Early Gait Function After Lung Transplantation in Patients With and Without Pretransplant Extracorporeal Membrane Oxygenation Support.

OBJECTIVE: We aimed to investigate the recovery of gait function, muscle strength, and the achievement of an independent gait after lung transplantation (LT) in patients with and without pretransplant extracorporeal membrane oxygenation (ECMO) support. METHODS: We retrospectively reviewed the medical records of 33 inpatients who underwent bilateral LT and received physical therapy. We assessed the Functional Ambulatory Category (FAC) and Manual Muscle Test (MMT) scores at baseline, 1 month, and 3 months of rehabilitation and the time it took to achieve a FAC score of 3 within 3 months of LT surgery in ECMO and non-ECMO patients. RESULTS: The FAC and MMT scores were generally improved during the first 3 months after LT. The number of patients who achieved a FAC score of 3 at 3 months did not significantly differ between the ECMO and non-ECMO groups (P = .193). At 1 month, significantly fewer patients had reached a FAC of 3 in the ECMO group than in the non-ECMO group (P = .042). There were no significant differences in the FAC (P = .398) and MMT scores (P = .079) at 3 months between the 2 groups. CONCLUSIONS: Both groups' gait function and muscle strength were continuously restored 3 months after LT. At 1 month, the gait function was assessed by the FAC score, and the rate to achieve a FAC of 3 was higher in the non-ECMO group than in the ECMO group, but at 3 months, the difference was not significant between the 2 groups.

The Relationship Between Dysphagia and Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis.

Background: Dysphagia is a common complication after stroke and is associated with the development of pneumonia. This study aimed to summarize the relationship between dysphagia and pneumonia in post-stroke patients. Materials and Methods: Articles published up to November 2021 were searched in the PubMed, Embase, Cochrane library, and Scopus databases. Studies that investigated the development of pneumonia in acute stroke patients with and without dysphagia were included. The methodological quality of individual studies was evaluated using the Risk Of Bias In Non-randomized Studies-of Interventions tool, and publication bias was evaluated using a funnel plot and Egger's test. Results: Of 5,314 studies, five studies were included in the meta-analysis. The results revealed that the incidence of pneumonia was significantly higher in the dysphagia group than in the non-dysphagia group (OR 9.60; 95% CI 5.75-16.04; p < 0.0001; I 2 = 78%). There was no significant difference in the mortality rate between the two groups (OR 5.64; 95% CI 0.83-38.18; p = 0.08; I 2 = 99%). Conclusion: Dysphagia is a significant risk factor for pneumonia after stroke. The early diagnosis and treatment of dysphagia in stroke patients are important to prevent stroke-associated pneumonia.

Adapting the International Dysphagia Diet Standardisation Initiative in East Asia: Feasibility study.

In dysphagia, food or water cannot be delivered safely through the oral cavity to the stomach; both are treated using texture-modified food and thickened fluid. Before, each country had its own diet modifications and texture measurement standards. In 2012, the International Dysphagia Diet Standardisation Initiative (IDDSI) was developed by several countries. Owing to cultural differences, it was necessary to determine whether the IDDSI could well be applied to clinicians and patients without difficulties in East Asia countries. To evaluate the IDDSI scale to find out the difficulties applying this scale in East Asia countries to educate the clinicians and patients. In May 2021, we enrolled physicians, nurses, nutritionists, and swallowing therapists involved in dysphagia treatment at a single center in Seoul. To evaluate the degree of understanding and difficulties of adapting IDDSI to clinicians in East Asia countries, we used the 17-item questionnaire with IDDSI sample foods and foods in Asian countries. In first 7 items, we compared IDDSI with the previously used scale based on the National Dysphagia Diet (NDD). In the next 10 questions, only the IDDSI levels were answered, and the absolute values of the answer-response differences were calculated. The IDDSI showed a significantly high intraclass correlation with the previously used NDD-based scale; the coefficient was higher for the nutritionists (0.988) and swallowing therapists (0.991). When evaluating whether the IDDSI could applied well in East Asia countries, the absolute values of the answer-response differences were lower than 0.5 in majority of levels, except for Level 4. Because the IDDSI framework might successfully be applied universally regardless of food culture, a worldwide standard for food rheology in dysphagia treatment might be possible.

Post-stroke Aphasia as a Prognostic Factor for Cognitive and Functional Changes in Patients With Stroke: Ischemic Versus Hemorrhagic.

OBJECTIVE: To investigate the comprehensive outcomes in aphasic patients, including their cognitive and functional status after ischemic or hemorrhagic stroke. It also aimed to clarify whether aphasia is a prognostic factor for cognitive and functional improvements in stroke patients. METHODS: Sixty-seven ischemic or hemorrhagic stroke patients in the subacute stage who had been diagnosed with aphasia using the Korean version of Frenchay Aphasia Screening Test (K-FAST) were included in the study. Forty-six stroke patients without aphasia were used as controls. All patients were examined with the Korean version of the Western Aphasia Battery (K-WAB). Cognitive and functional assessments of the patients including the Korean version of Mini-Mental State Examination (K-MMSE), and the Korean version of Modified Barthel Index (K-MBI) were performed during admission and 4 weeks after the initial assessments. RESULTS: The initial and follow-up total K-MMSE and K-MBI scores were significantly lower in aphasic patients than in non-aphasic controls. The K-WAB scores highly correlated with the total K-MMSE scores at the follow-up stage in all aphasic stroke patients. The K-WAB scores moderately correlated with the follow-up scores of the K-MBI in ischemic stroke patients but not in hemorrhagic stroke patients. CONCLUSION: Aphasia influences the cognitive and functional status of stroke patients and has a greater impact on cognitive improvement. Aphasia severity can be one of the prognostic factors for cognitive status in aphasic patients with stroke.

Repetitive Transcranial Magnetic Stimulation Enhances Recovery in Central Cord Syndrome Patients.

OBJECTIVE: To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on neurological and functional recovery in patients with central cord syndrome (CCS) involving the upper extremities between the treated and non-treated sides of the treated group and whether the outcomes are comparable to that of the untreated control group. METHODS: Nineteen CCS patients were treated with high-frequency (20 Hz) rTMS over the motor cortex for 5 days. The stimulation side was randomly selected, and all the subjects received conventional occupational therapy during the rTMS-treatment period. Twenty CCS patients who did not receive rTMS were considered as controls. Clinical assessments, including those by the International Standard for Neurological Classification of Spinal Cord Injury, the Jebsen-Taylor Hand Function Test, and the O'Connor Finger Dexterity Test were performed initially and followed up for 1 month after rTMS treatment or 5 weeks after initial assessments. RESULTS: The motor scores for upper extremities were increased and the number of improved cases was greater for the treated side in rTMS-treated patients than for the non-treated side in rTMS-treated patients or controls. The improved cases for writing time and score measured on the Jebsen-Taylor Hand Function Test were also significantly greater in number on the rTMS-treated side compared with the non-treated side and controls. There were no adverse effects during rTMS therapy or the follow-up period. CONCLUSION: The results of the application of high-frequency rTMS treatment to CCS patients suggest that rTMS can enhance the motor recovery and functional fine motor task performance of the upper extremities in such individuals.