Bo Ryun Kim

Cardiovascular fitness as a predictor of functional recovery in subacute stroke patients

Abstract Purpose: To investigate the correlation between baseline cardiovascular fitness and functional status, and whether baseline cardiovascular fitness is of predictive value in terms of functional recovery after rehabilitation in subacute stroke patients. Method: This study was a descriptive, observational cohort study. Fifty-five subacute stroke patients (37 males and 18 females; average age, 62.2 years) were enrolled for this study, and all subjects underwent symptom-limited low-velocity graded treadmill testing. Baseline assessments included cardiovascular fitness, 6-min walk test (6MWT), Korean-Modified Barthel Index (K-MBI) and Motricity Index (MI). Four weeks after rehabilitation, K-MBI was measured repeatedly. Results: Mean peak oxygen consumption (Vo2 peak) was 19.7 ± 6.7 mL/kg/min. Baseline K-MBI correlated significantly with Vo2 peak, peak heart rate (HR), 6MWT and MI, and in regression analysis, Vo2 peak and MI were significant independent predictors of baseline K-MBI. Follow-up K-MBI correlated significantly with Vo2 peak, peak HR, peak rate pressure product, 6MWT, baseline K-MBI and MI, and in linear regression analysis, Vo2 peak and baseline K-MBI were significant independent predictors of follow-up K-MBI. Conclusion: These results indicate that baseline cardiovascular fitness correlates significantly with the baseline functional status, in addition to being an important prognostic factor regarding the functional recovery of subacute stroke patients. Implications for Rehabilitation Reduced cardiovascular fitness is a well-studied physical impairment in stroke patients. Baseline cardiovascular fitness correlates significantly with the baseline functional status, in addition to being an important prognostic factor regarding the functional recovery of subacute stroke patients. Early intensive aerobic exercise training could be considered in subacute stroke patients not only to enhance their cardiovascular fitness but also to maximize their functional recovery.

The Effects of Neuromuscular Electrical Stimulation on Cardiopulmonary Function in Healthy Adults

Objective To evaluate the effect of neuromuscular electrical stimulation (NMES) on cardiopulmonary function in healthy adults. Method Thirty-six healthy adults without a cardiac problem were enrolled. All patients were randomly assigned to either a control (17 subjects, mean age 29.41) or an electrical stimulation group (19 subjects, mean age 29.26). The electrical stimulation group received NMES on both sides of quadriceps muscle using a Walking Man II® in a sitting position for 30 minutes over 2 weeks. Maximum oxygen consumption (VO2max), metabolic equivalent (MET), resting, maximal heart rate (RHR, MHR), resting, maximal blood pressure (RBP, MBP), and maximal rate pressure product (MRPP), exercise tolerance test (ETT) duration were determined using an exercise tolerance test and a 6 minute walk test (6MWT) before and after treatment. Results The electrical stimulation group showed a significant increase in VO2max (p=0.03), 6MWT (p<0.01), MHR (p<0.04), MsBP (p<0.03), ETT duration (p<0.01) and a significant decrease in RsBP (p<0.02) as compared with the control group after two weeks. NMES induced changes improved only in RsBP (p<0.049) and ETT duration (p<0.01). The effects of NMES training were stronger in females. Conclusion We suggest that NMES is an additional therapeutic option for cardiopulmonary exercise in disabled patients with severe refractory heart failure or acute AMI.

Comparison of cardiorespiratory responses during aquatic and land treadmill exercise in patients with coronary artery disease.

PURPOSE: To investigate cardiorespiratory responses during exercise stress tests using an aquatic treadmill and a land-based treadmill in patients with coronary artery disease (CAD). METHODS: Twenty-one stable CAD patients were enrolled. All patients participated in 2 symptom-limited incremental exercise tests, using both an aquatic and a land treadmill. For the aquatic treadmill protocol, patients were submerged to the upper waist in 28°C water. The treadmill speed started at 2.0 km/h and increased 0.5 km/h every minute thereafter. For the land treadmill protocol, the speed and gradient were started at 2.4 km/h and 1.5%, respectively. The speed was increased by 0.3 km/h and grade by 1% every minute thereafter. Oxygen consumption ( O2), heart rate (HR), and respiratory exchange ratio were measured continuously and peak values recorded. Rating of perceived exertion, percentage of age-predicted maximal HR, and total exercise duration were also recorded. RESULTS: Peak cardiorespiratory responses during both protocols were compared. The peak O2 and peak HR did not show any significant differences. The peak respiratory exchange ratio was significantly greater using the land treadmill than the aquatic treadmill protocol. Rating of perceived exertion, age-predicted maximal HR percentage, and total exercise duration were similar for both protocols. There was a significant linear relationship between HR and O2 with both protocols. CONCLUSIONS: This study demonstrated that aquatic treadmill exercise elicits similar peak cardiorespiratory responses compared with land treadmill exercise, suggesting that aquatic treadmill exercise may be effective for CAD patients in cardiac rehabilitation.

Robot-assisted gait training improves brachial-ankle pulse wave velocity and peak aerobic capacity in subacute stroke patients with totally dependent ambulation: Randomized controlled trial.

Objective: Brachial–ankle pulse wave velocity (baPWV) evaluates arterial stiffness and also predicts early outcome in stroke patients. The objectives of this study were to investigate arterial stiffness of subacute nonfunctional ambulatory stroke patients and to compare the effects of robot-assisted gait therapy (RAGT) combined with rehabilitation therapy (RT) on arterial stiffness and functional recovery with those of RT alone. Method: The RAGT group (N = 30) received 30 minutes of robot-assisted gait therapy and 30 minutes of conventional RT, and the control group (N = 26) received 60 minutes of RT, 5 times a week for 4 weeks. baPWV was measured and calculated using an automated device. The patients also performed a symptom-limited graded exercise stress test using a bicycle ergometer, and parameters of cardiopulmonary fitness were recorded. Clinical outcome measures were categorized into 4 categories: activities of daily living, balance, ambulatory function, and paretic leg motor function and were evaluated before and after the 4-week intervention. Results: Both groups exhibited significant functional recovery in all clinical outcome measures after the 4-week intervention. However, peak aerobic capacity, peak heart rate, exercise tolerance test duration, and baPWV improved only in the RAGT group, and the improvements in baPWV and peak aerobic capacity were more noticeable in the RAGT group than in the control group. Conclusion: Robot-assisted gait therapy combined with conventional rehabilitation therapy represents an effective method for reversing arterial stiffness and improving peak aerobic capacity in subacute stroke patients with totally dependent ambulation. However, further large-scale studies with longer term follow-up periods are warranted to measure the effects of RAGT on secondary prevention after stroke.

Peak Cardiorespiratory Responses of Patients with Subacute Stroke During Land and Aquatic Treadmill Exercise.

Objective The aim of this work was to investigate the cardiorespiratory responses of patients with subacute stroke to exercise stress tests with aquatic and land treadmills. Design Twenty-one consecutive patients who presented with first-ever subacute stroke in 2013–2015. All subjects underwent symptom-limited incremental exercise testing with aquatic and land treadmills. Land treadmill speed started at 1.5 km/h and increased 0.5 km/h every 1 to 2 minutes until maximal tolerable speed was achieved. Thereafter, the grade was elevated by 2% every 2 minutes. In the aquatic treadmill test, subjects were submerged to the xiphoid in 28°C water. Treadmill speed started at 1.5 km/h and was increased 0.5 km/h every 2 minutes thereafter. Cardiorespiratory responses were recorded with aquatic and land treadmills. Results Compared to land treadmill exercise, aquatic treadmill exercise achieved significantly better peak VO2 (22.0 vs 20.0; P = 0.02), peak metabolic equivalents (6.3 vs 5.8; P = 0.02), and peak rating of perceived exertion (17.6 vs 18.4, P = 0.01). Heart rate and VO2 correlated significantly during both tests (land treadmill: r = 0.96, P < 0.001; aquatic treadmill: r = 0.99, P < 0.001). Conclusions Aquatic treadmill exercise elicited significantly better peak cardiorespiratory responses than land treadmill exercise and may be as effective for early intensive aerobic training in subacute stroke patients.

The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy

Background Cervical compressive myelopathy (CCM) is a progressive, degenerative spine disease and the most common cause of spinal cord dysfunction in older individuals. Current clinical guidelines for spinal surgery recommend multimodal intraoperative monitoring (IOM) during spinal surgery as a reliable and valid diagnostic adjunct to assess spinal cord integrity. The aim of this study was to evaluate the effect of positive changes during IOM on the functional status in patients with CCM. Methods Patients who underwent spinal surgery with IOM due to CCM were enrolled. During the surgery, patients underwent IOM using motor evoked potential (MEP) and somatosensory evoked potential (SEP). MEP and SEP were checked before and immediately after decompression. A decrease in latency >10% or an increase in amplitude >50% was regarded as a “positive changes”. Subjects were divided according to the presence of positive changes. Motor scores of American Spinal Injury Association (ASIA) impairment scale and Korean version of Modified Barthel Index (K-MBI) were evaluated before and after operation. Results Twenty-nine patients underwent spinal surgery due to CCM. Eleven patients showed positive changes in MEP during IOM. When the two groups were compared, improvement rate in the ASIA motor score and K-MBI were significantly higher in patients with positive changes than in patients without positive changes at 1 month after surgery. However, 6 months after surgery, there were no significance differences between the groups. Regardless of positive change, nearly all patients suffered from neuropathic pain after operation. Conclusion Positive changes in MEP during IOM may affect functional improvement 1 month after operation and early discharge without significant complications in CCM patients. However, they do not affect the neuropathic pain and long-term functional outcome. Thus, tailored proper management is needed to achieve maximal functional recovery in each patient after cervical spinal decompression surgery.

Poster 28: The Assessment and Rehabilitation Outcomes on Fatigue in Patients With Brain Tumors

initiated with a leukemia-trained hospitalist providing concurrent care for leukemia patients transferred to inpatient rehabilitation. We will discuss inpatient rehabilitation outcomes for these patients and for a group of leukemia patients who received inpatient rehabilitation before the initiation of this program. Design: Retrospective medical records review. Setting: National comprehensive cancer center. Participants: Consecutive leukemia inpatients for whom we received inpatient consults and then admitted to our acute inpatient cancer rehabilitation unit from June 1, 2008, through January 31, 2010. Interventions: Specially trained hospitalist to assist in the daily management of acute medical issues. Main Outcome Measures: Length of stay, discharge disposition, rate of transfer back to acute care. Results: From June 1, 2008, to April 8, 2009, we received 91 leukemia consultations. 20 patients were transferred to the acute inpatient rehabilitation service. 8/20 discharged home with an average LOS of 9.1 days. 10/20 transferred back to the acute service with an average LOS of 10.5 days. On April 9, 2009, the leukemia hospitalist program on the acute inpatient rehabilitation unit was initiated. From April 9, 2009, to January 31, 2010, we received 71 leukemia consultations. 17 patients were transferred to the acute inpatient rehabilitation service. 14/17 discharged home with an average LOS of 10.1 days. 4/17 transferred back to the acute service with an average LOS of 10 days. Conclusions: Our data suggest that the comanagement of leukemia patients by a leukemia-experienced hospitalist can increase the likelihood of discharge home and decrease the rate of transfer back to the acute care leukemia service. This information may be beneficial to rehabilitation units who are considering inpatient rehabilitation of hematologic cancer patients.

Poster 310: The Swallowing Assessment and Long-term Outcome in Children Suspected of Dysphagia

Disclosures: L. Kim, None. Objective: To investigate the correlation of Manual Ability Classification System (MACS) and Bimanual Fine Motor Function (BFMF), the appropriateness of using these tools concordantly in children with cerebral palsy. In addition, how these tools are different in evaluating between bilaterally and unilaterally affected children. Design: A retrospective, cross-sectional, comparative study. Setting: Tertiary care hospital. Participants: 61 cerebral palsy patients were enrolled, and the mean age was 77.6 months. 39 children were spastic bilateral, 17 children were spastic unilateral, 3 were athetoid, 2 were dystonic type CP. Interventions: Not applicable. Main Outcome Measures: The coefficients of correlation of MACS and BFMF, MACS and GMFCS, BFMF and GMFCS. Results: In 61 children, the coefficients of correlation of MACS and BFMF, MACS and GMFCS, BFMF and GMFCS were 0.951, 0.752, 0.823 and all of these factors were significantly correlated. In spastic bilateral children, the coefficient of correlation of these tools was 0.978, 0.842, and 0.861, and all of these factors were significantly correlated. However, in spastic unilateral children, the coefficients of correlation of tools were 0.683, 0.370, 0.166, respectively, and only MACS and BFMF were correlated, but less significantly than in bilateral children. Conclusions: MACS and BFMF were significantly correlated in both bilaterally and unilaterally affected children, it would seem to indicate that these tools can be used concomitantly. Especially in bilaterally affected children, MACS and BFMF were correlated more than in unilaterally affected children. MACS and GMFCS, and BFMF and GMFCS were correlated significantly in bilaterally affected children but not in unilaterally affected children.