중등도 족관절 외측 인대 염좌 후 재활치료

김진영,임길병,김정민,이홍재,신용일 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.4

Objective: To evaluate the effect of comprehensive rehabilitation treatment in patients with moderate lateral ankle ligament sprain. Method: We reviewed the medical records of 22 patients who had been in rehabilitation program after moderate lateral ankle ligament sprain. We measured the range of motion of ankle joint, pain intensity by visual analogue scale (VAS) score, the difference of ankle circumference between normal and affected side, and strength of dorsiflexor, plantarflexor, invertor and evertor of ankle before and after rehabilitation. Results: The range of motion, VAS score, ankle circumference, strength of dorsiflexor, invertor and evertor of the affected ankle significantly improved after rehabilitation exercise (p<0.05). Eighteen out of 22 patients returned to the sports activities successfully after systemic rehabilitation. Conclusion: Systemic and appropriate rehabilitation is inevitably necessary after acute ankle sprain for the successful return to the sports activities. Objective: To evaluate the effect of comprehensive rehabilitation treatment in patients with moderate lateral ankle ligament sprain. Method: We reviewed the medical records of 22 patients who had been in rehabilitation program after moderate lateral ankle ligament sprain. We measured the range of motion of ankle joint, pain intensity by visual analogue scale (VAS) score, the difference of ankle circumference between normal and affected side, and strength of dorsiflexor, plantarflexor, invertor and evertor of ankle before and after rehabilitation. Results: The range of motion, VAS score, ankle circumference, strength of dorsiflexor, invertor and evertor of the affected ankle significantly improved after rehabilitation exercise (p<0.05). Eighteen out of 22 patients returned to the sports activities successfully after systemic rehabilitation. Conclusion: Systemic and appropriate rehabilitation is inevitably necessary after acute ankle sprain for the successful return to the sports activities.

하수관거시스템 개량 우선순위 결정 모형

이정호,박무종,김중훈 한국방재학회 2008 한국방재학회논문집 Vol.08 No.06

The main objective of sewer rehabilitation is to improve its function while eliminating inflow/infiltration (I/I). If we can identify the amount of I/I for an individual pipe, it is possible to estimate the I/Is of sub-areas clearly. However, in real, the amount of I/I for an individual pipe is almost impossible to be obtained due to the limitation of cost and time. In this study, I/I occurrence of each sewer pipe is estimated using AHP (Analytic Hierarch Process) and RPDM (Rehabilitation Priority Decision Model for sewer system) was developed using the estimated I/I of each pipe to perform the efficient sewer rehabilitation. Based on the determined amount of I/I for an individual pipe, the RPDM determines the optimal rehabilitation priority (ORP) using a genetic algorithm for sub-areas in term of minimizing the amount of I/I occurring while the rehabilitation process is performed. The benefit obtained by implementing the ORP for rehabilitation of sub-areas is estimated by the only waste water treatment cost (WWTC) of I/I which occurs during the sewer rehabilitation period. The results of the ORP were compared with those of a numerical weighting method (NWM) which is the decision method for the rehabilitation priority in the general sewer rehabilitation practices and the worst order which are other methods to determine the rehabilitation order of sub-areas in field. The ORP reduced the WWTC by 22% compared to the NWM and by 40% compared to the worst order. 하수관거시스템 개량의 주된 목적은 불명수(Inflow/Infiltration, I/I)를 제거함으로써 그 성능을 향상시키는데 있다. 이때 전체 하수관거시스템 내에서 개개 관거별 I/I 발생량을 정량화할 수 있다면, 전체 하수관거시스템 내에서 소유역별 해당 정보의 추출이 보다 명확해질 수 있다. 그러나 실제 현장에서는 예산 및 시간의 제약 때문에 개개 관거의 I/I 발생 정보의 획득은 거의 불가능하다. 본 연구에서는 하수 관거별 I/I 발생량을 AHP(Analytic Hierarch Process)를 이용하여 정량화하였으며, 산정된 관거별 I/I 발생량을 이용하여 효율적인 하수과거 개량 사업 시행을 위한 개량 우선순위 결정 모형(Rehabiliation Priority Decision Model for sewer system, RPDM)을 개발하였다. 개개 관거별 I/I 발생량 산정 결과에 기반하여 RPDM은 개량이 시행되는 기간 동안 발생하는 I/I 발생량을 최소화하는 소유역별 최적 개량 우선순위(Optimal Rehabilitation Priority, ORP)를 유전자 알고리즘을 이용하여 결정한다. 이때 최적 개량 우선순위에 따른 소유역별 개량 시행 시 발생하는 이익은 개량 기간 동안 하수처리장으로 들어가는 I/I의 하수처리비용(Waste Water Treatment Cost, WWTC)에 대한 절감을 의미한다. 본 연구에서는 개발된 RPDM에 의한 최적 개량 우선순위의 결과는 일반적인 하수관거개량사업의 우선순위 결정 방법인 점수가중평가법(Numerical Weighting Method, NWM)과 최악의 개량순서에 따른 결과들과 비교되었으며, 개량 기간 동안의 I/I 처리비용이 점수가중평가법에 비하여 22%, 최악의 개량순서에 비하여 40% 감소하는 것으로 나타났다.

재활의료서비스의 이상적인 전달체계

조강희 대한의사협회 2017 대한의사협회지 Vol.60 No.11

Rehabilitation care requires an organized health care delivery system, stroke, brain injury, spinal cord injury, amputation, severe multiple musculoskeletal injury, and congenital damage to the nervous system frequently result in permanent disability or a temporary serious reduction of bodily function. These diseases or injuries require acute medical treatment at general and tertiary hospitals, but then also require a long period of intensive and comprehensive rehabilitation treatment. Currently, a 3-stage rehabilitation care delivery system, involving acute, subacute (recovery), and chronic (maintenance) rehabilitation, is being considered. Although the concepts underlying this delivery system have not yet been clearly defined, acute rehabilitation should be provided at general and tertiary hospitals for patients with permanent disabilities, an unstable medical condition, and/or a severe temporary reduction of bodily function simultaneously with or immediately after acute medical treatment. Cardiac rehabilitation, respiratory rehabilitation, pressure ulcer management, rehabilitation of severe cerebral palsy, rare diseases, and cancer, for which the cooperation of internal, surgical, and critical care staff is essential, are included in acute rehabilitation. Additionally, intensive and comprehensive inpatient subacute (recovery) rehabilitation should be provided for patients with severely impaired bodily function who are medically stable. Subsequently, chronic rehabilitation may be required for patients who need postural changes throughout the day, those who require rehabilitation treatment intended to prevent long-term complications and to ensure the maintenance of body function, those who show shortness of breath or dysphagia, and those who show little improvements of bodily function, making discharge into the home difficult. These services can be categorized as outpatient, visiting, or long-term rehabilitation services.

한국의 재활의료 전달체계

권혁철,정영일,남은우 高神大學校 保健科學硏究所 1993 보건과학연구소보 Vol.3 No.-

This study was carried out for reorientation of Rehabilitation Service Delivery System (RSDS) through reviewing reference and observing field practice. The most important results are as follows: 1. The current rehabilitation facility for handicapped persons can be classified into four categories : (a) those for physically disabled persons, (b) those for mentally disturbed persons, (c) those for visually disturbed persons, and (d) those for acoustic and speech disturbed persons. The nationwide number of rehabilitation facilities is 101 of those, 43.5% is for physically disabled persons and 32.9% is for mentally disturbed persons. 2. A small number of circulating rehabilitation centers for physically disability are being run by comprehensive rehabilitation centers since 1992. 3. The hospitals are self-supporting only 20% of their operational costs, and the rest of the operational costs comes from federal tax(40%) and local tax(40%). 4. The number of handicapped persons in Taegu and Kyungpook province is estimated to be about 50,000, but only 20 percent out of them ws registered. The rehabilitation facilities located in this area receives 69% of their operational costs from central government. This figure is higher than the national average of 64.6%. 5. Although RSDS is different from other medical delivery system, nonetheless, it should be developed as a sub-system of national health care delivery system. Its development should also be in accordance with the need of local community. Therefore we suggest the development policy for the development of RMDS must consider the following points.; First, all rehabilitation-related medical systems should be integrated unde ra single comprehensive system so that handicapped persons may easily obtain better service available. Second, rehabilitation programs based on local community should be rejuvenated. In addition to in-patient service, development of intermediate facilities and programs connecting home and society should be encouraged. Third, rehabilitation medical services should be more specialized. Also, more emphasis should be given to team approach to rehabilitation medical services. Fourth, a comprehensive rehabilitation information system should be developed so that handicapped persons may have easy access to public welfare facilities, and the central government should formulate a comprehensive long-term plan for the rehabilitation system.

기업회생절차상 조사위원제도의 개선방안

박승두 단국대학교 법학연구소 2022 법학논총 Vol.46 No.1

In 1962, the Examiner system was first introduced in Korea under the former Company Reorganization Act through the Japanese Company Reorganization Act. Financial difficulties of companies due to the COVID-19 leads the needs of restructuring of the Examiner system for efficient and rapid rehabilitation. Thus, this article examines legislative history, operational status, and problems, then tries to suggest some insights in order to contribute to improve the national competitiveness. First, according to the legislative history, the former Company Reorganization Act appoints an Examiner before the decision to commence the reorganization procedure, and the court examines and reports the existence of the debtor’s reasons for application and dismissal. However, critics that the duplicated procedures result the delay made the Examiner appoint simultaneously with the start of the proceedings. Second, Debtor Rehabilitation and Bankruptcy Act allowed Examiners to be arbitrarily appointed as needed, but in principle, Examiners are appointed in court practice. The duties of the Examiner can be largely divided into investigations on matters related to the Custodian’s management and investigation rights, preparation and hearing of rehabilitation plans, and submission of reports after approval of rehabilitation plans. Lastly, observed problems and suggestions can be as follow: ① unlike other civil trials, rehabilitation procedures are more economical than judicial. Notwithstanding that, Seoul Rehabilitation Court tends to heavily rely on external Examiners rather than equip their on accounting and economic expertise. ② Debtors who applied for rehabilitation procedures tend to prefer bankruptcy procedures as they require excessive costs to be paid to Examiners. It leads the excessive cost and time, then the rehabilitation rate is also decreasing. Therefore, the structure of rehabilitation procedures, such as cost reduction, time reduction, and risk reduction, should be reviewed. ③ the Examiner system itself also have the several issues. It tends to be considered as high-cost and the reliability of their reports continues to decline. Put differently, the reduce of time and cost, improvement of objectivity and fairness prevention of abuse are required. 채무자회생법에 규정하고 있는 조사위원제도는 미국 연방파산법에서 출발하여 일본의 회사갱생법을 거쳐 1962년 구회사정리법에서 처음 도입하였다. 현재 코로나19사태로 재무구조가 악화되는 기업이 증가하는 상황이라 이러한 기업에 대한 효율적이고 신속한 회생지원을 위해서는, 조사위원제도를 점검하고 문제점이 있으면 이를 조속히 개선할 필요가 있다. 따라서 이 연구는 조사위원제도에 관하여 ① 입법 연혁과 ② 운용 현황을 검토한 후, ③ 문제점을 점검하고 그 개선방안을 제시함으로써, 회생절차의 효율성과 국가 경쟁력 제고에 기여하고자 한다. 먼저, 입법 연혁을 보면, 구회사정리법의 제정법에서는 정리절차 개시결정전에 조사위원을 선임하여 법원은 채무자의 신청사유 및 기각사유의 존재 여부 등을 조사하여 보고하게 하였으나, 이는 절차지연의 요인이 된다는 지적에 따라 채무자회생법은 개시결정시에 조사위원을 선임하도록 변경하였다. 둘째, 운용 현황을 보면, 채무자회생법은 조사위원을 필요에 따라 임의적으로 선임할 수 있도록 하였지만, 법원의 실무에서는 원칙적으로 조사위원을 선임하고 있으며, 조사위원의 업무는 크게, 관리인의 경영 및 조사권 관련 사항에 대한 조사, 회생계획안의 작성과 심리, 그리고 회생계획 인가 후 보고서의 제출 등으로 나눌 수 있다. 마지막으로, 문제점과 개선방안으로는, ① 법원의 역할 면에서 보면, 회생절차는 다른 민사재판과는 달리 사법적인 성격보다 경제적인 성격이 강하므로 이를 잘 반영하여야 함에도, 서울회생법원이 설립된 이후에도 회계 및 경제분야의 전문성을 갖추지 못하고 외부 조사위원에게 전적으로 의존하는 경향이있는데, 이를 개선하여야 한다. ② 회생절차의 구조 면에서 보면, 회생절차를신청한 채무자에게 조사위원에게 지급할 과도한 비용을 예납하게 하고 절차의 진행은 장기간 지체되고 회생률 또한 저하되고 있어, 파산절차를 선호하는 경향이 있다. 따라서 비용의 절감, 소요기간의 단축, 리스크의 축소 등 회생절차의 구조를 전면적으로 개선하여야 한다. ③ 조사위원제도의 좌표 면에서 보면, 고비용 저효율의 제도로 인식되고 조사보고서에 대한 신뢰도가 저하되고 있으므로, 객관성과 공정성을 제고함과 동시에 지위의 남용을 예방하기 위한 조치도 필요하다.

국내 급성기 재활의료 공급체계

유승돈,정용설,김태우 대한의사협회 2017 대한의사협회지 Vol.60 No.11

Acute-phase rehabilitation hospitals focus on managing disabilities, reducing sequelae and symptoms, and enhancing social reintegration, to provide patients with the highest possible independence and the best quality of life. In order to achieve these goals, it is necessary to ensure the appropriate length of hospital stays based on a consideration of disease severity and patients’ potential for rehabilitation, as well as to provide multidisciplinary rehabilitation. Multidisciplinary rehabilitation has been shown to be effective in the management of complex or severe conditions. Hospitals should include rehabilitation centers (specialized rehabilitation units) for patients with complex or severe needs. Starting in acute settings, specialized rehabilitation wards provide intensive, highly specialized interventions to restore function to patients with complex rehabilitation needs. Financial resources should be allocated to rehabilitation services to implement recommendations for the delivery of medical services In Korea, the appropriate allocation of resources for rehabilitation could increase both the availability and the quality of rehabilitation services by facilitating the establishment of specialized rehabilitation units in acute settings.

Usefulness of Pulmonary Rehabilitation in Non-small Cell Lung Cancer Patients Based on Pulmonary Function Tests and Muscle Index Analysis Using Computed Tomography Images in Korea

( Juwhan Choi ),( Sung Yong Lee ),( Zepa Yang ),( Jinhwan Lee ),( Jun Hee Lee ),( Hyun Koo Kim ),( Hwan Seok Yong ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Purpose The usefulness of pulmonary rehabilitation in patients with reduced lung function before lung surgery remains unclear, and there is no adequate method for evaluating the effect of rehabilitation. We aimed to evaluate the usefulness of rehabilitation in patients with non-small cell lung cancer (NSCLC) undergoing lung cancer surgery. Materials and Materials and Methods We retrospectively analyzed the medical records of patients with NSCLC who underwent lung surgery at Korea University Guro Hospital between 2018 and 2020. Patients were divided into two groups depending on whether they underwent pulmonary rehabilitation. Pulmonary function test (PFT) data and muscle index determined using chest computed tomography (CT) images were analyzed. Because the baseline characteristics were different between the two groups, propensity score matching was performed. Results Of 325 patients, 75 (23.1%) and 250 (76.9%) were included in the rehabilitation and non-rehabilitation (control) groups, respectively. The rehabilitation group had a worse general condition at baseline. After propensity score matching, 45 patients remained in each group. Pulmonary function (forced expiratory volume in 1 s, %) (P = 0.001) and the muscle index (P = 0.001) were better preserved in the rehabilitation group. Muscle loss of 3.4% and 0.6% was observed in the control and rehabilitation groups, respectively (P = 0.003). In addition, the incidence of embolic events was low in the rehabilitation group (P = 0.044). Conclusion Pulmonary rehabilitation is useful in patients with NSCLC undergoing lung surgery. Pulmonary rehabilitation preserves lung function, muscle and reduces embolic events after surgery. Pulmonary rehabilitation is recommended for patients with NSCLC undergoing surgery.

Cancer Rehabilitation: Experience, Symptoms, and Needs

김용미,김대열,전민호,전재용,윤기정,이무송 대한의학회 2011 Journal of Korean medical science Vol.26 No.5

The aim of this study was to examine the experience of cancer patients undergoing rehabilitation, to identify symptoms associated with rehabilitation from cancer, and to assess the need for rehabilitation services for cancer patients. Cancer patients (n = 402)at the Asan Medical Center (Seoul, Korea) were enrolled from June to September 2008. A chart review was used to collect demographic and clinical data, including type of cancer,current treatment, time from initial diagnosis to screening, and cancer stage. Each participant provided informed consent and was then given a questionnaire that asked about experience with rehabilitation, symptoms associated with rehabilitation, and the need for different types of rehabilitation services. Clinicians recommended rehabilitation for 8.5% of patients, and 6.7% underwent rehabilitation. Among study patients, 83.8%had one or more symptoms associated with rehabilitation, and 71.6% of patients with symptoms wanted rehabilitation management. The need for rehabilitation was associated with the presence of metastasis, advanced cancer stage, time to diagnosis, and type of current treatment. Our results provide specific information about particular functional symptoms and the rehabilitative needs of subgroups of cancer patients. It is suggested to develope and implement rehabilitation programs for cancer patients.

The Rehabilitation-Related Effects on the Fear, Pain, and Disability of Patients With Lumbar Fusion Surgery: A Systematic Review and Meta-Analysis

Haiyan Cheng,Jing Liu,Lin Shi,Xiuxiu Hei 대한척추신경외과학회 2023 Neurospine Vol.20 No.1

Objective: The lumbar fusion is an important surgery for the orthopedic diseases. The rehabilitation might improve the outcome of patients with lumbar fusion surgery. The rehabilitation-related effects can be revealed by a systemic review and meta-analysis of randomized clinical trials (RCTs). The purpose of this study is to clarify the rehabilitation effects in the patients with lumbar fusion surgery. Methods: We performed a systematic search and a meta-analysis for the RCT of rehabilitation treatment on the patients with lumbar fusion surgery. The comparison between rehabilitation treatment (including psychological rehabilitation, exercise, and multimodal rehabilitation) and typical treatment was performed to find if the rehabilitation treatment can improve the outcome after the lumbar fusion surgery. Fifteen studies of lumbar fusion patients under rehabilitation treatment and typical treatment were enrolled in a variety of rehabilitation modalities. The focused outcome was the rehabilitation-related effects on the fear, disability, and pain of patients after the lumbar fusion surgery. Results: Five hundred twenty-eight rehabilitation subjects and 498 controls were enrolled. The psychological-related rehabilitation showed a significant decrease in pain-related fear when compared to usual treatment. The multimodal rehabilitation can improve the disability outcome to a greater extent when compared to usual treatment. The multimodal rehabilitation seemed to have a more significantly positive effect to decrease disability after lumbar fusion surgery. In addition, the exercise and multimodal rehabilitation can relieve the pain after lumbar fusion surgery. The exercise rehabilitation seemed to have a more significantly positive effect to relieve pain after lumbar fusion surgery. Conclusion: The rehabilitation might relieve the pain-related fear, disability, and pain after lumbar fusion surgery.

뇌성마비인의 척추운동 재활요법이 척추자세 및 운동기능에 미치는 영향

오이표 한국특수체육학회 2004 한국특수체육학회지 Vol.12 No.2

The purpose of this study was to investigate the effects of vertebra rehabilitation exercise therapy on the improvement of vertebra posture and motion function in the individuals with Cerebral Palsy. The participants were totally sixteen individuals with Cerebral Palsy in their twenties or thirties who were diagnosed as the first-grade spastic type cerebral palsy in the Korean Society for the Cerebral Palsied, but participated in no regular exercise program. The participants of this study were classified into control group, vertebra position therapy group, exercise rehabilitation group, and group with both vertebral position therapy and exercise rehabilitation. The results of vertebra position, motion function, EMG and X-ray are as follows; Pelvis torsion in each group made little difference. Viewed in the pelvic tilt, the length in each group made no attentive difference, but the reduction of pelvic angle was significantly demonstrated in exercise rehabilitation group and group with vertebra position therapy plus exercise rehabilitation. In view of trunk imbalance, the more reduction of length was showed in vertebra position therapy group, exercise rehabilitation group and group with vertebra position therapy plus exercise rehabilitation than control group, and the more reduction of length in vertebra position group and vertebra position therapy plus exercise rehabilitation than only exercise rehabilitation group. Furthermore, the angle also revealed the more reduction in vertebra position therapy, exercise rehabilitation therapy, and vertebra position plus exercise rehabilitation therapy rather than control group, additionally, the more reduction in vertebra position therapy group and group with vertebra position therapy plus exercise rehabilitation than only exercise rehabilitation group. No significant difference between mean and maximum lateral deviation was demonstrated. The muscular endurance in group with vertebra position therapy plus exercise rehabilitation was significantly elevated than other groups, flexibility of each group except control was attentively elevated. Agility in vertebra position group and group with vertebra position plus exercise rehabilitation group Balance of each group was indicated in no great difference. Without gravity, both left and right sides EMG were meaningfully reduced only in the group with vertebra position therapy plus exercise rehabilitation. However, there made no meaningful difference in two kilogram in the improvement of vertebra position and function motion. Additionally, vertebral, pelvic correction with manual reduction will be able to improve balancing and flexibility.