목적 : 본 생애사 연구의 목적은 경수 5번 손상장애인의 내부자적 시각을 통해 일상생활의 적응과정을 이해하고 설명하고자 한다. 따라서 연구의 질문은 경수 5번 손상장애인은 일상의 삶에서 실제로 어떤 경험을 하고 있는가?연구방법 : 본 연구에서는 개인의 주체 형성 과정에서 주체가 조성되는 사회적 장치를 파악하기 위해서 생애사 연구 방법을 사용하였다. 연구 참여자는 최대변량표집(Maximum variation sampling)방법을 사용하였다. 면접내용이 더 이상 새로운 것이 나오지 않을 때까지 심층면접을 2시간씩 3회 실시하였다. 분석은 덴진(Denzin)의 해석적 생애사 방법을 사용하여 척수손상 후 침상시기, 지역사회에 적극적으로 참여한 시기로 구분하여 핵심내용을 중심으로 서술하였다.결과 : 척수손상 후에 좁은 침상에서 머물면서 삶의 의욕저하와 자살에 대한 경험을 하게 되었다. 하루가 공상과 망상으로 가득하며, 삶에 대한 미래가 없어 자살을 시도하지만 실패를 하게 된다. 지역사회 작업치료사의 도움으로 전동휠체어와 일상생활 보조기기를 사용하여 삶의 자신감을 회복하게 되고 적극적으로 자신의 삶에 참여하게 되었다.결론 : 본 연구에서는 경수5번 손상장애인의 재활은 병원 중심의 의학적인 접근만이 아닌 지역사회중심재활 중재가 필요하다. 특히 병원에서 지역사회로 돌아올 때 적극적인 전문가 네트워크가 연결되는 프로그램이 개발되어야 한다.

목적 : 척수손상 환자의 ASIA 운동능력 성취점수와 SCIMⅡ를 사용한 일상생활수행도와의 상관관계를 연구하여 일상생활수행 훈련 시 운동능력성취점수의 향상을 위한 효율적인 치료 방법의 선택 기준을 마련하고자 함이다. 연구방법 : 본 연구는 부산 시내에 거주하는 손상 후 6개월 이상인 42명의 척수손상 환자로 하였고 연구 기간은 2004년 12월부터 2005년 1월까지 이루어졌다. 평가도구는 ASIA의 운동능력 성취점수와 SCIMⅡ를 사용하여 운동능력 성취점수와 일상생활 수행도와의 상관관계를 알아보았다. 결과 : 척수손상환자 42명 중 손상 유형에 따라 3개의 군으로 나누어 비교하였다. 완전사지마비군에서 상지-전체 운동능력 성취점수와 일상생활활동과는 통계학적으로 유의한 상관관계를 보이고(p〈.01) 높은 상관관계가 나타났다(r=.90, r=.90). 불완전사지마비군에서는 상지-하지-전체 운동능력 성취점수와 일상생활활동과는 통계학적으로 유의한 상관관계를 보였고(p〈.05) 높은 상관관계를 보였다(r=.64, r=.81, r=.87). 하지마비군에서는 상지-하지-전체 운동능력 성취점수와 일상생활활동과는 통계학적으로 유의한 상관관계를 보였고(p〈.05) 보통의 상관관계를 보였다(r=-.49, r=.60, r=.61). 결론 : 이상의 결과로 볼 때 척수손상 환자에 대한 ASIA 운동능력 성취점수와 SCIMⅡ와는 상관관계가 있으므로 척수장애 재활의 지표를 확립하는 연구에 활용될 수 있을 것으로 생각된다.

The main purposes of this study were to find the correlation between walking ability assessment tools using the Modified Barthel Index (MBI), Functional Independence Measure (FIM), Spinal Cord Injury Measurement II (SCIM II), Walking Index for Spinal Cord Injury (WISCI), walking velocity, and walking endurance. The study population consisted of 56 patients with spinal cord injury referred to the department of Rehabilitative Medicine in the National Rehabilitation Hospital. All subjects were ambulatory with or without an assistive device. All participants were assessed by MBI, FIM, SCIM II, WISCI, walking velocity, and walking endurance. The data were analyzed using Pearson correlation analysis and X2. There was significant correlation between the MBI, FIM, SCIM II, WISCI, walking velocity, and walking endurance (p<.01). In particular, WISCI has a significant correlation with SCIM II(p<.001). Therefore the WISCI scale is an appropriate assessment tool to predict the gait ability of patients with spinal cord injury. Further study about MBI, FIM, SCIM II, WISCI, walking velocity, and walking endurance is needed using a longitudinal study design.

The purpose of this study was to evaluate the general characteristics, complications and level of social adaptation of spinal cord injured patients. The subjects were one hundred forty five members who were inpatients or outpatients from October 1, 2004 to April 30, 2005 in general hospitals and municipal welfare centers for the handicapped located in the metropolitan city of Gwangju. The following results were obtained using Modified Barthel Index (MBI). 1) Gender distribution was 77.9% male and 22.1% female. The mean age at the time of injury was 35.4 and the mean age during the study was 44.2. 2) The degree of paralysis among the subjects was as follows: 49.0% had complete paralysis and 51.0% suffered incomplete paralysis. The most frequently injured lesion among the subjects was cervical (49.0%), followed by thoracic (35.9%), and lumbar (15.2%). 3) The mean MBI score was 63.5. There was statistically significant difference in the MBI score in the relation between complete and incomplete paralysis, the relation between cervical, thoracic, and lumbar injury, and the relation between a recovery period of less than three years and more than three years according to the characteristics of injury (p<.05). 4) There was statistically significant difference in the MBI score of subjects who had complications concerning spasticity, deformity, urinary tract infection, and sexual dysfunction (p<.05). 5) The most serious emotional pain after spinal cord injury resulted from economic issues, which affected 35.2% of the subjects. The group having a shorter recovery period after spinal cord injury complained of psychological matters, the group having a longer recovery period complained about the surrounding environment (lack of convenient facilities), suggesting statistically significant difference (p<.05). 6) The most common activities of the group with injuries more than ten years old included meeting schoolmates and working, while most common activities of the group with injuries less than three years old included attending religious functions and miscellaneous others (watching TV, spending time with family), suggesting statistically significant difference (p<.05).

The purpose of this study was to find the effects of using aid in enhancing walking ability inpatients with spinal cord injury who have received rehabilitative care. The study population consisted of 24 spinal cord injury patients referred to the Department of Rehabilitation Medicine in the National Rehabilitation Center (NRC). All subjects were ambulatory with or without an assistive devices. All of the participants were assessed on SCIM II, WISCI II, FIM, MBI, gait speed (m/s), and walking endurance (120 min/m). The data were analyzed using a paired t-test, a one-way ANOVA, and a Duncan test. The results revealed that TSCIM II and all of the items of SCIM II of the cervical ASIA D group patients were higher than those of the Thoracic ASIA A and C group patients (p<.05). The FIM, MBI, and WISCI II of the cervical ASIA D group patients were higher than those of the Thoracic ASIA C group patients (p>.05). The walking velocities of the lumbar ASIA C group patients were higher than those of Thoracic ASIA A group patients (p<.05). The walking endurance of the lumbar ASIA C group patients was higher than that of the thoracic ASIA C group patients (p<.05). The ASIA D group patients used bilateral standard canes or crutches, but none used AFO. The ASIA A and C group patients used bilateral standard walkers with KAFO for standing and walking. The findings suggest that injury level as well as the functionality of walking aids should be considered when formulating a rehabilitative plan for patients with spinal cord injury.

중추신경계는 일단 손상이 되면 손상된 세포의 재생, 손상된 수초의 회복, 신경계의 정상적인 연결 등의 제한성 때문에 그 회복이 매우 힘들다. 이러한 중추신경계의 중요한 손상으로는 다발성 경화증, 뇌졸중, 척수손상, 외상, 축삭의 탈수초화 등이 있다. 이전 연구들은 많은 발생빈도를 보이고 있는 척수손상에서 실질적인 척수의 기능적인 회복을 위해 손상된 척수신경의 재생과 축삭의 재수초화가 중요한 요인이라고 전하고 있다. 최근에는 이러한 척수손상에 대한 치료적 접근으로서 세포이식 기술이 하나의 해결책을 열어주고 있다. 따라서 본 논문에서는 척수손상의 특성을 살펴보고, 척수손상에 의한 기능장애에 대해 세포이식이 기능의 회복을 증진시킬 수 있다는 증거를 논의하고자 한다.

This study was conducted to assess the effects of the gait training method in incomplete spinal cord injured persons using an auto-walking machine. Persons with incomplete spinal cord injury level C or D on the American Spinal Injury Association impairment scale participated for eight weeks in an auto-walking training program. The gait training program was carried out for 15 minutes, three times per day for 8 weeks with an auto-walking machine. The foot rests of the auto-walking machine can be moved forward, downward, backward and upward to make the gait pattern with fixed on crank. The patient's body weight is supported by a harness during waking training. We evaluated the gait speed, physiologic cost index, motor score of lower extremities and the WISCI (walking index for spinal cord injury) level before the training and after the forth and eighth week of walking training. 1. The mean gait speed was significantly increased from .22 m/s at pre-training to .28 m/s after 4 weeks of training and .31 m/s after 8 weeks of training (p=.004). 2. The mean physiologic cost index was decreased from 4.6 beats/min at pre-training to 3.0 beats/min after 4 weeks and 2.0 beats/min after 8 weeks of training, but it was not statistically significant (p=.140). 3. The mean motor score of lower extrernities was significantly increased from 29.8 to 35.8 after 8 weeks of training (p=.043). 4. The mean WISCI level was significantly increased from level 10 to level 19 after 8 weeks of training (p=.007). The results of this study suggest that the gait training program using the auto-walking machine increased the gait speed, muscle strength and galt pattern (WISCI level) in persons with incomplete spinal cord injury. A large, controlled study of this technique is warranted.

The purpose of this study was to provide information on driving characteristics in persons with spinal cord injury through basic statistic analysis of the survey results. The survey was administered to 44 drivers with spinal cord injury. The subjects' general, neurologic and driving characteristics were analyzed, as well as the degree of difficulty in using their vehicles between tetraplegia and paraplegia. The results were as follows: thirty-five (79.6%) of forty-four respondents was men. The average age was 35.0 years old and the age at the time of injury was 29.0 years old. Their neurologic characteristics were tetraplegics 12 (27.3%) and paraplegics 32 (72.2%). Among complete lesions, the highest level those who could drive independently was C7. All the vehicles were equipped with special devices, including "power steering", "automatic transmission" and "hand controls". The vehicles for cervical cord injury were equipped with "grip bars" as well as for the degree of difficulty in using their vehicles, all the subjects felt that "moving the wheelchair in and out of their vehicles" was too difficult for them to do. We suggest that the driver training should be an essential part of the rehabilitation program for patients with spinal cord injuries to maximize their mobility in the community. This training seems to be essential in order to modify the standards of the Handicapped Drivers Ability Test and to aid the driver rehabilitation program in the health insurance payment system. Also, the driver rehabilitation training program should include instruction in that moving wheelchairs in and out of vehicles.

본 증례연구는 복합손상을 가진 척수손상환자의 재활치료과정을 소개하여 유사한 사례의 치료에 도움이 되고자 하는 것이다. 증례연구의 대상자인 26세의 남자환자는 흉수 4번 완전손상과 사고 당시 전기화상에 의한 좌측하박 절단과 우측손의 정중신경이 마비되었다. 치료초기에는 일상생활동작 검사에서 MBI (Modified Barthel Index) 점수가 22점으로 독립적으로 가능한 것은 거의 없었고, 기능적으로도 모든 도움이 필요한 상태였으나 재활치료결과 독립적

In general, sitting balance is decreased in subjects with spinal cord injury. The purpose of this study was to evaluate the inter- and intra-rater reliability of the Functional Reach Test (FRT) which is used to measure sitting balance. The subjects of this study were 26 persons with spinal cord injury, and they were divided into three groups according to their injury level. Group I, II and III consisted of the following quadriplegics, , and paraplegics, respectively. Subjects sat on a mat table that was set at an 80 degree inclination. During three sessions, the length subjects could reach in the FRT test was measured by three physical therapists, and compared to each other. The results showed that intraclass correlation coefficients (2,1) were above 0.97 and inter-rater difference was not statistically significant. The one-way ANOVA demonstrated that reach differed between groups with lower thoracic lesion and the other test groups. In conclusion, we think modified FRT is useful and reliable method to measure the sitting balance in subjects with spinal cord injury.

For the purpose of disclosing estimated annual incidence rate and causative factors of traumatic spinal cord injury and obtaining basic data for the establishment of effective measures to prevent this injury, the medical record of 204 cases of Seoul residents with spinal cord injury which admitted in 46 general hospitals and National rehabilitation center located in Seoul, including Sam Yook Rehabilitation Center and Jung Ang Hospital in Kyungi do and occurred in 1995 were analyzed. The results were as follows: 1) The estimated annual incidence rate of traumatic spinal cord injury in 1995 of Seoul residents was 20.5 per million population. This incidence rate was the highest in the 40th years (34.1), followed by in the 50th years (26.5) and in the 20th years (25.6) in descending order. 2) The incidence rate ratio between male and female was 3.5:1. 3) The leading cause of injury was the highest in traffic accidents (42.2%), followed by falls from elevation (29.4%) and falls on the same level (9.8%). 4) Traffic accident mainly occured from 20th years to 40th years and falls from elevation in 50th years. 5) The level of spinal cord injury was the highest in cervical cord (63.2%), followed by the thoracic cord (21.1%) and lumbosacral cord (15.7%). Traffic accidents mainly caused in cervical cord injury whereas thoracic cord injury and lumbosacral cord injury were caused from falls from elevation. Above theconsiderations in mind, it suggested that in order to prevent traumatic spinal cord injuries, safety education of falls from elevation should be focused on the 20th years and 50th years male, moreover safety education of traffic accidents will be needed in the 30th years and 40th years male.

For the purpose of disclosing causative factors of traumatic spinal cord injury. the medical record of 429 cases with spinal cord injury which admitted in 46 general hospital and National rehabilitation center located in Seoul, including Sam Yook rehabilitation center and Jung Ang hospital in Kyungi do and occurred in 1995 were analyzed. The results were as follows: 1. This incidence frequency was the highest in the 20th years(31.2%), followed by in the 30th years(23.596) and in the 40th years(l8.9%) in descending order. 2. The incidence ratio between male and female was 4: 1. 3. The leading cause of injury was the highest in traffic accidents(49.2%), followed by falls from elevation(25.2%) and falls on the same leve1(8.4%). 4. Traffic accident mainly occured from 20th years to 40th years and falls from elevation in 50th years. 5. The level of spinal cord injury was the highest in cervical cord(54.8%). followed by the thoracic cord(28.9%) and lumbosacral cord(16.3%). Traffic accidents mainly caused in cervical cord injury and thoracic cord injury whereas lumbosacral cord injury was caused from falls from elevation.

The purpose of this study was to examine the importance of social role performance in the life satisfaction among spinal cord injuried persons. The study consisted of 81 participants. discharged from the hospital and resided at a private residence, who responded to a mailed questionnaire. The questionnaire contained questions on demographic characteristics: gender. age. marital status, level of education. religious affiliation, empolyment. income, severity of injury, age at onset of injury, time since injury, and duration of hospitalization, life satisfaction index-Z(LSI-Z) and a state of six social roles: working conditions, family relationships, friends relationships, social activities. leisure activities, and religious paticipation. The question on each social role was rated on five-point Likert scale ranging from 1 "very poor" to 5 "very good". The subjects were divided into 1-3/4-5(poor/good performance group) and the subjects who had not performed the social role were classified as poor performance group. The study found over seventy-five percent of participants belonged to the group with poor performance in all six roles. Also, only social activities of social roles was restricted by a severe disability but it was not restricted the others. Income was found to be associated with three social roles: friends relationships, social activities, and leisure activities. In addition, empolyment, income, and duration of hospitaization were found to be associated with life satifaction, however, the severity of injury was not. Subjects in the group with good performance in four social roles: working condition, family relationships. friends relationships, and social activities had significantly higher life satisfaction. Result from a multiple regression analysis indicated that income. role in working condition and family relationships were the significant predictors of life satisfaction. The finding was that the life satisfaction of persons with spinal cord injury appeared to be influenced by income and some aspects of social role performance but not by their disability. The results suggest that we need to encourage to provide financially independent environment and to perform social role designed to yield improvements in life satisfaction for persons with spinal cord injury.

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.

Spinal cord injury in child often occurs without evidence of fracture or dislocation. The mechanisms of neural damage in this syndrome of spinal cord injury without radiographic abnormality(SCIWORA) include flexion, hyperextension, longitudinal distraction, and ischemia. Inherent elasticity of the vertebral column in infants and young children, among other age-related anatomical peculiarities, render the pediatric spine exceedingly vulnerable to deforming forces. The neurological lesions encountered in this syndrome include a high incidence of complete and severe partial cord lesions. Children younger than 8years old sustain more serious neurological damage and suffer a larger number of upper cervical cord lesions than children aged over 8 years. Of the children with SCIWORA. 52% have delayed onset of paralysis up to 4 days after injury, and most of these children recall transient paresthesia, numbness, or subjective paralysis. The long-term prognosis in cases of SCIWORA is grim. Most children with complete and severe lesions do not recover; only those with initially mild neural injuries make satisfactory neurological recovery.

최근 삶의 질이 향상되면서 많은 사람들이 다양한 레저 활동을 즐기고 있다. 하지만 레저 활동 인구가 증가하면서 다양한 사고로 척수손상장애인이 되기도 한다. 이러한 이유로 척수손상장애인의 인구가 증가할 수 밖에 없다. 이러한 현상은 의료복지 측면에서의 수요 확대로 이어질 수 있다. 척수손상 정도에 따라 외출 및 외래진료에 어려움이 있는 척수손상환자들은 방문의료서비스의 이용 증대로 이어질 수 있다. 이러한 이유로 보건복지부에서는 서비스 양적 확충을 위해 지속적 연구가 진행되고 있다. 하지만 서비스 다각화 및 질적 향상 측면에서 체계화가 미흡한 실정이다. 선행연구의 대부분은 이용자를 대상으로 단편적인 만족도 및 욕구조사 중심으로 진행되었다. 이에 본 연구에서는 ICT 방문의료서비스 디자인을 위한 4D프로세스 중 Define 단계로 이해관계자 요구사항을 조사하였다. 조사 대상은 서비스 제공자 4명, 서비스 수요자 14명을 대상으로 진행하였다. 조사 대상자들의 구체적인 문제점 및 요구사항을 도출하기 위해 인터뷰 방법론을 활용하였다. 본 연구의 방법으로는 첫째, 척수손상장애와 ICT 방문의료서비스에 대한 이론적 고찰을 실시하였다. 둘째, 국내, 국외에서 진행된 ICT 방문의료서비스에 대한 사례 연구를 진행하였다. 그 결과 ICT 방문의료서비스 관련 이해관계자를 파악하였고 서비스 현황, 주요 시사점을 도출하였다. 셋째, ICT 방문의료서비스 관계자 4명과 척수손상장애인 14명을 대상으로 심층인터뷰와 포커스 그룹인터뷰를 진행하였다. 그 결과 6가지 주요 시사점을 도출할 수 있었다. 6가지 주요 시사점은 다음과 같다. 첫째, 외래진료와 원격진료 병행으로 인한 업무의 부담이다. 둘째, 간접적 원격 진료에 대한 신뢰성이 낮았다. 셋째, 서비스 내 커뮤니케이션 채널이 없었다. 커뮤니케이션 채널이 없어 주요 정보 공유에 문제가 있었다. 넷째, 생체정보 측정 장비와 ICT 의료시스템과의 데이터 호환성에 문제가 있었다. 기기와 시스템 간 호환이 되지 않아 비효율적인 의료서비스가 제공되고 있었다. 다섯째, 다수 환자에 대한 예방, 의료기록, 일정관리 등을 위한 ICT 모니터링 시스템 구축의 필요성이 나타났다. 여섯째, 다양한 특성의 척수손상장애인을 고려한 서비스 세분화이다. 향후 본 연구를 통해 도출된 6가지 시사점은 ICT 방문의료서비스디자인의 개선방향 설정에 활용될 것이다. 또한 의료서비스를 지원하는 시스템 개선방향에도 활용될 예정이다.