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The Effects of Dual Task Training on the Balance, Upper Extremity Function, and Activities of Daily Living in the Chronic Stroke Patients

이중과제 훈련이 만성 뇌졸중 환자의 균형, 상지기능, 일상생활활동 수행능력에 미치는 효과

  • Yu, Ji-Ae (Department of Occupational Therapy, Chungju University) ;
  • Park, Ju-Hyung (Department of Occupational Therapy, Chungju University)
  • 유지애 (청주대학교 작업치료학과 대학원) ;
  • 박주형 (청주대학교 작업치료학과 대학원)
  • Received : 2020.05.03
  • Accepted : 2020.06.20
  • Published : 2020.06.28

Abstract

This study investigated the effects of dual task training on balance, upper extremity motor function and activities of daily living in patients with chronic stroke. The study subjects were 14 chronic stroke patients. dual task training groups(n=7), and single task training groups(n=7). The intervention period was conducted for 3 times a week, 30 minutes per session, and 4 weeks for all groups. To measure the BT4, JTT, K-MBI were used before and after the intervention. Dual task training groups showed a significant increase in BT 4 and JTT scores(p<.05). The difference between the two groups was significant in the BT4 and JJT scores(p<.05). There was a score improvement in K-MBI, but there was no statistically significant difference(p>.05) Dual task training was effective in facilitating balance, upper extremity function and activities of daily living in patients with chronic stroke.

본 연구는 만성기 뇌졸중 환자에서 이중과제 훈련이 균형, 상지기능, 일상생활활동 수행능력에 미치는 효과를 알아보고자 실시하였다. 14명의 만성기 뇌졸중 환자를 대상으로 7명은 이중과제 훈련을, 7명은 단일과제 훈련을 주 3회, 회당 30분, 4주간 실시하였다. 균형능력의 평가는 Balance Trainer 4(BT 4)를 사용하였고, 상지기능은 젭슨-테일러 손 기능 평가(JTT)를, 일상생활활동 수행능력 평가는 한글판 수정바델지수(K-MBI)를 사용하였다. 중재 후, 이중과제 훈련군이 BT 4, JTT에서 유의한 변화를 보였다(p<.05). 두 그룹 간의 차이도 BT 4, JTT에서 유의한 차이를 보였다(p<.05). K-MBI 점수의 향상은 있었지만 유의한 차이는 보이지 않았다(p>.05). 이중과제 훈련군이 만성기 뇌졸중 환자의 균형, 상지기능, 일상생활활동 수행능력을 향상하는데 도움이 될 것으로 사료된다.

Keywords

References

  1. G. B. Prange, M. J. A. Jannink, C. G. M. Groothuis-Oudshoorn, H. J. Hermens & M. J. IJzerman. (2006). Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. The Journal of Rehabilitation Research and Development, 43(2), 171. DOI : 10.1682/jrrd.2005.04.0076
  2. Y. R. Kim, Y. I. Kim & M. J. Kim. (2017). A Convergent study of the physical related quality of life using SF-8 of stroke patient's caregiver. Journal of the Korea Convergence Society, 8(12), 119-127. DOI : 10.15207/JKCS.2017.8.12.119
  3. P. W. Duncan, L. B. Goldstein, R. D. Horner, P. B. Landsman, G. P. Samsa, & D. B. Matchar. (1994). Similar motor recovery of upper and lower extremities after stroke. Stroke, 25(6), 1181-1188. DOI : 10.1161/01.str.25.6.1181
  4. A. F. Pettersson, E. Olsson, & L. O. Wahlund. (2007). Effect of Divided Attention on Gait in Subjects With and Without Cognitive Impairment. Journal of Geriatric Psychiatry and Neurology, 20(1), 58-62. DOI : 10.1177/0891988706293528
  5. R. Kitatani, K. Ohata, K. Sakuma, Y. Aga, N. Yamakami, Y. Hashiguchi & S. Yamada, (2016). Ankle muscle coactivation during gait is decrease immediately after anterior weight shift practice in adults after stroke. Gait & Posture. 45(3), 35-40. DOI : 10.1016/j.gaitpost.2016.01.006
  6. S. C. Watson, L. S. Chipchase & S. Mackintosh. (2004). Balance, fear of falling, pain and gait aiduse by low care older people: Pilot study. Australasian Journal on Ageing, 23(2), 77-81. DOI : 10.1111/j.1741-6612.2004.00021.
  7. G. M. Babulal, T. N. Huskey, C. M. Roe, S. A. Goette & L. T. Connor. (2015). Cognitive impairments and mood disruptions negatively impact instrumental activities of daily living performance in the first three months after a first stroke. Topics in Stroke Rehabilitaion, 22(2), 144-151. DOI : 10.1179/1074935714Z.0000000012
  8. E. Kal, H. Houdijk, J. van der Kamp, M. Verhoef, R. Prosee, E. Groet & E. Scherder. (2018). Are the effects of internal focus instructions different from external focus instructions given during balance training in stroke patients? A double-blind randomized controlled trial. Clinical Rehabilitation 33(2). DOI : 10.1177/0269215518795243
  9. K. J. Park, H. S. Rhee, E. H. Cho, S. H. Koh & K. W. Lee. (1998). The influence of Lowenstein Occupational Therapy Cognitive Assessment on admition to Functional Independence Measure at discharge. The Journal of Korean Society of Occupational Therapy, 6(1), 1-13.
  10. S. O'Shea, M. E. Morris & R. Iansek. (2002). Dual Task Interference During Gait in People With Parkinson Disease: Effects of Motor Versus Cognitive Secondary Tasks. Physical Therapy, 82(9), 888-897. DOI : 10.1093/ptj/82.9.888
  11. D. A. Wajda, A. Mirelman, J. M. Hausdorff & J. J. Sosnoff. (2017). Intervention modalities for targeting cognitive-motor interference in individuals with neurodegenerative disease A systematic review. Expert Review of Neurotherapeutics, 17(3), 251-261. DOI : 10.1080/14737175.2016.1227704
  12. Y. R. Yang, R. Y. Wang, Y. C. Chen & M. J. Kao. (2007). Dual-Task Exercise Improves Walking Ability in Chronic Stroke: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 88(10), 1236-1240. DOI : 10.1016/j.apmr.2007.06.762
  13. K. I. Erickson, S. J. Colcombe, R. Wadhwa, L. Bherer, M. S. Peterson & P. Scalf. (2007). Training-induced functional activation changes in dual-task processing: an FMRI study. Cerebral Cortex, 17(1), 192-204. DOI : 10.1093/cercor/bhj137
  14. I. Melzer, M. Goldring, Y. Melzer, E. Green & I. Tzedek. (2010). Voluntary stepping behavior under single- and dual-task conditions in chronic stroke survivors: A comparison between the involved and uninvolved legs. Journal of Electromyography and Kinesiology, 20(6), 1082-1087. DOI : 10.1016/j.jelekin.2010.07.001
  15. Y. J. Kim, H. H. Son, J. L. Oh & R. J. Park. (2011). Effects of Dual Task Balance Training on Balance and Activities of Daily Living in Stroke Patient. The Journal of Korean Society of Physical Therapy, 6(1), 19-29.
  16. H. K. Park, K. H. Cho & W. H. Lee. (2011). The Effects of Dual Task Training on Postural Stability and Balance in Chronic Stroke. Journal of the Korea Academia-Industrial cooperation Society, 12(8), 3555-3562. DOI : 10.5762/KAIS.2011.12.8.3555
  17. H. S. Hwang, J. H. Kim & B. R. Choi. (2017). Comparison of the effects of visual feedback training and unstable surface training on static and dynamic balance in patients with stroke. Phys Ther Sci, 29(10), 1720-1722. DOI : 10.1589/jpts.29.1720
  18. K. Jadelis, M. E. Miller, W. H. Ettinger & S. P. Messier. (2001). Strength, Balance, and the Modifying Effects of Obesity and Knee Pain: Results from the Observational Arthritis Study in Seniors (OASIS). Journal of the American Geriatrics Society, 49(7), 884-891. DOI : 10.1046/j.1532-5415.2001.49178.x
  19. R. H. Jebsen, N. Taylor, R. B. Trieschmann, M. J. Trotter & L. A. Howard. (1969). An objective and standardized test of hand function. Archives of Physical Medicine and Rehabilitation, 50, 311-319.
  20. S. Shah, F. Vanclay & B. Cooper. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology, 42(8), 703-709. DOI : 10.1016/0895-4356(89)90065-6
  21. S. M. Jung & D. H. An. (2007). Effects of Short-Term Intensive Balance Training for the Performance Ability of Lower Extremities in the Elderly. Korean Research Society of Physical Therapy, 14(1), 11-20.
  22. S. W. Lee, J. H. Lee & Y. W. Lee. (2012). The Effect of Dual Motor Task Training on Sitting for Balance in Patients with Chronic Stroke. Journal of Special Education & Rehabilitation Science, 51(2), 301-318. DOI : 10.1589/jpts.24.345
  23. J. W. Kim, S. M. Kim & R. J. Park. (2003). The Effects of Task-Oriented Functional Training on Standing Balance in Stroke Patients. The Journal of Korean Society of Physical Therapy, 15(4), 923-936.
  24. M. A. Riley, T. A. Stoffregen, M. J. Grocki & M. T. Turvey. (1999). Postural stabilization for the control of touching. Human Movement Science, 18(6), 795-817. DOI : 10.1016/S0167-9457(99)00041-X
  25. N. H. McNevin, C. H. Shea & G. Wulf. (2003). Increasing the distance of an external focus of attention enhances learning. Psychological Research, 67(1), 22-29. https://doi.org/10.1007/s00426-002-0093-6
  26. T. A. Stoffregen, R. J. Pagulayan, B. G. Bardy & L. J. Hettinger. (2000). Modulating postural control to facilitate visual performance. Human Movement Science, 19(2), 203-220. DOI : 10.1016/S0167-9457(00)00009-9
  27. J. M. Kim, Y. S. Kim, J. W. Lee, H. Y. Chung & J. S. Roh. (1997). The Relationship Between Sensory Organization and Balance in Patients With Hemiplegia. Korean Research Society of Physical Therapy, 4(3), 61-69.
  28. H. K. Hur, M. C. Kim, M. O. Cho & S. S. Choi. (1997). The relationships among Berg's balance, daily living activities and depression for the aged. Korean Journal of Research in Gerontology, 6, 3-18.
  29. S. H. An, C. S. Park & Y. J. Seo. (2007). The Relationship Between Postural Control, ADL Function, Muscle Tone, and Functional Improvement in Chronic Stroke Patients. Korean Research Society of Physical Therapy, 14(1), 64-73.
  30. Y. H. Gu & B. R. Kim. (2013) An Impact of Action-Observation Training and Task-Oriented Training on Activities of Daily Living of Stroke Patients. Journal of Korean Society of Integrative Medicine, 1(3), 19-28. DOI : 10.15268/ksim.2013.1.3.019