• Journal of Korean Biological Nursing Science
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• 제6권2호
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• pp.19-30
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• 2004

The purpose of this study was to compare chest percussion with chest vibration in brain injury patients. 30 patients in SICU of one general hospital in T city were randomely divided by 3 groups and the arterial oxygen tension(PaO2) and the retained secretion were measured. The chest vibration was done among the first group, the chest vibration by hand after the chest percussion was done among the second group and the mechanical chest vibration after the chest percussion was done among the third group. The data was analyzed using SPSS 7.0(5% significance) and the results are below. 1) It was adopted the hypothesis that the amount of retained secretion of endotracheal suction after stopping the actions among the first, second and the third groups is different from each other.(F=41.62, p=0.00) 2) It was rejected the hypothesis that the arterial oxygen tension(PaO2)s are different from each other among the first, second and third group.(F=1.22, p=0.31) The amount of the retained secretion after chest percussion, chest vibration by hand or mechanical chest vibration was significantly different from each other. Therefore, chest physiotherapy could be regarded as the effective nursing intervention for the unconscieus patients who have the inappropriate airway cleaness and it was more effective to be together than to be alone.

• Journal of Korean Neurosurgical Society
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• 제45권3호
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• pp.151-156
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• 2009

Objective : It is well known that changes in cerebral hemodynamics occur after traumatic brain injury (TBI). Osmo-regulation in the brain is important for maintaining a constant milieu in the central nervous system. Nevertheless, to our knowledge, early osmolarity changes after minor head injury have not been studied until now. Methods : In this study, serum osmolarity was measured in 99 patients with minor head trauma. As a control group, blood samples were drawn from 99 patients who had a minor trauma in an extremity. Serum osmolarity was estimated using a fully automatic biochemical autoanalyzer within the first 3 hours after the trauma. Results : The mean serum osmolarity levels were $286.08{\pm}10.1\;mOsm/L$ in the study group and $290.94{\pm}5.65\;mOsm/L$ in the control group (p<0.001). However, after age adjustment between the study and control groups, this statistical significance was found to be valid only for patients over 30 years of age. Conclusion : It was noted that serum osmolarity levels decrease in the first 3 hours following minor head trauma in patients over 30 years of age. Further studies into this area could provide guidance for the management/treatment of elderly patients.

• Journal of Trauma and Injury
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• 제35권4호
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• pp.255-260
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• 2022

Purpose: To determine the incidence and risk factors of postoperative infection after cranioplasty in patients with traumatic brain injury (TBI). Methods: Data of 289 adult patients who underwent cranioplasty after TBI at a single regional trauma center between year 2018 and 2021 were reviewed retrospectively. Patient characteristics and various procedural variables, such as interval between craniectomy and cranioplasty, estimated blood loss, laterality and materials of the bone flap, and duration and classification of perioperative antibiotics usage were analyzed. Results: Postoperative infection occurred in 17 patients (5.9%). Onset time of infectious symptom ranged from 9 days to 174 days (median, 24 days) after cranioplasty. The most common cultured organism was Staphylococcus aureus (47.1%), followed by Klebsiella pneumoniae (17.6%) and Enterococcus faecalis (17.6%). Patients with postoperative infection were more likely to have diabetes (odds ratio [OR], 6.96; 95% confidence interval [CI], 1.92-25.21; P=0.003), lower body mass index (OR, 0.81; 95% CI, 0.66-0.98; P=0.029), and shorter duration of perioperative antibiotics (OR, 0.83; 95% CI, 0.71-0.98; P=0.026). Conclusions: For TBI patients with diabetes, poor nutritional status should be managed cautiously for increased risk of infection after cranioplasty. Further studies and discussions are needed to determine an appropriate antibiotics protocol in cranioplasty.

• The Journal of Korean Physical Therapy
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• 제32권6호
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• pp.391-393
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• 2020

Objectives: We investigated injury of corticostriatal (CStr) tract in patient with mild traumatic brain injury (mTBI), which was demonstrated by DTT. Method: A 44-year-old female with no previous history of neurological, physical, or psychiatric illness had suffered from head trauma resulting from a pedestrian car accident. She complained that could not quickly move the left hand with her intension. After three month's administration, her slowness movement of left hand recovered rapidly to the point that she was able to extend all fingers quickly. Results: On DTT configuration, the integrity of the left CStr tract was well-preserved, however the right CStr tract showed narrowing and partial tearing in the subcortical white matter on a DTT at 25 months after onset. Conclusion: Injury of the right CStr tract was demonstrated in a patient who developed mild motor control problems following mild TBI. We believe that the evaluation of the CStr tract from the secondary motor area for patients who showed unexplained motor control problem is necessary.

• 생물정신의학
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• 제12권2호
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• pp.221-226
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• 2005

교통사고 등에 의한 외상성 뇌손상에서 이차적으로 주의력결핍 과잉행동장애가 나타나는 경우가 점차 증가하고 있으며, 이에따른 치료방법도 점차 다양화되고 있는 추세이다. 주의력결핍 과잉행동장애에서 많이 사용되어지는 OROS Methylphenidate를 환자에게 투여하여 인지적인 개선뿐만아니라 충동성, 산만함, 공격성 등의 증상에 효과가 있는지의 여부를 살펴보고자 하였다. 약물투여 전에 비하여 약물투여 후에 환자는 충동성, 공격성, 부주의의 개선효과를 나타내었다.

• 생물정신의학
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• 제9권2호
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• pp.120-128
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• 2002

Objectives:The purpose of this study was to develop a cognitive rehabilitation program and to investigate the effect of the program that restores the deficiency of memory, which is necessary to operate on high cognitive function such as problem-solving or judgement, for TBI(traumatic brain injury) patients. Methods:Sixteen TBI patients participated in this study. The inclusion criteria were : 1) aged 18 to 60 ; 2) higher than IQ 80 ; 3) lower than MMSE-K 25 and K-MAS(Korean version of Memory Assessment Scale) 85. We administered our program to an experimental group(N=8) in order to improve attention and memory for 4 weeks(total 12 section). Our program was not administrated to a control group(N=8) for 4 weeks. After administrating this program, we measured MMSE-K and K-MAS for the experimental and control groups. Results:The findings of the study were as follows. 1) the experimental group showed significant improvement on MMSE-K score in comparison with baseline, but the control group did not. 2) the experimental group showed significant improvement on K-MAS score in comparison with baseline, but the control group did not. In particular, among the three subscales of K-MAS, only verbal memory scale revealed significant improvement, while visual and short-term memory scales revealed no differences. Conclusion:Our cognitive rehabilitation program improves cognitive state and memory, particulary verbal memory, for TBI patients. These results imply that our program aids in rehabilitation of basic cognition such as memory which is necessary to operate on high cognitive function such as problem-solving or judgement, for TBI(traumatic brain injury) patients.

• Journal of Trauma and Injury
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• 제30권2호
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• pp.41-46
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• 2017

Purpose: To determine the incidence of post-concussion syndrome (PCS) in Korean patients after minor traumatic brain injury. Methods: We conducted an observational cohort study of a convenience sample of patients presenting to the emergency department of a major academic Korean hospital. Patients who visited the Emergency Department for head trauma were screened. A researcher questioned the subject regarding his or her symptoms. Subjects were contacted by phone approximately 2 weeks after their Emergency Department visit and questioned about subsequent symptoms and subsequent visits for medical care. Results: Only 8% of subjects reported any post-concussion symptoms. Only 0.4% had three or more symptoms which might have met criteria for PCS. The median peak onset of symptoms was 3 days after injury. Conclusion: The incidence of PCS is Korean patients is much lower than that documented for patients in the United States or other western countries. On the other hand, this study results could give an idea that mild trauma could also cause the PCS. Further study is needed to replicate this finding and investigate possible explanations for this difference.

• 대한간호학회지
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• 제35권2호
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• pp.270-282
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• 2005

Purpose: This study was conducted to develop a comprehensive cognitive rehabilitation program that can be easily applied to brain injured patients by family members or nurses in community or hospital settings. Methods: A Systemic literature review design was used. Thirty-three related studies were reviewed. Result: Based on the results of the literature review, the training tasks for attention were designated to enhancing 4 hierarchical areas, i.e., focused, selective, alternating, and divided attention. On the other hand, the memory rehabilitation tasks mainly consisted of mnemonic skills, such as the association method which helps patients memorize given information by linking together common attributes, the visual imagery method, and self-instruction method. The problem solving rehabilitation program included a task of games or plays which stimulated the patients' curiosity and interest. The training tasks for problem solving were to encourage the process of deriving reasonable solutions for a problematic situation resembling real problems that the patients were faced with in their everyday life. Conclusion: It is expected that the cognitive rehabilitation program developed from this study could help patients having difficulty in their every day life, due to a reduced cognitive ability resulting from brain injury, to effectively adapt to every day life.

• Journal of Korean Neurosurgical Society
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• 제58권2호
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• pp.125-130
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• 2015

Objective : Repeated computed tomography (CT) follow up for traumatic brain injury (TBI) patients is often performed. But there is debate the indication for repeated CT scans, especially in pediatric patients. Purpose of our study is to find risk factors of progression on repeated CT and delayed surgical intervention based on the repeated head CT. Methods : Between March, 2007 and December, 2013, 269 pediatric patients (age 0-18 years) had admitted to our hospital for head trauma. Patients were classified into 8 subgroups according to mechanisms of injury. Types, amount of hemorrhage and amount changes on repeated CT were analyzed as well as initial Glasgow Coma Scale (GCS) scores. Results : Within our cohort of 269 patients, 174 patients received repeat CT. There were progression in the amount of hemorrhage in 48 (27.6%) patients. Among various hemorrhage types, epidural hemorrhage (EDH) more than 10 cc measured in initial CT was found to be at risk of delayed surgical intervention significantly after routine repeated CT with or without neurological deterioration than other types of hemorrhage. Based on initial GCS, severe head trauma group (GCS 3-8) was at risk of delayed surgical intervention after routine repeated CT without change of clinical neurologic status. Conclusion : We suggest that the patients with EDH more than 10 cc or GCS below 9 should receive repeated head CT even though absence of significant clinical deterioration.

• Journal of Korean Neurosurgical Society
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• 제66권1호
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• pp.63-71
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• 2023

Objective : Traumatic brain injury (TBI) is one of the most common injuries in patients with multiple trauma, and it associates with high post-traumatic mortality and morbidity. A trauma center was established to provide optimal treatment for patients with severe trauma. This study aimed to compare the treatment outcomes of patients with severe TBI between non-trauma and trauma centers based on data from the Korean Neuro-Trauma Data Bank System (KNTDBS). Methods : From January 2018 to June 2021, 1122 patients were enrolled in the KNTDBS study. Among them, 253 patients from non-traumatic centers and 253 from trauma centers were matched using propensity score analysis. We evaluated baseline characteristics, the time required from injury to hospital arrival, surgery-related factors, neuromonitoring, and outcomes. Results : The time from injury to hospital arrival was shorter in the non-trauma centers (110.2 vs. 176.1 minutes, p=0.012). The operation time was shorter in the trauma centers (156.7 vs. 128.1 minutes, p=0.003). Neuromonitoring was performed in nine patients (3.6%) in the non-trauma centers and 67 patients (26.5%) in the trauma centers (p<0.001). Mortality rates were lower in trauma centers than in non-trauma centers (58.5% vs. 47.0%, p=0.014). The average Glasgow coma scale (GCS) at discharge was higher in the trauma centers (4.3 vs. 5.7, p=0.011). For the Glasgow outcome scale-extended (GOSE) at discharge, the favorable outcome (GOSE 5-8) was 17.4% in the non-trauma centers and 27.3% in the trauma centers (p=0.014). Conclusion : This study showed lower mortality rates, higher GCS scores at discharge, and higher rates of favorable outcomes in trauma centers than in non-trauma centers. The regional trauma medical system seems to have a positive impact in treating patients with severe TBI.