DOH94-HP-1405 94 1 1 94 12 31
2-12 13-14 15-18 19-24 25-32 33-37 38-46 47-55 55-58 1
2 3 ( -1) ( -2) 6,394 3,643 (57.0%)748 (11.7%) 1999 2001 12.5 ( -1) 2
85 6 1. 2. 3. 4. 1. 2. 3. 4. 5. 84 6 1. (HIVD) (myofascial pain syndrome) (de Quervain s disease) (tennis elbow) ( )2. 3. 3
4
(OSHA) 1. Sedentary Work 5 2.Light Work 10 5 3.Medium Work 25 10 4. Heavy Work 50 25 5. (Very Heavy Work) ( ) ( )? 5
6 1998
7 2005 (A Physician s Guide to Return to Work ) 1. 2. 3. 4. 5. 6. 7
7. (1989-1992) (1993-1999) 1. 55 % 2. 26.3% 12 % 3. 0.63 % 13.4 % 4. 23% Prevention, Compensation, Return-to-work Case management 8
9
-1 1999 (%) 15~24() 25~44() 45~64() 495(4.2) 1524(12.9) 772(6.5) 2791(23.7) 98(0.8) 206( 1.7) 121(1.0) 425( 3.6) 98(0.8) 479( 4.0) 346(2.9) 923( 7.8) 452(3.8) 1429(12.1) 848(7.2) 2729(23.2) 95(0.8) 216( 2.2) 120(1.0) 476( 4.0) 566(4.8) 1448(12.3) 539(4.5) 2553(21.7) 119(1.0) 330( 2.8) 197(1.6) 646( 5.4) 203(1.7) 571( 4.8) 216(1.8) 990( 8.4) 34(0.2) 134( 1.1) 57(0.4) 225( 1.1) 2160(18.3) 6382(54.2) 3216(27.3) 11758(100.0) 10
-2 ( ) 88 793 114 14% 47 6% 20% 89 555 146 26% 64 12% 38% 90 263 91 35% 71 27% 62% 91 216 73 34% 54 25% 59% 11
-1 1999~2001 (Liang, et al, 2004) 12
13 ( )
14
15 (body function and structure) (activity) (participation) (impairment) (symptoms) (signs)
16 1. X 2. 3. 4. 5. 6. :
17 (risk) (work restriction) (capacity) (current ability) (Functional Capacity Evaluation)
(work limitation) (tolerance) 1. 2. 3. (impairment) (functional disability) (job handicap) 4. 5. 6. 7. 18
19 work disability work ability evaluation risk capacity tolerance job analysis functional capacity evaluation / (reaching) 1. 2.
20 3. 4. 5. 6. endurance -1-2
-1 1. 2. 10-20% / 3. 4. 21
-1 1. 8. 15. 2. 9. 16. 3. 10. 17. 4. 11. 18. 5. 12. 19. 6. 13. 20. 7. 14. 21. 22
23-2 /
-1 24
1. 2. 3. 4. 5. alternative job 25
26 1. 2. 3. 1. 2.
1 topographic evaluation (volumeter) 2 3 4 3. Guides to the evaluation of permanent impairment 4. 5. 6. 1 2 20% 3 27
4 7. (1) (2) (3) (4) (5) 1. 2. 3. 28
4. 6~8 5. 6. 7. 2-5 2-6 6-8 29
1. 2. 3. 4. 5. 6. 2 7. 8. daily noteprogress note (1)daily note 30
(2)progress note progress notes 1. 2. 3. 4. 5. 31
32
33 immobilization device reduction
Guides to the evaluation of permanent impairment (1) (2) 1. 2. 3. 4. 5. 6. 34
35 25-6 3-410-15
8. Guides to the evaluation of permanent impairment 1. (1) 3-4 (2) (3) (4) a. 36
b. 13-4 22.750 c. 5 80-90% 1 2 d. 2. (1) 110% (2) (3) (4) (5) 37
38 2002 Pransky 251 60% 20% 20% 68% 47% 42%
() (Back strain) 20 40 X () (Acute herniated nucleus pulposus) (annulus fibrosus) 30 50 ( ) 35 (90%) (L4-5) (L5-S1) L4-S1 39
(SLR) ( ) ( ) (push up) (extension exercise) (centralization) ( ) (traction) (decompression) (traction) (massage) (mobilization and manipulation) ( ) (mobilization or manipulation) (orthoses) Werneke M Fritz JM 40% (flexion) (extension) (HIVD) (facet joint dysfunction) (mobilization and manipulation) (spondylolisthesis) (segmental instability) (stabilization exercise) Jackson CP Brown MD 1983 (decrease pain) (strengthen weak muscles) (stretch contracted muscles) (decrease mechanical stress to spinal 40
structures) (improve fitness to prevent injury) (stabilize hypermobile segments) (improve mobility) Williams PC (radicular pain) (flexion exercise) (intervertebral foramen) McKenzie (extension exercise) (Pilates) (multifidus) (transversus abdominus) (flexor muscle) (extension muscle) 30% (strength) (endurance) (exercise programs) McKenzie (Centralization) (flexion) (extension) (range) (centralization) 41
(peripheralization) 1. (push up 1-11-21-3) 1-1 1-2 1-3 10 20 (end range) 1 2 2. (knee to chest 2-12-2) 10 20 2-1 2-2 (end range) 1 2 (lumbar stabilization) (transverses abdominis) (multifidus) (erector spine) (quadratus lumborum) 3-1 3-2 3-3 42
43 1. (abdominal hollowing) (3-1) (ASIA) (3-2) (bridging) (3-3) 2. (all four) (hollowing) (4-1) (4-2) 3. (5-1) ( 5-2) (dynamic stabilization) (aerobic exercise) 4-1 4-2 5-1 5-2
1. (Swiss ball) (hollowing) (weight shifting)(6-1) (6-2) (6-3) 6-1 6-2 6-3 2. ( ) (hollowing) (7-1) (7-2) (extension) 7-1 7-2 3. (8-1) 8-1 (extension) (trunk slight flexion) 44
(9-1) (9-2) (9-3) (10-1) 9-1 9-2 9-3 10-1 10-2 45
(11-111-211-3) 11-1 11-2 11-3 (12-112-2 12-3) 12-1 12-2 12-3 ( 13-113-213-3) 13-1 13-2 13-3 46
(Cumulative trauma/repetitive motion injury) 1990 (OSHA, Occupational Safety and Health Administration)Cumulative trauma disorder 2001 (Cumulative trauma disorder CTD) (Repetitive stress injury RSI) (over use) (muscle tension) (incorrect posture) (repetitive motion) (static posture) ( ) ) (muscle strains) (myofascial trigger point) (thoracic outlet syndrome) (carpal tunnel syndrome) (tendinitis) (arthritis) (neuritis) (nerve compression) (tenosynovitis) (ganglions) (microtrauma) (inflammation) (scar formation) 47
1993 1991 60% (1989 14 1993 28 1 ) (Rotator Cuff Impingement Syndrome) 1. (rotator cuff syndrome) (impingement syndrome) (subacromial impingement syndrome) (painful arc syndrome) (supraspinatus tendon) (subacromial bursa) (long head of biceps tendon) 60 120 (painful arc) (disused atrophy) 2. (DFM) (dynamic stabilization) 48
(1) (internal rotation) ( ) 0 (1-1)90 1-2 135 1-3 (subscapularis) (pectoralis major) (latissimus dorsi) (teres major) (anterior deltoid) 1-1 1-2 1-3 (2) (external rotation) ( ) 0 2-190 2-2 135 2-3 (infraspinatus) (teres minor) (posterior deltoid) 2-1 2-2 2-3 (3) ( ) (scapular plane) 45 3-1 (supraspinatus) (anterior and middle deltoid) 3-1 49
(4) ( ) 100 4-1 4-1 (horizontal abd) (Lateral Epicondylitis, Tennis Elbow) 1. (wrist extensors) (supinators) (extensor carpi radialis brevis) (extensor carpi radialis longus) 2. ( ) (1) 90 5-1 5-1 50
(2) 90 6-1 (3) 6-1 90 (ulnar deviation) 7-1 (Medial Epicondylitis, Golfer s Elbow) 1. (racquetball elbow) (swimmer s elbow) (pronator teres) (flexor carpi radialis) (pronation) 25 60 (ulnar neuropathy) 2. (1) (gripping exercise) 8-1 (intrinsic muscle) 8-1 (2) 90 7-1 9-1 51
(9-1) (3) 90 (10-1) 10-1 (4) 90 (11-1) 11-1 (DeQuervain s Tenosynovitis and Tendinitis) 1. (first dorsal compartment) (abductor pollicis longus) (extensor pollicis brevis) Finklestein s test( ) 2. (splint) (resting position) (1) (fingers total extension) 12-1 52
(12-1) (2) (wrist extension and radial deviation exercise) 90 (13-1) 13-1 (3) 90 ( 11-1 7-1) (Carpal Tunnel Syndrome) 1. (transverse carpal ligament) (flexor digitorum superficialis) (flexor digitorum profundus) (flexor pollicis longus) (median artery) ( ) Phalen s test Tinel s sign 2. (splint) (neutral position) (pulse) (taping) 53
(1) (median nerve gliding exercise) 90 (side bending) ( 14-1 14-1) (2) (tendon gliding exercise) (15-1) (metacarpophalangeal joints) (proximal interphalangeal joint) (distal interphalangeal joint) (15-2) ( (15-3) (15-4) 15-1 15-2 15-3 15-4 54
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