척수장애인의 사회적응을 위한 재활서비스체계 운영현황과 개선방안에 대한 연구

이용복 ( Lee Yong-bok ),김경란 ( Kim Kyoung Ran ) 한국장애인개발원 2011 장애인복지연구 Vol.2 No.1

본 연구는 척수장애인의 사회적응을 위하여 재활서비스체계 운영현황 및 문제점을 파악하여 그에 따른 개선방안을 제시하는 것을 목적으로 하고 있다. 이를 위해 전국의 척수장애인의 517명을 대상으로 척수장애인의 재활서비스 이용실태 및 문제점을 분석하고 서비스 이용욕구 및 만족도를 파악하기 위해서 설문조사를 실시하였고, 그 결과는 다음과 같다. 첫째, 지역사회 재활서비스 이용경험이 없는 경우가 40.8%로 나타났으며, 그 이유는 척수장애인을 위한 전문적인 재활서비스제공기관 부족이 63.6%, 그 다음이 재활서비스의 전문성 부족이 43.8%, 정보부족이 27.9%로 나타났다. 둘째, 재활서비스 이용경험이 있는 대상자 중 이용경험을 조사한 결과, 의료재활서비스 이용경험이 가장 많았으며, 의료재활서비스를 제외한 모든 재활지원프로그램(사회·심리 재활서비스, 성재활, 생활체육재활, 직업재활, 문화·예술, 기타서비스)은 이용경험이 없음이 수치가 더 높게 나타났으며, 이용만족도는 생활체육재활, 문화·예술서비스, 사회·심리재활서비스순으로 높게 나타났다. 이상의 연구결과를 종합해 보면, 지역사회에서 사회적응을 위하여 척수장애인을 위한 재활서비스 체계구축이 필요함을 시시하며 이에 따른 개선방안을 제시하고자 한다. 첫째, 척수장애인의 특성을 고려한 별도의 재활서비스 지원체계가 필요하며, 둘째, 척수장애인을 위한 다각적이면서 전문적인 접근이 필요하며, 셋째, 척수장애인의 사회적응을 위하여 중간거점센터역할을 할 수 있는 척수센터설립이 필요함을 제시한다. The purpose of this research was to make policy alternatives for rehabilitation service for persons with spinal cord injuries in order to grasp operation system which has the service usage. desires, satisfactions for the rehabilitation service programs so as to adapt in their communities. In order to grasp operation system and analyze the service usage. desires, satisfactions for the rehabilitation service for the purpose of fitting into communities, A self-report questionaire was used with a total of 517 persons with spinal injuries in living in the community. these questionnaires were used for analysis. The results of this study are follows. Firstly, about 40.8%of persons with spinal core injuries have not used rehabilitation service program in their communities only for persons with spinal core injuries. For this, the main reasons are that there were few service institutions for persons with spinal core injuries for the purpose of rehabilitation service to adapt their communities, followed by the shortage of professional rehabilitation service program with 43.8% and then a dearth of information with 27.9%. Secondly, most of service users who have ever once used rehabilitation service program in their communities have experienced medical rehabilitation service programs a lot, however, other rehabilitation service program (socio-psychological service program, sex rehabilitation service program, vocational rehabilitation service program, culture· art service program ) have not been used by persons with spinal core injuries. Thirdly, the results of satisfaction of using rehabilitation service program are sports rehabilitation , followed by socio-psychological service program, sex rehabilitation service program followed by culture,·art service and then socio-psychological rehabilitation service program. In order to enhance adaptation to community for persons with spinal core injuries, This study suggests several alternatives for them. Firstly, Rehabilitation service infrastructure should be needed for persons with spinal core injuries in consideration of unique pattern of their impairments. Secondly, professional, many sided approaches for rehabilitation service program in adaptation to community should be developed for persons with spinal core injuries. In particular, Most important thing focuses on the unique pattern of impairments of persons with spinal core injuries. Thirdly, in order to support of rehabilitation service system for persons with spinal core disabilities, spinal core injury center should be suggested in long-term adjustment of persons with spinal core injuries.

Associated Injuries in Spine Trauma Patients: A Single-Center Experience

( Seunghan Yu ),( Hyuk Jin Choi ),( Jung Hwan Lee ),( Byung Chul Kim ),( Mahnjeong Ha ),( In Ho Han ) 대한외상학회 2020 大韓外傷學會誌 Vol.33 No.4

Purpose: The purpose of this study was to determine the incidence and characteristics of associated injuries in patients with spine trauma. Methods: Data of 3,920 consecutive patients admitted to a regional trauma center during a 3-year period were analyzed retrospectively. Results: Of the 3,920 patients who were admitted to the trauma center during the 3-year study period, 389 (9.9%) had major spinal injuries. Among these 389 patients, 303 (77.9%) had associated injuries outside the spine. The most common body region of associated injuries was the extremities or pelvis (194 cases, 49.4%), followed by the chest (154 cases, 39.6%) and face (127 cases, 32.6%). Of these 303 patients, 149 (64%) had associated injuries that required surgical treatment such as laparotomy or internal fixation. Associated injuries were more common in patients with lumbar injuries (93.3%) or multiple spinal injuries (100%) than in those with lower cervical injuries (67.4%). There was a significant correlation between the location of the spinal injury and the body region of the associated injury. However, distant associated injuries were also common. Conclusions: Associated injuries were very common in spinal injury patients. Based on demographic groups, the trauma mechanism, and the location of spinal injury, an associated injury should be suspected until proven otherwise. Using a multidisciplinary and integrated approach to treat trauma victims is of the paramount importance.

유전자 변화를 근거로 한 척수손상의 단계의 구분

양준영,이준호,이준규,주용범,차수민 대한척추외과학회 2011 대한척추외과학회지 Vol.18 No.3

Study Design: An experimental study. Objectives: To define the phases of chronic spinal cord injury by researching the changes in gene expression. Summary of the Literature Review: The exact time of conversion from acute stage to chronic stage in spinal cord injury is unknown. Materials and Methods: We used 18 month-old Beagle dogs as study subjects. Under spinal cord monitoring, we underwent laminectomy on thoracic vertebra 10 and 11, and induced cord injury by a weight-drop injury method. Dogs in each group with spinal cord injury and group without spinal cord injury on POD 1, 7, 30, and 90. The motor functions were evaluated using the Tarlov scale. Tissues were prepared from 0.5cm up and down from the 10th thoracic level. Additional cephalic and caudal lesions from the injured site were prepared. We have checked the differentially expressed gene(DEG). Results: The mean Tarlov value was 0.67 which indicated a significant cord injury. 4 DEG (GP3, 9, 25, 34) were detected among 40primers after screening, the detection percentage of which was 10. In the tissues of study subjects with spinal injury, DEG was found at the injury site and cephalic lesion. DEG expressed GP3, GP9 and GP34 started expression on day 30, and GP25 was expressed on day 90. Conclusions: According to the changes in gene expression, the day 30 would be considered as the date of conversion from acute to chronic phase of cord injury. Inhibiting secondary inflammatory change and apoptosis following spinal cord injury until this period would maximize the effect of chronic phase therapy such as cell-transplantation. Key Words: Spinal cord injury, Differentially expressed gene

스키와 스노보드 사고에서 척추손상의 특징

차용성 ( Yong Sung Cha ),이강현 ( Kang Hyun Lee ),김선휴 ( Sun Hyu Kim ),장용수 ( Yong Su Jang ),김현 ( Hyun Kim ),신태용 ( Tae Yong Shin ),황성오 ( Sung Oh Hwang ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.1

Purpose: Few studies have been done for spinal injuries after skiing and snowboarding accidents. Assuming that the riding patterns of skiing and snowboarding were different, we analyzed the differences between the mechanisms, diagnoses and levels of spinal injuries caused by them. The purpose of this study was to gain a better understanding of spinal hazards associated with skiing and snowboarding in order to educate skiers and snowboarders. Methods: We conducted a prospective study of 96 patients who had sustained spinal injuries as a result of skiing and snowboarding accidents from January 2003 to March 2006. We used a questionnaire, radiological studies, history taking, and physical examinations. We analyzed the mechanism of injury, the level of spinal injury, the severity of spinal injury, and the Abbreviated Injury Scale scores (AIS score). We used the t-test and the chi-square test. Results: The skiing and the snowboarding injury group included in 96 patients. The skiing injury group included 30 patients (31.2%), and the snowboarding injury group included the remaining 66 patients (69.8%). The primary mechanism of injury in skiing was collisions and in snowboarding was slip downs (p=0.508). The primary level of spinal injury in skiing and snowboarding was at the L-spine level (p=0.547). The most common athlete ability of the injured person was at the intermediate level (p=0.954). The injured were most commonly at the beginner or the intermediate level (p=0.302). The primary diagnosis of spinal injury in skiing and snowboarding was back spain (p=0.686). The AIS scores did not differed between the two groups (p=0.986). Conclusion: The most common spinal injury after skiing and snowboarding accidents was back sprain. There was no difference in the severity of spinal injury between skiing and snowboarding accidents. (J Korean Soc Traumatol 2007;20:33-39)

Methylprednisolone투여가 흰쥐 척수손상모델의 운동유발전위의 변화에 미치는 영향

황용순,박상근 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Objectives: For the last two decades. various chemicals have been applied for the treatment of spinal cord injury but no chemicals were found to be as effective as methylprednisolone. And motor evoked potentials(MEPs) have been utilized clinically in monitoring and diagnosis of the motor disorders. To evaluate the efficacy of methylprednisolone on functional recovery following spinal cord injury and to determine the usefulness of motor evoked potential as a monitoring tool in spinal cord injury, the author used spinal cord injury model in rats. Methods: In the present study, the effects of methylprednisolone on functional recovery after spinal cord injury were carefully quantified behaviorally as well as electrophysiologically in white rats. Spinal cord injury was produced using NYU-spinal cord impactor. BBB(Basso, Beattie, and Bresnahan) test was conducted to measure the change of neurological status behaviorally, and MEPs and somatosensory evoked potentials (SSEPs) were recorded to determine the effects of methylprednisolone electrophysiologically. The results of these studios were compared each other to determine the usefulness of MEPs. Results: 1. According to the behavioral test using BBB test, methylprednisolone - treated animals showed improved functional recovery compared to the saline-treated animals. 2. MEP latencies in methylprednisolone-treated group were shorter than those in control group. Peak amplitudes of MEPs were larger in methylprednisolone-treated group than those in control group. 3. Peak amplitudes of SSEPs were larger in methylprednisolone-treated group than those in control group. In summary, the amplitudes of MEPs were recovered more rapidly in methylprednisolone-treated group than those of SSEPs and the latencies of MEPs showed similar tendency compared to those of SSEPs. 4. The thresholds of MEPs and SSEPs tended to be lower in methylprednisolone-treated group than those of control group. Conclusions: These results suggest that methylprednisolone may minimize the secondary spinal injury and improve the functional recovery after spinal cord injury. And motor evoked potential seems to be reliable as a tool monitoring the functional recovery after spinal cord injury, and be compensatory with SSEPs.

남성 상부운동신경원 손상 환자에서 척수손상의 위치와 청결간헐적도뇨가 성기능에 미치는 영향

차우헌,김기호,서영진,이경섭 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.12

Purpose: We investigated the effect of the level of spinal cord injury and urinary catheterization on sexual function and activity in male patients with upper motor neuron (UMN) injury. Materials and Methods: We reviewed patient's chart, radiologic and urodynamic study. We interviewed patient's sexual activity according to educational status, economic and marriage state, occupation, duration of spinal cord injury and pattern of voiding. A total of 114 male patients with neurogenic bladder due to UMN injury were included in the study. Group 1 consisted of 33 patients who underwent a clean intermittent catheterization (CIC) regimen and group 2 consisted of 81 patients with a suprapubic catheter, condom catheter, or Foley catheter. A detailed sexual behavior was taken for all patients to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5). Results: Satisfaction with intercourse (p=0.037) and total score (p=0.032) on the IIEF-5 were significantly higher in group 1 than in group 2. The other items on the IIEF-5 did not differ significantly between the groups. When the subjects were stratified according to level of spinal cord injury, 8 patients (18.6%) with cervical cord injury had no sexual activity, whereas 24 patients (33.8%) with non-cervical-cord injury did (p=0.048). Patients with no sexual activity were 12.1% (4/33) of the patients in the CIC group and 34.6% (28/81) of the patients who underwent other regimens (p= 0.016). Conclusions: Our results demonstrate that level of spinal cord injury and urinary catheterization may influence the sexual activity of male patients with UMN injury. Our results suggest that the CIC regimen had a positive effect on the sexual activity of these patients. Purpose: We investigated the effect of the level of spinal cord injury and urinary catheterization on sexual function and activity in male patients with upper motor neuron (UMN) injury. Materials and Methods: We reviewed patient's chart, radiologic and urodynamic study. We interviewed patient's sexual activity according to educational status, economic and marriage state, occupation, duration of spinal cord injury and pattern of voiding. A total of 114 male patients with neurogenic bladder due to UMN injury were included in the study. Group 1 consisted of 33 patients who underwent a clean intermittent catheterization (CIC) regimen and group 2 consisted of 81 patients with a suprapubic catheter, condom catheter, or Foley catheter. A detailed sexual behavior was taken for all patients to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5). Results: Satisfaction with intercourse (p=0.037) and total score (p=0.032) on the IIEF-5 were significantly higher in group 1 than in group 2. The other items on the IIEF-5 did not differ significantly between the groups. When the subjects were stratified according to level of spinal cord injury, 8 patients (18.6%) with cervical cord injury had no sexual activity, whereas 24 patients (33.8%) with non-cervical-cord injury did (p=0.048). Patients with no sexual activity were 12.1% (4/33) of the patients in the CIC group and 34.6% (28/81) of the patients who underwent other regimens (p= 0.016). Conclusions: Our results demonstrate that level of spinal cord injury and urinary catheterization may influence the sexual activity of male patients with UMN injury. Our results suggest that the CIC regimen had a positive effect on the sexual activity of these patients.

정신건강의학과적 관점에서의 척수손상

정상협(Sanghyup Jung) 대한생물치료정신의학회 2022 생물치료정신의학 Vol.28 No.2

Spinal cord injury is a devastating condition in which motor, sensory, and autonomic nerve functions are impaired due to traumatic or non-traumatic causes on the spinal cord. Patients with spinal cord injuries may experience paralysis caused by nerve damage secondary to various physical complications such as pain, spasticity, neurogenic bladder, neurogenic bowel, pressure ulcer, and sexual dysfunction. These physical symptoms of patients with spinal cord injuries bring about psychological difficulties, ranging from emotional reactions such as sadness and feelings of low self-esteem to depression, anxiety, sleep disorders, and suicidal tendencies. Conversely, mental health problems in patients with spinal cord injuries can also have negative effects on physical complications such as neuropathic pain and pressure ulcers, as well as rehabilitation therapy and prognosis. In other words, the physical and psychiatric symptoms of a patient with spinal cord injury bidirectionally influence each other. Existing medical approaches focus only on the physical rehabilitation of patients with spinal cord injuries and do not recognize these patients’ need for mental health support. Therefore, screening, evaluation, and appropriate management for psychiatric problems such as depression, anxiety, sleep disorders, and suicidal tendencies in clinical practice are required, which may ultimately benefit the quality of life and prognosis of patients with spinal cord injuries.

급성 척수 손상 고양이에서 Nimodipine 투여가 척수 혈류 및 척수 신경 기능 회복에 미치는 영향

조용은,김영수 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.1

Spinal cord injury causes immediate neuronal dysfunction and remained paralysis in life without clinical improvement. The spinal cord injury is caused by initial mechanical damage and secondary neuronal damage. The exact mechanisms of secondary neuronal damage are still unknown and their treatment is obscure even though many studies about them. The vascular change after injury is supported widely as a mechanism of secondary neuronal damage which causes decreased microcirculation and cord ischemia. There is considerable evidence that Ca ^(++) ions play a key role in the pathogenesis of posttraumatic ischemia and Ca^(++) ion influx promotes cellular dysfuction and cell death. So calcium antagonist is considered that it can improve spinal cord blood flow and restore impaired neuronal function. In this report, the effects of calcium channel blocker, nimodipine on spinal cord blood flow and spinal somatosensory evoked potential were measured and it was compared with vehicle group in 400 g-cm cord injured cat. And the effects of nimodipine were compared between nimodipine and adrenaline treated group of which mean systolic blood pressure was maintained above 100㎜Hg and nimodipine only treated group. Spinal cord blood flow was measured at T_(6)(injury level). T_(4), T_(12) by the hydrogen clearance technique and spinal somatosensory evoked potential was recorded at T_(4), T_(12) after injury at T6 level. The results of this study are summarized as follows: 1) The spinal cord blood flow was decreased abruptly just after spinal cord injury and it deceased progressively. 2) In nimodipine treated group, there was a improvement of spinal cord blood flow inspite of decreased mean systemic arterial pressure. It might be thought that the vasodilatory effect of nimodipine was more potent in spinal vasculature than in systemic peripheral vessels. 3) The increased spinal cord blood flow was more prominant and prolonged in nimodipine and adrenaline treated group than nimodipine only treated group. It was thought that increased heart beat and cardiac contratility by adrenaline counteracted systemic hypotension which resulted from vasodilatory effect of nimodipine. It suggests that maintenance of mean systemic arterial pressure is inportant during nimodipine theraphy in spinal cord injury. 4) The improvements of spinal somatosensory evoked potential were more evident in nimodipine and adenaline treated group. It might be caused by spinal cord blood flow improvement. From the above result it is speculated that the calcium channel blocker, nimodipine can improve spinal blood flow and impaird neuronal function in spinal cord injury.

급성 척수손상시 세포사망의 특성

진동규,김영수,윤도흠,주진양,이경희,성제경 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.12

급성 척수 손상의 병태생리와 치료에서 최신 접근

유재원,손홍문 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.3

Study Design: This is a literature review Objectives: We wanted to provide updated information for spine clinicians on the pathophysiology, medical treatment and the timing of surgical treatment after acute spinal cord injury. Summary of the Literature Review: There are many studies concerned with understanding the mechanisms of injury and improving the neurologic function after acute spinal cord injury. However, methylprednisolone therapy has been used only recently for the treatment of this malady. Materials and Methods: We conducted a literature review, with a particular focus on the development of pathophysiology and the emerging pharmacologic treatment of acute spinal cord injury, and on the effectiveness of performing early decompression. Results: After primary mechanical impact, a complex cascade of secondary injury follows during acute spinal cord injury. Neuroprotection and axonal regeneration are the main strategies to treat spinal cord injury. Beyond methylprednisolone, a number of other pharmacological treatments have been studied for the acute treatment of spinal cord injury. Animal studies support early decompression of the injured cord. Although there is no standard regarding the timing of decompression, there are many advantages of performing early decompression in human. Conclusion: Although a number of pharmacological therapies seem to have neuroprotective potential, high-dose methyprednisolone therapy is the only clinically approved treatment for acute spinal cord injury. Urgent decompression for acute spinal cord injury remains a reasonable practice option.