Many children with physical disability have feeding difficulties. In cases of children with cerebral palsy, feeding difficulties can be seen in abnormal oral motor activity and defective swallowing coo rdination. These problems originate from neurological lesions. The purpose of this study was to i nvestigate the effect of trunk and neck position on the following aspects of swallowing: stages of oral preparation, pharyngeal swallowing reflex, pharyngeal clearing and aspiration. Sixteen subjects with quadriplegic cerebral palsy were examined to assess their swal-lowing abil ity using videofluoroscopy(VFS). Subjects were evaluated in four different positions 1) trunk erect with the neck flexed 30°2) trunk reclined 30°posteriorly with the eck positioned neutrally 3) trunk re clined 30°posteriorly with the neck flexed 30° 4) trunk in supine with the neck flexed 30°. Friedman's test was used to analyze the effect of posi tion of the neck and trunk on swallowing. The results were as follows: 1. Ability of oral preparation was significantly better with the subject's trunk recli-ned 30°poste riorly and the neck flexed 30°than with the trunk erect and the neck flexed 30°(p < 0.05). 2. Ability of pharyngeal clearing was significantly better with the subject's trunk er-ect and the neck flexed 30° than in supine with the neck flexed 30°(p < 0.05). 3. Incidence of swallowing reflex was not significantly different among the four posi- tions (p > 0.05). 4. Prevention of aspiration was significantly better with the subject's trunk reclined 30°posteriorl y and the neck flexed 30° than with the trunk reclined 30°posteriorly and the neck neutrally positi oned or in supine with the neck flexed 30°(p < 0.05). These results suggest that positions of both the neck and the trunk have an effect on swallowi ng in children with cerebral palsy. The position with the trunk reclined 30°posteriorly and the n eck flexed 30°was found to be optimal for oral preparation and prevention of aspiration. Further r esearch to study swallowing ability in conjunc- tion with respiratory function is indicated.

The purpose of this study was to identify vital capacity (VC) in relation to the changing position of 19 patients with spinal cord injury (SCI) and 20 normal controls. Among the 19 SCI patients, there were 9 quadriplegics and 10 paraplegics. The vital capacity was measured in each subject during sitting, standing, lying, and head down position of 30 degrees. The data were analysed by the Kruskal-Wallis test, Mann-Whitney test, and Wilcoxon signed rank test. For the SCI, significant difference of VC accoring to the 4 positions between quadriplegics and paraplegics. In the control group, significant difference of VC according to the 4 positions. In 4 positions the VC of men were significantly larger than that of women between two groups. No statistical significant difference was shown in VC by the postural change between quadriplegics and paraplegics.

The objective of this study was to identify pulmonary functional variations in relation to postural changes, lapse after changing position, and the use of abdominal band in the cervical cord injured. The subjects of this study were 19 quadriplegic patients who had been admitted to the department of the Rehabilitation Hospital, College of Medicine, Yousei University, from April, 1997 through May 3, 1997. A spiroanalyzer was used to measure pulmonary function in supine, standing, time after changing position, and recording to the position, application method, and tightness of the abdominal band. The data were analyzed by the repeated measure one-way ANOVA, and Wilcoxon signed rank test. The findings were as follows: 1. All phase of the patients' pulmonary function improved significantly in supine posture in contrast to standing (vital capacity by and expiratory reserve volume by ). 2. The longer the time lapsed from supine posture to standing, the patient's expiratory reserve volume, maximum ventilation volume, vital capacity, and forced expiratory volume increased. 3. When the patient lay in supine position, the maximum ventilation volume, vital capacity, and the forced vital capacity increased then the center line of the abdominal band was placed along iliac crest; on the other hand, when the patient was standing, placing the bottom line of the abdominal band along iliac crest increased the maximum ventilation volume, vital capacity, and forced expiratory volume. 4. In placing the abdominal band in the patients, leaving space between the top and bottom lines of the band helped increased in maximum ventilation volume, vital capacity, and forced vital capacity for patient in supine as well as in standing. 5. When placing the abdominal band to patients in supine posture, reducing the length of the band by 2.5% along the patient's waist line increased the patients' vital capacity, while reducing the length by 10% to patients in standing increased the maximum ventilation volume. The abdominal band should be placed in such a way that the bottom part of the band should be more tightly fastened while leaving enough room for a hand to be placed in between the body and the band for the top part of the hand. It should also be noted that in a supine position, the bottom line of the band should be placed along the iliac crest, while in standing, the center line should be placed along the iliac crest. The length of the band should also be reduced by 2.5% of the waist line in supine position, and in standing, the length should be reduced by 10%. It should also be noted that the pulmonary function of the patients should be measured at least 10 minutes after one position change.

The purpose of this study was to compare and evaluate various hand functions in the most common position (chair sitting, standing, floor sitting) used by cerebral palsied children with spastic diplegia. The results, analysed statistically, could be useful in suggesting treatment strategy for the improvement of hand function in such patient. For this study, 27 children mild or moderate spastic diplegia were chosen. They were patients of the Rehabilitation Hospital, Yonsei University Medical Center. Both dominant and nondominant hands were tested by the Box and Block Test. Bilateral hand function was tested by bead striding and card sorting activities. Collected data was analysed using univariate correlation analysis and MANOVA. Results were as follows: 1) In chair sitting there was a significant positive correlation between dominant hand scores in the Bloc and Box Test and chronological age, gestation period, and time of treatment initiation. In bilateral hand function, card sorting scores correlated positively with time of treatment initiation. 2) In standing, there was a significantly positive correlation between dominant hand scores in the Block and Box Test and time of treatment initiation. 3) In floor sitting, there was a significantly positive correlation between the dominance hand scores in the Block and Box Test and the tine of treatment initiation. Bead stringing, a bilateral hand activity, correlated positively with gestation period and birth weight but negatively with the postnatal incubation period. 4) That score of children who walked showed no significant difference in any of the three postures. 5) Highest test scores in children who could nat walk were in the Box and Block Test for nondominant hand in bead stringing for bilateral hand function. There scores occurred with the children in thee chair sitting posture. The results showed that, in order to improve hand function in children with spastic diplegia, it is necessary to maintain a well supported upright trunk posture with variations allowed for relevance to the chosen position of thee improvements hand activity being performed.

The purpose of this study was to compare and evaluate various hand functions in the most common positions (chair sitting, standing, floor sitting) used by cerebral palsied children with spastic diplegia. The results, analysed statistically, could be useful in suggesting treatment strategy for the improvement of hand function in such patients. For this study, 27 children with mild or moderate spastic diplegia were chosen. They were patients of the Rehabilitation Hospital, Yonsei University Medical Center. Both dominant and nondominant hands were tested by the Box and Block Test. Bilateral hand function was tested by bead stringing and card sorting activities. Collected data was analysed using univariate, and MANOVA. Results were as follows: 1. The scores of children who walked showed no significant difference in any of the three postures. 2. The highest test scores in children who walked with assistance (aid /other person) were in the Box and Block Test for the nondominant hand, and in bead stringing for bilateral hand function. These scores occurred with the children in the chair sitting posture(p(0.05). The results showed that, in order to improve hand function in children with spastic diplegia, it is necessary to maintain a well supported upright trunk posture with varia- tions allowed for relevance to the chosen position of the hand activity being performed.

Body position is known to have an effect on vital capacity(VC). The purpose of this study was to examine effect on VC of posture, sex and smoking, and the difference between predicted and measured values of VC. VC was measured in the standing and the head-down position in 40 healthy subjects (20 men and 20 women) in a random order of testing. When subjects changed from standing to head-down position, this VC decreased by 19.9%. In both positions, VC changes in men were significantly larger than in women. No statistically significant difference was found in men who smoked. There was no difference between the predicted and measured values in men. But measured values were larger than predicted values in women. Because VC can decrease by 19.9% in the head-down position due to the effect of gravity, attention should be paid especially to patients who are placed in the head-down position for postural drainage since they already have a decreased VC.

The purpose of this study was to investigate which of 4 positions produced the highest action potential in the rectus femoris muscle of normal adult subjects. Testing was performed in supine with the right leg performing a simple straight leg raise with the knee fully extended. The left leg, however, was placed in 4 different positions: 1. Full support with flexion. 2. Flexed on the plinth with knee flexion and foot flat. 3. Same as N0.2 but with knee flexion. 4. Left leg hanging over the end of the plinth with knee flexion, hip flexion and no foot support. This study was designed to compare the level of electromyographic activity of the rectus femoris under 4 positions. Fourty-three healthy young adults performed three trials of each exercise condition in random order in the supine position. Electromyographic activity was recorded from surface electrodes. Rectus femoris action potentials in all 4 positions were significantly different. The highest action potential at the end of movement of the right leg occurred with the left leg hanging over the end of the plinth with knee flexion. It is therefore recommended the straight leg raising be performed with the contralateral leg flexed at over the end of the supporting surface to obtain a maximum rectus femoris isometric contraction.

Brain Perfusion CT는 시간적 제약을 많이 받는 허혈성 급성뇌경색 환자의 관류 상태에 대한 정보를 정확하고 신속하게 제공함으로써 적절한 치료를 하는데 유용한 촬영 기법으로 임상에서 많이 촬영되고 있다. 그러나 이런 장점에도 불구하고 수정체의 피폭선량이 아주 많다는 단점이 있다. 본 연구에서는 Brain Perfusion CT 검사 시 수정체 피폭선량을 최대한 감소시키기 위한 방법으로 Bismuth 차폐체와 Position의 변화를 통하여 수정체 피폭선량의 최소화 방안을 알아보기 위한 목적으로 본 실험을 진행하였다. 팬텀(PBU-50)을 사용하여 양쪽 수정체에 TLD(TLD-100)를 올려두고 IOML에 평행, IOML에 평행(Bismuth 차폐), SOML에 평행, SOML에 평행(Bismuth 차폐)의 총 4가지 Position으로 각각 5회씩 Brain Perfusion scan을 실시하여 수정체의 선량을 측정하였다. 그리고 각각의 Position에 따른 화질 변화를 측정하기 위해 4군데에 관심영역을 정하여 CT Number와 Noise의 변화를 측정하여 비교하였다. 측정된 선량을 일원배치 분산분석한 결과 유의확률 0.000으로 Position에 따라 수정체의 피폭선량에 차이가 있다고 나타났으며, Duncan 사후검정결과에서 IOML에 평행 scan을 기준으로 SOML에 평행 scan과 SOML에 평행 scan(Bismuth 차폐)에서 각각 89.16%, 89.66%로 수정체 선량이 많이 감소하였으며, IOML에 평행 scan(Bismuth 차폐) 에서 37.12%순으로 감소하여 나타났다. 연구 결과 피폭선량은 SOML에 평행한 scan과 Bismuth를 차폐하여 SOML에 평행한 scan이 동일하게 감쇠효과가 가장 크게 나타났다. 수정체의 등가선량 선량한도와 비교하여 IOML에 평행한 scan에서 종사자와 공중의 선량을 기준으로 비교하면 각각 39.47%, 394.73%로 나타났으나, Bismuth를 차폐하여 SOML에 평행한 scan에서 각각 4.08%, 40.8%로 현저하게 줄어 들었다. 화질평가에서 모든 영상의 CT Number와 Noise측정에서 팬텀 영상검사 평가기준에 적합하게 나타났다. Brain Perfusion CT 촬영 시 차폐체를 사용하고 수정체가 조사야에 들어오지 않도록 환자의 position을 조절하는 것이 수정체 피폭을 줄이는 가장 유용한 방법이라 사료된다.

하지전신계측검사(low extremity teleography)에서 자세 변화에 따른 중요장기의 방사선량을 측정하고 영상을 비교 분석하여 검사방법에 따른 유용성을 알아보고자 하였다. 대상은 하지전신계측검사를 시행한 성인남자 10명을 대상하였고 촬영조건은 관전압 73 kVp, 관전류량 32 mAs, SID 180 cm로 설정하였다. 방사선량 측정은 란도 팬텀을 이용하여 수정체, 갑상선, 생식선 부위에 유리선량계(glass dosimeter)를 부착한 후 전후방향자세와 후전방향자세를 각각 5번씩 시행하여 부위별로 방사선량을 측정한 후 Paired T-test로 비교 분석 하였다. 영상평가는 전후방향자세와 후전방향자세를 시행한 영상을 blind test를 실시하여 5점 척도로 평가하였다. 결과적으로 전후방향자세검사에 비해 후전방향자세검사가 수정체 약 6%, 갑상선 약 6%, 생식선에 미치는 방사선량을 약 27% 감소시킬 수 있으며 영상평가에서도 두 그룹 간에 큰 차이가 없어, 하지전신계측검사에서 전후방향자세검사보다 후전방향자세검사가 유용할 것으로 사료된다.

Purpose: Postural stability has an important role for developing locomotion skills, especially in childhood. The purpose of this study was to investigate the developmental change of postural stability with respect to locomotor skills. Methods: Thirty-five participants aged between five to seven year-old whom differentiated by pre examination were divided into Jumping, Hopping, Galloping and Skipping group, respectively. They were asked to perform quiet standing and leaning voluntarily forward, backward, left and right as far as possible on a force plate. A vector of center of pressure was measured to calculate postural stability and one-way ANOVA was performed. Results: Jumping group showed significant low postural stability than the others and there is no significant difference among Hopping, Galloping, and Skipping group who can perform advanced locomotor skills. Conclusion: Postural stability seems to increase when children acquire advance locomotor skills and this result might reflect nonlinear characteristic of human motor development.

앉은 자세를 장시간 유지하면 허리의 만곡에 변화가 오면서 통증이 발생하게 된다. 본 연구에서는 양반 앉은자세에 서 SPINE-GUARD(허리 안정화 벨트) 착용이 허리뼈의 코브각과 허리통증 그리고 몸통 굽힘각도의 변화에 미치는 영 향에 대해 알아보았다. 대상자 15명(남자)은 2주 동안 주 5회 매회 90분씩 벨트를 착용한 채로 영화를 감상하거나 강 의를 들었다. 허리뼈의 코브각은 착용전 48.36±14.57에서 착용후 28.09±11.63로 유의한 감소를 보였다(p<0.05). 통 증은 착용전 4.53±2.36이고, 착용후 2.733±2.153로 유의하게 감소하였다(p<0.05). 몸통의 굽힘각도 또한 착용전 82.33±20.30에서 착용 후 70.2±19.43로 유의한 감소를 보였다(p<0.05). 이것으로 보아 SPINE-GUARD의 착용은 허리뼈의 코브각 및 몸통굽힘각도의 변화 그리고 통증의 감소에 영향을 주는 것으로 사료된다.

경부 CT검사 시 선속경화인공물(Beam Hardening Artifact)에 의해 제 6번 7번 경추 및 추간판 등의 질환 및 그밖 에 해부학적 구조를 정확히 구분하기에 어려움이 있다. 경부 CT검사를 시행할 경우 자세의 변화방법을 적용한 견관절 의 방향과 위치에 따른 영상평가 및 커널값의 변화에 따른 영상평가를 통하여 선속경화 인공물의 원인을 알아보고 가 장 적절한 검사자세 및 Kernel값을 실험을 통하여 알아보고자 하였다. 경부 CT검사를 위해 내원한 환자 30명(2010년 7월1일 ~ 2010년 12월31일까지 내원한 환자)을 대상으로 Somatom Sensation 16(Siemens, Enlarge, Germany)장비 를 이용하였고, workstation은 AW 4.4 version(GE, USA)을 이용하였다.. 환자 자세는 견관절의 방향과 위치에 따라 세가지 자세로 변화를 주었으며 양쪽 팔을 편안하게 위치시킨 바로 누운 자세(group N), 왼쪽 팔을 거상 시킨 자세 (group S) 그리고 양손을 외 선위(eversion)시켜 최대한 아래로 내리는 자세(group P)로 견관절의 방향을 변화를 주 어 스캔을 시행하였고, 두 번째로 영상 재구성 방법을 이용하여 스캔 데이터에 커널값을 B10(very smooth), B20(smooth), B30(medium smooth), B40(medium), B50(medium sharp), B60(sharp), B70(very sharp)로 변화를 주어 재구성 하였다. 검사자세의 변화와 Kernel값의 변화를 주어 얻어진 영상 데이터를 이용하여 각 각의 노이즈 값 측정과 영상평가를 통하여 분석해보았다. 경부 CT검사 시 검사자세는 양손을 외선위(eversion)시켜 최대한 아래로 내 리는 자세(group P)로 하며, 커널 값은 B40(medium)또는 B50(medium sharp)으로 재구성할 경우 가장 적절한 자세 와 커널값으로 분석되어 임상에 적용 시 매우 유용할 것으로 사료된다.

이 연구의 목적은 인생전반에 걸쳐 인지 과제 수행 중 자동자세와 감각통합 반응의 발달과 변화에 대한 메커니즘을 Posturography를 통해 규명하고 궁극적으로 노인들의 낙상을 예방할 수 있는 기초 자료를 획득하는데 있다. 건강상의 문제가 없으며 어떤 형태의 대근감각, 인지적 또는 신경손상이 없는 남·녀를 대상으로 만 8세에서 75+세에 걸쳐 6개 연령층을 각각 15명식 무선 표집하여 연구 대상으로 선정하였다(8-9세, 14-15세, 20-25세, 40-45세, 65-74세, 75세+). 피험자들은 인지과제 수행과 인지과제 수행 없이 지면반력기 위에서 6가지 조건을 1회 20초씩 각 3회 시행하여 복합평형점수, 조건별 평형점수, 감각분석, 동작전략, COG 정렬 등의 감각구성에 대한 점수들이 획득되었다. 운동제어 검사는 지면반력기의 6가지 움직임 변화에 대한 체중분배, 잠복기, 진폭 등이 획득되었고 발바닥의 아래쪽이동과 발바닥의 위쪽이동에 대한 적응점수 등이 획득되었다. 실험 결과 종합 평형성, 조건별 평형성, 감각분석, 전략, COG정렬, 잠복기, 적응도, 등에 대해서 연령증가에 대한 변화가 인지과제 수행 여부에 관계없이 나타났다. 그러나 그 변화는 인지과제 수행시 노인 집단에서 더 크게 나타나났다. 노인의 자세제어 능력은 다른 연령집단과 비교하여 볼 때 인지과제 수행시 자세제어를 위한 종합적인 감각 통합과 이에 따른 전략에서 차이를 보이고 있고 이런 차이가 궁극적으로 많은 낙상을 가능하게 할 수도 있음을 보여주고 있다. 자동자세 반응에서 신경전달 속도와 적응면에서도 그 차이가 나타나고 있다. 노인들의 낙상은 일반적으로 알려진 신경계의 쇠퇴, 인지과제와 관련된 부적적한 감각통합, 그리고 돌발적인 상황에서의 자세제어 전략과도 관계가 있을 것으로 연구결과는 제언한다.