• 재활간호학회지
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• 제2권1호
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• pp.22-28
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• 1999

The development of standards and guidelines of rehabilitation nursing has been the major concerns for providing better nursing to the rehabilitation clients. As the patients with stroke and spinal cord injuries are the most prevalent physical disabilities in Korea, this study focussed on the nursing diagnoses of these two groups of patients. In order to identify the nursing diagnoses frequently used In their practice for the patients with stroke and spinal cord injuries, a survey was done with the questionnaire form developed by the research team. The surveyee were the staff nurses working at rehabilitation wards more than 2 years from 8 general hospitals in Korea, They identified and set the priorities of 13 nursing diagnoses from 79 stroke patients and 10 nursing diagnoses from 35 patients with spinal cord injuries during the periods from March 1 to June 2, 1999. The identified nursing diagnoses for the stroke patients are impaired physical immobility, sensory-perceptual alteration, activity intolerance, self-care deficit, altered defecation, altered urination, risk for injury, unilateral neglect, impaired skin integrity, altered thought processes, pain, altered health maintenance, dysreflexia. The identified nursing diagnoses for spinal cord injuries are altered urination, altered defecation, impaired skin integrity, pain, risk for injury, reflex incontinence, impaired physical immobility, self-care deficit, activity intolerance, knowledge deficit.

• 감성과학
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• 제7권2호
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• pp.179-186
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• 2004

중추신경계는 일단 손상이 되면 손상된 세포의 재생, 손상된 수초의 회복, 신경계의 정상적인 연결 등의 제한성 때문에 그 회복이 매우 힘들다. 이러한 중추신경계의 중요한 손상으로는 다발성 경화증, 뇌졸중, 척수손상, 외상, 축삭의 탈수초화 등이 있다. 이전 연구들은 많은 발생빈도를 보이고 있는 척수손상에서 실질적인 척수의 기능적인 회복을 위해 손상된 척수신경의 재생과 축삭의 재수초화가 중요한 요인이라고 전하고 있다. 최근에는 이러한 척수손상에 대한 치료적 접근으로서 세포이식 기술이 하나의 해결책을 열어주고 있다. 따라서 본 논문에서는 척수손상의 특성을 살펴보고, 척수손상에 의한 기능장애에 대해 세포이식이 기능의 회복을 증진시킬 수 있다는 증거를 논의하고자 한다.

• The Journal of Korean Physical Therapy
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• 제14권4호
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• pp.131-146
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• 2002

In the last years, it has become possible to regain some locomotor activity in patients with incomplete spinal cord injury (SCI) through intense training on a treadmill. The ideas behind this approach owe much to insights derived from animal studies. Many studies showed that cats with complete spinal cord transection(spinalized animals) can recover locomotor function. These observations were at the basis of the concept of the central pattern generator located at spinal level. The neural system responsible for the locomotor restoration in both cats and humans is thought to be located at spinal level and is referred to as the central pattern generator(CPG). The evidence for such a spinal CPG in human is emphasis on some recent developments which support the view that there is a human spinal CPG for locomotion. An important element in afferent inputs for both spinal injured cats and humans is the provision of adequate sensory input related locomotor, which can possibly activate and/or regulate the spinal locomotor circuitry This review article deals with the afferent control of the central pattern generator. Furthermore, the application of adequate afferent inputs related locomotor for stroke patients will be able to facilitate locomotion ability, which is automatic, cyclic, rhythmic. These insights can possibly contribute to a better therapeutic approach for the rehabilitation of gait in patients with stroke.

• The Journal of Korean Physical Therapy
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• 제25권5호
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• pp.273-281
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• 2013

Purpose: The purpose of this study is to determine the effect of motor imagery training on residual upper extremity strength and activities of daily living of chronic cervical spinal cord injury patients. Methods: Twelve ASIA A B patients, who had more than a 12-month duration of illness and C5 or 6 motor nerve injury level, were randomly divided into experimental group (n=6) and control group (n=6). Patients in the experimental group performed motor imagery training for five minutes prior to general muscle strengthening training, while those in the control group performed general muscle strengthening training only. The training was performed five times per week, 30 minutes per day, for a period of four weeks. General muscle strengthening training consisted of a progressive resistive exercise for residual upper extremity. Motor imagery training consisted of imagining this task performance. Before and after the training, EMG activity using BTS Pocket Electromyography and Spinal Cord Independent Measure III(SCIM III) were compared and analyzed. Results: The residual upper extremity muscle strengths showed improvement in both groups after training. Comparison of muscle strength improvement between the two groups showed a statistically significant improvement in the experimental group compared to the control group (p<0.05). SCIM III measurements showed significant improvement in the scores for Self-care and Transfer items in the experimental group. Conclusion: Motor imagery training was more effective than general muscle strengthening training in improving the residual upper extremity muscle strength and activities of daily living of patients with chronic cervical spinal cord injury.

• Journal of Korean Biological Nursing Science
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• 제15권2호
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• pp.65-73
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• 2013

Purpose: The purpose of this study was to review the literature on music intervention for neurological patients in Korea and to explore the effect of music intervention on functional rehabilitation of neurological patients. Methods: This systematic review examined literature from 2005 to 2010. The existing literature was searched in the electronic databases of RISS and KISS using the following keywords: music, rhythmic movement, stroke, brain injury, dementia, Parkinson, spinal cord injury. Seventy-seven studies were founded through the database. After The exclusion of duplicates, case studies, literature review, and irrelevant studies, nine studies were included for analysis. Results: They included nine quasi-experimental studies. The medical diagnoses of the study participants were stroke, dementia, brain injury, and spinal cord injury. Among nine studies, only two studies were conducted in the nursing area. Eight studies used comprehensive music programs composed of health education, gait training, vocal training, or relaxation therapy, and these comprehensive programs were effective in the areas of physical and psychosocial treatment. Seventeen sessions were provided on average throughout intervention, and the average duration of each session was 49.4 minutes. Conclusion: Comprehensive music intervention can be implemented in nursing care for patients with neurological problem.

• 대한지역사회작업치료학회지
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• 제3권1호
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• pp.21-31
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• 2013

목적 : 본 연구는 현재 보조공학 기기와 서비스를 이용하고 있는 지체장애인을 대상으로 보조공학에 대한 이용 실태와 만족도를 조사한 것이다. 연구방법 : 본 연구는 2012년 5월 8일부터 5월 18일까지 부산 및 창원지역의 병원에 입원한 환자들 중 척수손상과 뇌졸중 환자 110명을 대상으로 설문조사를 실시하였다. 결과 : 보조공학 기기는 척수손상(76.2%)과 뇌졸중(72.5%) 환자 모두 휠체어 및 이동기기를 가장 많이 사용하고 있었다. 이에 대한 만족도는 척수손상(3.32점)과 뇌졸중(3.48점) 모두 효과성에서는 높게 나타났지만, 다른 항목에서는 두 그룹에서 차이를 보였다. 보조공학 서비스는 척수손상 환자에서는 34명(39.4%)으로 보조기구 수리서비스를, 뇌졸중 환자에서는 8명(28.2%)으로 보조기구 적용 및 훈련을 가장 많이 이용하였다. 이에 대한 만족도는 전문가서비스의 질이 높게 나타났고, 서비스 전달 프로그램이 낮았다. 결론 : 본 연구는 지체장애인의 보조공학에 대한 이용 실태와 만족도를 조사하여 향후 보다 나은 보조공학 서비스를 위한 기초자료를 제공하고자 한다.

• Physical Therapy Rehabilitation Science
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• 제3권1호
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• pp.69-75
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• 2014

Objective: We developed a Motor-Assisted Rowing Machine (MARM) for Spinal Cord Injury (SCI), by modification of the Concept II rowing machine, so that the seats could be operated automatically in a backward and forward direction by a motor. Design: Case report. Methods: Motor rowing consisted of a chair with inclination control, a motor system, control button, monitor, program, leg supporter, safety belt, and seat. The patients were 2 men rowing athletes with SCI, classified as American Spinal Injury Association class B, participated in the study. Level of thoracic injury ranged from T8 to T10. The subjects rowed at a self-selected stroke rate with 50 watts. Two different rowing methods (static rowing without movement of the seat, dynamic rowing using MARM) were assigned to each participant during 10 minutes; 34 reflective markers were attached to their full bodies. Kinematic data were collected using the Vicon motion analysis system. Based on the full body model provided as a default by the equipment. In the rowing exercise, the rowing motions were divided into Drive Phase and Recovery Phase. Results: The two rowing methods differ in handle range, seat range, handle and seat ratio, handle velocity, and seat velocity during static and dynamic rowing. The rowing exercise using a rowing machine developed MARM increased tendency to the range of motion in the dynamic method compared to the static method. Conclusions: The newly developed MARM could be a useful whole body exercise for people with SCI.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.791-798
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• 2021

Objective : The period of mechanical ventilator (MV)-dependent respiratory failure after cervical spinal cord injury (CSCI) varies from patient to patient. This study aimed to identify predictors of MV at hospital discharge (MVDC) due to prolonged respiratory failure among patients with MV after CSCI. Methods : Two hundred forty-three patients with CSCI were admitted to our institution between May 2006 and April 2018. Their medical records and radiographic data were retrospectively reviewed. Level and completeness of injury were defined according to the American Spinal Injury Association (ASIA) standards. Respiratory failure was defined as the requirement for definitive airway and assistance of MV. We also evaluated magnetic resonance imaging characteristics of the cervical spine. These characteristics included : maximum canal compromise (MCC); intramedullary hematoma or cord transection; and integrity of the disco-ligamentous complex for assessment of the Subaxial Cervical Spine Injury Classification (SLIC) scoring. The inclusion criteria were patients with CSCI who underwent decompression surgery within 48 hours after trauma with respiratory failure during hospital stay. Patients with Glasgow coma scale 12 or lower, major fatal trauma of vital organs, or stroke caused by vertebral artery injury were excluded from the study. Results : Out of 243 patients with CSCI, 30 required MV during their hospital stay, and 27 met the inclusion criteria. Among them, 48.1% (13/27) of patients had MVDC with greater than 30 days MV or death caused by aspiration pneumonia. In total, 51.9% (14/27) of patients could be weaned from MV during 30 days or less of hospital stay (MV days : MVDC 38.23±20.79 vs. MV weaning, 13.57±8.40; p<0.001). Vital signs at hospital arrival, smoking, the American Society of Anesthesiologists classification, Associated injury with Injury Severity Score, SLIC score, and length of cord edema did not differ between the MVDC and MV weaning groups. The ASIA impairment scale, level of injury within C3 to C6, and MCC significantly affected MVDC. The MCC significantly correlated with MVDC, and the optimal cutoff value was 51.40%, with 76.9% sensitivity and 78.6% specificity. In multivariate logistic regression analysis, MCC >51.4% was a significant risk factor for MVDC (odds ratio, 7.574; p=0.039). Conclusion : As a method of predicting which patients would be able to undergo weaning from MV early, the MCC is a valid factor. If the MCC exceeds 51.4%, prognosis of respiratory function becomes poor and the probability of MVDC is increased.

• Archives of Plastic Surgery
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• 제34권4호
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• pp.531-534
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• 2007

Purpose: Plastic surgeons are responsible for the management of spinal cord injury patients with upper and lower extremity reconstruction, pressure sore, and wounds. Derailment of autonomic nervous systems caused by injury to the spinal cord may result in fatal autonomic dysreflexia. Autonomic dysreflexia is a syndrome of massive imbalance of reflex sympathetic discharge occurring in patients with spinal cord lesion above the splanchnic outflow(T6). It is characterized by a sudden onset and severe increase in blood pressure and is potentially life threatening. The other classic symptoms are headache, chest pain, sweating, and bradycardia. In order to lower the blood pressure, it is important to remove the noxious stimulus for autonomic dysreflexia. If such symptoms last for more than 15 minutes despite conservative interventions, antihypertension drugs are recommended. Methods: In this case study, we report an autonomic dysreflexia case that developed in a 45 year-old tetraplegia patient with sacral pressure sore. When he got bladder irrigation, his blood pressure went up very high and his mentality became stuporous. He was sent to ICU for his blood pressure and mental care. ICU care made his vital sign stabilized and his mentality alert. Results: After the patient underwent proper treatment like inotropic agent, he was transferred to the general ward and his pressure sore on sacral area was coveraged with gluteus maximus myocutaneous advancement flap. Conclusion: If treatment is not effective, the patients have to undergo sudden, severe hypertension, which can cause stroke or death. To provide safe and effective care, plastic surgeons should be able to recognize and treat autonomic dysreflexia.

• 한국운동역학회지
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• 제18권4호
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• pp.151-159
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• 2008

본 연구는 2008 베이징 장애인 올림픽에 참가하는 국가대표 휠체어 탁구 선수들 중 대표적인 절단장애 선수와 척수장애 선수의 스트로크를 대상으로 운동학적 비교분석을 실시하였다. 실재와 같은 경기상황을 설정하여 모든 경기 상황에서의 스트로크를 수집하였다. 그중 대표적인 포핸드 스트로크 세 개의 동작과 백핸드 스트로크 세 개의 동작을 추출하였다. 9대의 적외선 카메라를 이용하여 수집한 자료는 LabVIEW7.0 그래픽 프로그램을 이용한 운동학적 분석에 의하여 각운동으로 나타내었다. 그 결과 척수장애 선수의 포핸드 스트로크에서는 몸통의 회전이 하위분절인 어깨의 회전과 팔꿈치의 굴곡신전과 거의 동시에 이루어지고 있었다. 백핸드 스트로크는 몸통의 회전, 어깨의 굴곡-신전, 그리고 팔꿈치의 굴곡-신전이 날아오는 공의 연장선상에서 일정한 형태로 정렬되어 있었고 공을 치기위한 백스윙은 어깨의 회전을 이용해 만들고 있었다. 절단장애 선수의 포핸드 스트로크는 팔의 외측회전으로 백스윙과 내측회전으로 만들어지는 회전을 이용하여 스트로크 하고 있었다. 백핸드 스트로크는 어깨의 회전과 허리의 회전에 있어 내측회전이 백스윙을 만들고 백스윙 후 공을 향한 큰 폭의 외측회전으로 임팩트를 이루고 있었다.