ObjectiveTo identify the relationship between maximum phonation time (MPT) and swallowing function, as well as the elements of swallowing, in order to provide a rationale for speech therapy in patients with Parkinsonism manifesting dysphagia.MethodsThirty patients with Parkinsonism who underwent speech evaluation and videofluoroscopic swallowing study (VFSS) were recruited. The MPT, the longest periods of sustained pronunciation of /aa/, was evaluated. The VFSS was evaluated using Penetration Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and Videofluoroscopic Dysphagia Scale (VDS). The relationship between dysphagia scales and MPT was analyzed using Pearson correlation. The difference in VDS variables between subgroups (Parkinson disease or Parkinsonian syndrome, independent or dependent ambulation, and normal or abnormal MPT) and the difference in MPT between subgroups based on the VDS variables were analyzed using the independent t-test.ResultsBolus formation and laryngeal elevation functions were significantly higher in the normal MPT group compared with the impaired group. In the VDS variables, patients with intact bolus formation, oral transit time, pharyngeal swallow triggering, and laryngeal elevation showed significantly longer MPTs compared with the impaired groups. In addition, MPT was significantly correlated with the VDS and modestly correlated with the NIH-SSS, but not the PAS, suggesting that phonatory function is related to the oropharyngeal swallowing function, but not directly to the aspiration itself.ConclusionThe correlation between MPT and several swallowing-related elements was identified, indicating an interactive correlation between swallowing and phonation. This result justifies voice therapy as a treatment for dysphagia in patients with Parkinsonism.
ObjectiveTo investigate the effect of treadmill walking exercise as a treatment method to improve gait efficiency in adults with cerebral palsy (CP) and to determine gait efficiency during overground walking after the treadmill walking exercise.MethodsFourteen adults with CP were recruited in the experimental group of treadmill walking exercise. A control group of 7 adults with CP who attended conventional physical therapy were also recruited. The treadmill walking exercise protocol consisted of 3-5 training sessions per week for 1-2 months (total 20 sessions). Gait distance, velocity, VO2, VCO2, O2 rate (mL/kg·min), and O2 cost (mL/kg·m) were assessed at the beginning and at the end of the treadmill walking exercise. The parameters were measured by KB1-C oximeter.ResultsAfter the treadmill walking exercise, gait distance during overground walking up to 6 minutes significantly increased from 151.29±91.79 to 193.93±79.01 m, and gait velocity increased from 28.09±14.29 to 33.49±12.69 m/min (p<0.05). Energy efficiency evaluated by O2 cost during overground walking significantly improved from 0.56±0.36 to 0.41±0.18 mL/kg·m (p<0.05), whereas O2 rate did not improve significantly after the treadmill walking exercise. On the other hand, gait velocity and O2 cost during overground walking were not significantly changed in the control group.ConclusionTreadmill walking exercise improved the gait efficiency by decreased energy expenditure during overground walking in adults with CP. Therefore, treadmill walking exercise can be an important method for gait training in adults with CP who have higher energy expenditure.
This retrospective case-control study aimed to the effect of hypokalemia on the functional outcomes of patients with subacute stroke. A total of 96 post-stroke hemiplegic patients admitted to an inpatient clinic of the department of rehabilitation medicine between March 2014 and February 2018 were recruited. Serum potassium level was assessed at the time of admission, and the patients with hypokalemia on admission or within 7 days after onset were classified into the hypokalemic group. Functional assessments using the Hemispheric Stroke Scale (HSS), Functional Ambulation Category (FAC), Functional Independence Measure for locomotion, and Mini Mental Status Examination were performed. The primary outcome was the change in functional score during rehabilitation. No significant intergroup differences in baseline characteristics were found except hospital stay duration and use of diuretics. FAC recovery (0.91 vs. 1.66, p = 0.001), HSS lower extremity and total motor scores (0.37 vs. 1.10, p = 0.01; 0.83 vs. 2.18, p = 0.02, respectively) were significantly lower in the hypokalemic group. Pearson correlation analysis of the initial serum potassium level and functional recovery revealed significant correlations with the FAC or HSS lower extremity and total motor scores (p = 0.001, p = 0.01, and p = 0.04, respectively).
This is the first report of motor recovery after a seizure induced by high-frequency repetitive transcranial magnetic stimulation (rTMS).• The hand strength and coordination were improved after seizure induced by rTMS.• Rarely, neurologic recoveries are reported rather than deteriorations after seizures.
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