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Supplemental Digital Content is available in the text, Background: Differential diagnosis of idiopathic Parkinson disease (IPD) and multiple system atrophy-Parkinson type (MSA-P) is challenging since they share clinical features with parkinsonism and autonomic dysfunction. To distinguish MSA-P from IPD when the symptoms are relatively mild, we investigated the usefulness of the quantitative fractionalized autonomic indexes and evaluated the correlations of autonomic test indexes and functional status. Methods: Thirty-six patients with parkinsonism (22 with IPD and 14 with MSA-P) in Soonchunhyang University Bucheon Hospital from February 2014 to June 2015 were prospectively enrolled in the study. We compared fractionalized autonomic indexes and composite autonomic scoring scale between patients with IPD and MSA-P with Hoehn and Yahr (H&Y) score ≤3. Parasympathetic indexes included expiratory/inspiratory ratio during deep breathing, Valsalva ratio (VR), and regression slope of systolic blood pressure (BP) in early phase II (vagal baroreflex sensitivity) during Valsalva maneuver. Sympathetic adrenergic indexes were pressure recovery time (PRT) and adrenergic baroreflex sensitivity (BRSa) (BP decrement associated with phase 3 divided by the PRT), sympathetic index 1, sympathetic index 3, early phase II mean BP drop, and pulse pressure reduction rate. Additionally, we compared the unified multiple system atrophy rating scale (UMSARS) and H&Y scores and the autonomic indexes in all patients. Results: PRT was significantly different between the IPD and MSA-P groups (P = 0.004) despite the similar BP drop during tilt. Cut-off value of PRT was 5.5 s (sensitivity, 71.4%; specificity, 72.7%). VR (r = −0.455, P = 0.009) and BRSa (r = −0.356, P = 0.036) demonstrated a significant correlation with UMSARS and H&Y scores. Conclusions: Among the cardiovascular autonomic indexes, PRT can be a useful parameter in differentiating the early stage of MSA-P from that of IPD. Moreover, VR, and BRSa may be the optimal indexes in determining functional symptom severity.

Objectives: To evaluate the clinical efficacy of smartphone-assisted self-rehabilitation in patients with frozen shoulder. Design: A single-center, randomized controlled trial. Setting: Orthopedic department of a university hospital. Subjects: A total of 84 patients with frozen shoulder were recruited. Intervention: Patients were randomly divided into two groups: a smartphone-assisted exercise group ( n = 42) and a conventional self-exercise group ( n = 42). The study was performed over three months, during which each group performed home-based rehabilitation. Main measures: Visual analogue scale for pain and passive shoulder range of motion were assessed at baseline and after 4, 8, and 12 weeks of treatment. Technology Acceptance Model–2 and Usefulness, Satisfaction, and Ease of Use scores were evaluated in the smartphone group. Results: Initial visual analogue scale for pain of the smartphone group was 6.0 ± 2.2 and ended up with 1.8 ± 2.5 after 12 weeks, whereas the self-exercise group showed 5.8 ± 2.3 for the baseline visual analogue scale for pain and 2.2 ± 1.7 at the end. Significant time-dependent improvements in all measured values were observed in both groups (all Ps Conclusion: There was no difference between home-based exercise using a smartphone application and a conventional self-exercise program for the treatment of frozen shoulder in terms of visual analogue scale for pain and range of motions.

This study aimed to compare gait analysis and balance function measurements, such as the Berg balance scale (BBS) score to seek specific measurements that can represent the balance functions of patients with brain lesions. Additionally, we also compared other different gait function scale scores with gait analysis measurements. This study included 77 patients with brain lesions admitted to our institution between January 2017 and August 2020. Their gait analysis parameters and clinical data, including personal data; clinical diagnosis; duration of the disease; cognition, ambulation, and stair-climbing sub-scores of the modified Barthel index (MBI); manual muscle test (MMT) findings of both lower extremities; functional ambulation category (FAC); and BBS score, were retrospectively analyzed. A multiple linear regression analysis was performed to identify the gait analysis parameters that would significantly correlate with the balance function and other physical performances. In the results, the BBS scores were significantly correlated with the gait speed and step width/height2. However, the other gait function measurements, such as the FAC and ambulation and stair-climbing sub-scores of the MBI, were correlated only with the gait speed. Additionally, both the summations of the lower extremity MMT findings and anti-gravity lower extremity MMT findings were correlated with the average swing phase time. Therefore, in the gait analysis, the gait speed may be an important factor in determining the balance and gait functions of the patients with brain lesions. Moreover, the step width/height2 may be a significant factor in determining their balance function. However, further studies with larger sample sizes should be performed to confirm this relationship.

Background Cognitive training using virtual reality (VR) may result in motivational and playful training for patients with mild cognitive impairment and mild dementia. Fully immersive VR sets patients free from external interference and thus encourages patients with cognitive impairment to maintain selective attention. The enriched environment, which refers to a rich and stimulating environment, has a positive effect on cognitive function and mood. Objective The aim of this study was to investigate the feasibility and usability of cognitive training using fully immersive VR programs in enriched environments with physiatrists, occupational therapists (OTs), and patients with mild cognitive impairment and mild dementia. Methods The VR interface system consisted of a commercialized head-mounted display and a custom-made hand motion tracking module. We developed the virtual harvest and cook programs in enriched environments representing rural scenery. Physiatrists, OTs, and patients with mild cognitive impairment and mild dementia received 30 minutes of VR training to evaluate the feasibility and usability of the test for cognitive training. At the end of the test, the usability and feasibility were assessed by a self-report questionnaire based on a 7-point Likert-type scale. Response time and finger tapping were measured in patients before and after the test. Results Participants included 10 physiatrists, 6 OTs, and 11 patients with mild cognitive impairment and mild dementia. The mean scores for overall satisfaction with the program were 5.75 (SD 1.00) for rehabilitation specialists and 5.64 (SD 1.43) for patients. The response time of the dominant hand in patients decreased after the single session of cognitive training using VR, but this was not statistically significant (P=.25). There was no significant change in finger tapping in either the right or left hand (P=.48 and P=.42, respectively). None of the participants reported headaches, dizziness, or any other motion sickness after the test. Conclusions A fully immersive VR cognitive training program may be feasible and usable in patients with mild cognitive impairment and mild dementia based on the positive satisfaction and willingness to use the program reported by physiatrists, OTs, and patients. Although not statistically significant, decreased response time without a change in finger tapping rate may reflect a temporary increase in attention after the test. Additional clinical trials are needed to investigate the effect on cognitive function, mood, and physical outcomes.

We conducted a focus group discussion with bus workers to evaluate their experiences and perceptions, as well as their reasons for participating in a program for vulnerable workers. The study also sought to identify the strengths and weaknesses of the program. A total of nine bus workers participated in the focus group discussion. The focus group discussion was conducted based on a semi-structured guide, which was developed from discussions among the researchers and a review of major preliminary studies. The verbatim transcriptions were analyzed using content analysis. The sole existence of a health promotion program for vulnerable workers in Ulsan was sufficient to attract participants who had not been involved in other health management programs. Participants reported that participation in the program mitigated some of their musculoskeletal symptoms, which are often faced by bus workers. The findings of this study may contribute to the expansion of the health promotion program targeting workers in vulnerable working environments in Ulsan and other places. In order to increase users&rsquo, satisfaction and the sustainability of the program, it is necessary to develop a strategy to increase the accessibility of the program and enhance the self-efficacy of participants.

Injury to the thalamocortical tract (one in the Papez circuit) that leads to memory impairment following brain injury is very rare. In this study, we present a case of partial injury to the thalamocortical tract that causes memory impairment after concurrent thalamic and hippocampal infarct. A 20-year-old male complained of memory impairment 1 month after partial injury to the thalamocortical tract. Using a probabilistic diffusing tensor tractography, it was found that the right thalamocortical tract was thinner than the left thalamocortical tract. However, all other neural tracts including the fornix, cingulum, and mammillothalamic tract were intact on both hemispheres. Therefore, the memory impairment in this patient was considered as being due to thalamic infarct based on the observation that the fornix from hippocampal infarct was intact. This case suggests that the assessment of lesions in the neural tracts of the Papez circuit might be useful for understanding the mechanism of memory impairment following cerebral infarction.

In this demonstration paper, we introduce our RAPAEL rehabilitation system. It is designed for treatment of those who are suffering from brain diseases or disorders. The purpose of our system is to turn boring and unpleasant conventional rehabilitation exercises into more exciting and inspiring one. We developed an IoT-based wearable device and serious game for medical use.

It is not clear whether the fornix and cingulum are involved in cognition after putaminal hemorrhage (PH). We investigated structural changes and differences of the neural tracts, and the relationship between the integrity of the neural tracts and cognition not only at the affected but also at the unaffected side. Sixteen patients with left chronic putaminal hemorrhage and 20 healthy volunteers were enrolled. Using diffusion tensor tractography (DTT), we compared fiber number (FN), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of the neural tracts between patient and control groups. The relationship between the neural tract parameters and neuropsychological results was also analyzed. The left fornix FN was significantly lower than the right fornix FN in the patient group. Except for the cingulum FA, the neural tracts parameters for both the affected and unaffected hemispheres differed significantly between the groups. The fornix FA and ADC at the affected side were significantly correlated with intelligence quotient (IQ), mini-mental status examination (MMSE), and short-term memory. Interestingly, the fornix ADC at the unaffected side was significantly correlated with MMSE. However, none of the cingulum parameters was correlated with neuropsychological results. The fornix integrity is critical for cognitive impairment after putaminal hemorrhage.