To investigate difference in bilateral diaphragm movement of patients with tracheal aspiration according to post stroke residue severity and determine correlations of Penetration-Aspiration Scale (PAS), residue scale, and bilateral diaphragm movement. A total of 47 patients diagnosed with hemiplegic stroke were enrolled in this study. PAS, severity of valleculae, and pyriform sinus retention during videofluoroscopic swallowing study (VFSS) were assessed. Bilateral fluoroscopic diaphragm movements during spontaneous breathing and forced breathing were measured. Patients with tracheal aspiration (PAS≥6) had significantly (p=0.035) lower ipsilateral diaphragm movement during spontaneous breathing. Post-swallow residue severity showed statistically significant (p=0.028) difference in patients with ipsilateral diaphragm movement during forced breathing. In linear regression analysis, PAS showed weak correlations with ipsilateral spontaneous diaphragm movement (r=0.397, p=0.006), ipsilateral forced diaphragm movement (r=0.384, p=0.008), and contralateral forced diaphragm movement (r=0.323, p=0.027). Weak correlation was also observed between post swallow residue severity and ipsilateral diaphragm movement during spontaneous breathing (r=0.331, p=0.023) and forced breathing (r=0.343, p=0.018). We confirmed the relationship between swallowing function and bilateral diaphragm movement in this study. The severity of dysphagia after hemiplegic stroke was correlated with bilateral diaphragm movement. Further longitudinal studies are needed to assess the effect of breathing exercise on post-stroke dysphagia.

The head tilt of patients with torticollis is usually evaluated subjectively in clinical practice and measuring it in young children is very limited due to poor cooperation. No study has yet evaluated the head tilt using a three-dimensional (3D) scan and compared it with other measurement methods. Therefore, this study aimed to objectively demonstrate head tilt through clinical measurements and a 3D scan in children with torticollis. A total of 52 children (30 males, 22 females; age 4.6 ± 3.2 years) diagnosed with torticollis and 52 adults (26 men, 26 women; age 34.42 ± 10.4 years) without torticollis participated in this study. The clinical measurements were performed using a goniometer and still photography methods. Additionally, the head tilt was analyzed using a 3D scanner (3dMD scan, 3dMD Inc., Atlanta, GA, USA). There was a high correlation between the other methods and 3D angles, and the cut-off value of the 3D angles for the diagnosis of torticollis was also presented. The area under the curve of the 3D angle was 0.872, which was confirmed by a moderately accurate test and showed a strong correlation compared with other conventional tests. Therefore, we suggest that measuring the degree of torticollis three-dimensionally is significant.

Kim H, et al. J Korean Med Sci. 2025 Oct;41:e8. https://doi.org/10.3346/jkms.2026.41.e8

Purpose: To examine the effects of postoperative pulmonary telerehabilitation (PTR) in older adults with lung cancer using a popular mobile instant messenger. Methods: We conducted a randomized controlled trial in ambulatory patients (n = 64; aged ≥ 65 years) with lung cancer scheduled for video-assisted thoracoscopic surgery. Participants were randomly assigned to intervention (IG) or control (CG) groups. Four weeks after surgery, both groups received a one-time education session on standard home-based pulmonary rehabilitation at the rehabilitation center. The IG underwent a PTR program thrice weekly for 4 weeks using a mobile instant messenger or telephone. Both groups were instructed to maintain their exercise routine (at least 3 times a week) during the 4-week follow-up. Results: Compared with the CG, the IG showed significant improvements in peak oxygen uptake (VO _2peak ) and percent predicted VO _2peak of 3.3 mL/kg/min (95% CI, 1.9-4.8; P < .001) and 14% (95% CI, 7-21; P < .001), respectively, after PTR. These improvements persisted at the 4-week follow-up (VO _2peak = 3.8 mL/kg/min: 95% CI, 2.1-5.5; P < .001 and percent predicted VO _2peak = 13%: 95% CI, 6-20; P < .001). Compared with preoperative values, postoperative VO _2peak and percent predicted VO _2peak decreased significantly by 3.5 mL/kg/min (95% CI, 2.6-4.3; P < .001) and 15% (95% CI, 11-19; P < .001), respectively. Conclusions: A 4-week postoperative PTR program improved VO _2peak in older adults with lung cancer. Our findings suggest that PTR may be a feasible therapeutic strategy for lung cancer, even in older adults.

Rationale: Cardiac rehabilitation (CR) after heart transplantation (HT) decreases the mortality rate and increases exercise capacity of patients. Dilated cardiomyopathy develops in most patients with muscular dystrophy (MD), leading to advanced heart failure, necessitating the use of left ventricular assist devices or HT. As the clinical outcomes of left ventricular assist devices and HT in patients with myopathy differ from those in patients without myopathy, CR adapted to patients with MD should be considered. Patient concerns: A 39-year-old man with limb-girdle muscular dystrophy developed dilated cardiomyopathy and underwent HT. Diagnosis: The patient was diagnosed as having limb-girdle muscular dystrophy in 1997. Intervention: Early CR was performed based on the patient’s physical condition and ability. Outcomes: With chest physiology, aerobic, and resistance exercises, the patient was able to walk using a walker 28 days after HT. This is important because his lower-extremity strength and walking ability were, to some extent, maintained after surgery. Lessons: Since an increasing number of patients with MD are undergoing HT, specific CR programs for these patients should be discussed.