• Journal of Korean Neurosurgical Society
• /
• 제61권2호
• /
• pp.167-179
• /
• 2018

The prevalence of patients with adult spinal deformity (ASD) has been reported as high as 68%. ASD often leads to significant pain and disability. Recent emphasis has been placed on sagittal plane balance and restoring normal sagittal alignment with regards to the three dimensional deformity of ASD. Optimal sagittal alignment has been known to increase spinal biomechanical efficiency, reduce energy expenditure by maintaining a stable posture with improved load absorption, influence better bony union, and help to decelerate adjacent segment deterioration. Increasingly positive sagittal imbalance has been shown to correlate with poor functional outcome and poor self-image along with poor psychological function. Compensatory mechanisms attempt to maintain sagittal balance through pelvic rotation, alterations in lumbar lordosis as well as knee and ankle flexion at the cost of increased energy expenditure. Restoring normal spinopelvic alignment is paramount to the treatment of complex spinal deformity with sagittal imbalance. Posterior osteotomies including posterior column osteotomies, pedicle subtraction osteotomies, and posterior vertebral column resection, as well anterior column support are well known to improve sagittal alignment. Understanding of whole spinal alignment and dynamics of spinopelvic alignment is essential to restore sagittal balance while minimizing the risk of developing sagittal decompensation after surgical intervention.

• 대한인간공학회지
• /
• 제34권2호
• /
• pp.167-177
• /
• 2015

Objective: The objective of this research is to develop evaluation checklist for personal office furniture and apparatus to shape comfortable and efficient worksite for workers' welfare improvement, productivity enhancement and labor force preservation, and to identify office work environment by applying the checklist. Background: Because most office workers work using computers in a sitting posture, the ratio of office workers among total musculoskeletal disorders patients is forecast to increase. In this regard, an effort to prevent and manage such musculoskeletal disorders is required. Method: This research developed evaluation checklist for personal office furniture and apparatus by examining 25 domestic and international ergonomic literature and anthropometric data. This research carried out a fact-finding survey targeting the A Office and B Office of one public agency using the checklist. Results: Although, the checklist items on desks, chairs, computers and other goods conformed to the checklist standards, the following items did not conformed: desk height adjustment, seat board depth adjustment, lumbar support depth, foot rest, wrist rest, mouse tray, headset, speaker phone and Bluetooth. Conclusion: The evaluation checklist for personal office furniture and apparatus and fact-finding survey results are considered to be used as basic data for office work environment and workers' welfare improvement. Application: The information drawn from this research can be helpful to manufacturers' design and manufacture of ergonomic furniture and apparatus.

• 대한간호학회지
• /
• 제36권3호
• /
• pp.439-448
• /
• 2006

Purpose: The purpose of this study was to show a relationship between health perception and health promoting behaviors in chronic low back pain patients. Method: The subjects for this study were 213 persons who the visited hospital with low back pain-related problems. Results: The higher the level of the health perception in chronic back pain patients was the higher the rate of the practice of health promoting behaviors (r=0.393, p<.001). The health perception T score was $50.00{\pm}10.00$. As for health promoting behaviors, the T score was $49.99{\pm}10.00$. The subscale of the highest mean score was interpersonal support $(2.96{\pm}0.64)$ and the subscale of the lowest mean score was exercise $(2.13{\pm}0.99)$. Conclusion: This study showed that chronic low back pain patients had a lower level of perception of their health, and their practice to improve their health was not enough. Therefore, nurses should educate and encourage chronic low back pain patients in proper exercises and correct posture to strengthen and maintain lumbar extension muscle power.

• 간호행정학회지
• /
• 제7권2호
• /
• pp.265-284
• /
• 2001

The case management has been applied to improve the quality of care and the cost-effectiveness in the most health care institutions. In a way of case management, the critical pathway(CP) has been executed in many acute care settings, focused on the diagnoses with high cost, high volume, and high risk. This study was conducted to develop a case management program using CP as an intervention of patients with lumbar spinal stenosis for the surgery of posterolateral fusion, and to find out the effects of the critical pathway on the quality of nursing care, patient satisfaction as an outcome of care, length of stay and medical charge, and nurses' job satisfaction. At the same time, patients' functional states were checked with the Oswestry Low Back Pain Index, to show that the CP would not decrease the patients' function compared to the control group. The subjects were 25 control patients with a usual operation of lumbar fusion and 25 experimental patients with CP. They were all female, aged $50s{\sim}70s$, admitted in the Orthopedic surgery ward of a university hospital. Also nurses on the floor using CP were asked to respond to measurement tool of job satisfaction before and after the application of CP, and compared with other nurses on the different wards. Data were analyzed with t-test for continuous variables and chi-square for non-parametric variables in addition to the reliability test of the measurement tools. The results of this study were as followings: 1. Patients' functional states The differences in Oswestry scores of the experimental and control groups assessed at preoperation and at discharge were not statistically significant. The change in scores of the experimental group measured at preoperation and at discharge was larger than that of the control group, however the difference was not statistically significant. The results indicate that the CP did not decrease the patients' functional status. 2. The quality of nursing care The total of quality of nursing care given to the experimental group was better than that of the control group(P=.000). In addition, the experimental group showed better scores of quality of every item of care than the control group(P=.000 -.004). 3. Patient satisfaction Patients of the experimental group were not more satisfied with general care than the control group. But they were more satisfied with discharge care of 'explanation about medication, body posture, and brace application' and 'explanation about the adjustment of daily living and exercise during recovery'(P= .047, P=.028). 4. Nurses' job satisfaction Nurses working with the CP showed more job satisfaction than before the CP introduction(P=.048). But the control group of nurses on a different floor showed no change in job satisfaction at the same period of time. 5. Length of stay and medical charge The mean length of stay of the experimental group was shorter than that of the control group without statistical significance. The charge of medication and treatment of the experimental group were smaller than that of the control group(P=.011, P=.000). The results of the study support that the case management using critical pathway enables to improve the quality of care and job satisfaction, to reduce the medical charge, and consequently to increase satisfaction with care. However, the case management should be instituted focusing on the quality improvement of nursing and the client satisfaction, not just for the purpose of cost-effectiveness of health care facilities.

• 대한인간공학회지
• /
• 제34권2호
• /
• pp.151-165
• /
• 2015

Objective: This study aims to develop and scientifically investigate the efficacy of the Spine S-curve Reactive Backrest that responds to the spine curvature of the user when seated, and maintains and enhances the natural S-curve of the lower back, thereby helping to relieve fatigue, correct posture and prevent spine deformities. Background: The focus of current development, design guidelines and/or standards for office chairs is mainly placed on the chair's dimensions, incline angle, adjusting features and lumbar support. Research and development was called for developing a chair backrest that maintains and improves the S-curve of the full spine. Method: The Spine S-curve Reactive Backrest was ergonomically designed to maintain correct posture and enhance user comfort. When leaned on, the backrest responds to the user's spine line and the whole lower back sits closely against the backrest, thereby aligning the user's lower back and backrest as one to maintain and improve the natural S-curve formation of the spine. In order to evaluate the efficacy of the newly designed chair (new design) and the comparison target (chair), five male college students of standard body type with normal spine curvature were selected as test subjects, and a motion analyzer and electromyography were utilized to measure S-curve and erector spinae muscle activity when seated. Results: The spine S-curve was better maintained and improved when sitting in the new design than in the comparison chair. Particularly notable was the greater displacement gap of the thoracic spine than the cervical spine, and also that of the lumbar more than the thoracic spine, with the increase of the backrest tilting angle. Furthermore, the electromyogram results showed the new design caused a lower fatigue level of the erector spinae muscles compared to the comparison chair, and also earned a higher preference in the subjective opinion results. Conclusion: The newly designed chair in this study responds to the user's spine curvature and maintains and enhances the lower back's natural S-curve, and thereby relieves fatigue, promotes better posture, and helps to prevent spine deformities better than existing office chairs. There is a need to widely introduce and supply this new design. Application: The new design is applicable to office and student chairs, and is expected to improve concentration and work efficiency.

• 대한간호
• /
• 제36권2호
• /
• pp.73-83
• /
• 1997

Bed rest is recommended to prevent postlumbar puncture headaches(PLPHA), but the period of bed rest varies in the literature from 6 hours to 24 hours. In clinical practice the period of bed rest varies but nursing methods for adults and children have little difference. In Seoul National University Hospital, children have been given at least 6 hours bed rest after a lumbar puncture. Pediatric oncology patients require a lumbar puncture for an initial diagnosis, follow up treatment or administration of chemotherapeutic agent. But it is difficult for young children to lie supine or to refrain from their usual activities in any way, and unpleasant problems related to a shortage of beds often occurs during discharge or in an outpatient setting. The purpose of this study is to substantiate the preventive effect of PLPHA by the period of bed rest, to identify the other factors that influence PLPHA, and to use the nursing methods proper to children. The subjects were 65 children, ages 1-17, undergoing treatment in the children's cancer center at SNUCH during the period June 1, 1995, to Aug. 31, 1995. The team nurses asked questions about PLPHA of the parents and children in order to fill out a questionnaire. The data were evaluated by percent, t-test, Chi-square test and Mann-Whitney U test. Result; 1. There was no significant difference relating the bed rest time spent to the occurrence of postspinal headaches (t-test). 2. There was a significant risk of PLPHA in the children who were irritable before procedure and/or had experienced previous PLPHA(p<0.05, ${x^2}-test$). 3. The following factors were not found to be associated with increased risk of PLPHA: previous puncture experience, giving analgesics, the choice of puncturist, inpatient/outpatient status, gauge of needle, purpose, the amount of CSF removed, gender, diagnosis, the number of peripheral WBCs, previous lumbago experience after LP, position after bed rest, age, the number of aural puncture at the time. A longer period of bed rest is unlikely to be more effective to prevent PLPHA and seems impractical. A shorter period will save time and effort. Perhaps it will also allay some of the fears which surround LP. So 1 hour bed rest after LP is suggested and nursing methods for emotional support should be investigated to reduce PLPH.

• 한국전문물리치료학회지
• /
• 제9권3호
• /
• pp.23-37
• /
• 2002

This study examined the muscle recruitment order during extension of the hip joint in normal subjects, and evaluated whether the external support obtained from wearing a lumbosacral corset had an effect on muscle recruitment leading to increased lumbar stability. The subjects were 40 normal adults (32 male, 8 female) with no history of low back pain and no pathological findings in the nervous or musculoskeletal systems. All subjects extended their hip joints under 3 positions (prone, sidelying, standing). During extension, the onsets of contraction of the rectus abdominis, gluteus maximus, and semitendinosus muscles were measured. Electromyographic activity was measured using a surface electrode, and the muscle contraction onset time was designated as the point exceeding a threshold of 25 ms, using a mean plus twice of the standard deviation. To compare the average order of muscle contraction onset time, a Freedman two-way analysis of variance by ranks was used. The relative difference between muscle contraction onset time wearing and not wearing a lumbosacral corset was measured using a paired t-test. A difference in the average muscle contraction onset order for the rectus abdominis, gluteus maximus, and semitendinosus muscles was observed (p<.05) among three positions. However, wearing a lumbosacral corset did not. change the contraction order. In addition, wearing a lumbosacral corset produced a significant difference (p<.05) in the relative onset time between the rectus abdominis and gluteus maximus in the standing position, but no difference was observed for the other muscles or positions. In the future, patients suffering from low back pain should be compared with normal subjects to determine the effectiveness of a lumbosacral corset in changing muscle recruitment order.

• Journal of Korean Neurosurgical Society
• /
• 제64권6호
• /
• pp.922-932
• /
• 2021

Objective : It is challenging to make solid fusion by posterior screw fixation and laminectomy with posterolateral fusion (PLF) in thoracic and thoracolumbar (TL) diseases. In this study, we report our experience and follow-up results with a new surgical technique entitled posterior thoracic cage interbody fusion (PTCIF) for thoracic and TL spine in comparison with conventional PLF. Methods : After institutional review board approval, a total of 57 patients who underwent PTCIF (n=30) and conventional PLF (n=27) for decompression and fusion in thoracic and TL spine between 2004 and 2019 were analyzed. Clinical outcomes and radiological parameters, including bone fusion, regional Cobb angle, and proximal junctional Cobb angle, were evaluated. Results : In PTCIF and conventional PLF, the mean age was 61.2 and 58.2 years (p=0.46), and the numbers of levels fused were 2.8 and 3.1 (p=0.46), respectively. Every patient showed functional improvement except one case of PTCIF. Postoperative hematoma as a perioperative complication occurred in one and three cases, respectively. The mean difference in the regional Cobb angle immediately after surgery compared with that of the last follow-up was 1.4° in PTCIF and 7.6° in conventional PLF (p=0.003), respectively. The mean durations of postoperative follow-up were 35.6 months in PTCIF and 37.3 months in conventional PLF (p=0.86). Conclusion : PTCIF is an effective fusion method in decompression and fixation surgery with good clinical outcomes for various spinal diseases in the thoracic and TL spine. It provides more stable bone fusion than conventional PLF by anterior column support.

• 한국의류산업학회지
• /
• 제23권6호
• /
• pp.781-789
• /
• 2021

To enhance the design and comfort of waist-protection corsets, this study analyzed the product characteristics of five types of posture-correction corsets that are available commercially. Additionally, subjective evaluation of the corsets was conducted on women aged 20 to 60 years, in terms of design, material preference, fit, comfort, degree of correction, freedom of movement, tightness, and convenience of front fastening. Following product analysis, the five corset types were divided into: two soft, one semi-hard, and two hard types in terms of the degree of elongation. As a result of pattern analysis, the soft type was designed to improve fit by reflecting the body curvature, whereas the semi-hard and hard types were relatively flat. Through the wearing sensation assessment, the hard type manufactured by company S was the best in terms of design, material, fit, comfort, correction degree, and freedom of movement. The soft type was average in design, material, and fit while relatively poor in the correction degree and tightness. The results indicated that soft materials, flexible bones with appropriate tension, patterns designed to snugly fit the body with large curvature at the top and bottom for better inflection, and adjustable support belts that can be double-fixed are crucial elements in improving the corset design to boost the comfort of wearing. These study results are helpful in the development of waist-protection corsets with excellent wearing comfort and design appreciated by customers.

• 한국전문물리치료학회지
• /
• 제4권2호
• /
• pp.18-35
• /
• 1997

The purpose of this study were to determine causes of low back pain in bus drivers who usually work in prolonged sitting position and to find the relationship of back pain with general characteristics and work environmental characteristics, stress symptoms, to com맹re lordosis angle of habitual driving posture and resting posture in low back pain group and non-low back pain group, and to use this result as a basis for improvement of work environment and comprehensive rehabilitative management of low back pain. Ninety-eight bus drivers were selected from the membership of an urban transit union in Seoul. These informations were collected from May 1, 1997 to May 25, 1997 by means of structured questionnaires and X-ray findings. These data were analyzed by $x^2$ test, t-test, logistic regression using SAS. The major results were as follows: 1. Of the respondents, 66.3% of bus drivers were found to be experiencing back pain. 2. Of the respondents of low back pain groups, 78.5% reported that major cause of low back pain was due to prolonged sitting. 3. The group with experiences of frequent or continuous vibration had more low back pain (p<0.05). There were no significant differences among other work environmental factors. 4. Average stress score was significantly higher in the group with low back pain than in the group without low back pain (p<0.05). 5. The results of the logistic regression analyses were statistically significant vibration from seat and stress score among the risk factors (p<0.05). 6. Averaged lordosis angle of habitual driving posture was $7.6{\pm}14.9$ degrees in low back pain group, $16.5{\pm}8.7$ degrees in non-low back pain and averaged lordosis angle of resting sitting posture was $10.8{\pm}13.7$ degrees in low back pain, $18.9{\pm}9.6$ degrees in non-low back pain group but the difference in mean lordosis angles of two groups was not statistically significant. The results of this study indicate that professional drivers developed chronicity of low back pain due to unfit seat, poor habitual posture and stress from vibration or other risk factors. Therefore, there is need to improve work environment, i.e. enough resting, to set a seat to support lumbar spine properly and to provide comprehensive rehabilitation program including early diagnosis, proper treatment and education for self help management.