Kyoung Bo Lee

Six-month functional recovery of stroke patients: a multi-time-point study.

The aim of this study is to compare the time-course changes in neurologic impairments (trunk control, motor function, sensory, and cognition) and recovery in functional impairments (activity of daily livings and gait) simultaneously from initiating rehabilitation to 6 months after stroke. Consecutive stroke patients were recruited from the department of nervous surgery, and transferred into the department of rehabilitation medicine and continued on treatment during the acute stage. Outcome measures were examined at the initial rehabilitation baseline, 1, 2, and 4 weeks after rehabilitation treatment, and 3, 4, 5, and 6 months after stroke. Patients were assessed using the Trunk Impairment Scale, the Fugl-Meyer Motor and Sensory Assessments for the upper and lower limbs, Mini-Mental State Examination, Functional Ambulation Category, and Modified Barthel Index. Twenty consecutive patients were analyzed in the study with complete assessments. The recovery was relatively rapid during the 4 weeks after treatment (P value ranges from <0.001 to <0.007) and then to a lesser extent decelerated between 3 and 6 months after stroke (P value between <0.001 and 0.080). Statistical comparison by repeated measures analysis showed a significant interaction between time points and measures of all recovery variables (P<0.001). Significant differences in level of impairments and functional recovery were found at the different time points. In comparison with the lower leg and trunk control, the upper arm showed less recovery, with a significant difference. All variables except for leg motor function improved continuously over 6 months after stroke. Nevertheless, this study confirms the importance of the period within 3 months for recovery after stroke, during which most of the recovery occurred, ranging from 48 to 91%. Therefore, intensive treatment targeting motor and sensory functions early after stroke may be beneficial for recovery of impairments and functional performance.

The effect of various dual task training methods with gait on the balance and gait of patients with chronic stroke.

[Purpose] This study examined the effects of various dual task gait training methods (motor dual task gait training, cognitive dual task gait training, and motor and cognitive dual task gait training) on the balance and gait abilities of chronic stroke patients. [Subjects and Methods] Thirty-three outpatients performed dual task gait training for 30 minutes per day, three times a week, for eight weeks from June to August, 2012. Balance ability was measured pre-and posttest using the stability test index, the weight distribution index, the functional reach test, the timed up and go test, and the four square step test. Gait ability was measured by the 10 m walk test and a 6 min walk test before and after the training. The paired t-test was used to compare measurements before and after training within each group, and ANOVA was used to compare measurements before and after training among the groups. [Results] Comparisons within each group indicated significant differences in all variables between before and after the training in all three groups. Comparison between the groups showed that the greatest improvements were seen in all tests, except for the timed up and go test, following motor and cognitive dual task gait training. [Conclusion] In a real walking environment, the motor and cognitive dual task gait training was more effective at improving the balance and gait abilities of chronic stroke patients than either the motor dual task gait training or the cognitive dual task gait training alone.

Effects of Progressive Body Weight Support Treadmill Forward and Backward Walking Training on Stroke Patients’ Affected Side Lower Extremity’s Walking Ability

[Purpose] The purpose of the present study was to examine the effects of progressive body weight supported treadmill forward and backward walking training (PBWSTFBWT), progressive body weight supported treadmill forward walking training (PBWSTFWT), progressive body weight supported treadmill backward walking training (PBWSTBWT), on stroke patients’ affected side lower extremity’s walking ability. [Subjects and Methods] A total of 36 chronic stroke patients were divided into three groups with 12 subjects in each group. Each of the groups performed one of the progressive body weight supported treadmill training methods for 30 minute, six times per week for three weeks, and then received general physical therapy without any other intervention until the follow-up tests. For the assessment of the affected side lower extremity’s walking ability, step length of the affected side, stance phase of the affected side, swing phase of the affected side, single support of the affected side, and step time of the affected side were measured using optogait and the symmetry index. [Results] In the within group comparisons, all the three groups showed significant differences between before and after the intervention and in the comparison of the three groups, the PBWSTFBWT group showed more significant differences in all of the assessed items than the other two groups. [Conclusion] In the present study progressive body weight supported treadmill training was performed in an environment in which the subjects were actually walked, and PBWSTFBWT was more effective at efficiently training stroke patients’ affected side lower extremity’s walking ability.

Factors related to community ambulation in patients with chronic stroke.

Abstract Background: The focus of gait rehabilitation for walking in real-life settings should vary according to different aspects of gait performance. Investigation of factors related to impairments specific to community ambulation or activity participation may be helpful in determining and targeting appropriate treatment for gait rehabilitation. Objective To investigate the relationship between community ambulation and factors determining gait ability. Methods Forty-six outpatients with a previous stroke participated in a cross-sectional assessment. Community ambulation was assessed using a self-administered questionnaire. Outcome measures included impairments (strength, sensation, muscle tone, and balance) and ambulatory activity limitations (self-paced and maximum 10-m gait speed, 6-minute walking test, and concurrent manual/cognitive dual-task walking speed). Ability to increase speed and the dual-tasks cost were calculated. Multivariate analysis of variance and multiple regression analyses were used to determine differences in walking and identify important factors related to community ambulation. Results Pearson and Spearman analyses revealed that impairments (balance, r = .665; muscle strength, r = 0.653) and ambulatory activity limitation (gait speed, r = 0.684; walking distance, r = 0.654; ability to increase speed, r = 0.413) were significantly positively correlated with community ambulation level. Balance was an important factor in predicting increasing speed (P < 0.001). Muscle strength and tone were positive contributors to gait speed (P = 0.001 for both) and distance (P = 0.019 and P = 0.002, respectively). Cognitive and manual dual tasks showed no significant relationship to other variables. Stepwise multivariate regression analysis showed that important determinants of community ambulation level were strength (P < 0.001) and gait endurance (P = 0.001). Conclusions Muscle strength and walking distance are contributing factors in community ambulation for patients with chronic stroke.

The relationship between motor recovery and gait velocity during dual tasks in patients with chronic stroke.

[Purpose] The aims of this study were to identify the relationship between motor recovery and gait velocity during dual tasks in patients with chronic stroke and determine automatic gait ability following stroke. [Subjects and Methods] Thirty-three outpatients and twelve healthy subjects participated in a cross-sectional assessment. Community ambulation was assessed using a self-administered questionnaire. Outcome measures included the Motricity index, Berg Balance Scale, and gait speed under three conditions (self-paced ambulation for 10 m, ambulation while performing dual cognitive tasks, and ambulation while performing dual manual tasks). Gait automaticity was calculated. [Results] No significant differences were observed for muscle strength or balance between the limited community ambulation and the community ambulation groups. However, a significant difference in gait velocity was observed between the groups under the three conditions. In particular, a significant difference was detected only in the limited community ambulation group depending on the level of motor function recovery during cognitive and manual dual task ambulation. Additionally, we revealed that the community ambulation group had a lower level of gait automaticity compared with that in the normal group. [Conclusion] Our results show the influence of motor recovery on the change in gait velocity depending on the task if a patient is limitedly ambulatory. We revealed that community ambulators did not have a sufficient level of gait automaticity.

Effects of mirror therapy combined with motor tasks on upper extremity function and activities daily living of stroke patients

[Purpose] The objective of this study was to investigate the effects of mirror therapy combined with exercise tasks on the function of the upper limbs and activities of daily living. [Subjects and Methods] Twenty-five stroke patients who were receiving physical therapy at K Hospital in Gyeonggi-do, South Korea, were classified into a mirror therapy group (n=12) and a conventional therapy group (n=13). The therapies were applied for 30 minutes per day, five times per week, for a total of four weeks. Upper limb function was measured with the Action Research Arm test, the Fugl-Meyer Assessment, and the Box and Block test, and activities of daily living were measured with the Functional Independence Measure. A paired test was performed to compare the intragroup differences between before training and after four weeks of therapy, and an independent t-test was performed to compare the differences between the two groups before and after four weeks of therapy. [Results] In the intragroup comparison, both groups showed significant differences between measurements taken before and after four weeks of therapy. In the intergroup comparison, the mirror therapy group showed significant improvements compared with the conventional therapy group, both in upper limb function and activities of daily living. [Conclusion] The findings of this study demonstrated that mirror therapy is more effective than conventional therapy for the training of stroke patients to improve their upper limb function and activities of daily living.

Effects of progressive backward body weight suppoted treadmill training on gait ability in chronic stroke patients: A randomized controlled trial

BACKGROUND AND OBJETIVE A stroke patient with hemiplegic gait is generally described as being slow and asymmetric. Body weight-supported treadmill training and backward gait training are recent additions to therapeutic gait trainings that may help improve gait in stroke patient with hemiplegic gait. Therefore, we examined the effect of progressive backward body weight-supported treadmill training on gait in chronic stroke patients with hemiplegic gait. METHODS Thirty subjects were divided to the experimental and control groups. The experimental group consisted of 15 patients and underwent progressive backward body weight-supported treadmill training. The control group consisted of 15 patients and underwent general treadmill gait training five times per week, for a total of four weeks. The OptoGait was used to analyze gait kinematics, and the dynamic gait index (DGI) and results of the 6-minute walk test were used as the clinical evaluation indicators. A follow-up test was carried out four weeks later to examine persistence of exercise effects. RESULTS The experimental group showed statistically significant results in all dependent variables week four compared to the control group. However, until the eighth week, only the dependent variables, of affected step length (ASL), stride length (SL), and DGI differed significantly between the two groups. CONCLUSION This study verified that progressive bodyweight-supported treadmill training had a positive influence on the temporospatial characteristics of gait and clinical gait evaluation index in chronic stroke patients.

Clinical recovery from stroke lesions and related outcomes

Stroke lesions affect neurological status and are a critical determinant of treatment. This study investigated stroke lesions in terms of clinical recovery and related outcomes. Twenty-seven stroke patients were assessed via longitudinal observational study. Brain lesions were evaluated using MRI. The Fugl-Meyer Assessment and clinical evaluations were performed monthly between 1 and 6months after onset. The anterior limb (ICAL) and genu (ICG) of the internal capsule were associated with recovery of the upper limbs in chronic stroke patients. Involvement of the anterior half of the middle third of the corona radiata, the ICAL, the ICG, and the caudate nucleus were related to recovery of the lower limbs. Involvement of the middle third of the corona radiata, the ICAL, the ICG, and the lentiform nucleus were associated with sensory recovery. Clinical recovery from stroke, in terms of motor and sensory function, was related to injury in several white matter areas, such as the corona radiata and internal capsule, and was also associated with the basal ganglia as a gait pattern generator. Clinicians should be aware of stroke lesions, and should design therapeutic strategies accordingly, also with respect to treatment duration.

The contributions of balance to gait capacity and motor function in chronic stroke.

[Purpose] The aim of this study was to identify the contributions of balance to gait and motor function in chronic stroke. [Subjects and Methods] Twenty-three outpatients participated in a cross-sectional assessment. Gait ability was assessed using the functional ambulation category, self-paced 10-m walking speed, and fastest 10-m walking speed. Standing balance and trunk control measures included the Berg Balance Scale and the Trunk Impairment Scale. Univariate and multivariate regression analyses were performed. [Results] Balance was the best predictor of the FAC, self-paced walking speed, and fastest walking speed, accounting for 57% to 61% of the variances. Additionally, the total score of TIS was the only predictor of the motor function of the lower limbs and the dynamic balance of TIS was a predictor of the motor function of the upper limbs, accounting for 41% and 29% of the variance, respectively. [Conclusion] This study demonstrated the relative contribution of standing balance and trunk balance to gait ability and motor function. They show that balance has a high power of explanation of gait ability and that trunk balance is a determinant of motor function rather than gait ability.

The Prognosis and Recovery of Aphasia Related to Stroke Lesion

Objective To investigate the effects of specific brain lesions on prognosis and recovery of post-stroke aphasia, and to assess the characteristic pattern of recovery. Methods Total of 15 subjects with first-ever, left hemisphere stroke, who were right handed, and who completed language assessment using the Korean version of the Western Aphasia Battery (K-WAB) at least twice during the subacute and chronic stages of stroke, were included. The brain lesions of the participants were evaluated using MRI-cron, SPM8, and Talairach Daemon software. Results Subtraction of the lesion overlap map of the participants who showed more than 30% improvement in the aphasia quotient (AQ) by the time of their chronic stage (n=9) from the lesion overlap map of those who did not show more than 30% improvement in the AQ (n=6) revealed a strong relationship with Brocas area, inferior prefrontal gyrus, premotor cortex, and a less strong relationship with Wernickes area and superior and middle temporal gyri. The culprit lesion related to poor prognosis, after grouping the subjects according to their AQ score in the chronic stage (a cut score of 50), revealed a strong relationship with Brocas area, superior temporal gyrus, and a less strong relationship with Wernickes area, prefrontal cortex, and inferior frontal gyrus. Conclusion Brain lesions in the Brocas area, inferior prefrontal gyrus, and premotor cortex may be related to slow recovery of aphasia in patients with left hemisphere stroke. Furthermore, involvement of Brocas area and superior temporal gyrus may be associated with poor prognosis of post-stroke aphasia.