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목적 : 본 연구에서는 체계적 고찰을 통해 3D 프린팅 기술을 상지보조기 제작에 적용한 사례에 대해 알아 보고, 향후 작업치료사가 임상현장에서 상지보조기 제작에 3D 프린팅 기술을 적용할 때 필요한 정보를 정리하여 임상적용에 유용한 기초자료를 제시하고자 한다. 연구방법 : 2013년부터 2017년까지의 최근 5년간의 논문을 전자 데이터베이스 RISS, KISS, Scopus, PubMed와 Google Scholar를 사용하여 검색하였다. 검색 키워드로는 “3D Printing AND Orthosis OR Splint OR Brace”을 사용하였다. 검색된 논문은 2차 분류를 거쳐 최종적으로 16개의 논문을 선정하였 으며 이를 분석하고 고찰하였다. 결과 : 분석대상 논문의 약 80%가 단일대상 실험연구 및 사례연구로 질적수준은 낮은 편이었다. 제작자의 전공을 분석한 결과, 크게 4가지 계열로 구분됐으며, 그 중에서 공학계열이 가장 많았다. 다음으로는 보 건계열이 많았으며, 작업치료전공자는 2명이었다. 제작된 상지보조기의 종류는 6가지였으며, 그 중에서 코크 업 보조기와 손가락 보조기가 가장 많이 제작되었다. 제작에 가장 많이 사용된 소재는 플라스틱 소 재중 하나인 ABS수지였다. 분석된 논문에서 사용된 제조공법은 총 4가지가 있었으며, 가장 많이 사용된 제조공법은 FDM방식이다. 상지보조기 제작을 위한 상지 측정방법으로는 3D 스캐너가 가장 많이 사용 되었다. 결론 : 이번 연구를 통하여 3D 프린팅 기술을 적용한 상지보조기 제작방법에 대해 알 수 있었다. 이를 근 거로 작업치료사의 업무범위 중 한가지인 상지보조기 제작에 3D 프린팅 기술을 적용할 수 있는 기초근 거를 제공하고, 추후 연구에 대한 방향성을 제시하고자 하였다. 본 연구 결과를 바탕으로 작업치료분야 에서 3D 프린팅 기술을 적용한 상지보조기 개발 및 연구가 더욱 활발하게 이루어질 것으로 기대한다.

Objective: The purpose of this study is to investigate the application of 3D printing technology to the upper limb production through a systematic review and to summarize and analyze the necessary information to provide basic basis for future clinical application in the field of occupational therapy. Methods: For the last five years from 2013 to 2017, the articles were searched using electronic databases RISS, KISS, Scopus, PubMed and Google Scholar. As a search keyword, "3D Printing AND Orthosis OR Splint OR Brace" was used. The searched article were classified through the second classification and finally 16 article were selected and analyzed Results: About 80% of the article to be analyzed were single-target experimental studies and case studies with lower quality. As a result of analyzing the producers major, it was divided into four major categories. Among them, the engineering department was the most, followed by the health department. Six types of upper splint were manufactured. Cock-up splint and finger splint were made the most. ABS was the most commonly used plastic material. There are four manufacturing methods used in the analyzed article, and the most used manufacturing method is the FDM method. As a method of measurement, 3D scanners were the most popular method to manufactured upper splint. Conclusion: In this study, we learned how to make upper splint using 3D printing technology. Based on this, I would like to provide basic data for applying 3D printing technology to manufactured the upper splint which is one of the occupational therapist's job scope. I would like to present a direction for future research. Based on the results of this study, it is expected that the development and research of upper splint applying 3D printing technology in occupational therapy field will be more active.

본 연구의 목적은 손을 기능적 자세로 만들어주는 새로운 디자인의 보조기를 환자에게 적용하여 손기능에어떠한 영향을 주는지 알아보고자 하는 것이었다. 새로운 보조기는 엄지와 검지의 샅공간(web space)을 넓히는 새로운 디자인이다. 보조기 착용 후 환자는 엄지 벌림의 자세를 유지할 수 있었고 작은 물건 잡기가 가능하게 되었다. 환자는 손 기능에서 향상을 보였고 Box and Block 검사의 수행이 가능해져 1분에 8개의 블록을 옮길 수 있게 되었다. 그러나 물건에 손바닥의 접촉이 요구는 잡기는 이전보다 더 어려웠고 일상에서 착용시 물이 닿으면 고정되지 못한다는 단점 또한 있었다. 본 연구는 3D 프린팅을 이용한 첫 보조기 적용 연구라는 점에서 의미가 있으며 앞으로 작업치료분야에서 3D 프린팅을 통해 다양한 환자 맞춤형 보조기가 개발될 수 있을 것이라 기대한다.

The purpose of this study was to investigate the effect of a new designed splint on the hand function. A new design splint that enlarges the area between thumb and index finger was manufactured using 3D printing. After wearing a new splint the patient was possible to open thumb and hold a small object. She showed improvement in overall hand function and could move eight blocks in box and block test. But grasping a cup without a handle has become more difficult than before. Also there is a disadvantage that it could not be fixed by water. This study is meaningful in that it is the first splint application study using 3D printing. In the future, we expect that various patient-specific splints will be developed through 3D printing in the field of occupational therapy.

Objective To present our experience with ear splint therapy for babies with ear deformities, and thereby demonstrate that this therapy is an effective and safe intervention without significant complications.Methods This was a retrospective study of 54 babies (35 boys and 19 girls; 80 ears; age ≤3 months) with ear deformities who had received ear splint therapy at the Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University Hospital between December 2014 and February 2016. Before the initiation of ear splint therapy, ear deformities were classified with reference to the standard terminology. We compared the severity of ear deformity before and after ear splint therapy by using the physician’s ratings. We also compared the physician’s ratings and the caregiver’s ratings on completion of ear splint therapy.Results Among these 54 babies, 41 children (58 ears, 72.5%) completed the ear splint therapy. The mean age at initiation of therapy was 52.91±18.26 days and the treatment duration was 44.27±32.06 days. Satyr ear, forward-facing ear lobe, Darwinian notch, overfolded ear, and cupped ear were the five most common ear deformities. At the completion of therapy, the final physician’s ratings of ear deformities were significantly improved compared to the initial ratings (8.28±1.44 vs. 2.51±0.92; p<0.001). There was no significant difference between the physician’s ratings and the caregiver’s ratings at the completion of ear splint therapy (8.28±1.44 vs. 8.0±1.61; p=0.297).Conclusion We demonstrated that ear splint therapy significantly improved ear deformities in babies, as measured by quantitative rating scales. Ear splint therapy is an effective and safe intervention for babies with ear deformities.

Objective To assess the effectiveness of the resting foot splint to prevent ankle contracture.Methods We performed a randomized controlled trial in 33 patients with brain injury with ankle dorsiflexor weakness (muscle power ≤grade 2). Both groups continued conventional customized physical therapy, but the patients in the foot splint group were advised to wear a resting foot splint for more than 12 hours per day for 3 weeks. The data were assessed before and 3 weeks after the study. The primary outcome was the change in ankle dorsiflexion angle after 3 weeks. Results Before the study, there were no differences between groups in gender, age, time post-injury, brain injury type, initial edema, spasticity, passive range of ankle dorsiflexion, Fugl-Meyer score (FMS), or Functional Ambulation Classification. A significant improvement in ankle dorsiflexion angle, and FMS was found after 3 weeks in both groups. The splint group showed more spasticity than the control group after 3 weeks (p=0.04). The change of ankle dorsiflexion angle, foot circumference, spasticity, and FMS after adjusting initial value and spasticity were not significantly different between the 2 groups. Conclusion Wearing a resting foot splint for 3 weeks did not affect joint mobility in patients with subacute brain injury regularly attending personalized rehabilitation programs. Further studies of larger sample sizes with well controlled in spasticity are required to evaluate the effects of the resting foot splint.

목적 : 본 연구는 short thumb opponens splint 착용이 분만성 상완 신경총 손상 아동의 상지 기능과 손 기능에 미치는 효과를 알아보고자 실시하였다. 연구 방법 : 분만성 상완 신경총 손상으로 진단 받은 11세 남성 아동 1명을 대상으로, 증례 보고 방법 중 (single-subject experimental research design) ABA’ 설계를 사용하였다. 총 20회기로 매주 1회기 씩 20주간 진행하였다. 기초선 5회기는 중재 없이 평가하였고 중재기 10회기는 하루 6시간 short thumb opponens splint를 착용 하는 중재를 실시한 후 평가하였다. 추적기 5회기는 중재 없이 평가하 였다. 평가는 손기능 평가를 위한 상자와 나무토막 검사(Box and Block Test; BBT), 상지 기민성 검 사(nine-hole pegboard test)와 분만성 상완 신경총 손상 환자의 상지 기능 평가를 위한 Mallet scale, active movement scale 검사를 통해 변화를 알아보았다. 결과 : short thumb opponens splint 중재 결과, 상지 기능(Mallet scale, active movement scale)과 손기능(BBT, nine-hole pegboard test)은 중재 전에 비해 유의하게 향상되었다. 결론 : short thumb opponens splint 착용이 분만성 상완 신경총 손상 아동의 상지 기능과 손기능향상에 효과가 있다는 것을 확인하였고, 향후 분만성 상완 신경총 손상 환자의 임상적 중재의 기초 자료로 활용 될 수 있을 것이다.

Objective: The purpose of this study was to investigate the effects of a short thumb opponens splint on the upper extremity and hand functions in a child with an obstetric brachial plexus injury. Methods: This single-subject experimental design study of an 11 year-old male patient diagnosed with an obstetric brachial plexus injury was conducted using the ABA’ design. A total of 20 sessions were held, once a week for 20 weeks. During the baseline period, five sessions were assessed without intervention. During the intervention period, ten sessions were assessed after intervention with a 6 h short thumb opponens splint. In the follow-up period, five sessions were assessed without intervention. To measure the upper extremity and hand functions, a Box and Block Test(BBT), nine-hole peg test, mallet scale, and an active movement scale were assessed before, during, and after intervention. Results: After intervention with a short thumb opponens splint, the participant showed significant improvement in hand(BBT, nine-hole peg test) and upper extremity(mallet scale, active movement scale) functions and demonstrated improvement. Conclusion: The results of this study suggest that use of a short thumb opponens splint has a positive effect on the upper extremity and hand functions. These results can be used to form basis of a clinical intervention in patients with an obstetric brachial plexus injury.

본 연구는 첨단 제조기술로 각광받고 있는 3D 프린팅 기술을 장애인을 위한 보조기 제작에 도입하려는 목적이 있다. 신체 측정의 방법으로 기존의 방법과 3차원 신체 스캐닝(3D Scanning)을 모두 적용하여 측정부터 제작과 평가까지의 프로세스를 개발하고자 했다. 보조기를 필요로 하는 장애인들이 불충분한 제도적 지원과 비용 및 시간의 문제에 직면하여 원활한 보조기 지급 서비스를 받지 못하는 문제점을 극복하고자 했다. 기존의 보조기 제작 시 인체에 유해하거나 금기사항이 되어왔던 점을 개선할 수 있는지 근거를 마련하고, 3D 프린팅 기술을 이용하면 보조기의 고장이나 파손에 적극적이고 신속하게 대응해 낼 수 있어 장애인 편의성이 향상될 수 있고, 소요되는 비용과 보조기를 착용하기 까지 장애인이 거쳐야 되는 절차가 혁신적으로 감소될 수 있을 것이다. 이를 위해 의료진이나 관계자들이 3D 프린팅을 할 때 기술적인 프로세스를 제공하고 기존의 방법과 비교하기 위해 본 연구를 진행했다. 5가지 종류의 보조기를 실제 제작하는 전 과정을 규명하여 본 연구를 지침삼아 4명의 제작자가 3D 프린터와 스플린트 팬을 이용하여 동일한 보조기를 제작하였다. 인장강도는 방법과 보조기 종류에 상관없이 3D 프린팅 방법이 평균 23,400 kgf/㎠으로 7,100kgf/㎠의 물성을 보이는 폴리프로필렌을 사용한 스플린트 보다 약 3배 더 강도가 우수했다. 소요시간의 차이는 기존의 방법이 평균 730분 덜 소요되었다. 제작 비용적인 측면에서는 3D프린팅에 요구되는 비용이 기존 방법에 비하여 평균 32.8만원이 더 할애 되었다. 3D 프린팅을 이용한 보조기의 제작은 임상적으로 사용이 가능할 것으로 생각되고, 기존의 제작방법이 가지고 있는 문제점들을 개선하는 대안이 될 것으로 전망된다.

The purpose of this study was to investigate the effect of the occusal biteplane splint on the static balance ability of normal subjects. Sixteen adult males who had no orthopedic- surgical lesions in the jaw joints were enrolled. Subjects wore an occlusal bite-plane splint, and the static balance ability was measured with an occlusal bite-plane splint. The static balance, representing weight distribution of right-to-left ratio, appeared to be significantly decreased in eye open and closed status (p<.05) when wore the occlusal splint. This findings suggest that an occlusal bite-plane splint is probably favorably used to promote balance ability. We can recommend an occlusal bite-plane splint as a clinical method to improve the balance ability by adjusting the position of the lower jaw. Futher studies is needed.

The purpose of this study is defined increased active motion utilizing tenodesis splint and vibratory stimulation during functional activities. We selected three left cerebral vascular accident right hand dominance with right hemiplegic patients. who has been actively participating in occupational therapy. Patients participated twice per week from June 1st 1997 until August 30th 1997. According to our study, improvement has been noted in active extension with vibratory stimulation only. No signifinicant improvement was noted with tenodesis splint. Further study is necessary to generalization of stimulation for therapeutic use.

A 2-year-old, intact and a 10-year-old, castrated male Maltese were referred for treatment of progressive tooth mobility and periodontal disease. The first case was presented with tooth mobility of mandibular incisors (Grade 2-3) and the second case was also presented with tooth mobility of maxillary incisors (Grade 2-3) by periodontal disease. The treatment plan included supragingival scaling, closed root planing, subgingival curettage and removable-fixed periodontal splinting of the mandibular (case 1) and maxillary (case 2) incisors to stabilize them. Three months after therapy, oral examinations were performed for evaluation of success of therapy. In both cases, oral malodor, periodontal disease and tooth mobility were resolved and periodontal splints were remained rigidly.

If there are problems for us to sleep, we are faced with fatigue and dizziness in the day. Snoring and OSAS (obstructive sleep apnea syndrome) during sleeping are the main cause of sleep disorder. Treatments through surgical method and sleep splint can be performed to treat snoring and OSAS. Relapse of snoring and OSAS is common after treatment by surgical method. But, Recently sleep splint is frequently applied to treat snoring and OSAS with surgical treatment, because it is convenient and conservative. Sleep splint treat snoring and OSAS by ensuring airway through nose. As first step of fabrication occlusal bite is gained at a point that patient get feeling of increased nasal breathing in supined position, and next, the bite is transfered to sleep splint. This study surveyed the effect of sleep splint by questionnaire to the out-patients (the Dept. of Oral and Maxillofacial Surgery, Chonbuk National University Hospital) weared sleep splint and their partners, secondarily measured airflow through nose by aerophone II after wearing sleep splint and finally evaluated the effect of treatment of snoring and OSAS by sleep splint. The obtained result were as follows; 1. Though 'sleep splint' couldn't eliminate fundamental problems of snoring, it could improve the symptoms when patients were selected could using the 'Nakagawa's respiration method'. 2. Patients who used the sleep splint could breathe stably when patients are sleeping stably. Wearing a 'sleep splint' improved airflow by expanding the upper airway. 3. Even though sleep splint can be made with variable materials, the patients expressed the most satisfaction on the splint with '0.75mm hard shell'. 4. The 'Herbst' may allows the mandible to move the TMJ to relax. Nevertheless, some patients experienced a discomfort or irritation. 5. In Snoring and OSAS cases, it is recommended that patients should first explore non-surgical options prior to choosing a surgical treatment.

In recent years the relationship between occlusal stability, mandibular position and temporomandibular joint function has been greatly emphasized. Anterior repositiong splint has been used for the purpose of correcting a disk-condyle in coordination, so we have usually wed it in ease of the click of the temporpmandibular joint. We have used anterior repositioning splint in 28 patients who have chief-complain of click in symptoms of the temporomandibular joint arthrosis. At the patients who had long-lasting symptom and sign, late click or degenerative change of the temporomandibular joint, the anterior repositioning splint had less effect on than we had expected. So we are now to report that we must pay attention to use of anterior repositioning spint.

After making the surgical treatment plan, the surgical movements are duplicated in the model surgery. During this procedure, reference points and lines are drawn on the base of the models over the dental arch, and sawcuts are made according to these marked osteotomy lines. This method requires more accuracy for better postsurgical results in that the surgical splint which enables the surgeon to position the jaws intraoperatively is made from the casts as repositioned by the model surgery, and finally it will define the postsurgical results. This technique, however, has been found to be inexact, especially when the jaws are moved in several dimensions simultaneously. To overcome this, different methods have been developed for an accurate repositioning of the jaws as planned. A new appliance, Surgical Jaw Relator, was devised by the author for the simple 3-dimensional relocation of the upper and lower models, resulting in the easy construction of the splints such as centric relation splint, intermediate and final splint. This article describes an introduction and a clinical application of this appliance.

Purpose: The zygomatic arch is a key element which composes the facial contour. In many cases of zygomatic arch fracture, it is difficult to fix rigidly the fractured segments. If reduced bone segments were not fixed rigidly, they are proven to be displaced by mastication or unintentional external forces. So, unfixed zygomatic arch fracture after reduction may require a external device of prevention of collapse. We introduce a new protector which stabilizing the fractured segments to prevent for collapse of the reduced zygomatic arch fracture. Methods: After reduction of zygomatic arch with blind approach(Gillies', Dingman or Keen's approach), bone segments was pulled with percutaneous traction suture in medial aspect of zygomatic arch. Then, the suture was fixed with Aqua $splint^{(R)}$, externally. And intraoperative and postoperative X-ray was done. The splint was removed on 14 days after the operation. Results: 5 patients were treated with this method. 4 patients of total patients had no collapse in zygomatic arch. There was minimal collapse in one patient. Postoperative complications such as facial nerve injury, mouth opening difficulty, contour deformity, infection, scar were not observed. Conclusion: In comparison with other techniques, this technique has several advantages which are simple and easy method, short operation time, no scar, less soft tissue injury, and facilitated removal of splint. Therefore, Aqua $splint^{(R)}$ would be a good alternative to prevent for collapse in unstable zygomatic arch fractures

상악 전치부 완전탈구를 주소로 내원한 지적 장애를 동반한 뇌병변 장애를 가진 25세 환자에서 재식 후 구치부 bite block을 추가한 vacuum-formed splint을 이용한 교합 안정술을 통하여, 외상 치아의 동요도 감소 및 교합안정을 이루는데 도움이 될 것으로 사료 된다.

Reposition and splinting has been widely recommended when clinicians treat traumatically dislocated tooth. This case represents stabilization of traumatized tooth in a cerebral palsy patient who failed resin wire splint because of parafunctional oral habit and lack of cooperation. Clinically, mobility of traumatized tooth decreased due to stabilization using vacuum-formed splint with posterior occlusal block in 2 weeks. Vacuum-formed splint may be a simple and effective stabilization technique for traumatized tooth in a cerebral palsy patient.