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Objective To investigate the relationship between grip and pinch strength and independence in activities of daily living (ADL) in stroke patients. Methods Medical records of 577 stroke patients from January 2010 to February 2013 were retrospectively reviewed. Patients' grip and pinch strength of both hemiplegic and non-hemiplegic hands and the Korean version of Modified Barthel Index (K-MBI) score were collected. These patients were divided into three groups: group A (onset duration: ≤3 months), group B (onset duration: >3 months and

OBJECTIVE: To confirm the relationship between initial trunk performance and functional outcomes according to gait ability, and whether initial trunk performance is of predictive value in terms of functional prognosis in patients with stroke. METHODS: We reviewed 135 patients who suffered from stroke. Trunk performance of the patients was evaluated using the Trunk Impairment Scale (TIS). The patients were divided into 2 groups according to gait ability at initial stage of stroke. Correlation analyses were performed to assess relationship between initial TIS and functional outcomes. We also evaluated the relationship between initial TIS and the Korean version of Modified Barthel Index (K-MBI) subitems. Finally, stepwise multiple regression analyses were performed to examine the predictive validity of initial TIS and its subscales with functional outcomes. RESULTS: For both groups, initial TIS was correlated with K-MBI and Functional Ambulation Categories at 4 weeks after stroke; however, the relationship did not remain stable at 6 months in ambulatory patients. All K-MBI subitems, which were associated with trunk movement, as well as others about basic skills was correlated with initial TIS. Finally, when of subscales TIS, dynamic sitting balance (TIS-D) was included in by stepwise multiple regression analyses, high proportion of the explained variance was represented. CONCLUSION: The strong relationship between trunk performance and functional outcomes in patients with stroke emphasizes the importance of trunk rehabilitation. Indeed, an evaluation of a patient's initial TIS after stroke, especially TIS-D, could be helpful in predicting patient's functional prognosis.

OBJECTIVE To evaluate sarcopenic indices in relation to respiratory muscle strength (RMS) in elderly people. METHODS This study included 65 volunteers over the age of 60 (30 men and 35 women). The skeletal muscle mass index (SMI) was measured using bioimpedance analysis. Limb muscle function was assessed by handgrip strength (HGS), the Short Physical Performance Battery (SPPB), and gait speed. RMS was addressed by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) using a spirometer. The relationships between RMS and other sarcopenic indices were investigated using the Pearson correlation coefficients and multiple regression analysis adjusted for age, HGS, and SPPB. RESULTS Both MIP and MEP were positively correlated with SMI (r=0.451 and r=0.388, respectively, p

Objective To assess cough reflex sensitivity using the simplified cough test (SCT) and to evaluate the usefulness of SCT to screen for silent aspiration. Methods The healthy control group was divided into two subgroups: the young (n=29, 33.44±9.99 years) and the elderly (n=30, 63.66±4.37 years). The dysphagic elderly group (n=101, 72.95±9.19 years) consisted of patients with dysphagia, who suffered from a disease involving central nervous system (ischemic stroke 47, intracerebral hemorrhage 27, traumatic brain injury 11, encephalitis 5, hypoxic brain damage 3, and Parkinson disease 8). The SCT was performed using the mist of a 1% citric acid from a portable nebulizer. The time from the start of the inhalation to the first cough was measured as the cough latency. All the dysphagic patients underwent the videofluoroscopic swallowing study. Results The cough latency was more significantly prolonged in the healthy elderly group than in the healthy young group (p

A 51-year-old man showed hemiplegia on his right side after a traumatic brain injury (TBI). On initial brain computed tomography (CT) scan, an acute subdural hemorrhage in the right cerebral convexity and severe degrees of midline shifting and subfalcine herniation to the left side were evident. On follow-up brain magnetic resonance imaging (MRI), there were multiple microhemorrhages in the left parietal and occipital subcortical regions. To explain the occurrence of right hemiplegia after brain damage which dominantly on the right side of brain, we used diffusion tensor imaging (DTI) to reconstruct the corticospinal tract (CST), which showed nearly complete injury on the left CST. We also performed motor-evoked potentials, and stimulation of left motor cortex evoked no response on both sides of upper extremity. We report a case of patient with hemiplegia after TBI and elucidation of the case by DTI rather than CT and MRI.

Objective To investigate if walking is independently associated with low back pain (LBP) in the general population. Methods This cross-sectional study used public data from the Fourth and Fifth Korean National Health and Nutrition Examination Survey. Subjects included 5,982 community-dwelling adults aged ≥50 years. Presence of current LBP was defined as LBP for 1 month or more in the past 3 months. Walking was measured as total walking duration for the past week and subjects were divided into four quartiles. Independent effect of walking on LBP was determined using odds ratios (OR) adjusted for age, sex, osteoporosis, depression or anxiety, and radiographic lumbar spondylosis. Results Prevalence of LBP was 26.4% in this population. Older people and women had higher prevalence of current LBP. Prevalence of obesity and osteoporosis was higher in subjects with current LBP and quality of life was poorer in subjects with current LBP. Adjusted logistic regression model revealed that older age (OR, 1.655; p=0.018), female sex (OR, 2.578; p

Objective To assess the impact of aging on masticatory muscle function according to changes in hardness of solid food. Methods Each of fifteen healthy elderly and young people were selected. Subjects were asked to consume cooked rice, which was processed using the guidelines of the Universal Design Foods concept for elderly people (Japan Care Food Conference 2012). The properties of each cooked rice were categorized as grade 1, 2, 3 and 4 (5×103, 2×104, 5×104, and 5×105 N/m2) respectively. Surface electromyography (sEMG) was used to measure masseter activity from food ingestion to swallowing of test foods. The raw data was normalized by the ratio of sEMG activity to maximal voluntary contraction and compared among subjects. The data was divided according to each sequence of mastication and then calculated within the parameters of EMG activities. Results Intraoral tongue pressure was significantly higher in the young than in the elderly (p

Objective To investigate the relationships between respiratory muscle strength and conventional sarcopenic indices such as skeletal muscle mass and limb muscle strength. Methods Eighty-nine young adult volunteers who had no history of medical or musculoskeletal disease were enrolled. Skeletal muscle mass was measured by bioelectrical impedance analysis and expressed as a skeletal muscle mass index (SMI). Upper and lower limb muscle strength were evaluated by hand grip strength (HGS) and isometric knee extensor muscle strength, respectively. Peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were evaluated using a spirometer to demonstrate respiratory muscle strength. The relationships between respiratory muscle strength and sarcopenic indices were investigated using Pearson correlation coefficients and multiple linear regression analysis adjusted by age, height, and body mass index. Results MIP showed positive correlations with SMI (r=0.457 in men, r=0.646 in women; both p

We report a rare case of a 10-year-old girl with anomalous course of extensor pollicis longus (EPL) muscle, which exists with absence of thenar muscles and muscles in the 1st extensor compartment. Her chief complaint was severe atrophy on the right thenar eminence. On physical examination, there was no obvious functional abnormality on her right thumb. On magnetic resonance imaging, we found that the abductor pollicis brevis, opponens pollicis, abductor pollicis longus, and extensor pollicis brevis muscles were absent. The tendon of the EPL muscle was found, but it had abnormal insertion on the radial side of the proximal phalanx, not on the distal phalanx. This variation was thought to have played a major role in compensating for impaired abduction of the thumb, which is usually accompanied by agenesis of major abductors of the thumb.

Objective To determine whether there is side to side difference of the trunk rotation muscle in Korean male professional golf players. Healthy controls who did not play golf were also evaluated and compared with professional golf players. Method Fifty-one professional golf players and 50 healthy controls participated in this study. Bilateral isokinetic trunk rotation strength that represented the aiming side and non-aiming side trunk rotator function in a golf swing and other parameters were evaluated using the Biodex System III Isokinetic Dynamometer at angular velocities of 30, 60, and 120 degree per second. Results The professional golf players' peak torque and total work on their aiming sides were significantly higher than on their non-aiming side at all angular velocities. Additionally, the golf players' peak torque on their aiming side was significantly higher than those of the healthy controls only at the 60 degree per second angular velocity, but there was a slight and consistent trend in the others. Finally, the difference between the aiming side and the non-aiming side of the professional golf players and the healthy controls was also significant. Conclusion The aiming side rotation strength of the male professional golf players was higher than that of non-aiming side. The controls showed no side-to-side differences. This finding is attributed to the repetitive training and practice of professional golf players. A further study is needed to investigate if the strengthening of the trunk rotation muscle, especially on the aiming side, could improve golf performance.

Objective To evaluate the effects of physical properties of foods on the changes of viscosity and mass as well as the particle size distribution after mastication. Method Twenty subjects with no masticatory disorders were recruited. Six grams of four solid foods of different textures (banana, tofu, cooked-rice, cookie) were provided, and the viscosity and mass after 10, 20, and 30 cycles of mastication and just before swallowing were measured. The physical properties of foods, such as hardness, cohesiveness, and adhesiveness, were measured with a texture analyzer. Wet sieving and laser diffraction were used to determine the distribution of food particle size. Results When we measured the physical characteristics of foods, the cookie was the hardest food, and the banana exhibited marked adhesiveness. Tofu and cooked-rice exhibited a highly cohesive nature. As the number of mastication cycles increased, the masses of all foods were significantly increased (p

A 62-year-old female patient diagnosed with left brain stem stroke 2 months ago was admitted to our clinic for rehabilitation. She had no generalized spasticity on both extremities, but could open her mouth only approximately 2 mm between her upper and lower teeth due to severe trismus. On needle electromyography, the left masseter muscle showed paradoxically increased muscle activity during mouth opening. We injected 50 units of type A botulinum toxin (Botox®) into the left masseter muscle, and 20 units into the left temporalis muscle with guidance of ultrasonography. The interincisal distance increased to 8 mm on the 3(rd) day after injection, and 9 mm on the 4(th) day. One month later, the interincisal distance increased to 14 mm. The increased interincisal distance was maintained for 13 months after injection, and the quality of hygienic care and compliance of oral stimulation therapy also improved.