대한한방내과학회지 (The Journal of Internal Korean Medicine)

대한한방내과학회 (The Society of Internal Korean Medicine)
권호 표지
DOI QR코드

DOI QR Code

재활치료 중단 후 보행 양상이 다시 악화된 뇌졸중 환자 1례에 관한 고찰

A Clinical Study of a Stroke Patient with a Worsened Gait Pattern after Discontinuing Rehabilitation

  • 김철현 (원광대학교 광주한방병원 한방내과) ;
  • 문연주 (원광대학교 광주한방병원 한방내과)
  • Kim, Cheol-hyun (Dept. of Korean Internal Medicine, Won-Kwang University Medical Center) ;
  • Moon, Yeon-ju (Dept. of Korean Internal Medicine, Won-Kwang University Medical Center)
  • 투고 : 2017.03.21
  • 심사 : 2017.05.26
  • 발행 : 2017.05.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: This study describes the case of a patient with a left basal ganglia (BG) infarct who had made almost a complete recovery upon discharge from the hospital in 2014 but who was re-admitted after 31 months with a worsened hemiplegic gait. Methods: The patient had undergone no rehabilitation treatment in the 31 months since his discharge. When the patient was re-admitted to our hospital in 2017, stance and gait data were collected on the patient using a treadmill gait analysis system. In addition, the patient underwent a manual muscle test (MMT) evaluation, and his Motricity index (MI) and modified Barthel index (MBI) scores were recorded. After rehabilitation for one month, the patient was reassessed, and the results were compared to those on the day of re-admission and those recorded in 2014. Results: Compared to the 2014 evaluation results, the patient's stance parameters and gait parameters had worsened at re-admission. However, there was no significant change in the patient's MMT grade or MI and MBI scores in comparison to the results of the 2014 evaluation. After one month of rehabilitation, the patient was re-evaluated again, but there was no significant change in comparison to the evaluation results at re-admission. Conclusion: Some of the stroke patients who have passed six months since the onset of their stroke may require ongoing rehabilitation although the functions of them is almost recovered. Because there is a possibility that recovered functions get worse again without any rehabilitation for a long time. And once the recovered functions get worse, re-recovery of them is not easy.

키워드

참고문헌

  1. Ward N. Mechanisms underlying recovery of motor function after stroke. Postgrad Med J 2005;81:510-4. https://doi.org/10.1136/pgmj.2004.030809
  2. Biernaskie J, Chernenko G, Corbett D. Efficacy of rehabilitative experience declines with time after focal ischemic brain injury. J Neurosci 2004;24:1245-54. https://doi.org/10.1523/JNEUROSCI.3834-03.2004
  3. Kwakkel G, Kollen B, Wagenaar R. Long term effects of intensity of upper and lower limb training after stroke: a randomised trial. J Neurol Neurosurg Psychiatry 2002;72:473-9.
  4. Lind K. A synthesis of studies on stroke rehabilitation. J Chronic Dis 1982;35:133-49. https://doi.org/10.1016/0021-9681(82)90114-X
  5. Zebris. Zebris FDM 1.0 software user manual. Isny im Allgau: Zebris Medical GmbH; 2012, p. 62.
  6. Garland SJ, Willems DA, Ivanova TD, Miller KJ. Recovery of standing balance and functional mobility after stroke. Arch Phys Med Rehabil 2003;84:1753-9. https://doi.org/10.1016/j.apmr.2003.03.002
  7. de Haart M, Geurts AC, Huidekoper SC, Fasotti L, van Limbeek J. Recovery of standing balance in postacute stroke patients: a rehabilitation cohort study. Arch Phys Med Rehabil 2004;85 :886-95. https://doi.org/10.1016/j.apmr.2003.05.012
  8. Roerdink M, De Haart M, Daffertshofer A, Donker S, Geurts A, Beek P. Dynamical structure of center-of-pressure trajectories in patients recovering from stroke. Exp Brain Res 2006;174:256-69. https://doi.org/10.1007/s00221-006-0441-7
  9. Zebris. Zebris FDM 1.12 software user manual. Isny im Allgau: Zebris Medical GmbH; 2015, p. 64, 83-6.
  10. Lee SK, Choi SH, Oh JG, Lee IS, Park KE, Hong HJ, et al. Spatiotemporal Characteristics of Stroke Patients Gait. The Journal of the Society of Stroke on Korean Medicine 2013;14 :1-7.
  11. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture 2010;31:241-6. https://doi.org/10.1016/j.gaitpost.2009.10.014
  12. Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles, testing and function: with posture and pain. Baltimore: Lippincott Williams and Wilkins; 1993.
  13. Collin C, Wade D. Assessing motor impairment after stroke: a pilot reliability study. J Neurol Neurosurg Psychiatry 1990;53:576-9. https://doi.org/10.1136/jnnp.53.7.576
  14. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 1989;42:703-9. https://doi.org/10.1016/0895-4356(89)90065-6
  15. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys ther 1987;67;206-7. https://doi.org/10.1093/ptj/67.2.206