만성 경직성 편마비 환자에서 보툴리눔 독소 근주입 후 상지 운동기능 개선 효과

노세응,서은진,정복희,주민철 대한작업치료학회 2011 대한작업치료학회지 Vol.19 No.2

목적 : 만성 경직성 편마비 환자에서 보툴리눔 독소 근 주입 후 상지 운동기능 개선을 알아보고자 하였다. 연구방법 : 뇌졸중 발병 후 12개월 이상이 경과된 만성기 편마비 환자 18명을 대상으로 환측 상지의 요측수근굴근, 척측수근굴근, 심지굴근, 천지굴근에 보툴리눔 독소를 각각 25 단위 주사하였다. 평가는 주사 전, 주사 2주 후와 8 주 후의 상지 기능 변화 및 동작 분석을 시행하였다. 상지의 경우 수정 에쉬워스 척도와 도수 근력 평가, 뇌졸중 상 지 기능 평가, 수지의 파악력 및 측면 집기력을 평가하였고 정량 분석을 위하여 3차원 동작 분석기를 이용하여 손 목관절의 최대 굴곡-최대 신전, 손바닥 두드리기, 검지 두드리기, 30cm 추적운동의 동작을 분석하였다. 결과 : 보툴리눔 독소를 주사 후 마비측 수지의 파악력, 측면 집기력에서는 유의한 변화가 없었으나 손목관절의 신 전, 수지의 신전 근력, 뇌졸중 상지 기능 평가에서 유의한 호전이 관찰되었다(p<.05). 3차원 동작 분석기를 이용한 상지 기능의 평가에서 손목관절 최대 굴곡-손목관절 신전 동작의 관절운동범위에서 유의한 호전이 관찰되었으며 손목관절 최대 굴곡-손목관절 신전 동작 및 손바닥 두드리기와 검지 두드리기 동작에서 진동수의 유의한 증가와 변이도의 유의한 감소는 관찰되지 않았으나 진폭의 유의한 증가가 관찰 되었다(p<.05). 결론 : 만성 경직성 편마비 환자에서 환측 상지에 대한 보툴리눔 독소 치료는 상지 운동기능 개선에 유의한 효과를 보였다.

한국 성인의 심뇌혈관질환 인지도 관련 요인: 2013년 지역사회건강조사

이영훈,노세응 대한임상건강증진학회 2017 Korean Journal of Health Promotion Vol.17 No.2

Background:This study investigated factors related to awareness of cardio-cerebrovascular disease (CCVD) in a large Korean general population. Methods:Data for 228,781 subjects older than 19 years in 253 cities, counties, and districts were collected from the 2013 Community Health Survey in Korea. Associations between socio-demographics, health behaviors, comorbidities, and awareness of CCVD were examined using the chi-squared test and multiple logistic regression analysis. A total of 219,461 subjects were included in the final analysis after excluding subjects with null responses to any questions. Results:The awareness of CCVD was 26.7% in the total population (27.8% in males, 25.8% in females). Of the significant associating factors, the odds ratios for awareness of CCVD were two-fold higher in people aged 40-49 years , 50-59 years, and 60-69 years (ref. 19-29 years), living in Chungbuk provinces (ref. Seoul), higher education (ref. non-formal education), and diagnosed with angina pectoris (ref. non-diagnosed), as compared to their individual reference groups. Conclusions:Socio-demographics, health behaviors, and comorbidities have significant impact on awareness of CCVD. To improve the public’s awareness of CCVD and to reduce health inequalities, effective and specialized interventions should be developed that take these factors into account. 연구배경: 본 연구는 대규모 인구집단을 대상으로 심뇌혈 관질환 인지도와 관련된 요인을 파악하고자 시행되었다. 방법:2013년 지역사회건강조사에서 19세 이상 성인228,781명의 원자료가 수집되었다. 인구사회학적 특성, 건강행태 및 동반질병 영역의 다양한 요인들과 심뇌혈관질환인지도와의 관련성을 카이제곱 검정과 로지스틱 회귀분석을 통해 분석하였다. 일부 문항에 대해 무응답 또는 거절한사람을 제외한 219,461명을 최종 분석대상으로 하였다. 결과: 전체 대상자의 심뇌혈관질환 인지도는 26.7% (남자 27.8%, 여자 25.8%)였다. 심뇌혈관질환 인지도는 남녀모두 40대(남자 37.5%, 여자 40.5%)에서 가장 높았으며, 70 세 이상(남자 14.0%, 여자 5.5%)에서 가장 낮았다. 로지스틱 회귀분석에서 성별, 연령, 광역시·도, 거주지역, 직업, 교육수준, 혼인상태, 월평균 가구소득, 흡연상태, 음주빈도, BMI, 고혈압, 당뇨병, 이상지질혈증, 뇌졸중, 심근경색증, 협심증이 심뇌혈관질환 인지도와 유의한 관련성이 있었다. 특히, 40대·50대·60대(vs. 19-29세), 충북(vs. 서울), 높은 교육수준(vs. 무학), 협심증 진단의 집단에서 각 준거집단에비해 오즈비 2.0 이상의 높은 관련성을 보였다. 결론: 심뇌혈관질환 인지도는 인구사회학적 특성, 건강행태 및 동반질병 영역의 다양한 요인들과 유의한 관련성이 있었다. 일반인들의 심뇌혈관질환 인지도 향상 및 심뇌혈관질환 지식의 건강불평등을 개선하기 위해서는 심뇌혈관질환 인지도와 유의한 관련성이 있는 요인을 고려한 효과적이고 특화된 홍보전략 수립이 필요하다.

Diagnostic Value of Plain Abdominal Radiography in Stroke Patients With Bowel Dysfunction

문효정,노세응,김지희,주민철 대한재활의학회 2015 Annals of Rehabilitation Medicine Vol.39 No.2

Objective To evaluate the diagnostic value of plain abdominal radiography in stroke patients with bowel dysfunction.Methods A total of 59 stroke patients were recruited and assigned into constipation or non-constipation group. Patients were interviewed to obtain clinical information, constipation score, and Bristol stool form scale. The total and segmental colon transit time (CTT) was measured using radio-opaque markers (Kolomark). The degree of stool retention was evaluated by plain abdominal radiography and scored by two different methods (Starreveld score and Leech score). The relationship between the clinical aspects, CTT, and stool retention score using plain abdominal radiography was determined.Results Average constipation score was 4.59±2.16. Average Bristol stool form scale was 3.86±1.13. The total and segmental CTTs showed significant differences between the constipation and non-constipation groups. There was statistically significant (p<0.05) correlation between the total CTT and constipation score or between Starreveld score and Leech score. Each segmental CTT showed significant correlation (p<0.05) between segmental stool retention scores.Conclusion The stool retention score showed significant correlation with constipation score as well as total and segmental CTT. Thus, plain abdominal radiography is a simple and convenient method for the evaluation of bowel dysfunction in stroke patients.

Plain Abdominal Radiograph as an Evaluation Method of Bowel Dysfunction in Patients With Spinal Cord Injury

박현준,노세응,김강득,주민철 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.4

Objective To evaluate the usefulness of plain abdominal radiography as an evaluation method for bowel dysfunc-tion in patients with spinal cord injury (SCI).Methods Forty-four patients with SCI were recruited. Patients were interviewed about their clinical symptoms, and the constipation score and Bristol stool form scale were assessed. The colon transit time (CTT) was measured by using radio-opaque markers (Kolomark). The degree of stool retention and the presence of megacolon or megarectum were evaluated using plain abdominal radiographs. We examined the relationship between clinical aspects and CTT and plain abdominal radiography.Results The constipation scores ranged from 1 to 13, and the average was 4.19±3.11, and the Bristol stool form scale ranged from 1 to 6, with an average of 4.13±1.45. CTTs were 19.3±16.17, 19.3±13.45, 15.32±13.15, and 52.42±19.14 in the right, left, rectosigmoid, and total colon. Starreveld scores were 3.4±0.7, 1.8±0.86, 2.83±0.82, 2.14±1, and 10.19±2.45 in the ascending, transverse, descending, rectosigmoid, and total colon. Leech scores were 3.28±0.7, 2.8±0.8, 2.35±0.85, and 8.45±1.83 in the right, left, rectosigmoid, and total colon. The number of patients with megacolon and megarectum was 14 (31.8%) and 11 (25%). There were statistically significant correlations between the total CTT and constipation score (p<0.05), and Starreveld and Leech scores (p<0.05). Significant cor-relations were observed between each segmental CTT and the segmental stool retention score (p<0.05).Conclusion Plain abdominal radiography is useful as a convenient and simple method of evaluation of bowel dysfunction in patients with SCI.

Effects of Hippotherapy on Psychosocial Aspects in Children With Cerebral Palsy and Their Caregivers: A Pilot Study

장철환,주민철,노세응,이상열,이대보,이성호,김호균,박효인 대한재활의학회 2016 Annals of Rehabilitation Medicine Vol.40 No.2

Objective To investigate the effects of hippotherapy on psychosocial and emotional parameters in children with cerebral palsy (CP) and their caregivers.Methods Eight children with CP were recruited (three males and five females; mean age, 7.3 years; Gross Motor Function Classification System levels 1–3). Hippotherapy sessions were conducted for 30 minutes once weekly for 10 consecutive weeks in an indoor riding arena. The Gross Motor Function Measure (GMFM), Pediatric Balance Scale (PBS), and the Korean version of the Modified Barthel Index were evaluated. All children were evaluated by the Children’s Depression Inventory, Trait Anxiety Inventory for Children, State Anxiety Inventory for Children, Rosenberg Self Esteem Scale, and the Korean-Satisfaction with Life Scale (K-SWLS). Their caregivers were evaluated with the Beck Depression Inventory, the Beck Anxiety Inventory, and the K-SWLS. We assessed children and their caregivers with the same parameters immediately after hippotherapy.Results Significant improvements on the GMFM, dimension E in the GMFM, and the PBS were observed after hippotherapy compared with the baseline assessment (p<0.05). However, no improvements were detected in the psychosocial or emotional parameters in children with CP or their caregivers. None of the participants showed any adverse effects or accidents during the 10 weeks hippotherapy program.Conclusions Hippotherapy was safe and effectively improved gross motor and balance domains in children with CP. However, no improvements were observed in psychosocial or emotional parameters.

건선 환자에서 아시트레틴 치료 중 발생한 다장기 혈전성 폐색증 1례-증례 보고-

양충용,김태진,노세응,주민철,길은영,신용일 대한재활의학회 2007 Annals of Rehabilitation Medicine Vol.31 No.3

Long-Term Outcomes of Cardiac Rehabilitation in Diabetic and Non-diabetic Patients With Myocardial Infarction

김현준,주민철,노세응,김지희 대한재활의학회 2015 Annals of Rehabilitation Medicine Vol.39 No.6

Objective To investigate the long-term outcomes of cardiac rehabilitation (CR) on exercise capacity in diabetic (DM) and non-diabetic (non-DM) patients with myocardial infarction (MI). Methods Of the MI patients who received hospital-based CR from February 2012 to January 2014, we retrospectively reviewed the medical records of the patients who continued follow-up through the outpatient clinic and community-based self-exercise after CR. A total of 37 patients (12 with DM and 25 without DM) were included in this study. Exercise capacity was measured by symptom-limited exercise tests before and after hospital-based CR and 1 year after the onset of MI. Results Before the CR, the DM group had significantly lower exercise capacity in exercise times, peak oxygen consumption (VO2peak), and metabolic equivalent tasks (METs) than did the non-DM group. After the CR, both groups showed significantly improved exercise capacity, but the DM group had significantly lower exercise capacity in exercise times, submaximal rate pressure products (RPPsubmax), VO2peak, and METs. One year after the onset of the MI, the DM group had significantly lower exercise capacity in exercise times, RPPsubmax, and VO2peak than did the non-DM group, and neither group showed a significant difference in exercise capacity between before and after the CR. Conclusion As a result of continued follow-up through an outpatient clinic and community-based self-exercise after hospital-based CR in patients with MI, the DM group still had lower exercise capacity than did the non- DM group 1 year after the onset of MI, but both groups maintained their improved exercise capacity following hospital-based CR.

아급성기 뇌졸중 환자에서의 상지 재활 로봇 치료의 효과

주민철,박효인,노세응,김지희,김현준,장철환 대한뇌신경재활학회 2014 뇌신경재활 Vol.7 No.2

Objective: To investigate the effects of robot-assisted arm training on motor and functional recovery of upper limb in patients with subacute stroke. Method: Thirty one subacute stroke patients were randomly divided into 2 groups. Robot-assisted arm training group received robot-assisted therapy using ArmeoⓇSpring (Hocoma Inc., Zurich, Switzerland) for thirty minutes per day and five times every week during four weeks while control group received conventional arm training with same duration and frequency as robotic group. Outcome measures were used manual muscle test (MMT) for motor strength, Fugl-Meyer assessment (FMA), Manual function test (MFT) for arm function, Korean-modified Barthel index (K-MBI) for activities of daily living, Korean-mini mental state examination (K-MMSE) and Computerized Neuro-Cognitive Function test software-40 (CNT-40) for cognitive function. All recruited patients underwent these evaluations before and after four weeks robot-assisted arm training. Results: Robot-assisted training on upper limb after subacute stroke showed improvement on motor strength, arm function, and activities of daily living. But change values in terms of MMT, FMA, MFT, K-MBI exhibited a no statistically significant difference compared with conventional group (p>0.05). Conclusion: In patients with upper limb deficits after subacute stroke, Robot-assisted arm training was considered to facilitate motor and functional recovery of upper limb. But robot-assisted arm training did not significantly improve motor and arm function at 4 weeks compared with conventional arm training group. Further research is required about the comparison of conventional rehabilitation therapy group and the questions about the duration, severity of stroke.

건강한 성인에서 기계승마 운동 동안의 심폐 반응

부승현(S. H. Boo),노세응(S. E. Noh),이은선(E. S. Lee),주민철(M. C. Joo) 한국재활복지공학회 2016 재활복지공학회논문지 Vol.10 No.4

본 논문에서는 건강한 성인 26명(남자 14명, 여자 12명)을 대상으로 기계승마의 적용을 통한 심폐기능의 변화 및 그에 따른 운동 강도를 정량적으로 측정하여, 기계식 승마 치료의 임상 적용가능성과 유효성을 추정하였다. 기계승마 장비인 JOBA® (Panasonic Electric Works, Osaka, Japan)을 이용하였고, 운동의 강도는 level 2 (0.73 Hz)에서 4 (0.9 Hz), 6 (1.03 Hz), 8 (1.2 Hz), 9 (1.3 Hz)까지 증가시키고, 각각의 level에서 3분간 유지하였다. 운동 중 참여자의 심폐 반응은 호흡가스분석 시스템(TruOne 2400, Parvo Medics, USA)과 운동부하검사 시스템(Q Stress, Cardiac Science, USA)을 이용하여 심박수, 혈압, 최대산소소모량(VO2max)을 측정하였다. 또한 기계승마를 통해 유발되는 유산소 운동 강도를 평가하기 위해 대사당량(MET)을 측정하고, 예비심박수율(%HRR), 최대심박수율(%peak HR)과 칼로리소모량을 계산하였다. 그 결과는 SPSS 18.0 프로그램을 이용해 분석하였으며, 건강한 성인에서 간단한 사전 교육 후 15분간의 JOBA®를 이용한 기계식 승마 치료시 증등도의 운동 강도에 도달할 수 있는 것으로 평가되었다. In this paper, we evaluate the effectiveness of mechanical horseback riding exercise training for cardiopulmonary responses in 26 healthy adults (male 14, female 12) and suggest its clinical applicability. Exercise was performed using a mechanical horseback riding machine, JOBA® (Panasonic Electric Works, Osaka, Japan) and riding movement speed was increased from level 2 (0.73Hz), to 4 (0.9Hz), to 6 (1.03Hz), to 8 (1.2Hz), to 9 (1.3Hz) and maintained 3minutes in each level. Heart rate, blood pressure, maximum oxygen consumption (VO2max) were measured by respiratory gas analysis system (TruOne 2400, Parvo Medics, USA) and exercise tolerance test system(Q Stress, Cardiac Science, USA). To measure exercise intensity, metabolic equivalent (MET) were measured and percent of Heart rate reserve (%HRR), percent of peak heart rate (%peak HR) and calorie consumption were calculated. The results were analysed by SPSS 18.0. We found that the exercise intensity of mechanical horseback riding exercise using JOBA® for 15 minutes is moderate in healthy adult who received pre-training.

Accuracy of Heart Rate Measurement Using Smartphones During Treadmill Exercise in Male Patients With Ischemic Heart Disease

이은선,이진석,주민철,김지희,노세응 대한재활의학회 2017 Annals of Rehabilitation Medicine Vol.41 No.1

Objective To evaluate the accuracy of a smartphone application measuring heart rates (HRs), during an exercise and discussed clinical potential of the smartphone application for cardiac rehabilitation exercise programs.Methods Patients with heart disease (14 with myocardial infarction, 2 with angina pectoris) were recruited. Exercise protocol was comprised of a resting stage, Bruce stage II, Bruce stage III, and a recovery stage. To measure HR, subjects held smartphone in their hands and put the tip of their index finger on the built-in camera for 1 minute at each exercise stage such as resting stage, Bruce stage II, Bruce stage III, and recovery stage. The smartphones recorded photoplethysmography signal and HR was calculated every heart beat. HR data obtained from the smartphone during the exercise protocol was compared with the HR data obtained from a Holter electrocardiography monitor (control).Results In each exercise protocol stage (resting stage, Bruce stage II, Bruce stage III, and the recovery stage), the HR averages obtained from a Holter monitor were 76.40±12.73, 113.09±14.52, 115.64±15.15, and 81.53±13.08 bpm, respectively. The simultaneously measured HR averages obtained from a smartphone were 76.41±12.82, 112.38±15.06, 115.83±15.36, and 81.53±13 bpm, respectively. The intraclass correlation coefficient (95% confidence interval) was 1.00 (1.00–1.00), 0.99 (0.98–0.99), 0.94 (0.83–0.98), and 1.00 (0.99–1.00) in resting stage, Bruce stage II, Bruce stage III, and recovery stage, respectively. There was no statistically significant difference between the HRs measured by either device at each stage (p>0.05).Conclusion The accuracy of measured HR from a smartphone was almost overlapped with the measurement from the Holter monitor in resting stage and recovery stage. However, we observed that the measurement error increased as the exercise intensity increased.