ObjectiveTo examine whether transcranial direct current stimulation (tDCS) applied over the posterior parietal cortex (PPC) improves visuospatial attention in stroke patients with left visuospatial neglect.MethodsPatients were randomly assigned to 1 of 3 treatment groups: anodal tDCS over the right PPC, cathodal tDCS over the left PPC, or sham tDCS. Each patient underwent 15 sessions of tDCS (5 sessions per week for 3 weeks; 2 mA for 30 minutes in each session). Outcome measures were assessed before treatment and 1 week after completing the treatment.ResultsFrom pre- to post-treatment, there was an improvement in the motor-free visual perception test (MVPT), line bisection test (LBT), star cancellation test (SCT), Catherine Bergego Scale (CBS), Korean version of Modified Barthel Index (K-MBI), and Functional Ambulation Classification in all 3 groups. Improvements in the MVPT, SCT, and LBT were greater in the anodal and cathodal groups than in the sham group. However, improvements in other outcomes were not significantly different between the 3 groups, although there was a tendency for improved CBS or K-MBI scores in the anodal and cathodal groups, as compared with the sham group.ConclusionThe study results indicated that the facilitatory effect of anodal tDCS applied over the right PPC, and the inhibitory effect of cathodal tDCS applied over the left PPC, improved symptoms of visuospatial neglect. Thus, tDCS could be a successful adjuvant therapeutic modality to recover neglect symptom, but this recovery might not lead to improvements in activities of daily living function and gait function.

Background:This study aimed to demonstrate the effect of intra-articular (IA) lumbar facet joint (LFJ) pulsed radiofrequency (PRF) for the management of LFJ pain, and to compare the effect of IA LFJ PRF to IA corticosteroid injection (ICI). Pathology in the LFJ is a common source of lower back pain (LBP). It is responsible for chronic LBP in approximately 15% to 45% of patients. It has been reported that PRF stimulation can effectively reduce refractory joint pain.Methods:Sixty patients with LFJ pain were recruited and randomly assigned to 1 of 2 groups: the IA PRF group and the ICI group. There were 30 patients in each group. At pretreatment, 2 weeks, 1, 3, and 6 months after treatment, we assessed the severity of LBP using a numeric rating scale (NRS).Results:Compared with the pretreatment NRS scores, patients in both groups showed a significant decrease in NRS scores at 2 weeks, and 1, 3, and 6 months after each treatment. Between groups, changes in the NRS scores were significantly different over time. At 2 weeks and 1 month after each procedure, the NRS score after ICI was significantly lower than that after the PRF stimulation. However, at 3 and 6 months after the procedures, the decrements of NRS scores were not significantly different between the 2 groups. Six months after treatment, about half of patients in both groups reported successful pain relief (pain relief of ≥50%).Conclusion:In the current study, both IA PRF stimulation and ICI into the LFJ significantly relieved LFJ pain. Their effects persisted for at least 6 months after the procedure. Thus, IA PRF is a useful therapeutic option for the management of LFJ pain.

Objective The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

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Background: In this study, we evaluated the outcome of interlaminar epidural steroid injection (ESI) in patients with chronic pain induced by moderate or severe lumbar central spinal stenosis (LCSS), and compared the effects of interlaminar ESI according to the severity of LCSS.Methods: Sixty patients with chronic lower extremity pain due to LCSS were included and received interlaminar ESI. Two patients were lost to follow-up. On the basis of sagittal lumbar magnetic resonance imaging findings, 30 patients had moderate LCSS (group A) and 28 patients had severe LCSS (group B).Pain intensity was evaluated using a numeric rating scale (NRS) before treatment and at 1, 2, and 3 months after treatment.Results: In all the recruited patients, pain intensity was significantly lower at each evaluation time point compared to that before treatment. Intragroup analysis revealed that patients in each group showed a significant decrease in pain intensity at 1, 2, and 3 months after treatment. However, at 3 months after treatment, only 9 patients (30.0%) in group A and 5 patients (17.9%) in group B reported successful pain relief (pain relief of ≥50%). Pain intensity was significantly lower in group A than in group B at each evaluation time point.Conclusions: Interlaminar ESI might be effective for alleviating pain induced by moderate or severe LCSS, but its effectiveness appears to be limited. Patients with severe LCSS showed worse treatment outcome compared to patients with moderate LCSS.

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The aim was to investigate the relationship between transcranial magnetic stimulation (TMS) at the early stage of stroke and 6-month motor outcome for patients with anterior cerebral artery territory infarct. Patients were classified into TMS(+) and TMS(-) groups. At the 6-month evaluation, lower limb motor function for the TMS(+) group was significantly better than those for the TMS(-) group. Thus, early TMS evaluation is useful for predicting recovery of lower limb motor function in patients experiencing this type of stroke.