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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 assess the well-being of preterm newborns using the Bayley-III scales in a Korean-based population, and to evaluate the perinatal risk factors influencing developmental outcome.
Using the Bayley-III scales, we assessed 120 preterm infants who were referred for evaluation of neurodevelopmental performance. We subdivided them into an extremely preterm group (n=18) and a very/moderate to late preterm group (n=102). Bayley-III mean scores and the rate of infants showing a delay were compared for both groups. The relationship between perinatal risk factors and Bayley-III scores was analyzed. The risk factors were considered as very low birth weight, history of neonatal medical problems, and abnormal radiologic findings in brain magnetic resonance images (MRIs).
Although no significant differences in mean scores were observed between the extremely preterm group and the very/moderate to late preterm group, the rate of babies showing developmental delay in motor composite scores was significantly higher in the extremely preterm group. The proportions of preterm infants with cognitive, language, and motor delays were 38.3%, 26.7%, and 35.0%, respectively. Very low birth weight was a significant risk factor for low cognitive, language, and motor composite scores. Also, abnormal radiologic findings on brain MRI were significant indicators of lower motor composite scores.
Cognitive development was the most frequently delayed domain in preterm infants and motor development was more frequently delayed in the extremely preterm group. The very low birth weight and abnormal radiologic findings in brain MRI were predictive factors for neurodevelopmental outcome.
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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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To identify risk factors for developing a vertebral refracture after percutaneous vertebroplasty.
A retrospective analysis of 60 patients who had undergone percutaneous vertebroplasty between January 2008 and April 2010 was conducted. All patients were observed for a 1 year follow-up period, and fracture was defined when it was both clinically reported and radiographically confirmed. Twenty-seven patients with a refractured vertebra and 33 patients without a refracture were included. Of the 60 patients, 20 presented with a refracture from a cemented vertebra, whereas the remaining 40 patients did not. Clinical, imaging and procedure-related factors for each group were analyzed by the Fisher's exact, chi-square, and the Mann-Whitney
Local kyphotic angle and sagittal index were significant as a result of researching various risk factors related to vertebral refracture (p<0.001, p<0.001, respectively) and refracture from a cemented vertebra itself (p=0.004, p<0.001, respectively). Other factors were not significant.
Patients who had a high preoperative local kyphotic angle and a high sagittal index required a close follow-up and attention.
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MethodThe adult patient who were admitted to the ICU and taken ventilator care with endotracheal intubation were included. The time after admission was 48 to 144 hours. In case of axonal neuropathy of peripheral nerve, if affected nerves were in different two limbs or different three nerves were affected, CIP was diagnosed. If some nerves got abnormal results but did not satisfied the above criteria, the patient was classified as peripheral neuropathy group. The days of using neuromuscular blockade, continuous insulin infusion, catecholamine, vasopressor, corticosteroid, benzodiazepine, parenteral nutrition and fact for continuous renal replacement therapy, SOFA (sequential organ failure assessment) score were evaluated to find the risk factors.
ResultsEighteen patients were included. Six patients were CIP and another six were peripheral neuropathy. Risk factors for CIP were age, duration of intensive care, days of neuromuscular blockade and parenteral nutrition (p＜0.05). There was no difference on mortality rate among the three groups.
ConclusionThe result of early electrodiagnosis on ICU patients for CIP diagnosis revealed that risk factors of CIP were age, duration of intensive care, days of neuromuscular blockade and parenteral nutrition.
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: To estimate the probable cause and the time of cerebral insult in cerebral palsy (CP) based on MRI findings and risk factors.
Method: The subjects comprised all sixty-seven patients with CP showing abnormal MRI findings between March 1999 and September 2001 at the Catholic University of Korea, St. Mary's Hospital. A detailed medical history was available for all patients including those not born in our hospital. They ranged in age from two months to five years. We analyzed the brain magnetic resonance (MR) findings of patients with CP to correlate the probable cause and the time of cerebral insult through the consideration of medical histories including prenatal, perinatal and postnatal histories.
Results: Of the 67 MRIs, abnormalities were the followings; periventricular leukomalacias (PVLs) in 49 cases, cortical or subcortical infarction in 4 cases, brain atrophy in 7 cases, neuronal migration disorder in 4 cases, and delayed myelination in 3 cases. Among the patients with PVL, perinatal risk factors were responsible for cerebral insult in preterm, but pre- and perinatal contribution were similar in patients born at full term. Among the patients with cerebral infarction, only one case with meningitis at 11 months was suspected for cerebral insult. These patients had no risk factor as a peri- or post-natal etiology. Four patients with neuronal migration disorder had no risk factor for peri- or postnatal etiology except for the one who was a twin.
Conclusion: Review of brain MRI findings such as PVL, infarct, neuronal migration disorder and a detailed medical history including prenatal and perinatal etiology would be a useful method to estimate the probable cause and the time of cerebral insult in CP. (Korean Acad Rehab Med 2002; 26: 508-513)
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: To investigate the correlation of main risk factors and cognitive-perceptual functions of stroke patients assessed with Mini-mental status examination (MMSE) and Motor-free visual perception test (MVPT) scores.
Method: Subjects were 41 stroke patients from 35 to 70 years of age. Data collection was done through chart review on risk factors of stroke including hypertension, diabetes mellitus, heart disease, hypercholesterolemia, and cigarette smoking. Three months after the onset of stroke, MMSE and MVPT were performed.
Results: The subjects with diabetes had significantly lower scores in MMSE (p＜0.05) and MVPT (p＜0.05) compared to those with nondiabetics. The subjects with left hemispheric lesion scored higher in MMSE than those with right hemispheric lesion (p＜0.05).
Conclusion: Among the several risk factors, diabetes mellitus has significant relationship to cognitive and visual perceptual function in the stroke patients.
Objective: To examine the correlation between the prevalence and the risk factors of low back pain.
Method: The number of subjects in this study was 575 men and 325 women who have visited the health center of the CHA hospital. The prevalence of low back pain was evaluated and the risk factors were assessed by history taking, physical examination and the questionnaires. Estimated factors influencing low back pain were age, sex, height, weight, body mass index, waist to hip ratio, range of motion, smoking, alcohol drinking, fitness and other disease.
Results: 1) Low back pain was correlated with age, sex, waist to hip ratio, flexibility, arthritis, nervous and depressive disorder and daily activities. 2) Chronic low back pain was correlated with age, right lateral bending, arthritis, cardiovascular disorder and daily activities. 3) Radicular symptom was correlated with age, left and right lateral bending, smoking, exercise, arthritis, nervous and depressive disorder, diabetes and daily activities. 4) Height, weight, body mass index and alcohol drinking had no correlation with low back pain.
Conclusion: Understanding of the risk factors for low back pain will be helpful for providing objective standards for assessment of low back pain and preventing occurrence and recurrence of low back pain.
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: To investigate the survival rate and the prevalence of cerebral palsy in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants as well as the risk factors for the development of cerebral palsy.
Method: We reviewed medical records of 471 VLBW infants admitted to Asan medical center from 1989 to 1997 retrospectively.
Results: Ninety seven infants died before discharge from hospital, 7 died during follow-up, 55 status unknown due to discharge against medical advice, 26 discontinued follow-up. At corrected chronologic age of 2 years old, the prevalence of cerebral palsy was 10.5%, delayed development 4.5% and normal development 85.0%. Survival rate and prevalence of cerebral palsy among survivors remained statistically insignificant with time. Cerebral palsy was found in 8.5% of VLBW and 19.2% of ELBW. Decreasing gestation, abnormal neurosonographic findings, assisted ventilation, bronchopulmonary dysplasia, sepsis were risk factors associated with increased odds for cerebral palsy.
Conclusion: The prevalence of cerebral palsy in VLBW infants admitted to this hospital were comparable with recent studies from developed countries, and some of the predictors of cerebral palsy, ie, gestation period, neurosonographic findings, history of respirator use and sepsis, were also similar to those of western countries.
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: To investigate the frequency, nature and risk factors of musculoskeletal problems in pregnancy.
Method: We obtained the information through a questionnaire and physical examination of full-term (gestational age over 38 weeks) pregnant women. Prevalence, onset time, severity and risk factors of musculoskeletal problems were analyzed.
Results: Among the 70 pregnant women, 37 women (53%) complained of low back pain which was the most common musculoskeletal problem in pregnancy. Other problems were hand symptoms (31%), lower extremity joint pain (31%), leg cramp (29%), chest pain, shoulder pain and neck pain. Previous history of low back pain was significantly correlated with the occurrence of low back pain in pregnancy. Weight gain during pregnancy and amount of time of housework during pregnancy were significantly correlated with carpal tunnel syndrome. Pregnant women suffering from leg cramp were significantly old in age.
Conclusion: Prevalence of musculoskeletal problems during pregnancy was relatively high and several risk factors were related with occurrence of those problems. So, prophylactic risk factor control would be necessary to reduce musculoskeletal problems during pregnancy.
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