편마비 환자에서 족저근막의 두께 변화

박지원,박성희,고명환,Park, Ji-Won,Park, Sung-Hee,Ko, Myoung-Hwan 대한물리치료학회 2009 대한물리치료학회지 Vol.21 No.3

Purpose: This study investigated the change in plantar fascia thickness in hemiplegic and non-hemiplegic feet in stroke patients using an ultrasonographic evaluation. Methods: Sixteen hemiplegic and non-hemiplegic feet from 16 hemiplegic patients (patient group) and 16 feet from 8 healthy subjects (control group) were evaluated by ultrasonography. The sagittal sonograms were obtained in the prone position, and the plantar fascia thickness was measured at its insertion into the calcaneus. Results: The mean plantar fascia thickness was measured to be $4.5\pm0.8$mm in hemiplegic feet of the patient group, $3.4\pm1.0$mm for the contralateral non-hemiplegic feet and $2.8\pm0.3$mm for the control group. There was a statistically significant difference in plantar fascia between the hemiplegic feet and contralateral non-hemiplegic feet as well as between the contralateral non-hemiplegic feet and control group (p<0.01 and p<0.05, respectively). The plantar fascia thickness according to the Brunnstrom stage and modified Ashworth scale was increased significantly in the hemiplegic feet (p<0.01). Conclusion: These results show that the plantar fascia is overloaded in the hemiplegic and non-hemiplegic feet of stroke patients. A therapeutic approach should be considered for these patients.

만성 뇌졸중 환자의 시간에 따른 삼킴 기능 변화

임익재(Ikjae Im),고명환(Myoung-Hwan Ko) 한국장애인재활협회 2018 재활복지 Vol.22 No.1

본 연구는 2011년 1월 1일부터 2012년 12월 31일까지 대학 병원에 입원 또는 재원중인 만성 뇌졸중 환자를 대상으로 이들의 삼킴 장애 양상이 시간에 따라 변화하는지를 비교하고자 하였다. 대상자는 맨 삼킴 능력 평가(Mann Assessment Swallowing Ability)에 의해 178점 이하의 점수를 보인 삼킴장애 환자들로 이 기간 동안 최소 2회 이상의 비디오투시조영 삼킴 검사(videofluroscopic swallowing examination)를 수행한 환자 10명 이었다. 또한 이들의 삼킴 문제를 비교하기 위해 나이와 성별을 고려한 정상 성인 8명이 대조군으로 참여하였다. 시간에 따른 삼킴 장애 및 삼킴 기능을 비교하기 위해 만성 뇌졸중 환자의 구강통과시간, 인두통과시간, 후두폐쇄유발시간, 바륨 삼킴 검사(Modified Barium Swallowing Impairment Profile: MBSImP™ⓒ) 및 기능적 구강 섭취 척도(Functional Oral Intake Scale: FOIS)를 평가하였다. 삼킴 평가는 입원 후 일주일 이내에 이루어졌으며 기초선 평가 후 3 개월이 지난 뒤 재검사되었다. 연구 결과, 기초선 평가에서 만성 뇌졸중 환자는 정상인보다 지연된 삼킴 시간을 보였다(구강통과시간; z=-3.60, p<0.001, 인두통과시간; z=-2.77, p=0.004, 후두반응시간; z=-3.56, p<0.001). 만성 뇌졸중 환자군은 3개월 이후에도 비슷한 수준의 삼킴 시간을 보여 삼킴 효율성은 개선되지 않았음을 확인하였다. 반면, MBSImP™ⓒ와 FOIS 결과에서 구강 단계의 삼킴 기능과 구강 섭취 능력이 두 시점에 따라 통계적으로 유의한 차이가 있었다(MBSImP™ⓒ; z=-2.02, p=0.04, FOIS; z=-2.27, p=0.02). 3개월 후에 뇌졸중 환자는 구강 기능 및 구강 섭취 능력이 호전된 것으로 나타났으며 이는 일부 삼킴 기능이 회복되었기 때문으로 해석된다. 본 연구는 만성 뇌졸중 환자의 삼킴 장애 양상을 규명하고 호전 가능성을 살펴보았다는 점에서 의의가 있으며 만성 뇌졸중 환자의 삼킴 문제를 관리하고 계획하는 기초 자료를 수립하였다. The purpose of this study was to examine changes in the swallowing function with chronic stroke patient. Ten chronic stroke patients with dysphagia followed up for 3 months. Eight normal age match subjects were also participated. A total of 18 participated in this study and they were classified into two groups (stroke patient group and normal control group). Participants underwent videofluoroscopic swallowing examination. The swallowing function was evaluated over time. Oral transit duration, pharyngeal transit duration, laryngeal response duration, Modified Barium Swallowing Impairment Profile (MBSImP™ⓒ), and Functional Oral Intake Scale (FOIS) were applied. Chronic stroke patient group were showed significantly longer oral transit duration, pharyngeal transit duration and laryngeal response duration than normal control group at baseline. After 3 months in stroke patient group, the mean oral components score of MBSImP (1~5) significantly decreased and the mean score on FOIS increased compared to baseline. In conclusion, oral swallowing function and oral intake function improved by the 3 month evaluation. These results describe changes in swallowing function with chronic stroke patients over time and provide basic informations to understand dysphagia.

Relationships between Temporal Measurements and Swallowing Impairment in Unilateral Stroke Patients

임익재(Ikjae Im),고명환(Myoung-Hwan Ko) 한국언어청각임상학회 2020 Communication Sciences and Disorders Vol.25 No.4

배경 및 목적: 본 연구의 목적은 대뇌 편측 손상에 의한 뇌졸중 환자의 삼킴 시간과 삼킴 장애와의 연관 관계를 조사하는 것이었다. 또한, 손상 위치에 따라 삼킴 기능에서 차이가 있는지를 알아보기 위하여 대뇌 손상 위치와 삼킴 검사 결과 간의 연관 관계도 함께 조사하였다. 방법: 대상자는 대뇌의 편측만 손상된 뇌졸중 환자 56명이었다(평균 연령=64.73세, SD=13.45). 뇌졸중 환자는 모두 자기공명영상 검사와 비디오투시조영삼킴 검사(Videofluoroscopic swallowing study, VFSS)를 수행하였으며, 삼킴 평가에는 연한 농도의 액체 5 mL가 사용되었다. VFSS를 이용한 삼킴 기능 평가에는 수정된 바륨 삼킴 장애 프로파일(Modified Barium Swallowing Impairment Profile, MBSImP)과 삼킴 시간(구강통과시간, 인두통과시간, 후두폐쇄유발시간, 후두폐쇄지속시간)을 측정하였고, 연구 목적을 달성하기 위하여 두 변수 간 연관 관계를 조사하였다. 이때 삼킴 기능에 영향을 줄 수 있는 병변 위치, 연령 등을 고려하여 경로 분석을 실시하였고 각 변수들 간의 영향력에 대하여 분석하였다. 결과: 대뇌 편측 뇌졸중 환자는 연령이 증가할 수록 구강 삼킴 장애가 심해지고 후두폐쇄유발시간이 더 길어지는 것으로 조사되었다(p<.01). 후두폐쇄유발시간이 길어지면 구강 단계 삼킴 장애에도 영향을 주는 것으로 나타났다(p<.05). 또한 후두폐쇄유발시간이 길어지는 것과 후두폐쇄지속시간이 짧아지는 것은 서로 영향을 주는 것으로 조사되었고 이는 인두 삼킴 장애에도 영향을 주었다(p<.01). 우뇌 손상은 인두 삼킴 장애와 연관 관계가 있는 것으로 나타났다(p<.01). 논의 및 결론: 편측 손상 뇌졸중 환자의 삼킴 장애를 예측하기 하기 위한 지표로서 MBSImP와 삼킴 시간 간 연관 관계를 살펴보았고 두 삼킴 결과 간 밀접한 연관 관계가 있는 것을 확인하였다. Objectives: The primary aim of the present study was to investigate the relationships between temporal measurements and swallowing impairment. The secondary aim was to identify potential relationships among age, lesion side, clinical swallowing outcomes, fifty-six consecutive unilateral patients (mean age=64.73 years, SD=13.45, left damage=28 patients, right damage=28 patients) participated in this study. Methods: A videofluoroscopic swallowing study (VFSS) was performed using a single bolus of 5 mL of thin liquid. All patients completed both a magnetic resonance imaging study and VFSS. VFSS images were evaluated using the Modified Barium Swallowing Impairment Profile (MBSImP). Kinematic aspects of swallowing were characterized according to oral transit duration, pharyngeal transit duration, laryngeal response duration (LRD), and laryngeal closure duration (LCD). Path analyses were utilized to explore the relationships between age, lesion side, temporal measurements, and MBSImP score. Results: The results indicated that advanced age was associated with increased oral swallowing impairment and longer laryngeal response in unilateral stroke patients (p<.01). In addition, longer LRD was significantly associated with increased oral swallowing impairment (p<.05). Longer LRD and shorter LCD were significantly associated with increased pharyngeal swallowing impairment (p<.01). Right hemisphere damage was significantly associated with increased pharyngeal impairment (p<.01). Conclusion: The present study was the first to investigate the relationships between temporal measurements and MBSImP score, and the findings confirmed that swallowing outcomes via VFSS can provide physiologic evidence related to swallowing impairment in unilateral stroke patients. We discuss clinical markers to predict the risk of progression to swallowing impairments that may be useful as targets to effectively manage stroke patients with swallowing impairment.

경수 손상 환자의 삼킴 양상

한상형 ( Sang Hyoung Han ),서정환 ( Jeong Hwan Seo ),고명환 ( Myoung Hwan Ko ),박성희 ( Sung Hee Park ),송경진 ( Kyung Jin Song ) 전북대학교 의과학연구소 2008 全北醫大論文集 Vol.32 No.1

Objective: To evaluate the characteristics of dysphagia by using the videofluoroscopic swallowing study (VFSS) and the clinical dysphagia scale in patients with cervical spinal cord injury. Method: Twelve patients with cervical spinal cord injury and six normal adults were included in this study. Physical examination and clinical dysphagia scale were checked before VFSS. The parameters observed were penetration, aspiration, oral transit time (OTT), pharyngeal transit time (PTT), and pharyngeal delay time (PDT) during VFSS. Results: Five (41.7%) cervical spinal cord injury patients showed penetration or aspiration in VFSS. The duration of each phases in swallowing (OTT, PTT, PDT) was longer in cervical spinal cord injury patients than normal adults in VFSS (p<0.05). The score of clinical dysphagia scale was higher in patients with cervical spinal cord injury than normal adults. Tracheostomy and mechanical ventilation history seemed to be the predictor of dysphagia in cervical spinal cord injury patients. Conclusion: Swallowing abnormalities were very frequent (41.7%) in cervical spinal cord injury patients. We suggest that the risk of dysphagia should be evaluated for all of the cervical spinal cord injury patients to increase the quality of life via VFSS and clinical dysphagia scale.

자세균형 재활운동기기의 척추 중심근육에 미치는 영향 해석

한갑수(Kap-Soo Han),김경호(Kyungho Kim),고명환(Myoung-Hwan Ko) 대한전기학회 2015 대한전기학회 학술대회 논문집 Vol.2015 No.7

Relationship between Temporal Measurements of Pharyngeal Swallowing and Penetration-Aspiration in Unilateral Stroke Patients

임익재(Ikjae Im),김향희(HyangHee Kim),김현기(Hyun Gi Kim),고명환(Myoung Hwan Ko) 한국언어청각임상학회 2017 Communication Sciences and Disorders Vol.22 No.3

배경 및 목적: 본 연구는 아급성기 편측 반구 뇌졸중 환자의 삼킴 시간이 손상 위치에 따라 차이를 보이는지를 조사하고 침습 및 흡인에 영향을 준 삼킴 시간은 무엇인지를 규명하고자 하였다. 방법: 연구 대상자는 뇌자기공명영상을 통해 편측 반구 손상에 의한 뇌졸중 환자 60명이었으며, 좌반구 손상 환자 집단(27명)과 우반구 손상 환자 집단(33명)으로 분류되었다. 대상자들은 모두 비디오투시조영삼킴 검사를 수행하였으며 이 검사의 자료로부터 인두통과시간, 후두폐쇄유발시간, 후두폐쇄지속시간, 침습 및 흡인 여부를 조사하였다. 결과: 편측 손상 반구에 따라 인두 단계 삼킴 시간은 차이가 없었다. 한편, 우반구 손상 집단의 인두통과시간과 후두폐쇄유발시간은 침습 및 흡인에 통계적으로 유의한 영향을 주는 것으로 나타났다. 구체적으로, 음식물이 인두 단계를 0.71초 이내에 통과하지 않으면 침습 및 흡인이 발생하는 것으로 나타났으며(AUC=0.78; 95% CI, 0.58-0.96; p=.02)과 음식물이 인두 단계에 진입 후 후두 폐쇄 운동이 1.25초 이내에 일어나지 않으면 침습 및 흡인이 발생하는 것으로 나타났다(AUC=0.83; 95% CI, 0.64-1; p=.008). 논의 및 결론: 우반구 손상 환자의 인두통과시간과 후두폐쇄유발시간은 침습 및 흡인을 예측하는 변인이었으며, 이는 우반구가 인두 단계 삼킴 기능에 편향되어 있기 때문으로 해석된다. Objectives: Although few study have attempted to identify temporal measurements of swallowing in unilateral stroke patients, the relationship between temporal measurements and aspiration-related swallowing dysfunction remain unknown. The aim of this study was to investigate the relationship between temporal measurements of pharyngeal swallowing and aspiration in unilateral stroke patients. Methods: We conducted a prospective study of 60 patients undergoing both videofluoroscopic swallowing examinations and brain magnetic resonance imaging scan studies. Patients were divided into two groups: group 1 included subacute stroke patients with left cerebral hemispheric lesions (N=27) and group 2 included subacute stroke patients with right cerebral hemispheric lesions (N=33). The results of temporal measurements of swallowing, including pharyngeal transit duration (PTD), initiation laryngeal closure (ILC), and laryngeal closure duration (LCD) and penetration-aspiration, were analyzed during 5-mL thin liquids swallowing task. To determine the optimum cut-off value along with the presence of penetration-aspiration, receiver operating characteristic (ROC) curve analysis was performed. Results: The right cerebral hemispheric lesion group showed significant association with delayed PTD and ILC. The cut-off values for PTD and ILC were 0. 71 seconds (p=.02) and 1.25 seconds (p=.008), respectively. Conclusion: ILC is the most valid predictor for penetration-aspiration occurrence in stroke patients with right cerebral hemispheric lesions. Penetration-aspiration events on swallows are affected by delayed laryngeal closure and pharyngeal transit duration.

족저굴곡과 무릎 신전 토크를 이용한 보행 재활 훈련용 장하지 보조기 개발

김경(Kyung Kim),김재준(Jae-Jun Kim),허민(Min Heo),정구영(Gu-Young Jeong),고명환(Myoung-Hwan Ko),권대규(Tae-Kyu Kwon) 제어로봇시스템학회 2010 제어·로봇·시스템학회 논문지 Vol.16 No.10

The purpose of this study was to test the effectiveness of a prototype KAFO (Knee-Ankle-Foot Orthosis) powered by two artificial pneumatic muscles during walking. We had previously built powered AFO (Ankle-Foot Orthosis) and KO (Knee Orthosis) and used it effectively in studies on assistance of plantaflexion and knee extension motion. Extending the previous study to a KAFO presented additional challenges related to the assistance of gait motion for rehabilitation training. Five healthy males were performed gait motion on treadmill wearing KAFO equipped with artificial pneumatic muscles to power ankle plantaflexion and knee extension. Subjects walked on treadmill at 1.5 km/h under four conditions without extensive practice: 1) without wearing KAFO, 2) wearing KAFO with artificial muscles turned off, 3) wearing KAFO powered only in plantaflexion under feedforward control, and 4) wearing KAFO powered both in plantaflexion and knee extension under feedforward control. We collected surface electromyography, foot pressure and kinematics of ankle and knee joint. The experimental result showed that a muscular strength of wearing KAFO powered plnatarfexion and knee extension under feedforward control was measured to be lower due to pneumatic assistance and foot pressure of wearing KAFO powered plnatarfexion and knee extension under feedforward control was measured to be greater due to power assistance. In the result of motion analysis, the ankle angle of powered KAFO in terminal stance phase was found a peak value toward plantaflexion and there were difference of maximum knee flexion range among condition 2, 3 and 4 in mid-swing phase. The current orthosis design provided plantaflexion torque of ankle jonit in terminal stance phase and knee extension torque of knee joint in mid-swing phase.

뇌졸중 환자에서 아포지단백 E의 유전자형에 따른 인지기능의 예후

김성균 ( Seong Kyun Kim ),정현 ( Hyun Jung ),박성희 ( Sung Hee Park ),서정환 ( Jeong Hwan Seo ),고명환 ( Myoung Hwan Ko ) 전북대학교 의과학연구소 2008 全北醫大論文集 Vol.32 No.1

Back ground: To determine allele frequencies of apolipoprotein (Apo) E according to the type of stroke in Korea and to investigate the relationship between the Apo E genotype and prognosis of cognitive function after stroke. Method: Forty-four stroke patients admitted between January and September, 2006 were enrolled. Apo E genotypes were determined by polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis (PAGE). The outcome of cognitive function in stroke patients was measured by Mini-Mental State Examination (MMSE), Computerized Neuropsychological Test (CNT) and Seoul Verbal Learning Test (SVLT). Results: The most frequent Apo E genotype was E3/3 (71%), followed by E3/4 (16%), E2/3 (9%), E2/2 (2%) and E2/4 (2%). The delayed recall scores in SVLT were lower in the stroke patients who have 4 allele in comparison with the patients without that allele(p<0.01). Conclusion: Most frequent Apo E genotype was E3/3. 4 allele was correlated with worse prognosis of cognitive function in stroke patients in this study, especially delayed recall memory.

언어치료 솔루션의 재가치료 활용을 위한 사용적합성평가 및 만족도 조사 연구

조윤주(Yun-Ju Jo),김혜성(Hye-Seong Kim),강승록(Seung-Rok Kang),김기욱,고명환(Myoung-Hwan Ko) 대한기계학회 2022 대한기계학회 춘추학술대회 Vol.2022 No.11

The purpose of this study is to investigate a usability assessment to evaluate the safety and satisfaction of ‘Smart speech’, a speech therapy solution program so that speech therapy can be easily performed at home. Smart speech program consists of software, laptop and microphone, and includes 59 training games for oral exercise, breathing training and voice training. We evaluated whether the events occurring in the process of using the product were properly performed when the product manual was provided to 5 ordinary people without experience in speech rehabilitation and allowed to use easily. In addition, we investigated the survey of safety and satisfaction in the product. As a result of the experiment, it showed a 100% success rate in 23 tasks with 3 scenarios. In addition, in the satisfaction survey result, we found that more than 80% of the 15 items were satisfied with the convenience of use, treatment utilization, and overall satisfaction with the program. In the future, we thought that a speech therapy programs could be used as basic data to develop speech therapy medical devices for the speech-impaired using the results.

족저굴곡과 무릎 신전 토크를 이용한 보행 재활 훈련용 장하지 보조기 개발

김경(Kyung Kim),이정원(Jeong-Won Yi),신선혜(Sun-Hye Shin),허민(Min Heo),고명환(Myoung-Hwan Ko),권대규(Tae-Kyu Kwon) 대한기계학회 2011 대한기계학회 춘추학술대회 Vol.2011 No.10