• 대한간호학회지
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• 제33권5호
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• pp.591-600
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• 2003

Purpose: The purpose of this study was to investigate the effects of exercise training using biofeedback and constraint-induced movement on the upper extremity function of hemiplegic patients. Method: A non-equivalent pretest-posttest design was used. Study subjects were a conveniently selected group of 40 hemiplegic patients(20 experimental subjects, 20 control subjects) who have been enrolled in two community health centers. After biofeedback training the subjects of experimental group were given constraint-induced movement, involving restraint of unaffected U/E in a sling for about 6 hours in a day over a period of two weeks, while at the same time intensively training the affected U/E. Outcomes were evaluated on the basis of the VIE motor ability(hand function, grip power, pinch power, U/E ROMs), and motor activity(amount, quality). Result: 1. After 2 weeks of treatment, the motor abilities of affected U/E(hand function, grip power, pinch power, ROMs of wrist flexion, elbow flexion and shoulder flexion/extension) were significantly higher in subjects who participated in exercise training than in subjects in the control group with no decrement at 4-week follow-up. However, there was no significant difference in wrist extension between experimental or control group. 2. After 2 weeks of treatment, the amount of use and the quality of motor activity of affected U/E were significantly higher in subjects who participated in exercise training than in subjects in the control group with no decrement at 4-week follow-up. Conclusion: The above results state that exercise training using biofeedback and constraint-induced movement could be an effective intervention for improving U/E function of chronic hemiplegic patients. Long-term studies are needed to determine the lasting effects of constraint-induced movement.

• The Journal of Korean Physical Therapy
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• 제24권6호
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• pp.409-413
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• 2012

Purpose: Rehabilitative devices are used to enhance sensorimotor training protocols, for improvement of motor function in the hemiplegic limb of patients who have suffered a stroke. Sensorimotor integration feedback systems, included with these devices, are very good therapeutic frameworks. We applied this approach using electrical stimulation in stroke patients and examined whether a functional electric stimulation-assisted biofeedback therapy system could improve function of the upper extremity in chronic hemiplegia. Methods: A prototype biofeedback system was used by six subjects to perform a set of tasks with their affected upper extremity during a 30-minute session for 20 consecutive working days. When needed for a grasping or releasing movement of objects, the functional electrical stimulation (FES) stimulated the wrist and finger flexor or extensor and assisted the patients in grasping or releasing the objects. Kinematic data provided by the biofeedback system were acquired. In addition, clinical performance scales and activity of daily living skills were evaluated before and after application of a prototype biofeedback system. Results: Our findings revealed statistically significant gradual improvement in patients with stroke, in terms of kinematic and clinical performance during the treatment sessions, in terms of manual function test and the Purdue pegboard. However, no significant difference of the motor activity log was found. Conclusion: Hemiplegic upper extremity function of a small group of patients with chronic hemiparesis was improved through two weeks of training using the FES-assisted biofeedback system. Further research into the use of biofeedback systems for long-term clinical improvement will be needed.

• Physical Therapy Rehabilitation Science
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• 제8권2호
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• pp.79-85
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• 2019

Objective: The purpose of this study was to investigate the relationship between physical features, strength, function, and upper extremity musculoskeletal pain during rehabilitation of manual wheelchair users with spinal cord injuries. Design: Cross-sectional study. Methods: The degree and frequency of upper extremity musculoskeletal pain were measured in persons with spinal cord injuries using manual wheelchairs with the use of questionnaires. The pain scores of the hand, wrist, and shoulder joints were calculated by multiplying the seriousness and frequency of pain. We collected data on the manual muscle test, Spinal Cord Independent Measure-III, and the Body Mass Index. Statistical analysis was performed by descriptive analysis and Pearson's correlation analysis. Results: A total of 47 patients participated in this study and the neurological level of the injuries ranged from C2 to S5. Pain in the shoulder joints was the most common in persons with tetraplegia and paraplegia. Pain was experienced as mild to moderate, and occurred one or more times a week. Of the 32 persons with paraplegia, the most common area of complaint was the shoulder. Of the 15 persons with paraplegia, the shoulder joints were the most common site of pain. The independence levels of the persons with spinal cord injuries were highly correlated to muscle strength levels (p<0.05). Conclusions: This study investigated upper extremity musculoskeletal pain during rehabilitation of manual wheelchair users with spinal cord injuries and the relationship between physical features, strength, and function. In most persons with spinal cord injuries, pain and frequency of shoulder joints were high and pain levels were also related to functional levels.

• 재활치료과학
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• 제5권2호
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• pp.11-22
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• 2016

목적: 본 연구는 국외 뇌졸중 환자에게 적용한 한 말초감각신경자극의 효과에 대하여 고찰하기 위한 것으로 국외 학술지를 대상으로 체계적 문헌고찰 연구방법을 시행하였다. 연구방법: 2015년 10월 이전까지 국외 학술지에 게재된 논문을 Pubmed를 통하여 검색하였다. 주요 검색 용어로는 'peripheral nerve stimulation', 'electrical stimulation', 'sensory stimulation', 'somatosensory stimulation', 'stroke', 'hemiplegia', 'hemiparesis' 와 'hand', 'arm', 'upper limb'를 사용하였다. 최초 검색된 논문은 501편이었으나 선정 및 배제기준을 거쳐 10편의 연구가 선정되었다. 결과: 임상적으로 널리 사용되고 있는 말초감각신경자극은 뇌졸중 환자들에게 적용이 될 때에 보다 다양한 중재방법으로 연구에 적용이 되고 있었다. 말초감각신경자극치료는 뇌졸중 환자의 상지 기능에 효과를 나타냈으며, 대뇌피질의 활성화에도 긍정적인 영향을 나타냈다. 결론: 본 연구는 말초감각신경자극치료의 적용에 대한 근거를 제시하며, 향후 국내연구에서는 다양한 중재방법을 적용하여 말초감각신경자극의 효과를 더 정확하게 측정을 할 수 있는 방법에 대한 연구가 필요하다.

• 대한감각통합치료학회지
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• 제21권1호
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• pp.23-33
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• 2023

목적 : 본 연구의 목적은 경직성 편마비 뇌성마비 후기 아동의 위팔두갈래근에 진동자극을 적용한 훈련이 상지의 기능을 향상시키는데 도움이 되는지를 알아보는 것이다. 연구방법 : 본 연구는 13세에서 15세 사이의 경직성 편마비를 가진 뇌성마비 아동 3명을 대상으로 하였다. 개별대상자 실험연구 방법 중 다중 기초선 개별실험연구를 이용한 AB 연구 설계를 사용하였으며, 중재기간 동안 진동자극은 마비측 손에 제공되었다. 상지의 기능을 측정하기 위하여 사용된 평가는 라파엘 스마트 보드는 매 회기 별 중재 후 평가를 실시하였고, 젭슨-테일러 손 기능 평가(Jebsen-Tayler hand function test)와 운동 활동 척도 검사(Motor Activity Log; MAL)를 실험 전, 후로 실시하였다. 결과 : 라파엘 스마트 보드로 매 회기 상지기능의 부드러움과 종합점수를 측정한 결과 대상자 3은 평균값의 변화에서 유의미한 결과가 없었고 대상자 1, 2는 평균값에서 유의한 변화가 있었다. 중재 전후로 평가한 젭슨-테일러 손 기능 평가 및 운동 활동 척도 검사에서는 대상자 모두 유의한 변화를 보였다. 결론 : 진동자극을 적용한 훈련이 마비측에 대한 경험이 적은 편마비를 가진 아동에게 상지 기능과 움직임을 증진시킬 수 있는 긍정적인 영향을 보였다.

• The Journal of Korean Physical Therapy
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• 제23권5호
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• pp.65-72
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• 2011

Purpose: The intention of this study was to investigate the effects of modified constraint-induced movement therapy (mCIMT) with bilateral arm training (BAT) on the motor performance and daily activity performance of individuals with chronic hemiparetic stroke. Methods: Sixteen subjects one year after stroke participated in this study with a control group; the pretest-posttest method was used. The subjects were randomly allocated into two groups: combination of bilateral arm training and modified constraint-induced movement therapy (n=8), and modified constraint-induced movement therapy (n=8). The mCIMT group received therapy for 90 minutes in 3 sessions per week over a period of 4 weeks. The patients receiving a combination of mCIMT and BAT were treated for the same period and frequency. The results were evaluated using the Fugl-Meyer Assessment, Action Research Arm Test (ARAT), and Motor Activity Log-Amount of Use, and Quality of Movement (MAL-AOU, QOM) assessment tools. Results: The Fugl-Meyer Assessment showed that hand and wrist performance improved significantly more in the mCIMT group than in the Combination group (p<0.05). Result from the ARAT assessment showed greater scores for gross movement in the combined group than in the mCIMT group (p<0.05). The MAL-AOU showed that there was greater improvement in the combined group than in the mCIMT group (p<0.05). Conclusion: The forced use of the more affected side can be important for the enhancement of upper extremity performance for chronic hemiparetic stroke patients during their daily activities.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.707-713
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• 2009

Purpose: The deep inferior epigastric perforator(DIEP) free flap is well known as an ideal donor site for the breast reconstruction. The flap can provide huge amount of fat tissue for breast and buttock contour, while it is also very useful as a thin skin flap to reconstruct the upper and lower extremities. We used a DIEP free flap in various site reconstructions besides the breast and would like to reinsure the usefulness of this flap. Methods: Twenty nine consecutive patients who underwent DIEP free flap surgery from 2001 January to 2007 December were reviewed. The case constituted seven male patients and twenty two female patients. There were sixteen breast reconstructions, five face reconstructions, five lower extremity reconstructions, two upper extremity reconstructions, and one buttock contour reconstruction. All clinical data were based on the patient's medical records. Results: All DIEP free flaps survived without major complications. There was no hematoma, seroma, or partial necrosis. The donor sites were closed primarily with linear scar on lower abdomen. The thinnest part of flap was 0.7 cm in thickness. The size of the largest flap was $38{\times}13cm$. The flaps were used in various types of skin and adipose tissue, adipose tissue only, and skin only according to the requirement of recipient site. Conclusion: The DIEP free flap was enough to provide a thin and huge flap for both breast and extremity reconstructions. It was able to provide versatile designs with sufficient adipose tissue. So we use it for 3 - dimentional face and buttock contour reconstructions. The DIEP free flap is a valuable reconstructive donor for face, upper and lower extremity in addition to breast without compromising the integrity of abdominal wall.

• 대한인간공학회지
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• 제34권1호
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• pp.11-18
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• 2015

Objective: The aim of this study was to understand the effects of phone weight on the typing performance and muscle recruitment in the neck and upper extremity while typing a text message with dominant hand. The iPhone4 and iPhone5 were compared due to their 28-gram differences in weight. Background: Too much use of a cellular phone can lead the musculoskeletal disorders in the upper extremity. Phone makers tend to make their new models bigger, lighter, faster and smarter. Method: Fourteen healthy volunteers without any history of neuromuscular disorders or ongoing pain who used their smartphone more than one year were recruited. A 112g phone (iPhone5) and a 142g phone (iPhone4) were used for typing the lyric of the Korean national anthem with their dominant hand. Typing duration, the typing error, the perceived fatigue, and preference was investigated. Muscle recruitment and the resting gap of neck (middle trapezius and levator scapula), shoulder (infraspinatus and mid deltoid), elbow (biceps brachii and brachioradialis), thumb (extensor and abductor policis brevis) were collected using surface electromyography. Typing error was counted and typing speed was calculated in characters per min. The data were analyzed using a paired t-test and chi-square (${\chi}^2$) analysis for the effects of phone weight on the typing performance parameters and muscle recruitment. Results: Typing text message with iPhone5 took longer but had less muscle recruitment in brachioradialis, and extensor policis brevis muscles. Lighter weight of iPhone5 made biceps brachii to rest less without increasing the mean %EMG. Conclusion/Application: Findings of this study can be valuable information for phone designers to develop more productive device and for smartphone users to prevent the musculoskeletal disorders in the upper extremities.

• 대한물리의학회지
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• 제11권3호
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• pp.119-124
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• 2016

PURPOSE: The aim of this study was to evaluate activation of accessory respiratory muscles using electromyography during chest expansion upper extremity flexion, abduction, and external rotation exercises with an elastic band in children with cerebral palsy. METHODS: The subjects were 10 children with cerebral palsy. The inclusion criterion for participation was a Gross Motor Function Classification System level of I to III. The subjects were instructed to perform upper extremity flexion, abduction, and external rotation exercises with inspiration, and extension, adduction, and internal rotation exercises with expiration while seated on a chair without a backrest. PM (Pectoralis major), SCM (sternocleidomastoid), RA (rectus abdominis), and EO (external oblique) muscle activities were measured using electromyography. RESULTS: All tested muscles showed a statistically significant increase in activity after elastic band exercise. There were significant differences in PM, SCM, RA, and EO results after chest expansion exercise using elastic band. SCM showed the largest increase in activity after use of elastic bands, at $52.37{\pm}45.88$%, followed by the RA ($50.56{\pm}79.31$), EO ($35.42{\pm}35.45$), and PM ($31.72{\pm}25.64$). The increase in the SCM was greatest, followed by increases in the RA, EO, and PM CONCLUSION: These finding suggest that activity of accessory respiratory muscles increases with use of elastic bands during chest expansion exercise in cerebral palsy.

• 재활치료과학
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• 제7권3호
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• pp.23-33
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• 2018

목적 : 본 연구는 국외 학술지를 대상으로 한 체계적 문헌고찰 연구를 통해 경직을 가지고 있는 뇌졸중 환자를 대상으로 진동자극의 효과를 제시하는 데에 목적이 있다. 연구방법 : 전자 데이터베이스인 NDSL과 RISS를 사용하여 2009년 4월부터 2017년 10월까지의 논문을 검색하였다. 주요 검색 용어로 'Vibration therapy', 'Focal vibration ', 'Somatosensory', 'Upper limb'와 'Spasticity after stroke를 사용하였다. 선정기준과 배제기준을 통해 최종적으로 6개의 논문이 선정하였다. 결과 : 국소 진동자극의 효과를 알아보기 위한 중재방법으로는 진동자극만을 적용한 중재부터 과제기반 진동자극 중재부터 다양하였다. 중재효과를 알아보기 위해 경직, 상지기능, 일상생활동작 평가도구가 사용되었다. 국소 진동자극은 뇌졸중 환자의 경직 감소와 상지기능에 긍정적인 영향이 있는 것으로 나타났으며, 대뇌피질의 활성화에도 유의미한 효과가 있는 것으로 나타났다. 결론 : 본 연구를 통해 치료사들은 국소 진동자극 적용에 필요한 정보 및 근거를 찾을 수 있을 것이다. 하지만 다양한 국소 진동자극의 적용 방법으로 인해 효율적인 진동수, 진폭의 크기 및 진동을 적용할 위치를 확인하는 데에는 어려움이 있었다. 향후 국내연구에서는 국소 진동자극의 효과를 극대화 할 수 있는 체계적인 중재 프로토콜에 대한 연구가 필요하다.