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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.
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.
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.
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.