Eun Joo Kim

Association Between Unsafe Driving Performance and Cognitive-Perceptual Dysfunction in Older Drivers

To find an association between cognitive‐perceptual problems of older drivers and unsafe driving performance during simulated automobile driving in a virtual environment.

Effects of robot-assisted gait training on the balance and gait of chronic stroke patients: focus on dependent ambulators

[Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training.

Fear of Falling in Subacute Hemiplegic Stroke Patients: Associating Factors and Correlations with Quality of Life

Objective To determine the associating factors of fear of falling (FOF) and the correlations between FOF and quality of life (QOL) on subacute stroke patients in Korea. Method Fifty hemiplegic subacute stroke patients in our clinic were recruited. We directly asked patients with their fear of falling and interviewed them with the Korean version of falls efficacy scale-international (KFES-I). We divided the participants into two groups; with FOF and without FOF. We compared these groups with the strength of hemiplegic hip abductor, knee extensor, ankle plantar flexor, functional ambulation category (FAC) scale, stroke specific quality of life (SSQOL), and hospital anxiety depression scale (HADS). Results Thirty-four participants were enrolled, and more than half of the patients with subacute stroke had FOF. We compared the patients with and without FOF. According to the results, FOF was associated with the strength of hemiplegic hip abductor, knee extensor and ankle plantar flexor, FAC, total SSQOL, and domains (energy, mobility, self care, upper extremity function) of SSQOL (p<0.05). FOF was also associated with the anxiety score of HADS (p<0.05). KFES-I had a significant negative correlation with the strength of hemiplegic hip abductor, knee extensor and ankle plantar flexor, FAC, total SSQOL, and domains (energy, mobility, self care, upper extremity function) of SSQOL (p<0.01). Conclusion The FOF was associated with not only QOL but also with the physical and psychological factors, and in particular, anxiety. Therefore, further concerns about FOF in subacute stroke patients might be required.

Is swallowing of all mixed consistencies dangerous for penetration-aspiration?

Objective The aim of this study was to determine whether the risk and severity of penetration-aspiration with mixed consistency (MIX), which consists of cooked rice and thin liquid barium (LIQUID), are different from the risks and severities with each single consistency (cooked rice or LIQUID) in dysphagic patients. Design Dysphagic patients (N = 29) performed a videofluoroscopic swallowing study with the following foods: cooked rice, LIQUID, and MIX. Several components were analyzed using recorded videotapes. Results The Penetration-Aspiration Scale score for MIX was significantly lower than that for LIQUID (P < 0.016). The location of the leading edge at the onset of a pharyngeal swallow between MIX and LIQUID was not different (P = 0.705). The pharyngeal delay time of LIQUID was delayed significantly compared with that of MIX (0.142 ± 0.267 and –0.149 ± 0.096 sec, respectively, P < 0.016). The severity of pharyngeal residue among the foods was different according to the location. Conclusions Swallowing of MIX is not dangerous, and it is safer for not inducing penetration-aspiration as compared with the swallowing of LIQUID. The risk of penetration-aspiration may be judged depending on not only a food’s consistency but also on various factors that affect airway protection, including the texture of food.

The influence of sour taste on Dysphagia in brain injury: blind study.

Objective To verify the influence of sour taste on swallowing and the presence of reflex cough when sour material was swallowed in patients with dysphagia secondary to brain injury. Method Fifty dysphagic brain injury patients who underwent videofluoroscopic swallowing study (VFSS) were recruited. The patients who had shown severe aspiration at 2 ml of liquid were excluded. The dysphagic patients were given 5 ml each of a sour tasting liquid (SOUR) and a thin liquid barium (LIQUID) in random order. An expert analyzed the result of VFSS by reviewing recorded videotapes. Analysis components consisted of the Penetration-Aspiration-Scale (PAS) score, oral transit time (OTT), pharyngeal transit time (PTT), pharyngeal delay time (PDT) and the reflex cough presence. Results The PAS score for SOUR was significantly lower than the one for LIQUID (p=0.03). The mean OTT for SOUR was significantly shortened compared to that for LIQUID (p=0.03). The mean PTT and PDT were also shortened in SOUR, although the differences were not statistically significant (p=0.26 and p=0.32, respectively). There was no significant difference between SOUR and LIQUID regarding the presence of reflex cough (p=1.00). Conclusion The sour taste could enhance sensorimotor feedback in the oropharynx, thus lowering the chances of penetration-aspiration caused by shortening of the oropharyngeal passage times. There was no significant difference in the presence of reflex cough produced between LIQUID and SOUR.

A Learning Set Up for Detecting Minimally Conscious State (MCS)

Detecting signs of learning in persons diagnosed to be in a post-coma vegetative state and minimally conscious state (MCS) may modify their diagnosis. We report the case of a 65-year-old female in a vegetative state. We used microswitch-based technology that is based on patient response to eye-blinking. We followed an ABABCB design, in which A represented baseline periods, B intervention periods with stimuli contingent on the responses, and C a control condition with stimuli presented non-contingently. We observed the level of response during the B phases was higher than the level of A and C phases. This indicated the patient showed signs of learning. This state was confirmed by an evaluation through the Coma Recovery Scale-Revised (CRSR) score, and after completion of this study her CRSR score changed from 4 to 10. We believe microswitch technology may be useful to make a diagnosis of MCS and offer new opportunities for education to MCS patients.

Reliability and validity of the Korean version of the Communicative Activity Log (CAL)

Background: The ultimate goal of aphasia rehabilitation is to enhance communicative activities in people with aphasia (PWA) in order to increase their daily activities and social participation. The amount of communication and its quality largely vary according to language and cultural differences. Aims: This study was designed to develop a Korean version of the Communicative Activity Log (CAL), and to verify its reliability and validity for PWA after stroke. Methods & Procedures: A Korean version of the CAL (K-CAL) was developed through a cross-cultural adaptation process consisting of the following six steps: translation, reconciliation, back-translation, cognitive debriefing, feedback, and final reconciliation. Internal consistency, test–retest reliability, concurrent validity, and construct validity were used to verify its reliability and validity for PWA after stroke. A total of 50 PWA completed the K-CAL with the help of caregivers. All participants completed the K-CAL again 1 week later to measure test–retest reliability. Communication score on the Korean version of Stroke and Aphasia Quality of Life Scale-39 (K-SAQOL-39) was used to demonstrate concurrent validity. Severity of aphasia assessed by Korean version of the Frenchay Aphasia Screening Test (K-FAST) was used to determine construct validity of the K-CAL. Outcomes & Results: Among the 50 PWA, 20 had cerebral infarction and 30 had brain haemorrhage. Mean duration after onset of aphasia was 47.96 ± 62.01 months. Mean communication scores on the K-SAQOL-39 and K-FAST were 2.63 ± 0.97 and 12.69 ± 9.78 points, respectively. K-CAL demonstrated high internal consistency (Cronbach’s α = .987) and test–retest reliability (r = .915, p < .001). Correlation between K-CAL and communication score on the K-SAQOL-39 revealed a high concurrent validity (r = .915, p < .001). Correlation between K-CAL and K-FAST also showed a high construct validity (r = .882, p < .001). Conclusions: A K-CAL was successfully developed through a cross-cultural adaptation process. Our results suggested that K-CAL had high reliability and validity for assessing communicative behaviour of Korean PWA after stroke.

Upper extremity muscle activation during drinking from a glass in subjects with chronic stroke.

[Purpose] The purpose of this study was to compare the muscle activities of upper extremities during a drinking task between the stroke-affected and less-affected sides. [Subjects] Eight stroke patients (8 men; age 45.3 years; stroke duration 21.9 months) participated in this study. [Methods] Electromyography (EMG) was used to measure nine muscle activities of the upper extremity. The drinking task was divided into 5 phases. [Results] Analysis of the EMG data showed that the percentage of maximum voluntary isometric contraction (%MVIC) across all phases of drinking differed between the affected and less-affected sides. Participants used relatively higher levels of %MVIC in the anterior deltoid, flexor muscles, brachioradialis, and infraspinatus on the stoke-affected side. [Conclusion] The difference in muscle activation across all phases of the drinking movement allowed us to determine how upper extremity muscle activation may influence drinking performance on the stroke-affected and less-affected sides.