• 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.

• Archives of Plastic Surgery
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• 제42권4호
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• pp.391-406
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• 2015

Macrodystrophia lipomatosa (MDL) is a rare congenital non-hereditary disorder that has significant impact on patient morbidity. This study provides a comprehensive review of the natural history, diagnosis, management, and outcomes of the disorder. A literature search in PubMed was conducted to identify cases of MDL from January 1950 to 14 February 2014. After ruling out articles without information related to the management of the disorder, a summary of 32 studies was performed. An additional three cases from the authors are also presented. Based on 57 journal articles and three additional cases from the authors, around 108 cases of MDL were reviewed. Most patients were males who were admitted to a treatment clinic in the first four years of life. The lower extremities were more frequently affected, with unilateral presentation being most common. They commonly underwent a single-staged surgical procedure with follow-up periods ranging from more than one year up to 21 years. Out of 43 cases that underwent surgical procedures, 13 reported no complications, and there were seven cases of esthetic satisfaction and 15 cases of significant functional improvement. Depending on the severity of a patient's condition, the use of non-invasive diagnostic tools should be carefully considered. Surgery might be a better choice of management than observation, taking into account possible future complications in the absence of surgery and the beneficial outcomes of surgical procedures.

• Journal of Acupuncture Research
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• 제34권3호
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• pp.121-130
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• 2017

Objectives : The purpose of this study was to report the clinical effects of the Graston Technique and Chuna manual therapy, combined with Korean Medical Treatment for fibromyalgia. Methods : We treated a patient diagnosed with fibromyalgia. We used acupuncture, the Graston Technique, Chuna manual therapy, pharmacopuncture, herbal medicine, moxibustion and physical therapy. Outcomes were evaluated using the American College of Rheumatology Preliminary Diagnostic Criteria (ACR), the Fibromyalgia Impact Questionnaire (FIQ), and the Numeric Rating Scale (NRS). Results : The widespread pain index (WPI) scale score of the ACR decreased from 12 to 9, and the symptom severity scale (SS) score of the ACR decreased from 8 to 6. The FIQ score decreased from 63.69 to 50.15. On the NRS, lower back pain & lower limb pain decreased from 6 to 2; neck pain from 6 to 3; muscle tenderness & morning stiffness from 6 to 4; fatigue from 6 to 3; urticaria from 6 to 2. Conclusion : This case study suggests that the Graston Technique and Chuna manual therapy combined with Korean Medical Treatment may be effective treatments for fibromyalgia. However, further studies are needed.

• The Korean Journal of Pain
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• 제13권1호
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• pp.84-88
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• 2000

Background: An increase in the maximum level of sensory blockade (MLSB) following an epidural top-up in combined spinal epidural anesthesia (CSE) may be achieved by a volume effect as the volume of local anesthetic compresses the dural sac, by a local anesthetic effect, or by a combination of both effects. This study was conducted to investigate the contribution of each of these effects. Methods: Sixty patients scheduled for lower limb surgery under CSE were randomly allocated to one of three groups of twenty patients each. Using the needle-through needle technique, all patients received a subarachnoid dose of 10 mg hyperbaric 0.5% bupivacaine. At 30 min after subarachnoid injection, an epidural top-up with saline 10 ml (group II) or 0.5% bupivacaine 10 ml (group III) was administered; patients in group I received no epidural top-up. The level of sensory blockade was assessed at 5, 10, 15, 20, 25, 30 min after subarachnoid injection and at 5, 10, 15, 20, 25, 30 min after epidural top-up. Results: There was no significant difference in the MLSB and the onset time of MLSB among group I-III. Conclusions: We concluded that the epidural top-up with saline 10 ml or 0.5% bupivacaine 10 ml which injected at 30 min after subarachnoid injection did not significantly increase the level of subarachnoid block in lower extremity surgical patients.

• 한국의류산업학회지
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• 제11권4호
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• pp.621-632
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• 2009

The purpose of this study was to analyze the physical characteristic of the wheelchair users by directly measuring the disabled men who use a wheelchair and to classify body types. The subjects were 178 male wheelchair users 20-69 years range of age. The results of this study were as follows. The cause of disability was classified into four groups; Poliomyelitis(P), Spinal Cord Injury(S), Cerebral Palsy(C), Amputee(A). There was a remarkable difference in the physical characteristic of the wheelchair users due to their cause of disability. A have greater values in all the dimensions. P have the largest drop values and smaller values in the lower body dimensions. S have greater values in the height of upper body trunk, back interscye length, and chest circumference, whereas smaller values in waist front length and thigh circumference. C have smaller values in most body dimensions except circumference of lower limb. By the factor analysis on the anthropometric data came out the result to be eight factors. The result of cluster analysis using factor scores shows the body types of wheelchair users can be divided into four body types; PY, RBB, TBP, RA. PY type is short and has the largest drop values, whereas RBB type tends to have the smallest drop values. TBP type is tall and the torso tends to be larger than those of the other types. RA type has smaller values in front body dimensions and moderate values in other dimensions. The diversity in body types should be considered among the wheelchair users.

• 대한물리의학회지
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• 제5권3호
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• pp.487-498
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• 2010

Purpose : To investigate the immediate effects of transcutaneous electrical nerve stimulation(TENS) on the spasticity and the balance in the stroke patients. Methods : 26 subjects with spasticity over lower limbs were allocated randomly into two groups : (1) TENS group, (2) placebo-TENS group. TENS was applied on the both gastrocnemius for 60 minutes(100 Hz, 0.25 ms, 2 times sensory threshold). The modified Ashworth Scale(MAS) and Manual Muscle Tester were used to assess the spasticity of the ankle plantar flexors. Static balance under three conditions was measured by force-plate; in (1) the condition of standing with eyes opened, (2) with eyes closed and (3) the condition of standing on unstable surface with eyes opened. Results : When compared with the pre and post TENS application, TENS showed significant reduction of ankle spasticity in MAS and MMT measurement. Also, Application of high-frequency TENS improved the balance under three conditions. Conclusion : A single session of TENS to stroke patients could reduce spasticity and improve the balance.

• 대한물리의학회지
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• 제12권4호
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• pp.1-9
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• 2017

PURPOSE: This study investigated the effect that an elastic therapeutic taping treatment given to patients with chronic ankle instability had on the vertical ground reaction force, center of pressure, and range of motion in the ankle, knee and hip joints, during a Cross-cutting movement from landing. METHODS: This study analyzed 12 able-bodied adults and 12 patients with chronic ankle instability classified by using the Cumberland tool in the motion analysis laboratory, Hanseo University. The experiment was conducted under two conditions elastic taping and no treatment. In order to analyze the difference between the groups. An independent t-test was performed at p>.01. RESULTS: Plying an elastic therapeutic taping to the patients with chronic ankle instability significantly decreased the range of joint motion in the inversion of the ankle joint, the flexion of the knee joint, and the flexion and internal rotation of the hip joint during a cross-cutting movement from landing in comparison with the able-bodied adults p<.01. This restriction in the range of motion decreased the center-of-pressure trajectory length of patients with chronic ankle instability p>.01. CONCLUSION: An elastic therapeutic taping treatment given to patients with chronic ankle instability causes ankle stability to increase during a cross-cutting movement from landing.

• 대한물리의학회지
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• 제14권4호
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• pp.195-201
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• 2019

PURPOSE: This study aimed to quantify the effects of whole body vibration (WBV) stimulation training on the muscle thickness and gross motor function in children with spastic cerebral palsy. METHODS: Twenty children diagnosed with spastic cerebral palsy were assigned randomly to the Whole Body Vibration (WBV) group (n=10) and control group (n=10). The WBV group received vibration therapy including five different therapy, and the control group received only five general physiotherapy sessions. After 10 weeks of intervention, the muscle thickness was measured using ultrasound, and the Gross Motor Function D and E items were evaluated. RESULTS: After the intervention, both groups showed a significant increase in muscle thickness and gross motor function (p<.05). The WBV group showed a significant increase in the quadriceps femoris and tibialis anterior muscles compared to the control group, whereas no significant increase in the gastrocnemius muscle was observed (p<.05). The WBV group showed significant improvement in the Gross Motor Function D and E scores compared to the control group (p<.05). CONCLUSION: WBV training may be a useful way of improving the lower extremity muscle strength in children with spastic cerebral palsy, which may help improve the gross motor function.

• 대한임상전기생리학회지
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• 제9권2호
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• pp.25-30
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• 2011

Purpose : This study aims to examine the changes of muscle activity of the tibialis anterior muscle and the gastrocnemius muscle on the ground and unstable ground for functional reach test. Methods : This study chose 24 elderly men and 24 elderly women who could walk independently, reach their arm over 25 cm, show shoulder joint $90^{\circ}$ flexion, had no operations on lower limb joints, and don't take medication affecting the ability to keep balance. Muscular activity of the tibialis anterior muscle and the gastrocnemius muscle was measured using functional reach test and electromyogram. Functional reach test was conducted at a total of four sections, 0cm, 15cm, 20cm, and 25cm. Results : It was known that the gastrocnemius muscle was used more than the tibialis anterior muscle to keep balance and the elderly with good balance ability showed no great change of muscular activity on both the stable and unstable ground. Conclusion : It was found that the subjects used their gastrocnemius muscle more and lower limbs of frequently used parts to keep their balance. As the elderly have good balance ability, they showed no great change of muscular activity on both the stable and unstable ground.

• The Journal of Korean Physical Therapy
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• 제27권3호
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• pp.159-163
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• 2015

Purpose: This study aimed to determine the interaction among the neck, trunk, and lower extremities on the non-paretic side in head rotation along with non-paretic-side weight shifting of stroke patients. To compare stroke patients' ability to control posture through muscle activity variation related to pertubation during head rotation along with the non-paretic limb. Methods: We tested 15 hemiplegic patients and 15 normal individuals. Each group's muscle activity was measured by electromyography in neutral head position and head rotation position. We compared each group's resu lt based on measured values in patients' non-paretic neck muscles, trunk muscles, and lower limbs muscles activation. Results: The study showed that muscle activity increased in the sternocleidomastoid muscle (102.26%, 53.00%), splenius capitis muscle (97.93%, 54.93%), erector spinae muscle (241.00%, 127.60%), external oblique abdominal muscle (256.66%, 152.00%), and internal oblique abdominal muscle (252.80%, 152.6%), peroneus longus muscle (117.53%, 137.13%) and gastrocnemius muscle (119.06%, 137.20%), while the results for the sternocleidomastoid muscle, splenius capitis muscle, erector spinae muscle, external oblique abdominal muscle, internal oblique abdominal muscle, peroneus longus muscle, and gastrocnemius muscle showed a statistically significant difference (p<0.05). Conclusion: It is hard for stroke patients to engage in normal movement control under suggested conditions because of the insufficient movement against gravity on the stroke patient's non-paretic side and impaired cooperative patterns. To solve these problems, patients need their bodies to improve through effective movement, resulting in advanced control of their effective and functional activity.