• 재활치료과학
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• 제6권2호
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• pp.37-45
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• 2017

Background: The presence of visuospatial impairment can make patients slow functional recovery and impede the rehabilitation process in TBI patients. Objective: The aim of this study is to investigate effects of prism adaptation treatment for functional outcomes in patients following traumatic brain injury. Methods: The subject received prism adaptation treatment for 2 weeks additionally during traditional rehabilitation for 4 weeks. The Patient has prism adaptation treatment while wearing wedge prisms that shift the external environment about $12^{\circ}$ leftward. The patient received 10 sessions, 15-20min each session. Outcome measures were visuospatial deficit(line bisection, latter cancellation), Visual and spatial perception(LOTCA-visual perception and spatial perception), motor function of upper extremity(FMA U/E; Fugl-Meyer motor assessment upper extremity, ARAT; Action research arm test), balance(BBS; Berg Balance Scale), mobility(FAC; Functional ambulation classification) and functional level(FIM; Functional independent measure). All Assessments took place on study entry and post-treatment assessments were performed at discharge from the hospital. Results: After prism adaptation, the visuospatial impairment scores improved as indicated in the line bisection(-15.2 to -6.02), latter cancellation(2 to 0) and LOTCA- spatial perception scores(7 to 9). The upper motor function improved as indicated in the scores of affected FMA U/E(21 to 40) and ARAT(4 to 22). Ambulation and balance improved as indicated in the BBS scores(25 to 38) and FAC scores(0 to 4). ADL function improved as indicated in the FIM total scores 54 to 70(motor 34 to 61, cognition 20 to 29). Conclusion: Prism adaptation did improve functional level such as motor functions and ADL abilities in TBI patient. Further research is recommended.

• 대한통합의학회지
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• 제6권3호
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• pp.123-130
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• 2018

Purpose : The purpose of this study was to investigate the effects of mirror therapy with functional electrical stimulation to improve upper extremity motor function and activities of daily living (ADL) in stroke patients. Method : Thirty patients were randomly assigned to the experimental and control groups 15 patients in each. All subjects received the general occupational therapy consisting of five 30 min sessions per week for 8 weeks, in addition to 30 min of mirror therapy with functional electrical stimulation for the experimental group and 30 min of functional electrical stimulation for the control group for each session. To measure the functions of the upper limb and performance capacities in ADL, the Fugl-Meyer Assessment (FMA), and Manual Function Test (MFT), Modified Barthel Index (MBI) were used before and after the interventions. Results : Both the experimental and control groups showed a statistically significant increase in post-treatment FMA, MFT and MBI scores compared to their pre-treatment scores (p<.05). In addition, intergroup comparisons revealed a statistically significant increase in the scores of all assessments for the experimental group compared to those for the control group (p<.05). Conclusion : Based on these results, it is reasonable to conclude that mirror therapy with functional electrical stimulation is an effective intervention for improving upper limb motor function and ADL performance in stroke patients.

• 대한통합의학회지
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• 제5권1호
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• pp.43-53
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• 2017

Purpose : To examine the relative absolute reliability and validity of step test (ST) scores in subjects with chronic stroke. Method : A total of 27 stroke patients, participated in the study. A relative reliability index (intraclass correlation coefficient, ICC) was used to examine the level of agreement of inter-rater test-retest reliability for ST score. Absolute reliability indices, including the standard error of measurement(SEM) and the minimal detectable change (MDC), and limits of agreement by Bland and Altman analysis. The validity was demonstrated by spearman correlation of ST score with 10 m Walk Test (10mWT), Fugl-Meyer Assessment-Lower/Extremity (FMA-L/E)-total score, Berg Balance Scale (BBS)-total score. Result : An excellent inter-rater reliability in ST scores was found (paretic, ICC=0.993~0.996; nonparetic, ICC=0.982~0.991). In addition, excellent test-retest reliability was found (paretic, ICC=0.992; nonparetic, ICC=0.967). It all showed acceptable SEM of the ST score as paretic and nonparetic were 0.22 and 0.46 respectively (average score <10 %), and the MDC of the paretic and nonparetic were 0.61 and 1.27 respectively (possible highest score <20 %). indicating that measures had a small and acceptable measurement error. The ST score of paretic and nonparetic were also found to be significantly associated with 10MWT (r=0.77~0.79), FMA-LE scores (r=0.73~0.81) and BBS scores (r=0.72~0.76). Conclusion : The ST showed highly sufficient Inter-rater test-retest agreement and validity and acceptable measurement errors caused by due to chance variation in measurement. It also can be used by clinicians and researchers to assess the balance and mobility performance and monitor functional change in chronic stroke patients.

• 대한물리의학회지
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• 제8권4호
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• pp.549-558
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• 2013

PURPOSE: This study is designed as a retrospective study, and identified the clinical usability of Sit to Stand (STS) test for predicting of fall incidence in stroke patients who experienced a fall within 1 year. METHODS: Between July 2011 and November 2012, 69 inpatients with stroke in K rehabilitation hospital were participated under voluntarily signing the informed consent form. STS test and 10m walk test (10MWT) were used to assess the muscle strength of lower-extremity and walking velocity, respectively. Also, we tested dynamic balance and motor function of lower-extremity in affected-side using with the Berg balance scale (BBS) and the Fugl-Meyer assessment of lower extremity (FM-L/E). METHODS: There were significant differences between subjects with fall-experienced group and without subjects without fall-experienced group in STS test, 10MWT, BBS scores and FM-L/E. STS test significantly showed a negative correlation between 10MWT (r=-.657), BBS (r=-.512), and FM-L/E (r=-.563). And, 10MWT have a influence on the performance of STS test (the capacity of explanation = 20%). The cut-off value of STS performance predicting falls experience is ${\geq}14.36$ seconds (sensitivity=76%; specificity=79%, area under curve=.785). According to logistic regression analysis of falls experience, subjects ${\geq}14.36$ s showed that 4.164 times (odd ratio) increased in falls than subjects < 14.36 s in STS test. CONCLUSION: This study demonstrated that STS test may be a useful tool predicting and measuring falls in patients with stroke. Further study will be needed to elucidate the kinematic analysis of STS test and the relationship between physical activity level and falls in stroke patients.

• Journal of Acupuncture Research
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• 제28권4호
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• pp.37-47
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• 2011

Objective : The purpose of this study is to evaluate the effect of sweet bee venom pharmacopuncture on the post-stroke hemiplegic shoulder pain. Methods : 40 patients with post-stroke hemiplegic shoulder pain were randomly divided into 2 groups : study group(sweet bee venom pharmacopuncture treatment group, n=21) and Control group(normal saline treatment group, n=19). They were monitored for 4 weeks, followed up with visual analog scale(VAS), pain rating score(PRS), painless passive shoulder range of movement(PROM) and Fugl-Meyer Motor assessment(FMMA) at before treatment(T0), after 2 weeks(T2) and after 4 weeks(T4). Results : 1. Study group and control group showed pain decrease, but study group showed more significant effectiveness in VAS and PRS than control group. 2. Although there is no significant difference in PROM between study group and control group, both groups showed increase of PROM, and study group had some effectiveness on abduction and flexion as the treatment progresses. 3. There is no significant difference in FMMA between study group and control group. Conclusions : This study suggests that sweet bee venom pharmacopuncture has significant analgesic effect on the post-stroke hemiplegic shoulder pain. And it seems that sweet bee venom pharmacopuncture can be applicable to improve PROM in hemiplegia patients with stroke. Further studies based on larger population and long term follow-up are needed to confirm this suggestion.

• 대한한방내과학회지
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• 제35권1호
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• pp.1-11
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• 2014

Objectives : To investigate the effects of Sa-am acupuncture on muscle architecture and elastic properties of the spastic elbow flexor and to evaluate the correlation between clinical findings and parameters of real-time sonoelastography (RTS) in patients with chronic post-stroke hemiparesis. Materials and Methods : Seven patients (five males, two females) with chronic post-stroke hemiparesis were included. Sa-am acupuncture of Ganseunggyeok (肝勝格: LU8 LR4 補, HT8 LR2 瀉) was applied to the unaffected side 3 times a week for 4 weeks. During each acupuncture treatment period, patients were requested to exercise their affected arm, and spasticity and functional recovery outcomes of the affected arm were evaluated before and after Sa-am acupuncture treatment. Clinical outcomes were assessed using motricity index (MI), modified Ashworth scale (MAS), Fugl-Meyer assessment scale (FMA) and modified Barthel index (MBI) for elbow flexor spasticity. RTS images indicate the relative hardness of the examined muscles ranged from red (hard) to purple (soft) for color-scale, and from black (hard) to white (soft) for hue scale. Color and hue histograms of the biceps brachii and brachialis were analyzed using Image J software, and median red, blue, and hue pixel intensity were obtained. Results : MI and FMA score significantly increased and MAS score significantly decreased (p<0.05). F-wave maximal amplitude of affected abductor pollicis brevis significantly decreased (p<0.05). Muscle thickness of affected brachialis significantly increased (p<0.05). Red and green pixel intensity of affected brachialis significantly decreased (p<0.05). Conclusions : Our study revealed that Sa-am acupuncture is effective as a useful and safe treatment for spasticity in chronic post-stroke hemiparesis.

• 대한의용생체공학회:의공학회지
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• 제36권5호
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• pp.155-161
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• 2015

In the paper, we developed the mobile based rehabilitation system for patients with upper extremity hemiplegia after stroke and evaluated clinical usefulness and effectiveness of the system. The sensors built in the smartphone were used to track patients' upper limb motion and the movements was transferred to the tablet PC through bluetooth connection so that the game contents could be interact with the movements. The rehabilitation game contents was based on Brunnstrom stage(B-stage), and was designed to lead accurate movement of upper limb. For the clinical evaluation of the effectiveness, 11 patients were recruited and make them perform an exercise of their wrist, shoulder, and forearm using the system for two weeks. The change of upper limb motor function was measured using fugl-meyer assessment(FMA), Brunnstrom stage(B-stage). And the change of quality of life was measured using EuroQoL-5 Dimension(EQ-5D), Beck Depression Inventory(BDI). The results showed significant improvement in upper limb function but not in quality of life. We verified mobile based rehabilitation program could be useful and effective for the clinical use.

• PNF and Movement
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• 제15권3호
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• pp.237-246
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• 2017

Purpose: The purpose of this study was to investigate the effects of forward-and-backward shift trunk exercise using a proprioceptive neuromuscular facilitation (PNF) diagonal pattern in a closed kinematic chain exercise on the upper limb function and activity of daily living (ADL) in a stroke patient. Methods: One subject participated in this study. The study used a reversal A-B-A' design, where A and A' were the baseline period (no intervention), and B was the intervention period. The intervention was a forward-and-backward trunk shift exercise, using a PNF diagonal pattern on both a stand-on-hand position and a quadruped position of closed kinematic chain exercises, for 20 min per day for 2 weeks. The range of motion (ROM) of the shoulder joint was measured and a Fugl-Meyer assessment of upper extremity (FMA-UE) and a functional independence measure (FIM) were performed to measure upper limb function and activity of daily living (ADL). Results: ROMs of shoulder joint (flexion, extension, abduction, and external rotation) increased in the intervention phase. The FMA-UE score increased (from 28 to 36) in the intervention phase. The FIM score increased (from 20 to 25) in the intervention phase. These increases were maintained after intervention (Baseline II). Conclusion: These results suggest that forward-and-backward shift trunk exercises using a PNF diagonal pattern in a closed kinematic chain exercise have a positive effect on stroke patients' upper limb function and ADL ability.

• PNF and Movement
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• 제15권3호
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• pp.361-371
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• 2017

Purpose: The purpose of this study was to examine the effects of performing a dual task on gait velocity, temporospatial variables, and symmetry in subjects with subacute stroke. Methods: The study included 14 independent community ambulators with gait velocity of 0.8m/s. The Korean mini-mental state examination, the Berg balance scale, the Trunk impairment scale, and the Fugl-Meyer assessment scale were used to recruit homogeneous subjects. Subjects performed a single task (10m ambulation at a comfortable speed) and a dual task (10m ambulation at a comfortable speed while carrying a water-filled glass). Gait variables were examined with the OptoGait system. Results: The findings of this study were as follows: 1) Gait velocity decreased significantly in the dual-task condition as compared to the single task condition. 2) There were no significant differences between the paretic and non-paretic stances. 3) Paretic swing decreased significantly in the dual-task condition as compared to the single task condition. 4) The non-paretic, double-limb support phase increased significantly in the dual-task condition as compared to the single- task condition. 5) There was no significant difference in temporal symmetry. 6) Non-paretic step length decreased significantly in the dual-task condition as compared to the single-task condition. 7) There was no significant difference in spatial symmetry. Conclusion: Performing dual tasks decreases gait velocity, paretic swing phase, and non-paretic step length, while it increases non-paretic double limb support. In addition, although there is no difference in temporospatial symmetry, there is high inter-subject variability in temporospatial symmetry. Thus, dual tasks should be selected in accordance with the functional level of the hemiplegic patient, and inter-subject variability of the individual should be considered when dual tasks are considered for gait-training of hemiplegic patients.

• 대한통합의학회지
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• 제8권1호
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• pp.87-99
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• 2020

Purpose : This study aims to investigate the effect of somatosensory stimulation on the upper limb sensory and function and self-esteem of stroke patients. Methods : This study period was march 4 to april 4 (5 weeks). The subject were 20 stroke patients with somatosensory impairment in B hospital, seongnam, gyeonggi province. They were devided into two group-experimental and control-with 10 members each. The members of the experimental group underwent somatosensory stimulation, whereas the members of the control group underwent an occupation-based intervention for 5 weeks. Thirty-minute therapy was provided 3 times per week for 5 weeks. Before and after the intervention, both groups were evaluated via light touch, static two-point discrimination, stereognosis, Fugl-Meyer assessment (FMA), and self-esteem scale Results : In this study, light touch was not significant in both groups. Static two-point discrimination was significant among the experimental group member's index fingers. Among the control group members, it was significant in the ring finger. The comparison between the two groups was significant in the index finger. The stereognosis results were significant in the experimental group but not in the control group. The comparison between the groups after the intervention was not significant. FMA was significant in the shoulder/ elbow/ forearm (SEF), hand and coordination among the experimental group. Among the control group, it was significant in the SEF and hand. The comparison between the groups was significant in the SEF, hand and coordination. The self-esteem scale results were significant among both groups, and the comparison between the group's score was likewise significant. Conclusion : In conclusion, somatosensory stimulation therapy increases the static two-point discrimination, stereognosis, upper extremity function, and self-esteem of patients with stroke. Therefore, while somatosensory stimulation therapy is not the best therapy, it is one of the best occupational therapies for stroke patients.