• The Korean Journal of Pain
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• 제14권1호
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• pp.104-109
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• 2001

We describe the accidental injection of local anesthetics containing steroid into the subdural space during an attempted lumbar epidural injection for intractable radiculopathy in a patient with failed back surgery syndrome. A 24-year-old man complained of severe radiating pain to left lower extremity and showed a walking disturbance and severe lumbar scoliosis. The MRI finding was a left paramedian recurred disc herniation on L4-5 in a laminectomy state. Several therapeutic modalities such as epidural steroid injection, transforaminal injection, L2 root block, medication, and exercise therapy, etc failed. Initially, during epidural block at L4-5 under fluoroscopic guidance, a railroad track appearance appeared on epidurogram suggesting the presence of a subdural space. A second epidural block was tried at L5-S1. Following confirmation of epidural space upon epidurogram, 6 ml of 0.5% lidocaine including triamcinolone 40 mg was injected. The patient showed signs of the subdural injection including an unexpectedly high sensory block (T2) and a motor weakness of both lower extremities. Following this event, the severe radiculopathy and lumbar scoliosis were improved. Therefore, we conclude that subdural injection of steroid could be helpful in intractable radiculopathy, especially in the failed back surgery syndrome. However, it must be used cautiously with careful patient selection.

• 재활복지공학회논문지
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• 제12권1호
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• pp.46-52
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• 2018

본 연구는 65세 이상 도시거주 노인 107명을 대상으로 일반적 특성, 만성질환 상태, 낙상 관련 의학적 변수, 균형 관련 자신감, 신체적 능력, 우울감을 평가하는 도구를 통해 낙상에 영향을 미치는 관련 주 요인을 찾고자 하였다. 또한 유의한 차이가 있는 변수들 간의 상관관계를 파악하며, 이 중 낙상을 유발하는 데 높은 영향력이 있는 변수를 도출하여 예측력을 알아보았다. 연구 결과, 낙상군에서 요실금, 발의 통증, 하지근력약화, 만성 질환수 및 복용 약물수 빈도수가 비낙상군에 비해 통계적으로 유의하게 높았다. 또한 ABC (Activities-specific Balance Confidence) 총점, BBS (Berg Balance Scale) 총점, SGDS (Short Geriatric Depression Scale) 총점, FRT(Functional Reach Test) 값에서 통계학적으로 유의한 차이가 있었다. 낙상에 영향을 주는 주요인은 ABC 총점으로 점수가 낮을수록 낙상 위험이 높아짐으로써 균형능력에 대한 자기 확신감이 낮을수록 낙상의 가능성이 높아지는 것으로 나타났으며, ABC, SDGS, BBS 척도가 결합하여 적용될 경우 낙상군과 비낙상군을 구분하는 예측력은 70.1%로 높게 나타났다.

• 척추신경추나의학회지
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• 제10권1호
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• pp.87-95
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• 2015

Background : Charcot Marie Tooth disease can cause muscle weakness and foot deformity. Ankle pain induced by foot deformity affect patients' gait pattern and quality of life. Objectives : The purpose of this study is to evaluate the traditional Korean medicine treatment for ankle pain induced with Charcot-Marie Tooth Disease, especially Chuna manual therapy on ankle joints. Methods : One patient was treated with acupuncture, phamacopuncture, herbal medication and chuna manual therapy on ankle joints. To evaluate the pain of ankle, lower back and lower extremity, visual analog scale(VAS) was measured. Results : After treatment for 5 week, the pain of ankle joint was declined from VAS 6 to VAS 2. Conclusions : Traditional Korean medicine treatment including acupuncture, pharmacopuncture, herbal medication and Chuna manual therapy is effective for ankle pain with foot deformity. But further studies are required to prove the effectiveness of Chuna manual therapy on ankle joints.

• 대한간호학회지
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• 제29권3호
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• pp.665-678
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• 1999

Stroke is a major cause of death and long-term disability. Because muscle weakness is one of the most prominent consequences of stroke, it was considered important to determine whether exercise in order to improve muscle strength and range of motion could have an effect in limiting the learned disuse of the affected side. The purpose of the study was to identify the effects of an 8 week rehabilitation program on physical and cognitive ability in stroke patients. A total of 18 patients who were admitted to the oriental medicine unit of a K medical center in Seoul were recruited : ten for the experimental group and eight for the control group. The rehabilitation program consisted of three level's of active and passive exercises for prevention of muscle contracture and at range of motion. Muscle strength, flexibility of the upper and lower extremity, perceived balance, functional independence, depression, and quality of life for the two groups were compared at the pretest and 4 and 8 weeks after the rehabilitation program. The results are as follows : 1) When measuring muscle strengths of shoulder abduction and elbow flexion, hip flexion and knee extensor, ankle dorsi-flexor and muscle strength of knee flexor. Muscle strength of knee flexor for the experimental group was significantly higher than the comparison group at the 4 weeks. 2) Muscle strength and flexibility of the ankle dorsi -flexor for the experimental group was significantly better than for the control group at 8 weeks. 3) Functional independence, perceived balance, and Tinetti balance for the experimental group as measured at 4 and 8 weeks were better than for the control group. Also, there were changes over time in physical balance and functional ability, but there was no significant differences between the groups. 4) The experimental group showed a higher quality of life and lower depression than the control group at 8 weeks. 5) Muscle strength and flexibility of ankle dorsi -flexor were significantly changed over time and an interaction between group and time. The findings suggested that the rehabilitation program would improve the physical and psychological status of the stroke patients. Thus, the gains in actual or perceived ability to perform physical activities was marked.

• Tuberculosis and Respiratory Diseases
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• 제60권3호
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• pp.353-356
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• 2006

폐결핵 치료중 흉부엑스선상 악화 및 갑자기 발생한 하지 마비와 감각이상으로 자기공명영상 촬영후 급성 횡단척수염 진단 및 객담 검사상 다제내성 결핵균 검출로 2차 결핵약제와 스테로이드 병합치료를 시행하여 부분적으로 호전을 보였던 증례이다. 급성 횡단척수염은 매우 드문 질환이며 균주의 직접 침범이나 면역학적 기전으로 발생하나 후자가 더 가능성 있는 기전으로 생각되어지고 있다. 아직도 결핵 및 다제내성 결핵의 유병률이 높은 국내 상황에서 드물게 결핵이 원인으로 추정된 급성 횡단척수염의 증례를 보고하는 바이다.

• 한국산학기술학회논문지
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• 제11권10호
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• pp.3658-3665
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• 2010

최근 고령화 사회로의 진입 및 장애 인구의 증가로 인해, 인간의 복지를 위한 자동화 시스템에 대한 수요가 늘고 있다. 특히 재활 자동화와 관련한 로봇 시스템은 환자 본인 및 치료 보조자에 대한 수고를 덜어주면서도 기존의 전통적인 재활효과에 상응하는 성과를 얻을 수 있을 것으로 기대되고 있다. 본 연구는 하지 근력이 약화된 사용자들의 신체 자중을 보상해줌과 동시에 정상인과 같은 패턴의 보행 훈련을 수행할 수 있는 모바일형 보행 재활 시스템을 제안하고자 한다. 특히, 자중보상 시스템은 신체의 자세 변화 특징을 반영하여, 기구학적인 분석을 통해 구현하였으며 보행 가이드를 위한 제어 알고리즘과 더불어 메인 컨트롤 시스템이 내장된 모바일 플랫폼에 통합 적용되었다. 이러한 모바일 플랫폼은 사용자의 보행 속도의지를 반영하는 UCS(User Command System)와 플랫폼 자체에 내장된 자율주행 알고리즘의 병합되어 운용되도록 고안되었으며, 본 논문에서는 보행 훈련시의 BWS(Body Weight Support)의 효과에 대한 검증에 집중하고자 한다. 이를 위해 인체의 근전도 신호를 측정할 수 있는 EMG(Electromyography) 센서를 활용하여, BWS 및 모바일로봇을 활용한 자중 보상 시의 피험자의 하지 근력 패턴을 측정 및 분석하여, 정상 보행자와의 차이점을 비교함으로서 본 연구의 타당성을 검증하였다.

• Journal of Korean Neurosurgical Society
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• 제55권6호
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• pp.370-374
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• 2014

To present a case of cauda equina syndrome (CES) caused by chronic inflammatory demyelinating polyneuropathy (CIDP) which seemed clinically similar to Charcot-Marie-Tooth disease type1 (CMT1). CIDP is an immune-mediated polyneuropathy, either progressive or relapsing-remitting. It is a non-hereditary disorder characterized by symmetrical motor and sensory deficits. Rarely, spinal nerve roots can be involved, leading to CES by hypertrophic cauda equina. A 34-year-old man presented with low back pain, radicular pain, bilateral lower-extremity weakness, urinary incontinence, and constipation. He had had musculoskeletal deformities, such as hammertoes and pes cavus, since age 10. Lumbar spine magnetic resonance imaging showed diffuse thickening of the cauda equina. Electrophysiological testing showed increased distal latency, conduction blocks, temporal dispersion, and severe nerve conduction velocity slowing (3 m/s). We were not able to find genetic mutations at the PMP 22, MPZ, PRX, and EGR2 genes. The pathologic findings of the sural nerve biopsy revealed thinly myelinated nerve fibers with Schwann cells proliferation. We performed a decompressive laminectomy, intravenous IgG (IV-IgG) and oral steroid. At 1 week after surgery, most of his symptoms showed marked improvements except foot deformities. There was no relapse or aggravation of disease for 3 years. We diagnosed the case as an early-onset CIDP with cauda equine syndrome, whose initial clinical findings were similar to those of CMT1, and successfully managed with decompressive laminectomy, IV-IgG and oral steroid.

• Journal of Acupuncture Research
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• 제19권6호
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• pp.205-213
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• 2002

Objective : This study was to investigate on the Korean Bee-Venon acupuncture of Cauda equina syndrome which has been described as complex of low back pain, bilateral sciatica, saddle anesthesia and motor weakness in the lower extremity that progress to paraplegia with bladder and bowel incontinence. Methods : Clinical observation was done on Cauda equina syndrome in the Department of Acupuncture & Moxibustion, Kyungwon Inchon Oriental Medical Hospital from may 25 to June 24. The patients was treated with Korean Bee-Venon acupuncture at Samchosu(B22), Shinsu(B23), Taejangsu(B25), Pang-gwangsu(B28) and Yo-yang-gwan(Gv3) with oriental medicine treatment. We evaluated the bladder incontinence, duration of urination and area of anesthesia before and after treatment. Conclusions : 1. At the early time, gait disturbance was treated well, but discomfort bladder incontinence was remained. 2. The symptoms of Cauda equina syndrome especially bladder incontinence was recurred in short duration by Korean Bee-Venon acupuncture and oriental medicine treatment. 3. There was no significant changes in GOT/GPT before and after treatment.

• Journal of Korean Neurosurgical Society
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• 제50권5호
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• pp.434-440
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• 2011

Objective : The goals of surgical intervention for metastatic spinal cord compression (MSCC) are prolonging survival and improving quality of life. Non-ambulatory paraplegic patients, either at presentation or after treatment, have a much shorter life expectancy than ambulatory patients. We therefore analyzed prognostic factors for survival and postoperative ambulation in patients surgically treated for MSCC. Methods : We assessed 103 patients with surgically treated MSCC who presented with lower extremity weakness between January 2001 and December 2008. Factors prognostic for overall survival (OS) and postoperative ambulation, including surgical method, age, sex, primary tumor site, metastatic spinal site, surgical levels, Tokuhashi score, and treatment with chemo- or radiation therapy, were analyzed retrospectively. Results : Median OS was significantly longer in the postoperatively ambulatory group [11.0 months; 95% confidence interval (CI), 9.29-12.71 months] than in the non-ambulatory group (5.0 months; 95% CI, 1.80-8.20 months) ($p$=0.035). When we compared median OS in patients with high (9-11) and low (0-8) Tokuhashi scores, they were significantly longer in the former (15.0 months; 95% CI, 9.29-20.71 months vs. 9.0 months; 95% CI, 7.48-10.52 months; $p$=0.003). Multivariate logistic regression analysis showed that preoperative ambulation with or without aid [odds ratio (OR) 5.35; 95% CI 1.57-18.17; $p$=0.007] and hip flexion power greater than grade III (OR 6.23; 95% CI, 1.29-7.35; $p$=0.038) were prognostic of postoperative ambulation. Conclusion : We found that postoperative ambulation and preoperative high Tokuhashi score were significantly associated with longer patient survival. In addition, preoperative hip flexion power greater than grade III was critical for postoperative ambulation.

• 대한통합의학회지
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• 제7권4호
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• pp.13-21
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• 2019

Purpose : The purpose of this study was to investigate the effect of abdominal muscle strengthening exercise on abdominal muscle strength and respiratory function in stroke patients. Methods : The subjects were 14 stroke patients (10 males, 4 females) hospitalized at W rehabilitation hospital in Busan City and randomly assigned to 7 exercise groups and 7 control groups. Exercise was performed in combination with an upper and lower extremity pattern of proprioceptive neuromuscular facilitation. Measurements of abdominal muscle strength and respiratory function were made before intervention and 4 weeks after intervention. Abdominal muscle strength was assessed using a digital manual dynamometer, and respiratory function was assessed by spirometry. The collected data were analyzed with a paired t-test and independent t-test and the significance level was set as α =.05. Results : The results showed that applying abdominal muscle strengthening exercise to stroke patients showed a significant increase in abdominal muscle strength and a significant difference between groups (p<.05). Maximal-effort expiratory spirogram (MES) readings were significantly increased in forced vital capacity (FVC), and forced expiratory volume in one second (FEV₁), in the exercise group, and there were a significant differences between the groups in terms of FEV1 (p<.05). Slow vital capacity (SVC) was significantly increased in vital capacity (VC), tidal volume (TV), inspiratory reserve volume (IRV), and expiratory capacity (EC), and there were significant differences between the groups in VC, TV, expiratory reserve volume (ERV), EC, and inspiratory capacity (IC) (p<.05). Conclusion : Abdominal muscle strengthening exercise was effective in the abdominal muscle strength of stroke patients, and it was confirmed to have a positive effect on the enhancement of respiratory function. Therefore, it seems that exercise programs for stroke patients with respiratory weakness should include abdominal muscle strengthening exercises.