Assessment of functioning using the WHODAS 2.0 among people with stroke in Taiwan: A 4-year follow-up study.

BACKGROUND: Stroke is a leading cause of long-term disability and is considered a major global health burden. OBJECTIVES: We aimed to explore the 4-year changes in disability among patients with stroke under the existing health care system in Taiwan. METHODS: We used the "Taiwan Data Bank of Persons with Disability" (TDPD), which collects data on candidates nationwide who want to apply for government benefits or social welfare. We included adults>18 years with stroke who were registered between July 11, 2012 and October 31, 2018. This was a longitudinal follow-up study with 2 times of assessments. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate function initially and at 4-year follow-up. Generalized estimating equations (GEE) were used to analyse changes in disability over 4 years and interaction effects. RESULTS: A total of 3506 participants (2080 men) with mean age 62.2 (12.5) years and followed up for more than 4 years were included. Generally, participants with stroke showed improved function over the 4 years. Domain scores of mobility, participation, life activities, and overall score significant improved from 55.9 to 54.3, 53.0 to 43.6, 70.9 to 67.4, and 49.8 to 47.3, respectively (P<0.05). With respect to upper- and lower-limb motor deficiency, participants who required assistance or who were dependent showed significant improvement (P<0.05) in most of the WHODAS 2.0 domains except cognition. Younger patients (<65 years) tended to have significantly better outcomes, and institutionalized residents tended to show a significant and considerable deterioration in all WHODAS 2.0 domains. CONCLUSION: Participants with stroke showed an improvement in levels of functioning, specifically in mobility, participation, and life activities, over 4 years of follow-up.

Dysphagia in a Young Man.

This case report presents oropharyngeal dysphagia due to oromandibular and cervical dystonia, a rare consequence of aseptic meningitis. A 19-year-old male who was diagnosed with aseptic meningitis visited the rehabilitation outpatient clinic for a sense of foreign body in his throat and odynophagia. Repetitive involuntary movements of his facial, tongue, and laryngeal muscles accompanied by lateroanterior torticollis were observed. Videofluoroscopic swallowing study showed inefficient bolus formation due to repetitive rolling of his tongue and vallecular stasis without penetration or aspiration. Dysphagia and odynophagia had brought the patient significant weight loss and frustration. We provided swallowing training to improve the efficiency and safety of swallowing. The patient's symptoms improved gradually along with body weight gain and emotional stability. Acute-onset oropharyngeal dysphagia is devastating for young adults. A multidisciplinary approach is mandatory for optimal outcome. We share our experience as a team work and emphasize the rehabilitation aspect.

Effects of dextrose prolotherapy on tendinopathy, fasciopathy, and ligament injuries, fact or myth?: A systematic review and meta-analysis.

OBJECTIVES: Prolotherapy or proliferative therapy is a treatment option for damaged connective tissues involving the injection of a solution (proliferant) which theoretically causes an initial cell injury and a subsequent "proliferant" process of wound healing via modulation of the inflammatory process. Nonetheless, the benefits of dextrose prolotherapy have not been adequately evaluated. Therefore, the present study assesses the effectiveness and superiority of prolotherapy separately in treating dense fibrous connective tissue injuries. METHODS: PubMed, Scopus, and Embase were searched from the earliest record to February 18, 2019. This study included randomized controlled trials whichBoth analysis at individual studies level and pooled meta-analysis were performed. RESULTS: Ten trials involving 358 participants were included for review. At study level, the majority of comparisons did not reveal significant differences between dextrose prolotherapy and no treatment (or placebo) regarding pain control. The meta-analysis showed dextrose prolotherapy was effective in improving activity only at immediate follow-up (i.e., 0-1 month) (standardized mean difference [SMD]: 0.98; 95% confidence interval [CI]: 0.40-1.50; I = 0%); and superior to corticosteroid injections only in pain reduction at short-term follow-up (i.e., 1-3 month) (SMD: 0.70; 95% CI: 0.14-1.27; I = 51%). No other significant SMDs were found in this analysis. CONCLUSIONS: There is insufficient evidence to support the clinical benefits of dextrose prolotherapy in managing dense fibrous tissue injuries. More high-quality randomized controlled trials are warranted to establish the benefits of dextrose prolotherapy. REVIEW REGISTRATION: PROSPERO (CRD42019129044).

Pneumonia in Parkinson's disease: barium aspiration in videofluoroscopic swallowing study.

Barium aspiration into the tracheobronchial tree is a remarkable warning sign of dysphagia-related aspiration pneumonia. Clinical swallowing assessment is warranted for patients with aspiration pneumonia and videofluoroscopic swallowing study is a good add-on tool for dysphagia treatment plan. In patients with Parkinson's disease, dysphagia is often overlooked due to atypical presentations.