• 한국전문물리치료학회지
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• 제20권3호
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• pp.81-88
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• 2013

Active straight-leg raise (ASLR) is a physical evaluation procedure to test lumbar spine stability. Several previous studies have reported various methods to control the activation of abdominal muscles during ASLR. We investigated the effects of three different hip positions in frontal plane on abdominal muscles to increase or decrease the difficulty level of lumbar spine stability exercise during ASLR in pain free subjects. Eleven young and healthy subjects voluntarily participated in this study (6 men, 5 women; mean age=$24.0{\pm}1.2$ years, height=$160.0{\pm}7.3cm$, weight=$55.0{\pm}10.6kg$, body mass index=$21.5{\pm}2.3kg/m^2$). The subjects had three trials on each ASLR with hip $10^{\circ}$ adduction, neutral hip, and hip $30^{\circ}$ abduction. Separate repeated-measures analysis of variance (ANOVA) and the post hoc Bonferroni tests (with ${\alpha}$=.05/3=.017) were performed for each muscle among the three different hip positions in frontal plane (ASLR with hip $10^{\circ}$ adduction, neutral hip, and hip $30^{\circ}$ abduction). The ipsilateral external oblique (EO), contralateral EO, ipsilateral internal oblique/transverse abdominis (IO/TrA), and contralateral IO/TrA were significantly greater in ASLR with hip $30^{\circ}$ abduction compared with ASLR with hip $10^{\circ}$ adduction. Also, the ipsilateral EO, contralateral EO, and ipsilateral IO/TrA were significantly greater in ASLR with hip $30^{\circ}$ abduction compared with ASLR with neutral hip. These results suggest that ASLR with hip $30^{\circ}$ abduction and neutral would be useful method to strengthen the EO and IO/TrA. And, ASLR with hip $10^{\circ}$ adduction would be effective in early stages of lumbar stabilization program due to low activation of EO and IO/TrA during maintaining of ASLR position with low load.

• 재활복지공학회논문지
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• 제9권4호
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• pp.301-308
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• 2015

본 연구는 정상 성인 20명을 대상으로 복부 안정화에 영향을 미치는 노르딕 워킹과 파워 워킹을 2주간 집중 시행한 후, 복부중심 근육(배속빗근, 배바깥빗근, 배가로근)의 활성도 및 두께, 그리고 복부 피하지방의 두께 변화를 비교하였다. 연구 결과, 근전도를 이용한 배속빗근과 배바깥빗근의 근활성값은 노르딕 워킹과 파워 워킹군 모두에서 훈련 후 높게 나타났으며, 특히 노르딕 워킹 훈련군의 경우 파워 워킹 훈련군에 비해 통계학적으로 유의하게 높은 근활성도의 변화를 보였다. 초음파를 이용한 배가로근과 배속빗근, 배바깥빗근의 두께는 노르딕 워킹 훈련군과 파워 워킹 훈련군 모두에서 통계학적으로 유의한 증가를 나타내었으나 군간 변화 차이는 없었다. 노르딕 워킹은 스틱을 이용하여 균형 안정감을 제공하며 상지와 하지의 큰 움직임을 통해 복부 안정화를 유도하는 효과적인 훈련방법으로써 다양한 재활운동의 형태로 적용하기에 유용할 것으로 여겨진다.

• 대한통합의학회지
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• 제8권1호
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• pp.67-76
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• 2020

Purpose : The purpose of this study was to provide more effective interventions for elderly men with weak core muscles by measuring the thickness of the muscles according to the five core stabilization exercise and comparing the thickness differences in muscles in each posture. Methods : The study selected 29 elderly men aged 65 to 80 years old among outpatient patients at S Medical Center in B city, and measured the muscle thickness by exercise posture once. In order to find out the thickness of the external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) muscles were measured by using rehabilitative ultrasound imaging (RUSI) in five exercise conditions. Results : A significant change in the thickness of the EO muscles in each group was measured by the method of motion, followed by the abdominal crunches (1.67±0.15), the lower body rotations (1.54±0.07). As a result of measuring the thickness of the IO muscles of each group according to the exercise method, the bridge group (1.14±0.22) was the highest, followed by the abdominal drawing group (1.05±0.03). As a result of measuring the thickness of the TrA muscles of each group according to the exercise method, the abdominal crunches (0.98±1.00) were the highest, and the bridge group (0.57±0.05) were higher in order of magnitude. Conclusion : Consequently, the five core stabilization exercises all affect changes in abdominal thickness and are expected to continue to require training studies on muscle posture.

• Archives of Plastic Surgery
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• 제43권5호
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• pp.424-429
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• 2016

Background The objective of this paper was to describe a novel technique for improving the maintenance of nipple projection in primary nipple reconstruction by using acellular dermal matrix as a strut in one of three different configurations, according to the method of prior breast reconstruction. The struts were designed to best fill the different types of dead spaces in nipple reconstruction depending on the breast reconstruction method. Methods A total of 50 primary nipple reconstructions were performed between May 2012 and May 2015. The prior breast reconstruction methods were latissimus dorsi (LD) flap (28 cases), transverse rectus abdominis myocutaneous (TRAM) flap (10 cases), or tissue expander/implant (12 cases). The nipple reconstruction technique involved the use of local flaps, including the C-V flap or star flap. A $1{\times}2-cm$ acellular dermal matrix was placed into the core with O-, I-, and L-shaped struts for prior LD, TRAM, and expander/implant methods, respectively. The projection of the reconstructed nipple was measured at the time of surgery and at 3, 6, and 9 months postoperatively. Results The nine-month average maintenance of nipple projection was $73.0%{\pm}9.67%$ for the LD flap group using an O-strut, $72.0%{\pm}11.53%$ for the TRAM flap group using an I-strut, and $69.0%{\pm}10.82%$ for the tissue expander/implant group using an L-strut. There were no cases of infection, wound dehiscence, or flap necrosis. Conclusions The application of an acellular dermal matrix with a different kind of strut for each of 3 breast reconstruction methods is an effective addition to current techniques for improving the maintenance of long-term projection in primary nipple reconstruction.

• 대한물리의학회지
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• 제13권1호
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• pp.129-136
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• 2018

PURPOSE: This Study compared the level of activation of the muscles around the shoulder at the time of abduction through Pilates breathing and regular breathing by using quantified biofeedback. METHODS: Experiment was conducted on 25 healthy males and females in the age bracket of 20's~30's as the subjects. The level of activation of muscles displayed at the time of Pilates breathing were measured at intercostal (InC) muscle, transverse abdominis (TrA) muscle, internal oblique (IO) muscle and external oblique (EO) muscle by using surface electromyogram (EMG) and were provided as biofeedback. Moreover, the changes in the level of muscular activation at sternocleidomastoid (SCM) muscle, upper trapezius (UT) muscle and Deltoid (Del) muscle, which are the muscles around the shoulder, at the time of abduction of shoulder during Pilates breathing and regular breathing were measured. RESULTS: When abduction of shoulder is executed through Pilates breathing, the level of muscular activation of UT muscle was $11.56{\pm}7.10%$ at the time of exhaling of Pilates breathing and $17.54{\pm}9.57%$ at the time of exhaling of regular breathing. Del muscle also displayed lowered level of muscular activation at the time of Pilates breathing with $12.88{\pm}5.80%$ during inhaling and $15.14{\pm}5.49%$ during exhaling. CONCLUSION: In conclusion, the results could be interpreted as indicating that the muscle activities of upper trapezius and deltoid muscle were decreased based on Pilates breathing more than those on regular breathing.

• Archives of Plastic Surgery
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• 제36권1호
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• pp.75-79
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• 2009

Purpose: The transverse rectus abdominis musculocutaneous(TRAM) flap is the most commonly used autogenous tissue flap for breast reconstruction. Postoperatively, partial flap loss or fat necrosis are relatively common and it may result in a smaller breast volume with marked contour irregularities. These defects are not easy to reconstruct with local tissue rearrangement or with breast implants. The current authors present the results of 2 patients who underwent Latissimus dorsi(LD) flap reconstruction to correct partial flap or fat necrosis that developed after TRAM flap breast reconstruction. Method: Case1: A 50 - year - old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively partial flap necrosis was developed. Secondary breast reconstruction using LD flap was done. Case2: A 51 - year - old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively fat necrosis was developed. Secondary breast reconstruction using LD flap was done. Results: Secondary breast reconstruction using LD flap survived completely and produce successful reconstruction. There was no significant complication in both patients. Conclusion: LD flap provides sufficient, vascularized skin and soft tissue. The flap can be molded easily to replace deficient tissue in all areas of the breast. These attributes make it an ideal candidate for salvage of the partially failed TRAM flap breast reconstructio.

• Physical Therapy Rehabilitation Science
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• 제9권3호
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• pp.184-190
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• 2020

Objective: Patients with low back pain can possibly have impaired core muscle function, which is the common cause of low back pain. Spinal stabilization exercises are recommended for prevention and reinforcement. This study aimed to compare the effects of different types of feedback on abdominal and lumbar multifidus (LM) muscle recruitment during spinal stabilization exercises. Design: Cross-sectional study. Methods: Fifty-seven healthy subjects (sex=male 21/female 36, age=21.28±1.60 years) were divided into three different groups: the control group (n=19), the auditory feedback (AF) group (n=19), and the visual and auditory feedback (VAF) group (n=19). The control group received no feedback, whereas the AF group only received AF during exercises and the VAF group received the AF and visual feedback through the real-time ultrasound images. The main outcome measure was the assessment of the thickness of the abdominal muscles and LM measured by a dual ultrasound. Results: When VAF was applied, the thickness of the transverse abdominis significantly increased rather than when feedback was not applied or with AF only (p<0.05). The VAF group showed significant differences in both the control group and the AF group in the post-hoc test (p<0.05), and there was no significant difference between the control group and the AF group. Conclusions: With spinal stabilization exercises, VAF should be applied in standing posture for healthy adults to further promote the production of effective contractions.

• Archives of Plastic Surgery
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• 제39권4호
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• pp.384-389
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• 2012

Background Numerous procedures are available for nipple reconstruction without a single gold standard. This study presents a method for reducing donor-site morbidity in nipple reconstruction using a composite nipple graft after transverse rectus abdominis musculocutaneous flap breast reconstruction. Methods Thirty-five patients who underwent nipple reconstruction using a composite nipple graft technique between July of 2001 and December of 2009 were enrolled in this study. To reduce the donor site morbidity, the superior or superior-medial half dome harvesting technique was applied preserving the lateral cutaneous branch of the fourth intercostal nerves. The patients were asked to complete a previously validated survey to rate the color and projection of both nipples, along with the sensation and contractility of the donor nipple; and whether, in retrospect, they would undergo the procedure again. To compare projection, we performed a retrospective chart review of all the identifiable patients who underwent nipple reconstruction using the modified top hat flap technique by the same surgeon and during the same period. Results Thirty-five patients were identified who underwent nipple reconstruction using a composite nipple graft. Of those, 29 patients (82.9%) responded to the survey. Overall, we received favorable responses to the donor site morbidity. Projection at postoperative 6 months and 1 year was compared with the immediate postoperative results, as well as with the results of nipples reconstructed using the modified top hat flap. Conclusions The technique used to harvest donor tissue is important. Preserving innervation of the nipple while harvesting can reduce donor site morbidity.

• Archives of Plastic Surgery
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• 제36권2호
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• pp.140-146
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• 2009

Purpose: Autologous breast reconstruction with abdominal tissue is one of the best options after mastectomy. In a free transverse rectus abdominis myocutaneous(TRAM) or deep inferior epigastric artery perforator(DIEP) flap, a preoperative evaluation of the precise location of perforating vessels and vascular run - off systems is required. The objective of this report is to demonstrate the usefulness of multidetector computed tomography(MDCT) in the preoperative planning of patients undergoing breast reconstruction with abdominal flap. Methods: From June 2006 to January 2008, 28 patients underwent MDCT evaluation before breast reconstruction. All subjects were females with an age range of 30 to 55 years. The CT scan was performed using a 64 - slice MDCT scanner(Brilliance 64; Philips Medical Systems, Best, Netherlands). Results: One perforator or two major perforators were marked on image in good relation with a hand - held Doppler examination and intraoperative findings. All vascular run - off systems were cleared before operation. Conclusion: Preoperative evaluation of perforator arteries with MDCT angiography is beneficial in patients undergoing breast reconstruction. This technique provides a noninvasive approach of the vascular anatomy of the entire anterior abdominal wall.

• Archives of Reconstructive Microsurgery
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• 제22권1호
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• pp.7-12
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• 2013

Purpose: Breast reconstruction with lower abdominal tissue can produce the best outcome with acceptable rates of long-term complication. However, for cases in which sufficient abdominal tissue is not available, an superior gluteal artery perforator (SGAP) flap can be considered as the next option for autologous breast reconstruction. Materials and Methods: Among a total of 63 women who underwent breast reconstruction with free autologous tissue transfer from July 2010 to April 2011, SGAP flap was performed for four patients. In two cases, patients did not have enough abdominal tissue for sizable breast reconstruction. In another case, the patient had a long abdominal scar due to donor hepatectomy of liver transplantation. In the last case, which was a revisional case after radiation necrosis of a previous pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, a large amount of healthy skin and soft tissue was needed. SGAP flap was elevated in lateral decubitus position. The internal mammary vessels were used for recipient vessels in all cases. Results: Breast reconstruction was performed successfully in all four cases without flap loss. Donor site complication was not observed, except for one case of seroma. The shape of the reconstructed breast was satisfactory in all patients. Conclusion: SGAP flap is an excellent alternative option for the TRAM or deep inferior epigastric artery perforator flap for breast reconstruction. In terms of narrower width, harder consistency of soft tissue, and shorter pedicle, it is clear that the SGAP flap is less competent than the TRAM flap. However, in cases where abdominal tissue is not available, SGAP flap is the only way of providing a large amount of healthy tissue.