• 대한의용생체공학회:의공학회지
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• 제38권4호
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• pp.143-152
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• 2017

The main purpose of this research was to examine the EMG characteristics of driver's upper limb and driving performance for operating accelerator and brake pedal by using four types of left hand control devices(Push/Pull, Push/Right angle, Push/Rock, Push/Twist) during simulated driving. The persons with disabilities in the lower extremity have problems in operation of the vehicle because of functional impairments for controlling accelerator and brake pedal. Therefore, if hand control device is used for adaptive driving controls in persons with lower extremity loss, the disabled people could improve their quality of mobility life by driving a car. Twenty subjects were involved in this research to assess driving performance and EMG activities for operating accelerator and brake pedal by using four types of left hand controls in driving simulator. We measured EMG responses of six muscles(posterior deltoid, middle deltoid, biceps, triceps, extensor carpi radialis, and flexor carpi radialis) during pulling and pushing movement with four types of left hand controls for acceleration and braking. STISim Drive 3 program was used for evaluation test of four types of left hand control devices in straight lane course for time to reach target speed and brake reaction time. While operating the four types of left hand controls for acceleration, EMG activities of posterior deltoid in normal subjects were significantly increased(p < 0.05) compared to the disabled subjects. It was also found that EMG responses of triceps and posterior deltoid were significantly increased(p < 0.05) when using the Push/Right angle type than Push/Pull type. While operating the four types of left hand controls for braking, EMG activities of flexor carpi radialis and triceps in subjects with disability were significantly increased(p < 0.05) compared to the normal subjects. It was shown that muscle responses of posterior deltoid, middle deltoid and triceps were significantly increased when using the Push/Right angle type than Push/Rock type. Time to reach target speed and brake reaction time in subjects with disability was increased by 2.5% and 4.6% on average compared to normal subjects. The person with disabilities showed a tendency to relatively slow performance in acceleration at the straight lane course.

• 대한의용생체공학회:의공학회지
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• 제38권2호
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• pp.74-81
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• 2017

The purpose of this study was to investigate the EMG characteristics of driver's upper extremity and driving performance for manipulating brake and accelerator pedal by using left and right hand control devices during simulated driving. The people with disabilities in the lower limb have problems in operation of the motor vehicle because of functional loss for manipulating brake and accelerator pedal. Therefore, if hand control device is used for adaptive driving controls in people with lower limb impairments, the disabled people can improve their quality of life by driving a motor vehicle. Six subjects were participated in this study to evaluate driving performance and muscle activities for operating brake and accelerator pedal by using two different hand controls (steering column mounted hand control and floor mounted hand control) in driving simulator. We measured EMG activities of six muscles (posterior deltoid, middle deltoid, triceps, biceps, flexor carpi radialis, and extensor carpi radialis) during pushing and pulling movement with different hand controls for acceleration and braking. STISim Drive 3 software was used for the performance test of different hand control devices in straight lane course for time to reach target speed and brake reaction time. While pulling the hand control lever toward the driver, normalized EMG activities of middle deltoid, triceps and flexor carpi radialis in subjects with disabilities were significantly increased (p < 0.05) compared to the normal subjects. It was also found that muscle responses of posterior deltoid were significantly increased (p < 0.05) when using the right hand control than left hand control. While pushing the hand control lever forward away from the driver, normalized EMG activities of posterior deltoid, middle deltoid and extensor carpi radialis in subjects with disability were significantly increased (p < 0.05) compared to the normal subjects. It was shown that muscle responses of middle deltoid, biceps and extensor carpi radialis were significantly increased when using the right hand control than left hand control. Brake reaction time and time to reach target speed in subjects with disability was increased by 12% and 11.3% on average compared to normal subjects. The subjects with physical disabilities showed a tendency to relatively slow acceleration at the straight lane course.

• 재활복지
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• 제18권4호
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• pp.221-235
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• 2014

최근 급속한 인구 고령화로 인해 뇌졸중의 발생빈도가 증대되고 있으며, 후천적 장애의 주요 발생요인이 되고 있다. 본 연구는 뇌졸중의 후유증으로 인한 장애를 극복하기 위한 재활 과정에서 사용되는 보조장비인 체위제어용 자세변환기에 관한 것이다. 본 논문에서는 국내와 일본의 자세변환기 용품을 조사하여 기능과 용도에 따라 분류와 비교를 수행하였고, 와상체위를 제어하기 위해 스마트 고기능 자세변환 시스템의 설계방식을 제안하였다. 이는 욕창방지 튜브와 체위 경사동작 튜브를 통합한 매트리스 동작을 갖도록 고안된 것이다. 또한 스마트 기능을 추가하여 현재 기기 상태의 모니터링과 기본자세변경, 교대부양 및 체위제어의 무선 기능의 수행이 가능하도록 설계하였다. 시스템제어 하드웨어는 3개의 주요부, 즉 센서 검출부, 모터구동 제어부, 블루투스(Bluetooth) 통신을 위한 시스템제어부로 구성되어 있다. 결과로서, 본 연구에 의해 설계된 시스템이 최근 인터넷 정보화 기술의 적용분야인 IoT(Internet of Things) 기술이 접목된 고기능 스마트 자세변환장치로 실용화 될 수 있음을 확인하였다.

• 한국엔터테인먼트산업학회논문지
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• 제13권8호
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• pp.619-626
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• 2019

본 연구는 광주광역시 북구에 거주하고 생활건강지원센터에서 제공하는 재활프로그램에 참여하고 있는 성인발달장애인으로 참여형 재활프로그램이 성인발달장애인의 앉았다 일어서기, 일어나 걸어가기 및 지각-운동능력에 어떠한 영향을 미치는지 알아보고자 성인발달장애인 17명을 대상으로 참여형 재활프로그램을 13주간 주 1회 60분의 프로그램을 적용하여 중재 전, 후 그리고 12주 후 재측정하여 다음과 같은 결론을 얻었다. 앉았다 일어서기 검사에서는 중재 전과 후에 횟수의 증가는 있었지만 통계적으로 유의한 차이는 없었다. 일어나 걸어가기 검사에서는 시간에 따라 통계적으로 유의한 차이가 있었으며, 사후검증결과 중재 전보다 후에 유의한 효과가 있었다. 지각-운동능력 검사에서는 유의한 차이는 없었다. 본 연구의 결과를 종합해보면 참여형 재활프로그램이 기능적 동작과 관련된 동적균형에 긍정적인 영향을 미쳤음을 알 수 있었다. 그러나 운동조절 및 운동학습과 관련된 지각-운동능력에는 유의한 차이가 나타나지 않았다. 향후 성인발달장애인의 지역사회활동 증가와 낙상의 위험 감소 및 동적 균형능력 향상을 위해 참여형 재활프로그램을 활용하여 신체적 웰빙을 도모할 수 있을 방안으로 제안하는 바이다.

• 한국노년학
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• 제30권4호
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• pp.1293-1309
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• 2010

본 연구는 허약노인의 장애발생예방을 위하여 개발된 지역사회 방문재활 프로그램의 효과성을 평가하고, 허약노인 대상의 방문재활사업이 공공부문의 보건기관에서 실제 수행될 수 있도록 그 근거를 마련하는 것을 목적으로 하고 있다. 2009년 4월부터 8월까지 맞춤형 방문건강관리사업에 등록된 저소득 취약계층 노인들 중 110명의 허약노인을 선정하여, 이들을 대상으로 지역사회 중심의 실험연구를 수행하였다. 연구대상자는 무작위 방식으로 실험군(n=50)과 대조군(n=60)으로 나뉘어, 이 중 실험군은 3개월 동안 상·하지 근력강화, 보행능력 강화, 균형능력증진 등에 초점 맞추어진 허약노인 방문재활 프로그램에 참여하게 하였고, 대조군은 가정방문을 통한 낙상예방교육을 받게 하였다. 프로그램의 평가를 위해 1차 결과지표로서 신체기능척도, 간이신체기능 평가를 프로그램 사전·사후에 측정하였고, 그밖에 운동수행능력검사, 영양지표, 정서기능, 입원 및 낙상경험 등을 측정하였다. 연구결과 방문재활 프로그램에 참여한 대상자에서 신체기능척도와 간이신체기능평가 등 주요 노인기능지표의 유의한 향상이 관찰되었다. 신체기능척도에 대해서 실험군은 1.3 ± 3.8점의 상승이 있었던 반면, 대조군에서는 1.1 ± 5.4점의 감소가 있었다 (p=.020). 간이신체기능평가에 대해서도 실험군은 2.4 ± 2.0점의 상승이 있었던 반면, 대조군에서는 0.3 ± 1.5점의 상승만이 관찰되었다 (p<.001). 그밖에 허약노인을 위한 방문재활 프로그램은 운동수행능력, 정서기능, 반복낙상 횟수 및 낙상 후 기능저하 발생에 대해서도 유의한 효과를 보여주었다 (p .002-.038). 향후 우리나라 노인들의 장애발생을 예방하고 이로 인한 중증 장기요양단계로의 진입을 억제하기 위하여 허약노인 대상의 방문재활 프로그램과 이에 근거한 건강관리사업이 보다 적극적으로 확대·보급되어야 할 것이다.

• Archives of Plastic Surgery
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• 제46권6호
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• pp.589-593
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• 2019

Post-traumatic defects of the distal third of the leg often require skipping a few steps of the well-established reconstructive ladder, due to the limited local reliable reconstructive options. In rare cases, the reconstructive plan and flap choice may encounter challenges when the patient has psychiatric illness affecting compliance with postoperative care. We describe a case of a patient with severe intellectual disability and an open fracture of the distal lower limb. After fracture management and debridement of devitalized tissues, the resultant soft tissue defect was covered with a free gracilis flap. On postoperative day 7, the patient ripped out the newly transplanted flap. The flap was too traumatized for salvage, so a contralateral free gracilis muscle flap was used. The patient showed good aesthetic and functional outcomes at a 1-year follow-up. When planning the postoperative management of patients with psychiatric illness, less complex and more robust procedures may be preferred over a long and complex surgical reconstruction requiring good compliance with postoperative care. The medical team should be aware of the risk of postoperative collapse, focus on the prevention of pain, and be wary of drug interactions. Whenever necessary, free tissue transfer should be performed despite potential compliance issues.

• Clinics in Shoulder and Elbow
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• 제21권2호
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• pp.59-66
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• 2018

Background: Massive, irreparable rotator cuff tears (RCTs) are a challenging clinical problem in young patients. In recent years, arthroscopic superior capsular reconstruction (ASCR) is a popular treatment in the massive, irreparable RCTs. However, studies reporting clinical results of ASCR are rare in the literature. Methods: Between 2013 and 2015, six patients underwent ASCR. One patient treated with dermal allograft, while five patients with autogenous fascia lata graft. Demographic data, as well as preoperative and last follow-up clinical data including pain, range of motion (ROM), strength, American Shoulder and Elbow Surgeons system, the Constant system, the University of California at Los Angeles system, the Simple Shoulder Test, and the Shoulder Pain and Disability Index system were obtained. Acromiohumeral distances and Hamada classification were measured on standard anteroposterior x-ray. Results: All patients were men, and the average age was $59.5{\pm}4.18years$ (range, 53-65 years).The minimum follow-up was 18 months with a mean follow-up was $27.33{\pm}7.58months$ (range, 18-36). All patients had postoperative improvement in pain scores and functional scores. The ROM and strength did not improve after surgery. The Hamada score progressed of radiographic stage in 2 patients. In the case of dermal allograft, there was graft failure 6 weeks after ASCR. Conclusions: Our results support the ASCR as a viable treatment for surgical salvage in massive, irreparable RCTs. This treatment option may provide patients with decreased pain and increased function. And studying our case of dermal allograft failure provides opportunities to decrease graft failure in ASCR using dermal allograft.

• 한국ITS학회 논문지
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• 제6권1호
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• pp.58-71
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• 2007

교통약자 즉, 장애인과 노약자의 자립생활과 사회통합을 위한 장애물 없는 생활환경(Barrier-Free)의 실현은 건축, 도시, 교통, 도로 등 통합적인 측면에서 생활환경의 설계기준 재정비 등 하드웨어적인 측면과 함께 사회활동에 필요한 편의시설의 다양한 정보접근과 이용 등 소프트웨어적인 측면이 동시에 충족되어야 하며, 소프트웨어적인 측면은 편의시설의 이용성을 제고하는데 있어 매우 중요한 문제이다. 이러한 측면에서 편의시설의 이용성 향상을 위해 유비쿼터스 기술 등 정보통신기술을 활용한 지원시스템 구축이 필요하다. 대표적 교통약자인 장애인 노약자가 사회생활을 하기 위하여 주거지를 넘어 다른 장소로 이동하고자 할 경우에도 이들의 목적을 달성하기에 어려움이 없도록 정보를 제공하고 지원하는 시스템이 필요하다. 장애인, 노약자의 행태조사 및 요구조사를 통한 요구사항분석과 장애인, 노약자 중심의 생활 및 이동지원시스템관련 국외 연구동향 및 관련 기술요소파악 및 시스템 요구조건과 유즈케이스를 도출하였다.

• Neonatal Medicine
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• 제25권1호
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• pp.7-15
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• 2018

We need to understand the outcomes into adulthood for survivors born either extremely low birthweight (ELBW; <1,000 g) or extremely preterm (EP; <28 weeks' gestational age), particularly their blood pressure and cardiovascular metabolic status,respiratory function, growth, psychological and mental health performance, and functional outcomes. Blood pressure is higher in late adolescence and early adulthood in ELBW/EP survivors compared with controls. In some studies, expreterm survivors have higher insulin and blood lipid concentrations than controls, which may also increase their risk for later cardiovascular disease. ELBW/EP survivors have more expiratory airflow obstruction than do controls. Those who had bronchopulmonary dysplasia (BPD) in the newborn period have even worse lung function than those who did not have BPD. As a group, they are unlikely to achieve their full lung growth potential, which means that more of them are likely to develop chronic obstructive airway disease in later life. Although they are smaller than term born controls, their weight gradually rises and ultimately reaches a mean z-score close to zero in late adolescence, and they ultimately attain a height z-score close to their mid-parental height z-score. On average, ex-preterm survivors have intelligence quotient (IQ) scores and performance on tests of academic achievement approximately 2/3 SD lower than do controls, and they also perform less well on tests of attention and executive function. They have similar high rates of anxiety and depression symptoms in late adolescence as do controls. They are, however, over-represented in population registries for rarer disorders such as schizophrenia and Autism Spectrum Disorder. In cohort studies, ex-preterm survivors mostly report good quality of life and participation in daily activities, and they report good levels of self-esteem. In population studies, they require higher levels of economic assistance, such as disability pensions, they do not achieve education levels as high as controls, fewer are married, and their rates of reproduction are lower, at least in early adulthood. Survivors born ELBW/EP will present more and more to health carers in adulthood, as they survive in larger numbers.

• Archives of Reconstructive Microsurgery
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• 제21권1호
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• pp.56-60
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• 2012

Purpose: Thumb reconstruction plays most important role in hand injuries because total loss of a thumb constitutes about 40% disability in the hand. The reconstruction can be accomplished by pollicization, free toe-to-thumb transfer, wrap around procedure and lengthening extraction. However, we sometimes need consecutive or double free flaps in the reconstruction of mutilating hand injuries. Methods: We reconstructed a mutilating hand injury in a 54-years old man. Because of severe crushing injury of right thumb and index fingers, we reconstructed a thumb with pollicization using nearly amputated middle finger. Although it survived completely, the adjacent soft tissues which had been covered by fillet flap from the space past was necrosed on 1 month. We debrided the necrotic tissues and covered it with anteromedial thigh perforator free flap consecutively because he had an anatomical variation in branches of lateral femoral circumflex artery. Results: He had an uneventful postoperative course without any complication such as infection, dehiscence and flap necrosis. Three months later, he had undergone tenolysis and defatting procedure of flap site. He recovered the some amount of grip function and was happy with the result. Conclusion: In severe hand trauma including thumb amputation, thumb reconstruction using pollicization and perforator free flap could be an alternative option. It provides minimal donor site morbidity and an acceptable functional result.