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Pathophysiology of orthostatic tremor: a multiple case study (길입성 진전의 병태생리: 다증 증례 연구)

  • Seo, Man-Wook;Lee, Kwang-Woo
    • Annals of Clinical Neurophysiology
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    • v.4 no.1
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    • pp.44-50
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    • 2002
  • Introduction : Orthostatic tremor develops in the legs while standing up with no weakness, pain or imbalance in the leg and the tremor is characteristically not observed when walking. However there have been some confusions about orthostatic tremor in several aspects. For the past ten years, we have observed 4 patients with orthostatic tremor. In each case tests were performed to investigate the following three important areas of inquiry about orthostatic tremor. Firstly, whether this disorder is an independent diagnostic entity or a variant of essential tremor. Secondly, whether the progress of this disorder is specifically related with standing posture. Lastly, the nature of the pathophysiologic mechanism behind the appearance of the tremor when standing after the lapse of a certain latent period and its disappearance upon the commencement of walking. Methods : Our 4 cases of orthostatic tremor were studied clinically, electrophysiologically, and pharmacologically. Electrophysiological tests included tremor spectrum test and electromyography. Results : We observed the presence of this tremor in several other tonic postures, as well as its absence, in a vertically lifted position from all our cases. Our cases registered a variable tremor frequency between 5 and 12 Hz according to the tremor spectrum test and EMG. Furthermore all our 4 cases demonstrated patterns of both synchronous EMG activity and alternating EMG activity at various times in homologous muscles of both legs. Orthostatic tremor was improved significantly with propranolol as well as clonazepam. Conclusions : From the results of our study we drew the following conclusions. It is probable that orthostatic tremor is simply a variant of essential tremor rather than being an independent diagnostic entity and that in most cases its development is specifically related with muscle contraction rather than merely with the act of standing. Furthermore we discovered a clue in the previously described neural control mechanism that the nuclear bag fibers in the muscle spindle have lag time of several seconds in their response to muscle strength and that their baseline does not reset fully in rapidly moving muscle. This neural control mechanism could offer sufficient explanation for the phenomena of tremor appearance when standing and disappearance when walking in orthostatic tremor.

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Three-Phase Bone Scintigraphic Diagnosis of Acute Transient Synovitis (3상 골신티그램을 이용한 급성 일과성 활막염의 진단)

  • Chung, Soo-Kyo;Lee, Myung-Hee;Kim, Choon-Yul;Bahk, Yong-Whee
    • The Korean Journal of Nuclear Medicine
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    • v.19 no.1
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    • pp.73-75
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    • 1985
  • Acute transient synovitis of the hip presents clinically pain and limping. But in the majority of the cases, definite positive findings are not manifest in roentgenogram in its early phase. However radionuclide bone imaging combines with the assessment of vascularization and bone tracer uptake is of great value in solving this diagnostic problem. The materials for this study consisted of 29 children with acute transient synovitis of the hip, characterized by symptoms and physical signs of an arthritis, negative X-ray findings and disappearance of all symptoms and signs within a short period of time. They were twenty males and 9 females and age ranged from 1 to 12 years. We took pelvic reontgenogram in AP and frog-leg views. After intravenous bolus injection of 10 to 15 mCi of $^{99m}Tc-methylene$ diphosphonate, 24 sequential image of the pelvis was taken at 2-second interval for blood flow study. The scintigrams were made using a gamma camera with high resolution parallel hole collimator. Blood pool imaging was obtained at 2 minutes after tracer administration. After 3 hours, static images were taken and then closeup image of the hip using pin-hole collimator was followed. The results were as follows: 1) Bone scintigram was much more sensitive than conventional roentgenogram in diagnosis of acute transient synovitis of the hip. 2) Three-phase imagings showed increased vascular activities in blood pool scintigrams in 96%. 3) Pin-hole imaging showed increased tracer uptake in the regional bones of the hip, par ticularly in the medial aspect of femoral head and acetabulum. 4) We confirmed that three-phase imaging reinforced with pin-hole technique were very useful in diagnose of acute transient synovitis of the hip.

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Functional Taping Technique for Chronic Back Pain and Lower Extremity Pain - McConnell's Approach (만성 요통과 하지 통증에 대한 기능적 테이핑 기법 - McConnell 접근법 -)

  • Kim, Suhn-Yeop;Oh, Duck-Won;Kim, Taek-Yean
    • The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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    • v.14 no.2
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    • pp.50-59
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    • 2008
  • Taping techniques have been usually used by physical therapists long time ago, which have been considered a useful adjunct to treatment programs for a variety of musculoskeletal disorders. Also, taping techniques may be employed as effective prophylactic methods in clinical setting because of ease application and cost effectiveness. The aims of this study were to describe background information for the management of some chronic low back pain patients with/without leg pain that don't respond to conservative treatment, to demonstrate McConnell taping as successful therapeutic strategies for treating these patients, and to provide detailed application methods of McConnell taping in order that physical therapists can readily use the taping in clinical setting. This study emphasized to illustrate biomechanical benefits of McConnell taping in controlling undesirable muscle activation by decreasing mechanical loads on specific muscles. McConnell taping may be helpful for the inhibition of overactive synergist or antagonists, the facilitation of inactive synergists, the promotion of proprioception, the optimization of joint alignment, pain reduction, and unloading of irritable neural tissue. This study provides taping examples of low back pain, sacroiliac joint dysfunction and lower extremity symptoms associated with these conditions, and discusses the possible mechanisms for their successful application.

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Musculoskeletal Symptoms Prevalence and Its Related Factors of Workers in Manufacturing Industry of Automobile Parts in Gimhae City (김해시 자동차 부품 생산직 근로자의 근골격계 증상 유병률과 관련요인)

  • Park, Su-Hyung;Moon, Deog-Hwan;Kim, Chi-Hyok
    • The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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    • v.19 no.1
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    • pp.9-20
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    • 2013
  • Background: This study was conducted to provide preventive measure for the musculoskeletal disorders in automobile parts manufacturing workers. Method: The author surveyed to the musculoskeletal symptoms prevalence and its related factors from 10th to 17th April 2011 with structured self administered questionnaires. 223 out of 225 collected questionnaires were used for final analysis, excluding 2 questionnaires with no valid response. Based on the diagnostic criteria of NIOSH (National Institute for Occupational and Health), an investigation was made into the prevalence of musculoskeletal symptoms as well as into the factors related to individual items. Results: The prevalence of musculoskeletal symptoms according to the criteria of NIOSH was the highest in the shoulder (52.9%), followed by the neck (39.%), the hand/wrist (35%), the waist (29.6%), the arm/elbow (24.7%), and the leg/food (23.8%). One-way analysis showed that among general characteristics, age was the musculoskeletal risk factor with the greatest effect. Whereas among work-related characteristics, significant risk factor didn't find. Yet it was shown that among ergonomic work postures, high degree of musculoskeletal risk was shown by the posture involving frequent and repetitive movement of the arm and the hand/wrist and also by the posture involving standing for a long time. Multiple regression analysis showed that musculoskeletal risk was 1.795 times higher in those age 50 and over than in those under age 50; 1.67 times higher in the high risk stress group than in the low risk stress group; and 1.131 higher in the group involving the repetitive use of the hand/arm than in the other groups (p<.05). Conclusion: The prevalence and stress score of automobile parts manufacturing workers were higher than other occupation workers. Among general characteristics, drinking and smoking were shown to be related to stress score; while age was shown to have significant effect on musculoskeletal risk.

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A Methodology for Evaluating Mission Suitability of Manned-Unmanned Aircraft Teaming for SEAD Missions (SEAD 임무 수행을 위한 유x무인기 협업 체계의 임무적합도 평가 방법론 연구)

  • Seo, Wonik;Lee, Hyun Moo;Kim, Jeong-Hun;Choi, Keeyoung;Jee, Cheol-Kyu
    • Journal of the Korean Society for Aeronautical & Space Sciences
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    • v.48 no.11
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    • pp.935-943
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    • 2020
  • This paper presents a methodology for evaluating suitability of a manned-unmanned aerial vehicle team for a complicated mission. The study identified vehicle performance, equipment performance and level of autonomy as the key factors that affect the mission effectiveness. A manned and an unmanned aircraft were compared, and their performance was quantized in these respects. SEAD was chosen as a representative manned-unmanned team mission. The SEAD mission was broken down to a sequence of tasks. Mission experts evaluated the importance of each mark item for the mission legs. Combining the results showed proper type of aircraft for each leg depending on the complexity, safety, and importance of the task. Finally, the whole mission plan was laid out as a time-based sequence which alleviate pilot workload significantly.

Treatment of the Chronic Achilles Tendon Rupture by Lindholm Method (Lindholm 방법을 이용한 진구성 아킬레스 건 파열의 치료)

  • Lee, Ho-Jin;Chu, In-Tak;Choi, Seong-Pil
    • Journal of Korean Foot and Ankle Society
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    • v.13 no.1
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    • pp.28-33
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    • 2009
  • Purpose: This retrospective study was designed to evaluate the treatment results of chronic Achilles tendon rupture by Lindholm method. Materials and Methods: Between 2002 and 2006, we performed the reconstruction of the Achilles tendon by using of the gatrocnemius-sloeus fascia known as Lindholm method. Ten cases of ten patients were enrolled in this study (8 men and 2 women). The mean age of the patients at the time of operation was 49 years (range, 32${\sim}$66 years). The mean follow-up duration was 15.2 months (range, 12${\sim}$19 months). The retrospective review of the clinical history, physical examination, the American Orthopedic Foot and Ankle Society (AOFAS) score were conducted. Results: The mean AOFAS score before surgery was 74.10${\pm}$2.56 and that of the latest follow-up was 90.60${\pm}$5.72. The excellent results were six and good results were four patients. Eight patients were normal triceps power and the others were good. The average of heel to floor distance was 4.5 mm less in the operated legs than the contralateral ones in each patient, but there was no significant difference (p>0.05). The average of calf muscle circumference in the mid-leg was 7.5 mm less in the operated legs than the contralateral ones and there was significant difference (p<0.05). The active range of motion of the ankles, mean plantarflexion was 40 degrees and dorsiflexion was 16.8 degrees in operated side. The contralateral side was 43 degrees in plantarflexion and 19 degrees in dorsiflexion. No case showed rerupture of the reconstructed Achilles tendon. One patient had the superficial wound infection which was treated successfully by antibiotic therapy. Conclusion: It was suggested that the overall results of Lindholm method for the chronic Achilles tendon rupture indicated satisfactory outcomes.

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Smart Glasses Cannula Guide System Development for Interventional Cardiology Procedures (중재적 심장 질환 시술을 위한 스마트 글래스 삽입관 가이드 시스템 개발)

  • Jang, Ik Gyu;Heo, Yeong Jun;Jeon, Geum Sang;Choi, Jaesoon
    • Journal of Biomedical Engineering Research
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    • v.41 no.5
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    • pp.173-178
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    • 2020
  • Remote control intervention surgery robotic system improves treatment effect on cardiovascular patients and reduces X-ray exposure. However, at the time of the first procedure, CT (computerized tomography) and other ultrasound diagnostic equipment should be used because the operator must insert the cannula directly into the patient's leg. Improvements to this have been un-met-needs of hospitals. In this paper, we developed a system that can insert the cannula intuitively and quickly by displaying blood vessels at a glance through the system using smart wearable glasses. The core development method is as follows. In order to project augmented reality onto the surgical image, CT scan angiography image is extracted and processed. In the process, three CT-Markers are used to create a coordinate system of blood vessel images. Additionally, a reference marker is photographed on a single camera to obtain a camera coordinate system. Since the CT marker and the reference marker are in the same position, 3D registration is performed. In the text, a detailed explanation will be given.

Risk Assesment in the loaded works of muscular skeletal disorder for company attached to dining workers (기업체 식당종사자의 근골격계 부담 작업에 대한 위험성 평가)

  • Lee, Song-Kwon;Yoo, Wang-Keun;Lee, Jeong-Hee;Lim, Moo-Hyuk;Park, Man-Chul;Cha, Sang-Eun;Ki, Yun-Ho
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.17 no.2
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    • pp.101-110
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    • 2007
  • This study was performed to find out hazardous factors in the loaded works of muscular skeletal disorders(MSDs) for four company attached to dining workers from October 2005 to June 2006. The results are summarized as follows. 1. 42.5% of workers in study group were 40-50 years old, and females were higher than males, and the average of body weight was 70kg, 57kg in males and females, respectively. Working time per day was mostly 7-9hours, and the rate of worker who had never education and training was 46%. 2. The upper part and right part of body were higher than lower part and left part in symptoms of muscular skeletal disorders. Body parts which complained of symptoms were the order of right shoulder(55%), right arm(54%), right hand,(40%) waist(35%), leg(25%), and neck(24%). 3. The results of evaluation in the loaded works of muscular skeletal disorders to cooking, dish supply, preparing side dish, and washing the dishes and cleaning the floor of cooking room using RULA and OWAS checklists was action level 4(potential hazards, needs of change workplace), and the result of evaluation using back compressive force needed control measures as 779.27 lbs~1,274.04 lbs. In a view point of the result of this study, large dining rooms should be designed by ergonomic technology for the work surface height, width, and depth. The height of carrying car should be lower to 70cm, and repetitiveness and handling weight should be reduced by mechanical means, and education and training also should be performed for all of workers positively.

Musculoskeletal Disorder Symptom Factors and Control Strategies in General Hospital Nurses (종합병원 간호사의 근골격계질환 증상요인 및 관리방안)

  • Park, Jung-Keun
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.24 no.3
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    • pp.371-382
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    • 2014
  • Objectives: This study was undertaken in order to examine how musculoskeletal disorder(MSD) symptoms were affected by particular factors and then to explore control strategies to prevent MSDs in general hospital nurses. Materials: This, as part of a large study, was conducted using a set of information on literature review, questionnaire survey and focus group interview. It obtained prevalence and factors of MSD symptoms and examined how MSD symptoms were distributed and affected by the factors in nurses working at 15 general hospitals across Korea. The factors were personal factors, work organization, nursing tasks, physical factors and psychosocial factors. Results: A total of 501 nurses were determined as subjects. The highest MSD symptom prevalence was 61% for the shoulder, among body parts, followed by leg/feet(55%), low back(51%), neck(42%), wrist(38%), and elbow(21%). Prevalence for the whole body was 80%. Odds ratios ranged from 0.4 to 22.4 in logistic regression analyses. The symptoms were significantly attributed to factor variables such as body mass index, current health status, daily work time, nursing task, pooled-physical factors, ergonomic factors, work load, interpersonal conflict, and job insecurity. Conclusions: Two or more factor variables were significant, depending on body part, for MSD systems in the general hospital nurses. It was noticeable that physical factors, such as pooled-physical factors, ergonomic factors or work load, were selectively significant for MSD symptoms in all body parts, indicating that such information should be used for prevention of MSDs in the hospital sector.

Discomfort Analysis in Computerized Numeric Control Machine Operations

  • Muthukumar, Krishnamoorthy;Sankaranarayanasamy, Krishnasamy;Ganguli, Anindya Kumar
    • Safety and Health at Work
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    • v.3 no.2
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    • pp.146-153
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    • 2012
  • Objectives: The introduction of computerized numeric control (CNC) technology in manufacturing industries has revolutionized the production process, but there are some health and safety problems associated with these machines. The present study aimed to investigate the extent of postural discomfort in CNC machine operators, and the relationship of this discomfort to the display and control panel height, with a view to validate the anthropometric recommendation for the location of the display and control panel in CNC machines. Methods: The postural discomforts associated with CNC machines were studied in 122 male operators using Corlett and Bishop's body part discomfort mapping, subject information, and discomfort level at various time intervals from starting to end of a shift. This information was collected using a questionnaire. Statistical analysis was carried out using ANOVA. Results: Neck discomfort due to the positioning of the machine displays, and shoulder and arm discomfort due to the positioning of controls were identified as common health issues in the operators of these machines. The study revealed that 45.9% of machine operators reported discomfort in the lower back, 41.8% in the neck, 22.1% in the upper-back, 53.3% in the shoulder and arm, and 21.3% of the operators reported discomfort in the leg. Conclusion: Discomfort increased with the progress of the day and was highest at the end of a shift; subject age had no effect on patient tendency to experience discomfort levels.