Background: This study evaluated the effectiveness of upper thoracic manipulation (UTM) and proprioceptive training versus proprioceptive training alone on forward head posture (FHP) and cervicocephalic joint position sense (CJPS) in asymptomatic university students during a short interval of time. Objectives: To evaluate whether the suggested combination would provide greater benefit, and be superior to proprioceptive training alone in improving proprioceptive acuity and head posture. Design: A single-blind randomized controlled trial. Methods: Thirty-three university student volunteers with asymptomatic FHP were recruited. Subjects were randomly assigned to a manipulation group (n=16) receiving UTM combined with proprioceptive training or a proprioception group (n=17) receiving proprioceptive training only. The intervention period lasted 5 weeks in total, and consisted of one 15 to 20-minute session per week. FHP and CJPS were assessed before and after the intervention. Results: A significant pre- to post-intervention decrease in FHP and joint position error was identified in both groups (P<.05). Subjects in the manipulation group demonstrated greater improvements in CJPS and head posture compared to the proprioception group (P<.05). Conclusion: These findings support employing either intervention for treating asymptomatic students with FHP. However, the addition of UTM to proprioceptive training was more effective than proprioceptive training alone in reducing joint position errors and improving head posture.

Background: Forward head posture (FHP) is a postural alignment of the cervical vertebrae that leads to increased gravitational load on cervical segmental motions. The overhead arm lift test assesses the ability to actively dissociate and control low cervical flexion and move the shoulders through overhead flexion. Objects: The purpose of this study was to explore muscle activities in the upper trapezius (UT), serratus anterior (SA), sternocleidomastoid (SCM), and lower trapezius (LT) alongside changes in head position during the overhead arm lift test in individuals with FHP. Methods: Fifteen subjects with forward head posture and fifteen subjects with normal subjcects were enrolled in this study. The patients performed the overhead arm lift test, and muscle activities of the UT, SCM, SA, and LT were measured using surface electromyography and by evaluating changes in head position. Independent t-tests were used to detect significant differences between the two groups and Cohen’s d was calculated to measure the size of the mean difference between the groups. Results: The FHP group demonstrated significantly increased muscle activity of the UT (32.46±7.64), SCM (12.79±4.01), and LT (45.65±10.52) and significantly decreased activity in the SA (26.65±6.15) than the normal group. The change in head position was significantly higher in the FHP group (6.66±2.08) than the normal group. Effect sizes for all parameters assessed were large between the two groups. Conclusion: The subjects with excessive FHP displayed were unable to fix their heads in position during the overhead arm lift test. The overhead arm lift test can thus be used in clinical settings to confirm control of the neck in these subjects.

목 적：본 연구는 자기공명영상 검사에서 Head coil 적용 시 신생아의 머리와 같은 피사체의 작은 volume으로 인한 영상의 불균일성 개선을 위해서 올바른 position의 설정을 찾고자 하였다. 대상 및 방법：Philips 장비회사에서 제공되는 밑면의 둘레와 부피가 각각 31.4cm 1000cc(이하 P1), 37.68cm 2000cc(이하 P2), 43.96cm 3000cc(이하 P3)인 원통형 Mineral Oil Phantom을 사용하였으며, 영상 획득 장비는 3.0T 초전도 자기공명상장치(Archieva, Philips medical system)와 32 channel SENSE Head coil을 사용하였다. 각 Phantom을 옆면이 바닥에 위치하도록 하여 Head coil의 바닥에서부터 2.5cm 높이 간격으로 5cm 높이까지 scan하였으며, 본원 PED Brain MR검사 시사용되는 표준 T2 강조영상의 매개변수로써 TR 2300msec, TE 80msec, flip angle 90ﾟ, FOV 210×180mm, matrix 352×226, slice thickness 5mm, slice gap 1mm, slices 10slice, number of excitation 1.5, scan time은 1분 32초를 사용하였고, Coil의 감도를 균등하게 하기 위해 signal 강도를 맞춰주는 Clear mode를 적용하였다. Phantom의 관상면 영상(axial image)을 각각 10회씩 획득하였으며, 매 회 5번째 영상으로 평가하였다. 영상 평가는 Archieva, Philips medical system Viewforum 장비를 이용하였으 며, 자기공명영상 촬영 장치 정도관리에서 영상 강도 균일성 평가 시 이용되는 ACR method를 이용한 PIU(Percent Integral Uniformity) 값으로 비교 분석하였다. 통계적 분석방법은 Phantom의 높이를 달리하여 scan한 결과를 PIU 값의 합격 기준과 비교한 후, Matlab(ver,R2015a,Mathworks, USA)의 simple one way ANVOA를 이용하여 유의한 차이가 있는지 평가하였다. 결 과：영상의 강도 균일성의 PIU 합격기준은 3.0T 이상의 장비에서 82% 이상이어야 한다. 연구 결과 P1은 Head coil의 0cm, 2.5cm, 5cm 높이에서 scan하였을때 각각의 PIU 값은 52.1±0.53%, 77.85± 1.12%, 91.32±0.38%이었으며, P2는 Head coil의 0cm, 2.5cm, 5cm 높이에서 scan하였을때 각각의 PIU 값은 57.95±1.34%, 79.91±8.92%, 90.46±1.55%이었고, P3는 Head coil의 0cm, 2.5cm, 5cm 높이에서 scan하였을때 각각의 PIU 값은 60.84±1.90%, 83.81±1.72%, 90.34±1.78%이었다. 연구 결과 P1과 P2는 5cm 높이에서 P3는 2.5cm 높이에서 scan하였을때 PIU 값이 82% 이상임을 알 수 있다. Phantom의 높이를 달리하여 scan한 결과는 모든 P1, P2, P3에서 높이에 따른 PIU 값 차이가 통계적으로 유의하였다(p>0.05). 결 론：우리나라 신생아의 평균 머리둘레는 34.58~40.69cm이다. 그러므로 위 실험 결과에 따라서 32 channel SENSE Head coil을 사용하여 신생아의 PED, Brain 검사 시 coil의 바닥면에서 5cm를 높여 서 검사를 했을 때 영상의 불균일성을 개선함으로써 영상의 질을 향상 시킬 수 있다.