The activity level of 77 patients admitted within 7 days of stroke was evaluated on 17.0±4.2 and 43.1±7.9 days after onset. Nurses scored each patient's functional independent measure (FIM) in the ward as a measure of performance and therapists scored their (FIMR) without sphincter control in the training room as their capacity. FIMR patients had higher scores in self-care, transfer and locomotion, but no significant differences in cognitive scores were found between the two groups. The gap (Δ) between FIMR and FIM patients was significantly correlated to the FIM gain for 4 weeks in self-care, transfer, locomotion and social cognition. However, the correlation coefficients were not very high (r=0.27-0.35). For further examination, the patients were divided into three groups according to the difference (FIM gain-Δ) in FIM motor item scores without sphincter control. (G1, the difference≤-3, 15 cases; G2, 14≥the difference≥-2, 43 cases; G3, the difference≥15, 19 cases). To investigate the factors influencing the correlation, six factors (stroke type, age, both sides Motricity index (MI), trunk control test, FIM cognitive item scores) were analyzed among the groups. There was only one G1 patient out of a total of 19 cases with intracerebral hematoma. The G1 patient had higher scores in the affected side MI. The G3 patients were younger and had higher scores in the non-affected side MI. For subacute stroke patients, FIMR will be helpful in predicting FIM gain for 4 weeks. However, other multiple factors should also be considered to affect the prognosis.

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We describe two patients with swallowing disorders and palatal myoclonus. Case 1: A 54-year-old woman developed difficulty swallowing after a right cerebellar hemorrhage. Physical examination disclosed palatal myoclonus. Videofluoroscopy indicated a delayed swallowing reflex and a decreased range of motion of the tongue. Poor coordination of the bulbar muscles was also noted. A feeding gastrostomy was performed. Thermal stimulation and active ROM exercises for the cheek and tongue were carried out as rehabilitation, and drug therapy, including trihexyphenidyl and L-dopa/carbidopa, reduced the palatal myoclonus. The patient's swallowing reflex and voluntary tongue movements normalized with rehabilitation, until a regular diet could be taken orally. Case 2: A 77-year-old man presented with a swallowing disorder after bilateral cerebellar infarction. Physical examination demonstrated palatal myoclonus. The swallowing disorder was caused by a delayed swallowing reflex and decreased range of motion, strength, and coordination of the tongue. A semi-soft diet was initiated. Thermal stimulation, dry swallow exercises, and active ROM exercises for the cheek and tongue were carried out as rehabilitation. Drug therapy with L-dopa/carbidopa reduced the patient's myoclonus and his swallowing reflex and tongue function improved with rehabilitation. Finally, the patient's semi-soft diet was changed to soft. To our knowledge, this is the first report indicating the beneficial effect of rehabilitation and drug therapy on swallowing disorders with palatal myoclonus.

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