하반신마비 환자에서 보행기능의 복원을 위한 전기자극법의 개발

박병림,김민선 대한의용생체공학회 1994 의공학회지 Vol.15 No.4

An electrical stimulator was designed to induce locomotion for paraplegic patients caused by central nervous system injury. Optimal stimulus parameters, which can minimize muscle fatigue and can achieve effective muscle contraction were determined in slow and fast muscles in Sprague-Dawley rats. Stimulus patterns of our stimulator were designed to simulate eleclromyographic activity monitored during locomotion of normal subjects. Muscle types of the lower extremity were classified according to their mechanical property of contraction, which are slow muscle (msoleus m.) and fast muscle (medial gastrocnemius m., rectus femoris m., vastus lateralis m.). Optimal parameters of electrical stimulation for slow muscles were 20 Hz, 0.2 ms square pulse. For fast muscle, 40 Hz, 0.3 ms square pulse was optimal to produce repeated contraction. Higher'stimulus intensity was required when synergistic muscles were stimulated simultaneously than when they were stimulated individually. Electrical stimulation for each muscle was designed to generate bipedal locomotion, so that individual muscles alternate contraction and relaxation to simulate stance and swing phases. Portable electrical stimulator with 16 channels built in microprocessor was constructed and applied to paraplegic patients due to lumbar cord injury. The electrical slimulator restored partially gait function in paraplegic patients.

초보자를 위한 전정안반사

박병림 대한평형의학회 2012 Research in Vestibular Science Vol.11 No.-

Vestibulo-ocular reflex is a reflex eye movement that stabilizes images on the retina

전정기관 손상 후 자세조절기능의 회복을 위한 신경가소성

박병림,김민선 圓光大學校 醫科學硏究所 2002 圓光醫科學 Vol.17 No.2

전정기관은 전정안반사와 전정척수반사를 통하여 반사적 자세조절에 관여할 뿐만 아니라 전정자율신경반사를 통하여 자율신경계의 기능조절에 관여한다. 그러나 일측 전정기관의 손상은 오심, 구토, 현기증, 자발안진, 자세부조화 등의 전정증상을 유발하며, 이러한 증상은 시일이 경과함에 따라 점차 소실되는 전정보상을 가져온다. 전정보상은 중추신경계에서 손상 후 기능회복에 관여하는 신경가소성의 일종으로 이 내용에서는 전기생리학 및 분자생물학적 측면에서 전정보상기전을 기술하였다. 전정보상은 뇌간을 포함한 중추신경계에서 이루어지며, 다양한 구조들이 복합적인 기능으로 조화를 이루어 양측 전정신경핵에서 뉴론활동성의 대칭성을 회복함에 따라 완성되는 것이라 할 수 있다. 따라서 이러한 내용은 중추신경계 손상 후 신경가소성의 연구에 기초가 될 수 있을 뿐만 아니라 전정증상의 치료를 위한 자료를 제공할 수 있을 것이다. Vestibular system located in the inner ear induces vestibuloocular, vestibulospinal and vestibuloautonomic reflexes by head movement. Peripheral vestibular receptors detect head movement and their afferent signals are transmitted to the vestibular nuclei for inducing vestibular reflexes. Loss of unilateral vestibular function, as a result of unilateral labyrinthectomy (UL), transaction of the Ⅷ nerve, or vestibular neuritis, causes an imbalance in resting activity between the bilateral vestibular nuclei which results in vestibular symptoms including nausea, vomiting, vertigo, spontaneous nystagmus, head oscillation, and head deviation. However, over a period of a few days or weeks following UL, some of these symptoms abate in a process of behavioral recovery known as "vestibular compensation", which is an adequate model for lesion-induced neural plasticity. In this review, the mechanism for vestibular compensation following unilateral labyrinthectomy is discussed.

자율신경계의 구조와 기능

박병림 대한평형의학회 2017 Research in Vestibular Science Vol.16 No.4

The autonomic nervous system (ANS) integrates the function of the internal organs for the homeostasis against various external environmental changes. The efferent components of the ANS are regulated by sensory signals arising from the viscera as well as non-visceral organs. The central neural networks that integrate these sensory signals and modify visceral motor output are complex, and synaptic reflexes formed in the brainstem and spinal cord integrate behavioral responses and visceral responses through the central neural networks. A detailed understanding of the neural network presented above may explain the role of the vestibular system on the homeostasis more extensively.

家兎에 있어서 前庭半規神經 興奮에 對한 眼斜筋과 頭板狀筋의 反應

朴炳林 全南大醫大 1982 전남의대학술지 Vol.19 No.2

家兎 後半規管의 機能的 極性에 關하여

朴炳林 全南大醫大 1979 전남의대학술지 Vol.16 No.2

편마비 환자를 위한 근전도 유발 기능적 전기자극기의 개발과 이상적인 전극부착 위치

박병림,안상호,정호춘,진달복,김성곤,이상세,김영기 대한의용생체공학회 2004 의공학회지 Vol.25 No.2

편마비 환자에서 상지 기능을 효과적으로 회복시키기 위하여 근전도 유발 기능적 전기자극기 개발과 편마비 환자를 대상으로 손목, 수지신전 운동 시 가장 효과적으로 근수축을 감지 할 수 있는 위치와 전기 자극 시 가장 이상적인 손목, 수지 신전 운동이 일어나는 부위를 탐색하여 두 부과가 일치하는 이상적인 전극부착 위치를 설정하였다. 1) 전기자극 시스템으로 EMC 계측부, 정전류 회로부를 개발하고 프로그램으로는 근전도 유발 전기자극기와 Passive FES의 동작이 가능한 형태로 개발하였다 자극조건은 주파수 35 Hz, 펄스폭 150 ${\mu}\textrm{s}$, 비대칭적 이상성 파형을 선택하였다. 2) 상지 편마비 환자 15명을 대상으로 전완의 근위부 1/2부위를 12개의 영역으로 나눈 후 근위부의 외측으로부터 영역의 순서를 정하였다. 각 영역에서 환자의 손목을 신전 하였을 때 근전도 유발 자극기가 감지하는 활동전위의 진폭을 측정하였으며 가장 크게 감지된 영역은 4, 5 영역이었고, 전기자극을 시행하였을 때 손목과 수지부위가 신전 되는 모양이 이상적인 영역은 4, 5, 7, 8 영역이었다. 근전도 유발 전기자극을 시행하였을 때 근 수축을 감지하여 근전도 유발 전기자극이 일어나는 일련의 과정이 이상적인 영역은 해부학적으로 4, 5 영역이었다. The purpose of this study was to develop EMG triggered FES system for restoration of upper extremity function in chronic hemiplegic patients and to identify the optimal location of electrode application for the EMG triggered FES system which produces effective muscle contraction and detects EMG activity for extension in the wrist and finger joints. The stimulus system was composed of EMG measuring component, constant current component and the program for muscle contraction by EMG triggered FES and passive FES. Parameter of electrical stimulation was 35 ㎐ in frequency, 150 ${\mu}\textrm{s}$ in pulse width and symmetric bi-phasic wave. In 15 hemiplegic patients, EMG triggered FES was applied to the proximal half of forearm which was divided into 12 areas. The most sensitive area for measuring EMG activities during extension of the wrist and fingers was area 4, 5 and the optimal location of electrical stimulation for producing extension of the wrist and fingers was area 4, 5, 7, 8. These results suggest that the area 4 and 5 was considered as the most optimal location of electrode application for measuring EMG activities as well as producing extension of the wrist and fingers by EMG triggered FES system.

사지마비환자의 운동기능회복을 위한 전기자극기의 개발 및 응용

박병림,천상우,김민선,김상수,김성곤,정동명 圓光大學校 醫科學硏究所 1991 圓光醫科學 Vol.7 No.1-2

Optimal parameters for electrical stimulation are essential to the restoration of motor function by functional electrical stimulation in paralyzed extremities. To study the optimal parameters contractile responses of slow (soleus m.) and fast (medial gastrocnemius m.) muscles to various parameters of electrical stimulation of tibial nerve were observed in rats (Sprague-Dawley, 240-260 g). It was the optimal parameters for effective contraction that 0.2 ms of pulse width, 20Hz of frequency with supramaximal intensity for the soleus muscle and 0.3ms of pulse width, 40㎐ of frequency with supramaximal intensity for the medial gastrocnemius muscle. A electrical stimulator for patients was manufactured on the basis of above result. The stimulator was very effective for the restoration of motor function in paralyzed muscles.

사지마비환자를 위한 여러가지 변조체제의 전기자극기

박병림,김성주,김상수,김성곤 圓光大學校 醫科學硏究所 1989 圓光醫科學 Vol.5 No.1-2

A “multi-modulated electrical stimulator” was made for application in the prevention of muscle atrophy and restoration of motor functions on the upper motor neuron damage by cerebral palsy, traffic accident, cerebrovascular accident, and so on. EMG activities of the tibialis anterior muscle to stimulation of the peroneal nerve by the stimulator were analyzed in rats and a spinal injury patient of T5, 6. The followings are the characteristics of the stimulator. 1. It was possible to change the stimulus amplitude, pulse width, frequency, and stimulus interval in the range of 0 ∼ -15V, 0.1 ∼ 1ms, 5 ∼ 100㎐, and 2 ∼ 30sec, respectively. 2. Stimulus amplitude of one interval was increased and decreased gradually in order to produce muscle contraction and relaxation step by step. 3. EMG activity was not changed for 15min by the stimulation of less than 15sec interval, but was decreased gradually by more than 15sec interval. The stimulator with these features will be very useful for the restoration of motor functions in paralyzed extremities.

정상 성인에서 회전자극을 이용한 전정기능의 양적분석

박병림,김민선,정지영,이정헌,정성오,김성곤 圓光大學校 醫科學硏究所 1994 圓光醫科學 Vol.10 No.1-2

Sinusoidal rotatory test was performed to evaluate the vestibular function in 27 adults with 19∼25 years old(22±1.6, mean±SD). Vestibuloocular reflex induced by sinusoidal rotation of the whole body was analyzed in terms of gain, phase difference and directional preponderance. Sinusoidal rotatory chair controlled by DC servo-motor was manufactured : the range of rotation was 0∼±720˚ . and the range of frequency was 0.01∼0.4㎐. Nystagmus was occurred by sinusoidal rotation, and the direction of nystagmus was corresponded to the direction of rotation, also the velocity of nystagmus was proportioned to the velocity of rotation. In vestibuloocular reflex induced by sinusoidal rotation, gain was 0.60±0.02 at stimulus frequency of 0.05 ㎐, 0.63±0.02 at 0.1 ㎐, 0.58±0.02 at 0.2 ㎐, and phase was 28.4±0.8˚ at 0.05 ㎐, 18.7±0.8˚ at 0.1 ㎐, 11.5±0.6˚ at 0.2 ㎐, also directional preponderance was 5.3±1.0% at 0.05 ㎐, 2.9±0.5% at 0.1 ㎐, 2.9±0.3% at 0.2 ㎐. Gain, phase and directional preponderance in the vestibuloocular reflex induced by sinusoidal rotation must be measured in order to evaluate the vestibular function. And the sinusoidal rotatory chair manufactured in this study could be useful clinically to evaluate the vestibular function in patients with vestibular disorders.