주관절 각도 변화에 따른 척골신경의 단분절 운동신경전도 검사

변승득,신오수,권순모,김철현,김태건 대한근전도전기진단의학회 2008 대한근전도 전기진단의학회지 Vol.10 No.1

Objectives: The purpose of this study is to investigate the effect of elbow position on conduction velocities of short segments across the elbow and to obtain optimal elbow position for short segmental ulnar motor conduction study. Methods: Short segmental motor conduction studies of ulnar nerve were performed in nondominant upper limbs of twenty-five healthy adults. For each upper limb, ulnar nerve was stimulated at 2 cm intervals from 4 cm below to 6 cm above the medial epicondyle with elbow position in extension and 45。, 90。, and 135。flexion. Results: Each short segment across the elbow showed statistically significant slowing of conduction velocities compared to that of forearm segment with elbow position in extension and 45。flexion (p<0.05). Each short segment across the elbow didn’t show statistically significant slowing of conduction velocities compared to that of forearm segment with elbow position in 90。and 135。flexion (p>0.05), except the segment between 2 cm below the medial epicondyle and medial epicondyle with elbow position in 90。flexion (p<0.05). Differences of nerve conduction velocity between forearm segment and each short segment across the elbow were minimal with elbow position from 90。to 135。flexion. Conclusion: This study suggest that the degree of elbow flexion should be maintained 135。full flexion in short segmental ulnar nerve conduction study.

슬라이딩 재활기구의 최대 경사 각도와 보행 척도와의 관련성

이양수,변승득,김철현,김풍택 대한재활의학회 2007 Annals of Rehabilitation Medicine Vol.31 No.2

골반 교정 수술 후 발생한 가골에 의한 좌골 신경병증 - 증례 보고 -

박동휘,변승득,이지인 대한근전도전기진단의학회 2011 대한근전도 전기진단의학회지 Vol.13 No.2

Sciatic neuropathy is caused by many reasons; such as fractures of pelvic bone or femur. We report a case of a sciatic neuropathy which has occurred six months later after pelvic fracture surgery. He was a previous healthy 54 year-old male involved in a pedestrian traffic accident. After 2 weeks, an open reduction and an internal fixation operation was performed under the diagnosis of right pelvic acetabular fracture. Six months after operation, he complained about numbness and paresthesia in dorsum and sole of right foot and showed decreased muscle power to "fair" of knee flexion, ankle dorsi- and plantar flexion. In electrophysiologic study, right sciatic neuropathy was checked, and pelvis X-ray showed callus formation in plates inserted for internal fixation of the greater sciatic notch area. After conservative treatment, a patient showed clinical evidence of recovery within 1 year period of follow up.

편마비 환자에서 하지 균형조절 능력이 균형 및 보행에 미치는 영향

김철현,변승득,신오수,김태건,권순모,노재현,이양수,정순기 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.4

Objective: To investigate the effects of balance control of affected lower extremity on berg balance scale and gait in hemiparetic patients, using the newly developed balance control trainer of lower extremity. Method: Thirty five hemiparetic patients who could stand and ambulate more than 10 meters without assist on even surface were included in this study. The balance control trainer of lower extremity was designed to measure weight shift and knee flexion angle of hemiparetic side and to play a game named “Board cleaner” which use these data, so considering the vertical movement of the center of gravity. We measured above three parameters, and also evaluated with clinical tests including berg balance scale (BBS). We evaluated correlations between parameters on the balance control trainer of lower extremity and clinical parameters. Results: Weight shifting to affected side statistically significantly correlated only with BBS. Affected knee flexion had statistically significant correlations with all clinical tests examined, especially 10 meters walking time (10mWT), timed up and go test (TUG), and BBS. Scores earned from board cleaner game also had statistically significant correlations with all clinical tests examined, especially 10mWT, TUG, and BBS. Conclusion: Correlation exists between the ability to control the affected knee measured by balance control trainer of lower extremity and clinical parameters including 10mWT, TUG, and BBS, so we think the balance control trainer can be a useful tool for the evaluation in hemiparetic patients. Objective: To investigate the effects of balance control of affected lower extremity on berg balance scale and gait in hemiparetic patients, using the newly developed balance control trainer of lower extremity. Method: Thirty five hemiparetic patients who could stand and ambulate more than 10 meters without assist on even surface were included in this study. The balance control trainer of lower extremity was designed to measure weight shift and knee flexion angle of hemiparetic side and to play a game named “Board cleaner” which use these data, so considering the vertical movement of the center of gravity. We measured above three parameters, and also evaluated with clinical tests including berg balance scale (BBS). We evaluated correlations between parameters on the balance control trainer of lower extremity and clinical parameters. Results: Weight shifting to affected side statistically significantly correlated only with BBS. Affected knee flexion had statistically significant correlations with all clinical tests examined, especially 10 meters walking time (10mWT), timed up and go test (TUG), and BBS. Scores earned from board cleaner game also had statistically significant correlations with all clinical tests examined, especially 10mWT, TUG, and BBS. Conclusion: Correlation exists between the ability to control the affected knee measured by balance control trainer of lower extremity and clinical parameters including 10mWT, TUG, and BBS, so we think the balance control trainer can be a useful tool for the evaluation in hemiparetic patients.

소아 편마비 환자에서 구속유도 운동치료가 뇌피질 재조합에 미치는 영향

이지인,천경아,변승득 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.4

Objective: To investigate the effects of modified constraint- induced movement therapy (CIMT) on motor function and cortical activation in children with hemiplegic cerebral palsy (CP). Method: Five children with hemiplegic cerebral palsy were studied with Jebsen hand function test and quality of upper extremity skills test (QUEST), dynamic electromyography (EMG), and single photon emission computed tomography (SPECT) at rest before and after the CIMT period. Children were treated with a 4-week protocol of modified CIMT, consisting of twice-weekly 2-hour sessions of structured activities and a home program for non-treatment days. Children wore orthoses on their less affected upper extremities for 6 hours per day, during which time they were engaged in play, functional activities and 2-hour protocol of motor tasks. Results: Improvements in upper-extremity function were found in Jebsen hand function test and QUEST. Increased muscle activities in elbow extensors were observed in dynamic EMG during affected hand grip. In right hemiplegic patients, regional cerebral perfusion increased in right Brodmann area (BA) 3 and lentiform nucleus. In left hemiplegic patients, regional cerebral perfusion increased in right BA 6, 9, 21, left BA 19 and left cerebellum, but decreased in left BA 11. Conclusion: Modified CIMT appears to change local cerebral perfusion in areas known to participate in movement planning and execution. These changes might be a sign of cortical activation after CIMT in the children with hemiplegic cerebral palsy. Results of this study suggest that modified CIMT may be an effective way of treating children with hemiplegic CP. Objective: To investigate the effects of modified constraint- induced movement therapy (CIMT) on motor function and cortical activation in children with hemiplegic cerebral palsy (CP). Method: Five children with hemiplegic cerebral palsy were studied with Jebsen hand function test and quality of upper extremity skills test (QUEST), dynamic electromyography (EMG), and single photon emission computed tomography (SPECT) at rest before and after the CIMT period. Children were treated with a 4-week protocol of modified CIMT, consisting of twice-weekly 2-hour sessions of structured activities and a home program for non-treatment days. Children wore orthoses on their less affected upper extremities for 6 hours per day, during which time they were engaged in play, functional activities and 2-hour protocol of motor tasks. Results: Improvements in upper-extremity function were found in Jebsen hand function test and QUEST. Increased muscle activities in elbow extensors were observed in dynamic EMG during affected hand grip. In right hemiplegic patients, regional cerebral perfusion increased in right Brodmann area (BA) 3 and lentiform nucleus. In left hemiplegic patients, regional cerebral perfusion increased in right BA 6, 9, 21, left BA 19 and left cerebellum, but decreased in left BA 11. Conclusion: Modified CIMT appears to change local cerebral perfusion in areas known to participate in movement planning and execution. These changes might be a sign of cortical activation after CIMT in the children with hemiplegic cerebral palsy. Results of this study suggest that modified CIMT may be an effective way of treating children with hemiplegic CP.

뇌교 출혈 환자에서 동반된 각성 환시 2례 - 증례보고 -

신오수,박동휘,변승득,김태건,권순모 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.3

Peduncular hallucinosis that rarely reported in patients with brain stem lesion has several characteristics. The hallucination tends to be vivid, nonstereotypical images of person or animal. All the patients are aware that the hallucination is not part of reality. One of the suggested mechanisms of peduncular hallucinosis is imbalance among the cholinergic, serotonergic and other transmitting systems in the brain stem. We report two cases with typical features of peduncular hallucinosis which appeared about 30 and 12 months after pontine hemorrhage, respectively. We chose antipsychotics and selective serotonergic reuptake inhibitors for their medications, and their hallucinations disappeared about 2 months and 3 weeks after the medication, respectively. We suggest that peduncular hallucinosis should be considered in the patients with pontine hemorrhage if they complain of typical visual hallucinations.

다발성 농양과 동반한 양측성 대퇴신경 마비

김철현,이양수,변승득,이지인 대한임상신경생리학회 2005 Annals of Clinical Neurophysiology Vol.7 No.2

We report a 29-year old female who developed bilateral femoral neuropathy combined with multiple abscesses in both thigh muscles. She was present with weakness in both lower extremities for 15 days and intermittent chilling sense for 3 months. Nerve conduction study showed complete absence of compound muscle action potentials in bilateral femoral nerves when stimulated at inguinal area. Electromyographic examination revealed no motor unit action potentials in both rectus femoris and vastus medialis muscles. CT revealed multifocal abscesses in bilateral thigh muscles. After antibiotic treatment, the patient's neurologic symptoms were improved.

장결핵 후 발생한 결핵성 신경근척수염 - 증례 보고 -

박동휘,권순모,조동현,조동현,변승득,이지인,서혜진 대한근전도전기진단의학회 2010 대한근전도 전기진단의학회지 Vol.12 No.1

Tuberculous radiculomyelitis (TBRM) is a rare complication of tuberculosis involving central and peripheral nervous system. We would describe a case with TBRM which developed after intestinal tuberculosis. He presented our hospital with nausea and weight loss. He suffered operation with impression of peritonitis. After operation, he showed confused mentality and diagnosed with tuberculous meningitis. Nevertheless the anti-tuberculous medication and steroid therapy, symptoms progressed to incomplete paralysis of both upper extremities and complete flaccid paralysis of both lower extremities with muscle wasting, root pain, paraesthesia, and bladder disturbance. Deep tendon reflexes were not checked. Through the MRI and electrophysiologic studies, we diagnosed him as TBRM. After conservative therapy including antituberculous medication for 12 months and comprehensive rehabilitation therapy for 18 months, the patient showed improvement in muscle power and functional level with improvement in electrophysiologic parameters.

당뇨병성 신경병증에 동반된 수근관 증후군의 전기진단학적 검사방법

신오수,김태건,김철현,박동휘,권순모,변승득 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.4

Objective: To find out the most useful method among three electrodiagnostic tests for carpal tunnel syndrome (CTS) in patients with diabetic peripheral polyneuropathy (PPN). Method: Eighty-three hands out of seventy-four patients who had diabetic PPN and tingling sensation in their hands were included in this study. They were divided into two groups: Group A, PPN with CTS; Group B, PPN only. Fifty-four hands with CTS in patients without diabetes were included as a control group (Group C). Another forty normal hands were also included as a healthy control group (Group D). Clinical and electrophysiologic information was gathered from those subjects. Sensitivity, specificity and receiver operating characteristic (ROC) curves of the three electrodiagnostic tests, namely, the difference between the median nerve latency to the second lumbrical muscle and the ulnar nerve latency to the second interosseous muscle (L-I difference), ratio of distoproximal latency in median sensory nerve (MW ratio), and difference of distoproximal latency in median sensory nerve (MW difference) to diagnose clinical CTS were obtained. Results: The specificity of L-I difference as a diagnostic test for CTS was highest (87.0%). The area of ROC curve of L-I difference was also highest (0.949) among three different electrodiagnostic tests of CTS with diabetic PPN. Conclusion: We suggest that L-I difference as the most useful test with highest specificity for the diagnosis of CTS in the patients with diabetic PPN. Objective: To find out the most useful method among three electrodiagnostic tests for carpal tunnel syndrome (CTS) in patients with diabetic peripheral polyneuropathy (PPN). Method: Eighty-three hands out of seventy-four patients who had diabetic PPN and tingling sensation in their hands were included in this study. They were divided into two groups: Group A, PPN with CTS; Group B, PPN only. Fifty-four hands with CTS in patients without diabetes were included as a control group (Group C). Another forty normal hands were also included as a healthy control group (Group D). Clinical and electrophysiologic information was gathered from those subjects. Sensitivity, specificity and receiver operating characteristic (ROC) curves of the three electrodiagnostic tests, namely, the difference between the median nerve latency to the second lumbrical muscle and the ulnar nerve latency to the second interosseous muscle (L-I difference), ratio of distoproximal latency in median sensory nerve (MW ratio), and difference of distoproximal latency in median sensory nerve (MW difference) to diagnose clinical CTS were obtained. Results: The specificity of L-I difference as a diagnostic test for CTS was highest (87.0%). The area of ROC curve of L-I difference was also highest (0.949) among three different electrodiagnostic tests of CTS with diabetic PPN. Conclusion: We suggest that L-I difference as the most useful test with highest specificity for the diagnosis of CTS in the patients with diabetic PPN.