정신지체의 최신 지견

Mental retardation is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and adaptive skills, which originates before the age of 18. The prevalence of mental retardation among elementary school children in Korea is estimated as 9~12/1,000. In most cases of mental retardation, the interplay of genetic and environmental influences remains poorly understood. However, recent advances in molecular genetic techniques have enabled us to understand more about the molecular basis of several genetic syndromes associated with mental retardation. This article presents a review of three common genetic conditions causing mental retardation-Down syndrome, fragile X syndrome, and Prader-Willi syndrome-with the summary of the effectiveness of early intervention for the children with mental retardation

형제에서 발생한 선천성 근육성 사경-증례 보고 및 문헌 고찰-

Congenital muscular torticollis (CMT) is the most common cause of abnormal posture of the head and neck in infancy. Familial transmission of CMT has not been reported in Korean literature, to our knowledge. Four cases with CMT found in siblings are presented in this paper along with the review of literature on hereditary factor as one of the possible mechanisms on pathogenesis of CMT. Further case reports are required in order to verify heredity as a possible pathogenetic factor of CMT

감각신경성 청각장애를 동반한 18번 염색체 단완 결손 증후군 1례 - 증례 보고 -

Chromosome 18p deletion syndrome is one of the most frequent autosomal abnormalities with more than 150 reported cases in the world and 7 reported cases in South Korea. Frequent clinical features of 18p deletion syndrome include intellectual disability, growth retardation, and dysmorphic features including ptosis. To the best of our knowledge, sensorineural hearing loss has not been reported in the 18p deletion syndrome until now. A case with sensorineural hearing impairment associated with hypoplasia of bilateral cochlear nerves is presented in this paper. The sensorineural hearing impairment seen in this case could be related with deleted gene(s) located in the short arm of chromosome 18 or be an independent feature unrelated with 18p deletion. Further case reports are required in order to better define the relation between sensorineural hearing loss and the 18p deletion syndrome

가족구조에 따른 아동 정신병리, 부모의 정신건강상태 및 스트레스 대처방식 비교연구- "빈곤가족을 대상으로"

Objectives：The purpose of this study is to investigate the psychopathology of children and parent in low-income housed single-parent family. Methods：153 low-income housed parents with 8-13 aged children were assessed using the Symptom Checklist-90- R, Korean Child Behavior Checklist(K-CBCL), the Ways of Coping Checklist. Single-parent family and both-parents family samples were compared using t tests. Results：Children of single-parent family scored higher than two parent family on the immaturity(p<.05), attention problem(p<.001), aggressive behavior(p<.001). Parents of single-parent family had more hostility(p<.05). In coping strategies, single-parent families frequently used avoidance of problem(p<.001), but both-parents families did seeking social support(p<.05). Conclusions：Single-parent family is able to experience more psychiatric problems than both-parents family. It is necessary to support them politically from national dimension because it has the limit for each family to solve problems.연구목적： 본 연구에서는 빈곤가정들을 대상으로 가족 구조에 따른 아동의 정신병리와 부모의 정신건강상태 및 스트레스 대처방식을 비교하고자 하였다. 방 법： 학동기 아동이 있는 158세대의 빈곤가정을 한부모 가족과 양부모 가족으로 나누어 아동행동평가척도(K-CBCL), 간이 정신 건강 척도(SCL-90-R), 스트레스 대처방식 척도를 시행하였다. 통계분석은 t 검정으로 하였다. 결 과： 한부모 가족의 경우가 K-CBCL에서 아동의 미성숙(p<0.05), 주의집중문제(p<0.001), 공격성(p<0.001)이 유의미하게 높았고, 부모의 SCL-90-R에서는 적대감(p<0.05)이 유의미하게 높은 것으로 나타났다. 스트레스 대처방식에서는 양부모 가족 이 조력추구 방식이 높고(p<0.05), 한부모 가족이 문제회피 방식이 높았다(p<0.001). 결 론： 한부모 가족이 양부모 가족에 비해 더 많은 심리적 문제를 경험할 수 있다. 이러한 문제가 각각의 가족내에서 해결되기에는 한계가 크므로 국가적인 차원에서 정책적으로 지원책을 마련해야 할 것이다

흉수손상인에서 BTE Work Simulator를 이용한 의자차 추진력과 지구력측정

Objective: To evaluate the force, endurance and influencing factors for wheelchair propulsion in paraplegics using BTE work simulator, and to find out a better method improving fitness levels for the paraplegics. Method: Seventeen paraplegic men were enrolled for the study. Isometirc and isotonic strength and dynamic endurance levels for wheelchair propulsion were measured using BTE work simulator. Neurological and demographical characteristics of patients were collected by personal interviews and direct examinations. Results: The spinal cord injured level showed a significant correlation with dynamic endurance (r=0.503, p＜0.05) but not with the isometric and isotonic strength. The total duration of wheelchair use showed a significant correlation with the isotonic strength (r=0.497, p＜0.05), but not with the isometric strength and dynamic endurance. The age and outdoor activities or exercise time during one week showed no significant correlation. Conclusion: Spinal cord injured level positively correlated with dynamic endurance. Both cardiorespiratory effect and trunk balance may influence this correlation. The total duration of wheelchair use wasn't correlate with dynamic endurnace. It seems to be more advisable trunk balance training goes with dynamic endurance training in rehabilitation program

뇌졸중 환자에서 자연충만 방광내압측정법과 기존 역행충만법의 비교

Objective: To compare the personally developed natural filling cystometry (NFC) and conventional retrograde filling cystometry (RFC) Method: NFC and RFC were performed on 15 patients with stroke. Results: Patients were classified into three groups according to their usual lower urinary tract symptom. Four patients without urinary symptom did not show any detrusor overactivity or detrusor underactivity during NFC or RFC. Of the nine patients with urinary frequency or urgency, five (55.6%) showed detrusor overactivity during NFC and two (22.2%) during RFC. Two patients with straining showed .detrusor underactivity during both tests. Conclusion: There was no significant difference of cystometric findings between NFC and RFC in case of patients without urinary symptom or with detrusor underactivity, but those patients with urinary symptom that is suspected of detrusor overactivity showed a more frequent detrusor overactivity during NFC than RFC. Therefore, NFC is thought to be a useful tool in evaluating the neurogenic bladder of stroke patients suspected of detrusor overactivity since it can detect detrusor overactivity which were less detectable in RFC

새로 개발된 자연충만 방광내압측정기를 이용한 신경인성 방광의 평가 : 증례 보고

We developed a new, affordable, and easy-to-use natural-fill cystometric device to overcome the limitation of conventional cystometry, long been criticized for being unphysiological. The device was composed of one transurethral catheter, one rectal catheter, two digital manometers, and a portable computer. The transurethral and rectal catheters were connected to manometers, which were then connected to the computer. Three persons with neurogenic bladder were recruited for testing the device. To shorten the test duration, we gave patients 500 ml water before the test. As urine filled inside the bladder, the transurethral and rectal catheters transmitted respectively the intravesical and abdominal pressures to the digital manometers. The pressures were stored within the portable computer and turned into graphs indicating pressure changes. The natural-fill cystometry is thought to be a physiological test that is affordable and convenient because of its simple structure and small size

삼차의료기관 재활의학과 입원 환자들의 퇴원 양상

Objective: To identify the factors which can delay home discharges or transfers to other hospitals of rehabilitation inpatients in a tertiary hospital and the change of discharge destination during past 6 years. Method: This was a retrospective study of patients with a diagnosis of stroke, traumatic brain injury or spinal cord injury who were admitted to our hospital in 1996, 1999, 2001 and 2003. Demographic data, length of stay, discharge destination and functional status by the FIMTM instrument were studied by a medical record review. Result: Patients who were transferred to other hospitals ordischarged with delay showed significantly lower admission and discharge FIM scores, lower FIM efficiencies, longer length of stays and longer intervals between the onset and admission to a rehabilitation ward. Conclusion : Lower functional outcome was associated with a longer length of stay and discharge to another hospital. It would be necessary to establish the long term rehabilitation care facilities with extended rehabilitation program for the patients with lower functional gains in a rehabilitation unit of the tertiary hospitals

새로운 전정-경 반사 검사법

Objective: Vestibulo-collic reflex (VCR) has been thought to be a simple and reliable test in evaluating the vestibular function. But it can only be examined by actively contracting the sternocleidomastoid muscle (SCM) and it would be impossible to conduct the examination without the cooperation of the subject. The aim of this study was to demonstrate a new method for VCR in the absence of the subject’s cooperation. Method: Records were collected from 20 volunteers. Each subject was properly positioned on the bed with the head flexed, ipsilaterally bent and contralaterally rotated. An active electrode was placed over the belly of the SCM. 100 dB clicks were delivered through headphones. We compared the active contraction and passive positioning of the SCM in terms of the P1 latency and amplitude. Results: Vestibular-evoked myogenic potentials (VEMPs) were recorded without actively contracting the SCMs for all the subjects by using our new method. There was no difference in P1 latency and amplitude between the active contraction and passive positioning of the SCM. Conclusion: With our new method, VEMPs can be recorded without actively contracting the SCM. It may be useful for evaluating the vestibular function of children and patients who cannot cooperate

신경인성 방광의 치료에서 요도부목 설치의 성공례와 실패례 ⁣증례 보고

In spinal cord injury, various options exist for the management of the neurogenic bladder. For the management of neurogenic bladder, urethral stent was placed under a cystoscopic guidance as one day procedure. Urethral stents were inserted in a T12 spinal cord injured patient who had recurrent urinary tract infections and a vesicoureteral reflux (VUR) and a T3 spinal cord injured patient who had a detrusor-sphincter dyssynergia. In the first case, recurrent urinary tract infection and VUR were resolved after the stenting. In the second case, urethral stent was removed because of the failure of continuous drainage. Because of its easily reversible nature, the urethral stent can be adopted for use in pateints as an option of neurogenic bladder management