원시반사통합운동이 신경발달장애 아동의 앞쪽머리자세, 균형능력, 주의집중력에 미치는 효과 : 예비연구

정지웅 ( Ji-ung Jeong ),최한 ( Han Choi ),함석찬 ( Suk-chan Hahm ) 대한통합의학회 2021 대한통합의학회지 Vol.9 No.4

Purpose : Therapeutic exercise should improve the health outcomes of rehabilitation in children with neurodevelopmental disability. The purpose of this study was to investigate the feasibility of primitive reflex integration exercises on forward head posture, balance ability, and concentration in children with neurodevelopmental disability. Methods : This study included 10 children with neurodevelopmental disability. Primitive reflex integration exercises were performed for 40 minutes, twice a week for 8 weeks (16 sessions). The reflective markers were placed at the center of the shoulders and on the ears. A caliper was used to measure the distance between the attachments of the reflective markers to assess the forward head posture. Pediatric balance scale was used to quantify balance ability. Their abilities in terms of changeless sitting, looking at the teacher, putting children’s hands on their knees, and looking at immovable and movable objects, were assessed to quantify concentration. Results : There were significant improvements in forward head posture after the intervention (p=.005). Primitive reflex integration exercises significantly improved balance ability of children with neurodevelopmental disability (p=.027). There were also significant improvements in changeless sitting (p=.005), looking at the teacher (p=.004), putting children’s hands on their knees (p=.005), and looking at the immovable (p=.004) and movable (p=.004) objects. Conclusion : This study showed that primitive reflex integration exercises were a useful intervention to improve forward head posture, balance, and concentration in children with neurodevelopmental disability. Therefore, primitive reflex integration exercises may also promote and improve their general development. Further studies with appropriate sample size and control group are needed to conclude the effectiveness of primitive reflex integration exercises on improving posture, motor function, and concentration in children with neurodevelopmental disability.

뇌병변장애환자의 경관영양에 대한 연구

조성숙,최수정,설승민,신선미,Cho, Sung Sook,Choi, Su Jung,Sul, Seung Min,Shin, Sun Mi 대한소아소화기영양학회 2006 Pediatric gastroenterology, hepatology & nutrition Vol.9 No.1

목 적: 뇌성마비 등 뇌병변장애환자는 여러 가지 원인으로 영양장애와 성장장애가 오나 사지마비와 사지구축 자세이상 등으로 성장상태를 정확하게 측정하기도 어렵고 열량대사가 정상인과 달라서 영양 요구량을 아는 것이 쉽지 않다. 저자들은 경관 영양을 하는 중증 사지마비성 뇌병변장애환자의 영양상태와 열량섭취량을 알아보고자 하였다. 방 법: 2004년 1월에 본 서울시립아동병원에 입원하고 있는 환자 중에 2세 이상 30세 사이의 경관 영양을 하는 중증 사지마비성 뇌병변장애환자 86명을 대상으로 하여 신장, 체중, 상완둘레, 피부주름두께를 재고 섭취 에너지 열량을 계산하여 신장 및 체중에 대한 단위 섭취 열량을 측정하였다. 결 과: 1) 체중은 나이와 연령에 따른 평균의 46.5%이고, 신장은 84.2%, 상완둘레는 74.5%, 피부주름두께는 44.6%였다. 2) 열량섭취량은 한국인의 1일 열량권장량의 평균 45.2%를 섭취하고 있었으며 Mayo clinic nomogram에 맞추어는 평균 69.4%였다. 3) 단위 신장당 평균 7.2cal/cm, 단위 체중당 평균 57.0cal/kg을 섭취하고 있었다. 신장과 섭취열량과의 관계가 (Fig. 1, r=0.476) 체중에 따른 섭취 열량과의 관계(r=0.263)보다 상관계수가 높았다. 결 론: 중증뇌병변장애환자는 여러 가지 원인으로 성장장애가 와 있으며 경관 영양 하루 열량이 평균 $880.9{\pm}207.4kcal$, 즉 한국인 1일 열량권장량의 45.2%를 섭취하고 있었다. 하루 500kcal에서 1,100kcal, 즉 일일열량권장량의 16~50%라도 충분하다는 보고도 있지만 개개인에서 체중변화와 열량섭취를 충분한 시간을 가지고 주의 깊게 살펴서 열량 조절을 하는 방법을 적용해야 하며 이들의 열량 요구량에 대한 연구가 더욱 필요할 것으로 생각된다. Purpose: The purpose of this cross-sectional study was to assess the nutritional states and investigate the energy intake of tube-fed patients with severe neurodevelopmental disability. Methods: Eighty six tube-fed patients with severe neurodevelopmental disability were studied. Heights were measured by flexible scale segmentally. Nutritional parameters of weight, triceps skinfold thickness and mid-arm circumference were also measured. Total caloric intakes through the tube were calculated. Results: The anthropometric results showed that nutritional states of tube-fed patients with severe neurodevelopmental disability were poor. The mean daily caloric intake was much less than daily energy requirement (mean=45.2% of requirement). The caloric intake was 7.2 kcal/height (cm), 57.0 kcal/weight (kg). Height was more related with caloric intake (r=0.476) than weight (r=0.263). Conclusion: These results provide that tube-fed patients with severe neurodevelopmental disability were growth retarded and their energy intakes were much less than daily energy requirements. The preliminary evidence was that they need adequate nutritional supply.

발달장애의 치료저항성 행동문제에 대한 전기경련치료 적용의 최근 경향: 임상적 효과에 대한 서술적 고찰

서혜진,정인원,이남영,이규영,반건호,방수영,김희철,김용식 대한생물정신의학회 2023 생물정신의학 Vol.30 No.2

Individuals with developmental disorders exhibit a broad spectrum of aggressive behaviors, including self-directed actions and those directed toward others. These behaviors can lead to physical harm, disruptions in daily life, caregiver stress, and an increased risk for abuse and institutionalization. An integrated and multidisciplinary approach, including psychosocial approaches and pharmacotherapy, has been attempted to treat self-injurious and aggressive behaviors, but has shown limited effectiveness in reducing those behaviors. Recently, the use of electroconvulsive therapy has increased as an alternative treatment for pediatric and adolescent patients with treatment-resistant behavior problems in developmental disorders. This review elucidates the indications and clinical effectiveness of electroconvulsive therapy in the management of self-injurious behavior and catatonia in patients with developmental disorders such as autism spectrum disorders and intellectual disabilities.

신경발달장애아동 어머니의 불안정 성인애착과 심리적 안녕감의관계에서 자녀애착에 의해 조절된 장애수용의 매개효과

황영주,김윤주 한국상담심리교육복지학회 2023 상담심리교육복지 Vol.10 No.6

본 연구는 신경발달장애아동 어머니의 불안정 성인애착과 심리적 안녕감과의 관계에서 자녀애착에 의해 조절된 장애수용의 매개효과를 검증하는 데에 목적이 있다. 이를 위해 서울 경기 지역의 신경발달장애아동의 어머니 304명을 대상으로 설문을 실시하였으며, SPSS 25.0과 SPSS PROCESSMacro를 사용하여 분석하였다. 연구 결과는 다음과 같다. 첫째, 신경발달장애아동 어머니의 불안정성인애착이 심리적 안녕감에 미치는 영향에 있어 장애수용의 부분매개효과가 나타났다. 둘째, 장애수용과 심리적 안녕감의 관계에서 자녀애착의 조절효과가 유의하게 나타났다. 셋째, 불안정 성인애착이 심리적 안녕감에 미치는 영향에 있어 장애수용을 통한 자녀애착의 조절된 매개효과가 나타났다. 본 연구 결과를 근거하여, 신경발달장애아동 어머니가 안정적인 심리적 안녕감을 유지하기 위해서는 매개변인인 장애수용과 조절변인인 자녀애착 향상의 개입이 필요함을 시사한다. This study examined moderated mediating effects of maternal attachment through disabilityacceptance between the insecure adult attachment and the psychological well-being of mothersof children with neurodevelopmental disorders. The results are as follows. First, there havebeen significant mediating effects of disability acceptance in the effects of mothers’ insecureadult attachment on their psychological well-being. Second, there have been significantmoderated mediation effects in the relationships of disability acceptance and psychologicalwell-being. Third, there have been significant moderated mediating effects of maternalattachment through disability acceptance in effects of insecure adult attachment on interpersonalpsychological well-being. The results of this study show the need for intervention through theimprovement of disability acceptance as mediating variables and maternal attachment asmoderating variables for stable psychological well-being.

진흙 위에서 천천히 피는 꽃: 성인 장애자 대상 미술 수업에서 문화 예술 교육 강사들의 성인 장애자에 대한 현상학적 경험 연구

김경순(Gyongsoon KIM) 한국조형교육학회 2018 造形敎育 Vol.0 No.67

본 연구는 문화 예술 교육 강사들이 복지 시설의 성인 장애자들을 대상으로 한 미술 수업에서의 경험을 현상학적 연구 방법 을 적용하여 수행한 후 다음과 같은 결과를 얻었다. 상위 범주는 5개, 하위 범주 16개가 도출되었다. 각 상위 범주에 따르면 다음과 같다. 첫째, 성인 장애자들은 신경 발달 장애에 포함되는 다양한 장애를 가지고 있으며, 이러한 장애들은 기관마다 다른 양상으로 나타나므로 일관성을 찾기 어렵다. 둘째, 성인 장애자들의 인지, 지각, 행동, 정서 발달 지체는 미술 수업에 결정적으로 작용했다. 셋째, 수업에서의 장애적 현상은 혼합된 장애자 편성으로 인한 수업의 어려움, 돌발 행동, 미술 재료에 대한 반응의 차이, 제작의 어려움, 소통의 어려움, 부족한 학습 동기이다. 넷째, 장애자들은 다수가 선택한 것에 가치를 두며, 예술적 표현 활동을 향유했다. 마지막으로 프로그램 참여를 통해 성인 장애자들은 인지, 정서, 행동 조절력에서 다양한 향상 을 보였다. 이어 연구는 시사점과 제안점을 제시하였다. This study was conducted using a phenomenological research method by the educators of culture and arts education for adults with disabilities in area of fine art. As a result of the study, 5 upper categories and 16 lower categories were derived. According to each category, first, adults with disabilities have various disorders that are included in neurodevelopmental disorders, and these disorders appear to be different from one institution to another, making it difficult to find consistency. Second, delays in the cognitive, perceptual, behavioral, and emotional development of adults with disabilities played crucial role in art class. Third, the disability phenomenon in the class is the difficulty of teaching due to mixed disabilities, unexpected behavior, difference in reaction to art materials, difficulty of production and communication, insufficient learning motivation. Fourth, adults with disabilities enjoyed artistic expressiveness, placing value on the choices made by many. Finally, through participation in the program, adults with disabilities showed various improvements in cognitive, emotional, and behavioral control. The study then presented implications and suggestions.

Socioeconomic disparities and difficulties to access to healthcare services among Canadian children with neurodevelopmental disorders and disabilities

Sana Raouafi,Sofiane Achiche,Maxime Raison 한국역학회 2018 Epidemiology and Health Vol.40 No.-

OBJECTIVES: The aims of this study were to identify the associations of levels of severity of neurodevelopmental disorders and disabilities (NDD/D) in children with their household socioeconomic status (SES) and their frequency of visits to a healthcare provider, and to examine how the severity of disability varied with these determinants among NDD/D subgroups, in order to inform possible social policy changes and to improve access to the healthcare system. METHODS: Data from the 2006 Participation and Activity Limitation Survey on children aged 5-14 years, collected by Statistics Canada, were analyzed (n=7,072 and weighted n=340,340). Children with NDD/D constituted those with impairments in motor, speech, neurosensory, and psychological functioning, as well as those who had issues with learning/cognition and social interactions. The weighted sample size for this group was n=111,630 (total sample size for children with limitations: n=174,810). We used logistic regression to assess the associations of household SES and frequency of visits to a healthcare provider with disability level. We included NDD/D subgroups as interaction terms in the model. Multiple correspondence analysis (MCA) was conducted to develop a profile of disability level. RESULTS: After-tax low income, family assistance, out-of-pocket expenses, needing but not receiving health services from a social worker, condition of the dwelling, and residential location were associated with the severity of NDD/D. Using MCA, 2 disability profiles could be identified based on access to healthcare, household income status, and condition of the dwelling. CONCLUSIONS: More social interventions are needed to reduce difficulties in accessing healthcare and to diminish the socially determined health inequalities faced by children with NDD/D.

발달장애 문제행동 치료 가이드라인 제작을 위한 다학제적 접근

홍경기(Kyungki Hong),송호광(Hokwang Song),오매화(Maehwa Oh),오윤혜(Yunhye Oh),박수빈(Subin Park),김예니(Yeni Kim),최성구(SungKu Choi) 대한신경정신의학회 2018 신경정신의학 Vol.57 No.2

Objectives : To initiate and develop a treatment guideline in multidisciplinary approaches for related professions who are either working and/or living with children and adolescents with neurodevelopmental disorders who show behavioral problems. Methods : To collect and reflect opinions from multiple professions who assumedly have different interventions or mediations on behavioral problems, a self-report survey and Focus Group Interview(FGI) were conducted for a group of child and adolescent psychiatrists, behavioral therapists, special education teachers, social welfare workers, and caregivers. Results : According to a self-report survey and FGI results from multiple professional groups, aggressive behavior is the mostly common behavioral problem necessitating urgent interventions. However, both mainly used intervention strategies and effective treatment methods were different depending on professional backgrounds, such as pharmacological treatment, parent training, and behavior therapy, even though they shared an importance of improving communication skills. In addition, there was a common understanding of necessity to include parent training in a guideline. Lastly the data suggested lack of proper treatment facilities, qualified behavior therapists, and lack of standardized treatment guideline in the field needed to be improved for a quality of current therapeutic services. Conclusion : It is supported that several subjects should be included in the guidelines, such as how to deal with aggressive behavior, parent training, and biological aspects of neurodevelopmental disorders. Also, it is expected that publishing the guideline would be helpful to above multiple professions as it is investigated that there are lack of treatment facility and qualified behavioral therapists compared to need at the moment.

태아기 Topiramate 노출과 신경발달 장애 위험에 관한 체계적 문헌고찰

이주연,임다정,정종현,이정민,이모세 대한약물역학위해관리학회 2023 약물역학위해관리학회지 Vol.15 No.2

This systematic review aimed to investigate the potential risk of neurodevelopmental disorders resulting from fetal exposure to topiramate. Methods: A comprehensive search was conducted in major foreign databases, including PubMed and EMBASE, up to November 6, 2022. Studies that reported the risk of neurodevelopmental disorders in children exposed to topiramate during prenatal life were included in this review. Two reviewers independently screened the titles, abstracts, and full-text articles, and data were extracted using a standardized form. Results: Three studies that met the inclusion criteria were selected for analysis. Even though a recent large cohort study based on Nordic data showed that prenatal topiramate exposure significantly increases the risk of neurogenerative disorders including intellectual disability or autism spectrum disorder, other two studies did not show the significant results. Conclusion: While a recent study suggested that topiramate increases the risk of neurodevelopment disorders, previous two studies did not show the consistent results. Further studies with larger sample sizes, longer follow-up periods are needed.

A Korean case of CTCF related neurodevelopmental disorders

Seong Ryeong Kang,Soo Hyun Seo,Kyunghoon Kim,Hee Bum Yang,Hye Ran Yang,Anna Cho 대한의학유전학회 2023 대한의학유전학회지 Vol.20 No.2

CCCTC-binding factor (CTCF) is a transcriptional regulator that binds to a complex DNA motif in various orientations and plays a crucial role in regulating gene expression, chromatin restructuring, and developmental processes. Mutations in the CTCF are associated with neurodevelopmental disorders. Here we report the first Korean case with a de novo heterozygous variant in the CTCF (c.1025G>A; p.Arg342His). She showed global developmental delay, failure to thrive, and dysmorphic face, which are phenotypes consistent with previous reports in the autosomal dominant intellectual developmental disorder 21 (MIM 615502). She also showed clinical features not previously reported, such as antral web and tracheobronchomalacia. Our case follows suit and expands understanding of this rare disorder by reporting common features and, on the other hand, unreported concomitant congenital anomalies.

운동발달장애에 있어 조기 신경발달치료(Neurodevelopinental Treatment)의 효과

김경미 대한작업치료학회 1994 대한작업치료학회지 Vol.2 No.1