Yang-Soo Lee

Effects of the sliding rehabilitation machine on balance and gait in chronic stroke patients – a controlled clinical trial

Objective: To investigate the effects of a sliding rehabilitation machine on balance and gait in chronic stroke patients. Design: A non-randomized crossover design. Setting: Inpatient rehabilitation in a general hospital. Subjects: Thirty patients with chronic stroke who had medium or high falling risk as determined by the Berg Balance Scale. Interventions: Participants were divided into two groups and underwent four weeks of training. Group A (n = 15) underwent training with the sliding rehabilitation machine for two weeks with concurrent conventional training, followed by conventional training only for another two weeks. Group B (n = 15) underwent the same training in reverse order. The effect of the experimental period was defined as the sum of changes during training with sliding rehabilitation machine in each group, and the effect of the control period was defined as those during the conventional training only in each group. Main measures: Functional Ambulation Category, Berg Balance Scale, Six-Minute Walk Test, Timed Up and Go Test, Korean Modified Barthel Index, Modified Ashworth Scale and Manual Muscle Test. Results: Statistically significant improvements were observed in all parameters except Modified Ashworth Scale in the experimental period, but only in Six-Minute Walk Test (P < 0.01) in the control period. There were also statistically significant differences in the degree of change in all parameters in the experimental period as compared to the control period. Conclusions: The sliding rehabilitation machine may be a useful tool for the improvement of balance and gait abilities in chronic stroke patients.

Korean Stroke Cohort for functioning and rehabilitation (KOSCO): study rationale and protocol of a multi-centre prospective cohort study

BackgroundDevelopment of a long-term stroke care plan requires serial assessment of long-term patient function and consideration of caregiver mood. However, to date, few comprehensive cohort studies have included both stroke patients and caregivers.Methods/DesignKOSCO is a large, multi-centre prospective cohort study for all acute first-ever stroke patients admitted to participating hospitals in nine distinct areas of Korea. This study is designed as a 10-year, longitudinal follow-up investigating the residual disabilities, activity limitations, and quality of life issues arising in patients suffering from first-ever stroke. The main objectives of this study are to identify the factors that influence residual disability and long-term quality of life. The secondary objectives of this study are to determine the risk of mortality and recurrent vascular events in patients with acute first-ever stroke. We will investigate longitudinal health behaviors and patterns of healthcare utilization, including stroke rehabilitation care. We will also investigate the long-term health status, mood, and quality of life in stroke patient caregivers. In addition, we will identify baseline and ongoing characteristics that are associated with our secondary outcomes.DiscussionKOSCO is a prospective, multi-centre, 10-year longitudinal follow-up study investigating the residual disabilities, activity limitations, and quality of life issues arising in patients suffering from first-ever stroke.

Effect of obesity on functional outcomes at 6 months post-stroke among elderly Koreans: a prospective multicentre study

Objectives We examined whether obesity based on body mass index (BMI) was a predictor of functional independence measure (FIM) at 6 months after ischaemic stroke onset while adjusting for stroke risk factors and covariates and stratifying by age group. Design This is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation that was designed as a nested case study within a nationwide hospital-based cohort. Setting We identified all patients who were admitted to nine representative hospitals in Korea from 2012 until 2014 under a diagnosis of acute first-ever ischaemic stroke. The hospitals were selected from the metropolitan district, mid-sized cities and a small-sized city. Participants The sample included 2057 patients with acute ischaemic stroke who were at least 18 years old. Primary and secondary outcome measures We divided participants into two age levels (<65 and ≥65 years). Participants were classified into five groups according to their baseline BMI at admission: underweight (BMI<18.5), normal (18.5≤BMI<23), overweight (23≤BMI<25), obese (25≤BMI<30) and extremely obese (30≤BMI). Results The proportion of patients who were aged ≥65 years was 55.0%. The proportions of underweight, normal, overweight, obese and extremely obese patients were 2.6%, 24.3%, 29.6%, 37.2% and 6.3%, respectively, in the <65 years group and 5.5%, 34.5%, 27.9%, 28.8% and 3.3%, respectively, in the ≥65 years group. In a multiple linear regression, the 6-month FIM after stroke in the elderly group was significantly associated with being extremely obese (7.95, p<0.05) after adjusting for confounding variables. In the <65 years group, the 6-month FIM was not associated with any weight category. Conclusions This nationwide hospital-based cohort study showed that extreme obesity is a predictor of a good 6-month FIM, especially in patients with ischaemic stroke who are at least 65 years of age.

Return to work after stroke: The KOSCO Study.

OBJECTIVE To investigate the return to work status of patients with first-ever stroke with functional independence 6 months post-stroke. DESIGN Prospective cohort study. PARTICIPANTS Nine hundred and thirty-three patients with functional independence at 6 months after stroke onset. METHODS A complete post-enumeration survey was performed through a review of the medical records for first admission. In addition, structured self-administered questionnaires and a face-to-face interview were performed assessing occupational status, quality of life, and emotional status at 6 months after stroke. RESULTS Of the patients in this study, 60.0% returned to work at 6 months after stroke. Sex, age, educational level, and comorbidity level were independent factors related to return to work. The rate of return to work in female patients under 65 years of age was similar to that of male patients 65 years of age or older. Stroke patients who returned to work showed better emotional statuses than those who did not return to work. CONCLUSION Many stroke patients did not return to work despite functional independence at 6 months after stroke. Based on the results of this study, we suggest providing appropriate vocational rehabilitation for stroke patients and proper education for employers to increase the rate of early return to work in stroke patients.

Automated Evaluation of Upper-Limb Motor Function Impairment Using Fugl-Meyer Assessment

The Fugl-Meyer assessment (FMA) is the most popular instrument for evaluating upper extremity motor function in stroke patients. However, it is a labor-intensive and time-consuming method. This paper proposes a novel automated FMA system to overcome these limitations of the FMA. For automation, we used Kinect v2 and force sensing resistor sensors owing to their convenient installation as compared with body-worn sensors. Based on the linguistic guideline of the FMA, a rule-based binary logic classification algorithm was developed to assign FMA scores using the extracted features obtained from the sensors. The algorithm is appropriate for clinical use, because it is not based on machine learning, which requires additional learning processes with a large amount of clinical data. The proposed system was able to automate 79% of the FMA tests because of optimized sensor selection and the classification algorithm. In clinical trials conducted with nine stroke patients, the proposed system exhibited high scoring accuracy (92%) and time efficiency (85% reduction in clinicians’ required time).

Chronic Kidney Disease and Functional Outcomes 6 Months after Ischemic Stroke: A Prospective Multicenter Study

Background: The aim of this study was to investigate whether chronic kidney disease (CKD) predicts the outcome of the Functional Independence Measure (FIM) and the Korean version of the modified Barthel Index (K-MBI) 6 months after stroke with adjustment for age, gender, education, smoking, drinking, obesity, hypertension, diabetes mellitus, dyslipidemia, the FIM or K-MBI at discharge and the National Institutes of Health Stroke Scale (NIHSS) score 7 days post stroke. Methods: This study is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation. The sample included 2,037 ischemic stroke patients aged 18 years or older. The FIM and K-MBI scores were assessed at discharge and at 6 months after the onset of stroke. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was defined as an eGFR <60 ml/min/1.73 m2. Results: Overall, the mean age was 65.5 (±12.4) years. The proportion of men was 62.6%. The proportion of CKD cases was 12.7%. The means of the 6-month FIM and K-MBI were 109.8 (±27.9) and 87.0 (±26.4), respectively. In multiple linear regressions, the 6-month FIM after stroke was significantly associated with CKD (-2.85, p < 0.05), age (-0.29, p < 0.01), the FIM at discharge (0.46, p < 0.01) and the 7-day NIHSS score (-1.71, p < 0.01). Additionally, the post-stroke 6-month K-MBI was significantly associated with CKD (-2.88, p < 0.01), age (-0.27, p < 0.01), the K-MBI at discharge (0.46, p < 0.01) and the 7-day NIHSS score (-1.55, p < 0.01). Conclusions: This nationwide hospital-based cohort study showed that CKD might predict poor 6-month FIM and K-MBI scores in ischemic stroke patients.

Impact of central facial palsy and dysarthria on quality of life in patients with stroke: The KOSCO study

BACKGROUND There are a few reports on the impact of central facial palsy and dysarthria on quality of life (QOL) in stroke patients. OBJECTIVE To investigate the impact of central facial palsy on QOL compared with dysarthria during the chronic phase in patients with first-ever strokes. METHODS This study represents an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation study. We selected data from patients with functional independence of 0 or 1 by the modified Rankin Scale at 6 months after stroke onset, who showed an impairment only in National Institute of Health Stroke Scale items 4 (facial palsy) or 10 (dysarthria). Assessments included the European Quality of Life-5 Dimensions (EQ-5D) and the Geriatric depression scale-short form (GDS-SF). RESULTS Data from 149 patients were selected for this analysis from 3,929 patients who were followed up at 6 months. Thirty-nine and 110 patients were classified into the facial palsy and dysarthria groups, respectively. The groups did not differ significantly in baseline characteristics or functional assessments. EQ-5D was significantly lower in the facial palsy group than in the dysarthria group at 6 months after stroke (p = 0.036). GDS-SF was significantly higher in the facial palsy group than in the dysarthria group (p = 0.005). CONCLUSIONS The results of this study revealed that central facial palsy clearly has a more negative impact on QOL than dysarthria in chronic stroke patients with functional independence.

Effect of stress hyperglycemia and intensive rehabilitation therapy in non-diabetic hemorrhagic stroke: Korean Stroke Cohort for Functioning and Rehabilitation

We investigated the effect of stress hyperglycemia on the functional outcomes of non‐diabetic hemorrhagic stroke. In addition, we investigated the usefulness of intensive rehabilitation for improving functional outcomes in patients with stress hyperglycemia.

Long-term functional outcomes of patients with very mild stroke: does a NIHSS score of 0 mean no disability? An interim analysis of the KOSCO study.

Abstract Purpose: To explore the long-term functional outcomes of stroke patients with very mild severity at 6 months after stroke. Methods: This study presents the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. On day 7, stroke evaluation was performed using the functional assessment battery including the National Institute of Health Stroke Scale (NIHSS). At 6 months after stroke, functional outcomes using the face-to-face functional assessment battery including Functional Independence Measure (FIM) were analyzed in the patients who had a score of 0 on the NIHSS at 7 days after stroke onset. Results: In the very mild stroke group, 455 patients were followed up at 6 months. Out of these patients, 11.0% had impairments in cognitive function, 14.1% had motor impairment, and 2.1% had impairments in their mobility measured by the functional assessment battery. At 6 months after onset, 3.3% of stroke survivors without recurrence showed dependency according to the FIM. Conclusions: Many acute stroke patients with mild stroke severity as assessed by the NIHSS had impairments in various functional domains, and could have been easily overlooked for intensive rehabilitation therapy. Candidates for comprehensive rehabilitation therapy might be better identified by the functional assessment battery. Implications for rehabilitation Many acute stroke patients with mild stroke severity assessed by NIHSS could be easily overlooked for intensive rehabilitation therapy. Candidates for comprehensive rehabilitation therapy should be evaluated using a functional assessment battery rather than the NIHSS.

Prediction for return to driving after the first-ever stroke in Korea: The KOSCO study

OBJECTIVE To identify contributing factors that can be used to predict which patients with first-ever stroke will return to driving during 1 year after stroke. DESIGN Multicentre cohort study. SUBJECTS A total of 620 first-ever stroke patients who drove before stroke. METHODS The Stroke Cohort for Functioning and Rehabilitation is a large, multicentre, prospective cohort study of all patients with acute first-ever stroke admitted to participating hospitals in 9 areas of Korea. This study analysed the data from 1,354 patients who completed a face-to-face survey about return to driving at 1 year after stroke. A multiple binary logistic regression analysis model was used to analyse factors that potentially influenced return to driving during 12 months after stroke. RESULTS Of 620 subjects, 410 (66.1%) returned to driving after stroke. They resumed driving at a mean of 2.15 months after stroke (standard deviation 2.32 years). Regression models showed that sex, age, modified Rankin scale (mRS), education about return to driving, and Fugl-Meyer Assessment (FMA) were significantly related to return to driving. Stroke type, ambulatory function, and language function at 7 days were not correlated with return to driving. CONCLUSION Male patients, education about return to driving, lower mRS, and higher FMA at 7 days after stroke are predictors of return to driving. This model could be used by clinicians to help counsel patients and their families.