• Korean Journal of Applied Biomechanics
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• v.30 no.1
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• pp.83-91
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• 2020

Objective: The study aimed to develop a functional performance index that evaluates the functional performance of Parkinson's patients, i.e., to integrate biomechanical measurements of walking, balance, muscle strength and tremor, and to use multiple linear regression with stepwise methods to identify the most suitable predictors for the progression of disease. Method: A total of 60 subjects were tested for sub-variables of four factors: walking, balance, isometric strength and hand tremors. Potential independet variables were extracted through correlation analysis of the sub-variables and dependent variables, Hoehn & Yahr scale. And then, a stepwise multiple regression analysis using the potential independent variables was performed to identify predictor of Hoehn & Yahr scale. Results: First, the results of the study showed that physical composition and gait had a relatively more correlated with the progression of the disease, compared to balance and hand tremor. Second, Parkinson's functional performance is characterized by dynamic pattern of walking, such as foot clearance and turning angle (TA) of walking, and a high-explained regression model is completed. Conclusion: The study emphasized the importance of walking variables and body composition in minor pathological features compared to Parkinson's patient's balancing ability and hand tremor. Specifically, it revealed that dynamic walking patterns functionally characterize patients. The results are worth considering when assessing functional performance related to the progression of the disease at the site.

• Journal of Biomedical Engineering Research
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• v.36 no.4
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• pp.103-108
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• 2015

Discrimination of Parkinson's disease (PD) from Essential tremor (ET) is often misdiagnosed in clinical practice. Since tremor is time-varying signal, and dominant and harmonic frequencies are shown in tremor only with moderate or severe symptom, there are some limitations to use frequency related features. Moreover, patients with PD or ET can suffer from both resting tremor and postural tremor. In this study, 28 patients with PD and 17 patients with ET were enrolled. Tremor was measured with accelerations on the more affected hand during resting and postural conditions. The ratio of root mean square (RMS) of resting tremor to RMS of postural tremor, the mean coefficients of autocorrelation function (ACF), and the mean of differences of two adjacent coefficients of ACF at resting and postural were calculated and compared between PD and ET. The performance showed 98% accuracy with support vector machine and leave-one-out cross validation. In addition, the method accurately differentiated the patients with tremor-dominant PD from patients with ET, with 100% accuracy. Therefore, the developed algorithm can assist clinicians in diagnosing and categorizing patients with tremor, especially, patients with mild symptom or the early stage of a disease, for proper treatment.

• Journal of Korean Neurosurgical Society
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• v.37 no.2
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• pp.105-111
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• 2005

Objective: Tremor, either essential tremor or Parkinsonian tremor, has been effectively and safely treated by lesioning the ventral intermediate(Vim) nucleus of the thalamus with or without mircroelectrode recording. The authors evaluate the treatment outcome of sixteen tremor patients who had been treated with thalamotomy without microelectrode. Methods: Between September, 2001, and December, 2003, sixteen tremor patients were treated with thalamotomy without microelectrode recording. Twelve patients suffered from Parkinsonian tremor and four patients were essential tremor patients. The male to female ratio was 1.6 to 1 with median age of 59.6 years (range; 39-74 years). Under local anesthesia, a 3mm hole was made using a hand-held twist drill, and the dura mater was penetrated with a 1.2mm sharp drill beat. Radiofrequency(RF) electrode was placed in the Vim nucleus of thalamus. With intraoperative macrostimulation, RF lesion was made. Postoperative CT scan and/or MR imaging was performed to confirm the localization of the target lesioned. Preoperative and postoperative tremor was evaluated with simple tremor severity scale and the development of complications related with the procedure was closely reviewed at the immediate postoperative period and the last follow-up. Results: It produces immediate relief in up to 98.4% of the patients. There were no development of complications related with procedure, all patients discharged one or two days after surgery. Conclusion: Vim thalamotomy without microelectrode recording is a safe and effective procedure to control the tremor with minimal morbidity. Intraoperative macroelectrode stimulation safely localizes the Vim nucleus target of the thalamus for the treatment of patients with tremor.

• Annals of Clinical Neurophysiology
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• v.2 no.2
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• pp.95-100
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• 2000

Purpose : Primary writing tremor(PWT) can be classified as either type A or type B depending on whether tremor appeared during writing or whilst writing and also on adopting the hand postures normally used for writing. Through the clinical experience author has had an impression that PWT type B may not be purely dependant on specific writing postures. The objective of this study was to clarify whether PWT type B have writing posture-specificity or not. Results : The data indicated that type B PWT is not writing posture-specific. Various pronation and supination postures could evoke tremor as well as writing postures. Furthermore most of other pronation- and supination-related tasks could evoke tremors as well as action of writing. Conclusions : The present data suggest that PWT should be limited only on the pure form of task-spesific PWT type A.

• Journal of Korean Neurosurgical Society
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• v.37 no.6
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• pp.456-458
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• 2005

We report a case of hydrocephalus in a 8-year-old boy who presented bilateral hand tremor. The hydrocephalus was caused by the aqueductal stenosis due to expanding lacunae in the mesencephalothalamic area on MR findings. The tremor was improved after CSF drainage by spinal tap and ventriculoperitoneal shunt. The authors present the possible mechanism of hydrocephalus induced tremor.

• The Journal of Korea Robotics Society
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• v.16 no.1
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• pp.64-71
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• 2021

This paper describes a robotic teleoperation system to perform an accurate needle insertion into a cornea for a separation between the stromal layer and Descemet's membrane during deep anterior lamellar Keratoplasty (DALK). The system can reduce the hand tremor of a surgeon by scaling the input motion, which is the control input of the slave robot. Moreover, we utilize corneal applanation to estimate the insertion depth. The proposed system was validated by performing the layer separation using 25 porcine eyes. The average depth of needle insertion was 742 ± 39.8 ㎛ while the target insertion depth was 750 ㎛. Tremor error was reduced from 402 ± 248 ㎛ in the master device to 28.5 ± 21.0 ㎛ in the slave robot. The rate of complete success, partial success, and failure were 60, 28, and 12%, respectively. The experimental results showed that the proposed system was able to reduce the hand tremor of surgeons and perform precise needle insertion during DALK.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.32 no.1
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• pp.9-14
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• 2021

Spasmodic dysphonia, essential tremor, and vocal tremor related with Parkinson's disease are different disorders showing fairly similar symptoms such as difficulty in the speech onset, and tremble in the voice. However, the cause and the resulting treatment of these diseases are different. Spasmodic dysphonia is a vocal disorder characterized by spasms of the laryngeal muscles during a speech, invoking broken, tense, forced, and strangled voice patterns. Such difficult-to-treat dysphonia disease is classified as central-origin-focal dystonia, of a yet unknown etiology. Its symptoms arise because of intermittent and involuntary muscle contractions during speech. Essential tremor, on the other hand, is characterized by a rhythmic laryngeal movement, resulting in alterations of rhythmic pitch and loudness during speech or even at rest. Severe cases of tremor may cause speech breaks like those of adductor spasmodic dysphonia. In the case of hyper-functional tension of vocal folds and accompanying tremors, it is necessary to distinguish these disorders from muscular dysfunction. A diversified assessment through the performance of specific speech tasks and a thorough understanding for the identification of the disorder is necessary for accurate diagnosis and effective treatment of patients with vocal tremors.

• Archives of Plastic Surgery
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• v.48 no.4
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• pp.427-432
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• 2021

The conventional approach of looking down a microscope to perform microsurgical procedures is associated with occupational injuries, anti-ergonomic postures, and increased tremor and fatigue, all of which predispose microsurgeons to early retirement. Recently, three-dimensional (3D) visualization of real-time microscope magnification has been developed as an alternative. Despite its commercial availability, no supermicrosurgical procedures have been reported using this technology to date. Lymphovenous anastomoses (LVAs) often require suturing vessels with diameters of 0.2-0.8 mm, thus representing the ultimate microsurgical challenge. After performing the first documented LVA procedure using 3D-augmented visualization in our unit and gaining experience with this technique, we conducted an anonymized in-house survey among microsurgeons who had used this approach. The participants considered that 3D visualization for supermicrosurgery was equivalent in terms of handling, optical detail, depth resolution, and safety to conventional binocular magnification. This survey revealed that team communication, resident education, and ergonomics were superior using 3D digital hybrid visualization. Postoperative muscle fatigue, tremor, and pain were also reduced. The major drawbacks of the 3D visualization microscopic systems are the associated costs, required space, and difficulty of visualizing the lymphatic contrast used.

• Journal of Biomedical Engineering Research
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• v.34 no.3
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• pp.129-134
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• 2013

The essential tremor is an involuntary oscillatory movement of body parts. Conventional treatments of essential tremor have little effects in some patients and also leads to significant side effects. Alternative to these treatments, sensory stimulation may have beneficial effects on the essential tremor. The purpose of this study was to analyze an effect of sensory stimulation on essential tremor. Ten patients with essential tremor ($67.4{\pm}8.82$ yrs, 5 men and 5 women) participated in this study. Three-axis gyro sensors were attached on index finger, hand and forearm of patients. Task of 'arms outstretched forward' was performed with and without sensory stimulation. Vectorsum of three dimensional angular velocities (pitch, roll, yaw) was calculated. Outcome measures included root-meansquare (RMS) mean of the vector-sum amplitude, total power, peak power and peak frequency. RMS amplitude, total power and peak power were reduced by sensory stimulation (p < 0.05). Peak frequency was not affected by sensory stimulation. The results indicate that the sensory stimulation is useful to suppress the essential tremor.

• Journal of Biomedical Engineering Research
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• v.41 no.6
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• pp.247-255
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• 2020

Accurate diagnosis of movement disorders is important for providing right patient care at right time. In general, assessment of motor impairment relies on clinical ratings conducted by experienced clinicians. However, this may introduce subjective opinions into scoring the severity of motor impairment. Digital devices such as table PC and smart band with accelerometer can be used for more accurate and objective assessment and possibly helpful for clinicians to make right decision of patient's states. In this study, we introduce quantification algorithms of motor impairment which uses the digital data acquired during four clinical motor tests (Line drawing, Spiral drawing, Nose to finger and Hand flip tests). The step by step procedure of quantifying metrics (Tremor Frequency, Tremor Magnitude, Error Distance, Time, Velocity, Count and Period) are provided with flowchart. The effectiveness of the proposed algorithm is presented with the result from simulated data (normal, normal with tremor and slowness, poor with tremor, poor with tremor and slowness).