• 대한물리의학회지
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• 제12권3호
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• pp.99-104
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• 2017

PURPOSE: Gait disturbances in patients with hemiplegic stroke involve asymmetry of stance time. Step box training is used to supplement the limitations of stair walking training and increasing the torque value of the paralyzed lower leg's strength. This study aimed to investigate whether step-up training on unstable support could change walking ability in patients with chronic stroke. METHODS: Thirty stroke patients were randomly assigned to the step-up training group (experimental group), that performed training on an unstable surface, and the control group, that performed training on a stable surface. Walking speed, step length, and cadence were measured before and after training. Paired t-tests were used to compare pre- and post-intervention data, while the independent samples t-test was used to determine intergroup differences. Values of p < .05 were considered statistically significant. RESULTS: There was a significant difference in walking ability before versus after the intervention in both groups, although the experimental group showed greater differences than the control group (walking velocity by 8.1%; step length of the non-paralyzed side by 6.9%, respectively; p<.05). CONCLUSION: Step-up training might be more effective on an unstable surface than on a stable surface for increasing walking speed and step length of the non-paralyzed side.

• 한국산학기술학회논문지
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• 제11권9호
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• pp.3353-3357
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• 2010

본 연구는 만성 뇌졸중 환자를 대상으로 시각리듬자극(rhythmic visual stimulation, RVS)을 이용한 보행 운동을 적용하여 보행과 고유수용성감각에 미치는 효과를 알아보고자 하였다. 뇌졸중으로 6개월 이상 장애를 가진 21명이 연구에 참여하였고 실험군 10명과 대조군 11명으로 나누었다. 대조군은 14m의 보행로가 확보된 공간에서 준비운동 5분, 보행운동 20분, 정리운동 5분 씩 주 3회, 4주간 12회를 실시하였고, 실험군은 대조군의 운동프로그램과 같은 조건에서 보행운동시 시각리듬자극(RVS)을 추가적으로 적용하였다. 운동 전 후에 보행과 고유수용성감각을 측정하여 효과를 비교하였다. 통계처리 방법으로 실험 전?후 차이를 검증하기 위하여 Wilcoxon 부호 순위 검정을 실시하였고 대조군과의 차이 검증을 위하여 공분산분석 검정을 실시하였다. 모든 통계적 유의수준은 p<0.05로 하였다. 본 연구의 결과 시각리듬자극(RVS)이 적용된 실험군에서 보행속도와 분속수, Timed up and go test(TUG) 시간이 유의하게 증가하였고(p<.05), 고유수용성감각이 유의하게 증가하였다(p<.05). 결론적으로 시각리듬자극(RVS)을 이용한 보행운동이 만성 뇌졸중 환자의 보행과 고유수용성감각에 효과가 있는 것으로 나타났다. 향후 만성 뇌졸중 환자에게 음악적 요소인 시각리듬자극(RVS)이 정신적 육체적 기능을 상실한 뇌졸중 환자의 재활치료 프로그램에 적용하는 연구가 필요할 것으로 기대된다.

• 한국산학기술학회논문지
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• 제12권11호
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• pp.5019-5026
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• 2011

본 연구는 만성 편마비 환자의 교감신경 활동 강화가 근 긴장도 및 중추신경 흥분성 변화에 미치는 영향을 알아보기 위해 시행하였다. 연구기간은 2009년 10월 12일부터 12월 4일까지 실시하였으며, 연구대상자는 발병 후 6개월 이상 된 만성 편마비 환자 30명을 대상으로 하였다. 실험은 교감신경 활동을 강화하는 세 가지 과제(암산, 정적인 상태에서 쥐기운동, 쥐기운동 후 허혈)를 실시하였으며 측정은 과제를 수행하기 전과 중의 global synkinesis 수준과 중추신경원 활동전위을 각각 측정하였다. 중추신경원 활동전위는 H/Mmax비, V/Mmax비를 측정하였고, global synkinesis 수준은 근전도 활동전위의 실효치 값을 측정하여 분석하였다. 본 연구에서, global synkinesis 수준은 정적인 상태에서 쥐기 과제를 제외한 나머지 과제(암산, 쥐기 후 허혈)에서 슬관절 굴곡, 신전 시 감소했다(p<.05). 또한 V/Mmax비에서는 세 가지 과제 모두에서 감소하였다(p<.05). 결론적으로, 교감신경 활동 강화는 만성 편마비 환자의 중추신경 흥분성과 근 긴장도를 감소시킴을 알 수 있었다.

• 대한물리의학회지
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• 제8권2호
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• pp.271-280
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• 2013

PURPOSE: This study was conducted in chronic hemiplegic patients to examine the effect of the training of the ipsilateral arm that is identical to the model performing movements and the training of the contralateral arm on the function of the arm. METHODS: The subjects were participated total 2 patients(the subject 1 with left hemiplegia and the subject 2 with right hemiplegia). The study was conducted for 4 weeks. The action observation training were repeated 10 times in 10 days during intervention period. The evaluation of the arm function such as BBT, MFT and MAL in the each subject were examined 5 times in the baseline period, 10 times during the intervention period and 5 times during the baseline regression period. RESULTS: The results of the evaluation in each subject were presented as mean values and video graphs. The arm function of the 2 subjects were improved during the intervention period in comparison with the baseline period, and the improvement was maintained even during the regression baseline period. In addition, there were large variation ratio of BBT and MAL (AOU, QOM) in comparison with subject 1. CONCLUSION: According to the results, the action observation training was more effective in improving upper limb function of stroke patients who imitate the performed behavior of paralyed parts on the same side.

• 재활치료과학
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• 제6권2호
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• pp.47-58
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• 2017

목적: 뇌졸중 환자에게 의미 있는 작업을 기반으로 한 양측성 상지 훈련의 효과를 알아보기 위한 예비연구로 실시되었다. 연구방법: 뇌졸중으로 인한 편마비를 가진 환자 4명을 대상으로 실험군(2명)과 대조군(2명)으로 나누어 진행되었다. 2016년 5월부터 8월까지 진행하였으며, 대상자 당 총 5주간, 주 3회, 회기 당 60분의 작업기반 양측성상지훈련 중재와 전통적 양측성 상지 훈련을 각 각 실시하였다. 중재 전 후로 EMG, 가속도계, ARAT, Y-BAT, SIS, COPM를 실시하여 각 군간 비교 하였다. 결과: 실험군은 대조군 보다 노쪽 손목폄근과 앞 어깨 세모근의 근 활성도, SIS에서 손 기능(Hand function), 기억력(Memory)항목을 제외한 모든 항목에서 중재 전 후 큰 변화량을 나타냈으며, 양손의 사용량을 측정한 가속도계와 COPM, Y-BIT, ARAT평가의 잡기(grasp), 집기(pinch), 대동작 (gross movement)항목에서 실험군은 대조군 보다 중재 전 후 큰 변화량을 나타냈다. 결론: 본 연구를 통해 작업기반 양측성 상지 훈련이 신경학적 변화를 통한 상지기능 회복 및 사회참여 등에 효과적임을 알 수 있었다. 추후 연구에서는 작업기반 양측성 상지 훈련 프로토콜의 내용에 대해 높은 내용 타당도를 확보하기 위한 개발 연구가 필요할 것이며, 이를 토대로 많은 뇌졸중 환자를 대상으로 한 무작위대조군 실험 연구를 통한 효과 검증과 효과지속성에 대한 검증이 필요할 것이다.

• 대한물리치료과학회지
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• 제11권2호
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• pp.27-37
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• 2004

The propose of the study was to evaluate the efficacy of the partial body weight support during treadmill training on the ambulation in elderly with chronic stroke. Fourteen hemiplegic volunteers participated and were divided into an experimental and control groups. In the experimental group, the body weight support during treadmill training was performed 3 times per week for 6 weeks. In the control group, usual treadmill training was applied. Before and after experiments, temporal-spatial gait parameters were measured. The date of 14 patients who carried out the whole experimental course were statistically analyzed. The results of the study were : 1. In the comparison of gait velocity before and after experiment, the gait velocity was significantly increased in the experimental group and the control group(p<.05). In the comparison of difference of the gait velocity between groups, there was not significant difference between the experimental group and the control group(p>.05). 2. In comparison of gait cadence before and after experiment, the gait cadence was significantly increased in both groups(p<.05). In the comparison of difference of the gait cadence between groups, there was not significant difference between the experimental group and the control group(p>.05). 3. In the comparison of step length before and after experiment, the step length was significantly increased in the experimental group and the control group(p<.05). In the comparison of difference of the step length between groups, there was not significant difference between the experimental group and the control group(p>.05). 4. In the comparison of vastus medialis root mean square(RMS) before and after experiment, the vastus medialis RMS was significantly increased in the experimental group(p<.05). In the comparison of vastus medialis root mean square(RMS) before and after experiment, the vastus medialis RMS was not significantly increased in the experimental group(p>.05). In the comparison of difference of the vastus medialis RMS between groups, there was not significant difference between the experimental group and the control group(p>.05). 5. In the comparison of latency of somatosensory evoke potential(SSEP) before and after experiment, the latency of SSEP was significantly increased in the experimental group(p<.05). In the comparison of latency of somatosensory evoke potential(SSEP) before and after experiment, the latency of SSEP was significantly decreased in the control group(p>.05). In the comparison of difference of the latency of SSEP between groups, there was not significant difference between the experimental group and the control group(p>.05). 6. In the comparison of functional ambulation profile(FAP) before and after experiment, the FAP was not significant difference in the experimental group and the control group(p>.05). In the comparison of difference of the FAP between groups, there was not significant difference between the experimental group and the control group(p>.05).

• 대한정형도수물리치료학회지
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• 제10권1호
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• pp.83-101
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• 2004

The propose of the study was to evaluate the efficacy of the partial body weight support during treadmill training on the ambulation in elderly with chronic stroke. Fourteen hemiplegic volunteers participated and were divided into an experimental and control groups. In the experimental group, the body weight support during treadmill training was performed 3 times per week for 6 weeks. In the control group, usual treadmill training was applied. Before and after experiments, temporal-spatial gait parameters were measured. The date of 14 patients who carried out the whole experimental course were statistically analyzed. The results of the study were : 1. In the comparison of gait velocity before and after experiment, the gait velocity was significantly increased in the experimental group and the control group(p<.05). In the comparison of difference of the gait velocity between groups, there was not, significant difference between the experimental group and the control group(p>.05). 2. In comparison of gait cadence before and after experiment, the gait cadence was significantly increased in both groups(p<.05). In the comparison of difference of the gait cadence between groups, there was not significant difference between the experimental group and the control group(p>.05). 3. In the comparison of step length before and after experiment, the step length was significantly increased in the experimental group and the control group(p<.05). In the comparison of difference of the step length between groups, there was not significant difference between the experimental group and the control group(p>.05). 4. In the comparison of single support time asymmetry before and after experiment, the single support time asymmetry was no significant difference between groups(p>.05). In the comparison of difference of the single support time asymmetry between groups, there was not significant difference between the experimental group and the control group(p>.05). 5. In the comparison of step length asymmetry before and. after experiment, the step length asymmetry was not significant difference between the experimental group and the control group(p>.05). In the comparison of difference of the single step length asymmetry between groups, there was not significant difference between the experimental group and the control group(p>.05).

• 대한간호학회지
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• 제20권1호
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• pp.88-117
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• 1990

The purposes of this study are to delineate a profile of the state of a stroke patient's adaptation at 3 months after hospitalization and to explore the relationship between the level of adaptation and the variables which influence the adaptation of hemiplegic patients. To these ends, theoretical framework was derived basically from the stress adaptation model. The basic assumption underlying the level of adaptation is influenced by the presenting focal, contextual and residual stimuli. This group of stimuli is further operationalized and represented by a perception of stress. which is the perceived effect of the disability and by the mediating variables such as sociodemographic factors as an external conditioning variables and perceived social support and hardiness personality characteristics as an internal intervening variables. The dependent varibales in this study is the level of physical, psychological and social adaptation and is hypothesized to be a function of the interaction between 3 sets of variables namely, the perceived disability effect, external conditioning variables and internal intevening varibles. A total of fourty three subjects from 3 general hospitals in Seoul were observed and interviewed with the aid of 7 structured instruments. The data were collected twice on each subject : first at the pre-discharge period arid at 3 months post-discharge from hospital for the second time. The study was carried out for the period from February to August, 1988. The instruments used for the study include 4 existing scales and 3 scales developed by the researcher for this study. They are : 1) The ADL dependency scale and the scale of the clinical physical functions for the assessment of physical adaptation. 2) the SDS(self report of depression) to measure the level of psychological adaptation. 3) The scale for the amount of social activities for the measurement of the level of social adaptation. 4) The scale for the perceived effect of disability for the measurement of the focal stimuli. 5) The health related hardiness scale and the perceived interpersonal support self evaluation list(ISEL) for the measurement of the hardiness personality character and the perceived social support. The data obtained were analyzed using percentage, oneway ANOVA, Pearson coefficients correlation and stepwise multiple regression. The findings provide valuable information about the present level of physical adaptation at 3 months after discharge. The patient revealed a decreased ADL dependency and lowered limitation of physical function as compared with pre - discharge state. Psycholcgically, the average degree of depression at follow up was within normal range of depression. Socially, the amount of social activities was very low. The one way ANOVA and the correlational analysis revealed the relationship between the 3 sets of variables and the adaptation level as follows : 1) The perceived disability effect was related to the degree of the depression and the amount of social activities but was not related to the physical adaptation. 2) Among the sociodemographic variables, sex and education were related to the difference of ADL dependency and the change of physical function. These factors indicate that women more than men and educated more than the less educated were found more independent. The education was also related to the degree of depression suggesting that the higher the educational level, the more well adapted the patients were both physically and psychologically. Age, marital status and job state were not found to be related to the patient's adaptation level. 3) Among the internal intervening variables, the health related hardiness characteristic was related to the differences of ADL dependency, physical functions and the social activities, indicating that the higher the hardiness character the higher the level of physical and social adaptation. 4) The perceived social support, another internal intervening variable, was related to the degree of depression and the social activities. This data suggest that the higher the perception of social support, the better adapted the patients were psychogically and socially. In summarizing the results of the correlational analysis, the level of physical adaptation was influenced by sex, the years of education and the hardiness character. The level of psychological adaptation was influenced by the years of education, the perceived disability effect and the perceived social support. And the level of social adaptation was influenced by the perceived disability effect, the hardiness character and the perceived social support. The stepwise multiple regression analysis shows findings as follows : 1) The most important factor to explain the difference of ADL dependency was sex, indicating females were more independent than males. 2) The most important factor to explain the difference of physical function and the degree of depression was the patient's education level. 3) The strongest explaining factor for the amount of social activities was perceived self esteem(one of the subconcepts of perceived social support). Thus the most important factors influencing the level of adaptation were found to be sex, education, the hardiness character and self esteem. From the above findings, the significance of this study can be delineated as follows : 1) Corroboration of the assumed relationship between the various variables and the adaptation level as suggested in the conceptual model. 2) Support for the feasibility of the cognitive approach for nursing intervention such as hardness character training, counselling and teaching for self-care in the chronic patients.