골절 방지 시스템의 개발을 위한 낙상 시뮬레이션과 충격 흡수 시스템에 관한 연구

김성현,김동욱,김남균,Kim, S.H.,Kim, D.W.,Kim, N.G. 대한의용생체공학회 2010 의공학회지 Vol.31 No.6

The social activities of the elderly have been increasing as our society progresses toward an aging society. As their activities are increased, the occurrence of falls that could lead to fractures are increased. Falls are serious health hazards to the elderly and we need more thorough understanding of falls including the progress of falls and the impact area in various fall directions. Many of the traditional methods of falls research dealt with voluntary falls by younger subject since older subject can easily get fracture from voluntary falls. So, it has been difficult to get exact data about falls of the elderly. Here, we tried to capture the characteristics of the movements of major joints using three dimensional motion capture system during falls experiments using a moving mattress that can safely induce unexpected falls. Healthy younger subjects participated in the actual falls experiment and the moving mattress was actuated by a pneumatic system. The kinematic parameters such as velocities of major segments were imported to a computer simulation environment and falls to hard surfaces were simulated in a computational environment using a realistic human model of aged persons. The simulation was able to give approximations to contact forces which can occur during actual falls. And we designed impact absorption system to reduce the impact during falls. We can adapt this system to fracture prevention system that we are going to study.

재가노인의 낙상과 삶의 질에 관한 구조모형

장정미 ( Chong-mi Chang ) 한국고등직업교육학회 2011 한국고등직업교육학회논문집 Vol.12 No.3·4

The purpose of this study was to develop a hypothetical structural model that explains falls and quality of life in elderly people living at home and to examine the compatibility between the model and actual data. Twelve measurable test variables were used to estimate falls and quality of life. They included the internal variables ; falls, quality of life, degree of Activities of Daily Living(ADL), and the external variables ; muscle strength, balance, dizziness, fear of falling, fall efficacy. Results of hypotheses testing : 10 out of 18 hypotheses were accepted. According to the results of this research, significant variables influencing degree of ADL were balance, fear of falling, and fall efficacy. Significant variables influencing the falls were balance, fear of falling. Significant variables influencing quality of life were balance, fear of falling, fall efficacy, degree of ADL and falls. The result showed that 21% of the variance of falls was explained, 26% for quality of life and 65% for degree of ADL. This study had a high power of explanation of falls in elderly people living at home because, although 50% of falls are environment related, the model focuses on personal variables that can be controlled by the individual.

노인환자의 낙상 위험 약물 사용 현황과 낙상 발생 위험도 분석

최서윤,박윤희,김재연,곽혜선,송영천 한국병원약사회 2012 병원약사회지 Vol.29 No.2

Central nervous system drugs, antihypertensives can cause drowsiness, confusion resulting in a fall. Taking these medicines further increases the risk of falls in elderly patients who have high risk of falls and take many kinds of drugs. A lot of researches on risk factors about a fall have been performed, but disturbance variables are often distorted the results. In this study, using case-crossover design to control other factors, we investigated the impact of drugs causing a fall to hospitalized elderly patients. We selected patients over 65 years of age who were reported about fall accidents between January 2009 and September 2011. Age, sex, fall risk assessment score, and underlying diseases were investigated. To analyze the risk of drug inducing fall, we researched the inpatients’exposure of medication within 7 days before having fall (risk period) and 1 month before the fall (period in contrast). Selected drugs inducing fall have already been noted as risk factors for a fall in literatures; Antihypertensive drugs, anticonvulsants,alzheimer's disease therapeutics, antiparkinsonian agents, antidepressants, antipsychotics, anxiolytics, sedatives, hypnotics and opioid analgesics, antihistamines, skeletal muscle relaxants and others such as metoclopramide. We found the elderly patients who have experience taking the medicine inducing a fall are 162 (96.4%), accounted for the majority. Patients taken four or more fall risk drugs in risk period were 71 cases (42.3%), compared to 26 cases (15.5%) in the contrasting period, which means the more fall risk drugs were taken during 7 days before having fall(p<0.001). Exposure medications such as diuretics (OR=2.3, 95% CI=1.3-4.2), antipsychotics (OR=2.8, 95% CI=1.2-6.4), zolpidem (OR=3.5, 95% CI=1.4-8.9), opioid analgesics (OR=3.5,95% CI=2.1-5.6) were significantly more likely to have falls during hospitalization. As mentioned above, the majority of elderly patients experienced a fall were exposed to fall risk drugs and took multi-drugs of them more than four. Therefore, it is needed to prepare the role of mediator as a pharmacist for preventing falls in elderly patients.

요양병원 치매 환자의 낙상실태와 낙상위험요인 분석

임정옥,구미옥 한국노인간호학회 2016 노인간호학회지 Vol.18 No.2

Purpose: This study was conducted to examine circumstances related to falls in patients who had a fall, and identify fall risk factors among inpatients with dementia in long-term care hospitals. Methods: Eighty-four patients who experienced a fall were matched with 168 control patients by gender, age, and length of hospital stay. Data were collected from patients' medical records and fall reports, and analyzed using descriptive statistics, x2 test, Fisher's exact test, and logistic regression analysis with the SPSS/WIN 21.0 program. Results: Incidence of falls was 12.6/100 persons/year. Of the 84 patients who experienced a fall, 42.9% fell once, 16.7% fell twice, and 40.5% fell three or more. In the fall group, falls commonly occurred during nurses' day duty (42.3%). The most common causes of falls were walking (54.9%), and loss of balance (56.7%). The fall risk factors which predicted fall occurrence were arrhythmia, urinary problems, unstable gait, behavioral and psychological symptoms of dementia, the use of diuretics and antidepressant drugs, dependence on a caregiver, use of a hospital bed and patients at high-risk for a fall. Conclusion: These findings can be used to develop fall risk assessment tools and fall prevention programs for inpatients with dementia in long-term care hospitals.

한국 노인의 낙상 실태와 위험요인: 일부 지역의 인구비례 할당 표본 조사

임재영,박원범,오민균,강은경,백남종 대한노인병학회 2010 Annals of geriatric medicine and research Vol.14 No.1

Background: To investigate the occurrence of falls and their consequences in a representative population and to identify risk factors of falls in the elderly. Methods: The study participants were community-dwelling elderly people aged 65 years or old as a population based sample of one large city. A total of 828 people 65 years or older participated in this study. They were interviewed over the telephone by a trained interviewer using a structured questionnaire to obtain a fall history and details of their most recent fall including date, time, place, circumstances, and associated injury. As for risk factors for falls, we asked about living arran- gement(with family or alone), alcohol intake, exercise, visual and hearing impairments, memory and sensory problems, lower limb weakness, and arthritis symptoms. Fear of falling and fear-related activity restriction were also evaluated. Results: The incidence of falls during the last one year was 13.0%. Women experienced falls more frequently. Falls occurred mainly in spring and summer and from 10 AM to 3 PM. Common causes of falls were slipping and tripping. 14.9% of those who fell suffered consequent fractures. Being female was a significant risk factor for falls; and females tended to get injured more severely following a fall. During the recent one year, decreased proprioception in the lower extremity was a significant risk factor for falls. Those with histories of falls, and especially women, tended to limit their activities due to the fear of falling. Conclusion: Overall, it appears that elderly women are more greatly affected by falls at several levels. Female partici- pants fell more frequently and suffered more severe consequences. Fall-related injuries and risk factors for falls disproportionately affected women. And, being female and any amount of decreased sensation in the feet were significant risk factors for falls. 연구배경: 일부 지역의 인구 비례할당 표본 조사를 통하여노인의 낙상의 발생과 그 결과를 조사하고 낙상 위험 인자를확인하고자 하였다. 방법: 한 지역의 65세 이상 인구의 비례할당 표본을 대상으로 숙련된 조사요원에 의한 전화조사를 통해 낙상발생 날짜,시간, 장소, 상황 등에 대하여 조사하였다. 그리고 관련된부상 등 낙상 결과에 관한 조사와 낙상에 대한 위험인자,즉 독거 유무, 알코올섭취량, 운동량, 청각과 시각장애, 기억력, 감각 문제, 하지 위약 및 관절염 증상 등을 물어보았다. 또한 낙상의 두려움과 두려움 관련 활동제한도 평가하였다. 결과: 지난1년 동안 낙상의 발생률이 13%였고, 여성의발생률이 더 높았다. 낙상은 주로 봄이나 여름 10시~3시사이에 주로 나타났다. 낙상의 일반적인 이유는 미끄러짐과걸려 넘어짐이었다. 14.9%의 사람이 골절상을 입었다. 여성이 낙상의 중요한 위험요소였는데, 여성의 경우 더 심각하게부상을 나타내는 경향이 있었다. 최근 1년 동안 낙상의 주된위험요소로는 하지의 고유수용체감각의 감소였다. 특히 여성에서 낙상에 대한 두려움 때문에 활동을 제한하는 경향을보였다. 결론: 노인에서 여성 자체가 낙상의 위험인자이다. 여성노인이 더 자주 넘어지고 낙상 후에 더 나쁜 낙상 결과를갖게 되며, 낙상 관련 두려움과 이로 인한 활동제한도 더많았다.

골절 방지 시스템의 개발을 위한 낙상 동적 특성 분석

김성현,김용욱,권대규,김동욱,김남균 대한의용생체공학회 2007 의공학회지 Vol.28 No.6

The social activities of the elderly have been increasing as our society progresses toward an aging society. As their activities are increased, the occurrence of falls that could lead to fractures are increased. Falls are serious health hazards to the elderly and we need more thorough understanding of falls including the progress of falls and the impact area in various fall directions. Many of the traditional methods of falls research dealt with voluntary falls by younger subject since older subject can easily get fracture from voluntary falls. So, it has been difficult to get exact data about falls of the elderly.Here, we tried to capture the characteristics of the movements of major joints using three dimensional motion capture system during falls experiments using a moving mattress that can safely induce unexpected falls. Healthy younger subjects participated in the actual falls experiment and the moving mattress was actuated by a pneumatic system. The kinematic parameters such as velocities and accelerations of major segments were imported to a computer simulation environment and falls to hard surfaces were simulated in a computational environment using a realistic human model of aged persons. The simulation was able to give approximations to contact forces which can occur during actual falls.

Original Article : Changes of spatio-temporal gait parameters according to experience falls in post-stroke patients

( Ki Hun Cho ),( Wan Hee Lee ) 물리치료재활과학회 2012 Physical therapy rehabilitation science Vol.1 No.1

Objective: Falls are defined as contact of the body with the floor after losing balance during activities of daily living. Falls commonly occur among the elderly, and stroke patients in particular are at a high risk of falling. The purpose of this study was to investigate the changes of temporal and spatial gait parameters and gait symmetry according to experience falls in post-stroke patients. Design: Cross-sectional study. Methods: Fifty three patients with stroke were recruited on a voluntary basis from the rehabilitation unit, who currently undergoing physical therapy. All participants were asked to answer questions regarding the frequency of falls in the past 1 year. Fifty-three patients with stroke were allocated 2 groups according to experienced falls: stroke with falls (n=26) during past 1 year and stroke without falls (n=27). The spatial and temporal gait parameters and gait symmetry ratio were measured using GAITRite system. Results: The spatial gait parameters and the temporal gait parameters were significantly different between the stroke with falls group and the stroke without falls group (p<0.05). Furthermore, step length was the only significantly different among symmetry ratio (p<0.05). Conclusions: Experience of falls can lead to impairment of gait ability in stroke patients. This result is expected to be used as a basic data for rehabilitation program development to prevent a fall of post-stroke patients.

낙상 재현을 위한 보행자 생체 정보 기반의 낙상 유도 시스템 개발

이종일,한종부,구재완,이석재,손동섭,서갑호 한국로봇학회 2020 로봇학회 논문지 Vol.15 No.3

This paper is about a fall inducement system for guiding like a real fall. Reliable fall data can be used as an essential element in developing effective fall protection devices. We can get this data if the induced fall is very realistic. The proposed system analyzes gait characteristics and determines when to fall based on the pedestrian's biometric data. To estimate the fall inducement time, an active estimation algorithm was proposed using different biometric values for each pedestrian. The proposed algorithm is designed to response actively to the ratio of gait cycle and a stance period. To verify this system, an experimental environment was implemented using a multi-rail treadmill equipped with a ground reaction force measurement device. An experiment was conducted to induce falls to pedestrians using a fall inducement system. By comparing the experimental scene to the video of the actual fall, it has been confirmed that the proposed system can induce a reliable fall.

뇌졸중 환자의 낙상예방교육이 낙상지식과 낙상예방행위에 미치는 효과

문병현,김지원 사단법인 한국융합기술연구학회 2023 아시아태평양융합연구교류논문지 Vol.9 No.10

본 연구는 재활병원에 입원한 뇌졸중 환자들을 대상으로 낙상에 대한 예방 교육 중 올바른 보행보조도구 사용방법과 낙상을 방지할 수 있는 이동방법에 대한 교육이 낙상에 관한 지식 정도와 낙상예방행위에 미치는 효과를 파악하기 위한 목적으로 실시한 연구이다. 연구 대상자는 G시에 소재한 재활병원의 뇌졸중 환자 133명을 대상으로 실시하였으며 2021년 4월부터 7월까지 4주간의 낙상예방교육을 통해 대상자의 낙상지식과 낙상예방행위의 점수를 확인하였다. 낙상예방교육 전후 효과를 분석하기 위하여 SPSS ver. 22.0을 사용하여 대응표본 t검정(paired t-test)을 실시하였다. 낙상예방교육 후 낙상지식과 낙상예방행위에 대한 각 항목들이 전반적으로 향상됨을 확인하였으며 낙상지식과 낙상예방행위는 모두 낙상예방교육 전에 비하여 낙상예방교육 이후 유의한 증가를 보였다(p<.05). 따라서 뇌졸중환자에게 낙상예방교육이 운동중재에 한정되는 것이 아닌 이동방법과 보조도구 사용에 대한 반복적인 학습이 뇌졸중 환자의 낙상예방에 도움을 줄 수 있을 것이다. This study examined the effects fall prevention education including how to use walking aids and how to weight shifting training of stroke patients who hospitalized to rehabilitation hospitals on knowledge about falls and preventive behavior about falls. The subjects of the study were 133 stroke patients at a rehabilitation hospital located in G city, who understood the purpose of this study and voluntarily participated in it. And the subjects' knowledge about falls and preventive behavior about falls scores were confirmed through four weeks of fall prevention education from april to july 2021. The collected data were analyzed by paired t-test analysis using the SPSS 22.0 program about the effects before and after fall prevention education. After fall prevention education, it was confirmed that knowledge about falls by question and preventive behavior about falls by question improved overall, and both knowledge about falls and preventive behavior about falls showed a significant increase after fall prevention education compared to before fall prevention education (p<.05). Based on these results, fall prevention education is not limited to exercise intervention for stroke patients, and repetitive learning on the use of weight shifting methods and walking aids can help stroke patients prevent falls.

입원환자 낙상 발생 실태와 원인에 관한 분석 연구

김철규,서문자 한국의료QA학회 2002 한국의료질향상학회지 Vol.9 No.2

Background : The purpose of this research was to examine the fall incidence rate and its related factors of fall in inpatients. Methods : The data were collected from the 138 fall incident reports in one tertiary hospital in Seoul from April 1st 1999 to September 30th 2001. The Fall Incident Report Form was originally developed based on that of Massachusetts General Hospital revised in 1995. And this was modified for this survey by the collaborating work of QI team including researcher and department of nursing service of this particular hospital. The contents of Fall Incident Form were general characteristics of patient, factors related to fall, types and places of fall, circumstances, nursing interventions, and outcome. Results : 1)the incidence rate of fall was 0.08% of total discharged patients and 0.081 per 1000 patient-day. This incidence rate is much lower than that of general hospitals in USA. This finding might result from the different incidence report system of each hospital. 2)The characteristics of fall-prone patient were found as follows. They were mostly over 60 years old, in alert mental status, ambulatory with some assistance, and dependent on ambulatory device. The types of diseases related high incidence rate were cerebrovascular disease(3.2), hypertension(1.6), cardiovascular disease(1.4), diabetes(1.3) and liver disease(0.6). 3)The majority of fall events usually occurred in bed, beside(walking or standing)and bathroom in patient room. Usually they were up on their own when they fell. And there were more falls of elderly occurred during night time than day or evening. 4)63.8% of fall events resulted in physical injuries such as fracture and usually the patients had diagnostic procedures and some treatment(ex.suture)which caused additional cost to the patients and their families. 5)The found risk factors of fall were drugs(antihypertensive drug, diuretics)and environmental factors like too high bed height, long distance of bedside table and lamp switch, and slippery tile of bathroom floor. Conclusion : Considering these results, every medical and nursing staff should be aware of the risk factors of patients in hospital, and should intervene more actively the preventive managements, specially for the elderly patients during night. Therefore, it is recommended that the development of Fall Prevention Programs based on these results.