• Journal of Yeungnam Medical Science
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• v.22 no.2
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• pp.119-130
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• 2005

Stroke is a leading cause of chronic physical disability. The recent randomized controlled trials have that motor function of chronic stroke survivors could be improved through physical or pharmacologic intervention in the stroke rehabilitation setting. In addition, several functional neuroimaging techniques have recently developed, it is available to study the functional topography of sensorimotor area of the brain. However, the mechanisms involved in motor recovery after stroke, are still poorly understood. Four motor recovery mechanisms have been suggested, such as reorganization into areas adjacent to the injured primary motor cortex (M1), unmasking of the motor pathway from the unaffected motor cortex to the affected hand, attribution of secondary motor areas, and recovery of the damaged contralateral corticospinal tract. Understanding the motor recovery mechanisms would provide neurorehabilitation specialists with more information to allow for precise prognosis and therapeutic strategies based on the scientific evidence; this may help promote recovery of motor function. This review introduces several methodologies for neuroimaging techniques and discusses theoretical issues that impact interpretation of functional imaging studies of motor recovery after stroke. Perspectives, for future research are presented.

• The Journal of Korean Physical Therapy
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• v.22 no.3
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• pp.31-35
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• 2010

Purpose: The aim of this study was to use fMRI and clinical prognosis criteria to evaluate therapeutic interventions in stroke patients with corona radiata infarct and acquire fundamental information about recovery mechanisms. Methods: Four subjects (2 men, 2 women) who had strokes with corona radiata infarct were recruited. For all subjects, motor functions such as motricity index (MI), modified brunnstrom classification (MBC), functional ambulatory category (FAC), and bathel index (BI) were evaluated. Evaluations were done at least 4 times over a period of approximately 6~7 months from stroke onset. We compared the final evaluation with the first. Results: All patients with corona radiata infarct showed improvement in motor outcomes with the passing of time. The strength of all patients improved from zero or trace levels to normal or good levels in the MI (Motricity Index) test. Other motor outcomes including the modified brunnstrom classification (MBC), the functional ambulatory category (FAC), and the bathel index (BI) also improved with the passing of time. Conclusion: Stroke patients with corona radiata infarcts change for the better over time. Therefore, one can introduce clinical interventions by the aspect of progress in functional motor recovery.

• Journal of East-West Nursing Research
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• v.2 no.1
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• pp.22-36
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• 1997

Functional recovery of cerebrovascular accident (CVA) patients were studied by examining functional independence measure (FIM) to evaluate the functional state of the patients at admission to and at discharge from the hospital and its relationship with the family support. Study subjects consisted of 129 CVA patients, who were admitted and received rehabilitation treatment at K Medical Center of Oriental Medicine from August 3 to December 18, 1997. The results were as follows: 1) Total FIM score was $72.37{\pm}25.16$ at admission and $101.67{\pm}22.13$ at discharge. The difference of average score was 29.30, which was statistically significant by paired t-test. 2) The largest difference between FIM scores at admission and at clischarge was observed in items of walking and wheel-chair riding, and the smallest clifference in items of social interaction. 3) The recovery was faster with motor function than with cognitive function, because the difference of FIM scores at admission and at discharge was much larger with motor function. 4) Recovery was better in groups under age 49 than in groups above age 70. Functional recorvery was prominent especially in groups with normal sensory state and speech functions, and groups without urinary incontinence. Recovery was less significantly in patients with paraplegic patients hospitalized longer than 2 months, patients with family all the time, and patients with CVA over 11 days. 5) We could not find any relationship between functional recovery and family support. FIM scores were lower in groups of old age(r=-0.325), long stayed in hospital (r=-0.426), and long period of time after the onset of disease(r= -0.339) with a reciprocal correlation between FIM scores and these parameters. 6) Stepwise multiple regression analysis was done to evaluate factors to affect the recovery from CVA. FIM score at admission could explain 51.2 % of the functional recovery. Important factors were periods of hospitalization, state of sensory function, age, and education (listed in decreasing order of importance). In total, they could explain 64.89% of the functional recovery. These results indicate that functional recovery of CVA patients, who were admitted to oriental medicine hospital for rehabilitation treatment, could be estimated by measuring FIM scores. Recovery was significantly better at discharge from the hospital than at admission and motor function recovery rate was much faster than that of cognitive function. 2. Recommendation Based on these results, we recommend following further studies. 1) Comparative study of recovery of motor function and of sensory function would be necessary by measuring FIM scores once a week to evaluate the recovery of CVA patients. 2) It would be interesting to see whether there is any difference of functional recovery between patients treated with either western medicine or oriental medicine. 3) Psychological factors affecting the recovery of CVA patients need to be studied.

• The Journal of Korean Physical Therapy
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• v.21 no.4
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• pp.111-115
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• 2009

Purpose: The aim of this study was to present fundamental information regarding clinical prognosis and clinical criteria for therapeutic intervention in stroke patients with focal pons infarction. Methods: Four stroke patients (male: 2, female: 2) who were diagnosed with pons infarction were recruited. All subjects had motor functions evaluated using methods such as the Motricity Index (MI), the Modified Brunnstrom Classification (MBC), Functional Ambulatory Category (FAC), and the Bathel Index (BI). Evaluations were done at least 4 times over a period that was approximately 8~11 months from stroke onset. We compared the final evaluation with the first evaluation. Results: All patients with focal pons infarction showed improvement with time in motor function. The physical strength of all patients was improved to normal or good grades from zero or trace grades in the Motricity Index test. Also, other motor functions such as ambulatory capacity and activities of daily living (ADL) improved with time. Conclusion: Aspects of functional recovery and clinical prognosis are clearly predictable for specific patients with focal pons infarction. In addition, adequate therapeutic interventions can be provided clinical criterion to patients, according to aspect of functional recovery. Accordingly, patients with pons infarction change for the better over time.

• The Journal of Korean Physical Therapy
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• v.22 no.6
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• pp.53-58
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• 2010

Purpose: Our goal was to determine the difference in motor recovery between two stroke types: the corona radiata (CR) infarct type and the intracerebral hemorrhage (ICH) type, by using assessment methods for motor functions. Methods: Forty subjects who were diagnosed as having had a stroke with an infarct (men: 11, women: 9, mean age: $62.25{\pm}7.59$) or a stroke with an ICH (men: 12, women: 8, mean age: $59.75{\pm}6.11$) were recruited. In all subjects, motor functions of the affected extremities were measured 2 times: at stroke onset (initial) and 6 months after the onset (final) by the motricity index (MI), the modified Brunnstrom classification (MBC), and functional ambulatory category (FAC). We compared the final assessment with the initial one. Results: Motor functions of all patients improved with the passing of time. All scores of motor function assessment in the ICH type were higher than in the infarct type. Comparing the initial assessment with the final one, upper MI and MBC scores of the upper extremities were significantly different between the two stroke types (p<0.05), but lower MI and FAC scores of the lower extremities were not (p>0.05). Conclusion: These findings imply that patterns of motor recovery in patients with either the infarct type or the ICH type of stroke change for the better over time. The degree of motor recovery in the ICH type was better than in the infarct type. Therefore, one can introduce clinical interventions by the aspect of progress in functional motor recovery.

• Physical Therapy Korea
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• v.18 no.1
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• pp.93-103
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• 2011

This study was implemented to verify the feasibility of motor function recovery and the appropriate period for therapy. The research began with spinal laminectomy of 40 white rats of Sprague-Dawley breed and induced them spinal crush injury. Following results were obtained by using the modified Tarlov test (MTT), Basso, Beattle, Bresnahan locomotor rating scale (EBB scale) and modified inclined plate test (MIPT). First, the measurement using the MTT confirm that the most severe aggravation and degeneration of functions are observed two days after induced injury, and no sign of neuromotor function recovery. Second, better scores were achieved by open-ground movement group on BBB locomotor rating scale test, and weight-bearing on inclined plate group show better performance on MIPT. Third, both BBB and MIPT scale manifested the peak of motor function recovery during 16th day after the injury and turn into gradual recovery gradient during 16th to 24th. Fourth, the control group showed functional recovery, however, the level of recovery was less significant when compared with group open-ground movement group and weight-bearing on inclined plate group. Hence, it was clearly manifested that the lumbar region of the spinal cord had shown the best performance when its functions were measured after the execution of specific physical training; therefore it indicated the possibility of learning specific task even in damaged lumbar regions. Thus it is expected to come out with better and more effective functional recovery if concentrated physical therapy was applied starting 4 days after the injury till 16 days, which is the period of the most active recovery.

• PNF and Movement
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• v.6 no.2
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• pp.39-50
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• 2008

Purpose : This article reviewed the advances in the understanding of the effect of motor rehabilitation and brain plasticity on functional recovery after CNS damage. Methods : This is literature study with Pubmed, Medline and Science journal. Results : The inability of CNS neurons to regenerate is largely associated with nonneuronal aspects of the CNS environment. Especially, this neuronal growth inhibition is mediated by myelin associated glycoprotein, olygodendrocyte-myelin glycoprotein, and NOGO. Enriched environment, motor learning, forced limb use have been utilized in scientific studies to promote functional reorganization and brain plasticity. Especially, enriched environment and motor enrichment may prime the brain to respond more adaptively to injury, in part by expressed neurotrophic factors. Conclusions : These reviews suggest that activity-induced neural plasticity occur in damaged brain areas in order to functional reorganization, where it could contribute to motor recovery, and represent a target for stroke rehabilitation.

• The Journal of Korean Physical Therapy
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• v.19 no.3
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• pp.1-9
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• 2007

Purpose: Previous studies have suggested that BDNF has a role in plasticity and survival following spinal cord injury and treadmill exercise increases BDNF levels in the normal brain and spinal cord. We attempted to determine whether swimming exercise improve motor function following experimental contusive spinal cord injury and whether motor outcome is associated with BDNF expression. Methods: Thirty six Sprague-Dawley rats (weight, 250 to 300 g) were divided into control (n=18) and experimental swimming group (n=18). Spinal cord injury was produced using NYU-spinal impactor at the eleven thoracic levels in both groups. Swimming exercise started $7^{th}$ day from SCI operation, lasted 5 min per day, 5 days a week for 4 weeks and then exercise times a day were increased in one number to each week. Motor functional recovery was determined by the Basso-Beattie-Bresnahan (BBB) locomotor rating scale, modified inclined board plane test, histological findings, H&E and BDNF expression observed at $1^{th}$, $3^{rd}$, $7^{th}$, $14^{th}$, $21^{st}$ and $28^{th}$day after injury. Results: 1. The BBB scores were higher in experimental group than control group at $14^{th}$, $21^{st}$ day (left hind limb) and at $21^{th}$ day (right hind limb) (p<0.05) after injury. 2. The inclined board plane test were significantly greater in experimental group than control group at $7^{th}$ day (p<0.05), $14^{th}$ and $28^{th}$ day (p<0.01) after injury. 3. The BDNF expression was severe revealed in experimental group than control group at $7^{th}$, $14^{th}$ and $28^{th}$ day after injury. Conclusion: This study suggests that swimming applied from the early phase after spinal cord injury be beneficial effects in motor functional recovery.

• Journal of Korean Neurosurgical Society
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• v.45 no.3
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• pp.143-150
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• 2009

Objective : The purpose of this study was to investigate the reliable factors influencing the surgical outcome of the patients with traumatic acute subdural hematoma (ASDH) and to improve the functional outcome of these patients. Methods : A total of 256 consecutive patients who underwent surgical intervention for traumatic ASDH between March 1998 and March 2008 were reviewed. We evaluated the influence of perioperative variables on functional recovery and mortality using multivariate logistic regression analysis. Results : Functional recovery was achieved in 42.2% of patients and the overall mortality was 39.8%. Age (OR=4.91, p=0.002), mechanism of injury (OR=3.66, p=0.003), pupillary abnormality (OR=3.73, p=0.003), GCS score on admission (OR=5.64, p=0.000), and intraoperative acute brain swelling (ABS) (OR=3.71, p=0.009) were independent predictors for functional recovery. And preoperative pupillary abnormality (OR=2.60, p=0.023), GCS score (OR=4.66, p=0.000), and intraoperative ABS (OR=4.16, p=0.001) were independent predictors for mortality. Midline shift, thickness and volume of hematoma, type of surgery, and time to surgery showed no independent association with functional recovery, although these variables were correlated with functional recovery in univariate analyses. Conclusion : Functional recovery was more likely to be achieved in patients who were under 40 years of age, victims of motor vehicle collision and having preoperative reactive pupils, higher GCS score and the absence of ABS during surgery. These results would be helpful for neurosurgeon to improve outcomes from traumatic acute subdural hematomas.

• Journal of Korean Academy of Nursing
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• v.36 no.4
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• pp.621-629
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• 2006

Purpose. The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. Methods. The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. Results. The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. Conclusions. The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation methods. This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.