• 한국전문물리치료학회지
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• 제8권4호
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• pp.81-89
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• 2001

전시냅스 억제(presynaptic inhibition)와 동시냅스 억제(homosynaptic depression)는 보행 시에 분절반사(segmental reflex)를 조절하는 두 가지 독립적인 기전이다. 근방추 피드백(feedback)은 전시냅스 억제(inhibition)를 통해 보행 시 원심성 근육 수축기에서 적절이 조절될 수 있다. 이러한 전시냅스 억제 작용은 H-reflex의 강도로 나타내질 수 있는데, 원심성 근육 수축기 동안 H-reflex의 강도가 약해지는 것으로 보아 전시냅스 억제 작용은 증가되는 것으로 보여진다. 근방추 구심성 피드백(feedback) 역시 동시냅스 억제를 통해서 조절될 수 있다. 따라서 전시냅스와 동시냅스 억제는 보행 시작 중에 반사의 기전을 조절하는 중요한 역할을 한다. 반사의 조절 기전은 알파(alpha) 운동 신경원의 흥분도와 더불어 상위 척수의 기전들을 통해서 영향받고 조절된다. 경직성 마비 환자들은 초기의 입각기, 혹은 유각기 중에 손상된 비정상 비복근 H-reflex 조절기전을 보여준다. 이러한 비정상적인 조절기전은 발바닥의 말초신경을 자극함으로써 부분적으로 회복될 수 있다.

• Annals of Clinical Neurophysiology
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• 제4권2호
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• pp.119-124
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• 2002

Background : Guillain-$Barr{\acute{e}}$ syndrome(GBS) is a neurologically emergent condition, leading to respiratory insufficiency without an early and appropriate treatment. Thus, the treatment of GBS requires early diagnosis but it is difficult due to the low sensitivity of laboratory tools in the initial stage. Hoffman reflex (H-reflex) and its facilitation by Jendrassik maneuver (JM) are sensitive tools evaluating the central circuit of motor system on the spinal cord level. The aim of this study is to test whether the change of H-reflex and F-wave under the JM is able to detect the early stage of GBS and whether GBS involves the central nervous system (CNS). Material and Methods : All 7 GBS patients who showed normal or nearly normal nerve conduction study were included. The facilitation of H-reflex and changes of F-wave were calculated by measuring the percent difference of H-reflex or F-wave amplitude under JM compared to basal H-reflex of F-wave amplitude. The changes of F-wave and H-reflex in the GBS patients were compared with them of 8 healthy controls. Results : The F-wave amplitudes of both healthy controls and GBS patients did not changed under the influence of JM ($102.4{\pm}24.9%$, $108.7{\pm}29.0%$ respectively). However, the facilitation of H-wave by JM in the GBS patients was absent ($98.8{\pm}5.8%$), even though the H-reflex amplitude I the healthy controls increased under the influence of JM ($124.8{\pm}12.1%$). Conclusions : The loss of H-reflex facilitation in GBS implies that this phenomenon might be the most early change detected in the electrophysiological study and support the early diagnosis, and that GBS might include lesion in the spinal motor CNS.

• 대한물리의학회지
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• 제6권1호
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• pp.71-79
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• 2011

Purpose : The purpose of this study was carried out to investigate the effect of repetitive transcranial magnetic stimulation on increase of H-reflex inhibition and fascilitation of range of motion of spastic ankle joint in chronic stroke patients. Methods : 30 chronic stroke patients were randomly divided into three groups, a control group(placebo rTMS group), 5 Hz rTMS group and manual therapy group. The MAS and ROM of ankle joint and H-reflex inhibition of soleus muscle were evaluated on each group. Results : The rTMS group decreased MAS of ankle joint and increased H-reflex inhibition of soleus muscle, and ROM of ankle joint than manual therapy group. The placebo rTMS group did not affected the change of MAS, ROM of ankle joint and H-reflex inhibition of soleus muscle. Conclusion : The rTMS was a good therapeutic tool to improve the foot drop in the chronic stroke patients.

• Annals of Clinical Neurophysiology
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• 제1권2호
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• pp.126-146
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• 1999

In clinical neurology various different electrophysiological tests are widely used to demonstrate the unsuspected malfunctioning in the nervous system and to monitor over time the clinical status of patients. In addition clinical neurologists and neurosurgeons take advantage of the intraoperative monitorings to increase the quality of neurosurgical operations in the posterior fossa, in the spinal cord, or in visual pathways. In the field of movement disorders, elecrophysiolgical tests provide neurologists with making accurate differential diagnoses with useful therapeutic stratergies as well as with investigating the pathophysiological machanisms. By using the electromyographic tests it could be possible for us to evaluate the types of blephalospasm, the extent of hemifacial spasm, the level of myoclonus, and the prime muscles of torticollis etc. Sometimes the myographic guidance may be critical for choosing the exact injecting site of botulinum toxin. These several decades various electroencephalographic and evoked potential tests has been utilized in the electrophysiological laboratories to understand the basic pathophysiology of myoclonus, spasticity and other central motor dysfunctions. It could be one of the breakthroughs in the area of behavorial neurology that the brain function can be mapped by the spontaneous or evoked electrical activities of nervous system since the movement related potentials (MRPs) had been studies for several decades. Various reflex tests such as masseter reflex, blink reflex, click evoked vestibulocollic reflex, facial reflex, stretch reflex, flexor reflex, H-reflex, H-reflex recovery curve, vestibular inhibition of H-reflex, reciprocal inhibition, recurrent or Renshaw reflex, Ib inhibition, cutaneous reflex have been also used to understand normal or abnormal physiology in movement disorders. Polysomnography, posturography and gait studies are also applied in clinical neurology in association with with movement disorders which are useful in deciding the treatment regimen.

• 대한임상전기생리학회지
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• 제2권3호
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• pp.65-73
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• 2004

In experimental method, this study was that galvanic vestibular stimulation in vestibular system influenced the excitability of spinal neuron through. H-reflex was measured by galvanic vestibular stimulation of binaural(right-negative pole and left-positive pole) at left head turning and prone position in sixteen normal subjects in their twenties age were selected. The summary of the comparison results were obtained below. 1. In the change of H reflex according to galvanic vestibular stimulation(GVS), Hmax amplitude(p<.05) increased significantly after stimulation. 2. In the change of H reflex according to galvanic vestibular stimulation(GVS), Hmax/Mmax ratio(p<.05) increased significantly after stimulation. In the conclusion, galvanic vestibular stimulation influenced the excitability of vestibulospinal tract and spinal neuron.

• Journal of Yeungnam Medical Science
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• 제14권1호
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• pp.111-122
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• 1997

정상 성인에서 상지로 부터 H-반사가 유발될수 있는지를 알아보고, 또 상지에서의 H-반사 검사가 경수 신경근병증의 진단에 유용한지를 알고자 본 연구를 실시하였다. 정상 성인 31명을 대상으로 좌우 62개의 요측수근굴근, 요측수근신근, 상완요골근, 소지외전근의 H-반사를 검사하여 잠복기와 interlatency time을 구하였고 경수 신경근병변을 가진 환자 12명을 대상으로 H-반사를 검사하였다. 정상군에서 요측수근신근의 H-반사의 잠복기의 평균은 $15.99{\pm}1.25$ msec, 양측 차이의 평균치는 $0.68{\pm}0.71$ msec이었으며 interlatency time은 평균치가 $13.93{\pm}1.32$ msec, 양측 차이의 평균치는 $0.73{\pm}0.62$ msec 이었다 요측수근굴근의 H-반사의 잠복기의 평균은 $16.16{\pm}1.65$ msec, 양측 차이의 평균치는 $0.47{\pm}0.48$ msec이었고 interlatency time의 평균치는 $13.91{\pm}0.99$ msec, 양측 차이의 평균치는 $0.49{\pm}0.47$ msec 이었다. 상완요골근의 경우는 H-반사의 잠복기의 평균치가 $16.47{\pm}1.59$ msec, 양측 차이의 평균치가 $0.63{\pm}0.43$ msec 이었고 interlatency time의 평균치는 $14.68{\pm}1.61$ msec, 양측 차이의 평균치는 $0.79{\pm}0.71$ msec 이었다. 소지외전근에서의 H-반사의 잠복기의 평균치는 $24.46{\pm}1.42$ msec, 양측 차이의 평균치는 $0.59{\pm}0.42$ msec, 양측 차이의 평균치는 $0.59{\pm}0.42$ msec이고 interlatency time의 평균치는 $22.31{\pm}1.24$ msec, 양측 차이의 평균치는 $0.19{\pm}0.44$ msec를 보였다. 정상군에서는 팔 길이와 키가 커짐에 따라서 H-반사의 잠복기가 길어지는 양상을 보였다. 경수 신경근병변을 가진 12명중 11명에서 H-반사 검사상 이상 소견을 보였으며 제 6,7 경수 신경근 병변을 보인 5명중 4명에서 요측수근굴근의 H-반사의 이상 소견을 보였고, 제 7 경수 신경근병변을 보인 4명 모두에서 요측수근굴근과 요측수근신근에서의 이상 소견을 보였다. 제 5 신경근병변을 보인 환자 1명에서 상완요골근에서의 이상 소견을 보였다. 본 연구를 통하여 정상 성인에서 상지로부터 H-반사가 측정할 수 있으며, H-반사의 잠복기는 팔 길이와 키에 연관이 있음을 알았다. 또 경수 신경병증의 진단에 H 반사가 적용될 수 있음을 확인 하였다.

• 대한물리치료과학회지
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• 제10권1호
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• pp.65-73
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• 2003

The purpose of this study was to determine whether neuromuscular electrical stimulation(NMES), applied over the antagonist or the agonist, would alter the H reflex. Attention was focused on the roles of stimulus location. We used normal eight subjects without neuromuscular disease which were divided into 3 groups; the subjects were diveded into group of antagonist, agonist, antagonist-agonist. All groups were meted of eight subjects. Neuromuscular electrical stimulation was administered for 15 minutes. All subjects were subjected to three tests, including a pre-test, post-test and post-20 minute test. The data were analyzed by repeated measures ANOVA and paired t-test. The results were as follows; 1. H latencies were significantly increased in agonist and antagonist-agonist group (p<.01). 2. H/M intervals were significantly increased in agonist and antagonist-agonist group (p<.01). 3. H amplitudes were significantly increased in agonist (p<.001) and antagonist-agonist group (p<.01). 4. H/M ratios were significantly decreased in agonist and antagonist-agonist group (p<.01). In agonist group. H-reflex amplitudes and H/M ratios were more significantly decreased than antagonist group. Future studies will need to determine what influence NMES may have on the excitability of spinal motor neurons in people having UMN syndrome.

• 한국운동역학회지
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• 제19권4호
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• pp.655-661
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• 2009

본 연구는 기합소리를 세 가지 유형에 따라 인체내부의 근력의 차이를 비교하기 위해 H-reflex방법과 대퇴직근의 MVIC측정을 하여 추후 충격력과 운동수행에 미치는 효과를 규명하고 최적의 기합소리의 방법을 찾는데 도움을 주고자 설계하였다. 가자미근 H반사는 정강신경이 지나가는 오금에 전기자극을 주어 유발하였고, 표면근전도를 통하여 자료를 수집한 결과 기합 없이 측정한 결과 보다 기합을 지르면서 측정 시 28%증가하였고, 기합을 짧게 지른 직후 측정한 결과 29%가 증가한 것을 볼 수 있었다. 근전도 측정은 오른쪽 하지의 대퇴직근(Rectus femoris)에 표면전극을 부착해 MVIC를 측정한 결과 기합의 유형에 따라 10%와 1%의 증가를 보였다. 이러한 연구 결과에 비추어 기합이 운동신경효율성(H-reflex)과 MVIC의 크기를 변화시키는 것으로 보았을 때 근력증대에 긍정적인 요인을 미치는 것으로 사료되지만 근력증대의 변인 중 기합소리뿐만 아니라 호흡과 관련된 연구, 뇌파와 관련된 연구 등 일반화시킬 수 있는 많은 변인들에 관한 포괄적인 연구가 이루어 져야 할 것으로 사료된다.

• 대한임상전기생리학회지
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• 제1권1호
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• pp.1-15
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• 2003

The purpose of this study was to determine the effect of neuromuscular electrical stimulation(NMES) on the alteration of spinal motor neuron excitability. In this article, I would like to experiment on a standard capacity of clinical electrophysiology, a difference in applying methods and a clinical efficiency of NMES by Nerve conduction velocity. We used normal eight subjects without neuromuscular disease and all subjects participated 3 session, which at least 1 week between session. Participants classified according to each group in Antagonist, Agonist, Antagonist-Agonist by the NMES. The test was measured continuously pre test, post-test, post 20 minute test by EMG including H reflex, F wave, motor nerve conduction velocity(MNCV). The following results were obtained; 1. H-reflex latencies and H/M intervals were significantly increased in agonist and antagonist-agonist group(p<.01). 2. H-reflex amplitudes and H/M ratios were significantly decreased in agonist and antagonist-agonist group(p<.01). In agonist group, H-reflex amplitudes and H/M ratios were more significantly decreased than antagonist group. 3. F-wave latencies were significantly increased in agonist and antagonist-agonist group(p<.01). F/M intervals were significantly increased in antagonist-agonist group(p<.01). F wave conduction velocities were significantly increased in agonist and antagonist-agonist group(p<.01) but F/M ratios were not significant. 4. MNCV were significantly decreased in agonist(p<.01). These results lead us to the conclusion that agonist and Antagonist-agonist was significantly decreased excitability of spinal motor neuron. Conversely, Antagonist does not decreased. Therefore, A further direction of this study will be to provide more evidence that NMES have an effect on excitability of spinal motor neurons in UMN syndrome.

• 대한의용생체공학회:의공학회지
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• 제4권1호
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• pp.3-8
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• 1983

Characteristics of the lung inflation and deflation reflexes were measured at various temperatures on the cervical vagi in five anesthetized mongrel dogs. Nerve temperature was maintained at the body temperature, and 2-14˚C with 2˚C apart using a specially designed automated vagal cooling apparatus with an accuracy to within $\pm$ 0.1˚c at each temperature. The inflation reflex was blocked abruptly at 8-10˚C. The deflation reflex started weakened at 14˚C, thereafter showed a gradual blockade with the temperature decreased with a substantial variance among the animals.It was approximately 75% blocked at 2-5˚C. These differences in temperature characteristics made it hard to differentiate the deflation reflex from the inflation reflex. In one animal, however, the inflation reflex was completely blocked with the deflation reflex almost alive at 6-8˚C. This suggests that differential cold blockade of the vagal reflexes can be done only in selected subjects. Furthermore, the fact that these two reflexes were blocked at different temperatures may be due to the differences in the nerve fiber size and the changes in the conduction velocity with temperature.