• PNF and Movement
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• v.21 no.2
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• pp.185-192
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• 2023

Purpose: This study aimed to confirm the effectiveness of the diaphragm stretching technique as a treatment method for low back pain by evaluating maximum inspiratory pressure, maximum expiratory pressure, and changes in back mobility in patients with low back pain. Methods: Thirty-four patients with low back pain were randomly divided into two groups: an experimental group and a control group. The diaphragm stretching technique was conducted in the experimental group, and the placebo intervention was conducted in the control group. The diaphragm stretching technique was conducted once, maintaining tension for 7 min. The placebo intervention was conducted in the same position as the diaphragm stretching technique, but with only light contact maintained without pressure. Maximum inspiratory pressure, maximum expiratory pressure, and back mobility were measured before and after the intervention, and the changes were compared and analyzed. A paired sample t-test was used to compare measurements within the group before and after the intervention. An independent t-test was used to compare the experimental and control groups. Statistical significance (α) was set at 0.05. Results: In the experimental group, maximum inspiratory pressure, maximum expiratory pressure, and back mobility increased significantly after the intervention (p < 0.05). However, there was no significant difference in the changes in all areas of the control (p > 0.05). As a result of comparative analysis of changes before and after the intervention, there were significant differences in maximum inspiratory pressure, maximum expiratory pressure, and back mobility only in the experimental group (p < 0.05). Conclusion: The diaphragm stretching technique improved maximum inspiratory pressure, maximum expiratory pressure, and back mobility compared to the placebo intervention. Therefore, the diaphragm stretching technique can be recommended as a physical therapy intervention to improve pain in patients with LBP.

• PNF and Movement
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• v.21 no.2
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• pp.151-158
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• 2023

Purpose: This study aimed to examine the immediate effects of different breathing training techniques on diaphragm excursion and vital capacity in healthy adults. Specifically, the study focused on comparing respiratory exercise without PNF, bilateral pattern respiratory exercise, and bilateral pattern with spiral pattern respiratory exercise. Methods: Twenty-seven healthy adults in their 20s participated in the study. Diaphragm excursion and vital capacity were evaluated under three different conditions. A one-way repeated ANOVA was used to analyze the differences in diaphragm excursion and vital capacity among the interventions. Results: Statistically significant differences were observed in diaphragm excursion among the interventions, comparing respiratory exercise without PNF, bilateral pattern respiratory exercise, and bilateral pattern with spiral pattern respiratory exercise. Similarly, statistically significant differences were found in vital capacity among the interventions without PNF respiratory exercise, bilateral pattern respiratory exercise, and bilateral pattern with spiral pattern respiratory exercise. Conclusion: The study demonstrated that incorporating the spiral technique in respiratory exercise led to increased diaphragm excursion and lung capacity compared to other interventions. These findings suggest that PNF respiratory exercise combined with the spiral pattern may have clinical implications for the treatment of respiratory diseases. Further research is warranted to explore the long-term effects and clinical application of these approaches.

• The Journal of the Acoustical Society of Korea
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• v.14 no.5
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• pp.29-35
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• 1995

Nonlinear distortion arising from the nonlinear movement of the loudspeaker diaphragm degradates the tone quality. The distortion is, in low frequency range, mainly caused by nonlinear characteristics of the suspension stiffness and the force factor. In this paper, the nonlinear suspension stiffness and the nonlinear force factor are modeled to the quadratic functions and a method is proposed to determine their coefficients. An additional mass to the diaphragm moved the quiescent point of the diaphragm and uncoupled the stiffness and the force factor. This made it possible to deter mine the coefficients of the nonlinear suspension stiffness by measuring the resonance frequencies at several quiescent points. The coefficients of the nonlinear force factor are then determined by fitting the curve which is calculated from the waveforms of input voltage and input current, and the displacement of the diaphragm at resonance frequency.

• Journal of Biomedical Engineering Research
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• v.23 no.5
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• pp.391-395
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• 2002

Shunt valves used to treat patient with hydrocephalus were numerically simulated to investigate influence of pressure pulsation on their flow control characteristics. We modeled flow orifice through the shunt valve and imposed pulsating pressure and valve diaphragm movement to compute flow through the valve. The results of our study indicated that flow rates increased more than 40% by introducing pressure pulsation and diaphragm movement on the shunt valve. Our results demonstrate the pressure-flow control characteristics of shunt valves implanted above human brain may be quite different from those obtained by syringe pump test just after manufacture that induces uniform pressure.

• Geomechanics and Engineering
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• v.31 no.5
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• pp.489-503
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• 2022

A 1257-m-long irregular deep foundation pit located in the central of Nanjing, China was constructed using the combined full-width and half-width top-down method. Based on the long-term field monitoring data, this study analyzed the evolution characteristics of the vertical movement of the columns, internal force of the struts, and axial force of the structural beam and slab. The relevance of the three mentioned above and their relationship with the excavation process, structural system, and geological conditions were also investigated. The results showed that the column uplift was within the range of 0.08% to 0.22% of the excavation depth, and the embedded depth ratio of the diaphragm wall and the bottom heave affected significantly on the column uplift. The differential settlement between the column and diaphragm wall remained unchanged after the base slab was cast. The final settlement of the diaphragm wall was twice the column uplift. The internal force of the struts did not varied monotonically but was related to numerous factors such as the excavation depth, number of struts, and environmental conditions. Additionally, the dynamic force and deformation of the columns, beams, and slabs were analyzed to investigate the inherent relationship and variation patterns of the responses of different parts of the structure.

• Proceedings of the Korean Geotechical Society Conference
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• 1991.10a
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• pp.312-331
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• 1991

Top-down Method of basement construction technique has been applied for building of the deep basement car park the close proximity of priceless historic buildings in LONDON. Numerical analysis for the prediction of ground movement of the surrounding buildings was performed in order to compare the field data at the various stages of excavation and support. The predicted results from the elasto-plastic analytical method were compared with the observed data and the agreement is very satisfactory. It may be concluded that the system of diaphragm wall supported by the permanent base slabs (Top-Down Method) was proved to be the most effective technique in terms of reducing any critical damage to the surrounding buildings.

• Radiation Oncology Journal
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• v.24 no.3
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• pp.192-200
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• 2006

[ $\underline{Purpose}$ ]: To evaluate the movement of surgical clips implanted in breast tumor bed during normal breathing. $\underline{Materials\;and\;Methods}$: Seven patients receiving breast post-operative radiotherapy were selected for this study. Each patient was simulated in a common treatment position. Fluoroscopic images were recorded every 0.033 s, 30 frames per 1 second, for 10 seconds in anterior to posterior (AP), lateral, and tangential direction except one patient's images which were recorded as a rate of 15 frames per second. The movement of surgical clips was recorded and measured, thereby calculated maximal displacement of each clip in AP, lateral, tangential, and superior to inferior (SI) direction. For the comparison, we also measured the movement of diaphragm in SI direction. $\underline{Results}$: From AP direction's images, average movement of surgical clips in lateral and SI direction was $0.8{\pm}0.5\;mm$ and $0.9{\pm}0.2\;mm$ and maximal movement was 1.9 mm and 1.2 mm. Surgical clips in lateral direction's images were averagely moved $1.3{\pm}0.7\;mm$ and $1.3{\pm}0.5\;mm$ in AP and SI direction with 2.6 mm and 2.6 mm maximal movement in each direction. In tangential direction's images, average movement of surgical clips and maximal movement was $1.2{\pm}0.5\;mm$ and 2.4 mm in tangential direction and $0.9{\pm}0.4\;mm$ and 1.7 mm in SI direction. Diaphragm was averagely moved $14.0{\pm}2.4\;mm$ and 18.8 mm maximally in SI direction. $\underline{Conclusion}$: The movement of clips caused by breathing was not as significant as the movement of diaphragm. And all surgical clip movements were within 3 mm in all directions. These results suggest that for breast radiotherapy, it may not necessary to use breath-holding technique or devices to control breath.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.90-93
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• 2002

In particle radiotherapy, a shape of the beam to conform the irradiation field is statically defined by the compensator, collimator and potal devices at the outside of the patient body. However the target such as lung or liver cancer moves along with respiration. This increases the irradiated volume of normal tissue. Prior discussions about organ motions along with respiration have been mainly focused on inferior-superior movement that was usually perpendicular to beam axis. On the other hand, the change of the target depth along the beam axis is very important especially in particle radiotherapy, because the range end of beam (Bragg peak) is so sharp as to be matched to distal edge of the target. In treatment planning, the range of the particle beam inside the body is calculated using a calibration curve relating CT number and water equivalent path length (WEL) to correct the inhomogeneities of tissues. The variation in CT number along the beam path would cause the uncertainties of range calculation at treatment planning for particle radiotherapy. To estimate the uncertainties of the range calculation associated with patient breathing, we proposed the method using sequential CT images with respiration waveform, and analyzed organ motions and WELs at patients that had lung or liver cancer. The variation of the depth along the beam path was presented in WEL rather than geometrical length. In analyzed cases, WELs around the diaphragm were remarkably changed depending on the respiration, and the magnitude of these WEL variations was almost comparable to inferior-superior movement of diaphragm. The variation of WEL around the lung was influenced by heartbeat.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.149-159
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• 2016

Purpose : To evaluate the usefulness of the breathing exercise,we analyzed the change in the RPM signal and the diaphragm imagebefore 4D respiratory gated radiation therapy planning of lung cancer patients. Materials and Methods : The breathing training was enforced on 11 patients getting the 4D respiratory gated radiation therapy from April, 2016 until August. At the same time, RPM signal and diaphragm image was obtained respiration training total three steps in step 1 signal acquisition of free-breathing state, 2 steps respiratory signal acquisition through the guide of the respiratory signal, 3 steps, won the regular respiration signal to the description and repeat training. And then, acquired the minimum value, maximum value, average value, and a standard deviation of the inspiration and expiration in RPM signal and diaphragm image in each steps. Were normalized by the value of the step 1, to convert the 2,3 steps to the other distribution ratio (%), by evaluating the change in the interior of the respiratory motion of the patient, it was evaluated breathing exercise usefulness of each patient. Results : The mean value and the standard deviation of each step were obtained with the procedure 1 of the RPM signal and the diaphragm amplitude as a 100% reference. In the RPM signal, the amplitudes and standard deviations of four patients (36.4%, eleven) decreased by 18.1%, 27.6% on average in 3 steps, and 2 patients (18.2%, 11 people) had standard deviation, It decreased by an average of 36.5%. Meanwhile, the other four patients (36.4%, eleven) decreased by an average of only amplitude 13.1%. In Step 3, the amplitude of the diaphragm image decreased by 30% on average of 9 patients (81.8%, 11 people), and the average of 2 patients (18.2%, 11 people) increased by 7.3%. However, the amplitudes of RPM signals and diaphragm image in 3steps were reduced by 52.6% and 42.1% on average from all patients, respectively, compared to the 2 steps. Relationship between RPM signal and diaphragm image amplitude difference was consistent with patterns of movement 1, 2 and 3steps, respectively, except for No. 2 No. 10 patients. Conclusion : It is possible to induce an optimized respiratory cycle when respiratory training is done. By conducting respiratory training before treatment, it was possible to expect the effect of predicting the movement of the lung which could control the patient's respiration. Ultimately, it can be said that breathing exercises are useful because it is possible to minimize the systematic error of radiotherapy, expect more accurate treatment. In this study, it is limited to research analyzed based on data on respiratory training before treatment, and it will be necessary to verify with the actual CT plan and the data acquired during treatment in the future.

• Radiation Oncology Journal
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• v.19 no.4
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• pp.319-326
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• 2001

Purpose : Planning target volume (PTV) for tumors in abdomen or thorax includes enough margin for breathing-related movement of tumor volumes during treatment. Depending on the location of the tumor, the magnitude of PTV margin extends from 10 mm to 30 mm, which increases substantial volume of the irradiated normal tissue hence, resulting in increase of normal tissue complication probability (NTCP). We developed a simple and handy method which can reduce PTV margins in patients with liver tumors, respiratory motion reduction device (RRD). Materials and methods : For 10 liver cancer patients, the data of internal organ motion were obtained by examining the diaphragm motion under fluoroscope. It was tested for both supine and prone position. A RRD was made using MeV-Green and Styrofoam panels and then applied to the patients. By analyzing the diaphragm movement from patients with RRD, the magnitude of PTV margin was determined and dose volume histogram (DVH) was computed using AcQ-Plan, a treatment planning software. Dose to normal tissue between patients with RRD and without RRD was analyzed by comparing the fraction of the normal liver receiving to $50\%$ of the isocenter dose. DVH and NTCP for normal liver and adjacent organs were also evaluated. Results : When patients breathed freely, average movement of diaphragm was $12{\pm}1.9\;mm$ in prone position in contrast to $16{\pm}1.9\;mm$ in supine position. In prone position, difference in diaphragm movement with and without RRD was $3{\pm}0.9\;mm$ and 12 mm, respectively, showing that PTV margins could be reduced to as much as 9 mm. With RRD, volume of the irradiated normal liver reduced up to $22.7\%$ in DVH analysis. Conclusion : Internal organ motion due to breathing can be reduced using RRD, which is simple and easy to use in clinical setting. It can reduce the organ motion-related PTV margin, thereby decrease volume of the irradiated normal tissue.