번역중입니다.

[김영생]

case study Li

할아버지 이씨에 대한 사례연구

Li is a 67-year-old retired high school science teacher /who was hit by a car as he walked across a city street.

이씨는 67세로 고등학교 과학교사로 은퇴하였다. 길을 건너다가 자동차사고를 만나 지체부자유자가 되었다.

Before his accident,/ he was active in a variety of volunteer activities that included teaching English as a second language at the local adult education program, working as a docent at the local botanical garden, and leading nature hikes in a nearby county park.

사고가 나기 전에 그는 매우 활동적인 사람이었다. 여러 가지 자원봉사활동을 했다. 지방의 이민자를 위한 성인교실에서 영어를 가르쳤다. 지방의 식물원에서 시간강사로 일했다. 지방의 공원에서 자연탐사 하이킹을 인솔하기도 하였다.

He also was an amateur watercolor artist /who had recently begun to receive recognition for his landscape paintings.

아마추어 수채화 화가였다. 최근들어서는 풍경화 부문에서 주변으로부터 점차 인정을 받기 시작하였다.

Upon referral to occupational therapy,/ he was nonambulatory because of a fracture of the pelvis and right femur.

작업치료와 관련하여 그는 보행을 하지 못한다. 골반,  우측대퇴부의 골절 때문이었다.

He also/ had fractures of his right clavicle and humerus, and multiple fracture of his dominant right forearm and hand.

그는 우측 쇄골 상박골에서 골절

그는 우측 팔뚝과 손에서 복잡골절을 갖고 있다.

He had a severe concussion and experienced dizziness and impaired balance, memory loss and confusion, and episodes of agitation.

그는 심각한 충격을 받았다.

그는 현기증 균형장애, 기억상실, 혼란, 교란의 상황을 경험했다. 

clinical thinking questions

임상적 사고를 위한 질문

1. what type of activities should Li learn how to do?

어떤 동작을 이씨 할아버지는 연습으로 익혀내야 할까?

2. what strategies should Li's therapist use to facilitate his learning?

어떤 전략을 이씨 할아버지 담당 치료사가 사용해야 할까? 그 동작을 익히기 위해서 어떤 전략이 필요할까?

Teaching /is a fundamental skills /for occupational therapists.

교육기술은 작업치료사에게 있어서 기본이다.

Therapist spend much of their time with client teaching a variety of activities.

치료사는 환자에게 여러 동작을 가르치느라고 많은 시간을 보내게 된다.

Effectiveness as a teacher depends on the therapist a ability to organize the environment and the instuctional method to meet the learning needs of the individual client

교육하는 사람으로서의 효능감 (교육성과)은 온갖 여건을 조직하는 치료사 능력에 따라, 그리고 환자 하나하나의 요구하는 바에 따라 개별화하고 맞춤이 되는 치료사 교육방법에 따라 달라지게 된다.

this chapter discusses the process of teaching for occupational therapist working with clients who have physical disabilities, and presents the reasons why occupational therapists teach activities, the phases and types of learning, and principles of teaching and learning with this population.

이 챕터(장)는 신체장애가 있는 환자를 돕는 작업치료사 교육과 관련한 내용이다. 작업치료사가 어떤 동작 하나하나를 환자에게 가르치는 이유를 각각 말해준다. 학습의 단계, 학습의 형태, 이런 학습자들에 있어서 교수학습의 원리들을 하나하나 상세하게 말해준다.

provide Reinforcement and Grading of Activities.

행동 강화 & 행동 평가 (제공)

the concept /of reinforcement comes from operant conditioning theory, /which states that behaviors that are rewarded or reinforced tend to be repeated.

강화라는 개념은 조작적 조건화 이론에서 왔다. 보상을 받은 행동은 다시 또다시 반복적으로 나타나게 된다는 이론이다.

Many types /of reinforcement such may be used.

여러 형태의 강화이론이 사용된다.

For some clients,/ social reinforcement such as a smile /or verbal encouragement creates motivation to continue.

어떤 환자에게 있어서는 미소나 말로 하는 칭찬 같은 사회적 강화가 어떤 동작을 반복적으로 나타나게 만들어가게 한다.

Other clients may require more tangible rewards, such as rest periods, snacks, favorite activities, etc.

어떤 환자에게는 휴식시간, 간식, 좋아하는 활동 등의 더 많은 유형 보상이 효과를 나타내기도 한다.

Still other clients are motivated by visible indications of their progress.

어떤 환자들은 그들의 발전과 관련한 가시적 암시에 의하여 더 잘 동기화된다.

Use of a praph or chart to demonstrate daily improvement in performance skills or client factor such as grip strength, sitting tolerance, or range of motion can help a client to engage more actively in the therapy process.

praph나 차트의 사용, 이해력, 착석 또는 이동 범위 같은 환자 관련 요인의 활용은 치료과정에서 환자가 좀더 능동적으로 참여하게 만들어준다.

These are examples of extrinsic reinforcement.

다음은 외적 강화의 사례다.

Many clients are motivated by completion of a task, for instance, preparing a snack and then eating it, or dressing themselves independently so they can visit with friend.

많은 환자들은 친구들과 어디를 방문하기 위해 간식 준비하기, 간식 먹기, 혼자서 옷입기 등과 같은 어떤 과제의 완성과정에서 잘 동기화기 된다.

Completion of the task provides intrinsic reinforcement, seen in the individual's satisfaction in his or her ability to participate in desirable activities as result of completing the task.

과제 완성은 내적 강화를 준다. 이것은 과제 완성의 결과로 자신이 하고자 하는 바람직한 활동에 참가할 수 있게 되는 자기 능력에 대한 확인에서 맛보게 되는 개인적 만족이기 때문이다.

An activity that is /motivating and meaningful/ to the client can increase active participation and improve intervention outcome.

환자에게 동기화가 되고 의미를 주는 어떤 활동은 능동적 참여를 증가시킨다. 그리고 중재효과를 높여준다.

Several studies have shown (1) that adding purposeful /or imagery-based occupations to rote exercise result in more repetitions than are used for rote exercise alone.

몇가지 연구는 다음과 같은 것을 보여준다.

(1) 목적이 있고 심상 작업의 증가는

(2)

that client /select occupationally embedded activities over rote exersice tasks, and

환자는 작업적으로 둘러쌓는 활동을 선택한다. 기계적 운동 과제 이상으로 선택한다.

(3) that added purpose occupations result /in greater retention and transfer of/ motor learning that occur with rote exercise.

증가된 목적 작업은 더 큰 보존을 초래한다. 기계적 운동을 일으키는 운동학습으로으 전이까지 초래한다.

Sietsema and colleagues found that better scapular abduction and efficiency / forward reach were achieved when clients with traumatic brain injury focused on reaching to control a game panel than when they focused on how far they could reach an arm forward.

Sietsema와 동료에 의하면

더 나은 어깨의 외전,  효능 / 앞으로 내밀어 잡기는 이루어지게 된다.

트라우마 뇌상 환자가 게임판을 조종하려고 팔을 뻗음에 집중할 때 이루어지게 된다.

트라우마 뇌상 환자가 얼마나 멀리 앞으로 팔을 뻗을까에 집중할 때보다 더 잘 이루어지게 된다.

Similarly, Nelson and associate showed that intervention to improve coordinated forearm pronation-supination was more effective in stroke rehabilitation when clients focused on turning an adapted dice thrower in the context of a game than when they focused on the movement itself.

또 Nelson과 그의 동료에 의하면

복수근육을 사용하는 팔뚝 내전 및 외전을 향상시키는 중재가 일격 기능회복훈련에서 더 효과적이었다. 환자가 게임상황에서 맞춤식 주사위 던지기에 초점을 맞추었을 때가 더 효과적이었다. 혼자만의 움직임에 몰입했을 때보다 더 효과적이었다.

* 팔뚝 내전(팔뚝을 움직여서 손바닥을 아래 보게 하기), * 팔뚝 외전(손바닥을 하늘 보게 하기)

Wu and coworker found that intervention to improve symmetric posture in adults with hemiplegia had significantly better outcomes when subjects focused on wood sanding and bean bag toss games.

Wu와 그의 동료에 의하면 반신불수 성인의 경우 자세 균형을 향상시키는 중재가 의미있게 더 나은 효과를 가져왔다. 피험자가 숲 모래사장에서  콩주머지 던지기 게임에 집중했을 때 더 나은 효과를 가져왔다.

In addition to structuring the type of reinforcement, the therapist needs to carefully grade the challenges of the activity, so the client can experience success and mastery during the process of learning the activity.

강화 방법의 습득 외에도, 치료사는 도전적 활동을 조심스럽게 단계적으로 전개해나가야 한다. 그래서 환자가 활동의 습득과정에서 성공과 숙달을 경험하게 해야 한다.

If the client has too much difficulty completing a task, social reinforcement or inherent meaningfulness of the activity will not be enough to override frustration or fartigue.

만일 환자가 과제를 끝마치는 데 있어서 너무 심한 곤란을 겪게 된다면, 사회적 강화나 활동에서 나오는 고유의 의미는 좌절이나 피곤의 우위에 서게 하기에 충분치 못하게 될 것이다.

Therefore, therapist must analyze the activity and determine how to grade the activity to meet the learning and reinforcement needs of the individual client.

그러므로 치료사는 활동을 분석해야 한다. 환자 개개인의 학습 요구 또는 강화 요구에 잘 부응하기 위하여 과제 활동을 어떻게 단계화해야 할른 지를 결정해야 한다.

This includes as described in the previous section, what type of reinforcement will facilitate intrinsic motivation, and how best to structure feedback and practice schedules; these decisions are discussed in the next section.

이런 내용은 앞의 절에서 언급된 바와 같다. 즉 어떤 타입의 강화가 내적 동기화를 용이하게 하는가 하는 내용이다. 그리고 어떻게 하면 피드백이 가장 잘 이루어지는가, 그리고 그 피드백 계획들은 어떻게 해야 가장 잘 실천해낼 수 있는가, 그리고 이 모든 결정들은 다음의 절에서 논의될 것이다.

Li's therapist knew that his strong desire to return to his occupation of leading nature hikes would motivation him to improve his balance and standing tolerance.

이씨 할아버지의 치료사는 알고 있었다.

자연탐사하이킹을 지도해 나가는 일 즉 그의 일로 회귀하고자 하는 그의 강력한 희망이야말로 그를 동기화할 것이다. 그래서 이씨 할아버지의 균형, 서있기(참아내기)를 향상시켜나갈 것이다.

The therapist explained how a variety of activities involving challenges to Li's sitting and standing balance would help him regain his postural stability.

그 치료사는 이씨 할아버지의 앉기 서기 균형을 향한 도전과 같은 여러 활동들이 어떻게 이

씨 할아버지를 도와 그의 자세안정을 되찾게 해 줄 것이라고 설명을 했다.

Li participated actively in these tasks and generated ideas for additional tasks that could be incorporated into his OT program; he also practiced outside of the therapy environment.

이씨 할아버지는 이 과제들에서 능동적으로 참여를 했다. 부수적인 과제와 관련이 있는 아이디어들을 생각해냈다. 그 부수적 과제들은 그의 OT 프로그램으로 병합될 수 있었다.

His intrinsic motivation to perform these tasks in varied contexts was evident in his improved balance skills.

다양한 다른 상황에서 이 과제들을 수행하게 할 수 있는 그야말로 그의 내적 동기화는 그의 향상된 균형 기술에서 한층 더 명백해졌다.

Celebrations and farewells on day 10

Korea reaches gold target as Jang Mi-ran bids adieu
'진기록' 속출…한국, 이대로만 나간다면

Aug 07,2012

	Weight lifter Jang Mi-ran reacts after finishing her final routine in the women’s over-75-kilogram clean-and-jerk weight lifting competition at ExCeL Center in London. [YONHAP]

Day 10 of the London Olympics was an especially moving one for Team Korea. The country met its gold-medal target with pistol shooter Jin Jong-oh’s second gold of the Games, bringing the total to 10 with one week left.

But on the same day, weight lifter Jang Mi-ran reminded the nation that the Olympics are not just about the medal standings.

The defending champion battling a series of injuries at her third Summer Games finished fourth in the over-75-kilogram event, likely the last of her Olympic career. After her lift, Jang kneeled down and prayed before kissing the barbell and bowing before the crowd.

Jang, 28, ruled the weight lifting world in the late 2000s, taking four world championships with gold and silver medals at the Olympics. But since the Beijing Games, she has suffered from shoulder and back injuries. A car accident also prevented her from training.

It was clear from the start that young weight lifters Zhou Lulu of China and Tatiana Kashirina of Russia were going to be competing for gold in the heaviest weight lifting class this time around.

Jang cleared a total of 289 kilograms, 125 kilograms in the snatch and 164 kilograms in the clean and jerk, much less than her 326-kilogram world record. Zhou, 24, won the gold with a new world record of 333 kilograms - 146 in the snatch and 187 in the clean and jerk.

“I am just thankful that I’ve finished the competition without getting injured,” a tearful Jang said at the ExCeL Arena after the event. “I am worried that I have let down people who supported me and have showed me affection since my total wasn’t like what I did in Beijing.”

	Jin Jong-oh, left, celebrates his gold medal with silver medalist Choi Young-rae after finishing their 50-meter pistol shooting event at the 2012 Olympics in London on Sunday. Jin beat Choi by 0.5 points and claimed his second gold of the Games.

While Jang’s performance wasn’t a repeat of 2008, Team Korea has overcome a rocky beginning to stand in fourth place in the gold medal count and is close to the Beijing total. The strong outing has a lot to do with Jin’s dominance in the men’s pistol shooting events.

Jin, who delivered Korea’s first gold medal in the men’s 10-meter air pistol shooting on July 28, beat teammate Choi Young-rae in the 50-meter event by 0.5 points to win his second.

He became the first local shooter to take home two gold medals at an Olympics and is also the first Korean athlete in an individual sport to defend a title after winning the 50-meter in Beijing.

In other events on Sunday, Choi Gyu-jin, a Greco-Roman wrestler, finished fourth after losing to Mingiyan Semenov of Russia in the men’s 55-kilogram bronze medal contest

다.

Swimmer Park Wins Silver in Men's 200-meter Freestyle

Write 2012-07-31 07:26:42   Update 2012-07-31 09:04:01

South Korea's swimming champion Park Tae-hwan took silver in the men’s 200-meter freestyle event at the London Olympics on Monday.

Park and China’s Sun Yang shared the podium in second place with the same time of one minute and 44-point-93 seconds at the Olympic Park Aquatics Centre. France’s Yannick Agnel captured the gold medal with a time of one minute and 43-point-14 seconds.

Park’s time on Monday was zero-point-13 seconds behind the Asian record he posted during the 2010 Asian Games in Guangzhou.

Monday marked the second time for Park to win the silver in the 200-meter freestyle event after the Beijing Olympics four years ago. Monday’s medal also came after Park won silver in the 400-meter freestyle event last Sunday.

Park is the first South Korean athlete to win two medals in two consecutive events at the Olympics.

Anchor: Former Saenuri Party leader Park Geun-hye who is touted as most likely to win the ruling camp's presidential primary has officially declared her bid for a run at the presidential office. Jang Souie has this report.

Report: Saenuri Party Representative Park Geun-hye announced her bid for the presidency during an event at Times Square shopping mall in Seoul Tuesday morning. She said the government needs to shift the focus of its policies to place a priority on the livelihood and happiness of the citizens.

Park stressed that she will achieve economic democratization, job creation and welfare tailored to South Korea for the happiness of South Koreans.

She also pledged to strengthen the country’s support system for childcare and transform its education system so it nurtures students' dreams and talents instead of focusing solely on competition and good grades.

Park also promised to raise the level of confidence and peace on the Korean Peninsula by putting an end to the vicious cycle of distrust, confrontation and uncertainty between the two Koreas and creating conditions for North Korea to become a responsible member of the international society.

After announcing her presidential bid, Park held a special session with the crowd where she took questions and exchanged opinions and also sang with participants to close the event.

This is Park's second presidential run following her first campaign in 2007. She is the first daughter of former President Park Chung-hee and a five-term lawmaker. She lost to Lee Myung-bak in the party primary five years ago but has since become a strong presidential contender by winning the hearts of many citizens.

Jang Souie, KBS World Radio News.
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