목적 : 본 연구에서는 암묵 및 외현적 속성을 가진 운동 과제를 통해 정신훈련과 실제훈련의 효과와 정신 훈련에 적합한 속성의 운동 과제를 알아보고자 하였다. 연구방법 : 정상 성인 36명을 세 집단(정신훈련군, 실제훈련군, 대조군)으로 무작위 할당하고, 표적조준과제와 시열반응과제를 이용하여 정신훈련 및 실제훈련 실시하였다. 표적조준과제는 모니터에서 제공하는 좌우의 두 개의 원안에 마우스를 위치함과 동시에 클릭을 하게 하였고, 시열반응과제는 모니터에서 제시되는 네 가지의 색깔에 대응하는 반응패드를 손가락을 이용하여 최대한 빨리 정확히 누르도록 하여, 반응시간을 측정하였다. 정신훈련과 실제훈련은 각각 하루 30분, 3일 동안 훈련하였고, 훈련 전과 후의 운동반응시간을 측정하여 비교하였다. 결과 : 표적조준과제에서는 정신훈련군과 실제훈련군에서 모두 대조군에 비해 통계학적으로 유의하게 반응시간의 변화를 보였고(p<.05), 시열반응과제에서도 정신훈련군과 실제훈련군에서 대조군에 비해 통계학적으로 유의하게 반응시간의 변화 차이를 보였다(p<.05). 또한 각각의 과제에서 집단간의 표준화된 점수의 비교에서 표준 조준과제의 경우, 실제훈련군에서 통계학적으로 유의하게 높은 증가를 보였고(p<.05), 시열반응과제의 경우에는 실제훈련군이 그 증감이 높았지만, 통계적으로 유의한 결과를 보이지 않았다(p>.05). 결론 : 정신훈련은 암묵 및 외현적 속성을 가진 모든 과제에서 운동학습이 이루어졌고, 암묵적 지식의 습득보다는 외현적 지식이 요구되는 과제에서 운동학습의 효과가 높았다.

목적 : 편마비 환자에서 손상된 대뇌반구의 동측은 정상으로 인식되었으나 운동장애가 있음이 보고되고 있다. 본 연구는 편마비 환자의 동측 상지를 이용한 연속반응시간과제에서 동측운동결함 여부를 정상군과 비교 관찰하였다. 연구방법 : 편마비 환자 18명(오른쪽 편마비 10명, 왼쪽 편마비 8명)을 대상으로 손상된 대뇌반구의 동측 손가락을 이용한 연속반응시간과제를 수행하는 동안 환자군과 연령과 성별이 일치하는 정상군 18명과 비교하여 반응시간을 분석하였다. 연속반응시간과제는 구획설계와 무작위설계로 구성하였고 자극은 4가지 색깔(빨강, 노랑, 초록, 파랑)의 원모양이 하나씩 연속적으로 컴퓨터 모니터에 제시되었고, 연구대상자는 일련의 자극과 색깔이 일치하는 반응패드의 버턴을 가능한 빠르고 정확하게 누르도록 하여 반응시간을 측정하였다. 각 설계단위 당 10회 반복하는 것을 1블록으로 설정하여 총 3블록을 수행하였고, 수집된 자료는 이원분산분석으로 통계 처리하였다. 결과 : 구획설계와 무작위설계 모두에서 집단간 주효과 검증결과 집단 간에는 통계학적으로 유의한 차이가 관찰되었다(p<0.001). 그러나 오른손·왼손간 주효과 검증결과 및 집단×왼쪽·오른쪽간 상호작용에는 통계학적으로 유의한 차이가 관찰되지 않았다(p>0.001). 결론 : 환자군에서 연속반응시간과제의 반응시간이 정상군보다 느리게 나타나 편측 대뇌반구 손상으로 인한 편마비 환자의 동측 상지에 동측운동결함이 발견되었다.

목적 : 인간의 뇌는 손상을 받은 후에 자발적인 회복이나 뇌신경 회로의 재조직화를 통해 기존의 기능을 회복 할 수 있다．이러한 뇌의 재조직화가 뇌졸중 환자의 운동 기능회복에 중요한 역할을 하는 것으로 알려져 있다．최근의 뇌지도화 기법이 발달함에 따라，뇌손상 환자의 운동 기능 회복에 따른 뇌신경망의 재조직화에 대한 몇 가지 기전이 보고되었고，특히 뇌손상 부위에 따라 뇌활성화되는 양상이 서로 다르게 나타날 수 있다고 추정되고 있다．따라서 본 연구는 뇌손상 부위에 따른 뇌 활성도의 양상을 비교하고자 하였다． 연구방법 : 본 연구에 참여한 대상자는 손의 운동 기능이 일상생활을 독립적으로 할 수 있는 정도로 회복되고 그 기능이 서로 비슷한 대뇌피질(n＝2) 또는 방사관(n=2)에 국소적인 손상을 받은 뇌경색 환자 4명과 신경학적 증상에 대한 과거 병력이 없는 정상 성인(n=7)을 대상으로 하였다．환자군에서 도수근력검사，악력，퍼듀-페그 보드와 경상운동의 정도를 측정하였고，모든 대상자는 손가락의 굴곡과 신전을 반복하는 과제를 실시하는 동안，기능적 자기공명영상의 촬영에 참가하였고，이 때 활성화되는 뇌부위를 분석 비교하였다． 결과 : 환자군에서 평가된 손의 운동 기능은 모두 비슷하였지만，뇌 활성화되는 양상은 서로 다르게 나타났다，대 뇌피질에 손상을 받은 환자들은 정상인 및 그들의 비손상측 손 운동시 활성화되는 양상과 같이 운동을 수행한 손의 반대측 일차운동피질에서 활성화를 보였다．방사관에 손상을 받은 환자군은 양측의 일차운동피질에서 활성화를 보였다． 결론 : 뇌손상 부위는 대뇌피질과 방사관으로 분류되었고，손의 운동 기능 회복의 정도는 비슷하였다．하지만 활성화된 부위는 명확하게 다르게 나타났다．따라서 뇌손상 부위에 따라 뇌신경 회로의 재조직되는 형태가 서로 다르게 나타난다는 것을 알 수 있다．이는 뇌신경재활의 영역에서 마비된 손의 기능이 회복됨에 따라 뇌신경망 에서 나타나는 가소성을 증명하는 것으로，환자의 예후 측정과 신경생리학적 기전에 대한 이해를 제공할 것으로 생각된다．

Theoretical framework of motor learning is used to enhance perceptual motor skill in physical therapy intervention, which can be subdivided into two main types-explicit and implicit. The purpose of this study was to examine whether stroke patients with unilateral brain damage learn implicitly a motor skill using the arm ipsilateral to the damaged hemisphere. Speculation then followed as to the formation of therapeutic plans and instructions provided to patients with stroke. 20 patients with stroke and 20 normal participants were recruited. All the subjects practiced serial reaction time tasks for 30 minutes a day and retention tests on the following day. The tasks and tests involved pressing the corresponding buttons to 4 colored circles presented on a computer screen as quickly and accurately as possible. Patients with stroke responded more slowly than controls. However, both groups showed decreased reaction time in the experimental and retention periods. Also, there was no significant difference between both groups regarding explicit knowledge of consecutive order. Therefore, patients with stoke had the ability to learn implicitly a perceptual motor skill. Prescriptive instruction using implicit and explicit feedback may be beneficial for motor skill learning in physical therapy intervention for patients with brain damage.

Prospective memory (PM) is related to remember to carry out a previously intented behaviour. The purpose of this study was to develop a paradigm for measuring PM function to diagnosis in mild cognitive impairment 1 or brain injury in patients 2. among brain injured patients Thirty-eight normal healthy subjects participated in current study. The paradigm was composed of four conditions: a baseline and three intention conditions (expectation, execution 1 and 2). In the expectation condition, subjects were asked to make a new response to intented stimuli during ongoing task, but the intented stimuli never occurred. In the execution 1 (one type of expected stimulus) and 2 (two types of expected stimuli), the intended stimuli did occur in 20% of trials. The reaction time and error rate were calculated in each condition. Repeated measures using ANOVA of subject's mean reaction times (RTs) and mean error rates (ERs) showed main effects of conditions during ongoing task. The comparison of PM tasks in executive condition 1 and 2 also showed significance in RTs and ERs. This paradigm reflects sufficiently the performance of prospective memory function during ongoing task in normal individuals. Thus, we suggest that the paradigm will be helpful to study neural network of PM function using brain imaging techniques and diagnosis of PM dysfunction.

The purpose of this study was to investigate how COP displacement of a hemiplegic foot in stance phase during gait is related to clinical balance measures and the recovery stage in hemiplegic stroke patients. Twenty-eight functionally ambulant hemiplegic patients who had suffered from strokes and thirty age-matched healthy subjects participated in this study. COP parameters were calculated. Clinical balance was measured using the Functional Reach Test (FRT) and Timed Up and Go Test (TUGT). The recovery stage, proprioception, and clonus of the ankles or lower extremities were also measured for physical impairment status. The COPx max-displacement in the medial-lateral side of the stroke patients was significantly longer than that of the normal group (p=.038). The COPy max-displacement in the anterior-posterior side of the stroke patients was significantly shorter than that of normal group (p<.001). Significant differences in the COPx and COPy displacement asymmetry index were found between the two groups (p<.01). The FRT was correlated with the COPx displacement (r=.552) and COPy displacement (r=.765). The TUGT was correlated with the COPy displacement (r=-.588) only. The recovery stage of the lower extremities was correlated with COPy displacement (r=.438). The results of the study indicate that the characteristic of COP displacement in hemiplegic feet in stance phase during gait is related to balance ability and recovery in stroke patients. COP parameters acquired by the mapping of foot pressure in stance phase during gait will provide additional useful clinical information. This information can be used by clinicians to assess objectively the pathologic gait with other diseases and to evaluate the therapeutic effects on gait in stroke patients.

The purpose of this study was to investigate the correlation and characteristics between electromyographic (EMG) activities of lower leg muscles and the posturographic assessment of static balance control in normal adults. Twenty-four young, healthy adults(12 males, 12 females) participated in the study. Center of pressure (COP) parameters were obtained using force platform as total path distance, total sway area, X mean frequency and Y mean frequency for 20 seconds in the following conditions: (1) comfortable standing with eyes opened or closed, (2) uncomfortable standing (feet together) with eyes opened or closed, (3) virtual moving surround delivered using Head mount display (HMD) with four different moving patterns. The virtual moving patterns consisted of close-far, superior-inferior tilting (pitch), right-left tilting (roll), and horizontal rotation (yaw) movements. Surface electromyographic activites were recorded on the tibialis anterior, peroneus longus, medial and lateral heads of gastrocnemius muscles under each condition. Correlation between the posturographic measures and EMG activities were evaluated. Total path distance and total sway area of COP were significantly increased during uncomfortable standing. EMG activity of tibialis anterior was significantly more during uncomfortable standing and virtual moving surround stimulation than during comfortable standing. Total path distance and sway area of COP during comfortable standing with closed eyes showed significant positive correlation with the EMG activities of the lateral head of gastrocnemius muscle. Total path distances and total sway area of COP during muscle. Total path distances and total sway area of COP during presentation of virtual moving surround also had significant positive correlations with EMG activities of the lateral head of gastrocnemius muscle under close-far movement.

Motor skill learning can be acquired implicitly without consciousness of what is being learned. The purpose of this study was to examine the characteristics of implicit motor learning in young and elderly people using a perceptual-motor task. Forty normal young and elderly subjects participated. A modified version of the Serial Reaction Time Task (SRTT) using six blocks of twelve perceptual motor sequences was administered. The paradigm consisted of the first random sequence block followed by the four patterned blocks and another random block. In each block, the go signal consisted of an asterisk displayed in the one of the four parallel arrayed boxes in the middle of the screen. Subjects were instructed to push the corresponding response buttons as quickly as possible. Young subjects demonstrated shorter reaction times during the consecutive patterned blocks reflecting appropriate learning accomplished. Elderly subjects were able to learn a perceptual-motor task with implicit knowledge, but the performance was lower than that of the young persons. These results indicated that implicit sequence learning is still preserved in elderly adults, but the rate of learning is slower.

Repetitive transcranial magnetic stimulation (rTMS) modulates cortical excitability beyond the duration of the rTMS trains themselves. Depending on rTMS parameters, a lasting inhibition or facilitation of cortical excitability can be induced. Therefore, rTMS of high or low frequency over motor cortex may change certain aspects of motor learning performance and cortical activation. This study investigated the effect of high and low frequency subthreshold rTMS applied to the motor cortex on motor learning of sequential finger movements and brain activation using functional MRI (fMRI). Three healthy right-handed subjects (mean age 23.3) were enrolled. All subjects were trained with sequences of seven-digit rapid sequential finger movements, 30 minutes per day for 5 consecutive days using their left hand. 10 Hz (high frequency) and 1 Hz (low frequency) trains of rTMS with 80% of resting motor threshold and sham stimulation were applied for each subject during the period of motor learning. rTMS was delivered on the scalp over the right primary motor cortex using a figure-eight shaped coil and a Rapid(R) stimulator with two Booster Modules (Magstim Co. Ltd, UK). Functional MRI (fMRI) was performed on a 3T ISOL Forte scanner before and after training in all subjects (35 slices per one brain volume TR/TE = 3000/30 ms, Flip angle , FOV 220 mm, matrix, slice thickness 4 mm). Response time (RT) and target scores (TS) of sequential finger movements were monitored during the training period and fMRl scanning. All subjects showed decreased RT and increased TS which reflecting learning effects over the training session. The subject who received high frequency rTMS showed better performance in TS and RT than those of the subjects with low frequency or sham stimulation of rTMS. In fMRI, the subject who received high frequency rTMS showed increased activation of primary motor cortex, premotor, and medial cerebellar areas after the motor sequence learning after the training, but the subject with low frequency rTMS showed decreased activation in above areas. High frequency subthreshold rTMS on the motor cortex may facilitate the excitability of motor cortex and improve the performance of motor sequence learning in normal subject.

We report the reorganization of motor network resulted from intensive unilateral coordination training and the effect of cross education on the untrained side in patient with traumatic brain injury using functional magnetic resonance imaging (fMRI). A 22 year-old male patient who had suffered from diffuse axonal injury for 58 months showed coordination deficit in the left hand at initial examination. Intensive motor training including complex finger movements and coordination activities using a metronome was introduced to the patient 4 hours per day for a week. FMRI was performed on a 3T ISOL Forte scanner. All functional images were analyzed using SPM-99 software. Hand function was improved after training not only in the trained left hand, but also in the untrained right hand. There was no activation in the right primary motor area (M1) during left hand movement before training whereas robust activation of left M1 was demonstrated by the right hand movement. Profuse activation of bilateral prefrontal lobes was seen during both hand movements before training. After training of left hand, right M1 became prominently activated during the left hand motion. The activation of bilateral prefrontal lobes disappeared after training not only for the left hand movement but also for the right, which clearly demonstrated the effect of cross education. This case report demonstrated the learning-dependent reorganization of the M1 and the effect of cross education.

뇌 손상 후 급성기에 기능의 자발적인 회복이 일어나지만 환자들은 환측의 상지를 잘 사용하지 못하게 된다. 그 결과 원하는 움직임을 억제하는 상황을 발생시키는데 이것을 학습 무사용 증후군(learned nonu se syndrome)이라 한다. 이러한 학습 무사용 증후군을 치료하기 위해 억제-유도 치료(constraint-induced therapy)가 고안되었다. 억제-유도 치료는 연속되는 몇 주간에 걸쳐 매일 많은 시간 동안 건측의 상지를 묶어두고 환

The purpose of this study was to examine the effect of the upper limb nerve mobilization (ULNM) on functional recovery of upper extremity in hemiplegic patients following stroke. Twenty patients who had functional impairment on upper extremity were participated. Subjects were randomly divided into two groups: Control group (n=10) received traditional physical therapy only for 4 weeks; Experimental group (n=10) received ULNM treatment along with traditional physical therapy for the same period. Upper extremity functions were assessed by manual muscle test (MMT), modified Ashworth scale (MAS), and Fugl-Meyer assessment (FMA) before and after the treatment. In both experimental and control group, upper extremity functions were significantly improved in MMT (p<.01) and FMA (p<.01), however only experimental group showed significant improvement in FMA after the treatment (p<.05). Moreover, experimental group showed significantly greater improvement than control group in MMT (p<.05), MAS (p<.05), and FMA (p<.05). We conclude that the upper extremity functions is a useful additional therapeutic technique for the effective treatment of upper extremity deficits in hemiplegic patients.

최근 도시 인구의 증가에 따라 하수 및 분뇨 발생량이 증가하고 있으며, 다양한 오염원으로부터 유입되는 하수에는 질병을 유발할 수 있는 다양한 병원성 미생물이 존재한다고 알려져 있다. 하수처리를 위한 다양한 공정에서는 미생물을 포함하고 있는 bioaerosol이 발생할 수 있으며, 하수 및 분뇨에 포함된 병원성 박테리라 등을 포함하고 있을 가능성이 높다. 따라서 호흡을 통해 하수처리장의 근무자 및 주변 주민에게 위해를 가할 수 있으므로, bioaerosol의 발생 특성 및 감소에 관한 연구가 필요한 현실이다. 하수처리공정 중 bioaerosol이 발생하는 대표적인 환경으로는 활성 슬러지 공정이 있으며, 폭기조에서의 대량 폭기로 인한 높은 농도의 bioaerosol이 발생한다고 알려져 있다. 최근에는 기존의 재래식 활성슬러지 공정(CAS, Conventional Activated Sludge)보다 소요 면적이 적고, 고농도의 미생물 농도를 유지하고 있어 수질 처리 효율이 좋은 호기성 MBR(Membrane bioreactor)의 사용이 증대되고 있다. 그러나 호기성 MBR은 고농도의 미생물 농도 유지 및 멤브레인의 파울링 감소를 위해서는 많은 양의 공기 폭기를 유지해야하므로, 상대적으로 높은 농도의 bioaerosol의 발생이 한정된 공간에서 이루어질 것으로 예상된다. 호기성 MBR의 특성상 운전 조건에 따라서 반응기 내 미생물의 농도 및 특성이 달라질 것이며, 이에 따라 bioaerosol의 발생량 및 특성도 영향을 받을 것으로 예상된다. 그러나 국내에서는 하수처리 과정 중 호기성 MBR 공정에서의 bioaerosol 발생에 관한 연구가 전무하며, 이에 대한 기초 연구 및 발생량 감소를 위한 연구가 미흡한 실정이다. 본 연구에서는 하수처리장 MBR 공정에서 운전 조건에 따른 반응기 내 미생물 농도 및 특성을 확인하고, bioaerosol 발생량을 비교하고자 하였다. 더불어 bioaerosol 발생량을 저감할 수 있는 방안에 대한 연구를 추가적으로 진행하고자 하였다.

To examine the potency of biosorbent, the adsorption capacity of Pseudomonas cepacia H42 isolated from fresh water plant root was compared with Saccharomyces cerevisiae SEY2102 on bases of biomass, concentration of heavy metal, presence of light metals, immobilized cell, and ion exchange resin. P. cepacia H42 biomass of 0.05-0.5 g/L increased adsorption and above 1.0 g/L of yeast biomass was the most effective in adsorption. By applying the same amount of biomass, lead showed the highest adsorption on two strains and the adsorption strength was lead>copper>cadmium on both strains. The high heavy metal concentration induced the high adsorption capacity. P. cepacia H42 adsorption was in the order of copper>lead>cadmium and lead>copper>cadmium by yeast in 10 mg/L. Both strain showed same adsorption strength in the order of lead>copper>cadmium in 100 mg/L and 1000 mg/L. The adsorption capacity of both yeast and P. cepacia H42 was decreased in the presence of light metals and the order of cadmium>copper>lead. Mg 2+ induced the least adsorption while Na + induced highest adsorption. The adsorption capacity of immobilized yeast and P. cepacia H42 was detected between 200-400 mL in flow volume and decreased in the presence of light metals. Ion exchange containing light metals caused 30-50% adsorption reduction on both strains.