• The Journal of Korean Physical Therapy
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• 제23권3호
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• pp.7-12
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• 2011

Purpose: The cane is one of the most popular assistive devices for stroke patients. Clinical complaints of sensorimotor functions on the ipsilateral upper limb were appealed in stroke patients who had used a cane for a long period. Therefore, we investigated whether cane usage for a long-term period affected sensoriomotor dysfunctions on the non-affected upper limb, in terms of pain presence, shoulder joint sense, a nine-hole pegboard test, and a tracking task. Methods: We recruited 12 stroke patients, who were divided into the cane-using (CU) group or the non-cane using (NCU) group, according to cane usage experience. We evaluated joint position sense for the integrity of proprioceptive reposition sense in the shoulder joint, used a nine-hole pegboard test for upper limb dexterity evaluation, and a tracking task for visuomotor coordination. Results: Four patients in the CU group had complained of shoulder pain none did in the NCU group. In addition, the CU group showed more reposition errors on the shoulder joint than the NCU group did. In addition, the CU group had more difficulty in proprioceptive sense perception and in performance of the nine-hole pegboard teat and tracking task, compared with the NCU group. Conclusion: Our findings suggest that cane usage for a long period in stroke patients could give rise to trigger joint pain and decrease proprioceptive sense. In addition, complex motor performance in the ipsilateral upper limb could deteriorate. In stroke patients who had used acane for long period, careful observation and proper intervention will be necessary.

• The Journal of Korean Physical Therapy
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• 제26권3호
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• pp.163-168
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• 2014

Purpose: The purpose of this study was to investigate whether ipsilateral shoulder pain affects the sensorimotor function of the same side shoulder in patients with stroke. Methods: Thirty stroke patients, who were divided into the ipsilateral shoulder pain group (n=15) and the ipsilateral shoulder non-pain group (n=15). Subjects were evaluated on performance of a tracking task, joint reposition test and 9-Hole pegboard test for sensorimotor functions, and Fugl-Meyer test and Motricity Index for functional ability of the contralateral side. Results: In comparison of the two groups, significant differences in performance on functional ability, including the Fugl-Meyer test(both upper and lower limb) and Motricity Index(only lower limb) were observed (p<0.05). With regard to sensorimotor functions, the ipsilateral shoulder pain group were observed significantly poor scores on the Accuracy Index, joint reposition score and 9-Hole pegboard test, when compared with the ipsilateral shoulder non-pain group (p<0.05). Conclusion: We found that ipsilateral shoulder pain could impede accurate performance of a movement and result in deteriorated proprioception of the ipsilateral shoulder. Therefore, careful evaluation and appropriate therapeutic intervention are essential for stroke patients who suffer from ipsilateral shoulder pain.

• PNF and Movement
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• 제16권1호
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• pp.151-159
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• 2018

Purpose: The aim of this study was to examine the activation of the contralateral upper and lower extremities and trunk muscle during ipsilateral upper extremity diagonal isokinetic exercise. Methods: Twenty-one healthy male subjects with no history of shoulder injury undertook ipsilateral diagonal isokinetic exercise at 60, 120, and $180^{\circ}/sec$, utilizing a standard Biodex protocol. Muscle activation amplitudes were measured in the upper trapezius, pectoralis major, biceps brachii, rectus abdominis, external oblique, rectus femoris, adductor longus, and biceps femoris muscles using electromyography. A one-way analysis of variance and paired t-tests were conducted, and the data were analyzed using SPSS, version 21.0. Results: The results revealed no statistically significant interaction between motion and angular velocity and no statistically significant contralateral muscle activation according to angular velocity (p>0.05). However, they revealed statistically significant contralateral muscle activation according to motion (p<0.05). Conclusion: These results suggest that the movements involved in contralateral upper extremity diagonal isokinetic exercise can enhance muscle strength in patients affected by stroke, fracture, burns, or arthritis.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2004년도 추계학술대회 논문집
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• pp.1303-1306
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• 2004

We developed a symmetrical upper limb motion trainer for chronic hemiparetic subjects. This trainer enabled the practice of a forearm pronatio $n^ination and wrist flexion/extension. In this study, we have used functional magnetic resonance imaging(fMRI) with the developed symmetrical upper limb motion device, to compare brain activation patterns elicited by flexion/extension wrist movements of control and hemiparetic subject group. In control group, contralateral somatosensory cortex(SMC) and bilateral cerebellum were activated by dominant hand movement(Task 1), while bilateral movements by dominant hand(Task 2) activated the SMC in both cerebral hemispheres and ipsilateral cerebellum. However, in hemiparetic subject group, contralateral supplymentary motor area(SMA) was activated by unaffected hand movement(Task 1), while the activation of bilateral movements by unaffected hand(Task 2) showed only SMA in the undamaged hemisphere. This study, demonstrating the ability to accurately measure activation in both sensory and motor cortex, is currently being extended to patients in clinical applications such as the recovery of motor function after stroke.ke.

• The Journal of Korean Physical Therapy
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• 제31권4호
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• pp.212-215
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• 2019

Purpose: This study examined whether there is a difference in motor learning through short-term repetitive movement practice in stroke survivors with a unilateral brain injury compared to normal elderly participants. Methods: Twenty-six subjects who were divided into a stroke group (n=13) or sex-aged matched normal elder group (n=13) participated in this study. To evaluate the effects of motor learning, the participants conducted a tracking task for visuomotor coordination. The accuracy index was calculated for each trial. Both groups received repetitive tracking task training of metacarpophalangeal joint for 50 trials. The stroke group performed a tracking task in the upper extremity insi-lesional to the damaged hemisphere, and the normal elder group performed the upper extremity matched for the same side. Results: Two-way repetitive ANOVA revealed a significant difference in the interactions ($time{\times}group$) and time effects. These results indicated that the motor skill improved in both the stroke and normal elder group with a tracking task. On the other hand, the stroke group showed lesser motor learning skill than the normal elder group, in comparison with the amount of motor learning improvement. Conclusion: These results provide novel evidence that stroke survivors with unilateral brain damage might have difficulty in performing ipsilateral movement as well as in motor learning with the ipsilateral upper limb, compared to normal elderly participants.

• 재활치료과학
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• 제2권1호
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• pp.13-23
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• 2013

강제유도운동치료는 최근 신경재활 분야에서 가장 주목 받고 있는 상지 재활 치료방법 중 하나로 하루 6시간씩 주 5일 2주간 강도 높은 훈련을 환측 팔에 제공하고, 건측의 사용을 억제하기 위해 깨어 있는 시간의 90%를 구속하는 치료방법이다. 최근에는 전통적인 강제유도운동치료의 임상적 한계를 바탕으로 수정된 강제유도운동치료가 많이 적용되고 있다. 수정된 강제유도운동치료는 하루 5시간씩 주 5일, 10주간 건측을 억제하고 하루 30분간 손상측을 치료하는 방법이다. 이는 일상생활 수행 평가인 소아 운동 활동 측정표(Pediatric Motor Activity Log; PMAL)와 상지 질적 평가(Quality of Upper Extremities Skills Test; QUEST), 환측의 상지 기능을 평가하는 멜버른 상지 평가(Melbourne Assessment of Unilateral Upper Limb Function; MAULF), 환측과 건측의 양손 협응을 보기 위한 Assisting Hand Assessment(AHA)를 통해 강제유도운동치료의 효과를 입증하였다. 본 고찰에서는 강제유도운동치료 적용 후, 신경학적 변화를 살펴본 연구를 중점적으로 분석하였다. 경직성 편마비형 뇌성마비 아동에게 강제유도운동치료 또는 수정된 강제유도운동치료를 적용한 결과, 신체부분의 움직임의 양에 따라 대뇌피질에 나타나는 신체 부위의 크기가 변한다는 것을 보여주었다. 또한 반대측 운동피질의 활성을 증가시켜주고, 동측 피질의 활성을 감소시켜 신경재조직에 영향을 주기 때문에 강제유도운동치료는 신경가소성의 원리를 이용한 상지 재활 치료 방법이라 하겠다.

• The Journal of Korean Physical Therapy
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• 제25권1호
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• pp.36-41
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• 2013

Purpose: To investigate whether the long-term use of a cane induces pain in the unaffected lower limb of stroke patients. Methods: A total of 107 stroke patients with chronic hemiparesis were recruited in this study and classified into two groups; a cane-use group (n=49) and non-cane-use group (n=58). The existence of pain in the unaffected lower limb was assessed on a visual analog scale in the hip, knee, and ankle joint, and the University of Alabama pain behaviors scale (UAB pain behavior scale) used to measure the intensity of pain. In addition, the Motricity Index (MI) was tested in the upper and lower extremities. Results: The proportion of pain in each joint of the lower limb was significantly higher in the cane-use group, compared to the non-cane-use group (p<0.05). In addition, significant differences were observed on the UAB pain behavior scale between the two groups. The lower MI score was significantly lower in the cane-use group, compared with the control group. However, no difference was observed in MI scores of the upper limb between the two groups. Conclusion: These findings reveal that long-term cane usage can induce pain in the unaffected lower limb of stroke patients. We suggest careful consideration when prescribing a cane, depending on functional ability in hemiparetic patients, and recommend continuous evaluation for pain in the affected lower limb.

• Archives of Plastic Surgery
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• 제35권5호
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• pp.533-538
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• 2008

Purpose: Sensory changes in the upper limb are complications of a mastectomy with immediate breast reconstruction with the treatment of breast cancer. The purpose of this study is to clarify whether immediate breast reconstruction worsens the sensory changes. Methods: From March 2004 to December 2005, 20 patients who had a mastectomy with immediate breast reconstruction(reconstruction group) were compared with 23 patients who had a mastectomy alone(control group). All patients had stage I or II breast cancer. The sensory changes were assessed in a blind manner by one examiner that used light touch sensation, static two-point discrimination, pain, vibration, hot and cold temperature perception. The sensory changes were identified along the sensory dermatome for diagnosing the damaged nerves. The following factors and their relationship with the sensory changes were analyzed : age, complications, and the mastectomy method. Results: There was no statistical difference in the static two-point discrimination, pain, vibration, hot and cold temperature perception between the two groups. However, the ability to recognize light touch was significantly better(p=0.045) in the reconstruction group than in the control group. The main site of sensory change was the proximal and medial portion of the upper limb in both groups. At these sites, the mean value of Semmes-Weinstein monofilament was $1.01g/mm^2$(reconstruction group 0.82, control group 1.17) and 2-point discrimination was 51.74(converted to perfect score of 100; reconstruction group 42.50, control group 59.78). The total rate of early complications was found to be significantly lower(p=0.006) in the reconstruction group than in the control group. Conclusion: These findings suggest that an immediate breast reconstructive procedure following a mastectomy is as safe as or safer than a mastectomy alone with respect to postoperative sensory changes of the ipsilateral upper limb.

• 대한물리치료과학회지
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• 제27권1호
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• pp.34-42
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• 2020

Background: The purpose of this study was to investigate the effects of ipsilateral and contralateral load changes during single-leg standing on the leg muscle activities of healthy people. Design: Randomized controlled trial. Methods: For all the subjects, a load was randomly applied to the ipsilateral or the contralateral side. While the load was applied, the subject raised a hand and then performed single-leg standing for 10 seconds using the dominant side. Results: During single-leg standing, the muscle activity of the gluteus medius, peroneus longus on the supporting side increased statistically significantly when an upper limb load was applied contralaterally, but no statistically significant differences were detected in the muscle activities of the tibialis anterior and the gastrocnemius using a test of within-subjects effects. Conclusion: It can be seen that muscle activities increase during exercise when the amount and frequency of a load are increased and when the same load is applied to different sides of the body. Such muscle activity increases may be applied to change the intensity of exercise when one is in a static posture, such as during single-leg standing.

• 대한의용생체공학회:의공학회지
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• 제28권1호
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• pp.139-147
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• 2007

The aim of this study was to evaluate effects of short-tenn repetitive-bilateral excercise on the activation of motor network using functional magnetic resonance imaging (fMRI). The training program was performed at 1 hr/day, 5 days/week during 6 weeks. Fugl-Meyer Assessments (FMA) were performed every two weeks during the training. We compared cerebral and cerebellar cortical activations in two different tasks before and after the training program: (1) the only unaffected hand movement (Task 1); and (2) passive movements of affected hand by the active movement of unaffected hand (Task 2). fMRI was performed at 3T with wrist flexion-extension movement at 1 Hz during the motor tasks. All patients showed significant improvements of FMA scores in their paretic limbs after training. fMRI studies in Task 1 showed that cortical activations decreased in ipsilateral sensorimotor cortex but increased in contralateral sensorimotor cortex and ipsilateral cerebellum. Task 2 showed cortical reorganizations in bilateral sensorimotor cortex, premotor area, supplemetary motor area and cerebellum. Therefore, this study demonstrated that plastic changes of motor network occurred as a neural basis of the improvement subsequent to repetitive-bilateral excercise using the symmetrical upper-limb ann motion trainer.