• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2003년도 제27회 추계학술대회
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• pp.73-73
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• 2003

Purpose: To determine the motor cortex dysfunction in hemiparetic patients due to deep intracerebral hematoma, authors performed proton magnetic resonance spectroscopy (lH MRS) for the evaluation of biochemical changes in the cortex on affected hemisphere according to axonal injury at the level of internal capsule. Methods: Ten control subjects and 14 patients with documentable hemiparesis of varying severity hemiparesis were included. All the hemiparesis was caused by deep intracerebral hematoma (putaminal and thalamic hemorrhage). In vivo 1H MRS study was performed on a 3T MRI/MRS system using STEAM sequence. As a single-voxel technique, Spectral parameters were: 20 ms TE, 2000 ms TR, 128 averages, 2500 Hz spectral width, and 2048 data points. Results: We found that the mean N-acetylaspartate (NAA)/phosphocreatine (Cr) and NAA/choline (Cho) ratios were significantly decreased in the motor cortex of the hemiparesis patients compared with control subjects. Conclusions: 1H MRS examinations of the motor cortex might help to differentiate distinct clinical entities of hemiparesis and to monitor pharmacological effects in therapeutic trials, providing a quantitative biological marker for motor neuron dysfunction. Acknowledgement: This study was supported by a grant of the Center for Functional and Metabolic Imaging Technology, Ministry of Health & Welfare, Republic of Korea. (02-PJ3-PG6-EV07-000).

• 한국전문물리치료학회지
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• 제12권2호
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• pp.81-89
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• 2005

The purpose of this study was to investigate the effect of Modified Constraint-Induced Therapy (MCIT) on the effected upper extremity of children with hemiparesis. Four children with hemiparetic upper extremity caused by brain injuries were trained by MCIT for ten weeks. During the same period, all of the subjects were also involved in thirty-minute regular physical therapy and occupational therapy. During the treatment period, the unaffected upper extremities of the subjects were restrained by a specially designed hand splint or a mitten for five hours a day, five days per week. For two hours out of the five-hour restraint period, the affected upper extremities were intensively trained by performing various functional tasks, which were individually structured to emphasize use of the affected arm. A single-subject design with A-B-A reversal was employed in this study. The affected limb motor ability was evaluated by Melbourne Assessment, measuring the time to grasp and release nine pegs, and measuring grasping power. As a consequence of this study, the affected limb motor test scores of all four subjects in the baseline period were improved during the treatment period. Furthermore, the treatment effect was maintained during a one-month follow-up period. The results of this study support the assumption that MCIT is an effective therapeutic method to improve the sensory and motor abilities of hemiparetic children. It also increases the frequency of functional use of the hemiparetic hands of brain-injured children. Based on the results of this study, it can also be assumed that the modified CIT method is especially beneficial to these children by reducing the negative emotional effects of forceful restraint of the unaffected upper extremity. To optimize the functional recovery of the paretic upper extremity by CIT, the restriction period per day should be decided individually, according to the characteristics of the individual.

• 한국산학기술학회논문지
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• 제12권12호
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• pp.5741-5747
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• 2011

본 논문은 뇌졸중 환자를 대상으로 그들의 균형능력을 평가하여 낙상의 위험을 예견하기 위하여 임상에서 가장 보편적으로 사용되고 있는 버그균형척도와 균형 및 평형능력을 평가하기 위하여 사용되는 Smart Balance Master System의 평형지수 사이의 상관관계를 알아보기 위함이었다. 22명의 만성 뇌졸중 환자가 본 연구에 참여하였다. 조용하고 잘 정돈된 치료실에서 대상자에게 버그균형척도와 Smart Balance Master System을 실시하였다. 연구결과 버그균형척도와 Smart Balance Master System의 평형지수는 중등도 이상의 유의한 상관관계를 보여주었다. 또한 Smart Balance Master System의 6가지 조건에서 모든 '눈 감고 지지면 동요 조건'에서 유의한 상관성이 없었으며, 다른 5가지 조건과는 중등도 이상의 유의한 상관성을 보여주었다. 뇌졸중 환자는 균형능력을 유지하기 위하여 시각에 대한 의존도가 높으며, 버그균형척도가 이런 부분을 적절히 평가하지 못하기 때문에 '눈 감고 지지면 동요 조건'과 유의한 상관성을 보여주지 못한 것으로 사료된다. 따라서 임상에서 뇌졸중 환자를 대상으로 그들의 낙상을 예견하기 위해서는 한 가지 이상의 임상 평가방법을 사용하여 감각기관의 모든 영향을 고려하는 것이 그들의 낙상 위험을 예견하는데 보다 적절하고 효율적인 방법으로 사료된다.

• PNF and Movement
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• 제8권2호
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• pp.17-24
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• 2010

Purpose : The purpose of present study was to determine effects of a visual feedback training on balance ability in poststroke hemiparetic subjects. Methods : Fourteen chronic stroke patients participated. Participants were randomly divided into either visual feedback training group(7 experimental group, 7 control group). All of participated were inpatients at local rehabilitation center and had been receiving a traditional rehabilitation program, five days a week. Exprimental group have additionally undergone for four weeks, three days a week, the visual feedback training but control group was not received any additional program except the traditional rehabilitation program. The Berg Balance Scale(BBS), the FICSIT-4, the MTD-balance system to measure a balance ability were carried out twice before and after training. Results : After participation in the program, subjects of visual feedback training demonstrated a significant improvement in the scores of the BBS, the FICSIT-4, the MTD-Balance system. The control group had no change on the any tests. After the training, the result to improve significantly in visual feedback training group compared to post-test of control group were the score of BBS and the FICSIT-4 and the MTD-Balance system. Conclusions : The present study suggests that the visual feedback training program may become a useful strategy for enhancing balance ability in the rehabilitation of stroke patiens.

• PNF and Movement
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• 제7권1호
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• pp.9-16
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• 2009

Purpose : The aim of this study was to determine the effect of proprioceptive neuromuscular facilitation(PNF) on balance ability in poststroke hemiparetic subjects. Methods : The subjects of this study were 12 patients with hemiplegia who volunteered to participate in the experiment which was carried out over the course of 4 weeks. The Proprioceptive Neuromuscular Facilitation is applied to group with three positions (sidelying, half-standing, modified plantigrade). The tests between before and after the intervention were measured by FSST (Four Square Step Test), FICSIT-4 (Frailty and Injuries: Cooperative Studies of Intervention Techniques), BBS(Berg Balance Scale). The data were analyzed using paired t-test and Wilcoxon signed rank test to determine the statistical significance. Results : The results of this study were summarized as follows: 1. After intervention, the score of BBS and FICSIT-4 significantly were increased compared with before intervention. 2. After intervention, the time of FSST were reduced significantly compared with before intervention. Conclusions : According to above results, Proprioceptive Neuromuscular Facilitation improved with balance ability of patients with hemiplegia. This study provided basic data for effects Proprioceptive Neuromuscular Facilitation on balance ability. In conclusion, Proprioceptive Neuromuscular Facilitation with other interventions is effective way to improve balance ability of patients with hemiplegia.

• PNF and Movement
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• 제4권1호
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• pp.37-44
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• 2006

Purpose : Improved walking is a common goal after stroke. Although the neurodevelopmental intervention(PNF) is the most widely used approach in the walking training of hemiparetic subjects. There is little neurophysiological evidence for its presumed effects on gait symmetry and facilitation of paretic muscles during the therapeutic intervention. The study, therefore, investigated the immediate effects of gait entrainment by a PNF techniques. Methods : Included persons with stroke who were living in the community. Sixteen subjects were assigned to the experimental group participated in a measures design that evaluated the subjects with pre-treatment, post-treatment(8 weeks). Temporal-spatial parameter of gait were analysed for using the computerized GAITRite system. Intervention : Training for the experimental group was carried out 3 times a week for 8 weeks. The training sessions were comprised of 50 minutes of walking with pattern and techniques in PNF. Results : The experimental group had improvements in the functional walking ability after 8 weeks treatment and Post-treatment test scores were more significant than the pre-treatment score. The treatment group demonstrated significantly post-treatment test improvement in gait velocity, cadence and FAP. Post-treatment test scores were more significant than the pre-treatment score(p<0.05). Conclusion : The results of this study showed that the PNF exercise intervention can improve functional gait ability. This study provides evidence for the efficacy of PNF treatment at improving locomotor function in chronic stroke.

• The Journal of Korean Physical Therapy
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• 제21권1호
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• pp.1-7
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• 2009

Purpose: The aim of this study was to determine the effect of proprioceptive neuromuscular facilitation (PNF) leg patterns on muscle activation of paretic and nonparetic arm in post-stroke hemiparetic subjects. Methods: Eighteen hemiparetic patients participated in this study. Each subject was asked to perform four PNF leg patterns against maximal manual resistance on nonparetic leg. EMG data were collected from biceps and triceps on the paretic and nonparetic side. The measured EMG data was digitized and processed to root mean square (RMS) and expressed as percentage maximal voluntary isometric contraction (％MVIC). The data were analyzed using paired t-test and one-way analysis of variance (ANOVA) with repeated measures to determine the statistical significance. Results: The results of this study were summarized as follows: Firstly, during four PNF patterns application, all of the ％MVIC values of biceps and triceps in paretic and nonparetic arms increased significantly compared with resting condition (p<0.05). Secondly, there was a significant difference in ％MVIC of paretic biceps between PNF leg pattern 1 and 4 (p<0.05). Conclusion: In conclusion, regardless of the kinematic components of PNF leg patterns, all of the muscle activation of biceps and triceps in paretic and nonparetic arm was significantly increased. The finding of this study indicates that irradiation effect caused by PNF leg patterns is beneficial for increased muscle activation of both paretic and nonparetic arms in post-stroke patients.

• 한국전문물리치료학회지
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• 제26권2호
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• pp.49-60
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• 2019

Background: After stroke, in order to improve gait function, it is necessary to increase the muscle strength and to enhance the propriocetive function of the lower extremity. Objects: This study aimed to compare the effects of open kinetic chain (OKC) versus closed kinetic chain (CKC) isokinetic exercise of the hemiparetic knee using the isokinetic equipment on lower extremity sensorimotor function and gait ability in patients with chronic stroke. Methods: Thirty participants with chronic hemiplegia (> 6 months post-stroke) were randomly divided into 2 equal groups: CKC group and OKC group. Patients from both groups attended conventional physiotherapy sessions 3 times a week for 6 weeks. Additionally, subjects from the CKC group performed isokinetic exercise using the CKC attachment, while those from the OKC group performed isokinetic exercise using the OKC attachment. The isokinetic knee and ankle muscles strength, position sense of the knee joint, and spatiotemporal gait parameters were measured before and after interventions. Results: The knee muscles peak torque/body weight (PT/BW) and hamstring/quadriceps (H/Q) ratio significantly increased in both groups (p<.01). In particular, ankle plantarflexors PT/BW, position sense of the knee, gait velocity, and spatial gait symmetry significantly improved in the CKC group (p<.01, p<.05, p<.01, and p<.01, respectively). Conclusion: CKC isokinetic exercise can be an effective therapeutic intervention for the improvement of sensorimotor function of the lower extremity and gait functions, such as gait velocity and symmetry. CKC position in isokinetic strength training is effective to improve functional ability in patients with chronic stroke.

• 한국산학기술학회논문지
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• 제13권3호
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• pp.1114-1121
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• 2012

심상회전은 어떤 대상이나 형태를 심상으로 하나의 각도에서 다른 각도로 회전시키는 활동으로, 일상생활동작을 수행할 때 환경과 자신에 대한 위치 및 움직임을 계획하는 단계에서 필요한 기능 중 하나이다. 본 연구는 정상인과 만성 편마비환자를 대상으로 반응시간(reaction time)과 정답율(precision)에 심상회전과제가 미치는 영향을 알아보고, 임상에서 편마비 환자를 치료할 때 심상회전능력의 변화가 과제수행에 장애요인이 될 수 있는지를 알아보기 위함이다. 본 연구는 만성 편마비 환자 31명과 정상성인 20명이 참여하였다. 연구대상자는 거울상(mirror image)을 이용한 대조과제(comparison task)와 각도불일치상(angular disparity image)을 이용한 회전과제(rotation task) 등의 2 가지 유형의 심상회전과제를 수행하였다. 검사자는 대상자에게 한 쌍의 상에 대하여 동일한 상인지 아닌지를 '예'와 '아니오'로 가능한 한 빠르게 대답하라고 요구하였고, 상을 노출한 시간부터 대상자가 대답한 시간까지의 반응시간과 정답률을 측정하였다. 대조과제 및 회전과제에 대한 반응시간은 편마비 환자에서 정상인에 비하여 유의하게 느리게 나타났다. 그러나 편마비 환자와 정상인은 심상회전과제에 대한 정답율에서 유의한 차이를 보이지 않았다. 본 연구에서 편마비 환자군과 정상군 모두에서 쌍을 이룬 상의 각이 불일치할 때 반응시간이 느리게 나타났지만, 정상군보다 편마비 환자군에서 심상회전에 오랜 시간이 걸렸다. 따라서 재활과정에서 편마비 환자를 대상으로 치료계획을 수립하고 치료를 할 때, 회전각도를 이용한 난이도 조절이 가능할 것으로 사료된다. 또한 본 연구결과는 정상인에 비하여 편마비 환자의 심상회전에 차이가 있다는 것을 재활과정에서 치료사는 염두 해 두어야 한다고 제안한다.

• The Journal of Korean Physical Therapy
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• 제27권5호
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• pp.364-368
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• 2015

Purpose: Walking in the dual-task condition is a critical skill for hemiplegic patients to live in real-life situations. The purpose of this study was to compare the effect of dual-task gait training and general gait training on gait parameters and cognitive function in patients with chronic stroke during dual-task walking. Methods: The study included 23 patients with chronic hemiparetic stroke who were randomly divided into experimental (dual-task gait training) and control (general walking training) groups. The 11 subjects in the experimental group and nine subjects in the control group received dual-task gait training (walking while handling a ball, crossing obstacles, picking up various objects, and problem solving simple cognitive tasks and general over-ground gait training, respectively, for 30 minutes per day 5 days per week for 4 weeks. Spatiotemporal parameters and cognitive tasks in the dual-task gait condition were measured. Statistical analysis of the changes between the pre- and post-intervention measurement variables was performed using ANCOVA. Results: In the gait condition under cognitive tasks, the changes pre- and post-intervention in gait velocity, stride length, double support limb, and step symmetry were significantly greater in the dual-task gait training group; however, the dual-task gait training group showed no significant improvement compared to the general gait training group in terms of the assessment of cognitive tasks. Conclusion: The findings suggest that dual-task gait training may be beneficial for walking ability in dual-task walking condition.