. Asphyxia showed high correlation with abnormality of BAEP and CP (p＜0.01). Gestational age, low birth weight, toxemia, germinal matrix hemorrhage (GMH) grade II and intubation were correlated with CP (p＜0.05) but not with the abnormality of BAEP.
Conclusion: It is suggested that BAEP study of high-risk neonate is useful in prediction of CP because of low false negative and high sensitivity.
Objective: The purpose of this study is to present the epidemiological data on patients with a stroke admitted to the severance hospital, Yonsei University College of Medicine (YUMC) and to investigate the significant risk factors of stroke.
Methods: We reviewed medical records of 532 patients with a stroke admitted to the hospital of from 1992 to 1996 retrospectively.
Results: The incidence was highest in the sixth decade. Ischemic stroke (64.3%) was more common than a hemorrhagic stroke (35.7%) and the thrombotic infarction was the leading type (28.3%) of all kinds of stroke. Middle cerebral arterial territory was the most commonly involved site for the thrombotic and embolic stroke. Of the intracerebral hemorrhages, basal ganglia (48.4%) was the most commonly involved site with was followed by the thalamus (24.2%), lobar (19.3%), and cerebellum (6.5%). In subarachnoid hemorrhages, the aneurysm was most frequently located in the middle cerebral artery (34.4%). The possible contributing factors of stroke were hypertension, hypercholesterolemia, cigarette smoking and diabetes mellitus. The common complications during hospitalization were the frozen shoulders, depression, pneumonia, reflex sympathetic dystrophy (RSD), and hydrocephalus.
Conclusion: This study showed the changing trends of stroke in its distribution of subtypes. Multicenter prospective study using stroke registry would be required for the determination of national epidemiologic trends.
The correction of risk fators is very important in the prevention of stroke. This study was designed to investigate the risk factors of stroke patients and to correlate these risk factors with Functional Independence Measure(FIM) scores to be used for possible prognostic values in rehabilitation program.
The subjects were 75 patients from 36 to 84 years of age. Data collection was done through chart reviews on risk factors of stroke including hypertension, transient ischemic attacks or previous stroke history, diabetes mellitus, heart disease, cigarette smoking, alcohol intake and hypercholesterolemia. Risk factors in stroke by the order of frequency were hypertension(68.0%), previous stroke history(38.7%), heart diseases(22.7%), hypercholesterolemia(24.0%), and diabetes mellitus(16.0%). The frequency of hypercholesterolemia, diabetes mellitus, heart disease, smoking in cerebral infarction group was higher than in intracerebral hemorrhagic group. There was no stastically significant correlation between risk factors and FIM scores.
The results suggest that hypertension was the most important risk factor in stroke and the rate of risk factors was higher in cerebral infarction than in cerebral hemorrhage.
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