ObjectiveTo investigate the inter-rater agreement using the Videofluoroscopic Dysphagia Scale (VDS).MethodThe present study was designed as a multicenter, single-blind trial. A Videofluoroscopic Swallowing Study (VFSS) was performed using the protocol described by J.A Logemann. Thick-fluid, pureed food, mechanically altered food, regularly textured food, and thin-fluid boluses were sequentially swallowed. Each participant received a 3 ml bolus followed by a 5 ml bolus of each food material, in the order mentioned above. All study procedures were video recorded. Discs containing these video recordings in random order were distributed to interpreters who were blinded to the participant information. The video recordings were evaluated using a standardized VDS sheet and the inter-rater reliability was calculated.ResultsIn total, 100 patients participated in this study and 10 interpreters analyzed the findings. Inter-rater reliability was fair in terms of lip closure (κ: 0.325), oral transit time (0.253), delayed triggering of pharyngeal swallowing (0.300), vallecular residue (0.275), laryngeal elevation (0.345), pyriform sinus residue (0.310), coating of the pharyngeal wall (0.310), and aspiration (0.393). However, other parameters of the oral phase were lower than those of the pharyngeal phase (0.06-0.153). Moreover, the summation of VDS reliability (intraclass correlation coefficient: 0.556) showed moderate agreement.ConclusionVDS shows a moderate rate of agreement for evaluating the swallowing function. However, many of the parameters demonstrated a lower rate of agreement, particularly the oral phase parameters.

This study aimed to investigate the effect of serum albumin at admission, measured within 24 h after stroke onset, on the functional outcome in ischaemic stroke patients. The medical records of 76 first-ever hemiplegic ischaemic stroke patients were reviewed. Collected data included age, sex, initial stroke severity, cerebrovascular risk factors, lesion-related variables, aetiologic subtype of stroke and serum albumin at admission. The functional outcome was measured by functional independence measure (FIM) and modified Barthel index (MBI). Serum albumin at admission and initial National Institutes of Health Stroke Scale (NIHSS) score were correlated with the functional outcome, respectively. Serum albumin at admission was an independent predictor of MBI gain on multiple regression analysis. Serum albumin at admission would be a useful predictor of the functional outcome and trials for the correction of hypoalbuminaemia from the acute stage would be helpful to decrease the risk of poor outcome in ischaemic stroke patients.

ObjectiveTo investigate the effects of aerobic exercise on neuropathic pain and verify whether regular treadmill exercise alters opioid receptor expression in the rostral ventral medulla (RVM) in a neuropathic pain rat model.MethodsThirty-two male Sprague-Dawley rats were used in the study. All rats were divided into 3 groups, i.e., group A, sham group (n=10); group B, chronic constriction injury (CCI) group (n=11); and group C, CCI+exercise group (n=11). Regular treadmill exercise was performed for 30 minutes a day, 5 days a week, for 4 weeks at the speed of 8 m/min for 5 minutes, 11 m/min for 5 minutes, and 22 m/min for 20 minutes. Withdrawal threshold and withdrawal latency were measured before and after the regular exercise program. Immunohistochemistry and Western blots analyses were performed using antibodies against µ-opioid receptor (MOR).ResultsBody weight of group C was the lowest among all groups. Withdrawal thresholds and withdrawal latencies were increased with time in groups B and C. There were significant differences of withdrawal thresholds between group B and group C at 1st, 2nd, 3rd, and 4th weeks after exercise. There were significant differences of withdrawal latencies between group B and group C at 3rd and 4th weeks after exercise. MOR expression of group C was significantly decreased, as compared to that of group B in the RVM and spinal cord.ConclusionIn neuropathic pain, exercise induced analgesia could be mediated by desensitization of central MOR by endogenous opioids, leading to the shift of RVM circuitry balance to pain inhibition.

Rationale: Spinal cord injury (SCI) patients who experience difficulties with independent walking use gait-assistive devices such as a cane, walker, or wheelchair. Few studies have explored gait patterns or cardiopulmonary function in chronic SCI patients after powered exoskeleton training. We investigated whether the cardiopulmonary function of a patient with an incomplete chronic cervical SCI and a hemiplegic gait pattern could be improved by walking training using a powered exoskeleton (Angelegs).Patient concerns: A 57-year-old male was diagnosed with an SCI at C3-C4. The right upper and lower limb motor functions differed when evaluated before entry into the program. Motor function was good in the right leg but poor in the left one. Before program entry, the patient could walk for about 10 m using a cane. He did not have a history of severe medical or psychological problems and was not cognitively impaired. Diagnosis:The patient was tetraplegia with incomplete SCI at C3-C4. Interventions:The patient was trained for 6 weeks using a powered exoskeleton. The training program consisted of sit-to-stand and stand-to-sit movements, maintenance of balanced standing for 5 minutes, and walking for 15 minutes.Outcomes: After 6 weeks of training, gait speed improved in the timed up-and-go test, and cardiac function was enhanced as measured by the metabolic equivalent and VO 2 tests.Lessions: Walking training using a powered exoskeleton can facilitate the effective rehabilitation and improve the gait speed and cardiopulmonary function of patients with chronic SCIs or strokes.

The aim of this study was to follow up the changes in the number of motor units according to the Brünnstrom stage through a motor unit number estimation of the F-wave (F-MUNE) after a stroke, and to identify the functional significance of F-MUNE. Twenty-five patients (15 men, 10 women) with a first unilateral stroke were recruited. The maximal M-potential was evoked by the supramaximal stimulation of the median nerve at the wrist, and the maximal stimulation intensity was determined on both hemiplegic and unaffected hands. The reproducible all-or-none F-wave was evoked in 30% of the maximal stimulation intensity and was constantly stimulated at that level. The prototypes of the F-wave were chosen, and the values of F-MUNE were calculated by dividing the amplitude of the maximal M-potential by the mean amplitude of the F-prototype. The changes in F-MUNE were compared according to the progression of the Brünnstrom stage and correlated with those of the functional scales. The mean motor unit numbers decreased significantly in the hemiplegic side compared with the unaffected side. According to the progression of the Brünnstrom stage, the values of F-MUNE were reduced significantly by increasing the amplitude and recruitment of the F-prototype, and the functional scores also improved. These results show that the F-MUNE equation did not show a functional recovery-related increase in stroke patients.