기능적 자기공명영상을 이용한 구심성 및 원심성 근 수축에 따른 뇌 활성도 분석

김중선,김중휘,박민규,박지원,Kim, Chung-Sun,Kim, Joong-Hwi,Park, Min-Kyu,Park, Ji-Won 대한물리치료학회 2010 대한물리치료학회지 Vol.22 No.2

Purpose: Behavior and movement are accomplished by voluntary contractions of skeletal muscles. There are three types of muscle contractions: concentric, isometric and eccentric. The aim of our study was to determine whether there is a difference in the cortical activation pattern between concentric contraction and eccentric contraction of the wrist extensor muscle. Methods: Four healthy right-handed volunteers without any previous history of physical or neurological illness were recruited. fMRI scanning was done during 4 repeated blocks of concentric and eccentric exercise of the wrist joint. Subjects exercised for 12 seconds and then rested for 12 seconds before beginning the second set of exercises. To determine the excitability of cortical neurons during exercise, voxel count and intensity index were analyzed. Results: For right hand movements, when concentric contractions of the right wrist were done, only the left primary motor area was activated. In contrast, during eccentric contraction, both the primary motor area and secondary motor area were activated. For left hand movements, both concentric and eccentric contractions induced only the supplementary motor cortex and the contralateral primary motor cortex. Conclusion: During eccentric contractions, both the primary motor area and secondary motor area are activated in ipsilateral and contralateral brain areas. Thus, eccentric contractions require more complex and difficult movements than concentric contractions do.

A study of the effect of sequential injection of 5-androstenediol on irradiation-induced myelosuppression in mice

김중선,장원석,이선주,손영훈,박선후,이승숙 대한약학회 2015 Archives of Pharmacal Research Vol.38 No.6

Herein, we aimed at examining the therapeuticeffects of 5-androstenediol (5-AED), a natural hormoneproduced in the adrenal cortex, on radiation-induced myelosuppressionin C3H/HeN mice. The mice were subjectedto whole-body irradiation with a sublethal dose of5 Gy gamma-irradiation to induce severe myelosuppression,and 5-AED (50 mg/kg) was administered subcutaneously. 5-AED was administrated 1 day before irradiation(pre-treatment) or twice weekly for 3 weeks starting from1 h after irradiation (post-treatment). Treatment with5-AED significantly ameliorated the decrease in theperipheral blood neutrophil and platelet populations inirradiated myelosuppressive mice, but had no effect on thelymphocyte population. It also ameliorated hypocellularityand disruption of bone marrow induced by irradiation andled to rapid recovery of myeloid cells. Further, it attenuatedthe decrease in spleen weight and megakaryocyte andmyeloid cell populations in the spleen and promoted multilineagehematopoietic recovery. We found that a singleinjection of 5-AED produced only a temporary therapeuticeffect, while sequential injection of 5-AED after irradiationhad a more pronounced and prolonged therapeutic effectand reduced myelosuppression by irradiation. Thus,sequential injection of 5-AED after irradiation hastherapeutic potential for radiation-induced myelosuppressionwhen administered continuously and can be a significanttherapeutic candidate for the management of acuteradiation syndrome, particularly in a mass casualty scenariowhere rapid and economic intervention is important.

가상현실치료프로그램이 만성 뇌졸중 환자의 상지기능 회복과 뇌 재조직화에 미치는 사례보고

김중선,권용현 대구대학교 특수교육재활과학연구소 2005 특수교육재활과학연구 Vol.44 No.1

This case report was to investigate the effect of virtual reality program on cortical reorganization and the related clinical function test, which applied to two chronic stroke patients with intensive massed practice protocol. They have three different tasks applied to paretic upper extremity in virtual reality program for one hour per day, five times per week during four weeks. Cortical activation and motor function test were measured by functional MRI, Fugl-Meyer assessment, Box and Block & Manual Function Test before and after VR program. Findings reveals that the change of cortical reorganization showed a similar pattern to that seen in normal adults and the clinical function test were greatly improved. Thus, Virtual reality program has the capability of creating an interactive, motivating environment in which participants give attention to, and that these environments can be manipulated to create individualized treatments. 최근 컴퓨터와 영상 기술의 발전으로 실제와 같은 가상의 현실을 보다 효율적으로 훈련할 수 있는 가상현실 프로그램이 여러 분야에서 시도되고 있다. 이러한 프로그램을 이용하여 두 명의 만성 뇌졸중 환자의 상지에 집중적 훈련을 실시함으로서 상지기능의 회복과 이에 따른 뇌의 재조직화를 연구하였다. 상지 훈련 프로그램은 하루 1시간, 주 5회, 4주 동안 집중적으로 적용되었다. 훈련 전·후 퍼글-마이어 검사, 상자와 나무토막 검사, 상지기능 검사를 평가하였고 기능적 자기공명영상장치를 이용하여 대뇌 피질의 활성도 변화를 측정하였다. 훈련 적용 후, 상지 기능은 현저하게 증가하였고, 뇌 활성도는 정상인에서 관찰되는 유사한 패턴으로 변화하였다. 따라서, 가상현실 프로그램은 만성 뇌졸중 환자의 상지기능 회복에 효과적이며 뇌 재조직화를 촉진하였고, 이는 대상자에게 흥미를 유발하고 환경과 상호 작용하는 능력을 제공하였기 때문이라 추정된다.

경두개직류전류자극이 시열반응과제에 대한 운동 수행 능력에 미치는 영향

김중선,남석현,조인술,Kim, Chung-Sun,Nam, Seok-Hyun,Cho, In-Sul 대한물리치료학회 2010 대한물리치료학회지 Vol.22 No.5

Purpose: The aim of this study is to investigate whether motor cortex excitability by transcranial direct current stimulation (tDCS) over primary motor cortex (M1) affects motor performance of serial reaction task. Methods: Cathodal, anodal and sham tDCS (1 mA) are applied over right M1 of 24 subjects for 30 minutes including 11minutes for task period time. We applied two electrodes at the same position to both an experimental group and a sham-controlled group, and we made 2 groups recognize to be applicated of stimulation. Flexion, extension of wrist and thumb flexion are carried out following colors of arrows on the monitor. Serial reaction time task was applied to confirm the difference of the reaction time between 2 groups. Results: Reaction time is decreased in both tDCS-group and Sham-controlled tDCS group, and the degree of reduction is much greater in the post-test than pre-test. Reduction of reaction time between groupsis statistically significant. Conclusion: We consider that anodal tDCS increased the cortical excitability of the underlying motor cortex and it can be helpful to modulate motor performance. It seems that tDCS is an effective modality to modulate brain function, and it will be great help to mediate strategy for the brain injury patients.

편측 뇌손상 환자의 동측 운동 결함에 대한 고찰

김중선,김경,권용현,Kim, Chung-Sun,Kim, Kyung,Kwon, Yong-Hyun 대한물리치료학회 2006 대한물리치료학회지 Vol.18 No.4

Recently, several investigations revealed that after unilateral brain damage, movement abnormalities were exposed on the ipsilateral side as well as the upper extremity contralateral to the damaged hemisphere. Even the motor abilities had significantly recovered from ipsilateral motor deficits on not only simple sensoriomotor function, also clinical assessments since subacute stage, although could not completely returned. Such motor deficits were detected in a diversity of motor tasks depending on the interhemispheric specialization, further in clinical evaluation and a daily of activities. In the clinical features, muscular weakness, sensory loss and impaired manual dexterity were observed. In a laboratory experiment, there were increasing evidences that the kinematic processing deficits was founded in various-specific motor tasks, which ranged from simple basic element to complex tasks, such as tapping task, step-tracking, goal directional aiming task, and iso(and non-)directional interlimb coordination. In the point of view, the manifest understanding in related to ipsilateral deficits provide the clinicians with an important information for scientific management about brain injured patient's prognosis and therapeutic guidelines.

호흡곤란으로 내원하여 정상흉부 X-선 소견을 보인 52세 여자

김중선,양동규,김성규 한국의학사 1998 診斷과治療 Vol.18 No.7

온열 자극에 따른 심혈관계 반응:전신욕과 반신욕의 비교

김중선,이왕수,경희두,장혁재,조영석,연태진,정우영,채인호,최동주 대한심장학회 2004 Korean Circulation Journal Vol.34 No.12

Background and Objectives:The beneficial effects of systemic thermal therapy such as taking a hot tub or sauna have been described for patients with cardiovascular disease. Despite such positive effects, there is still concern over the safety of these procedures. Half-body immersion has recently been widely used as an alternative to achieve the same benefit, and it is better tolerated than conventional whole-body immersion (WBI). However, there has been no study that has clarified the cardiovascular effect of half-body immersion (HBI). Subjects and Methods:We asked 13 healthy men (age:20 to 27 years) to immerse themselves to the shoulder level on day 1) and to the umbilical level on Day 2 for 20 minutes in a hot tub, respectively (temperature:39.0 to 41.0℃). Changes of skin (TSk) and esophageal temperature (TEo), hemodynamic and autonomic responses, and symptom scale were measured during the immersion. Results:All the volunteers were compliant and there were no adverse events. During immersion, the TEo increased continuously with each methods, but 10 minutes after immersion the TEo for the WBI patients was higher (p=0.03). The heart rate (HR) increased and the diastolic blood pressure decreased for both conditions. In contrast to HBI, the ejection fraction (EF) (p=0.10), and cardiac output (CO)(p=0.005) increased continuously for WHI. Among the HRV parameters, the values for the low-to-high frequency ratio (p=0.03) increased significantly with WHI after 10 minutes. The symptom scale during (p=0.01) and immediate after immersion in the hot tub (p=0.005) was better for HBI. Conclusion:Core temperature, echocardiographic systolic parameters and sympathetic activity were increased more slowly for HBI compared to WBI. This suggests that HBI could be a safer alternative for systemic thermal therapy for the patients with cardiovascular disease. 배경 및 목적: 심장 질환 환자에서의 온열 치료는 혈역학적 지표, 임상적인 증상, 심장 및 혈관 내피세포 기능을 향상시킬 수 있다고 알려져 있다. 이러한 잇점에도 불구하고 환자에서의 적용은 안전성에 대한 우려가 있는 상태로, 최근 반신욕의 경우는 전신욕과 비슷한 효과를 가지면서 보다 안전하고 편안하게 이용할 수 있는 방법으로 생각되고 있다. 하지만 현재까지 반신욕의 혈역학적 및 심장 기능에 변화에 대한 연구는 없었고 이에 본 저자들은 반신욕과 전신욕의 심장 기능 및 자율 신경계의 변화를 살펴 봄으로써 반신욕의 유용성과 안전성에 대해 알아보고자 하였다. 방 법: 대상군은 13명의 지원자(age range, 20 to 27 years;mean BSA 1.7 m2, mean BMI 22.5 kg/m2) 였고, 전신욕은 어깨 높이로 반신욕은 배꼽 높이로 시행하였다. 검사 중 물의 온도는 39~41℃로 유지하였고 20분 입수 시간 동안 피부 및 식도 중심 온도, 혈역학적인 변화, 심초음파를 통한 심장 기능의 변화, 증상의 변화 및 자율 신경계의 변화를 5~10분 간격으로 측정하였다. 결 과: 식도 중심 체온은 두 군 모두 지속적으로 상승하는 양상이었으며 전신욕 군의 경우 10분 이후 급격한 양상으로 증가되었다. 입수 동안 심 박동수는 증가되었으며 이완기 혈압은 감소되었다. 증상은 전신욕 군의 경우가 반신욕 군에 비하여 심하게 나타났으며 p=0.01) 입수 직후 기립시 증상도 전신욕 군에서 많이 나타났다(p=0.005). 심초음파를 통한 수축기능의 변화에서는 반신욕 군의 경우 심구혈율(p=0.10), 심박출량(p=0.005)이 10분까지 증가되다가 10분 이후 유지되었지만 전신욕 군은 지속적으로 상승하였다. 자율 신경 기능 평가를 위한 심박동 변이 분석상 저주파수에 대한 고주파수의 빈도의 비율이 전신욕 군에서 높았다(p=0.03). 결 론: 결론적으로 반신욕은 전신욕에 비해 혈역동학적 변화가 완만하며 교감신경계의 항진 정도가 낮아 심혈관계 부하가 적은 방법이었고 심혈관계 질환의 재활 치료에 도움이 된다고 알려져 있는 온열 치료 중 하나로 보다 안전한 방법으로 생각된다.

Neurophysiological and Clinical Features of the Pusher Syndrome: Review Article

김중선,남석현 대한물리치료학회 2010 대한물리치료학회지 Vol.22 No.3

Patients with the pusher syndrome show severe misperception of their own upright body orientation although visual vestibular processing is almost intact. They recognize their body as oriented upright when it is actually tilted nearly 20 degrees to the affected side. These patients resist any attempts to assively correct their tilted body posture towards an earth vertical upright orientation. They use the non-affected side arm and/or leg to actively push towards the affected side. Pusher syndrome patients have different prognoses and symptoms than general stroke patients without pusher syndrome. Pusher syndrome patients have a poor prognosis, so they need a long duration of treatment. Therefore, accurate diagnosis and proper treatment are important. In this study, we reviewed the symptoms, causes, evaluation, and treatment for pusher syndrome.

포스타 전시 발표 : 감염, 알레르기, 류마티스 ; Allopurinol에 의한 박탈성 피부염환자에서 탈감작 요법 1예

김중선,정혜원,박정엽,조영준,허애정,김철우,윤영연,박중원,홍천수 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

Advanced Course: 순환기2 : 구조적 심질환에서 경피적 중재시술의 최신발전

김중선 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.2