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Background: In Korea, cardiac rehabilitation is poorly established in hospitals and communities. Therefore, this study aimed to determine the perceptions of the need for cardiac rehabilitation programs and relevant health policies among hospital directors and health policy managers.Methods: We sent a questionnaire to 592 public health policy managers and directors of selected hospitals, 132 of whom returned a completed questionnaire (response rate: 22.3 %). The participants were categorized into five types of organizations depending on their practice of PCI(Percutaneous Coronary Intervention), establishment of cardiac rehabilitation, director of hospital, and civil servant. The responses were analyzed using a Kruskal-Wallis test. Differences in the opinions between directors of hospitals that perform/do not perform PCI, directors of hospitals with/without cardiac rehabilitation, and between hospital directors and health policy managers were analyzed with Mann-Whitney tests for post-hoc comparisons. Results: Responses about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, hospitals’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive among hospitals that perform PCI than those that do not. Responses to questions about the effectiveness of cardiac rehabilitation and hospitals’ roles in cardiac rehabilitation tended to be more positive in hospitals with cardiac rehabilitation than in those without. Hospital directors responded more positively to questions about targeting diseases for cardiac rehabilitation and governmental health policies’ roles in cardiac rehabilitation than civil servants, and both hospitals and public organizations provided negative responses to the question about patients’ roles in cardiac rehabilitation. Responses to questions about targeting diseases for cardiac rehabilitation, patients’ roles in cardiac rehabilitation, and governmental health policies’ roles in cardiac rehabilitation were more positive in hospitals that perform PCI than those that do not and public organizations.Conclusions: Hospitals must ensure timely referral, provide education, and promote the need for cardiac rehabilitation. In addition, governmental socioeconomic support is needed for incentives, nighttime cardiac rehabilitation programs, and continuum of service into community-based programs.

Due to prolonged survival and the relatively young median age of patients, the quality of life (QOL) of breast cancer survivors is an important issue in Korea. We conducted an educational program for breast cancer survivors, and evaluated its impact on knowledge, QOL, and lifestyle changes. This study utilized a single-arm pretest-posttest design. Participants were tested before and after an educational program to measure changes in knowledge. To measure QOL change, we conducted a QOL survey at the time of enrollment and again 6 months later. Regarding the knowledge test, mean scores increased from 9.62 to 14.74 points following education (p

Purpose: The aim of this study was to identify the change in hand grip strength (HGS) for consecutive 6 months in breast cancer survi vors (BCS) undergoing postoperative adjuvant chemotherapy (adjCTX) and to determine the factors relevant to HGS after chemotherapy completion Methods: This study was a retrospective observational cohort study. BCS (N=38) who underwent breast cancer surgery and subsequent adjCTX were enrolled. The HGS of both sides was measured before adjCTX and 3 weeks, 2 months and 6 months after adjCTX. And we also collected body composition, anthropometric measurements, social demographics and clinical data. Then we analyzed the changes in HGS over time, and correlation of collected data with HGS at 6 months. Results: A significant increase in HGS of the unaffected side was observed within the first 3 weeks of adjCTX and maintained up to 6 months. In correlation analysis, HGS of both sides was positively correlated with the ipsilateral HGS at 3 weeks, and contralateral HGS at 6 months. And skeletal muscle mass was also positively correlated with the HGS of the unaffected side. In addition, subjects treated with targeted therapy had lower HGS of the unaffected side. However, HGS of the affected side was significantly lower in subjects with breast reconstruction and treated without radiotherapy. Conclusions: To maintain the early recovery of HGS, active and continuous exercise intervention for strengthening might be necessary.

In Korea, the actual distribution of cardiac rehabilitation (CR) to the clinical field is insufficient due to the many barriers for cardiovascular patients to participate in CR. Community-based CR is a useful alternative to overcome these obstacles. Through a nationwide survey, we investigated the possibility of regional medical and public health management institutes which can be in charge of community-based CR in Korea.The questionnaires on recognition of CR and current available resources in health-related institutions were developed with reference to the CR evaluation tools of York University and the International Council of Cardiovascular Prevention and Rehabilitation. The questionnaires were sent to regional public and private medical institutions and public health management institutions.In total, 2,267 questionnaires were sent to 1,186 institutions. There were 241 and 242 responses from 173 and 179 regional private and public medical institutions, respectively. And a total of 244 responses were gathered from 180 public health management institutions. Although many institutions were equipped with the necessary facilities for exercise training, there were few patient-monitoring systems during exercise. Most institutions were aware of the need for CR, but were burdened with the cost of establishing personnel and facilities to operate CR.Most regional medical, and public health management institutions in Korea are unprepared for the implementation of community-based CR programs. To encourage the utilization of such, there should be efforts to establish a national consensus.

Regional Cardiocerebrovascular Centers (RCCs)—a Korean government initiative—seek to reduce medical gaps across regions, and their cardiac rehabilitation (CR) programs are expected to model post-acute care for the Korean CR program. Accordingly, this study aimed to evaluate the current status of CR programs in the RCCs. We distributed surveys on the CR condition, activity, and barriers to 12 RCCs in different provinces. The results revealed significant gaps in the annual number of acute myocardial infarction admissions, and CR candidates, capacity, and density across the 12 RCCs. The CR capacity (50–500) and density (0.42–7.36) indicated particularly large gaps. Twelve RCCs had the necessary facilities, equipment and personnel for CR assessments and management, with high CR referral (97%) and patient education (78%) rates. However, the inpatient CR exercise training (56%) participation rate was inadequate, with much lower enrollment (47%) and adherence (17%) rates to the outpatient CR program and large differences across centers. Therefore, this study’s results will provide the evidence required to establish special national health strategies to overcome the CR barriers of patient, doctor/hospital, and policy factors for activating Korean CR programs.

The development of technology-based home fitness has emerged from the booming digital healthcare market and recent demands for at-home fitness and health equipment due to the COVID-19 pandemic. Digital healthcare company Alyce Healthcare recently developed Weelo, which is a web-based online fitness program. Weelo recommends an exercise protocol through machine-learning-enabled recognition of the user’s motion and provides visual and auditory feedback. We evaluated whether Weelo improves physical and mental well-being to assess its capabilities and effectiveness. Thirty-two participants performed a total of 20 exercise sessions following the Weelo guide on a laptop. The participants were evaluated using a before and after exercise program, body composition, handgrip strength, six-minute walk test, modified star excursion balance test, short form 36, fatigue severity scale, Beck depression index, and a satisfaction survey. Overall, there was a significant improvement in muscle strength, endurance, and balance ability, as well as an improved quality of life and significant reduction in fatigue and depression. Participants showed high motivation to continue following the Weelo exercise program. In conclusion, utilizing Weelo improved physical and mental well-being and is considered to be an individual-use indoor exercise program that serves as an alternative to traditional face-to-face exercise.

Fahr's disease (FD) is a rare neurologic disorder characterized by the symmetric and bilateral intracerebral calcification in a patient. We describe the case of a 65-year-old woman who presented with gait disturbance, abnormal mentality, and visual field defect. The result of a brain computerized tomography showed spontaneous intracranial hemorrhage in the right parieto-occipital area, and also showed the incidence of symmetric and bilateral intracerebral calcification. Moreover, laboratory studies indicated characteristic hypoparathyroidism. This brings us to understand that additionally, one of her sons also presented with similar intracerebral calcification, and was subsequently diagnosed with FD. Thus, her case was consistent with that of a patient experiencing FD. The patient had hypertension, which we now know might have caused the intracerebral hemorrhage. However, this patient's brain lesions were in uncommon locations for spontaneous intracerebral hemorrhage, and the lesions were noted as occurring away from the identified heavily calcified areas. Thus, it seemed that the massive calcification of cerebral vessels in the basal ganglia, the most common site of intracerebral hemorrhage, might have prevented a hypertensive intracerebral hemorrhage. Eventually, an intracerebral hemorrhage occurred in an uncommon location in the patient's brain.

The percentage of patients undergoing cardiac rehabilitation programs (CRP) is very low (30–40%), and hospitals providing CRP are either insufficient or lacking, even in countries with advanced medical care; therefore, this study aims to investigate the barriers, as well as compare the differences between hospitals, with or without CRP. We conducted a survey, in which the questionnaire was distributed through post or email to 607 specialists who work at 164 hospitals performing percutaneous coronary interventions (PCI). The results were as follows: (1) of the 164 hospitals, 132 responded (response rate: 80.5%). While all 47 hospitals with CRP responded (100%), from among the 117 hospitals without CRP, 85 responded (72.7%). (2) Of the 607 specialists, 227 responded (response rate: 36.9%). The response rates according to specialties were as follows: cardiologists (28.9%), cardiac surgeons (24.5%), and physiatrists (64.1%). (3) While the specialists at hospitals with CRP identified patient referral, transportation, and cost as the major barriers, for those at hospitals without CRP, all items were considered barriers, especially the items related to equipment, space, workforce, and budget as being more serious barriers. Therefore, in order to actively promote CRP, it is suggested that governments consider the customized support system according to the performance of CRPs.

Background: Evidence supporting a tablet personal computer (PC)-based mode for a systemic approach to managing the breast cancer survival is limited. Objective: The objective of this study was to evaluate whether a tablet personal computer (PC) survey is feasible for screening the risks of the recurrence of breast cancer and the survivor issues associated with breast cancer treatment. Materials and methods: A descriptive study design was used. A pilot test of the tablet PC survey for its feasibility was undertaken using 40 breast cancer survivors at a university affiliated cancer management-survivorship clinic. The tablet PC survey was evaluated by structured questionnaires designed to assess patient experiences responding to the tablet PC-based surveys and user friendliness of the device itself. Results: Older patients and those with a lower education were more likely to have difficulty with the tablet PC administration and required assistance. Both physicians and nurses reported that the tablet PC survey was a useful tool that assisted healthcare professionals with providing quality of care. Conclusion: This pilot test supported the feasibility of a tablet PC survey as a vehicle for breast cancer survivorship management. Keywords: Breast cancer, Survivorship, Tablet, Survey

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.

Objective The aim of this study was to evaluate the effect of anodal transcranial direct current stimulation over the primary somatosensory cortex on the recovery of somatosensation, motor function, and the activities of daily living in patients with subacute stroke. Design This study was a prospective, randomized sham controlled, double-blinded study. Patients with subacute stroke having somatosensory deficits (N = 24) were enrolled and assigned randomly to the anodal and sham stimulation groups. Patients received 10 consecutive anodal or sham transcranial direct current stimulations over the primary somatosensory cortex on the side of the stroke lesion. Before and after each stimulation session, Nottingham sensory assessments, Semmes Weinstein monofilaments examination, and manual function tests were performed, and modified Brunnstrom classification, modified Barthel index, and functional ambulation categories were assessed. Results Although there was no clear significant difference between the two groups, when the changes from baseline to posttreatment evaluation were compared between the groups, a partially significant improvement was observed in the anodal stimulation group compared with the sham stimulation group. Interestingly, the tactile sensation of the unaffected side also improved. Moreover, the greater improvement in activities of daily living function was observed in the anodal stimulation group too. Conclusion Anodal transcranial direct current stimulation over the primary somatosensory cortex may be a useful adjuvant therapy for the recovery of somatosensation and activities of daily living function in patients with sensory deficits after stroke.

Computed tomography (CT) is a reference method for measuring skeletal muscle mass, and the amount of fat in the skeletal muscle can be calculated based on CT attenuation. This study aimed to comprehensively investigate the effect of muscle quality and quantity on metabolic syndrome (MetS) according to sex. This retrospective cross-sectional study enrolled 8081 individuals aged ≥20 years who underwent self-referral abdominopelvic CT at our hospital. The total abdominal muscle area (TAMA), low-attenuation abdominal muscle area (LAMA), normal-attenuation abdominal muscle area (NAMA), and extramyocellular lipid area (EMCLA) were measured using cross-sectional CT data of the L3 lumbar vertebrae. The TAMA and NAMA showed negative correlations with risk factors for MetS and a positive correlation with high-density lipoprotein cholesterol, whereas the LAMA and EMCLA showed an inverse trend in both the sexes (p &lt, 0.001). After adjusting for various factors, a higher LAMA index and the ratio of LAMA to TAMA were associated with a higher prevalence of MetS. High TAMA indices were associated with a lower prevalence of MetS. Furthermore, muscle quality and quantity were associated with the prevalence of MetS in both males and females. However, the LAMA showed a stronger association with MetS in males than in females.

The objective of this proof-of-concept study was to demonstrate the targeted delivery of erythropoietin (EPO) using magnetically guided magnetic nanoparticles (MNPs).MNPs consisting of a ferric-ferrous mixture (FeCl3·6H2O and FeCl2·4H2O) were prepared using a co-precipitation method. The drug delivery system (DDS) was manufactured via the spray-drying technique using a nanospray-dryer. The DDS comprised 7.5 mg sodium alginate, 150 mg MNPs, and 1000 IU EPO.Scanning electron microscopy revealed DDS particles no more than 500 nm in size. Tiny particles on the rough surfaces of the DDS particles were composed of MNPs and/or EPO, unlike the smooth surfaces of the only alginate particles. Transmission electron microscopy showed the tiny particles from 5 to 20 nm in diameter. Fourier-transform infrared spectroscopy revealed DDS peaks characteristic of MNPs as well as of alginate. Thermal gravimetric analysis presented that 50% of DDS weight was lost in a single step around 500°C. The mode size of the DDS particles was approximately 850 nm under in vivo conditions. Standard soft lithography was applied to DDS particles prepared with fluorescent beads using a microchannel fabricated to have one inlet and two outlets in a Y-shape. The fluorescent DDS particles reached only one outlet reservoir in the presence of a neodymium magnet. The neurotoxicity was evaluated by treating SH-SY5Y cells in 48-well plates (1 × 10 cells/well) with 2 μL of a solution containing sodium alginate (0.075 mg/mL), MNPs (1.5 mg/mL), or sodium alginate + MNPs. A cell viability assay kit was used to identify a 93% cell viability after MNP treatment and a 94% viability after sodium alginate + MNP treatment, compared with the control. As for the DDS particle neurotoxicity, a 95% cell viability was noticed after alginate-encapsulated MNPs treatment and a 93% cell viability after DDS treatment, compared with the control.The DDS-EPO construct developed here can be small under in vivo conditions enough to pass through the lung capillaries with showing the high coating efficiency. It can be guided using magnetic control without displaying significant neurotoxicity in the form of solution or particles.

Hand grip strength (HGS) is a means to assess health status and physical abilities indirectly. Various factors are known to be related to HGS, but data on the factors influencing HGS in the Korean population are lacking. Recently, the Korea National Health and Nutrition Examination Survey (KNHANES) conducted by the Korea Centers for Disease Control and Prevention surveyed social status, nutrition, physical status, and other medical history including HGS. This study aimed to investigate the social, physical, and individual health behavior factors associated with low HGS in the elderly Korean population. This population-based cross-sectional study was based on the 2014-2016 KNHANES. Community-dwelling Korean elderly (aged ≥65 years) were included in this survey. The relationship between HGS and socioeconomic status, nutrition, exercise, and other clinical characteristics were analyzed using multivariate logistic regression. The sample size was 3,634 (weighted: 6,006,406). Elderly men and women with low HGS showed lower body mass index, reduced physical activity and lower education level. Among elderly men, excessive carbohydrate and inadequate protein intake were observed in the low HGS group. Meanwhile, older women who did not drink alcohol and had diabetes were at higher risk of low HGS. In conclusion, various physical, nutritional, socioeconomic and comorbidity statuses were seemed to be the factors associated with HGS in Korean elderly. However, further cohort or case-control study will be necessary to determine the causal relationship of those factors and HGS.

Background and Objectives Functional magnetic resonance imaging (fMRI) has shown that transcranial direct current stimulation (tDCS) of the hand motor cortex modulates cortical activity of the healthy human brain. However, few studies have assessed the effects of tDCS on the leg motor cortex. We therefore used fMRI to examine the modulating effects of tDCS on lower limb motor cortex responses. Methods In this sham-controlled case-control study, 11 subjects were exposed to active anodal (n = 6) or sham (n = 5) stimulation, with the anode being positioned on the leg motor cortex of the right hemisphere. Each tDCS was delivered for 15 minutes at 2 mA, with each subject receiving a total of four stimulatory sessions on consecutive days. Cortical activity was measured before the first and after the fourth session by fMRI, and changes in cortical activity were calculated. Results Anodal tDCS increased activation of the ipsilateral supplementary motor area and lowered the extent of activation of both anterior cingulate gyri, the right middle and superior temporal gyri, the middle and superior frontal gyri, and the primary and secondary somatosensory cortices. Conclusions Anodal tDCS increased corticospinal excitability of the lower limb motor cortex in healthy subjects, suggesting that multiple brain cortical areas may be associated with leg motor performance via involvement of variable corticocortical connections.

Lumbar stabilization exercises are effective for the treatment of patients with low back pain. However, personalized exercise programs are required to facilitate more efficient treatment, as each individual exhibits the different characteristics of the trunk muscles and pain.To determine the effects of graded lumbar stabilization exercises on the trunk muscles in healthy individuals, using surface electromyography.A cross-sectional prospective study.Outpatient pain clinic.Ten healthy male participants without low back pain were recruited on a volunteer basis.Four common lumbar stabilization exercises were selected, including the curl up, dead bug, Superman, and bird dog exercises. Each exercise was divided into 5 intensity levels, with participants performing all exercises at each intensity level, to a total of 20 exercises. Electromyographic changes in the trunk muscles according to intensity level were analyzed.Using superficial electromyography, the peak amplitude and area under the curve for each of the rectus abdominis (RA), external oblique abdominis (EO), multifidus (MF), and erector spinae (ES) muscles were measured.In general, as the level of intensity increased, the activity of the related lumbar stabilizing muscles also increased significantly (P.05). Specifically, the peak amplitudes of the RA (P = .008) and EO (P.001) were increased during the curl up exercise, whereas the peak amplitudes of the MF (P.001) and ES (P = .002) were increased during the bird dog exercise. The prolonged exercise duration of the Superman exercise increased the mean area under the curve of MF, ES, and RA (P.001).Using a graded exercise program, an appropriate level of exercise intensity can be prescribed and modulated according to patient tolerance and physical ability. Therefore, a graded lumbar stabilization exercise program may represent an effective way to strengthen the lumbar stabilizing muscles in patients with low back pain.

Kim CR, Yoo JY, Lee SH, Lee DH, Rhim SC. Gait analysis for evaluating the relationship between increased signal intensity on T2-weighted magnetic resonance imaging and gait function in cervical spondylotic myelopathy. Objective To determine relationships between increased signal intensity (ISI) on T2-weighted cervical spine magnetic resonance imaging (MRI) and parameters of gait analysis in patients with cervical spondylotic myelopathy (CSM). Design Retrospective comparative study. Setting Gait analysis laboratory. Participants Patients (N=36) who undertook cervical laminectomy or laminoplasty because of CSM. Interventions Not applicable. Main Outcome Measures Subjects were evaluated by using the modified Japanese Orthopaedic Association (JOA) scale, the Nurick scale, cervical spine MRI, and gait analysis. Two radiologists classified patients into 3 groups: intense, faint, and no ISI. Results Relative to patients without ISI, those with ISI showed significantly slower gait speed, longer step time, decreased single-limb support time, increased double-limb support time, and limited range of motion of knee and ankle ( P Conclusions In patients with CSM who received surgical treatment, more intense ISI on T2-weighted MRI correlated preoperatively with increased difficulties in gait function. Gait analysis may be a useful tool for evaluating gait functions in cervical myelopathy.

Objective To establish reference values for hand grip strength (HGS) in a healthy Korean population and to identify the dependent anthropometric variables that affect HGS. Methods Based on the sixth Korea National Health and Nutrition Examination Survey from 2014 to 2015, we analyzed the HGS data of 7,969 South Koreans. Individuals with specific chronic diseases and who reported poor subjective health status were excluded to ensure a healthy population sample. Means with standard deviations (SDs) and 95% confidence intervals were calculated for each 5-year interval starting from 10 years of age. To determine the relationship between HGS and anthropometric variables, we performed correlation analyses between HGS and height, weight, and body mass index (BMI). Additionally, based on these findings, the cut-off value for low HGS was presented by deriving -2SD values of healthy young adults as recommended by the European Working Group on Sarcopenia in Older People. Results The mean age and BMI of men and women were 38.3 and 38.2 years and 23.8 and 22.4 kg/m2, respectively. Mean HGS of the dominant hand in men and women was 39.5 and 24.2 kg, respectively. The peak in HGS was at 35–39 years of age, after which HGS decreased in both sexes. HGS was significantly correlated with height, weight, and BMI. The cut-off values for weak HGS were < 28.9 and < 16.8 kg in men and women, respectively. Conclusion These results provide useful reference values to assess HGS in patients who undergo hand surgery or who have various diseases that affect HGS. Moreover, a cut-off value for low HGS may help in defining sarcopenia among the Korean population.

81 Background: The aim was to assess the feasibility of using tablet PC for assessment of risk of breast cancer recurrence and primary cancer, physical and psychological effect of breast cancer and treatment, health promotion at first visit among breast cancer survivors. Methods: The prospective study was carried out in the survivorship clinic, university teaching and tertiary referral hospital. After clearance from the Institutional Review Board, 40 breast cancer patients first visiting survival clinic received surgical treatment and adjuvant chemotherapy were included in the study after informed written consent, irrespective of the age and stage of disease. The patients were answered as per quality of life, physical function and activity, pain, fatigue, anxiety and depression, distress by using tablet PC. We evaluated the information of education, marriage, job, economic status and health, knowledge about management of cancer survivors, feasibility (difficulty, simplicity, necessity, comfort, satisfaction, recommendation) of using tablet PC and difficulty of the questionnaire in understanding, psychological, social and documenting aspect. Results: Most of patients using tablet PC agree with easy (85.7%), simplicity (75.4%), necessity (75.5%), comfort (72.1%), satisfaction (83.9%), recommendation to others (77.8%). Age over 60 years (83% vs 96%, p=0.037), general health status (r=0.491, p=0.001) affect to the difficulty of using tablet PC. And age, knowledge, education, general health status affect to the understanding of questionnaire. In multivariation analysis, educational status (elementary school (β=-0.312, p= 0.016), middle school (β=-0.452, p=0.001) and general health status (β=-0.344, p=0.010) affect to the understanding of questionnaire. Conclusions: We can use tablet PC in outpatient cancer surviors clinic effectively. But we need careful evaluation for who are not good in general health status.

Objective To determine the effects of cervical kyphosis on the recovery of swallowing function in subacute stroke patients. Methods Baseline and 1-month follow-up videofluoroscopic swallowing studies (VFSSs) of 51 stroke patients were retrospectively analyzed. The patients were divided into the cervical kyphosis (Cobb's angle

To identify relationships between sleep patterns and functional outcomes in patients with subacute stroke with insomnia.We prospectively studied 30 patients with subacute stroke. Each patient completed the St. Mary's Hospital sleep questionnaire, the Korean modified Barthel index, a computerized neuropsychological test, and the Beck depression inventory. The time interval between baseline and follow-up was 3 wks. Patients with insomnia were all treated with hypnotics, and patients were divided into two groups according to sleep patterns.Poor sleep quality, decreased total sleep time, and increased frequency of nocturnal awakening were observed in patients with insomnia, but sleep patterns improved, when hypnotics were administered, to levels comparable with those of the (noninsomnia) control group. There was no significant difference in functional, cognitive, or depressive status between the insomnia and noninsomnia groups at baseline, but attention in patients with insomnia tended to be lower. At follow-up, functional and cognitive status had improved in both groups, and there was no significant difference between the two groups in sleep quality, sleep time, or nocturnal awakening.Patients with stroke with insomnia showed poor sleep patterns. Active management improved sleep patterns and helped such patients achieve functional and cognitive outcomes equivalent to those attained by patients without insomnia.

Objective To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in stroke patients, and to assess the difference in swallowing function between stroke patients with COPD (COPD group) and stroke patients without COPD (control group). Methods The subjects included 103 stroke patients. They underwent the pulmonary function test and were assigned to either the COPD group or the control group. Their penetration-aspiration scale (PAS) scores and functional dysphagia scale scores were compared by performing a videofluoroscopic swallowing study. The intergroup differences in lip closure, bolus formation, mastication, and the oral transit time, laryngeal elevation, cricopharyngeal dysfunction, oronasal regurgitation, residue in pyriform sinus and vallecula, pharyngeal transit time, aspiration, and esophageal relaxation were also compared. Results Thirty patients were diagnosed with COPD. The COPD group showed statistically higher PAS scores (4.67±2.15) compared to the control group (2.89±1.71). Moreover, aspiration occurred more frequently in the COPD group with statistical significance (p