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인지적 게임을 이용한 능동적 두경부 움직임 훈련이 뇌졸중 환자의 균형에 미치는 영향

Effects of Active Craniocervical Movement Training Using a Cognitive Game on Stroke Patients' Balance

  • 김미선 (식품의약품안전평가원 의료기기심사부 정형재활기기과) ;
  • 최우성 (충남대학교 의공학연구소) ;
  • 최종덕 (대전대학교 보건의료과학대학 물리치료학과)
  • Kim, Mi-sun (Institute of Food and Drug Safety Evaluation, Medical Device Evaluation Department Orthopedic and Restorative Device Division) ;
  • Choi, Woo-sung (Institute of Biomedical Engineering, Chungnam National University) ;
  • Choi, Jong-Duk (Department of Physical Therapy, College of Health & Medical Science, Daejeon University)
  • 투고 : 2020.12.02
  • 심사 : 2021.01.18
  • 발행 : 2021.02.20

초록

Background: Compared with normal people, stroke patients have decreased voluntary craniocervical motion, which affects their balance. Objects: This study was conducted in order to examine the effects of active craniocervical movement training using a cognitive game on stroke patient's cervical movement control ability, balance, and functional mobility. Methods: The subject of this study were 29chronic stroke patients who were randomly allocated to either an experimental, cognitive game group (n = 15), or control group (n = 14), to which only neuro-developmental treatment (NDT) was applied. The intervention was conducted 5 times per week, 30 minutes per each time, for a total of 4 weeks. Active angle reproduction test, static stability test, limits of stability test, and Time up and Go (TUG) test, respectively, were carried out in order to evaluate cervical movement control ability, static balance, dynamic balance, and functional mobility. Paired t-test was used in order to compare differences between prior to after the intervention, along with an independent-test in order to compare prior to and after-intervention differences between the two groups. Results: After the craniocervical training with a body-driven cognitive game, the experimental group showed significant differences in flexion, extension, and lateral flexion on the affected side, and rotation on the affected side in the active angle reproduction test. The experimental group indicated significant differences in sway length both with eyes-open and with eyesclosed in the static stability test and in limits of stability test and TUG test. The control group to which NDT was applied had significant differences in flexion in the active angle reproduction test and in limits of stability test and TUG test. Conclusion: The above results mean that craniocervical training using a body-driven cognitive game positively influences stroke patient's cervical movement control ability and as a result their balance and functional mobility.

키워드

참고문헌

  1. Leung J, Alais D, Carlile S. Compression of auditory space during rapid head turns. Proc Natl Acad Sci U S A 2008;105(17):6492-7. https://doi.org/10.1073/pnas.0710837105
  2. Lamontagne A, Paquet N, Fung J. Postural adjustments to voluntary head motions during standing are modified following stroke. Clin Biomech (Bristol, Avon) 2003;18(9):832-42. https://doi.org/10.1016/S0268-0033(03)00141-4
  3. Keshner EA, Woollacott MH, Debu B. Neck, trunk and limb muscle responses during postural perturbations in humans. Exp Brain Res 1988;71(3):455-66. https://doi.org/10.1007/BF00248739
  4. Peterson BW, Choi H, Hain T, Keshner E, Peng GC. Dynamic and kinematic strategies for head movement control. Ann N Y Acad Sci 2001;942:381-93.
  5. Norre ME, Forrez G, Stevens A, Beckers A. Cervical vertigo diagnosed by posturography? Preliminary report. Acta Otorhinolaryngol Belg 1987;41(4):574-81.
  6. Heikkila H, Johansson M, Wenngren BI. Effects of acupuncture, cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study. Man Ther 2000;5(3):151-7. https://doi.org/10.1054/math.2000.0357
  7. Paloski WH, Wood SJ, Feiveson AH, Black FO, Hwang EY, Reschke MF. Destabilization of human balance control by static and dynamic head tilts. Gait Posture 2006;23(3):315-23. https://doi.org/10.1016/j.gaitpost.2005.04.009
  8. Barin K, Seitz CM, Welling DB. Effect of head orientation on the diagnostic sensitivity of posturography in patients with compensated unilateral lesions. Otolaryngol Head Neck Surg 1992;106(4):355-62. https://doi.org/10.1177/019459989210600407
  9. Kogler A, Lindfors J, Odkvist LM, Ledin T. Postural stability using different neck positions in normal subjects and patients with neck trauma. Acta Otolaryngol 2000;120(2):151-5. https://doi.org/10.1080/000164800750000801
  10. Koceja DM, Allway D, Earles DR. Age differences in postural sway during volitional head movement. Arch Phys Med Rehabil 1999;80(12):1537-41. https://doi.org/10.1016/S0003-9993(99)90327-1
  11. Sjostrom H, Allum JH, Carpenter MG, Adkin AL, Honegger F, Ettlin T. Trunk sway measures of postural stability during clinical balance tests in patients with chronic whiplash injury symptoms. Spine (Phila Pa 1976) 2003;28(15):1725-34. https://doi.org/10.1097/01.BRS.0000083170.34304.A3
  12. Field S, Treleaven J, Jull G. Standing balance: a comparison between idiopathic and whiplash-induced neck pain. Man Ther 2008;13(3):183-91. https://doi.org/10.1016/j.math.2006.12.005
  13. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987;67(2):206-7. https://doi.org/10.1093/ptj/67.2.206
  14. Keshner EA, Dhaher Y. Characterizing head motion in three planes during combined visual and base of support disturbances in healthy and visually sensitive subjects. Gait Posture 2008;28(1):127-34. https://doi.org/10.1016/j.gaitpost.2007.11.003
  15. Lamontagne A, De Serres SJ, Fung J, Paquet N. Stroke affects the coordination and stabilization of head, thorax and pelvis during voluntary horizontal head motions performed in walking. Clin Neurophysiol 2005;116(1):101-11. https://doi.org/10.1016/j.clinph.2004.07.027
  16. Roby-Brami A, Feydy A, Combeaud M, Biryukova EV, Bussel B, Levin MF. Motor compensation and recovery for reaching in stroke patients. Acta Neurol Scand 2003;107(5):369-81. https://doi.org/10.1034/j.1600-0404.2003.00021.x
  17. Lee KS. The relationship of muscle activities of neck, trunk, lower limb and balance following head rotation in stroke patients [thesis]. Gyeongsan: Daegu University; 2010.
  18. Urton ML, Kohia M, Davis J, Neill MR. Systematic literature review of treatment interventions for upper extremity hemiparesis following stroke. Occup Ther Int 2007;14(1):11-27. https://doi.org/10.1002/oti.220
  19. Jack D, Boian R, Merians AS, Tremaine M, Burdea GC, Adamovich SV, et al. Virtual reality-enhanced stroke rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2001;9(3):308-18. https://doi.org/10.1109/7333.948460
  20. Gordon SM, Troncale J. Evaluation of the effectiveness of an addiction treatment training program for physicians. Am Clin Lab 2002;21(5):22-4.
  21. Rizzo J, Bernstein D, Gress F. A performance, safety and cost comparison of reusable and disposable endoscopic biopsy forceps: a prospective, randomized trial. Gastrointest Endosc 2000;51(3):257-61. https://doi.org/10.1016/S0016-5107(00)70351-8
  22. Sveistrup H. Motor rehabilitation using virtual reality. J Neuroeng Rehabil 2004;1(1):10. https://doi.org/10.1186/1743-0003-1-10
  23. Colarusso RP, Hammill DD. Motor-Free visual perception test - revised. Novato: Academic Therapy Publications; 1996.
  24. Kwon YC, Park JH. Korean version of Mini-Mental State Examination (MMSE-K) - part I: development of the test for the elderly -. J Korean Neuropsychiatr Assoc 1989;28(1):125-35.
  25. Chen J, Solinger AB, Poncet JF, Lantz CA. Meta-analysis of normative cervical motion. Spine (Phila Pa 1976) 1999;24(15):1571-8. https://doi.org/10.1097/00007632-199908010-00011
  26. Lantz CA, Chen J, Buch D. Clinical validity and stability of active and passive cervical range of motion with regard to total and unilateral uniplanar motion. Spine (Phila Pa 1976) 1999;24(11):1082-9. https://doi.org/10.1097/00007632-199906010-00007
  27. Loudon JK, Ruhl M, Field E. Ability to reproduce head position after whiplash injury. Spine (Phila Pa 1976) 1997;22(8):865-8. https://doi.org/10.1097/00007632-199704150-00008
  28. Kristjansson E, Dall'Alba P, Jull G. Cervicocephalic kinaesthesia: reliability of a new test approach. Physiother Res Int 2001;6(4):224-35. https://doi.org/10.1002/pri.230
  29. Dumas JP, Arsenault AB, Boudreau G, Magnoux E, Lepage Y, Bellavance A, et al. Physical impairments in cervicogenic headache: traumatic vs. nontraumatic onset. Cephalalgia 2001;21(9):884-93. https://doi.org/10.1046/j.1468-2982.2001.00264.x
  30. Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the timed "up & go" test in people with Parkinson disease. Phys Ther 2001;81(2):810-8. https://doi.org/10.1093/ptj/81.2.810
  31. Podsiadlo D, Richardson S. The timed "up & go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39(2):142-8. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  32. Haavik-Taylor H, Murphy B. Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study. Clin Neurophysiol 2007;118(2):391-402. https://doi.org/10.1016/j.clinph.2006.09.014
  33. Taylor HH, Murphy B. Altered sensorimotor integration with cervical spine manipulation. J Manipulative Physiol Ther 2008;31(2):115-26. https://doi.org/10.1016/j.jmpt.2007.12.011
  34. Humphreys BK, Irgens PM. The effect of a rehabilitation exercise program on head repositioning accuracy and reported levels of pain in chronic neck pain subjects. J Whiplash Relat Disord 2002;1(1):99-112. https://doi.org/10.1300/J180v01n01_09
  35. Jull G, Falla D, Treleaven J, Hodges P, Vicenzino B. Retraining cervical joint position sense: the effect of two exercise regimes. J Orthop Res 2007;25(3):404-12. https://doi.org/10.1002/jor.20220
  36. van Nes IJ, Geurts AC, Hendricks HT, Duysens J. Short-term effects of whole-body vibration on postural control in unilateral chronic stroke patients: preliminary evidence. Am J Phys Med Rehabil 2004;83(11):867-73. https://doi.org/10.1097/01.PHM.0000140801.23135.09
  37. Cromwell RL, Newton RA, Carlton LG. Horizontal plane head stabilization during locomotor tasks. J Mot Behav 2001;33(1):49-58. https://doi.org/10.1080/00222890109601902
  38. Imai T, Moore ST, Raphan T, Cohen B. Interaction of the body, head, and eyes during walking and turning. Exp Brain Res 2001;136(1):1-18. https://doi.org/10.1007/s002210000533
  39. Bohannon RW. Lateral trunk flexion strength: impairment, measurement reliability and implications following unilateral brain lesion. Int J Rehabil Res 1992;15(3):249-51. https://doi.org/10.1097/00004356-199209000-00010
  40. Tanaka S, Hachisuka K, Ogata H. Trunk rotatory muscle performance in post-stroke hemiplegic patients. Am J Phys Med Rehabil 1997;76(5):366-9. https://doi.org/10.1097/00002060-199709000-00003
  41. Kairy D, Paquet N, Fung J. A postural adaptation test for stroke patients. Disabil Rehabil 2003;25(3):127-35. https://doi.org/10.1080/0963828021000024924