Yang-Soo Lee’s research while affiliated with Kyungpook National University and other places

Background There are relatively few reports on the long-term sequential functional recovery and prognosis in patients with cerebellar infarction. The aim of this study was to investigate the long-term recovery of multifaceted functional outcomes up to 36 months after onset and the functional prognosis of isolated cerebellar infarction. Methods This study was a retrospective analysis of the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) data up to 36 months after onset. Isolated cerebellar infarction was defined as the presence of lesions in the cerebellum without lesions in other brain parenchyma. We assessed multifaceted functional domains, including motor (Fugl-Meyer Assessment, FMA), ambulatory (Functional Ambulation Category, FAC), cognitive (Korean Mini-Mental State Examination, K-MMSE), swallowing (American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale, ASHA-NOMS), and language functions (Short version of the Korean Frenchay Aphasia Screening Test, Short K-FAST), using serial measurements. In addition, functional outcome was assessed with the Functional Independence Measure (FIM) up to 36 months after onset. Results Among 390 screened isolated cerebellar infarction patients, a total of 183 patients were included in this study. Cognitive (mean[SD] of K-MMSE 27.6 ± 3.6) and swallowing (ASHA-NOMS 6.8 ± 0.7) functions showed significant improvement up to 3 months (p < 0.05). Motor (FMA 98.8 ± 3.8) and language (ASHA-NOMS 6.9 ± 0.4) functions improved significantly up to 6 months (p < 0.05). Furthermore, ambulatory function (FAC 4.7 ± 0.9) and functional independency (FIM 122.2 ± 12.0) continued to improve up to 12 months (p < 0.05). Vascular territory involving superior cerebellar artery, older age, female sex, and greater initial severity were identified as negative independent prognostic factors predicting functional outcome measured by FIM at 12 months after stroke. Conclusion The plateau of recovery in multifaceted functional outcomes varied among patients with cerebellar infarction. Functional independence plateaued at 12 months and showed a relatively favorable prognosis up to 36 months after stroke.

Post-stroke dysphagia is a common and debilitating complication affecting millions of people worldwide, often leading to malnutrition, pneumonia, and reduced quality of life. This study, an interim analysis of the Korean Study Cohort for Functional and Rehabilitation, aimed to identify long-term changes and predictive factors associated with post-stroke dysphagia at 3 years after stroke. A total of 4735 patients with acute first-ever stroke, including both ischemic and hemorrhagic subgroups, were followed, and dysphagia was assessed using the ASHA-NOMS scale. All the patients were then followed up for up to 36 months. The results showed significant improvements in dysphagia up to 12 months after stroke in the total and hemorrhagic stroke group, and the decline in swallowing function after 24 months in the total stroke and ischemic stroke groups was a novel finding. The hemorrhagic stroke group showed worsening dysphagia after 30 months. It is unclear whether patients who experienced worsening of swallowing function had other conditions, including new strokes, that might have contributed to this decline. Male gender, age at stroke, K-FAST at 7 days, ASHA-NOMS scale, mRS score at 3 months, and early comprehensive rehabilitation were identified as predictors of a decrease in the ASHA-NOMS score after 24 months. Additionally, the K-MBI score at 3 months post-stroke was found to be a significant factor influencing long-term improvements in swallowing function. These findings suggest that patients should be closely monitored for dysphagia beyond 24 months after stroke onset, as swallowing function may decline over time. During follow-up, it is essential to carefully consider the multiple factors associated with this decline.

Background and objectives Aneurysmal subarachnoid hemorrhage (aSAH) remains a significant global health concern, and therefore, understanding their functional outcomes is essential. The aim of this study was to investigate the 1-year functional outcomes of patients with aSAH. Methods We retrospectively analyzed data of patients with aSAH from the Korean Stroke Cohort for Functioning and Rehabilitation study, up to 1-year post-onset. The cohort data were collected twice. The 1st data was collected from August 2012 through May 2015, and the 2nd data was collected January to December in 2020, from nine different hospitals. Assessments were performed from 7-day to 1-year. Disability, measured by modified Rankin Scale (mRS), was analyzed in terms of good outcome (mRS 0 or 1) and mortality. In addition, functional level was further assessed using Functional Independence Measure (FIM) in aSAH survivors at 1-year post-onset. A subgroup analysis was conducted, with participants further classified into two groups: one with mild-to-moderate disability (mRS 0~3) and another with severe disability (mRS 4 or 5), as reported 7 days after onset. Multiple imputation method was used to handle missing data. Additionally, mixed-effects model was used to analyzed the trajectory of FIM. Results A total of 517 patients with aSAH were included. Of these, 246 (47.6%) showed mild-to-moderate disability and 471 (52.4%) showed severe disability at 7-day. At 1-year after onset, the mortality rate was 6.0% and the good outcome was reported in 76.2% of patients. In aSAH survivors at 1-year, FIM showed a significant improvement over time, with a significant difference demonstrated between the subgroups. Age, initial clinical severity, and cognitive function at 7-day were also identified as significant covariates. Conclusions The majority of patients reporting mild-to-moderate disability at 7-day exhibited good functional outcome, and even among those with severe disability, there was a favorable outcome with continuous improvement in their functional levels. Therefore, proper assessments and effective management should be employed to achieve favorable functional outcomes among aSAH survivors.

Background and Purpose: Nutritional status can influence the outcomes and mortality of various diseases. The association between initial nutritional status and ischemic stroke outcomes, however, remains poorly understood. This study investigated whether the Controlling Nutritional Status (CONUT) score at admission could predict functional recovery, complications, and survival following an ischemic stroke. Methods: We enrolled a total of 938 patients experiencing their first acute ischemic stroke and categorized them into three groups based on their CONUT score at admission: CONUT 0–1, CONUT 2–4, and CONUT 5–12. The CONUT score was assessed using the serum albumin, total cholesterol, and lymphocyte count. We evaluated the incidence of complications during their hospital stay. Outcomes, including the Modified Rankin Scale (mRS), Functional Independence Measurement (FIM), Functional Ambulatory Classification (FAC), and mortality, were assessed at baseline, as well as at three and six months post-stroke. Results: CONUT scores were significantly associated with functional outcomes (mRS, FIM, and FAC) and mortality during the six-month follow-up period post-stroke (all p < 0.05). The CONUT 5–12 group exhibited significantly poorer improvements in mRS, FIM, and FAC scores (all p < 0.05) and a lower survival rate (p < 0.01) during the six-month follow-up compared to the CONUT 0–1 and CONUT 2–4 groups. Additionally, the incidence of pneumonia, urinary tract infections, pressure sores, falling injuries, and fractures was significantly higher in the CONUT 5–12 group than in the other groups (all p < 0.01). Conclusions: CONUT scores at admission are associated with functional recovery, mortality, and the incidence of complications following a first-ever ischemic stroke. Consequently, the early identification of patients at risk of malnutrition via CONUT scores can be crucial in enhancing patient assessment after an acute stroke.

Muscle strength is essential to perform daily activities, and it is an important predictor of the length of a hospital stay, hospital readmission, and mortality, as well as being related to mobility and unfavorable outcomes. The muscle strength test is used to identify weakness and detect change in muscle strength. However, it is difficult to detect changes in muscle strength without the use of a quantitative test, which also serves the purpose of increasing motivation in subjects with a gait problem. To be used in a clinical setting, the test must be practical, which means considering the cost of the equipment, the space required for the equipment, the portability of equipment, safety (risk of injury), the duration of the measurement, and the ease of data acquisition. The manual muscle test, hand grip dynamometry, handheld dynamometry, and functional tests (e.g., the sit-to-stand test, heel raise test, etc.) are all useful in a clinical setting.

For effective stretching, it is necessary to use the appropriate amount of stretching and prolonged stretching. The amount of stretching can be divided by the resistances to stretching: the horizontal region, the transitional region, and the vertical region. In the transitional region, resistance is increased gradually with further stretching. Stretching in the middle of the transitional region may be the optimal region of stretching. To perform sustained stretching, many methods are utilized, such as orthoses, serial casting, a tilt table, or a sliding tilt table. Stretching with a sliding tilt table may be more comfortable for people than stretching with a tilt table because the smaller inclination angle can be used to stretch due to the reduced friction caused in the downward movement. In addition, it can minimize discomfort, facilitate muscle relaxation, and may even maximize the effectiveness of the stretching.

Balance tests can be conducted to evaluate steady state balance, proactive balance, and reactive balance. To examine the many dimensions of balance, multiple tests are utilized. Since there is always a risk of falling and injury while conducting a balance test, it is essential to prepare for prevention of falls and injuries. For the sake of testing of proactive balance, tasks that have horizontal and vertical movement of the center of mass are better than tasks that require horizontal movement only. The Berg Balance Scale is the most commonly used test battery in both research and the clinical field to evaluate balance. This test is easy to administer and score, and it does not require expensive equipment, space, and specialized training. And this test is psychometrically sound. Limitations of Berg Balance Scale are the floor and ceiling effect.

Considering the size of the aging population, cautious gait may be the most common gait abnormality, and balance training can be used to effectively address this problem. Even when people have sufficient muscle strength in the knee extensors, poor control of these muscles can lead to genu recurvatum. Training in a lying down position, particularly using a sliding tilt table, is highly beneficial for improving knee control, specifically eccentric contraction. Circumduction gait refers to an abnormal gait in which the leg moves in a semicircular pattern to advance the leg. It is used as a compensation for poor hip flexion. Correction of circumduction gait can be achieved through the strengthening of the hip flexor muscles.

The most common walking disorder in people with stroke is hemiplegic gait. Hemiplegic gait may result from learned nonuse and compensatory strategies to impairment. Step-by-step, task-oriented gait training, restoration of motor function and balance before starting gait training may help to prevent abnormal gait patterns. It is important to note that maladaptive neural plasticity may contribute to the development of spasticity, making step-by-step training a potential preventive measure. Many people who have undergone hip surgery also experience gait disabilities. Proper gait training following hip surgery can help maximize their gait function and overall mobility. Abnormal gait is common among elderly individuals, often stemming from problems related to balance loss and muscle weakness. Early detection and intervention are crucial because there is evidence that balance training and strengthening exercises can be effective in improving muscle strength and balance in the elderly.

Task-oriented gait training focuses on improving the performance of functional tasks and includes training aimed at reducing underlying impairments, part practice, and whole practice. Step-by-step task-oriented gait training follows a systematic progression, starting with muscle strengthening and advancing through step-ups, step-downs, step-down touches (or foot reaches and single-leg squats), and concluding with over-ground gait training. Step-by-step task-oriented gait training have many advantages, including the potential to maximize gait function and prevent abnormal gait patterns. It is also simple to learn and execute while also being cost-effective as it does not require expensive equipment.