측방보행 훈련이 급성기 뇌졸중 환자의 균형 자신감, 낙상 효능감, 낙상 위험도에 미치는 영향: 무작위 대조 예비 연구

주민철,정경만,Joo, Min-Cheol,Jung, Kyeoung-Man 한국의료질향상학회 2021 한국의료질향상학회지 Vol.27 No.1

Purpose: The aim of this study was to determine the effect of side walking on balance confidence, falls efficacy and fall risk in acute stroke patients. Methods: The study included 14 patients with acute stroke who were randomly allocated to a side walking group (Experimental group, N=7) and a forward walking group (Control group, N=7). Both groups performed the exercise 5 times a week for 2 weeks. Outcomes were assessed using Korean-Activities-specific Balance Confidence Scale (K-ABC), Korean-Fall Efficacy Scale (K-FES), Korean-Fullerton Advanced Balance Scale (K-FAB). Results: After 2 weeks of training, both groups showed significantly improved ABC, FES, FAB (p<.05 in both groups). However, the ABC, FES, FAB in the experimental group was significantly better than in the control group (p<.05). Conclusion: These findings indicate that side walking training may be effective at improving balance confidence and decreasing fall down risk in early stroke patients. Therefore, side walking training may be recommended as an intervention in reducing the incidence of falls in acute stroke patient.

회전보행 훈련이 초기 뇌졸중 환자의 균형 자신감, 낙상 효능에 미치는 영향: 무작위 대조 예비 연구

주민철,정경만,정일승,Joo, Min-Cheol,Jung, Kyeoung-Man,Jeong, Il-Seung 한국의료질향상학회 2020 한국의료질향상학회지 Vol.26 No.1

Purpose: This study aimed to determine the effect of curved walking training on balance confidence and fall efficacy in early stroke patients. Methods: The study included 16 early stroke patients who were randomly allocated to a curved walking training group (experimental group, N=8) and a straight walking training group (control group, N=8). Both groups performed the exercise 5 times a week for 3 weeks. Outcomes were assessed using the Activities-specific Balance Confidence (ABC) Scale, Fall Efficacy Scale (FES), Berg Balance Scale (BBS), and Timed Up and Go (TUG) test. Results: After 3 weeks of training, both groups showed significantly improved ABC, FES, BBS, and TUG (p<.05 in both groups). However, the ABC, FES, BBS, and TUG scores in the experimental group were significantly better than those in the control group (p<.05). Conclusion: These findings indicate that curved walking training may be effective at improving balance confidence and decreasing fall risk in early stroke patients. Therefore, curved walking training can be used as a recommended walking method in early stroke patients.

휠체어 이동 및 조작 훈련을 통한 모의 대피훈련 향상 활동의 효과

주민철,정유진,채수민,조성태,Joo, Min-Cheol,Jung, Yu-Jin,Chae, Su-Min,Cho, Sung-Tae 한국의료질향상학회 2020 한국의료질향상학회지 Vol.26 No.2

Purpose: The purpose of this study was to determine the effect of simulation evacuation training improvement activity through wheelchair skill training. Methods: The study included 40 patients with early stroke who were randomly allocated to a wheelchair skill training group (Experimental group, n=20) and a general exercise group (Control group, n=20). Both groups performed the exercise 3 times a week for 3 weeks. Outcomes were assessed using Wheelchair Skills Test Skills Performance (WSTSP), Wheelchair Skills Test Skills Safety (WSTSS) and Wheelchair Propulsion Velocity (WPV). Results: After 3 weeks of training, both groups showed significantly improved WSTSP, WSTSS and WPV (p<.01 in both groups). However, the WSTSP, WSTSS and WPV in the experimental group were very significantly better than in the control group (p<.01). Conclusion: These findings indicate that wheelchair skill training may be effective at improving wheelchair skill ability and wheelchair propulsion velocity in stroke patients who cannot walk independently. Therefore, short-term wheelchair skill training could be useful for patient safety in simulated evacuation situations.

뇌졸중 환자의 회전 보행 시 회전 방향이 보행 특성에 미치는 영향

정경만,주민철,정유진,Jung, Kyeoung-Man,Joo, Min-Cheol,Jung, Yu-Jin 한국의료질향상학회 2017 한국의료질향상학회지 Vol.23 No.2

Purpose: The purpose of this study was to determine the effects of rotation direction during curved walking on gait parameters in stroke patients. Methods: A group of thirty subjects with stroke (Berg Balance Scale score${\geq}41$ were fifteen, Berg Balance Scale score${\leq}40$ were fifteen) were enrolled in this study. Testing indications included two directions for rotation in each subject. These indications were for rotation toward the affected and unaffected side in stroke patients. The gait speed, affected side single support duration, affected side double support duration were recorded. The obtained data were analyzed by using paired t-test and Wilcoxon signed rank test in the group that are below and above 40 points of Berg Balance Scale score. Results: There was significant increase affected side single support duration was turned the affected side in stroke patients that presented a Berg Balance Scale score${\geq}41$ (p<.05). There were significant increase gait speed, affected side single support duration, and significant decrease affected side double support duration while subjects were turned the affected side in stroke patients that presented a Berg Balance Scale score${\leq}40$ (p<.05). Conclusion: This result may be effective to rotate in the paralyzed direction to improve the ability of the paralyzed lower limb to gain weight during gait training for stroke patients with a Berg Balance Scale score<40. Therefore, walking training program for hemiplegic patient needs to be suggested in the direction of turning for suitable balance ability.

스마트폰 동영상 교육 프로그램이 일개 대학병원에서의 재활병동 입원환자 교육 만족도에 미치는 영향

정경만,주민철,정유진,김희한,이경화,이동순,최준완,Jung, Kyeong- Man,Joo, Min-Cheol,Jung, Yu-Jin,Kim, Hee-Han,Lee, Kyeong-Hwa,Lee, Dong-Sun,Choi, Jun-Wan 한국의료질향상학회 2017 한국의료질향상학회지 Vol.23 No.1

Purpose: This study was to determine the effect of a smartphone video educational program on educational satisfaction of patients in rehabilitation units at a university hospital. Methods: The subjects of this study were 60 stroke patients recruited and divided into two groups; experimental group (n=30) and control group (n=30). Subjects in the experimental group and control group conducted conventional physical and occupational therapy. In addition, only the experimental group provided smartphone video information for a total of 15 sessions. The video consisted of five episodes (10 minutes each) viewed a total of 15 times (for each video three times). The outcome was assessed by educational satisfaction. Result: After inervention, both groups revealed significant increased awareness of prevention of infection educational satisfaction and prevention from falling educational satisfaction and exercise program educational satisfaction. However, the experimental group was more effective than the control group relative to heightened awareness of increasing prevention of infection prevention from falling and exercise program. Conclusion: We suggest that a smartphone video educational program may be effective in improving awareness of the prevention of infection, prevention from falling, and exercise program educational satisfaction. Therefore, video-based information is beneficial for such patients. Further studies are needed for better understanding of the effectiveness of a smartphone video educational program in rehabilitation units at a university hospital.

이마관자엽 치매 환자에서 나타난 하지 근력 저하와 복합부위 통증증후군에 대한 증례 보고

이광민(Kwang Min Lee),노세응(Se Eung Noh),주민철(Min Cheol Joo),황용(Yong Hwang),김지희(Ji Hee Kim) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.12

이마관자엽 치매는 조기 발현형 치매 중 두 번째로 흔한 형태로 행동, 언어, 인지 장애를 보이는 신경퇴행성 질환이다. 이마관자엽 치매에서 운동 기능 이상이 동반되는 경우는 운동 신경원 질환과 파킨슨증, 진행성 핵상 마비 등으로 대표되나, 다른 동반 질환 없이 이마관자엽 치매가 중추신경계의 운동신경영역을 직접 침범하여 나타난 운동 기능 이상은 보고된 바가 없다. 또한, 임상적 치매 집단과 복합부위 통증 증후군 사이의 연관성은 보고된 바가 없다. 저자들은 이마관자엽 치매환자에서 나타난 중추신경계 원인의 하지 근력 저하를 뇌 자기공명영상과 전기진단학적 검사를 통해 진단하였고, 동반된 복합부위 통증증후군을 삼상 골주사 검사를 통해 진단하였으며, 이에 따른 임상적 치료를 시행하였다. 스테로이드를 이용한 복합부위 통증증후군 치료 후에 환자의 통증은 호전되었고, 입원 상태에서 하지 근육에 대한 기능적 전기 자극 치료, 근력강화 운동 및 보행 훈련을 포함한 포괄적 재활치료를 시행한 후에 저명한 기능적 호전을 보였다. 이마관자엽 치매에서 관찰된 중추신경계 원인의 근력 저하에 대한 재활 치료는 전반적 기능의 향상에 효과적일 것으로 추정된다. Frontotemporal dementia, the second most common cause of early onset dementia, is a neurodegenerative clinical syndrome characterized by progressive deficits in behavior, executive function and language. Although motor symptoms in frontotemporal dementia are represented by motor neuron disease, parkinsonism and progressive supranuclear palsy syndrome, there have been no reports of motor weakness caused by the direct involvement of central motor nervous systems in frontotemporal dementia. Moreover, no association between clinical dementia groups and complex regional pain syndrome has been reported. We diagnosed a rare case with motor weakness and complex regional pain syndrome of lower limbs due to central nervous system lesion in a patient with frontotemporal dementia by magnetic resonance imaging, electrodiagnostic study and three phase bone scan. Following steroid therapy for complex regional pain syndrome, pain was improved. Functional improvement was noted after rehabilitation therapy, including functional electrical stimulation, muscle strengthening exercise and gait training during hospitalization. This case report suggests that rehabilitation therapy for motor weakness in frontotemporal dementia could be effective for improving overall function.

척수 손상 흰쥐에서 배변 유도를 위한 천수신경부 전기자극의 적정 주파수

김용성 ( Yong Sung Kim ),주민철 ( Min Cheol Joo ),이문영 ( Moon Young Lee ),김기훈 ( Ki Hoon Kim ),오정택 ( Jung Taek Oh ),강동백 ( Dong Baek Kang ),신용일 ( Yong Il Shin ),최석채 ( Suck Chei Choi ),박병림 ( Byung Rim Park ) 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.2

목적 : 천수신경에 대한 전기자극은 척수 손상 환자의 상당수가 불편을 느끼는 배변곤란과 같은 장기능을 촉진하기 위해 사용되어 왔다. 그러나, 아직까지 배변 증가 등 장기능 촉진을 위한 전기자극의 적합한 조건에 대한 연구는 거의 없는 실정이다. 이에 본 연구는 척수손상 쥐에서 전기자극에 의한 배변 효과를 관찰하고 적합한 자극조건을 추구하고자 하였다. 대상 및 방법 : 총 31마리의 Sprague-Dawley 암컷 쥐를 사용하였다. 제 9~10 흉추 부위에서 후궁절제술을 시행한 후 외과용 칼을 이용하여 척수를 완전 절단하였다. 전기자극을 위한 전극은 척수 손상을 유발한 직후 제 2~4 천추부위를 절개하고 후궁절제술을 시행하지 않은 상태에서 전극을 근육 사이에 삽입 고정 하였다. 전기자극의 강도는 꼬리 또는 하지의 수축이 시작하는 운동역치의 절반으로 하였고 (0.5-2 V), 자극 너비는 0.3 ms의 구형파로, 주파수는 각각 10, 30 및 50 Hz를 사용하였다. 전기자극은 수술 당일 오후부터 7일 동안 하루 4시간씩 시행하였다. 수술후 2일, 4일 그리고 7일 째 감각 및 운동 기능을 평가하였으며 수술후 7일째까지 회복이 전혀 안되었음을 확인하였다. 또한 각 동물의 체중, 배변의 개수 및 무게를 매일 아침 기록하여 비교하였다. 결과 : 수술 직후 현저히 감소되었던 배변 개수 및 무게는 모든 군에서 시일의 경과에 따라 회복되었으며 30 Hz 전기자극군의 경우 수술후 3일 째에 이미 수술전의 상태 정도로 배변 총무게가 회복됨을 보여 주었다. 그러나 다른 모든 군에서는 수술후 6일째까지 수술전 상태로 회복하지 못하여, 수술 2일에서 6일 째까지 30 Hz 전기자극군이 모든 다른 군에 비해 척수 손상 후 유의하게 배변 양이 증가함을 관찰할 수 있었다. 결론 : 척수 손상 쥐에서 배변유도를 위한 천수부 전기자극은 효과적인 치료 방법이며, 파라미터의 변화에 따라 작용이 차이가 있으므로 자극 목적 및 방법 등에 따라 적절한 파라미터의 선택이 필요할 것으로 생각한다. Background/Aims: The sacral nerve electrical stimulation (ES) has been used to promote bowel emptying in the spinal cord injured patients. However, optimal parameter of ES to promote bowel emptying was not established yet. The aim of this study was to investigate the effectiveness of ES to promote bowel emptying at spinal injured rats and find the optimal frequency. Methods: Thirty-one adult Sprague-Dawley female rats were used. A complete spinal cord transection was performed surgically at the T10 cord level. The electrodes for ES were implanted in the sacral spinal cord region. Intensity of stimulation was determined by the half of the movement threshold. Stimulation width was 0.3 ms. The frequencies of ES were 10 Hz, 30 Hz, and 50 Hz, for each group. ES was applied for 4 hours per day. We measured the body weight as well as the number and the weight of fecal pellet every morning. Results: The stool output was significantly higher in the group of 30 Hz stimulation than all other groups. Conclusions: These results suggest that electrical stimulation could be used to promote bowel emptying in spinal cord injured patients and it is important to use an optimal frequency of stimulation for best improvement of bowel symptoms. (Kor J Neurogastroenterol Motil 2007;13:123-131)

경수부 척수손상 환자의 기립성 저혈압에서 플루드로코티손의 효과 - 무작위 대조군 연구

이도희(Do-Hee Lee),주민철(Min-Cheol Joo) 한국산학기술학회 2021 한국산학기술학회논문지 Vol.22 No.6

본 연구는 기립성 저혈압이 동반된 경수부 척수손상 환자에서 플루드로코티손의 치료 효과에 대해 알아보고자 하였다. 기립경사도 검사를 통해 기립성 저혈압으로 진단된 경수부 척수손상 환자 26명을 무작위로 배정하였고, 보존적 치료 혹은 추가로 플루드로코티손 치료 중 한가지를 시행하였다. 플루드로코티손은 주마다 0.1㎎에서 0.2㎎로 증량하여 총 2주간 투약하였고, 초기 및 2주 후의 혈압 및 심박수, 혈액학적 검사 수치의 변화를 평가하였다. 치료 2주 후에 치료군에서 기저 혈압의 유의미한 상승이 나타났다(p<.05). 기립성 혈압 감소의 비율 분석에서 치료군의 기립성 혈압감소가 덜 나타나는 경향성을 보였다. 플루드로코티손 치료군의 7.69%에서 경증의 이상 반응을 보고하였다. 이를 통해 플루드로코티손이 기저 혈압의 상승 및 기립성 저혈압 감소를 통해 심혈관계 합병증 방지 및 재활치료 지속 등의 치료 효과를 나타내었음을 알 수 있으며, 척수손상 환자의 기립성 저혈압에서 하나의 치료 방안으로 고려해볼 수 있다고 생각된다. The purpose of this study was to investigate the therapeutic effect of fludrocortisone in patients suffering from cervical spinal cord injury (SCI) with orthostatic hypotension (OH). Twenty-six patients with cervical SCI diagnosed with OH through a head-up tilt test were randomly assigned, and they were given either conservative treatment or additional fludrocortisone treatment. Fludrocortisone was administered for 2 weeks, increasing from 0.1 ㎎ to 0.2 ㎎ week . Blood pressure (BP), heart rate (HR), and blood parameters were measured at the beginning and after 2 weeks. After 2 weeks of treatment, there was a significant increase in the baseline BP of the treatment groups (p<.05). When analyzing the drop ratio, there was a tendency for a lower orthostatic BP drop in the treatment groups. Mild adverse events were reported in 7.69% of the treatment groups. Fludrocortisone exhibited therapeutic effects such as preventing cardiovascular complications and continuing rehabilitation through increased baseline BP and reduced OH, and can therefore be considered as a treatment option for OH in patients with SCI.

척수손상 흰쥐에서 대장 운동에 대한 지실의 효과

최철원 ( Chul Won Choi ),주민철 ( Min Cheol Joo ),이문영 ( Moon Young Lee ) 한방재활의학과학회 2008 한방재활의학과학회지 Vol.18 No.4

Objectives : The purpose of this study was to investigate the effect of Poncirus Trifoliata(PT) on improvement of fecal impaction in spinal cord injured(SCI) rats. Methods : Fifteen adult Sprague-Dawley female rats were used weighing 200~250 g. A complete spinal cord transection was performed surgically at the T10 cord level. Experimental groups were assigned into 3 groups: Control(n=5), SCI+vehicle(n=5) and SCI+PT(n=5). PT was administered 100 mg/kg in 0.5 ml every 24 hours from 1st operation day to 7th day. We measured the body weight and food intake as well as the number and the weight of fecal pellet every morning. After 1 week of operation, whole colon was divided into proximal and distal segments under anesthesia. Each segment of colon was mounted with longitudinal direction in a organ bath. We measured spontaneous contraction and compared the area under the curve in each segments. Enhanced responses were observed by acetylcholine(10-6 M), 40 mM KCl solution, L-NAME(10-4 M). Results : The fecal number and weights were significantly higher in the group of SCI+PT than SCI+vehicle group(p<0.05). In organ bath study, area under the curves of the spontaneous contraction in SCI+vehicle and SCI+PT groups were significantly increased compared to control group. Contractility of distal colon in response to acetylcholine or KCl in SCI+vehicle group was significantly decreased compared to other groups(p<0.05). Conclusions : These results suggest that PT might be useful to promote bowel emptying in spinal cord injured rats.

초발 뇌졸중환자의 기능회복에 대한 다수준 분석

이시온(Sion Lee),한준희(Junhee Han),손민균(Min Kyun Sohn),이종민(Jongmin Lee),김덕용(Deog Young Kim),신용일(Yong-Il Shin),오경재(Gyung-Jae Oh),이양수(Yang-Soo Lee),주민철(Min Cheol Joo),이소영(So Young Lee),송민근(Min-Keun Song),안정훈( 한국자료분석학회 2023 Journal of the Korean Data Analysis Society Vol.25 No.3

뇌졸중이란 뇌혈류 차단으로 산소와 영양공급이 막혀 뇌조직 일부의 손상이 초래되는 질병이다. 뇌졸중에 의한 사망률은 감소하는 추세지만 후유장애, 특히 기능장애로 불편함을 호소하는 환자는 늘어나고 있다. 그러나 뇌졸중 환자를 대상으로 한 연구만 지속될 뿐, 재발 환자를 포함하지 않은 초발 뇌졸중 환자를 대상으로 한 연구는 아직 부족한 실정이다. 이에 본 연구는 한국판 수정 바델 지수(K-MBI)라 불리는 재활 분야에서 흔하게 사용하는 뇌졸중 환자의 일상생활활동 평가 도구를 기능점수의 기준으로 사용해 초발 뇌졸중 기능에 영향을 미치는 요인을 규명하고 궁극적으로 보건의료 정책에 도움을 주고자 했다. 본 연구에서 사용된 자료는 각 개체에 대한 반복적인 측정값으로 이루어진 종단자료로 상관성을 고려하는 분석 방법이 필요해 다수준 분석을 시행하였다. 일반화 추정 방정식 모형(GEE)으로는 모든 변수가 유의하게 나왔지만 다수준 모형은 배우자 유무(미혼보다 기혼), 입원 기간(짧을수록), 나이(적을수록)에 따라 기능점수 회복이 유의미했다(p-value<0.05). 또한, 초기 뇌졸중 중증도에 따른 기능점수의 차이가 있음을 확인했다. 따라서 본 연구는 초발 뇌졸중 환자의 기능향상을 위해서 초기 뇌졸중 중증도에 따라 다른 의료적 접근의 필요성을 제시한다는 점에서 의의가 있다. Stroke is a disease in which oxygen and nutrition are blocked by blocking cerebral blood flow, causing damage to some of the brain tissue. The mortality rate from stroke is decreasing, but the number of patients complaining of discomfort due to aftereffects, especially dysfunction, is increasing. However, only studies on stroke patients continue, and studies on initial stroke patients that do not include recurrence patients are still insufficient. Accordingly, this study tried to identify factors affecting initial stroke function and ultimately help health care policies by using a tool for evaluating daily life activities of stroke patients commonly used in the rehabilitation field called the Korean version of the K-MBI. The data used in this study is longitudinal data consisting of repeated measurements for each object, and a multi-level analysis was conducted because an analysis method that considers correlation was needed. All variables were significant in the generalized estimation equation model (GEE), but the majority model showed significant functional score recovery depending on the presence of a spouse (married than unmarried), hospitalization period (shorter), and age (less); p-value<0.05. In addition, it was confirmed that there was a difference in function scores according to the severity of the initial stroke. Therefore, this study is meaningful in that it presents the need for a different medical approach depending on the severity of the initial stroke to improve the function of patients with initial stroke.