재활로봇치료의 적용 및 효과 근거

범재원,남형석,김성완 한국로봇학회 2016 로봇과 인간 Vol.13 No.2

뇌질환 환자에서의 연하곤란 치료법

범재원,한태륜 대한의사협회 2013 대한의사협회지 Vol.56 No.1

Dysphagia is caused by various pathologic conditions of which brain disorders are the major etiology. If food materials enter an airway, aspiration pneumonia or serious asphyxia can develop, which necessitates early detection and proper management of dysphagia. Diagnosis of dysphagia includes history taking, physical examination, bedside screening tests, videofluoroscopic swallowing study (VFSS), and fiberoptic endoscopic examination of swallowing (FEES). Dysphagia management or rehabilitation consists of direct and indirect training methods. The direct one consists of modification of the texture and viscosity (using fluid thickener) of the diet,and diverse compensatory techniques for posture change (chin tuck, head rotation, and head tilt),airway protection (supraglottic swallowing and super-supraglottic swallowing) and improvement of bolus passage (effortful swallowing, multiple swallowing, Mendelsohn maneuver). Indirect training methods without using food are made up of thermal tactile stimulation, electrical stimulation of suprahyoid or infrahyoid muscles, repetitive transcranial magnetic stimulation, and strengthening of the tongue or pharyngeal muscles involved in swallowing (Shaker’s exercise and vocal cord adduction exercise). Oral hygiene, adequate hydration, and nutritional support are also crucial. Although the prognosis of dysphagia is favorable with proper rehabilitation, enteral feeding through percutaneous endoscopic gastrostomy or an oroesophageal tube would be helpful to patients who have unresolved dysphagia for some time. Further large-scale clinical studies will be needed to establish evidence on various training methods for dysphagia management.

Corrected QT Interval Prolongation during Severe Hypoglycemia without Hypokalemia in Patients with Type 2 Diabetes

범재원,김정민,정은주,김주영,고승영,나상돈,김철환,박건,강미연 대한당뇨병학회 2013 Diabetes and Metabolism Journal Vol.37 No.3

Background: To evaluate the effects of severe hypoglycemia without hypokalemia on the electrocardiogram in patients with type 2 diabetes in real-life conditions. Methods: Electrocardiograms of adult type 2 diabetic patients during the episodes of severe hypoglycemia and the recovered stage were obtained and analysed between October 1, 2011 and May 31, 2012. Patients who maintained the normal serum sodium and potassium levels during the episodes of severe hypoglycemia were only selected as the subjects of this study. Severe hypoglycemia was defined, in this study, as the condition requiring active medical assistance such as administering carbohydrate when serum glucose level was less than 60 mg/dL. Results: Nine type 2 diabetes patients (seven men, two women) were included in the study. The mean subject age was 73.2±7.7years. The mean hemoglobin A1c level was 6.07%±1.19%. The median duration of diabetes was 10 years (range, 3.5 to 30 years). Corrected QT (QTc) intervals were significantly increased during the episodes of severe hypoglycemia compared to the recovered stage (447.6±18.2 ms vs. 417.2±30.6 ms; P<0.05). However, the morphology and the amplitude of the T waves were not changed and ST-segment elevation and/or depression were not found during the episodes of severe hypoglycemia. Conclusion: In this study, QTc interval prolongation during the episodes of severe hypoglycemia was observed without hypokalemia. Therefore, the distinct alterations in cardiac repolarization during the episodes of severe hypoglycemia may not be associated with hypokalemia.

Harris lines observed in human skeletons of Joseon Dynasty, Korea

범재원,우은진,이인선,김명주,김이석,오창석,이상섭,임상범,신동훈 대한해부학회 2014 Anatomy & Cell Biology Vol.47 No.1

The Harris line (HL), caused by bone-growth arrest and manifesting on X-rays as a radiopaque transverse line in the metaphysis of the long bones, is an indicator reflecting stress conditions such as disease or malnutrition. HL frequency has been assumed to differ between pre-modern and modern societies, as reflective of increased caloric intake and overall nutritional improvements attendant on industrialization. To determine if such a change occurred in Korea, in the present study we compared the respective HL statuses in medieval Joseon and modern Korean population samples. HLs were found in 39.4% (28/71) of the Joseon Koreans. Whereas only 27.5% (11/40) of the males showed an HL, fully 54.8% (17/31) of the females exhibited it. Notably, HLs were observed in only 16.4% (35/213) of the modern Koreans; more remarkably still, the HL rate was almost the same between the sexes, 16.7% (20/120) for the males and 16.1% (15/93) for the females. The HL frequency was much higher in the Joseon Koreans than in their modern counterparts, reflecting the improvement of nutritional status that had been achieved in the course of South Korea’s modernization. This HL-frequency decrease was much more obvious in the female populations. The higher HL frequency among the Joseon females might reflect the relatively poor nutritional condition of females in pre-modern Korean society.

수술이 불가능한 환자에서 기관지내 다형성 선종의 내시경적 절제 1예

윤명호 · 최승 · 박재영 · 김철환 · 범재원 · 박건 · 이은우 조선대학교 의학연구원 2011 The Medical Journal of Chosun University Vol.36 No.3

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기저부가 넓은 기관지 평활근종의 전기소작술에 의한 내시경적 절제 1 예

박재영 · 윤명호 · 최승 · 김철환 · 범재원 · 박건 · 이은우 조선대학교 의학연구소 2012 The Medical Journal of Chosun University Vol.37 No.3

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편마비환자에서 로봇 보조 상지 재활치료의 효과

서한길,범재원,오병모,한태륜 대한뇌신경재활학회 2014 뇌신경재활 Vol.7 No.1

Objective: To investigate the effects of short-term robot-assisted upper limb training on hemiplegicpatients compared to conventional physical therapy. Method: This study was a prospective, single-blinded, randomized controlled trial. Eighteen hemiplegicpatients due to brain lesions were randomly assigned to: (1) robot-assisted upper limb training andconventional upper limb physical therapy for 30 min a day, respectively (Robot group); or (2) conventionalupper limb physical therapy for 30 min twice a day (Conventional group). All interventions were providedfor 2 weeks, 5 times a week. Each patient was evaluated at pre- and post-treatment by the Fugl-Meyerassessment-upper extremity (FMA-UE), Jebsen hand function test (JHFT), grip power, modified Barthelindex-upper extremity (MBI-UE), line bisection test, and Albert test. Results: The Robot group showed significant improvement in FMA-UE (pre: 13.22 ± 14.20, post: 21.67± 15.84; p = 0.018), MBI-UE (pre: 14.33 ± 7.42, post: 16.56 ± 6.95; p = 0.041), and line bisectiontest (pre: 25.15 ± 34.48, post: 14.93 ± 28.38; p = 0.043). The Conventional group showed significantimprovement only in MBI-UE (pre: 9.22 ± 6.06, post: 15.56 ± 6.19; p = 0.008). The improvementin MBI-UE was larger in the Conventional group than Robot group (6.33 ± 3.28 vs. 2.22 ± 2.49; p= 0.014). Conclusion: This study suggests that short-term robot-assisted upper limb training may improve upperlimb function in hemiplegic patients. However, proper physical therapy may be needed to transferimproved upper limb function to activity of daily living. In addition, goal-directed reaching tasks usinga robot are expected to be a treatment option for hemineglect.

The Effects of Body Mass Composition and Cushion Type on Seat-Interface Pressure in Spinal Cord Injured Patients

조강희,범재원,육지현,안승찬 대한재활의학회 2015 Annals of Rehabilitation Medicine Vol.39 No.6

Objective To investigate the effects of body mass composition and cushion type on seat-interface pressure in spinal cord injured (SCI) patients and healthy subjects. Methods Twenty SCI patients and control subjects were included and their body mass composition measured. Seat-interface pressure was measured with participants in an upright sitting posture on a wheelchair with three kinds of seat cushion and without a seat cushion. We also measured the pressure with each participant in three kinds of sitting postures on each air-filled cushion. We used repeated measure ANOVA, the Mann-Whitney test, and Spearman correlation coefficient for statistical analysis. Results The total skeletal muscle mass and body water in the lower extremities were significantly higher in the control group, whilst body fat was significantly higher in the SCI group. However, the seat-interface pressure and body mass composition were not significantly correlated in both groups. Each of the three types of seat cushion resulted in significant reduction in the seat-interface pressure. The SCI group had significantly higher seatinterface pressure than the control group regardless of cushion type or sitting posture. The three kinds of sitting posture did not result in a significant reduction of seat-interface pressure. Conclusion We confirmed that the body mass composition does not have a direct effect on seat-interface pressure. However, a reduction of skeletal muscle mass and body water can influence the occurrence of pressure ulcers. Furthermore, in order to minimize seat-interface pressure, it is necessary to apply a method fitted to each individual rather than a uniform method.

근육내 혈관종 환자에서 발생한 급성 요골신경병증 - 증례보고 -

정성진,범재원,정일영,임재영 대한근전도전기진단의학회 2016 대한근전도 전기진단의학회지 Vol.18 No.2

We report a case of radial neuropathy developed in a patient with intramuscular hemangioma. A 19-year-old man had shown the sudden onset of swelling and pain in his left upper arm and then wrist drop came out three days after onset of symptoms. He had been diagnosed with intramuscular hemangioma of his left upper arm three years ago. The electrodiagnostic study showed some or profuse abnormal spontaneous activities without motor unit action potentials in most muscles innervated by radial nerve except for triceps brachii. The upper arm MRI revealed increased radial nerve diameter although the surrounding hemangioma size decreased. The possibility of hemangioma-related inflammatory neuropathy was reviewed.

Recovery of Proprioception in the Upper Extremity by Robotic Mirror Therapy: a Clinical Pilot Study for Proof of Concept

남형석,고석규,범재원,김윤재,박장우,고은실,정선근,KIMSUNGWAN 대한의학회 2017 Journal of Korean medical science Vol.32 No.10

A novel robotic mirror therapy system was recently developed to provide proprioceptive stimulus to the hemiplegic arm during a mirror therapy. Validation of the robotic mirror therapy system was performed to confirm its synchronicity prior to the clinical study. The mean error angle range between the intact arm and the robot was 1.97 to 4.59 degrees. A 56-year-old male who had right middle cerebral artery infarction 11 months ago received the robotic mirror therapy for ten 30-minute sessions during 2 weeks. Clinical evaluation and functional magnetic resonance imaging (fMRI) studies were performed before and after the intervention. At the follow-up evaluation, the thumb finding test score improved from 2 to 1 for eye level and from 3 to 1 for overhead level. The Albert's test score on the left side improved from 6 to 11. Improvements were sustained at 2-month follow-up. The fMRI during the passive motion revealed a considerable increase in brain activity at the lower part of the right superior parietal lobule, suggesting the possibility of proprioception enhancement. The robotic mirror therapy system may serve as a useful treatment method for patients with supratentorial stroke to facilitate recovery of proprioceptive deficit and hemineglect.