당뇨병성 신경병증에 동반된 족근관 증후군

심은결,윤태식,이미진,홍영선,한수정 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.6

Objective: To investigate the frequency of tarsal tunnel syndrome (TTS) in the diabetic neuropathy patients. Method: Electrodiagnostic study was performed to diagnose diabetic neuropathy and tarsal tunnel syndrome (TTS) in 56 patients (male 25, female 31) with diabetes mellitus. The frequency of combined TTS in diabetic neuropathy patients was calculated.Results: Out of 56 diabetic patients, 52 patients were diagnosed as diabetic peripheral neuropathy. The frequency of concomitant TTS was 22 cases in 52 diabetic patients with diabetic neuropathy.Conclusion: In diabetic neuropathy group, the frequency of TTS was higher than general population.

The Effect of Obturator Nerve Block on Hip Lateralization in Low Functioning Children with Spastic Cerebral Palsy

박은숙,심은결,나동욱,이원철 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.1

Purpose: Hip adductor spasticity has a great impact on developing hip displacement in children with cerebral palsy (CP). Obturator nerve (ON) block is less invasive intervention rather than soft tissue surgery for reduction of hip adductor spasticity. The aim of this study is to investigate the effect of ON block on hip lateralization in low functioning children with spastic CP. Materials and Methods: The study was performed by retrospective investigation of the clinical and radiographic follow-up data of low functioning children [gross motor function classification system (GMFCS)level III to V] with spastic cerebral palsy whose hip was subluxated. Migration percentage (MP) was measured on hip radiographs and its annual change was calculated. In intervention group, ON block was done with 50% ethyl alcohol under the guidance of electrical stimulation. Results: The data of 49 legs of 25 children for intervention group and the data of 41 legs of 23 children for nonintervention group were collected. In intervention group, the MP were significantly reduced at 1st follow-up and the MPs at 2nd and last follow-up did not show significant differences from initial MP. Whereas in nonintervention group, the MPs at 1st, 2nd and last follow-up were all significantly increased compared to initial MPs. Conclusion:ON block with ethyl alcohol is useful as an early effective procedure against progressive hip displacement in these children with spastic CP.

편마비 환자에서 정량적 감각기능 검사로 측정한 온도감각역치

배하석,심은결,윤태식,이정민,김성민 이화여자대학교 의과대학 2009 EMJ (Ewha medical journal) Vol.32 No.1

Objectives:Hemiplegic patients with unilateral cerebral lesions suffer from sensory deficit as well as motor deficit. But clinical assessment of thermal sensation is one of the least reliable components of neurological examination and is difficult to quantify. Methods:We measured thermal sensory thresholds of cold sense, warm sense, cold pain and hot pain in hemiplegic patients with thermal sensory analyzer(TSA). To investigate and quantify the thermal sensory deficit of hemiplegic patients, we compared the measurements with normal con-trols, between body regions, and between hemiplegic and sound side. Results:Hemiplegic patients showed impaired thermal sensory thresholds in all modalities compared to their sound side and normal controls. Conclusion:Quantitative sensory test using thermal sensory analyzer can be useful to quantify the thermal sensory deficit and follow up the progress.

Architectural Changes of the Gastrocnemius Muscle after Botulinum Toxin Type A Injection in Children with Cerebral Palsy

박은숙,정수진,심은결,나동욱 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.5

Purpose: This study used ultrasonography (US) to investigate the architectural changes in gastrocnemius muscles (GCM) after botulinum toxin injection (BoNT-A) in children with cerebral palsy (CP). Materials and Methods: Thirteen childrenwith CP who received a BoNT-A injection into their GCM to treat equinus were recruited (9 males and 4 females). Architectural changes in both the medial and lateral heads of the GCM from a total of 20 legs were assessed using B-mode, real-time US. Muscle thickness (MT), fascicle length (FL), and fascicle angle (FA) were measured over the middle of the muscle belly in both a resting and neutral ankle position. Measures at 1 and 3 months after the injection were compared with baseline data taken before the injection. Results: The mean age of the subjects was 5.8 (±1.6) years. Spasticity was significantly reduced when measured by both the modified Tardieu scale and the modified Ashworth scale at 1 and 3 months after injection (p<0.05). The MT and FA of both the medial and lateral heads of the GCM were significantly reduced for both neutral and resting ankle positions at 1 and 3 months after the injection. The FL of both the medial and lateral heads of the GCM were significantly increased in a resting position (p<0.05), but not in a neutralposition. Conclusion: Our results demonstrated muscle architectural changes induced by BoNT-A injection. The functional significances of these changes were discussed.

Estimation of Gastrocnemius Muscle Volume Using Ultrasonography in Children with Spastic Cerebral Palsy

박은숙,정수진,심은결,나동욱 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.4

Purpose: This study aimed to investigate useful parameters for estimating gastrocnemius(GCM) muscle volume (MV) using ultrasonography (US) and anthropometryin children with spastic cerebral palsy (CP). Materials and Methods: Eighteenlegs from nine children with spastic CP aged 2 to 6 years were investigated in this study. Tibial length (TL) of each leg was measured and muscle thickness (MT) and anatomical cross-sectional area (aCSA) of GCM muscles were assessed using US. The volume of the GCM was measured by magnetic resonance imaging (MRI) scans. The relationship of TL, MT, and aCSA with MV measured by MRI was investigated. Simple and multiple regression analyses were performed to establishmuscle volume prediction equations. Results: Resting MT, aCSA, and TL were highly related to MV of both medial and lateral head of GCM determined by MRI. The MV prediction equation based on simple regression analysis resulted in r2 values ranging from 0.591 to 0.832 (p<0.05). The r2 values were higher using aCSA as independent variable than using MT. The MV prediction equation based on multiple regression analysis resulted in r2 values ranging from 0.779 to 0.903 (p<0.05). However, the relatively high standard error of the estimate values ranged from 18.0--33.6% on simple regression and 15.5--25.6% on multiple regression. The contribution of aCSA was higher than that of MT for predicting MV of GCM. Conclusion: Our study demonstrated the suitability of US assessment of aCSA and MT combined with TL for estimating MV of GCM in children with spastic CP and showed that aCSA is more useful parameter than MT.

A Nine-Month-Old Boy With Isodicentric Chromosome 15: A Case Report

박덕호,임승규,박은숙,심은결 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.2

Isodicentric chromosome 15 [idic(15)] is a rare chromosomal abnormality that occurs due to inverted duplication of chromosome 15q. It is associated with many clinical findings such as early central hypotonia, developmental delay, cognitive dysfunction, autism spectrum disorders, and seizure. Delayed development is a common problem referred to pediatric rehabilitation clinics. A 9-month-old boy with delayed development was referred to our clinic for assessment and treatment. On chromosomal analysis, he was diagnosed as idic(15) syndrome with 47,XY,+idic(15)(q12) on karyotyping. Herein we describe his clinical manifestations and provide a brief review of the related literature.

변실금에서 음부신경전도검사의 진단적 가치와 항문압 검사와의 관계

이정민,정순섭,윤태식,한수정,심은결 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.5

Objective: To evaluate the diagnostic value of pudendal nerve terminal motor latency (PNTML) and the relationship with manometric profiles in patients with fecal incontinence. Method: A total of 29 patients with fecal incontinence who visited colorectal clinic were recruited. The PNTMLs of 29 patients were compared with those of normal controls (2.03±0.39) using one-sample t test. Patients were classified into three groups according to pudendal nerve latency; Group I (normal latency, n=8), group II (unilaterally delayed latency, n=9), group III (bilaterally delayed latency, n=12) and compared with manometric parameters (mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume, maximal tolerance volume). Results: The PNTML is 3.83±2.19 in right side, 4.57±2.19 in left side which are significantly delayed in patients with fecal incontinence compare to that of normal controls, 2.03± 0.39. (p=0.031 in Rt., p=0.000 in Lt.) Among group I∼III, there were no statistically significant differences in the values of mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume and maximal tolerance volume. There was no correlation between the PNTML and any of manometric parameters. Conclusion: The PNTML is valuable in diagnosing patients with fecal incontinence. It is suggested that combined assessments are necessary to identify the cause of fecal incontinence. Objective: To evaluate the diagnostic value of pudendal nerve terminal motor latency (PNTML) and the relationship with manometric profiles in patients with fecal incontinence. Method: A total of 29 patients with fecal incontinence who visited colorectal clinic were recruited. The PNTMLs of 29 patients were compared with those of normal controls (2.03±0.39) using one-sample t test. Patients were classified into three groups according to pudendal nerve latency; Group I (normal latency, n=8), group II (unilaterally delayed latency, n=9), group III (bilaterally delayed latency, n=12) and compared with manometric parameters (mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume, maximal tolerance volume). Results: The PNTML is 3.83±2.19 in right side, 4.57±2.19 in left side which are significantly delayed in patients with fecal incontinence compare to that of normal controls, 2.03± 0.39. (p=0.031 in Rt., p=0.000 in Lt.) Among group I∼III, there were no statistically significant differences in the values of mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume and maximal tolerance volume. There was no correlation between the PNTML and any of manometric parameters. Conclusion: The PNTML is valuable in diagnosing patients with fecal incontinence. It is suggested that combined assessments are necessary to identify the cause of fecal incontinence.