디지털융복합연구 (Journal of Digital Convergence)

  • 제17권9호
  • /
  • Pages.271-278
  • /
  • 2019
  • /
  • 2713-6434(pISSN)
  • /
  • 2713-6442(eISSN)
한국디지털정책학회 (The Society of Digital Policy and Management)
권호 표지
DOI QR코드

DOI QR Code

가상현실 훈련이 아급성 뇌졸중 환자의 상지기능과 일상생활활동에 미치는 효과

Effects of virtual reality training on upper extremity function and activities of daily living in patients with sub-acute stroke

  • 전민재 (국립재활원 재활연구소 건강보건연구과) ;
  • 문종훈 (국립재활원 재활연구소 건강보건연구과)
  • Jeon, Min-Jae (Dept. of Healthcare and Public Health Research, National Rehabilitation Research Institute, National Rehabilitation Center) ;
  • Moon, Jong-Hoon (Dept. of Healthcare and Public Health Research, National Rehabilitation Research Institute, National Rehabilitation Center)
  • 투고 : 2019.07.02
  • 심사 : 2019.09.20
  • 발행 : 2019.09.28
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

본 연구의 목적은 가상현실 훈련이 아급성 뇌졸중 환자의 상지기능과 일상생활활동에 미치는 효과를 규명하는 것이다. 아급성기 뇌졸중 환자 18명이 본 연구에 참여하였다. 모든 대상자는 실험군 9명과 대조군 9명으로 배정되었다. 두 군은 하루 30분, 주 5회, 4주 동안 보편적인 작업치료를 받았다. 실험군은 가상현실 훈련을 회기 마다 30분 더 받았으며, 대조군은 보편적인 작업치료를 회기 마다 30분 더 받았다. 결과 측정은 중재 전과 후에 Fugl-Meyer 평가와 한국판 수정바델지수에 의해 수행되었다. 연구 결과, 실험군은 중재 후 Fugl-Meyer 평가 점수와 한국판 수정바델지수 점수에서 유의한 향상을 보였다(p<.05). 대조군은 Fugl-Meyer 평가의 어깨/팔꿈치/전완, 손목, 손 하위항목과 한국판 수정바델지수에서 유의한 향상을 보였다(p<.05). 중재 후 실험군은 대조군보다 Fugl-Meyer 평가의 총점, 손목과 손하위항목에서 유의하게 더 큰 향상을 보였다(p<.05). 이러한 결과들은 가상현실 훈련이 아급성기 뇌졸중 환자의 상지기능 향상에 긍정적인 효과를 나타낼 수 있음을 시사한다.

The aim of this study was to investigate the effects of virtual reality training on upper extremity function and activities of daily living in patients with sub-acute stroke. The present study enrolled 18 patients with sub-acute stroke. All subjects were assigned into either the experimental group (n=9) or control group (n=9). Both groups received conventional occupational therapy for 30 minutes/day, 5 times a week, for 4 weeks. Additionally, the experimental group performed virtual reality training in each session for 30 minutes/day, and the control group conducted conventional occupational therapy in each session for 30 minutes/day. The outcome measures were performed through the Fugl-Meyer Assessment (FMA) and the Korean-modified Barthel Index (K-MBI) before and after intervention. In results, the experimental group showed significant improvements in the scores of FMA and K-MBI after intervention (p<.05). The control group showed significant improvements in the shoulder/elbow/forearm, wrist, and hand sub-domains of the FMA and K-MBI (p<.05). After intervention, the experimental group showed significantly greater improvements in the total score and in the wrist and hand sub-domains of the FMA than control group (p<.05). These findings suggest that virtual reality training may have positive effects on the improvements of upper extremity function in patients with sub-acute stroke.

키워드

참고문헌

  1. P. W. Duncan et al. (2005). Management of adult stroke rehabilitation care. Stroke, 36(9), 100-143.
  2. S. A. Maulden, J. Gassaway, S. D. Horn, R. J. Smout & G. DeJong. (2005). Timing of initiation of rehabilitation after stroke. Archives of physical medicine and rehabilitation, 86(12), 34-40. https://doi.org/10.1016/j.apmr.2005.08.119
  3. R. B. King. (1996). Quality of Life after Stroke. Stroke, 27(9), 1467-1472. https://doi.org/10.1161/01.STR.27.9.1467
  4. H. M. Feys et al. (1998). Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke. Stroke, 29(4), 785-792. https://doi.org/10.1161/01.STR.29.4.785
  5. D. Jack et al. (2001). Virtual reality-enhanced stroke rehabilitation. IEEE transactions on neural systems and rehabilitation engineering, 9(3), 308-318. https://doi.org/10.1109/7333.948460
  6. M. C. Howard. (2017). A Meta-Analysis and Systematic Literature Review of Virtual Reality Rehabilitation Programs. Computers in Human Behavior, 70(1), 317-327. https://doi.org/10.1016/j.chb.2017.01.013
  7. C. W. Yin, N. Y. Sien, L. A. Ying, S. F. C. M. Chung & D. Tan May Leng. (2014). Virtual reality for upper extremity rehabilitation in early stroke: a pilot randomized controlled trial. Clinical rehabilitation, 28(11), 1107-1114. https://doi.org/10.1177/0269215514532851
  8. G. Saposnik et al. (2010). Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation. Stroke, 41(7), 1477-1484. https://doi.org/10.1161/STROKEAHA.110.584979
  9. A. Henderson, N. Korner-Bitensky & M. Levin. (2007). Virtual reality in stroke rehabilitation: a systematic review of its effectiveness for upper limb motor recovery. Topics in stroke rehabilitation, 14(2), 52-61. https://doi.org/10.1310/tsr1402-52
  10. A. L. Faria, A. Andrade, L. Soares & S. B. i Badia. (2016). Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients. Journal of neuroengineering and rehabilitation, 13(1), 96-103. https://doi.org/10.1186/s12984-016-0204-z
  11. D. Y. Kim et al (2010). Assessment of post-stroke extrapersonal neglect using a three-dimensional immersive virtual street crossing program. Acta Neurologica Scandinavica, 121(3), 171-177. https://doi.org/10.1111/j.1600-0404.2009.01194.x
  12. L. M. Weber, D. M Nilsen, G. Gillen, J. Yoon & J. Stein. (2019). Immersive virtual reality mirror therapy for upper limb recovery following stroke: A pilot study. American journal of physical medicine & rehabilitation. DOI : 10.1097/PHM.0000000000001190. [Epub ahead of print]
  13. H. Kim, A. Lee, Y. I. Shin, W. H Chang, K. H. Koo, H. Seong & Y. H. Kim. (2018). Effects of digital smart glove system on motor recovery of upper extremity in subacute stroke patients. Annals of Physical and Rehabilitation Medicine, 61, e28. DOI : 10.1016/j.rehab.2018.05.061
  14. A. Mirelman, P. Bonato & J. E. Deutsch. (2009). Effects of training with a robot-virtual reality system compared with a robot alone on the gait of individuals after stroke. Stroke, 40(1), 169-174. DOI : 10.1161/STROKEAHA.108.516328
  15. S. Y. Heo, H. J. Lee, A. J. Ham, Y. N. Kim, S. N. Jeong & K. M. Kim. (2016). The Effects of Virtual Reality Therapy on Executive Function and Balance for Stroke Patients: A Randomized Controlled Clinical Trial. The Journal of Korean Society of Occupational Therapy, 24(4), 1-14. https://doi.org/10.14519/jksot.2016.24.4.01
  16. D. S. Lee & D. J. Kim. (2018). The Effect of XBOX based Virtual Reality Training on Stroke Patients' Upper Limb Function and Activities of Daily living. Korean Aging Friendly Industry Association, 10(2), 53-63. DOI : 10.34264/jkapa.2018.10.2.53
  17. Y. M. Lim, J. Y. Lee, S. J. Jo, Y. S. Ahn & D. H. Yoo. (2017). A Systematic Review on the Effects of Virtual reality-based Telerehabilitation for Stroke Patients. The Journal of Korean Society of Community Based Occupational Therapy, 7(1), 59-70. DOI : 10.18598/kcbot.2017.07.01.07
  18. D. H. Bang, Y. J. So & H. S. Cho. (2013). Imagery training effects of Upper limb function and Activities of daily living in Subacute stroke patients. Journal of Digital Convergence, 11(8), 235-242. https://doi.org/10.14400/JDPM.2013.11.8.235
  19. Y. Kang, D. L. Na & S. Hahn. (1997). A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. Journal of the Korean Neurological Association, 15(2), 300-308.
  20. S. J. Shin. (2016). The Effect of Apraxia on Activity of Daily Living in Stroke Patients. Journal of Digital Convergence, 14(6), 527-533. https://doi.org/10.14400/JDC.2016.14.6.527
  21. A. R. Fugl-Meyer, L. Jaasko, I. Leyman, S. Olsson & S. Steglind. (1975). The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scandinavian journal of rehabilitation medicine, 7(1), 13-31.
  22. J. Sanford, J. Moreland, L. R. Swanson, P. W. Stratford & C. Gowland. (1993). Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Physical therapy, 73(7), 447-454. https://doi.org/10.1093/ptj/73.7.447
  23. C. V. Granger, G. L. Albrecht & B. B. Hamilton. (1979). Outcome of Comprehensive Medical Rehabilitation: Measurement by PULSES Profile and The Barthel Index. Archives of physical medicine and rehabilitation, 60(4), 145-154.
  24. J. H. Moon, J. Y. Park, Y. S. Kim & I. H. Bak. (2018). Effect of Art Therapy-based Purposeful Activities on Hand Function, Daily Living, Depression, and Volition for Rehabilitation in Patients With Acute Stroke: A Pilot Study. Journal of Korean Society of Neurocognitive Rehabilitation, 10(1), 15-24. DOI : 10.29144/KSCTE.2018.10.1.15
  25. J. H. Moon, K. H. Kim, S. H. Lee, & Y. S. Won. (2017). Effects of Purposeful Activities Combined with Music on Upper Extremity Function, Therapeutic Motivation, and Mood in Acute Stroke Patients. PNF and Movement, 15(3), 267-279. DOI : 10.21598/JKPNFA.2017.15.3.267
  26. J. H. Moon, C. H. Na, K. Y. Park, S. J. Heo & C. H. Lee. (2018). A Pilot Investigation for usage Problems, Improvement Needs and Current Status of Upper Extremity Rehabilitation Equipment using SNS. The Journal of the Korea institute of electronic communication sciences, 13(2), 463-472. https://doi.org/10.13067/JKIECS.2018.13.2.463
  27. J. H. Moon, K. Y. Park, H. J. Kim & C. H. Na. (2018). The Effects of Task-Oriented Circuit Training Using Rehabilitation Tools on the Upper-Extremity Functions and Daily Activities of Patients with Acute Stroke: A Randomized Controlled Pilot Trial. Osong public health and research perspectives, 9(5), 225-230. DOI : 10.24171/j.phrp.2018.9.5.03
  28. J. Broeren, M. Rydmark, A. Bjorkdahl & K. S. Sunnerhagen. (2007). Assessment and training in a 3-dimensional virtual environment with haptics: a report on 5 cases of motor rehabilitation in the chronic stage after stroke. Neurorehabilitation and neural repair, 21(2), 180-189. https://doi.org/10.1177/1545968306290774
  29. A. S. Merians, H. Poizner, R. Boian, G. Burdea & S. Adamovich. (2006). Sensorimotor training in a virtual reality environment: does it improve functional recovery poststroke?. Neurorehabilitation and neural repair, 20(2), 252-267. https://doi.org/10.1177/1545968306286914
  30. Y. H. Choi, J. Ku, H. Lim, Y. H. Kim & N. J. Paik. (2016). Mobile game-based virtual reality rehabilitation program for upper limb dysfunction after ischemic stroke. Restorative neurology and neuroscience, 34(3), 455-463. https://doi.org/10.3233/RNN-150626
  31. S. J. Housman, K. M. Scott & D. J. Reinkensmeyer. (2009). A randomized controlled trial of gravity-supported, computer-enhanced arm exercise for individuals with severe hemiparesis. Neurorehabilitation and neural repair, 23(5), 505-514. https://doi.org/10.1177/1545968308331148
  32. S. H. Jang et al. (2005). Cortical Reorganization and Associated Functional Motor Recovery after Virtual Reality in Patients with Chronic Stroke: An Experimenter-Blind Preliminary Study. Archives of physical medicine and rehabilitation, 86(11), 2218-2223. https://doi.org/10.1016/j.apmr.2005.04.015
  33. K. August, J. A. Lewis, G. Chandar, A. Merians, B. Biswal & S. Adamovich. (2006). FMRI analysis of neural mechanisms underlying rehabilitation in virtual reality: activating secondary motor areas. In 2006 International Conference of the IEEE Engineering in Medicine and Biology Society (pp. 3692-3695). IEEE.
  34. H. S. Woo, W. K. Park & T. H. Cha. (2012). Correlation Between Korean-WMFT Functional Score and Activities of Daily Living. The Journal of Korean Society of Occupational Therapy, 20(3), 95-104.
  35. W. Kakuda et al. (2012). A multi-center study on low-frequency rTMS combined with intensive occupational therapy for upper limb hemiparesis in post-stroke patients. Journal of neuroengineering and rehabilitation, 9(1), 4. DOI : 10.1186/1743-0003-9-4.
  36. C. J. Parker et al. (2001). A multicentre randomized controlled trial of leisure therapy and conventional occupational therapy after stroke. Clinical rehabilitation, 15(1), 42-52. https://doi.org/10.1191/026921501666968247
  37. S. Smallfield & J. Karges. (2009). Classification of occupational therapy intervention for inpatient stroke rehabilitation. American Journal of Occupational Therapy, 63(4), 408-413. DOI : 10.5014/ajot.63.4.408