• Journal of Chest Surgery
• /
• 제44권5호
• /
• pp.332-337
• /
• 2011

Background: The optimal timing of surgery for infective endocarditis complicated by embolic stroke is unclear. We compared early versus delayed surgery in these patients. Materials and Methods: Between 1992 and 2007, 56 consecutive patients underwent open cardiac surgery for the treatment of infective endocarditis complicated by acute septic embolic stroke, 34 within 2 weeks (early group) and 22 more than 2 weeks (delayed group) after the onset of stroke. Results: The mean age at time of surgery was $45.7{\pm}14.8$ years. Stroke was ischemic in 42 patients and hemorrhagic in 14. Patients in the early group were more likely to have highly mobile, large (>1 cm in diameter) vegetation and less likely to have hemorrhagic infarction than those in the delayed group. There were two (3.7%) intraoperative deaths, both in the early group and attributed to neurologic aggravation. Among the 54 survivors, 4 (7.1%), that is, 2 in each group, showed neurologic aggravation. During a median follow-up of 61.7 months (range, 0.4~170.4 months), there were 5 late deaths. Overall 5-year neurologic aggravation-free survival rates were $79.1{\pm}7.0%$ in the early group and $90.9{\pm}6.1%$ in the delayed group (p=0.113). Conclusion: Outcomes of early operation for infective endocarditis in stroke patients were similar to those of the conventional approach. Early surgical intervention may be preferable for patients at high risk of life-threatening septic embolism.

• 대한물리의학회지
• /
• 제5권3호
• /
• pp.385-394
• /
• 2010

Purpose : The present study was to examine the difference and severity of asymmetry in independently ambulating stroke survivors and to establish the association between gait asymmetry, velocity, and the motor function of lower extremity. Methods : The subjects used in this study were 43 subjects with hemiparesis being able to walk independently. Motor function of lower extremity was measured clinically with the Fugl Meyer-Lower /Extremity Assessment. Overground gait velocity and spatia-temporal parameters were collected by the GAITRite system. Results : Thirty(69.77%) patients showed statistically significant temporal asymmetry while 28(65.1%) exhibited statistically significant spatial asymmetry. One-way ANOVA results showed a main effect of temporal asymmetry group(normative, mild, severe) for gait velocity(F=74.129), FM-L/E(F=17.270), swing-stance symmetry(F=66.869, F=13.485, respectively), spatio-temporal asymmetry(F=13.166, F=31.800, respectively) 66, F=31.800, respectively). Gait velocity was negatively associated with temporal asymmetry(r=-.83), spatial asymmetry(r=-.60). Motor function of lower extremity was also associated with temporal asymmetry(r=-.58), and spatial asymmetry(r=-.50). Conclusion : The study attempted to establish the standard assessment of hemiparesis gait symmetry in light of the complex relationship with motor impairment and gait velocity. More future work will need to link the degree of gait asymmetry to clinically relevant outcomes to better establish the clinical significance of such observations.

• 재활치료과학
• /
• 제9권2호
• /
• pp.87-98
• /
• 2020

목적 : 본 연구는 재가 뇌졸중 환자를 대상으로 가정방문 작업치료를 제공한 사례를 통해 가정방문 작업치료 서비스의 효과성을 검증하고자 하였다. 연구방법 : 서울시 소재 보건지소에 가정방문 작업치료 서비스를 신청한 뇌졸중 환자 두 명을 대상으로 가정방문 작업치료 프로그램은 대상자의 일상생활동작 기능, 작업수행 기능, 인지기능, 정서 기능을 평가하고 클라이언트 중심 접근(Client-centered approach)을 기반으로 작업치료 목표를 설정하고 중재를 계획하였다. 작업치료 프로그램은 클라이언트의 주요 문제를 바탕으로 여가 활동 탐색 및 참여를 목표로 설정하여 12회기의 프로그램으로 구성하였다. 결과 : 두 사례 모두 COPM 점수에 향상이 있었고, 사례 2에서 MBI와 K-MMSE 점수의 향상이 있었다. 또한 사례 1에서 KGDS 점수의 향상이 있었다. 결론 : 가정방문 작업치료는 뇌졸중 환자의 삶의 질 향상 및 경제적 부담 등을 고려하면서 뇌졸중 환자의 일상생활활동, 인지, 정신적 기능의 변화가 있음을 확인하였다. 가정 및 지역사회 통합에 있어 기관중심재활에서 지역사회중심재활로 지속적이고 연속된 재활 서비스가 활성화가 요구되어지며, 병원에서 퇴원하는 뇌졸중 환자들의 신체적, 인지적, 정신적 및 사회적 접근의 증진을 위한 적극적인 가정방문 작업치료서비스가 필요하다.

• 재활간호학회지
• /
• 제6권1호
• /
• pp.79-89
• /
• 2003

Purpose: This research with one group pre-post design was carried out to test the practical feasibility to administrate the Music Movement program developed for the stroke patients. Subjects: 12 stroke survivors at "J" Public Health Center in Seoul. were participated in. The average age was 68 years old, the ratio of sex was almost 5.8:4.2, the duration of was almost over 1 year. Method: Music Movement program was conducted for 2 hours ${\times}$ 1day ${\times}$ 6 weeks. The contents of Music Movement program were consisted of the preparatory activities, main activities and the wrap up activities. The preparatory activities are ice braking, greeting, explanation of the aims of music movement program, and introduction of stroke disease and ROM exercise. The main activities are the body motions with singing and playing musical instruments. The wrap up activities are stretching and joints and discussion of home activities. Data Collection: The outcome variables are muscle strength, finger pinch power, ROMs, flexibility, depression, and life satisfaction. Depression was measured by CES-D(Kim, I. J., 1999), life satisfaction by ladder scale(McDowell & Newell, 1996), and ADL state(Holbrook & Skilbeck, 1983). Data Analysis: SPSS/PC 10.0 for Window was used. Wilcoxon Signed Ranks Test was used to analyze outcome measures. The level of statistical significance was set at p<.05. Results: This program was effective to decrease the depression level of subjects(p<.05). The muscle strength, hand grip power, ROMs, life satisfaction, and rehabilitation state of the subjects were slightly increased but no significant differences were found between the pre and post test. Additionally every patient replied that they were very satisfied and expressed their appreciation for this program very much. Of course they strongly want to continue to participate in and meet the peer group again. Conclusion: Considering these results, the practical feasibility of Music Movement program can be supported. Therefore, this Music Movement program can be examined with the quasi-experimental design with control group and ongoing reviews. After that, this program would be applied in public health centers, medical institutes, and welfare centers for the rehabilitation of stroke patients.

• 기본간호학회지
• /
• 제7권1호
• /
• pp.71-85
• /
• 2000

Social support was found to have buffering effects on the stress response of stroke patients. Especially, the aspects of social support found to be most influential were support from a close, personal source, and overall satisfaction with support. The purpose of this study was to identify the current social network and its characteristics according to gender difference in post-hospitalized stroke patients in Korea. The sample consisted of a convenience sample of 254 patients was recruited 129 men and 125 women who were receiving follow-up care at outpatients clinics. Four aspects of social support-source, quantity, qualify & type- were measured using the modified Social Support Inventory for Stroke Survivors(SSISS) which was developed by McColl & Friedland(1989). Regarding sources of social support, 61.4% reported for 'spouse' as primary caregiver and 31.9%, 'children'. But the distribution of sources of personal support were related to gender; 82.2% of male patients had support from their spouses, while only 40% of female patients reported from 'spouse' but 51.4% from 'children'. Among the children, daughters and sons were more significant support persons than daughters-in-law. The percentages for sources of these significant other support persons were 55.5% for 'children', 8.7% for 'spouse', and 8.3% for 'brothers'. The physician at the outpatient department was the main source of professional support. For the quantify and qualify of social support, the primary caregiver's support was more significant than support by significant other persons. Male patients reported that primary the caregiver' support was greater than that of significant other persons, while female patients perceived significant other persons as giving greater support. Regarding the type of perceived social support, the stroke patients were highly satisfied with the primary caregiver's support in aspects of instrumental, emotional, and informational support. They also reported high satisfaction with support from significant others' support in the aspect of emotional support, while emotional and informational support from professionals was reported as satisfactory. In conclusion, gender difference in the social support network was found in that male patients perceived more support from their spouses, while female patients perceived more support from their children as compared to their spouses.

• 전자공학회논문지
• /
• 제53권12호
• /
• pp.180-190
• /
• 2016

본 전향적 예비 임상연구를 통하여 이중 체임버 구조를 기반으로 하는 뇌졸중 환자용 컵을 개발하고 임상적으로 유용한지 검증하고자 했다. 체계적 과정을 거쳐 컵을 개발하고, 남녀 동수의 뇌졸중 환자 16명을 대상으로 개발된 컵을 사용하여 이들의 제한된 운동기능을 보완 할 수 있는지 3차원 동작 분석(3-dimensional motion analysis), 표면 근전도 검사(surface electromyography; sEMG), 3차원 체간 움직임 분석(3-dimensional trunk movement analysis)의 운동 형상학적 방법을 통하여 검증하고자 했다. 실험 결과, 이중 체임버 컵(dual chamber based assistive cups; DC) 데이터 그룹에서 플라시보 컵(placebo-cups; PC)의 경우 보다 어깨부위의 ROM(range of motion)이 더 적게 사용되었고, sEMG에서는 상부 승모근, 삼각근, 삼두근에서 근 활성도가 낮게 나타났다. 체간 분석에서 전방, 후방의 방향에서 체간의 개입이 더 적게 관찰되었다.

• 한국전문물리치료학회지
• /
• 제14권4호
• /
• pp.50-57
• /
• 2007

The purpose of this study was to investigate the relationship between delays in initiation and termination of tibialis anterior contraction through surface electromyographic (sEMG) analysis in adults with hemiplegia and healthy subjects and clinical assessment of lower-limb mobility. EMG activity of 6 long-term survivors of stroke and 5 healthy subjects was recorded during maximal isometric ankle dorsiflexion in 3 seconds beeper signals. It must be done as fast and forcefully as possible. Lower limb mobility was assessed with Modified Emory Functional Ambulation Profile (mEFAP). Delay in initiation and termination of muscle contraction was significantly prolonged in the affected lower limb relative to the unaffected limb. Termination of muscle contraction in the hemiplegic lower limb was significantly delayed than the initiation on the affected sides. Delay in initiation and termination of muscle contraction correlated significantly with a few range of mEFAP. Abnormally delayed initiation and termination of muscle contraction may contribute to hemiparetic lower limb mobility in hemiparetic patients. Consequently, this study showed that abnormal delay of initiation and termination of muscle contraction may contribute to hemiparetic lower limb mobility in adults with hemiplegia. Further studies are needed to demonstrate a treatment effect.

• 로봇학회논문지
• /
• 제18권4호
• /
• pp.376-384
• /
• 2023

In this paper, we introduce an upper extremity rehabilitation robot, NREH (NRC End-effector based Rehabilitation arm at Home). Through NREH, stroke survivors could continuously exercise their upper extremities at home. NREH allows a user to hold the handle of the end-effector of the robot arm. NREH is a end-effector-based robot that moves the arm on a two-dimensional plane, but the tilt angle can be adjusted to mimic a movement similar to that in a three-dimensional space. Depending on the tilting angle, it is possible to perform customized exercises that can adjust the difficulty for each user. The user can sit down facing the robot and perform exercises such as arm reaching. When the user sits 90 degrees sideways, the user can also exercise their arms on a plane parallel to the sagittal plane. NREH was designed to be as simple as possible considering its use at home. By applying error augmentation, the exercise effect can be increased, and assistance force or resistance force can be applied as needed. Using an encoder on two actuators and a force/torque sensor on the end-effector, NREH can continuously collect and analyze the user's movement data.

• Journal of Korean Neurosurgical Society
• /
• 제52권4호
• /
• pp.293-299
• /
• 2012

Objective : To evaluate the surgical efficacy of and factors associated with decompressive craniectomy in patients with an internal carotid artery (ICA) territory infarction. Methods : Seventeen patients (8 men and 9 women, average age 61.53 years, range 53-77 years) were treated by decompressive craniectomy for an ICA territory infarction at our institute. We retrospectively reviewed medical records, radiological findings, and National Institutes of Health Stroke Scale (NIHSS) at presentation and before surgery. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS). Results : Of the 17 patients, 15 (88.24%) achieved a poor outcome (Group A, GOS 1-3) and 2 (11.76%) a good outcome (Group B, GOS 4-5). The mortality rate at one month after surgery was 52.9%. Average preoperative NIHSS was $27.6{\pm}10.88%$ in group A and $10{\pm}4.24%$ in group B. Mean cerebral infarction fraction at the septum pellucidum level before surgery in group A and B were 33.67% and 23.72%, respectively. Mean preoperative NIHSS (p=0.019) and cerebral infarction fraction at the septum pellucidum level (p=0.017) were found to be significantly associated with a better outcome. However, no preexisting prognostic factor was found to be of statistical significance. Conclusion : The rate of mortality after ICA territory infarction treatment is relatively high, despite positive evidence for surgical decompression, and most survivors experience severe disabilities. Our findings caution that careful consideration of prognostic factors is required when considering surgical treatment.