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CLINICAL CHARACTERISTICS OF CHRONIC MOTOR TIC DISORDER AND TOURETTE'S DISORDER (만성 틱 장애 뚜렛씨 장애의 임상 특성)

  • Shin, Sung-Woong;Lim, Myung-Ho;Hyun, Tae-Young;Seong, Yang-Sook;Cho, Soo-Churl
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.12 no.1
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    • pp.103-114
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    • 2001
  • Tourette's disorder is a disease which manifests one or more motor tics and vocal tics for more than a year. Chronic motor tic or vocal tic disorders are characterized by only one kind of tics for more than a year. We intended to investigate the clinical characteristics of the patients with chronic motor tic disorders or Tourette's disorders who had admitted from May 1, 1998 to May 1, 1999 to Seoul National University Hospital Child and Adolescent Psychiatry ward. In addition, we compared the clinical characteristics of the patients in order to elucidate the relationship between the two disorders. The patients with learning disabilities were selected as controls. There was no statistically significant difference between the onsets of the patients with chronic motor tic disorders(n=13, $7.3{\pm}2.5$ years), and Tourette's disorder(n=39, $7.2{\pm}2.2$ years), but with learning disability($4.2{\pm}1.9$ years). Also, the patients with chronic motor tic disorder and Tourette's disorder showed similar age at admission($11.7{\pm}2.7$ versus $11.5{\pm}2.6$ years), duration of admission($5.7{\pm}5.4$ versus $11.0{\pm}8.7$ weeks), mothers' ages at child birth($27.3{\pm}2.9$ versus $28.3{\pm}6.7$ years old),and fathers' age at child birth($32.2{\pm}3.2$ versus $33.3{\pm}5.2$ years old). We observed that those who had learning disabilities were alike in those aspects, except for age at visit to clinic($9.8{\pm}3.2$ years old). Family history of psychiatric illnesses(24.1% versus 46.2%), recognized precipitating factors(11.1% versus 35.7%) and response to pharmacological treatments(77.8% versus 76.9%) of the patients with chronic motor tic disorders and Tourette's disorders were observed and no differences were found. Comorbid patterns of diseases were noted. Intrafamilial conflicts were more common in the patients with learning disabilities than those with chronic tic disorders or Tourette's disorders. Precipitating factors were observed more frequent in chronic tic disorder and Tourette's disorder than learning disability. Neurocognitive profiles were investigated, and verbal IQs of the patients with chronic motor tic disorder, Tourette's disorder and learning disability were $92.3{\pm}10.7$, $94.7{\pm}14.9$, $94.3{\pm}13.8$, performance IQs $93.0{\pm}20.5$, $97.5{\pm}13.0$, $95.0{\pm}16.9$ and full-scale IQs $91.9{\pm}20.1$, $95.8{\pm}14.5$, $93.9{\pm}15.1$, respectively, which were found to be not significantly different. No difference was found in structural neurological abnormalities and EEG profiles. The patients with learning disabilities showed more common Bender-Gestalt test abnormalities. In conclusion, we have not found any affirmative clues for the division of chronic motor tic disorder and Tourette's disorder in clinical perspective.

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A Study on Legal and Regulatory Improvement Direction of Aeronautical Obstacle Management System for Aviation Safety (항공안전을 위한 장애물 제한표면 관리시스템의 법·제도적 개선방향에 관한 소고)

  • Park, Dam-Yong
    • The Korean Journal of Air & Space Law and Policy
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    • v.31 no.2
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    • pp.145-176
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    • 2016
  • Aviation safety can be secured through regulations and policies of various areas and thorough execution of them on the field. Recently, for aviation safety management Korea is making efforts to prevent aviation accidents by taking various measures: such as selecting and promoting major strategic goals for each sector; establishing National Aviation Safety Program, including the Second Basic Plan for Aviation Policy; and improving aviation related legislations. Obstacle limitation surface is to be established and publicly notified to ensure safe take-off and landing as well as aviation safety during the circling of aircraft around airports. This study intends to review current aviation obstacle management system which was designed to make sure that buildings and structures do not exceed the height of obstacle limitation surface and identify its operating problems based on my field experience. Also, in this study, I would like to propose ways to improve the system in legal and regulatory aspects. Nowadays, due to the request of residents in the vicinity of airports, discussions and studies on aviational review are being actively carried out. Also, related ordinance and specific procedures will be established soon. However, in addition to this, I would like to propose the ways to improve shortcomings of current system caused by the lack of regulations and legislations for obstacle management. In order to execute obstacle limitation surface regulation, there has to be limits on constructing new buildings, causing real restriction for the residents living in the vicinity of airports on exercising their property rights. In this sense, it is regarded as a sensitive issue since a number of related civil complaints are filed and swift but accurate decision making is required. According to Aviation Act, currently airport operators are handling this task under the cooperation with local governments. Thus, administrative activities of local governments that have the authority to give permits for installation of buildings and structures are critically important. The law requires to carry out precise surveying of vast area and to report the outcome to the government every five years. However, there can be many problems, such as changes in the number of obstacles due to the error in the survey, or failure to apply for consultation with local governments on the exercise of construction permission. However, there is neither standards for allowable errors, preventive measures, nor penalty for the violation of appropriate procedures. As such, only follow-up measures can be taken. Nevertheless, once construction of a building is completed violating the obstacle limitation surface, practically it is difficult to take any measures, including the elimination of the building, because the owner of the building would have been following legal process for the construction by getting permit from the government. In order to address this problem, I believe penalty provision for the violation of Aviation Act needs to be added. Also, it is required to apply the same standards of allowable error stipulated in Building Act to precise surveying in the aviation field. Hence, I would like to propose the ways to improve current system in an effective manner.

Change of Green Space Arrangement and Planting Structure of Apartment Complexes in Seoul (서울시 아파트단지의 녹지배치 및 식재구조 변화 연구)

  • Lee, Dong-Wook;Lee, Kyong-Jae;Han, Bong-Ho;Jang, Jae-Hoon;Kim, Jong-Yup
    • Journal of the Korean Institute of Landscape Architecture
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    • v.40 no.4
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    • pp.1-17
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    • 2012
  • This study was carried out to propose the improved method by analyzing the change of green space arrangement and planting structure of apartment complexes in Seoul. 12 survey sites, which have obvious differences, were selected by reflecting the change of floor area ratio, underground parking place, and green space ratio. We divided the survey sites into four types that high green ratio(over 40%) apartment on natural ground, low green ratio(under 40%) apartment on natural ground, low green ratio(under 40%) apartment on artificial ground, and high green ratio(over 40%) apartment on artificial ground each period based on green space ratio and ground structure, plant crown volume, planting density, and planting pattern. The main factors of change of green space arrangement were green space ratio and ground structure. The Green space ratio was changed by the floor area ratio with constructing underground parking place and floor area ratio was adjusted by government policy and economic status. Average width of front green area has been changed from 10.0m in high green ratio apartment on natural ground for 3.5m, 2.7m, and 4.5m each period. The average width of the buffer green area has been changed from 15.0m in high green ratio apartment on natural ground of 7.7m, and 2.7m by extending parking place in the low green ratio apartment of artificial ground, so buffer green areas have been reduced and disconnected. So buffer green area in apartment complexes has been extended that the average width of the buffer green area was 3.8m caused by growing recognition of green since 2001. The ratio of native plant in canopy layer was increased from 45.1 % in the case of the high green ratio apartment of natural ground in 1980~1983 to 55.6%. Average plant crown volume increased from $1.27m^3/m^2$ in high green ratio apartment on natural ground for $3.47m^3/m^2$ in a low green ratio apartment on natural ground. But average plant crown volume is $0.27m^3/m^2$ in the high green ratio apartment of the artificial ground plant density of canopy layer was changed from 5 individuals per $100m^2$ to 14.5 individuals per $100m^2$. We should construct the buffer green area with natural ground and get the function of ecological and beautiful environment regarding to garden concept in case of front green area, width 4.5m. We should get the function of increasing green volume by multi-layer planting with shade woody species and flower woody species in case of back-side green area, width over 5.0m. We should get the function of covering the wall and increasing green landscape by planting with high woody species in case of side green area. We should apply the ecological planting technique to buffer green area and connect buffer green area to inner green area in apartment complexes.

The Environmental and Ecological Meaning of Bibo Landscape in Otgol Village (옻골마을 비보경관의 환경생태적 의미)

  • Jang, Byoung-Kwan;Whang, Bo-Chul
    • Journal of the Korean Institute of Landscape Architecture
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    • v.36 no.2
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    • pp.32-41
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    • 2008
  • An empirical study and environmental and ecological analysis were conducted on Otgol Village(a village of the Gyeongju Choi's clan in Daegu) where an enclosed pond and groves are still observed. In particular, the enclosed pond and groves and village water system were investigated from an ecological perspective. The enclosed landscape is described based on feng shui principles and the environmental and ecological significance were examined. In general, the environmental and ecological significance is very broad; however, they were analyzed in terms of the quality of life as an empirical study as follows: First, water quality was measured to investigate the improvement of continuous water system functions. In other words, water quality was measured at East Valley(resting space), West Valley(living space), the enclosed pond where the two valleys merge, and the stream that flows out of the pond. Second, the climate functions of the enclosed groves that border the village were examined. In other words, temperature was measured in two places(200m distance from the center of the groves). Third, whether or not a sound ecosystem can be sustained was investigated. In other words, landscape ecological indicators were chosen and measured. The results are as follows: First, the enclosed pond played the role of purifying water quality. While the East Valley has been popular with men for its rock walls and torrents, the West Valley has been popular with women as a living space(ex: doing the laundry). Therefore, the difference of water quality can be explained. Second, since enclosed groves are in a small village forest, they are very weak in terms of being wind proof and temperature reduction effects. Instead, they play the role of the village boundary. Third, the groves are ecologically sound considering the landscape ecological indicators and are similar to ordinary traditional rural villages. In terms of the connection of the green zone, the village groves are well connected to the village boundary wood. If the village groves are restored, in particular, they would offer a decent habitat for grove creatures. According to this study, the traditional village space was formed upon the influence of Feng Shui theories that are based on environmental and ecological principles that focus on the harmony between humans and nature. From the environmental and ecological perspective, the enclosed pond and groves are important factors in building a sustainable village. The diverse water space would help to improve water quality and increase water volume by promoting the water circulation system. In addition, the village woods would surround the village and decrease the temperature and humidity difference between winter and summer. If the groves are small and badly damaged, however, they are meaningful only in dividing the region. The overall improvement of a forestation system and botanical composition may increase the biological diversity and promote the migration of species. Otgol Village has developed an enclosed landscape to improve the village environment. In other words, a sound and refreshing living environment can be developed when the natural ecological system is well understood and properly preserved. Additionally, this traditional village planning will be the environmental and ecological method. From the perspective of environmental ecology, therefore, a traditional village is recommended.

A Study on the Meaning of Plant Material in the 2016 Korea Garden Show Designer's Garden (2016년 코리아가든쇼 작가정원의 식물 의미에 관한 연구)

  • Lee, Chung-Hee;Jin, Hye-Young;Lee, You-Mi;Song, Yu-Jin
    • Journal of the Korean Institute of Landscape Architecture
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    • v.45 no.3
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    • pp.41-53
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    • 2017
  • This study was performed to determine what the plant material were selected to reflect in the 2016 Korea Garden Show designer's garden. It was analyzed that plant material was used to display the theme of the garden and to create a specific space. Under the given theme of 'K-Garden, Shinhallyu Garden(new style garden culture) with the most Korean taste', the plants were used to highlight the theme in two types: 'representation' and 'expression'. There were two 'representation' gardens that imitate a particular space of Korean taste and four 'expression' gardens that showcase the designer's thoughts with abstract concepts and concrete objects. Three gardens included both types of garden. The way of revealing the subject with plants was used more for 'expression' than for 'representation'. There were eleven spaces for 'representation' of the Korean taste, a vegetable garden, faucet, pond, field, nature, a Hanok court garden, groves of bamboo, tile roof, stone wall, rock and backyard of a Hanok connected to the mountain. The planting material was used in two ways: reflecting only the ecological characteristics of the plant, and considering the ecological and visual characteristics together. Vegetation plantings reflecting the ecological characteristics were observed in all eleven spaces. Nine of the spaces reflected the growth environment of the plants, but the other two did not reflect the ecological characteristics of the plants, unlike the designer's intention. In the case of the four spaces that considered the ecological and visual characteristics together, color and size were considered visual characteristics. The plants in the seven spaces that included 'expression' as the theme were selected to reflect the visual characteristics in the order of color, shape, texture, and size, rather than reflecting ecological characteristics. A group planting method was applied. When the plants were used as materials for creating space, Norman(1989) analyzed three enclosure factors(overhead, vertical, ground plane). Only two deciduous trees were used in the overhead plane while five species of evergreen shrubs and thirty species of various deciduous plants were used in the vertical plane. There were forty-five species (nine trees and thirty-six herbaceous plants) forming the ground plane, and various herbaceous plants were utilized without duplication in each garden. The designer's garden of the Garden Show played a role in introducing new groundcover plants to the public. Three of the nine gardens did not include ornamental plants, and the use of decorative plants in other gardens was few compared to the number of plantings. In the Korea Garden Show designer's garden, most of the plants were being used with the intention of exposing the theme or architectural uses. In the 2016 Korea Garden Show designer's garden, many species of plants were used as materials for showcasing themes rather than for creating spaces. Also, the method of 'expression' was used more than the method of 'representation' in order to highlight the theme. This indicates that the planting materials reflect visual characteristics such as color, shape, texture, size rather than ecological characteristics.

Diagnosis of Obstructive Sleep Apnea Syndrome Using Overnight Oximetry Measurement (혈중산소포화도검사를 이용한 폐쇄성 수면무호흡증의 흡증의 진단)

  • Youn, Tak;Park, Doo-Heum;Choi, Kwang-Ho;Kim, Yong-Sik;Woo, Jong-Inn;Kwon, Jun-Soo;Ha, Kyoo-Seob;Jeong, Do-Un
    • Sleep Medicine and Psychophysiology
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    • v.9 no.1
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    • pp.34-40
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    • 2002
  • Objectives: The gold standard for diagnosing obstructive sleep apnea syndrome (OSAS) is nocturnal polysomnography (NPSG). This is rather expensive and somewhat inconvenient, however, and consequently simpler and cheaper alternatives to NPSG have been proposed. Oximetry is appealing because of its widespread availability and ease of application. In this study, we have evaluated whether oximetry alone can be used to diagnose or screen OSAS. The diagnostic performance of an analysis algorithm using arterial oxygen saturation ($SaO_2$) base on 'dip index', mean of $SaO_2$, and CT90 (the percentage of time spent at $SaO_2$<90%) was compared with that of NPSG. Methods: Fifty-six patients referred for NPSG to the Division of Sleep Studies at Seoul National University Hospital, were randomly selected. For each patient, NPSG with oximetry was carried out. We obtained three variables from the oximetry data such as the dip index most linearly correlated with respiratory disturbance index (RDI) from NPSG, mean $SaO_2$, and CT90 with diagnosis from NPSG. In each case, sensitivity, specificity and positive and negative predictive values of oximetry data were calculated. Results: Thirty-nine patients out of fifty-six patients were diagnosed as OSAS with NPSG. Mean RDI was 17.5, mean $SaO_2$ was 94.9%, and mean CT90 was 5.1%. The dip index [4%-4sec] was most linearly correlated with RDI (r=0.861). With dip index [4%-4sec]${\geq}2$ as diagnostic criteria, we obtained sensitivity of 0.95, specificity of 0.71, positive predictive value of 0.88, and negative predictive value of 0.86. Using mean $SaO_2{\leq}97%$, we obtained sensitivity of 0.95, specificity of 0.41, positive predictive value of 0.79, and negative predictive value of 0.78. Using $CT90{\geq}5%$, we obtained sensitivity of 0.28, specificity of 1.00, positive predictive value of 1.00, and negative predictive value of 0.38. Conclusions: The dip index [4%-4sec] and mean $SaO_2{\leq}97%$ obtained from nocturnal oximetry data are helpful in diagnosis of OSAS. CT90${\leq}$5% can be also used in excluding OSAS.

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An influence of operator's posture on the shape of prepared tooth surfaces for fixed partial denture (진료자세가 고정성 국소의치의 지대치 삭제에 미치는 영향)

  • Won, In-Jae;Kwon, Kung-Rock;Pae, Ah-Ran;Choi, Dae-Gyun
    • The Journal of Korean Academy of Prosthodontics
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    • v.49 no.1
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    • pp.38-48
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    • 2011
  • Purpose: Dentists suffer back, neck and shoulder pain during their careers due to bad operating posture. If dentists have a good operating posture ergonomically, there would be less pain and discomfort in the shoulder and back. Therefore, dentists should learn the Home position which enables dentists to approach a stable posture ergonomically. This study was to compare tooth preparation in the Home position and the Random position, and evaluate the clinical efficacy of the Home position. Materials and methods: Tooth preparation for fixed partial denture was performed on the maxillary left 2nd premolar and maxillary left 2nd molar at the two different operating positions were compared. The amount of occlusal reduction, marginal width, subgingival margin depth, and convergence angle were measured. A T-test was performed separately to compare the results of the Random position and the Home position. Results: 1. The amounts of average thickness of occlusal reduction on fossa were deficient to the ordered ones in the Random position and the Home position (P > .05). 2. The average subgingival margin depth of prepared margin on maxillary left 2nd premolar, maxillary left 2nd molar were excessive in the Random position than in the Home position. On the maxillary left 2nd premolar, there was no statistical difference in the Random position and the Home position except Distal midline, DL line angle, Lingual midline, ML line angle (P< .05). On the maxillary left 2nd molar, there was no statistical difference in the Random position and the Home position (P < .05). 3. Average convergence angle in the Random position and the Home position were excessive compared to the ordered angle. There was no statistical difference in the Random position and the Home position (P > .05). 4. Analysis of pearson correlation : In the Random position, the amounts of average thickness of occlusal reduction, the average subgingival margin depth of prepared margin, convergence angle were significantly associated with each other (P < .05). But in the Home position, they were not significantly associated with each other (P < .05). 5. The time needed for preparation in the Home position was faster or equal than that of the Random position as time went on. Conclusion: In conclusion, there were no significant differences between Home position and Random position in measures of occlusal reduction, marginal width, marginal depth, convergence angle. However, preparation time and incidence of damaging adjacent teeth were less in Home position than in Random position. Therefore, if trained properly, Home position which is more ergonomically stable can be adopted for clinical use.

COMPARISON OF POLYMERIZATION SHRINKAGE AND STRAIN STRESS OF SEVERAL COMPOSITE RESINS USING STRAIN GUAGE (스트레인 게이지를 이용한 수종의 복합레진의 중합수축 및 수축응력의 비교)

  • Kim, Young-Kwang;Yoo, Seung-Hoon;Kim, Jong-Soo
    • Journal of the korean academy of Pediatric Dentistry
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    • v.31 no.3
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    • pp.516-526
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    • 2004
  • Polymerization shrinkage of photoinitiation type composite resin cause several clinical problems. The purpose of this study was to evaluate the shrinkage strain stress, linear polymerization shrinkage, compressive strength and microhardness of recently developed composite resins. The composite resins were divided into four groups according to the contents of matrix and filler type. Group I : $Denfil^{TM}$(Vericom, Korea) with conventional matrix, Group II : $Charmfil^{(R)}$(Dentkist, Korea) with microfiller and nanofller mixture, Group III : $Filtek^{TM}$ Z250(3M-ESPE, USA) TEGDMA replaced by UDMA and Bis-EMA(6) in the matrix, and Group IV : $Filtek^{TM}$ Supreme(3M-ESPE, USA) using pure nanofiller. Preparation of acrylic molds were followed by filling and curing with light gun. Strain gauges were attached to each sample and the leads were connected to a strainmeter. With strainmeter shrinkage strain stress and linear polymerization shrinkage was measured for 10 minutes. The data detected at 1 minute and 10 minutes were analysed statistically with ONE-way ANOVA test. To evaluate the mechanical properties of tested materials, compressive hardness test and microhardness test were also rendered. The results can be summarized as follows : 1. Filling materials in acrylic molds showed initial temporary expansion in the early phase of polymerization. This was followed by contraction with the rapid increase in strain stress during the first 1 minute and gradually decreased during post-gel shrinkage phase. After 1 minute, there's no statistical differences of strain stress between groups. The highest strain stress was found in group IV and followed by group III, I, II at 10 minutes-measurement(p>.05). In regression analysis of strain stress, group III showed minimal inclination and followed by group II, I, IV during 1 minute. 2. In linear polymerization shrinkage test, the composite resins in every group showed initial increase of shrinkage velocity during the first 1 minute, followed by gradually decrease of shrinkage velocity. After 1 minute, group IV and group III showed statistical difference(p<.05). After 10 minutes, there were statistical differences between group IV and group I, III(p<.05) and between group II and group III(p<.05). In regression analysis of linear polymerization shrinkage, group II showed minimal inclination and followed by group IV, III, I during 1 minute. 3. In compressive strength test, group III showed the highest strength and followed by group II, IV, I. There were statistical differences between group III and group IV, I(p<.05). 4. In microhardness test, upper surfaces showed higher value than lower surfaces in every group(p<.05).

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A Clinical Study on Transpulmonary Leukostasis and Prophylactic Effects of Steroid in Cardiac Surgery (심장수술시 백혈구의 폐내정체와 스테로이드의 예방적 효과에 관한 연구)

  • 최석철
    • Biomedical Science Letters
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    • v.2 no.2
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    • pp.133-151
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    • 1996
  • After cardiac surgery, it has been recognized that various complications were associated with injured humoral and cellular immunity by cardiopulmonary bypass(CPB). Especially, in postoperative pulmonary dysfunction, transpulmonary leukostasis followed complement activation and inflammatory responses are major pathogen. Some studies have showed that pretreated-corticosteroids before CPB protected postoperative pulmonary dysfunction. Corticosteroids may inhibit complement and leukocyte activation. On based previous studies, present investigator determined changes of leukocyte counts and transpulmonary leukostasis during cardiac surgery and postoperative periods. For the evaluation of postoperative pulmonary function and edema, $PaO_2$ and chest X-ray were compared between pre-CPB and post-CPB. Fever and other parameters were also observed postoperatively. The aim of this study was to define for the prophylactic effects of corticosteroid(Solu-Medrol: 30mg/kg) on all the researched parameters. This study was prospectively designed with randomized-blind fashion for 50 patients undergoing cardiac surgery. According to the purpose of study, all patients were divided into placebo and steroid group. : Placebo group was 25 patients received normal saline(not corticosteroid), and steroid group was 25patients received corticosteroid(Solu-Medrol: 30mg/kg) before initiation of CPB. The results of study were summarized as follows. 1. Total peripheral leukocyte counts decreased significantly at 5 minutes of CPB in all patients(P<0.01), and began to increase progressively at later periods of CPB with neutrophilia. The significant rise remained at postoperative 7th day(P<0.05). 2. During partial CPB, transpulmonary leukostasis occurred in placebo group(P<0.001), whereas it was prevented in steroid group. 3. In both groups, peripheral lymphocyte counts were stable during CPB, but began to reduce at time of intensive care unit(ICU) and the lymphocytopenia remained until postoperative 3rd day. The lymphocyte counts recovered on postoperative 7th day. 4. In both groups, peripheral counts of monocyte were relatively stable in the early peroid of CPB, and increased gradually in the later periods of CPB. This significant monocytosis remained throughout postoperlative periods(P<0.05). 5. The mean value of postoperative $paO)_2$ was lower than that of pre-CPB in placebo group(P=0.01) but didn't significant in steroid group(P=0.90). In the incidence of pulmonary edema signs and fever, placebo group was higher than steroid group(P=0.001, p=0.01, respectively). However mechanical respiratory supporting and care periods at intensive care unit were not significant difference between two groups(P>.0.05).With the above results, the investigator concluded that leukocyte activation and pulmonary sequestration were caused by cardiac surgery with CPB and demonstrated that high dose corticosteroid will provide prophylactic effect for pulmonary leukostasis and higher neutrophilia. These effects may ameliorate postoperative pulmonary dysfunction and contribute to postoperative less morbidity. However, further study should be performed because postoperative lymphocytopenia continued for 3 days in both groups, which may suspected damage or suppression of cell-mediated immunity with used corticosteroid.

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Case study of Music & Imagery for Woman with Depression (우울한 내담자를 위한 MI(Music & Imagery) 치료사례)

  • Song, In Ryeong
    • Journal of Music and Human Behavior
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    • v.5 no.1
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    • pp.67-90
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    • 2008
  • This case used MI techniques that give an imagery experience to depressed client's mental resource, and that makes in to verbalism. Also those images are supportive level therapy examples that apply to positive variation. MI is simple word of 'Music and Imagery' with one of psychology cure called GIM(Guided Imagery and Music). It makes client can through to the inner world and search, confront, discern and solve with suitable music. Supportive Level MI is only used from safety level music. Introduction of private session can associate specification feeling, subject, word or image. And those images are guide to positive experience. The First session step of MI program is a prelude that makes concrete goal like first interview. The Second step is a transition that can concretely express about client's story. The third step is induction and music listening. And it helps to associate imagery more easily by used tension relaxation. Also it can search and associate about various imagery from the music. The last step is process that process drawing imagery, talking about personal imagery experience in common with therapist that bring the power by expansion the positive experience. Client A case targets rapport forming(empathy, understanding and support), searching positive recourse(child hood, family), client's emotion and positive support. Music must be used simple tone, repetition melody, steady rhythm and organized by harmony music of what therapist and client's preference. The client used defense mechanism and couldn't control emotion by depression in 1 & 2 sessions. But the result was client A could experience about support and understanding after 3 sessions. After session 4 the client had stable, changed to positive emotion from the negative emotion and found her spontaneous. Therefore, at the session 6, the client recognized that she will have step of positive time at the future. About client B, she established rapport forming(empathy, understanding and support) and searching issues and positive recognition(child hood, family), expression and insight(present, future). The music was comfortable, organizational at the session 1 & 2, but after session 3, its development was getting bigger and the main melody changed variation with high and low of tune. Also it used the classic and romantic music. The client avoids bad personal relations to religious relationship. But at the session 1 & 2, client had supportive experience and empathy because of her favorite, supportive music. After session 3, client B recognized and face to face the present issue. But she had avoidance and face to face of ambivalence. The client B had a experience about emotion change according depression and face to face client's issues After session 4. At the session 5 & 6, client tried to have will power of healthy life and fairly attitude, train mental power and solution attitude in the future. On this wise, MI program had actuality and clients' issues solution more than GIM program. MI can solute the issue by client's based issue without approach to unconsciousness like GIM. Especially it can use variety music and listening time is shorter than GIM and structuralize. Also can express client's emotion very well. So it can use corrective and complement MI program to children, adolescent and adult.

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