• 한국산학기술학회논문지
• /
• 제17권7호
• /
• pp.459-466
• /
• 2016

본 연구는 아급성기 뇌졸중 환자에서 로봇 보조치료법이 운동능력 및 기능적인 회복에 미치는 효과를 알아보고자 하였다. 환자 53명이 연구에 참여하였다. 로봇보조 보행치료군은 고식적인 치료에 추가로 Lokomat$^{(R)}$ 이용하여 하루에 삼십분씩, 일주일에 5회, 4주 동안 시행하였으며, 대조군은 고식적인 치료에 추가로 하루에 삼십분씩 고식적인 치료를 시행 받았다. 모든 환자들은 임상지표의 비교를 위해, 치료 전과 4주간의 치료 후 Fugl-Meyer assessment, Motricity index, functional ambulation category, Berg balance scale, 10m 보행검사, 한국판 수정 바델지수, 한국판 간이 정신 상태검사와 벡 우울증 척도를 평가 받았다. 환자들은 기능회복과 체성 감각 유발전위 검사 결과의 관계를 알아보기 위해 유발 전위 검사를 시행하였다. 아급성기 뇌졸중 환자에서 로봇 보조 보행치료군에서 대조군에 비해 하지의 운동기능, 보행 능력, 일상생활능력의 유의한 호전이 나타났다. 체성 감각 유발 전위 검사의 결과는 임상 지표들의 관련성 분석에서 Motricity index와 한국판 수정 바델지수와 관련이 있는 것으로 나타나 아급성기 뇌졸중 환자의 기능을 예측하는데 유용할 것으로 생각된다. 로봇 보조 보행치료는 아급성기 뇌졸중 환자의 운동기능과 보행기능의 회복을 촉진하는 것으로 생각된다.

• 대한물리치료과학회지
• /
• 제3권1호
• /
• pp.907-918
• /
• 1996

Evoked potentials(EP) are defined as electric responses of the nerves system to sensory stimulation. EPs are used mainly to test conduction in the visual, auditory, and somatosensory systems, especially in the central parts of these systems. Somatosensory evoked potentials (SEP) are the potentials elicited by stimulation of peripheral nerves and recorded at various sites along the sensory pathway. SEPs types consist mainly of SEPs to electric stimulation of arm or leg nerves. SEPs to arm stimulation are usually recorded simultaneously from clavicular, cervical, and scalp electrodes; SEPs to leg stimulation are recorded from lumbar, low thoracic, and scalp electrodes. Subject variables that have practical impotance are age, limb length, body height, and temperature. General clinical interpretation of abnormal SEPs wave decreases of peripheral conduction time, and abolition of SEPs recorded from different levels to identify lesions of peripheral nerves, plexus, nerve root, spinal cord, cauda equina, hemispheric brainstem, and cerebral parts of the somatosensory pathway.

• 대한임상검사과학회지
• /
• 제48권3호
• /
• pp.262-268
• /
• 2016

편측성 안면경련(hemifacial spasm)은 불수의적으로 안면의 근육에서 발작적인 경련이 일측성으로 반복해서 발생하는 질환이다. 한 근육의 수축으로 인해 동시적으로 여러 근육이 동시에 수축되는 동시 수축성(synkinesia)이 특징이다. 발병원인은 제 7뇌신경인 안면신경이 혈관에 의해 압박을 받아서 나타나게 된다. 본 연구는 편측성 안면경련 환자의 미세혈관 감압 수술을 받은 환자를 대상으로 수술 중 진행되는 신경계 감시검사 방법들에 대해 다루었다. 청각유발전위 검사에서는 수술용 뇌 견인기의 사용시 주의 사항과 검사시기에 대해 언급하였다. 안면신경의 근전도검사에서는 잡파의 혼입과 신경손상 시 근전도 파형의 감별에 대해, 측면전파 반응 검사에서는 마취의 유지의 중요성에 대해 그리고 체성감각 유발전위검사에서는 환자를 좀더 자세하게 검사할 수 있도록 새로운 방법을 제안하였다. 위에 언급한 내용들을 토대로 검사한다면 수술 중 신경계 감시 검사를 원활하게 할 수 있으리라 생각된다.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제18권4호
• /
• pp.652-672
• /
• 1996

Dysfunction of the inferior alveolar nerve may result from trauma, diseases or iatrogenic injury. The development and refinement of an objective method to evaluate this clinical problem is highly desirable and needed, especially concerning for an increasing medico-legal issue. Evoked potential techniques have attracted considerable attention as a means of assessing the function and integrity of nerve pathways. The purpose of this study was to characterize the Sensory Evoked Potentials(SEPs) and Somatosensory Evoked Potentials(SSEPs) elicited by electrical stimulation of mental nerve. SEPs and SSEPs were measured and analyzed statistically before and after needle injury on the inferior alveolar nerve of Sprague-Dawalye rats. Measuring SEPs was more sensitive in evaluation of the recovery of sensory function from inferior alveolar nerve injury then measuring SSEPs but we measured SSEPs in the hope of providing a safe, simple and objective test to check oral and facial sensibility, which is acceptable to the patient. We stimulated mental nerve after needle injury on the inferior alveolar nerve and SEPS on the level of mandibular foramen and SSEPs on the level of cerebral cortex were recorded. Threshold, amplitude, and latency of both of SEPs and SSEPs were analyzed. The results were as follows ; 1. Threshold of SEPs and SSEPs were $184{\pm}14{\mu}A$ and $164{\pm}14{\mu}A$ respectively. 2 SEPs were composed of 2 waves, i.e., N1 N2 in which N1 was conducted by II fibers and N2 was conducted by III fibers. 3. SSEPS were composed of 5 waves, of which N1 and N2 shower statistically significant changes(p<0.01, unpaired t-test). 4. SEPs and SSEPs were observed to be abolished immediately after local anesthesia and recovered 30 minutes later. 5. SEPs were abolished immediately after injury. N1 of SSEPs was abolished immediately and amplitued of N2 was decreased($20.7{\pm}12.2%$) immediately after 23G needle injury, but N3, N4 and N5 did not change significantly. Recovery of waveform delayed 30 minutes in SEPs and 45 minutes in SSEPs. 6. The degree of decrease in amplitude of SEPs and SSEPs, after 30G needle injury was smaller than those with 23G. SEPs recorded on the level of mandibular foramen were though to be reliable and useful in the assessment of the function of the inferior alveolar nerve after injury. Amplitude of SSEPs reflected the function and integrity of nerve and measuring them provided a safe, simple and abjective test to check oral and facial sensibility. These results suggest that measuring SEPs and SSEPs are meaningful methods for objective assessment in the diagnosis of nerve injury. N1 and N2 of SSEPs can be useful parameters for the evaluation of the nerve function following a needle injury.

• Journal of Korean Neurosurgical Society
• /
• 제29권7호
• /
• pp.954-958
• /
• 2000

In the removal of small subcortical lesion in the eloquent area like sensory-motor cortex, the prevention of neurologic deficit is important. We present our technique of identification of M-1, S-1 cortex in a case of subcortical granuloma located in sensorymotor cortex. To accurately localize mass, stereotactic craniotomy was planned. At the beginning of procedure, functional MRI of motor cortex was done with stereotactic headframe in place. Next, the stereotactic craniotomy about 4 cm was done under propofol anesthesia for cortical mapping. After reflection of dura, central sulcus was identified with phase-reversal response of intraoperative SEP(somatosensory evoked potential) of contralateral median nerve. Then the patient was awakened, and direct cortical stimulation was done. We observed the muscle contractions of elbow, hand and fingers and the paresthesia over forearm, hand, fingers on the M-1 and S-1 cortex. Through cortical mapping and stereotactic guidance, we concluded that the mass lie immediately posterior to central sulcus, then the mass was carefully removed through small transsulcal approach, opening about 1 cm of rolandic sulcus.

• 한국임상수의학회지
• /
• 제17권2호
• /
• pp.388-394
• /
• 2000

이 실험은 소형견종에 대한 정상 SEPs의 범위를 알아내기 위해 실시되었다. 임상증 상이 정상인 28두를 대상으로 자극점에서 channel 1 까지의 Pl(LPI), channel 1까지의 Nl (LN1), 자극점에서 channel 2가지의 Pl(TP1), channel 2까지의 N1(TNI)의 절대잠복기와 LP1-TN1` 의 파간잠복기를 알아내기 위해서 실시하였다. 이번 실험에서 LPI, LNI, TPI, TNI의 절대잠복기 (absolute latency)의 평균값은 2.69$\pm$0.31 msec, 4.91$\pm$0.49m/sec, 4.64$\pm$0.39 msec, 5.21$\pm$0.42 msec 띠었다. LP1과 TN1 사이의 파간절대잠복기의 핑균값은 2.52$\pm$7.19 msec 이었다. 측정 치들을 속도로 변환하였을 경우 다음과 같았다. 측, LPI, LNI. Tfl, TNI 그리고 LP1-TN1 에서의 속도의 평균값은 각각 93.11$\pm$ 8.58 m/sec, 50.99$\pm$ 5.36m/sec. 80.18$\pm$ sec, 71.31$\pm$4.79m/sec그리고 49.50$\pm$3.58m/sec 이었고. 71.66m/sec, 37.79m/sec, 65.75m/ sec, 59.33 m/sec, 40.55m/sec 의 최저속도를 초과하였을 때 정상범위로 간주하였다. LPI, LNI, TPI,TN1까지의 절대잠복기와 자극전극에 시 측정전극가지의 거리 사이에는 상관관계가 있었다 LP1, LN1, TP1, TN1의 상관계수는 각각 0.621, 0.494. 0.577,0.618 이었다 요추에서 기록된 SEPs갈은 LP1의 상관계수가 LN1 보다 높았으며 흉추에서 기록된 SEPs값은 TN1의 상관계수가 TP1보다 높았다. LP1과 TN1의 파간잠복기와 channel 1과 2의 거리차이와의 상관계수는 0.571이다. 따라서 LPI, LNI. TPI, TNI그리고 LPI-TNI 들의 최저속도를 이용 하여 척수 손상 여부를 판단할 수 있다고 생각된다.

• Journal of Yeungnam Medical Science
• /
• 제22권1호
• /
• pp.96-103
• /
• 2005

뇌성마비로 인해 오른 손에서 단부전마비를 호소하는 환자를 대상으로 기능적 자기공명영상 장치와 경두개 자기 자극기를 사용하여 운동신경의 회복기전을 연구하였다. 대상자는 21세 된 남자 환자로 오른손에 경미한 운동 기능의 손상을 보였고, 자기공명영상의 소견에서 좌반구의 precentral knob에서 병변을 보였다. 기능적 자기공명영상 촬영은 한 명의 대상자와 여덟 명의 정상인을 대상으로 표준화된 헤드코일을 사용하여 1.5 T의 장치에서 BOLD 기술을 적용하여 실시하였다. 대상자들의 운동 수행은 1 Hz 주기로 손가락의 굴곡과 신전을 반복하는 과제가 제시되었다. 경두개 자기 자극은 원형 코일을 사용하여 코일의 앞쪽 부분이 대상자의 두피에서 1 cm 정도 떨어진 정접 부위에 적용되었고 양측의 짧은엄지벌림근에서 발생된 운동 유발 전위가 동시에 측정되었다. 자기공명영상의 결과에서 환자의 비손상측(좌측) 손과 정상군의 좌측 손의 운동 수행 시 오른쪽의 일차운동감각영역(SM1)의 precentral knob에서 활성도가 나타났다, 그러나, 환자의 손상측(우측) 손의 운동 수행 시, 좌측 일차운동감각영역의 손상된 precentral knob 내측 부위에서 활성도를 보였다. 또한, 경두개 자기 자극의 결과에서 손상측 짧은엄지벌림근에서 발생된 운동 유발 전위에 해당하는 뇌 부위가 환자의 정상측과 비교하여 1 cm 내측에서 발견되었다. 그러므로 손상측 손의 운동 기능이 손상된 precentral knob의 내측 부분으로 전위되어 신경재구성이 이루어진 것으로 추정되는 결론을 얻었다.

• 생물정신의학
• /
• 제4권1호
• /
• pp.108-115
• /
• 1997

The alcoholic neuropathies developed in approximately 34% of chronic alcoholics and the sexual dysfunction had been experienced in 8-54% of male alcoholics(Schiavi 1990). The aims of this study were to identify the prevalence of subclinical polyneuropathies and sexual disorders in alcohol dependence, and to evaluate the association between them. The nerve conduction velocity(NCV), electromyography(EMG), and pudendal somatosensory evoked potentials(SEPs) were tested for the male alcoholics(N=34) and controls(N=17 for NCV & EMG, N=25 for pudendal SEPs). The pudendal SEPs were measured by the following procedures, in which we stimulated the dorsal nerve of penis attached by the ring electrode(stimulus intensity, three times of threshold : stimulus rate, 1-4.7Hz : stimulus duration, 0.1 or 0.2msec), and recorded at the scalp(active electrode, 2cm behind Cz : reference electrode, Fz). The NCV and EMG detected signs of peripheral neuropathies in 79.4% of alcoholics. Among the alcoholics, 64.7% were abnormal on the pudendal SEPs. Among the alcoholics who revealed abnormality on EMG and NCV, 81.4% were abnormal on the pudendal SEPs, in which 51.9% were not responded. The P1 latencies of pudendal SEPs on neuropathic alcoholics were significantly delayed(p<0.05) than non-neuropathic alcoholics. There was a relative correlation between peripheral neuropathies and sexual disorders in the alcoholics. The prevalence of subclinical neuropathies and sexual disorders seemed to be much higher in alcohol dependence than expectation, and these two problems were relatively correlated, and our results suggested that the peripheral polyneuropathies were one of the prerequisites of sexual disorders.

• 대한임상전기생리학회지
• /
• 제5권2호
• /
• pp.47-59
• /
• 2007

The purpose of this study were to investigate the effects of electroacupuncture(EA) on sensory nerve function in acute hyperglycemia rats. Male Sprague-Dawley rats weighing 250~270 g(8 weeks of age) were used in this study, and the induced hyperglycemia rats were produced by intraperitoneal injection of streptozotocin(70 mg/kg body weight). Only animals with blood glucose levels of 300 mg/dl or higher were used in this study. Animal were divided into two groups: the control group and EA group (n=7 in each group). For EA, two stainless-steel needles were inserted into Zusanli (ST36) which is located at the anterior tibial muscle and about 10mm below the knee joint. Pulsed current(2 Hz, 0.3 ms) were applied to the inserted needle for 20 mim. We measured glucose level, weigh, sensory nerve conduction and somatosensory evoked potential(5EP) before and after injecting streptozotocin, 2 weeks, 4 weeks. The change of blood glucose on EA group trended to decrease compared with the control group and there were significant differences(p<0.05). The body weight of the EA group trended to be reduced compared with the control group and there were significant differences(p<0.05). The amplitude of sensory nerve action potential on EA group to increase compared with the control group and there were significant differences(p<0.05). There were no significant differences in SEP. These results suggest that EA has beneficial effect on diabetic neuropathy and this effect may be related in part with prevention of hyperglycemia.

• Annals of Clinical Neurophysiology
• /
• 제1권2호
• /
• pp.106-111
• /
• 1999

Backgroud : The generators of N37 and P37 of posterior tibial nerve somatosensory evoked potential(PTSEP) have not been exactly known. Recently, some reports suggested that P37 and N37 might have different generator. We conducted a study to know the generators of P37 and N37 of PTSEP using gating mechanism. Methods : We evaluated subcortical and cortical somatosensoy evoked potentials(SEPs) in response to posterior tibial nerve stimulation in 3 experimental conditions of foot movement and compared them with PTSEPs in full relaxation of foot. The experimental conditions were: (a) active flexion-extention of stimulated foot, (b) isometric contraction of the stimulated foot, (c) passive flexion-extention of the stimulate foot. We analyzed the latencies and amplitudes of following potentials; P30, N37, P37, and N50. Results : The amplitude of P30 potential did not change during at any paradigms. The amplitudes of P37 and N50 were significantly attenuated in all condition. However, the amplitude of N37 showed no significant change during at any paradigms. Conclusions : These results suggest that the generators of P37 and N37 of PTSEP be different in cortex.