국내 급성기 재활의료 공급체계

유승돈,정용설,김태우 대한의사협회 2017 대한의사협회지 Vol.60 No.11

Acute-phase rehabilitation hospitals focus on managing disabilities, reducing sequelae and symptoms, and enhancing social reintegration, to provide patients with the highest possible independence and the best quality of life. In order to achieve these goals, it is necessary to ensure the appropriate length of hospital stays based on a consideration of disease severity and patients’ potential for rehabilitation, as well as to provide multidisciplinary rehabilitation. Multidisciplinary rehabilitation has been shown to be effective in the management of complex or severe conditions. Hospitals should include rehabilitation centers (specialized rehabilitation units) for patients with complex or severe needs. Starting in acute settings, specialized rehabilitation wards provide intensive, highly specialized interventions to restore function to patients with complex rehabilitation needs. Financial resources should be allocated to rehabilitation services to implement recommendations for the delivery of medical services In Korea, the appropriate allocation of resources for rehabilitation could increase both the availability and the quality of rehabilitation services by facilitating the establishment of specialized rehabilitation units in acute settings.

출혈열콩팥증후군 후 발생한 생식샘저하증과 요추압박골절 1예 − 증례 보고 −

유승돈,김동환,유병선,최성혜,허기은 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.5

Male osteoporosis is known to progress slowly and is less severe compared to female osteoporosis, and the incidence of lumbar compression fracture is considerably lower in male population. Hypogonadism which can develop from various causes including hypopituitarism is a common cause for secondary male osteoporosis. Hypopituitarism as a late complication of severe form of hemorrhagic fever with renal syndrome (HFRS) is known to occur occasionally but its clinical symptoms rarely appear. A 75-year-old male patient who had recovered from HFRS 13 years ago was admitted due to severe low back pain. He presented with gradually developed symptoms of hypogonadism and hypothyroidism resulting from hypopituitarism. MRI revealed collapsed pituitary gland and empty sella. This case presents with a male patient with multiple lumbar compression fractures due to severe osteoporosis secondary to hypogonadism, which resulted from hypopituitarism as a late complication of HFRS.

VATER 연관질환군 환자에 동반된 지방척수수막류와 척수 종양 1례-증례보고-

유승돈,이윤정,이종인,유황재,박노혁 대한재활의학회 2005 Annals of Rehabilitation Medicine Vol.29 No.3

VATER association represents vertebral defects, anal atresia, tracheo-esophageal fistula with esophageal atresia, renal abnormalities and radial limb dysplasia. The probability of the simultaneous occurrence of any three of these defects is so unlikely that it suggests a sporadic non-random association. This non-random association appears to be related to mesodermal defects in early developmental period. Weexperienced one case of VATER association in 21 months old male child having vertebral anomalies with severe scoliosis, rib defects, imperforated anus, right renal agenesis, lipomyelomeningocele, spinal cord tumor. We reported a case of VATER association with brief review of related literature.

뇌졸중 환자에서 체외충격파 치료기의 상지 경직에 대한 효과

유승돈,김희상,정필교 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.4

Objective: To investigate the effect of extracorporeal shock wave therapy (ESWT) on muscle spasticity of elbow and wrist affected by stroke. Methods: We studied 21 patients affected by stroke with spasticity in upper limbs. The neurological status of the stroke patients were evaluated by K-NIHSS and the evaluation of efficacy on the upper limb spasticity were based on modified Ashworth scale (MAS), modified Tardieu scale (MTS), and active elevation of upper limb. Treatment was performed 1 session/week, total 3 sessions in each patient. Patients were evaluated at baseline and 4 weeks after treatment using MAS of elbow flexor and active elevation of upper limb. Patients were monitored at baseline, after sham stimulation, and at 1, 4 weeks after ESWT using MTS of elbow flexor and wrist pronator. Results: After ESWT, patients showed significant improvement in muscle tone of elbow flexor and wrist pronator after the 1st and 4th weeks compared with baseline and sham stimulation (<0.001). The active elevation of hemiplegic upper limb was significantly increased (p<0.05). Conclusion: We suggest the ESWT could be a useful treatment method on upper limb spasticity in the patients of stroke. Further studies with a larger group of patients are warranted. Objective: To investigate the effect of extracorporeal shock wave therapy (ESWT) on muscle spasticity of elbow and wrist affected by stroke. Methods: We studied 21 patients affected by stroke with spasticity in upper limbs. The neurological status of the stroke patients were evaluated by K-NIHSS and the evaluation of efficacy on the upper limb spasticity were based on modified Ashworth scale (MAS), modified Tardieu scale (MTS), and active elevation of upper limb. Treatment was performed 1 session/week, total 3 sessions in each patient. Patients were evaluated at baseline and 4 weeks after treatment using MAS of elbow flexor and active elevation of upper limb. Patients were monitored at baseline, after sham stimulation, and at 1, 4 weeks after ESWT using MTS of elbow flexor and wrist pronator. Results: After ESWT, patients showed significant improvement in muscle tone of elbow flexor and wrist pronator after the 1st and 4th weeks compared with baseline and sham stimulation (<0.001). The active elevation of hemiplegic upper limb was significantly increased (p<0.05). Conclusion: We suggest the ESWT could be a useful treatment method on upper limb spasticity in the patients of stroke. Further studies with a larger group of patients are warranted.

Characteristics of Computerized Neuropsychologic Test According to the Location of Aneurysmal Subarachnoid Hemorrhage

유승돈,Jihea Bark,김동환,Gook Ki Kim 대한재활의학회 2011 Annals of Rehabilitation Medicine Vol.35 No.5

Objective To evaluate characteristics of cognitive impairments according to the location of aneurysmal subarachnoid hemorrhage (SAH) using a computerized neuropsychological test (CNT). Method A total of 211 patients were transferred to our rehabilitation department after becoming neurologically stable following aneurysmal SAH. Twenty four of the 211 patients met the inclusion criteria and participated in a screening test using the mini-mental state examination (MMSE). Twenty patients with a MMSE score <26were followed prospectively with a CNT and Beck depression inventory (BDI). Eleven patients had anterior communicating artery (ACoA) aneurysms and the other 9 had middle cerebral, internal carotid or posterior communicating artery aneurysms. Results There were no diff erences in age, education, Hunt and Hess grade, or Fisher grade between the patients with ACoA aneurysmal SAH compared to patients with other aneurysmal SAH. In patients with ACoA aneurysmal SAH, scores of BDI (p=0.020), verbal learning test were lower than those of other aneurysmal SAH patients. In contrast, patients with non-ACoA aneurysmal SAH took signifi cantly more time in auditory (p=0.025) and visual continuous performance tests (p=0.028). The cognitive defi cit following aneurysmal SAH could be characterized by its location using CNT. Conclusion Using CNT in aneurysmal SAH patients could be a useful tool for evaluating the characteristics of cognitive impairment and planning rehabilitation programs according to each characteristic.

Biomechanical Parameters in Plantar Fasciitis Measured by Gait Analysis System With Pressure Sensor

유승돈,김희상,이종하,윤동환,김동환,전진만,이승아,한유진,소윤수,김용,한선영,이우진,한영록 대한재활의학회 2017 Annals of Rehabilitation Medicine Vol.41 No.6

Objective To investigate the differences in biomechanical parameters measured by gait analysis systems between healthy subjects and subjects with plantar fasciitis (PF), and to compare biomechanical parameters between ‘normal, barefooted’ gait and arch building gait in the participants.Methods The researchers evaluated 15 subjects (30 feet) with bilateral foot pain and 15 subjects (15 feet) with unilateral foot pain who had a clinical diagnosis of PF. Additionally, 17 subjects (34 feet) who had no heel pain were recruited. Subjects were excluded if they had a traumatic event, prior surgery or fractures of the lower limbs, a leg length discrepancy of 1 cm or greater, a body mass index greater than 35 kg/m2, or had musculoskeletal disorders. The participants were asked to walk with an arch building gait on a treadmill at 2.3 km/hr for 5 minutes. Various gait parameters were measured.Results With the arch building gait, the PF group proved that gait line length and single support line were significantly decreased, and lateral symmetry of the PF group was increased compared to that of the control group. The subjects with bilateral PF displayed significantly increased maximum pressure over the heel and the forefoot during arch building gait. In addition, the subjects with unilateral PF showed significantly increased maximum pressure over the forefoot with arch building gait.Conclusion The researchers show that various biomechanical differences exist between healthy subjects and those with PF. Employing an arch building gait in patients with PF could be helpful in changing gait patterns to normal biomechanics.

Efficacy of Ultrasonography Guided Stellate Ganglion Blockade in the Stroke Patients with Complex Regional Pain Syndrome

유승돈,Sang Soo Jung,김희상,윤동환,김동환,Jinmann Chon,Dong Whan Hong 대한재활의학회 2012 Annals of Rehabilitation Medicine Vol.36 No.5

Objective To compare the efficacy of ultrasonography guided stellate ganglion block (US-SGB) with that of blind SGB in management of the stroke patients with complex regional pain syndrome (CRPS) type 1.Method Forty-two patients with post-stroke CRPS were randomly assigned to either US-guided SGB (22 patients) or blind SGB group (20 patients). The mean age of US-guided SGB and blind SGB groups was 61.3±5.6 years and 59.1±4.5 years. We performed two blockades at 7-day intervals on the affected side of patients with CRPS. Pain intensity, using a visual analog score (VAS), score of CRPS clinical severity, and the amounts of affected hand swelling with a hand volumeter were assessed before, 2 weeks and 4 weeks after treatment. Results In both groups, VAS and the amount of hand swelling were significantly decreased after 2 weeks and after 4 weeks. Between two groups, VAS difference of US-guided SGB group and that of blind SGB group were 2.61±1.09, 1.88±0.62 at 2 weeks and 3.67±1.03, 3.13±0.62 at 4 weeks, respectively. US-guided SGB group showed more significant improvement in mean change of VAS compared to the blind SGB group (p-value<0.05). Conclusion Both US-guided SGB and blind SGB techniques were effective in relieving pain in subacute stroke patients with CRPS. US-guided SGB was better in pain relief but has no advantages in reduction of hand swelling in this study.

브로카 실어증 환자와 명칭성 실어증 환자에서 유창성 회복 정도에 따른 뇌활성화 비교: fMRI 연구

유승돈 대한뇌졸중학회 2005 Journal of stroke Vol.7 No.2

Background and objectives: Compared with brain activation of normal controls, the brain activation patternsof patients with Broca’s or anomic aphasia were investigated by fMRI study with 2 speech production tasks.Methods: Nine patients with Broca’s aphasia and 8 subjects of anomic aphasia were participated in this study. Innormal control group, we studied 9 healthy adults using 2 tasks. All subjects were right handed. Functional imagewas performed during 2 tasks of block design (4 activation blocks, 5 control blocks per session); (1) picture naming,(2) word reading. All data processing and statistical analysis were performed using SPM 99 and statistical significancelevel was set at p〈0.01. Results: In picture naming task, the fusiform gyrus, superior temporal and middletemporal gyrus, superior frontal gyrus, middle frontal gyrus, prefrontal gyrus of the left hemisphere were predominantlyactivated. During word reading tasks, activations of the left middle temporal and left angular gyriwere remarkable, and the areas of the right inferior parietal lobule and right fusiform gyrus were activated. Duringpicture naming and word reading tasks, the strong activation of contralateral Broca’s area was typical in Broca’saphasic patients, but in anomic aphasic patients, the strong activation of ipsilateral perilesional Broca’s area wasproduced. Conclusion: There are evidences of brain plasticity of an expressive language area into the right Broca’s homologue area. The right hemisphere and undamaged perilesional areas in the left hemisphere play a role insome patients, especially due to severity.(Korean Journal of Stroke 2005;7(2): 197~207)

신체소유장애를 보이는 후대뇌동맥 경색 환자 1례 - 증례보고 -

유승돈,전진만 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.3

Hemiplegic stroke patients may have abnormal awareness or perception of the affected limb (s). For example, patients may experience their limb as not belonging to them (asomatognosia) or attribute their own body parts to other persons (somatoparaphrenia). Disturbed sensation of limb ownership (asomatognosia, somatoparaphrenia) for the hemiplegic limb has been reported in patients with right insula lesion. We report a case of a 70-year-old right handed female who had somatoparaphrenia and neglect dyslexia after right posterior cerebral artery and posterior corpus callosal infarction. Additionally, she showed visual defect, dyschromatopsia, and hemispatial neglect.

Atypical Supernumerary Phantom Limb and Phantom Limb Pain in Two Patients with Pontine Hemorrhage

유승돈,김동환,정용설,전진만,박지혜 대한의학회 2011 Journal of Korean medical science Vol.26 No.6

Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.