Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology.Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion: This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Kim EJ, et al. Ann Rehabil Med. 2012 Dec;36(6):797-803. http://dx.doi.org/10.5535/arm.2012.36.6.797

Objective: To systematically review the efficacy of e-Health interventions on physical performance, activity and quality of life in older adults with sarcopenia or frailty.Methods: A systematic review was conducted by searching the MEDLINE, Embase, Cochrane Library, CINHAL, Web of Science, and the Physiotherapy Evidence Database for experimental studies published in English from 1990 to 2021. E-Health studies investigating physical activity, physical performance, quality of life, and activity of daily living assessment in adults aged ≥65 years with sarcopenia or frailty were selected. Results: Among the 3,164 identified articles screened, a total of 4 studies complied with the inclusion criteria. The studies were heterogeneous by participant characteristics, type of e-Health intervention, and outcome measurement. Age criteria for participant selection and sex distribution were different between studies. Each study used different criteria for frailty, and no study used sarcopenia as a selection criteria. E-Health interventions were various across studies. Two studies used frailty status as an outcome measure and showed conflicting results. Muscle strength was assessed in 2 studies, and meta-analysis showed statistically significant improvement after intervention (standardized mean difference, 0.51; 95% confidence interval, 0.07–0.94; p=0.80, I2=0%). Conclusion: This systematic review found insufficient evidence to support the efficacy of e-Health interventions. Nevertheless, the studies included in this review showed positive effects of e-Health interventions on improving muscle strength, physical activity, and quality of life in older adults with frailty.

Background: Cognitive impairment is a common consequence of stroke, requiring effective rehabilitation strategies. Telerehabilitation has emerged as a promising alternative to in-person cognitive therapy, yet existing systems often lack mechanisms for real-time personalization and engagement monitoring. This study aimed to evaluate the clinical effectiveness of a self-guided AI-driven cognitive telerehabilitation compared to a therapist-supervised rehabilitation in subacute stroke patients.Methods: In this multicenter, parallel-group, randomized controlled non-inferiority trial, 63 participants with cognitive impairment within 6 months of stroke onset were randomized 1:1 to either a self-guided AI-driven telerehabilitation group or a therapist-supervised rehabilitation group. Both groups completed 24 sessions within 6 weeks using the same mobile platform. The primary outcomes were cognitive function measures, including the Korean Mini-Mental State Examination-2 (K-MMSE2), Trail Making Tests (A and B), and Digit Span Tests (forward and backward), with non-inferiority formally tested using the K-MMSE2. Secondary outcomes included functional independence, psychosocial measures and usability questionnaire.Results: Fifty-five participants completed the study. Both groups showed significant improvements across all primary cognitive measures, with no statistically significant differences between groups. Non-inferiority analysis confirmed that the self-guided AI-driven telerehabilitation was not inferior to the therapist-supervised rehabilitation based on K-MMSE2 changes. Usability assessment among users of the cognitive rehabilitation system indicated high overall satisfaction with no serious adverse events reported.Conclusion: This study demonstrates that a self-guided AI-driven telerehabilitation can deliver cognitive improvements comparable to a therapist-supervised rehabilitation in subacute stroke patients.Clinical trial registration: https://cris.nih.go.kr/cris/index/index.do, KCT0008969.

Introduction: One of the possible treatment options for patient with cognitive dysfunction is cognitive telerehabilitation. Previous systematic reviews on cognitive telerehabilitation have focused on specific disease groups and the analysis of intervention methods did not differentiate between traditional face-to-face cognition treatment and usual care. In this systematic review, we aim to analyze randomized controlled trials (RCTs) that compare telerehabilitation with face-to-face treatment or usual care for improving cognitive function in elderly individuals with cognitive dysfunction or patients with acquired brain injury.Methods: We conducted this systematic review following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). In this systematic review, we searched 7 electronic databases (PubMed, Cochrane, EMbase, CINAHL, Web of Science, Scopus, KMbase) to identify relevant studies published through December 10, 2024. We conducted a meta-analysis to assess the quality of the studies and synthesize the evidence. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.Results: Finally, 16 studies were included in the analysis. For comparing telerehabilitation with face-to-face cognition treatment, the meta-analysis included 2 RCTs for global cognition (immediate outcome), 2 RCTs for attention (immediate outcome), 2 RCTs for visuospatial function (immediate outcome). For comparing telerehabilitation with usual care, the meta-analysis included 7 RCTs for global cognition (immediate outcome), 3 RCTs for global cognition (persistence outcome), 4 RCTs for attention (immediate outcome), 3 RCTs for executive function (immediate outcome), 3 RCTs for working memory (immediate outcome), 3 RCTs for visuospatial function (immediate outcome).Discussion: Telerehabilitation has been shown to be more effective than usual care in improving global cognitive function, and its effectiveness is not inferior to that of traditional face-to-face cognitive treatment. By overcoming the limitations of traditional cognition rehabilitation and providing continuous treatment, telerehabilitation can offer effective treatment in specific situations.

Lee KL, et al. Ann Rehabil Med. 2012 Jun;36(3):365-370. http://dx.doi.org/10.5535/arm.2012.36.3.365