Search

Background: Central post‐stroke pain (CPSP) has a detrimental effect on the quality of life of post‐stroke patients. However, no definitive and effective method has been established yet for the treatment of CPSP. Objective: We aimed to examine the applicability of single‐injection peripheral nerve blocks (PNBs) for the treatment of CPSP. Subjects: In this retrospective study, we included 22 patients (mean age = 56.3 years; 13 men and 9 women) diagnosed with CPSP who visited an outpatient rehabilitation clinic in Seoul National University Bundang Hospital between December 2018 and April 2020. Methods: The patients underwent ultrasound‐guided single‐injection PNB (lidocaine + epinephrine [1: 200,000]) according to the primary site of pain. The level of pain (measured using a numeric rating scale) was recorded before and after the PNB, and the occurrence of adverse events were also measured. The primary outcome of this study was the amount of pain reduction after PNB. Secondary outcome measures obtained 1 month after the PNB included the pain reduction rate 1 month after the PNB, the patient‐reported satisfaction and effectiveness regarding the PNB, intention for re‐injection, and the patients' willingness to recommend this procedure to others. Results: The mean pain reduction after PNB was 3.3 ± 2.8. PNB was associated with pain reduction that persisted for greater than 1 month in 68% (15/22) of the patients. Thirteen of 22 patients reported a pain reduction of 50% or more. The mean pain reduction rate was 43.6%. Of the 22 patients, 13 were willing to undergo a second round of treatment with PNB. Nine of them underwent the procedure. No adverse events were observed in this study. Conclusions: Our study provides preliminary data suggesting that PNB could be an effective and feasible method to treat CPSP. [ABSTRACT FROM AUTHOR]

Aim The most appropriate muscle index for the definition of sarcopenia has not been agreed on. We aimed to investigate the associations of muscle mass and strength with 5-year mortality and low physical performance. Methods We included 560 participants aged 65 years or older in the analysis. Muscle and fat mass were assessed by dual-energy X-ray absorptiometry. Leg muscle and grip strength were measured using dynamometers. The clinical outcomes were 5-year mortality and low physical performance ( Short Physical Performance Battery score < 9) in 5 years. Associations between muscle indices and clinical outcomes were analyzed. A Cox proportional hazard model for mortality and a logistic regression model for physical performance were used. Results Decreases in leg muscle and grip strength were significantly associated with 5-year mortality and low physical performance in both sexes. Total muscle mass in men and appendicular skeletal mass in both sexes were associated with mortality, but not with low physical performance. Lower leg muscle strength ( OR 0.107; P = 0.020) was an independent predictor of low physical performance in women after adjusting for age, fat, cognition, and depression. Lower leg muscle ( OR 0.123; P = 0.031) and lower grip strength ( OR 0.950; P = 0.012) were independent predictors of low physical performance in men. Conclusions Muscle strength is a better indicator of 5-year adverse clinical outcomes of mortality and low physical performance than muscle mass. Muscle strength was an independent predictor of low physical performance in 5 years. Geriatr Gerontol Int 2016; 16: 577-585. [ABSTRACT FROM AUTHOR]

Objectives To investigate the relationship between dysphagia and mild cognitive impairment ( MCI) in older adults residing in an independent-living facility in Korea. Design Population-based, cross-sectional study. Setting Seongnam, Korea. Participants Korean men and women aged 65 and older living in a typical South Korean city (n = 415) were enrolled in the Korean Longitudinal Study on Health and Aging. Measurements Dysphagia was assessed using the Standardized Swallowing Assessment ( SSA). Cognitive function was evaluated using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery, digit span test, and lexical fluency test. MCI was diagnosed using operational diagnostic criteria and further classified into amnestic and nonamnestic MCI. Results Men with nonanmestic MCI had a greater likelihood of having dysphagia (odds ratio ( OR) = 3.77, 95% confidence interval ( CI) = 1.12-12.72) than men without MCI. Men with nonanmestic MCI were almost six times as likely to have dysphagia ( OR = 5.78, 95% CI = 1.15-29.27) as men with no neurological disorder after adjusting for age, education level, current smoking and drinking, diabetes mellitus, and apolipoprotein E-4 carrier status. Conclusion Men with nonamnestic MCI were more likely to have dysphagia than were their counterparts without MCI, whereas this difference was not found in men with amnestic MCI and women. Assessment of executive functions that interfere with planning of motor activities may be useful in predicting dysphagia and in planning preventive and therapeutic strategies for older men. [ABSTRACT FROM AUTHOR]

Objective: To investigate the incidence of falls and risk factors for falls in persons who had a stroke. Design: Telephone survey. Setting: Tertiary university hospital. Patients and Methods: Patients who had a stroke and were admitted to the rehabilitation unit between April 2006 and July 2008 were listed and contacted by telephone from February 2009 to August 2009. Main Outcome Measurements: Information obtained from the interviews, which were performed 20 ± 8 months after discharge from inpatient rehabilitation, included demographic data, information about falls, and current ambulatory function. After the telephone interview, medical records of participants during admission were reviewed. Results: Of the 404 enrolled patients, 330 were included in the analysis. Of the 330 patients, 62 (19%) had a history of a fall after stroke onset. Of 222 ambulatory patients, 51 patients (23%) fell. Falls frequently occurred in winter, and most falls occurred indoors (70%). Twenty-nine percent of patients experienced repeated falls. About half of those who fell were injured, and 11% sustained fractures. Patients who had a stroke and had severe deficits showed a lower probability of poststroke falls. In a subgroup analysis of patients with ambulatory capacity, left-sided hemiplegia/hemiparesis was associated with an increased risk of falls. Conclusions: This study reveals a high incidence of poststroke falls after discharge from inpatient rehabilitation. More caution should be taken for patients with ambulatory ability and left hemiplegia/hemiparesis because they are more vulnerable to falls after a stroke. An increased prevalence of fear of falling in people who fell suggests that an appropriate intervention to reduce fear of falling should be provided to patients who have had a stroke. [ABSTRACT FROM AUTHOR]

To determine whether the potency of botulinum toxin A (BTA) decreases after being reconstituted with normal saline and stored in refrigerator, we injected one side of the extensor digitorum brevis muscle with 2.5 units of botulinum toxin A that had been immediately reconstituted with saline, and the contralateral side with identical material that had been reconstituted and stored in a refrigerator for preselected periods (1, 2, and 4 weeks) in 32 healthy volunteers. Mean compound muscle action potential amplitudes expressed as a percentage of the baseline amplitude were more reduced in sides injected with immediately reconstituted BTA than in sides injected with BTA stored for 1 week or more ( P < 0.05). No bacterial growth was observed in any stored BTA samples. Storage of reconstituted BTA at low temperatures may affect the potency of the toxin. Therefore, the use of BTA after refrigerated storage is not recommended. © 2006 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the sexual function and activity in male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury. Methods: Eighty-nine patients (mean age 37.6 years with a range of 18–66) were included in the study. We requested all subjects to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5). Results: Of 89 patients, 60 (67.4%) reported having attempted no sexual intercourse over the past 6 months and 28 (31.5%) presented with IIEF-5 scores less than or equal to 21 points. When subjects were stratified according to the years since injury, 50.0% (16 of 32) with less than 2 years post-injury had no sexual activity, while 77.2 (44 of 57) with 2 years or more post-injury did ( P = 0.027). Patients with sexual activity were 40.4% (23 of 57) and 18.8% (6 of 32) in patients who were able and unable to perform self-catheterization, respectively ( P = 0.037). Patients with less than 2 years post-injury had 3.3-fold higher risk (odds ratio 3.33; 95% confidence interval 1.01–10.97; P = 0.048) of no sexual activity than those with 2 years or more post-injury on the multivariate model. The other parameters were not appreciably related to sexual activity. Conclusion: Our results demonstrate that sexual activity as well as erectile function is poor in this population. In addition, our findings suggest that years since injury may influence sexual activity of patients with spinal cord injury. [ABSTRACT FROM AUTHOR]