경중족 절단 환자의 의족지 착용에 따른 족저압력 분포 특성

성우성,양희승,성홍기,김학준,Seong, Woo-Sung,Yang, Hee-Seung,Sung, Hong-Kee,Kim, Hak-Jun 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.1

Purpose: This study was designed to evaluate characteristics of foot pressure distribution with or without partial prosthetic foot in transmetatarsal amputee. Materials and Methods: The subjects were 9 transmetatarsal amputees. Foot pressures were measured at hallux, the $1^{st}-5^{th}$ metatarsal head (MTH), mid-foot, condyle area by F-scan system in amputated or contralateral foot during active walking. Results: In amputated foot, mean peak pressure was greatest in midfoot without prosthetic foot but it was greatest in hindfoot with prosthetic foot. In unaffected foot, although mean peak pressure was higher in hallux, and $1-5^{th}$ MTH compared to amputated foot, it was greatest in hind foot both with and without prosthetic foot. However, in unaffected foot, mean peak pressure significantly decreased in hallux and $5^{th}$ MTH after wearing the prosthetic foot. There was a significant difference in mean peak pressure in hallux and $5^{th}$ MTH between amputated and unaffected foot after wearing prosthetic foot. However, other region had no significant difference with or without prosthetic foot between feet. Conclusions: The use of partial prosthetic foot tends to shift weight bearing from the heel area to forefoot and could significantly reduce hind foot peak pressure and redistributed to peak pressure. The partial prosthetic foot can also offer the peak pressure to reduction both amputated foot and unaffected foot and help to toe off during walking.

마이크로 제어방식과 비마이크로 제어방식 무릎관절장치 사용 넓적다리 절단자의 트레드밀 경사로 오르막 내리막 보행시 특성

성우성(Woo-Sung Seong),정동훈(Dong-Hoon Jeong) 한국디지털콘텐츠학회 2023 한국디지털콘텐츠학회논문지 Vol.24 No.12

This study examined the gait characteristics of four individuals with transfemoral amputations after wearing micro/non-microprocessor knees. Accordingly, time, distance, and kinematic variables were measured while the participants walked uphill and downhill on a treadmill set at ±7°. To determine statistical significance, a single-group pre/post test and Wilcoxon test were conducted, with a significance level set at α=0.1. The results showed that time/distance and kinematic variables did not exhibit statistical significance. However, the kinetic moment value for flexion of the microprocessor knee significantly decreased on both the amputated and normal sides, and stability increased while walking downhill. It was predicted that the microprocessor would be superior to the non-microprocessor in the stance and swing phases. There was no statistically difference in the gait analysis results.

절단장애인의 의지사용을 위한 한국어 의지평가 설문지 KPEQ(Korean-Prosthesis Evaluation Questionnaire)의 개발 및 타당성 검증

성우성 ( Seong Woo-sung ),김장환 ( Kim Jang-hwan ),정동훈 ( Jeong Dong-hun ) 대구대학교 특수교육재활과학연구소 2017 특수교육재활과학연구 Vol.56 No.2

본 연구에서는 국내 절단장애인의 의지사용과 관련된 삶의 질, 기능적 가동성, 만족도 등의 객관적인 연구를 위하여, 한국어 의지평가 설문지(Korean Prosthesis Evaluation Questionnaire, KPEQ)를 개발하고 그 타당도를 검증하고자 하였다. 이를 위해 6명으로 위원회를 구성하여 영문 PEQ(Prosthesis Evaluation Questionnaire)를 번역-역번역 과정을 통해 한국어 PEQ를 완성하였다. 4명의 관련분야에 종사하고 있는 전문가와 7명의 실무자를 상대로 2회의 설문조사를 통해 설문지의 각 항목과 문항에 대한 검토 및 평가를 실시하였다. 이와 함께 각 문항에 대하여 내용타당도(Content validity)를 검증하고 80% 이상인 문항은 해당 문항을 타당한 것으로 판단하였다. 연구결과, 설문조사 한국어 PEQ의 8개 영역에 대한 평균 내용타당도는 1차 0.80~0.90으로 나타났고, 2차 0.90~0.95로 나타났다. 전문가집단에서 1차 평균 0.87에서 2차 0.90으로 증가하여 90% 합의율을 나타냈고, 실무자 집단에서도 1차 평균 0.87에서 2차 0.93으로 93%의 합의율을 보였다. 2회에 걸친 문항별 내용타당도는 평균 0.80 이상의 합의율을 보였으며, 델파이 설문조사 결과 전문가와 실무자의견을 토대로 각 문항을 수정, 보완하여 최종 KPEQ를 완성하였다. 향후, 개발된 KPEQ를 절단장애인에게 적용하여 급간내상관계수(Intraclass correlation coefficient), 내적일치도(Cronbach`s α), 그리고 Bland-Altman Plots를 조사하는 연구가 필요하다. 이를 통해 국내의 많은 임상전문가들에게 객관적인 의지평가 설문지로 KPEQ가 임상에 적용되어 절단장애인들의 재활에 도움이 될 것으로 기대한다. For an objective research on the quality of life, functional mobility, and satisfaction related to Korean amputees` use of prosthesis this study aimed to develop KPEQ (Korean Prosthesis Evaluation Questionnaire) and to verify the validity. To accomplish our goal, we formed a committee of 6 experts in Prosthetics and completed KPEQ through an English forward-backward translation process. We conducted two separate questionnaires on four experts and seven practitioners in related fields to review and evaluate each item and questions. Therefore, the Content validity was verified for each item and the items that were more than 80% were judged valid. The results showed the mean content validity of the KPEQ was 0.80 ~ 0.90 in the first and 0.90 ~ 0.95 in the second. Expert group, the agreement rate increased from 0.87 to 0.90, indicating a 90%. In Practitioner group, the agreement rate was 93% from 0.87 to 0.93. The content validity of each question was 0.80 or more on average and The Delphi survey resulted that the final KPEQ was completed by revising and supplementing each question based on the opinions of experts and practitioners. In the future, the KPEQ will be applied to the amputees and the intraclass correlation coefficient (ICC), internal consistency (Cronbach`s α), and Bland- Altman Plots will be measured. KPEQ will be applied to many clinicians in Korea as an objective assessment questionnaire. It is expected that it will help rehabilitation of amputees.

다리 절단장애인의 엉덩관절 굽힘 구축각도를 반영한 의지 소켓 정렬 후 보행분석

성우성 ( Seong Woo-sung ),김장환 ( Kim Jang-hwan ),정동훈 ( Jeong Dong-hoon ) 대구대학교 특수교육재활과학연구소 2021 특수교육재활과학연구 Vol.60 No.1

본 연구는 엉덩관절 굽힘 구축이 있는 다리 절단장애인 8명을 대상으로 엉덩관절 굽힘 구축을 반영한 소켓의 정렬기준을 확인하기 위하여 현재 소켓 굽힘 정렬 각도를 측정하여 기준으로 하였고, 토머스 검사를 통해 측정한 엉덩관절 굽힘 구축 각도에 5° 를 더하여 소켓 기울기 정렬을 수정한 후 3차원 동작분석기를 통해 보행의 변화를 비교 하였다. 단일집단 사전·사후 검사설계를 이용 하였고, 엉덩관절 굽힘 구축 정렬적용 전과 후에 따른 보행주기 동안의 시·공간적, 운동 형상학적, 그리고 운동역학적변수는 대응표본 t-검정을 이용하여 차이를 알아보았다. 본 연구 결과 엉덩관절 굽힘 구축을 반영한 소켓 정렬이 보행의 시간-거리 변수와 무릎 안정성을 위한 운동형상학적 변수에서 개선되었음을 보여주었다. 본 연구를 통해 의지 제작과정 동안 정렬의 중요성을 확인하였으며, 특히 엉덩관절이 굽힘 구축된 넙다리 절단장애인의 소켓 기울기 정렬 기준을 확인하는데 기초자료를 제공한다. 이를 통해 넙다리 절단장애인이 보다 안전한 의지 착용에 도움이 될 것으로 판단되며 향후 수평이동 정렬과 무릎관절장치의 종류에 따른 정렬 변화에 대하여 추가적인 연구가 필요하다고 사료된다. In this study, the current socket flexion alignment angle was measured and used as a reference to confirm the socket alignment criteria reflecting of 8 trans-femoral amputees with hip flexion contractures, and the hip flexion contracture measured through the Thomas test and correcting the socket inclination alignment by adding 5° to the socket angle, gait was compared through a 3D motion analyzer. As a result, the socket alignment reflecting hip joint flexion contracture improved the time-distance variable of walking and the kinematic variable for knee stability, confirming the importance of alignment, and in particular as judged that it will be provided as basic data for confirming the socket tilt alignment criteria. Through this, it is thought that it will be helpful for the trans-femoral amputee’s prosthetic fitting.

대퇴의지의 4가지 조건별 소켓각도 정렬에 따른 보행특성

성우성 ( Seong Woo-sung ),김장환 ( Kim Jang-hwan ),정동훈 ( Jeong Dong-hun ) 대구대학교 특수교육재활과학연구소 2019 특수교육재활과학연구 Vol.58 No.2

본 연구는 대퇴절단장애인 11명을 대상으로 대퇴의지의 소켓각도 정렬에 따른 보행 특성을 위해 연구대상자가 착용중인 대퇴의지 소켓의 각도를 4가지 조건(중립 0°, 5° 굴곡, 5° 내전, 5° 굴곡 및 5° 내전)으로 구분하여 실험하였다. 이중 대퇴의지의 벤치 정렬 기준으로 알려진 조건 4(5° 굴곡 및 5° 내전) 정렬이 다른 정렬보다 효과적인지 증명하기 위하여 3차원 동작분석기를 통해 보행 특성을 분석하였다. 연구결과는 다음과 같다. 첫째, 조건 4의 소켓각도 정렬은 다른 정렬과 보행의 시간-거리 변수(분속수, 보행 속도, 활보장, 건측 보장)에서 유의한 차이가 있었다. 둘째, 조건 4의 소켓각도 정렬은 다른 정렬과 보행의 운동형상학적 변수(골반사위, 고관절굴곡 및 신전)에서 유의한 차이가 있었다. 따라서 선행연구에서 제시된 것처럼 대퇴의지의 소켓각도는 5° 굴곡 및 5° 내전했을 때 보행분석학적으로 효과적인 것으로 나타났다. This study examined the gait characteristics of 11 trans-femoral amputees in accordance with socket angle alignment. The study conducted experiments, dividing socket angles of worn trans-femoral prostheses into four conditions(neutral 0°, 5° flexion, 5° adduction, 5° flexion & 5° adduction). In order to prove whether the alignment known as the bench alignment of trans-femoral prostheses - condition 4: 5° flexion & 5° adduction - were more effective than other alignments, the study analyzed gait characteristics using a three-dimensional motion analysis system. The results were as below. First, socket angle alignment of condition 4 had a significant difference with other alignments in terms of spatio-temporal parameters of gait (cadence, walking speed, stride length, walking of the normal side). Second, socket angle alignment of condition 4 had a significant difference with other alignments in terms of kinematic parameters gait(flexion of hip joint and extension). by the precedent research, when and if socket angle of the trans-femoral prosthesis were 5° flexion & 5° adduction, it showed the effectiveness and high satisfaction of users from the perspective of gait analysis.

절단장애인을 위한 한국어 의지평가 설문지의 신뢰도

성우성(Woo-Sung Seong),김장환(Jang-Hwan Kim),정동훈(Dong-Hun Jeong) 한국디지털콘텐츠학회 2018 한국디지털콘텐츠학회논문지 Vol.19 No.7

Korean-PEQ (prosthesis evaluation questionnaire) was developed and verified its validity research but, evaluating its reliability applied to the lower extremity amputees have not been conducted. The aim of this study was to apply the Korean-PEQ for lower extremity amputees to evaluate the reliability. As a result, all of the items responding of Korean-PEQ shown to less than 15% ceiling effect and floor effect. therefore, the results were shown to be appropriate. Korean-PEQ reliability of each region of intra-class coefficient was shown to .719(95% CI .600~.811)~920(95%CI .890~.945) and the inter-region reliability was higher as 0.958. Item internal consistency Cronbachs α values are shown as higher .910.

편측 종아리 절단장애인에서 두 가지 소켓에 따른 사용만족도와 보행특성 비교: 단일사례연구

김장환,성우성,안동영,심우섭 대구대학교 특수교육재활과학연구소 2015 특수교육재활과학연구 Vol.54 No.2

본 연구는 연즉 종아리 절단장애인을 대상으로 KBM(Kondylen-Bettung Munster) 및 TSB(Total Surface Bearing) 소켓이 각각 적용된 의지 착용이 사용만족도와 보행 특성에 미치는 영향을 알아보고자 하였다. 연구 대상자는 K-4 활동 수준으로 스포츠 활동에 적극적으로 참여하는 현측 종아리 절단장애인 1명을 선정하였다. 의지 사용만족도 설문지 (PEQ,prosthetic evaluation questionnaire)를 사용하여 만족도를 조사하였고,2분 보행검사 (2minute walk test)와 영상분석 프로그램을 통해 보행 능력 (capacity) 과 보장 (step length)을 비교하였다. 실험은 단일대상연구 중 A-B-A-B 디자인을 적용하였다. KBM 의지에 비하여 TSB 종아리 의지를 착용하였을 때,PEQ 설문 점수가 증가하였고,2분 보행검사 결과가 개선되었으며,건축과 절단측의 보장 차이가 강소하였다 본 연구를 통해 TSB 종아리의지가 소켓의 편안함과 현가기능 및 보행 능력을 향상시키고,같은 시간 동안 보다 멀리 걸을 수 있어 운동 능력이 개선되었으며,보행 동안 양측 다리의 보장이 더욱 대칭적으로 나타났다. 이러한 결과에 따라 종아리 절단장애인의 보행 편위 (gait deviation)를 감소시킬 수 있고 일상 생활 및 운동 활동에 보다 효율적일 수 있다는 임상적 사례를 제시한다. The purpose of this study was to investigate the differences of a prosthetic satisfaction and gait characteristics between KBM and TSB socket of prosthesis in unilateral transtibial amputee‘ An active (K-4 level) subject has participated in this study. A subjective completed the prosthesis evaluation questionnaire(PEQ) with embedded satisfaction-related questions, and underwent two minute walk test and quantitative two-dimensional motion analysis to compare the walking capacity and step length. This study is a single subject design (A - B-A-B). As a result, compared with a KBM socket, a TSB socket showed that composite scores for the PEQ and two minute walk test were increased, while a distance of step length between both legs was reduced. Through the result of this study, a comfort,suspension function and walking capacity were improved, and also steps were more symmetric during gait, when TSB socket was worn. It suggest that gait deviations were decreased when the prosthesis with TSB socket was adopted, so transtibial amputees were able to adapt their daily living and sporting activities effectively.

편측 종아리 절단장애인에서 두 가지 소켓에 따른 사용만족도와 보행특성 비교: 단일사례연구

심우섭,김장환,성우성,안동영 대구대학교 특수교육재활과학연구소 2015 특수교육재활과학연구 Vol.54 No.2

본 연구는 편측 종아리 절단장애인을 대상으로 KBM(Kondylen-Bettung Munster) 및 TSB(Total Surface Bearing) 소켓이 각각 적용된 의지 착용이 사용만족도와 보행 특성에 미치는 영향을 알아보고자 하였다. 연구 대상자는 K-4 활동 수준으로 스포츠 활동에 적극적으로 참여하는 편측 종아리 절단장애인 1명을 선정하였다. 의지 사용만족도 설문지(PEQ, prosthetic evaluation questionnaire)를 사용하여 만족도를 조사하였고, 2분 보행검사(2 minute walk test)와 영상분석 프로그램을 통해 보행 능력(capacity)과 보장(step length)을 비교하였다. 실험은 단일대상연구 중 A-B-A-B 디자인을 적용하였다. KBM 의지에 비하여 TSB 종아리 의지를 착용하였을 때, PEQ 설문 점수가 증가하였고, 2분 보행검사 결과가 개선되었으며, 건측과 절단측의 보장 차이가 감소하였다. 본 연구를 통해 TSB 종아리의지가 소켓의 편안함과 현가기능 및 보행 능력을 향상시키고, 같은 시간 동안 보다 멀리 걸을 수 있어 운동 능력이 개선되었으며, 보행 동안 양측 다리의 보장이 더욱 대칭적으로 나타났다. 이러한 결과에 따라 종아리 절단장애인의 보행 편위(gait deviation)를 감소시킬 수 있고 일상생활 및 운동 활동에 보다 효율적일 수 있다는 임상적 사례를 제시한다.

레저용 하퇴(Trans-Tibial)의지 제작과 적용

김경숙,안동영,성우성 한국스포츠리서치 2004 한국 스포츠 리서치 Vol.15 No.6

The propose of application and fabrication of trans-tibial prostheses for leisure or waterproof is to fabricate the prostheses which the trans-tibial amputees will be erected in water sports, therefore it can offer the basic data on the improvement of Fabrication of trans-tibial prostheses for leisure or waterproof. Two trans-tibial amputees participated in this case study. One fitted the endoskeletal, the other fitted the exoskeletal prosthesis which was fabricated for this case study. Evaluation for this test was done in a public bath and swimming pool. The Conclusion was as follow: The prostheses for leisure or waterproof were appropriate for shower, sauna and standing, slight movement, But the problem of ankle joint movement to get propulsion and buoyancy might be needed to modify active movement such as swimming. Also, amputees might try to adapt to these prostheses.

Effect of a target-controlled infusion of remifentanil in combination with desflurane during the "maintenance" phase of general anesthesia

신명근,심행선,성우성,양근영 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.1

Background: The goal of this study was to determine the optimal target-controlled concentration of remifentanil combined with desflurane, by using a more widely and decreasing end-tidal concentration of desflurane. Methods: Ninety ASA I patients, who underwent general anesthesia for elective orthopedic or extremity surgeries,were registered and randomly allocated to receive either a target-controlled concentration of 1 ng/ml (group R1), 2ng/ml (group R2) remifentanil, or desflurane only without remifentanil infusion (group D). Mean arterial pressure (MAP) and heart rate (HR) were recorded at 5-min intervals from after a 10-15 min period of surgical incision to before a 10-min period prior to the end of an operation. End-tidal concentration of desflurane was increased or decreased in proportion to the changes in MAP and HR. If the value of bispectral index (BIS) was from 60-62 for more than 2 min or systolic blood pressure would fall below 90 mmHg, the patient was excluded from the study to prevent a risk of "explicit awareness" and shock. Results: The end-tidal desflurane concentration was lower in the group receiving 1 ng/ml (5.2 ± 0.5 vol%; P <0.001) and 2 ng/ml remifenanil (4.4 ± 0.5 vol%; P < 0.001) compared to patients in group D (7.9 ± 0.5 vol%). Conclusions: We recommend the use of 2 ng/ml or less remifentanil combined with desflurane for decreasing concentrations of desflurane without significant side effects, during the "maintenance" phase, and not during the induction phase of general anesthesia. Background: The goal of this study was to determine the optimal target-controlled concentration of remifentanil combined with desflurane, by using a more widely and decreasing end-tidal concentration of desflurane. Methods: Ninety ASA I patients, who underwent general anesthesia for elective orthopedic or extremity surgeries,were registered and randomly allocated to receive either a target-controlled concentration of 1 ng/ml (group R1), 2ng/ml (group R2) remifentanil, or desflurane only without remifentanil infusion (group D). Mean arterial pressure (MAP) and heart rate (HR) were recorded at 5-min intervals from after a 10-15 min period of surgical incision to before a 10-min period prior to the end of an operation. End-tidal concentration of desflurane was increased or decreased in proportion to the changes in MAP and HR. If the value of bispectral index (BIS) was from 60-62 for more than 2 min or systolic blood pressure would fall below 90 mmHg, the patient was excluded from the study to prevent a risk of "explicit awareness" and shock. Results: The end-tidal desflurane concentration was lower in the group receiving 1 ng/ml (5.2 ± 0.5 vol%; P <0.001) and 2 ng/ml remifenanil (4.4 ± 0.5 vol%; P < 0.001) compared to patients in group D (7.9 ± 0.5 vol%). Conclusions: We recommend the use of 2 ng/ml or less remifentanil combined with desflurane for decreasing concentrations of desflurane without significant side effects, during the "maintenance" phase, and not during the induction phase of general anesthesia.