외상성 뇌손상 환자에서 발생한 Striatal Hand-증례보고-

도현경,김동건,정규영,김현동 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.3

Striatal hand is characterized by flexion in metacarpopharyngeal (MCP) joints and hyperextension in proximal interphalangial (PIP) joints and flexion in distal interphalangeal (DIP) joint. In clinical practice, this problem is often overlooked or misdiagnosed as rheumatoid arthritis and the opportunity for an early diagnosis and a correct management of the patient's is missed. In this report, a case with striatal hand following traumatic brain injury (TBI) without cardinal Parkinsonian signs is presented, and the differential diagnosis of the disease is discussed. A-62-year-old man presented with hemiplegia subsequent to traumatic brain injury. During the last two years, “swan neck” deformity of the hands occurred. We could diagnose this case as striatial hand with exclusion of similar rheumatologic causes by careful study and its characteristic deformity pattern. Clinician should consider the possibility of striatal hand when the patient with TBI presents swan neck deformity for an early diagnosis and a correct management.

뇌손상 환자에서의 보호자 우울에 대한 인지행동학적 특성의 영향

도현경,한나미,정규영,김현동,공보금,황지선,조윤정,이동석 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.1

Objective: To evaluate the relationship between depression and cognitive-behavioral characteristics of caregivers using social problem solving inventory (SPSI), social support or conflict scale (SSS or SCS) and somatic symptoms (SS). Method: Fifty five couples of brain-injured patients and caregivers participated in this study. We conducted a questionnaire survey of caregivers with Beck depression index (BDI), SPSI, SSS, SCS and SS for cognitive-behavioral characteristics. And also we studied demographic factors of patients and caregivers, clinical features of brain-injured patients, care- giving duration and time per day through interview and review of medical records. The statistical analyses were performed by independent t-test, one-way ANOVA, Pearson correlation test and linear regression analysis-stepwise method. Results: BDI of the caregivers showed a negative correlation with SPSI, SSS, patients’ MMSE and caregivers’ education level, also a positive correlation with SCS, SS and patients’ GDS (p<0.05). And married caregivers showed more depressive mood (p<0.05). Of these factors, the most influencing factors on BDI were GDS and SCS through linear regression analysis (p<0.01). Conclusion: MMSE, GDS and education level as cognitive- mental factors rather than physical and economic strain had a statistical correlation with depression of caregivers. Especially, SPSI, SSS and SCS as cognitive-behavioral characteristics should be considered on evaluation of depression of caregivers and will be helpful for successful rehabilitation for patients and caregivers. Objective: To evaluate the relationship between depression and cognitive-behavioral characteristics of caregivers using social problem solving inventory (SPSI), social support or conflict scale (SSS or SCS) and somatic symptoms (SS). Method: Fifty five couples of brain-injured patients and caregivers participated in this study. We conducted a questionnaire survey of caregivers with Beck depression index (BDI), SPSI, SSS, SCS and SS for cognitive-behavioral characteristics. And also we studied demographic factors of patients and caregivers, clinical features of brain-injured patients, care- giving duration and time per day through interview and review of medical records. The statistical analyses were performed by independent t-test, one-way ANOVA, Pearson correlation test and linear regression analysis-stepwise method. Results: BDI of the caregivers showed a negative correlation with SPSI, SSS, patients’ MMSE and caregivers’ education level, also a positive correlation with SCS, SS and patients’ GDS (p<0.05). And married caregivers showed more depressive mood (p<0.05). Of these factors, the most influencing factors on BDI were GDS and SCS through linear regression analysis (p<0.01). Conclusion: MMSE, GDS and education level as cognitive- mental factors rather than physical and economic strain had a statistical correlation with depression of caregivers. Especially, SPSI, SSS and SCS as cognitive-behavioral characteristics should be considered on evaluation of depression of caregivers and will be helpful for successful rehabilitation for patients and caregivers.

초고령 노인의 신체기능장애와 재활 전략

도현경,임재영 대한노인병학회 2015 Annals of geriatric medicine and research Vol.19 No.2

In recent, oldest-old adults over 85 years are increasing rapidly. Major geriatric problems such as frailty, fall, osteoporosis, sarcopenia, gait disturbance in this population are higher prevalent and more severe than those in older adults under 85 years. Therefore, strategy to evaluate and manage them with combined medical problems and related impairments should be considered to prepare for super aged society in the near future. We introduced comprehensive geriatric physical performance battery to examine a variety of physical function in multidomains, which can be applied to prescribe exercise, nutrition and medications as single or combined therapy specific to the level of physical function. It would be desirable that modality-specific exercise intervention to prevent from functional decline of oldest-old adults will be integrated with clinical setting. Eccentric biased strengthening exercise is highlighted as an appropriate exercise intervention for sarcopenic oldest-old because of low energy expenditure and utilization of the aged muscle stiffness. Furthermore, specially designed exercise machines enabling them to do exercise are developed for severe deconditioned patients that can’t participate in the conventional strengthening exercise. Oldest-old adults are expected to become a major patient group in geriatric medicine sooner or later. Basic principles of management for oldest-old adults are not different from geriatric management of frailty and sarcopenia in general old population. Along with the assessment of the multidomain of physical parameters, multidimensional modality-specific interventions should be developed based on each individual physical profiles.

정상인과 편마비 환자에서 요측수근굴근 H반사

정규영,도현경,황지선,김현동 대한근전도전기진단의학회 2008 대한근전도 전기진단의학회지 Vol.10 No.1

Objective: This study is designed to examine the difference in flexor carpi radialis (FCR) H-reflex between hemiplegic patients and normal subjects, and to investigate the relation-ship between parameters of FCR H-reflex and upper limb spasticity. Methods: H-reflex of FCR was performed to 47 normal person and 20 hemiplegic patients. Parameters used were onset latency, amplitude and Hmax/Mmax ratio. Effect by factors like age, sex, arm length and relationship between Modified Ashworth scale (MAS) and parameters of H-reflex in spasticity of hemiplegic patients was analyzed by SPSS 10.0 Result: In normal subjects, amplitude correlated inversely with age (p<0.01), arm length correlated directly with onset latency (p<0.01). Amplitude and Hmax/Mmax ratio were increased significantly in hemiplegic patients than normal person (p<0.01), correlated directly with MAS at the wrist (p<0.01) . Conclusion: FCR H-reflex in normal subjects was influenced by arm length and age. Amplitude and Hmax/Mmax ratio among parameters were significantly different in both groups and was significantly correlated with upper limb spasticity. From these findings, FCR H-reflex is considered to be useful adjunctive study for evaluation of upper limb spasticity in hemiplegic patients.

편마비 환자의 정상측과 마비측의 비복근 운동점에서의 근육 두께 차이

김동건,도현경,김현동,황지선,정규영,정호중 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.1

Objective : To investigate any difference of muscle thickness in the motor points of the gastrocnemius between the paretic and non-paretic legs in hemiplegics. Method : Ultrasonography was used to assess in vivo the gastrocnemius muscle thickness at the motor points in the paretic and non-paretic legs of twenty-four patients with stroke. Results : Muscle thickness at the motor points were reduced in the paretic legs compared to the non-paretic legs (p<0.05). There was no correlation between muscle thickness and duration of hemiplegia, site of hemiplegia. However, it did not take regular pattern of the muscular atrophy in the paretic legs. Conclusion : The gastrocnemius muscle of the paretic leg had smaller thickness compared with the non-paretic leg. The present results indicate that paresis in hemiplegics may affect the accuracy of intramuscular injection of botulinum toxin A. Therefore, we recommend ultrasonography for visually controlled, anatomically precise injection of botulinum toxins.

정상 성인에서 족욕 전후의 자율신경 기능의 변화

김현동,엄미자,도현경 대한재활의학회 2010 Annals of Rehabilitation Medicine Vol.34 No.1

Objective: To monitor the changes of autonomic nervous function before and after foot bathing through autonomic function tests using electrophysiological instrument. Method: Twenty five healthy adults took a foot bathing through popular ‘foot bath’ for 30 minutes at 43oC. Autonomic tests were performed three times before foot bathing, immediately and 15 minutes after foot bathing. Sympathetic skin response (SSR) and blood pressure after sustained grip for sympathetic tone, heart rate variation during deep breathing and Valsalva maneuver for parasympathetic tone (Expiratory/Inspiratory (E/I) ratio, Valsalva ratio) were measured. Results: SSR amplitudes in one hand decreased significantly during foot bathing (p<0.05) and did not return to their initial levels within 15 minutes after foot bathing. But, blood pressure after sustained grip, E/I ratio and Valsalva ratio did not show statistical difference (p>0.05). Conclusion: Heat therapy through foot bathing in normal adults reduced sudomotor response to electrical stimuli, which can be considered as reduction of specific sympathetic nervous function. We propose that foot bathing could be promising one of partial heat therapies for pain without cardiovascular complications unlike conventional whole body bathing. (J Korean Acad Rehab Med 2010; 34: 74-78)Key Words:

Primo Vascular System of Murine Melanoma and Heterogeneity of Tissue Oxygenation of the Melanoma

홍민영,박사라,도현경,전길자,서민아,이영미 사단법인약침학회 2011 Journal of Acupuncture & Meridian Studies Vol.4 No.3

Murine melanoma requires the complex development of lymphatic, vascular, and nonvascular structures. A possible relationship between the primo vascular system (PVS) and the melanoma metastasis has been proposed. In particular, the PVS may be involved in oxygen transport. Vasculogenic-like networks, similar to the PVS, have been found within melanoma tumors, but their functional relationship with the PVS and meridian structures are unclear. Herein, we report on the use of an electrochemical O2 sensor to study oxygenation levels of melanoma tumors in mice.We consistently found higher tissue oxygenation in specific sites of tumors (nZ5). These sites were strongly associated with vascular structures or the PVS. Furthermore, the PVS on the tumor surface was associated with adipose tissue. Our findings suggest that the PVS is involved in the regulation of metastasis.