• 한국전문물리치료학회지
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• 제15권2호
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• pp.73-80
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• 2008

With the introduction of the video display terminal (VDT), the efficiency and productivity of work has improved. However, VDT syndrome is threatening the health of workers as a side effect of prolonged use of a VDT. Among various VDT syndromes, the musculoskeletal disorder, especially, the cumulative trauma disorder (CTD) is the common research topic related with upper extremities function. The aim of this study was to investigate the effect of the wrist-hand orthosis (WHO) on fatigue in middle deltoid, anterior deltoid, serratus anterior, and upper trapezius during one-hour computer keyboard typing. Twelve healthy subjects participated in this study. Surface electromyography was used to assess the localized muscle fatigue (LMF), and the LMF was calculated at 10 minutes, 20 minutes, 40 minutes, and 60 minutes in each muscle, with and without the WHO. Data were analyzed by paired t-test with a level of significance of .05. The results of this study are as follows: 1) At 10 minutes, the LMF decreased significantly with applied WHO in the middle deltoid, anterior deltoid, and upper trapezius (p=.001, p=.026, p=.019, respectively). 2) As the computer keyboard typing period increased, there were no significant LMF differences, except for the upper trapezius. Therefore, it can be concluded that the WHO can be applied to decrease the LMF for the initial 10 minute period in the middle deltoid, anterior deltoid, and upper trapezius' but that the long term effect of WHO in reducing the LMF was proven only in upper trapezius during continued computer keyboard typing.

• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.61-67
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• 2010

Emergency free flap has been advocated to cover the severely injured extremity for more than two decades, due to its numerous advantages such as low incidence of flap failure and infection rate and early recovery of function. But there are very few reports about these. The authors report their experience in using the emergency free flap for reconstruction of extremities. For last 10 years, 4 patients ranging from 3 to 27 years old with severely traumatized extremities were treated with emergency free flap transfers. Three were males and the other was a female. Flap size ranged from $2{\times}5\;cm^2$ to $7{\times}22\;cm^2$. The locations of the recipient site were the dorsum of the foot, the cubital fossa, the popliteal fossa and the upper arm. The number of the donor sites used was as follows: one scapular flap, two parascapular flaps, and one radial forearm flap with the radial bone. All of the flaps survived without need of re-exploration. There was no infection or flap loss. Involved joints have recovered a normal range of motion. Therefore, we consider that the emergency free flap is a very safe and reliable method to cover the severely injured extremities.

• PNF and Movement
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• 제12권3호
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• pp.143-150
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• 2014

Purpose: The corticospinal tract (CST) is known to be an important pyramidal tract for walking and motor function. However, very little is known about the functional role of the CST in the recovery of motor function. In the current study, we investigated the relation between the CST and motor function in chronic hemiparetic stroke patients. Methods: Fifty-four patients and 20 normal subjects were recruited. The Functional Ambulation Category (FAC) was used in measurement of the walking ability. We classified patients into three groups according to the ability to walk independently: group A, patients who could not walk independently (FAC: 0-2); group B, patients who could walk independently (FAC: 3); and group C, patd walk functionally (stairs and uneven surfaces, FAC 4-5). The Motricity Index (MI) was used to measure the motor function of the affected upper and lower extremities (maximum score: 100). The fractional anisotropy (FA) value, apparent diffusion coefficient (ADC) value, and fiber volume of the CST were used for the diffusion tensor imaging (DTI) parameters. Results: In terms of the CST of the unaffected hemisphere, the FA value of group A was significantly lower than that of normal controls (p <0.05). The fiber volume of group C was significantly higher than that of normal controls (p <0.05). In contrast, the ADC values of all patient groups and the control group did not show any difference (p >0.05). In terms of lower MI and total MI, significant differences were observed between all patient groups (p <0.05). In addition, significant differences in terms of the upper MI scores were observed between groups A and C and between groups B and C (p <0.05); however, no significant difference was observed between groups A and B (p>0.05). Conclusion: The increased fiber volume of the CST in the unaffected hemisphere appears to be related to functional walking ability in chronic stroke patients. This result would be useful for elucidation of the neural recovery mechanism of walking and the investigation of new modalities for the recovery of walking following a stroke with CST injury.

• Journal of Korean Neurosurgical Society
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• 제52권3호
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• pp.267-269
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• 2012

Traumatic brachial plexus injuries can be devastating, causing partial to total denervation of the muscles of the upper extremities. Surgical reconstruction can restore motor and/or sensory function following nerve injuries. Direct nerve-to-nerve transfers can provide a closer nerve source to the target muscle, thereby enhancing the quality and rate of recovery. Restoration of elbow flexion is the primary goal for patients with brachial plexus injuries. A 4-year-old right-hand-dominant male sustained a fracture of the left scapula in a car accident. He was treated conservatively. After the accident, he presented with motor weakness of the left upper extremity. Shoulder abduction was grade 3 and elbow flexor was grade 0. Hand function was intact. Nerve conduction studies and an electromyogram were performed, which revealed left lateral and posterior cord brachial plexopathy with axonotmesis. He was admitted to Rehabilitation Medicine and treated. However, marked neurological dysfunction in the left upper extremity was still observed. Six months after trauma, under general anesthesia with the patient in the supine position, the brachial plexus was explored through infraclavicular and supraclavicular incisions. Each terminal branch was confirmed by electrophysiology. Avulsion of the C5 roots and absence of usable stump proximally were confirmed intraoperatively. Under a microscope, neurotization from the musculocutaneous nerve to two medial pectoral nerves was performed with nylon 8-0. Physical treatment and electrostimulation started 2 weeks postoperatively. At a 3-month postoperative visit, evidence of reinnervation of the elbow flexors was observed. At his last follow-up, 2 years following trauma, the patient had recovered Medical Research Council (MRC) grade 4+ elbow flexors. We propose that neurotization from medial pectoral nerves to musculocutaneous nerve can be used successfully to restore elbow flexion in patients with brachial plexus injuries.

• Archives of Reconstructive Microsurgery
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• 제11권1호
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• pp.11-18
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• 2002

Large soft tissue defects around the knee joint are known to significantly diminish joint function. Severe soft tissue defects on the anterior aspect of the knee joint especially bring on significant joint motion limitation. Although simple split skin grafts can cover the skin defect, the progressing scar contracture of the grafted skin causes joint stiffness. One of the best solutions of large soft tissue defects around the knee joint is covering the defect with a good quality skin flap. Separated flaps with one vascular pedicle are good candidates for covering anterior and posterior aspects of the joint for example. Authors performed 12 cases of combined scapular and latissimus dorsi free flaps from 1984 to 2000. Among them, we experienced 5 cases of knee joint defect covering using the double free flap for coverage of the soft tissue defect with preservation of the knee joint function and satisfactory results. The system of flaps based on the subscapular artery and vein provides a variety of composite free flaps. The possible flaps that can be harvested based on this single vascular pedicle include the scapular and parascapular skin flap, the serratus anterior and latissimus dorsi muscular flap, the lateral scapular bone flap, the latissimus dorsi-rib flap, and the serratus anterior-rib flap. This combined flap is available for multiple tissue defects or complex defects because it can be incorporated with skin, muscle and bone flaps. A main advantage is the independent vascular pedicles of each component, which allow freedom in orientation of each components. Consequently it can be freely applied to any form of three dimensional defects on the upper and lower extremities. The combination of scapular cutaneous flap and latissimus dorsi musculocutaneous flap can be resurfaced for massive cutaneous defects on the extremities. We report the use of the combined scapular and latissimus dorsi free flap in five patients to reconstruct massive defects on the extremities with resultant improved joint function. There was no flap failure and minimal complications and disadvantages. The anatomy of this flap is reviewed and the indication and advantages are discussed. All of the five flaps survived and there was no scar contracture affecting the joint motion.

• 한국전문물리치료학회지
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• 제29권2호
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• pp.147-155
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• 2022

Background: Although various conventional approaches have been employed to reduce spasticity in neurological rehabilitation, only a few studies have shown scientific evidence for its effectiveness. Thus, we introduced a different concept (Ueda method) of rehabilitation therapy that can complement the limitations of conventional therapy. Objects: This study aimed to investigate the immediate effects of the application of the Ueda method on patients with spasticity after stroke via an electrophysiological study. Methods: We conducted a randomized double-blind pilot study in two rehabilitation hospitals involving 30 stroke patients who were randomly allocated to the Ueda (n = 15) and convention (n = 15) groups. Electromyographic data of six examined muscles in both upper extremities of all patients were recorded. The A-ApA index and activation ratios of upper extremity muscles were evaluated and compared between the groups to confirm post-intervention changes in upper-extremity flexor spasticity and flexion synergies. Repeated-measures analysis of variance was conducted to confirm the therapeutic effect (2 × 2) as a function of group (Ueda vs. convention) and time (pre-/post-intervention) on all outcome measures (p < 0.05). Results: In the Ueda group, the mean A-ApA index values differed significantly before and after the intervention (p = 0.041), indicating a weak evidence level; however, the effect size was medium (d = -0.503). The interaction effects of the A-ApA index between the Ueda and convention groups and between pre-intervention and post-intervention stages were significant (p = 0.012). The effect size was large (n_p² = 0.220). In the Ueda group, the activation ratios of the anterior deltoid fiber significantly decreased after the intervention in all reaching tasks. Conclusion: The Ueda method reduces upper-extremity flexor spasticity and changes its synergy in stroke patients and should be considered a rehabilitation therapy for spastic stroke patients.

• PNF and Movement
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• 제10권4호
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• pp.71-76
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• 2012

Purpose : The purpose of this study was to examine the effects of PNF of irradiation using an indirect treatment of the stroke patient's static weight support and walking speed. Methods : Was carried out a total of nine different the PNF method of treatment for patients with left hemiplegia stroke. PNF of treatment is not in the non-paralyzed side of the trunk and upper and lower extremities by applying resistance and increased strength of the affected side. Assessment of treatment weight support both feet measured and modified using the timed up and go test were compared before and after treatment. Results : Treatment of the paralyzed side of the quadriceps and hamstring, gluteus medius muscle strength increased, and both sides of the foot body weight support improved walking speed was increased. Conclusion : Irradiation using PNF indirect treatment improves the function of the gait of stroke patients.

• 한국전문물리치료학회지
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• 제13권4호
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• pp.39-46
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• 2006

The purpose of this study was to determine the effects of slump sitting postures on the masticatory, neck, shoulder, and trunk muscles associated with work-related musculoskeletal disorders (WRMD). Eleven healthy adults (age, $23.3{\pm}2.7$ yrs; height, $174.0{\pm}4.1$ cm; weight, $61.4{\pm}6.6$ kg) participated in this study. The participants were free of injury history and neurologic deficits in the masticatory, neck muscles and upper extremities at the time of participation. The subjects were asked to perform erect and slump sitting postures under the guidance of physical therapists. The surface electromyography (EMG) was recorded from the anterior temporalis, masseter, upper trapezius, serratus anterior, middle trapezius, L3 paraspinal, external abdominal oblique, gluteus maximus muscles of 11 adults as they performed visual terminal display work, which are known as the weakened and tightened muscles owing to WRMD. The recorded signals were averaged and normalized to the mean amplitude of the EMG signal obtained during submaximal reference voluntary contractions. The results of study were as follows: The masseter, upper trapezius, serratus anterior, middle trapezius, L3 paraspinal, external abdominal oblique muscles significantly differed in the slump sitting posture (p<.05). The muscle activities of the serratus anterior, middle trapezius muscle, and external abdominal oblique were significantly lower and that of the masseter, upper trapezius, L3 paraspinal muscles were significantly higher. Further research is needed to assess the motor control problems and the function of the deep muscles in posture stability of patients with WRMD.

• 대한안전경영과학회지
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• 제4권2호
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• pp.11-22
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• 2002

In this study, an asymmetric lifting posture prediction model was developed, which was a three-dimensional model with 12 links and 23 degrees of freedom open kinematic chains. Although previous researchers have proposed biomechanical, psychophysical, or physiological measures as cost functions, for solving redundancy, they lack in accuracy in predicting actual lifting postures and most of them are confined to the two-dimensional model. To develop an asymmetric lifting posture prediction model, we used the resolved motion method for accurately simulating the lifting motion in a reasonable time. Furthermore, in solving the redundant problem of the human posture prediction, a moment weighted Joint Range Availability (JRA) was used as a cost function in order to consider dynamic lifting. However, it is known that the moment weighted JRA as a cost function predicted the lower extremity and L5/S1 joint motions better than the upper extremities, while the constant weighted JRA as a cost function predicted the latter better than the former. To compensate for this, we proposed a hybrid moment weighted JRA as a new cost function with moment weighted for only the lower extremity. In order to validate the proposed cost function, the predicted and real lifting postures for various lifting conditions were compared by using the root mean square(RMS) error. This hybrid JRA reduced RMS more than the previous cost functions. Therefore, it is concluded that the cost function of a hybrid moment weighted JRA can be used to predict three-dimensional lifting postures. To compare with the predicted trajectories and the real lifting movements, graphical validations were performed. The results also showed that the hybrid moment weighted cost function model was found to have generated the postures more similar to the real movements.

• PNF and Movement
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• 제21권3호
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• pp.327-335
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• 2023

Purpose: Cerebellar injury can be caused by a variety of factors, including trauma, stroke, and tumor. Cerebellar injury can manifest in different clinical symptoms and signs depending on the size and location of the injury. The purpose of this study was to examine and compare the recovery patterns of each motor function by tracking the motor levels of patients with cerebellar injury. Methods: This study recruited 11 patients with quadriplegia resulting from cerebellar injury. The motricity index (MI), modified Brunnstrom classification (MBC), and functional ambulation category (FAC) methods were used to evaluate motor levels. The motor function evaluation was performed immediately after the onset of the condition and at intervals of one month, two months, and six months after onset. Results: The MI values of the upper and lower extremities and hand function (MBC) indicated severe paralysis in the early stages of onset. Compared to the onset time, significant motor function recovery was observed after 1, 2, and 6 months (p < 0.05). In contrast, there was no significant pattern of recovery between 1, 2, and 6 months after onset (p > 0.05). FAC indicated showed significant recovery at one month compared to onset (p<0.05), and there was also a significant difference between 1 and 2 months (p < 0.05). On the other hand, there was no significant difference in FAC between 2 and 6 months (p > 0.05). Conclusion: Patients with cerebellar injury showed significant recovery in functions related to muscle strength and voluntary muscle control one month after onset and gradually recovered further over the next six months. On the other hand, gait function, which is closely related to balance, showed a relatively slow recovery pattern from the beginning of the disease to the six month follow-up.