• PNF and Movement
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• 제18권1호
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• pp.65-75
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• 2020

Purpose: The purpose of this study was to investigate the differences in muscle thickness and ground reaction force of the vastus medialis oblique and vastus lateral oblique muscles during squats at ankle angles of toe 0°, toe in 10°, and toe out 10°. Methods: In this study, 9 male and 17 female students in their 20s participated in a randomized controlled trial and were compared according to the ankle angles of toe 0°, toe in 10°, and toe out 10°. To determine the reliability and measurement of muscle thickness according to ankle angle using ultrasound equipment and muscle thickness, the participants' ankle angles-toe 0°, toe in 10°, and toe out 10°-were measured three times at the vastus medialis oblique and vastus lateralis oblique muscles during squats. At the same time, the maximum vertical ground reaction force was measured with a force plate. A total of three measurements were taken and averaged, and two minutes of squat movements were assessed between ankle angles to prevent target action. Results: The results of this study illustrated that the reliability of the vastus medialis oblique muscles and vastus lateralis oblique muscles in ankle angle was high. The difference in muscle thickness was significantly greater in comparing the toe out 10° angle with the toe 0° angle than between toe in 10° and toe out 10° in vastus medialis oblique and vastus lateralis oblique (p < 0.05). There was no statistically significant difference between the ankle angle of toe 0° and toe in 10° (p > 0.05). The maximum vertical ground reaction force was significantly greater at toe out 10° than at the ankle angle of toe 0° and toe out 10° and between toe in 10° and toe out 10° (p < 0.05). There was no statistically significant difference in the comparison between toe 0° and toe in 10° (p > 0.05). Conclusion: Squatting at an ankle angle of toe out 10° increases the dorsi flexion; thus, the stability of the ankle and the thickness of both oblique muscles increased to perform more effective squats. In addition, as the base of support widens, it is thought that the stability of the posture increases so that squat training can be performed safely.

• 한국엔터테인먼트산업학회논문지
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• 제14권3호
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• pp.475-482
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• 2020

허리 안정화 근육들을 강화하기 위해 실시하는 복부 드로우인 기법(ADIM)은 복부내압을 상승시켜 배가로근(TrA)과 배속빗근(IO)을 선택적으로 수축시키는 운동법이다. 본 연구는 일상생활에서 많이 사용하는 자세인 앉은 자세에서 ADIM을 실시했을 때 파악력에 어떠한 영향을 미치는지 확인하고자 하였다. 정상 성인 30명을 대상으로 앉은 자세에서 ADIM을 실시하도록 한 후 실시하지 않은 상태와 실시한 상태에서 각각 파악력을 측정하여 앉은 자세에서 실시한 ADIM이 파악력에 미친 영향과 가장 많은 영향을 발휘하는 근육이 있는지 알아보았다. 측정에 동원된 근육은 RA, EO, IO/TrA, 그리고 ES로 ADIM 적용 시 가장 활성화된다고 알려진 허리 안정화 근육들이다. 연구 결과 앉은 자세에서 실시한 ADIM이 실시하지 않은 자세 보다 모든 근육들의 활성도가 유의하게 증가하였으며 파악력 또한 유의하게 증가하였다. 측정된 각 근육의 차이값을 비교해 어떤 근육이 파악력에 더 큰 영향을 알아보았으나 유의한 상관관계를 나타낸 근육은 보이지 않았다. 이는 특정 근육이 파악력에 영향을 미친 것이 아니라 복부내압의 증가가 파악력에 영향을 미친 것으로 사료된다. 따라서 앉아서 오랜 시간 생활하는 일반인들의 일상생활에 파악력 증가와 허리 안정성 향상을 위한 치료적 중재방법에 활용할 수 있을 것으로 제안할 수 있겠다.

• 대한통합의학회지
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• 제12권2호
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• pp.47-53
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• 2024

Purpose : This study investigated the effects of concentric and eccentric contractions on muscle strength using an isokinetic dynamometer (ID) in college students in their 20s. It aimed to understand the impact of differences between the dominant and non-dominant sides on strength asymmetry and to elucidate the clinical implications of these differences to establish an appropriate posture and environment for patients. Methods : The experiment was conducted with 30 healthy adult participants. Prior to the experiment, participants underwent a warm-up targeting the shoulders, and efforts were made to eliminate factors that could potentially influence the measurement results. Subsequently, the maximum safe range of motion of shoulder joint abduction, extension, and flexion was measured using an isokinetic muscle function testing device. Muscle strength was assessed using concentric and eccentric contractions alternating between the dominant and non-dominant sides, and paired sample t-tests were used for the analysis. Results : There was no significant difference between bilateral peak torques for eccentric contraction in shoulder joint abduction, extension, and flexion (p>0.05). There was also no significant difference between bilateral peak torques for concentric contraction in shoulder joint abduction, extension and flexion (p>0.05). Conclusion : This study found no statistically significant difference in muscle strength between the dominant and non-dominant sides during concentric and eccentric contractions. However, previous studies have shown significant differences between the dominant and non-dominant sides during eccentric and concentric contractions during internal shoulder rotation in the general population, as well as significant differences in the upper trapezius muscle. Therefore, further research is needed to support the application of different intensities for bilateral muscle strengthening exercises in clinical practice.

• 간호행정학회지
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• 제7권2호
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• pp.265-284
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• 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.

• 대한간호학회지
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• 제12권2호
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• pp.1-26
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• 1982

The main purpose of this study was to test the effect of the structured information on the sleep amount of the patients undergoing open heart surgery. This study has specifically addressed to the Following two basic research questions: (1) Would the structed in formation influence in the reduction of sleep disturbance related to anxiety and Physical stress before and after the operation? and (2) that would be the effects of the structured information on the level of preoperative state anxiety, the hormonal change, and the degree of behavioral change in the patients undergoing an open heart surgery? A Quasi-experimental research was designed to answer these questions with one experimental group and one control group. Subjects in both groups were matched as closely as possible to avoid the effect of the differences inherent to the group characteristics, Baseline data were also. collected on both groups for 7 days prior to the experiment and found that subjects in both groups had comparable sleep patterns, trait anxiety, hormonal levels and behavioral level. A structured information as an experimental input was given to the subjects in the experimental group only. Data were collected and compared between the experimental group and the control group on the sleep amount of the consecutive pre and post operative days, on preoperative state anxiety level, and on hormonal and behavioral changes. To test the effectiveness of the structured information, two main hypotheses and three sub-hypotheses were formulated as follows; Main hypothesis 1: Experimental group which received structured information will have more sleep amount than control group without structured information in the night before the open heart surgery. Main hypothesis 2: Experimental group with structured information will have more sleep, amount than control group without structured information during the week following the open heart surgery Sub-hypothesis 1: Experimental group with structured information will be lower in the level of State anxiety than control group without structured information in the night before the open heart surgery. Sub-hypothesis 2 : Experimental group with structured information will have lower hormonal level than control group without stuctured information on the 5th day after the open heart surgery Sub-hypothesis 3: Experimental group with structured information will be lower in the behavioral change level than control group without structured information during the week after the open heart surgery. The research was conducted in a national university hospital in Seoul, Korea. The 53 Subjects who participated in the study were systematically divided into experimental group and control group which was decided by random sampling method. Among 53 subjects, 26 were placed in the experimental group and 27 in the control group. Instruments; (1) Structed information: Structured information as an independent variable was constructed by the researcher on the basis of Roy's adaptation model consisting of physiologic needs, self-concept, role function and interdependence needs as related to the sleep and of operational procedures. (2) Sleep amount measure: Sleep amount as main dependent variable was measured by trained nurses through observation on the basis of the established criteria, such as closed or open eyes, regular or irregular respiration, body movement, posture, responses to the light and question, facial expressions and self report after sleep. (3) State anxiety measure: State Anxiety as a sub-dependent variable was measured by Spi-elberger's STAI Anxiety scale, (4) Hormornal change measure: Hormone as a sub-dependent variable was measured by the cortisol level in plasma. (5) Behavior change measure: Behavior as a sub-dependent variable was measured by the Behavior and Mood Rating Scale by Wyatt. The data were collected over a period of four months, from June to October 1981, after the pretest period of two months. For the analysis of the data and test for the hypotheses, the t-test with mean differences and analysis of covariance was used. The result of the test for instruments show as follows: (1) STAI measurement for trait and state anxiety as analyzed by Cronbachs alpha coefficient analysis for item analysis and reliability showed the reliability level at r= .90 r= .91 respectively. (2) Behavior and Mood Rating Scale measurement was analyzed by means of Principal Component Analysis technique. Seven factors retained were anger, anxiety, hyperactivity, depression, bizarre behavior, suspicious behavior and emotional withdrawal. Cumulative percentage of each factor was 71.3%. The result of the test for hypotheses show as follows; (1) Main hypothesis, was not supported. The experimental group has 282 minutes of sleep as compared to the 255 minutes of sleep by the control group. Thus the sleep amount was higher in experimental group than in control group, however, the difference was not statistically significant at .05 level. (2) Main hypothesis 2 was not supported. The mean sleep amount of the experimental group and control group were 297 minutes and 278 minutes respectively Therefore, the experimental group had more sleep amount as compared to the control group, however, the difference was not statistically significant at .05 level. Thus, the main hypothesis 2 was not supported. (3) Sub-hypothesis 1 was not supported. The mean state anxiety of the experimental group and control group were 42.3, 43.9 in scores. Thus, the experimental group had slightly lower state anxiety level than control group, howe-ver, the difference was not statistically significant at .05 level. (4) Sub-hypothesis 2 was not supported. . The mean hormonal level of the experimental group and control group were 338 ㎍ and 440 ㎍ respectively. Thus, the experimental group showed decreased hormonal level than the control group, however, the difference was not statistically significant at .05 level. (5) Sub-hypothesis 3 was supported. The mean behavioral level of the experimental group and control group were 29.60 and 32.00 respectively in score. Thus, the experimental group showed lower behavioral change level than the control group. The difference was statistically significant at .05 level. In summary, the structured information did not influence the sleep amount, state anxiety or hormonal level of the subjects undergoing an open heart surgery at a statistically significant level, however, it showed a definite trends in their relationships, not least to mention its significant effect shown on behavioral change level. It can further be speculated that a great degree of individual differences in the variables such as sleep amount, state anxiety and fluctuation in hormonal level may partly be responsible for the statistical insensitivity to the experimentation.

• 한국의학물리학회지:의학물리
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• 제2권2호
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• pp.109-120
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• 1991

골수이식을 받게 될 환자의 이상 골수를 완전히 죽이기 위해 MV 정도의 선질의 광자선에 의한 전신방사선요법이 시행되고 있다. 국소방사선요법에 이용되고 있는 방사선치료장치에 의한 일상적인 방법으로 환자의 전선에 걸쳐 방사선을 조사하기에는 조사면의 크기가 훨씬 미치지 못한다. 그래서 환자의 전선에 걸쳐 방사선을 조사할 수 있는 방법이 개발되어야 한다. 방사선 전신조사를 위한 여건이 병원에 따라 다를 것이기 때문에 병원에 따라 독특한 방법이 개발될 수 있다. 서울대학교병원에서는 코발트치료기 만이 두부를 기울일 수 있어서 전신조사에 이용될 수 있다. 코발트치료기의 두부를 밖으로 90$^{\circ}$ 기울일 때 선축은 수평이고 또한 맞은편 벽과 직각이 된다. 이 때 선원에서 맞은편 벽가지 거리는 319cm 이였다. 벽에서 환자의 중앙시상면까지 간격을 40cm라고 가정할 때, 중앙시상면에서 명목상 최대 조사면 크기가 122cm$\times$122em 이였고, 조사선량 분포를 측정한 결과로는 130cm$\times$129cm 이였으며 상하방향에서는 대칭이 아니였다. 환자가 쭈그리고 앉은 자세를 취한다면 조사면의 크기는 전신조사를 시행할 수 있을 정도로 충분히 크다. 환자 좌우폭의 평균을 30cm 라고 가정하고, 중앙시상면에서 선원쪽 15cm 위치에 기준표면 (SSD는 264cm, 명목상 조사면 크기 115.5cm$\times$155.5cm)을 두고 단면의 크기가 25cm$\times$25cm이고 두께가 30cm 인 폴리스티렌 팬톰에서 평판형 전리함으로 PDD를 측정하였다. 최대선량점의 깊이는 0.3cm 이였고 표면선량율은 82%, 50% 깊이는 16.9cm였다. 대향조사시 선축상 선량분포는 중점의 선량에서 10%이내로 일치하였다. SCD를 279cm. 최대 조사면, 기준깊이 15cm 에 대한 TPR 을 폴리스티렌 팬톰에서 깊이 10cm 에서 20cm 에 걸쳐 측정하였다 . 측정범위에서 TPR 은 직선성을 보였다. 인체팬톰의 최대 전단면(coronal plane) 에 있는 각 구멍에 TLD 조각을 넣고, 코발트 선원에서 팬톰의 시상면까지 거리를 279cm 되게 하고 선축은 팬톰의 27번 절편과 28번 절편의 접변과 최대 전단면의 교차선과 일치시켜 양방향에서 15분씩 조사하여 전단면에서 선량을 측정하였다. 팬톰내 선축상 중앙점의 선량을 기준으로 다른 부위의 선량을 비교하였다. 두경부와 복부, 폐의 하반에서 선량의 차이는 $\pm$ 10% 이내였고, 폐의 상반과 어깨와 골반 부위에서 선량은 10%이상 저선량을 보였다. 특히 어깨부위에는 30%이상 저선량을 보였다. 이로부터 서울대병원과 유사한 조건에서 코발트로 전신조사하는 경우에는 폐나 두경부에 대응하는 조직보상체를 이용하기보다는 어깨부위에 선량을 추가하는 것이 바람직할 것이라고 생각한다.

• Journal of the Korean Data and Information Science Society
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• 제24권6호
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• pp.1319-1329
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• 2013

이 연구는 Rasch 모형을 적용하여 아마추어 골프 선수들에게 적합한 코치-선수와의 관계 척도를 개발하고 타당화시키는데 목적이 있다. 코치-선수 관계 척도는 Kim과 Park (2008)이 개발한 한국판 척도를 검사내용에 기초한 증거를 토대로 수정 (11문항, 7척도)하여 아마추어 골프 선수 217명 (중학교, 고등학교, 대학교)에게 조사하였다. 그리고 WINSTEPS 프로그램을 이용하여 Rasch 모형의 기본가정인 일차원성을 검증 (주성분 분석)하였으며, 응답범주에 적절성은 단계조정값 (step calibration)을 통해 규명하였다. 이때 적합도 지수 (infit, outfit)를 통해 문항별 적합도를 검증하였으며, 골프경력 (10년미만, 10년이상)에 따라 차별기능문항을 추정하였다. 문항별로 추정되는 적합지수가 1.30 이상을 부적합하게 판단하였고, 분석에 모든 유의수준을.05로 설정하였다. 분석결과, Rasch 측정모형에 의해 설명되는 관찰분산이 20% 이상 (33.7%)으로 나타나 11문항의 일차원성 가정은 만족하였다. 그리고 응답범주 (7척도)를 단계조정값으로 분석한 결과에서 부적합하게 나타나 5점 척도로 재점수화하여 재분석한 결과에서 적합하게 나타났다. 특히 체계화된 응답범주 (5척도)를 이용하여 문항의 적합도를 추정한 결과, 상보성 요인에서 문항 10 (나는 최선을 다할 준비가 되어 있다)과 문항 11 (나는 호의적인 자세를 취한다)이 부적합 문항으로 나타났고 골프경력에 따라 차별기능문항 추정결과에서는 상보성 요인인 문항 11이 경력에 따라 비균일적으로 차별화되는 것으로 나타났다. 따라서 부적합하고 차별되는 두 문항을 제거하여 아마추어 골프 선수에게 적합한 코치-선수 관계 척도는 9문항에 5점 척도가 타당한 것으로 규명되었다.

• 대한디지털의료영상학회논문지
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• 제14권2호
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• pp.23-31
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• 2012

There are AEC mode and fix mode to exposure when the whole spine antero-posterior radiography is done by using DR equipment. This study compared the utility of fix mode to AEC mode, by evaluating organ dose and effective dose and by examining the quality of radiographic image. GE DEFINIUM 8000 and ART-200X Rando Phantom manufactured by Flukebiometical were used for this study. The Rando phantom was set in front of wall detector of X-rays equipment. AEC mode was set at 80kVp and Fix mode was set at 80kVp, 25mAs, 32mAs, 40mAs, and 50mAs. Whole spine AP image were aquired by combining C, T-L and L-S spine images obtained through 3 exposures. When obtaining C, T-L and L-S spine images, were checked for Air kerma (mGy) value calculated by UNFORS Xi meter attached at the phantom surface of center of radiation field. The effective and organ doses were compared by PCXMC program (PC-Based Monte Carlo Program). The quality of obtained radiographic image was evaluated visually by 3 radiologists using resolution chart. When the effective doses was calculated based on tissue weighting factor of ICRP-103, 1.278mSv was measured by AEC mode, and Fix mode measured 0.405mSv at 25mAs, 0.518mSv at 32mAs, 0.649mSv at 40mAs, and 0.810mSv at 50mAS. In addition, the organ dose measured with esposure at 25mAs by Fix mode was almost equivalent to the organ dose by AEC mode, at the esophagus, thyroid, oral mucosa, salivaly glands located at the cervical spine part, while the organ dose by Fix mode was in general lower than the organ dose by AEC mode at the other organs. When Fix mode at 32mAs, 40mAs, and 50mAs was compared to AEC mode for organ dose in 26 organs, AEC mode had higher measurement in 21 organs but not for than brain, trachea, thyroid, oral mucosa, and salivaly glands which are located at the cervical spine part. The image quality evaluated by resolution test chart was much higher with AEC mode than the quality with Fix mode at all exposure conditions. However, while the image quality of cervical spine exposured at 50mAs by Fix mode was lower than the quality of AEC mode, thoraco-lumbar spine and lumbo-sacral spine were calculated and the quality was similar to AEC mode. Scoliosis occurs mainly at thoraco-lumbar and lumbo-sacral spine, not at cervical spine. Compared to AEC mode, Using the appropriate protocol (80kVp, 50mAs) of fix mode for whole spine AP radiography was thought to be useful because the image quality of the thoraco-lumar and lumbo-sacral spine was similar on AEC mode, Also organ and effective doses can be decreased with Fix mode. Therefore, It is considered that fix mode can be used properly with AEC mode for whole spine AP radiography when considering patient's body posture.

• 대한방사선치료학회지
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• 제31권1호
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• pp.17-24
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• 2019

목 적: 본 연구는 정위적체부방사선치료(Stereotactic Body Radiation Therapy, SBRT)용으로 개발된 선형가속기 VERO치료 시, 동중심점(Isocenter) 일치성과 점선량(Point dose)의 정확성을 평가하고자 한다. 대상 및 방법: 2018년 6월부터 12월까지 본원에서 시행한 SBRT 중 무작위로 선정한 10건의 치료계획으로 분석하였다. 선형가속기의 출력 안정성을 평가하기 위해 출력검출기 PTW-LinaCheck로 출력균일성(Output constancy)을 측정하였다. Laser와 kV imaging, MV beam의 기하학적 Isocenter의 정확성을 Isocenter Phantom(Tofu Phantom, Brain Lab)을 이용해 측정하고 평가하였다. 계획선량과 치료선량의 정확성 평가는 아크릴 팬텀($30{\times}30{\times}20cm$), 이온챔버 CC-01(IBA Dosimetry)와 Electrometer(IBA Dosimetry)를 이용해 선량을 측정하여 비교 및 분석하였다. 결 과: VERO의 출력균일성을 측정한 결과 0.66 %로 계산되었다. 기하학적 Isocenter 정확성은 Phantom 내부 Ball Isocenter의 오차 값을 분석한 결과 X축 방향에서는 최대 0.4 mm, 최소 0.0 mm로 평균값 0.28 mm였고, Y축 방향에서는 최대 -0.4 mm, 최소 0.0 mm로 평균값 -0.24 mm의 결과값을 얻었다. 치료계획선량과 실제측정선량을 비교 및 분석한 결과 치료계획선량과 실제측정선량의 오차는 최대 0.97 %, 최소 0.08%로 측정되었다. 결 론: 장비의 출력선량 평균은 0.66 %로 권고기준 ${\pm}3%$에 충족하고 매우 균일하게 출력되었다. 기하학적 Isocenter 정확성 평가에서 권고기준 ${\pm}1mm$ 이내로 환자 자세의 재현성이 매우 우수하다고 생각된다. 치료계획선량과 실제측정선량의 차이는 평균 0.52 %로 권고기준 3 % 이내로 충족하여 예측한 선량을 얻을 수 있음을 확인하였다. 이 실험들을 통해 VERO장비가 SBRT에 적합하고 우수한 치료 효과를 얻을 수 있을 것으로 사료된다.