• 대한물리의학회지
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• 제10권4호
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• pp.49-57
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• 2015

PURPOSE: This study aimed to investigate the effect of emphasized initial contact gait training on balance and gait ability in hemiplegia patients. METHODS: Twenty-four hemiplegic patients were randomly allocated to an experimental group or control group. All participants received 30-min neurodevelopmental treatment. Furthermore, the experimental group received initial contact-emphasized auditory feedback gait training, whereas the control group received gait training without auditory feedback. The intervention was performed 3 times per week, 20 min per each time, for a total of 6 weeks. Balance was assessed using the center of pressure path length, center of pressure velocity, and limitation of stability path length, whereas gait ability was assessed using the 10-m walking test and functional gait assessment. RESULTS: In both groups, center of pressure path length and center of pressure velocity significantly decreased after training. Compared to the control group, the experimental group showed a 10% significant improvement (p<.05). In the limitation of stability path length of both sides, the experimental group showed a significant increase compared to that before intervention. Compared to the control group, the experimental group showed a 7% significant improvement in results of the 10-m walking test and functional gait assessment (p<.05). CONCLUSION: Emphasized Initial contact gait training is considered an effective treatment for improving gait ability and balance ability in stroke patients.

• Journal of Acupuncture Research
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• 제17권2호
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• pp.209-220
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• 2000

Spasticity, an abnormal increase in resting muscle tone, is one of the most common symptoms of stroke, and its management is becoming a major issue in rehabilitation. The aims of this study are to determine the effects of electroacupuncture(EA), TENS and neuromuscular electric stimulation(NMES) on spasticity, as well as the possibility of tissue comliance method as a spasticity scale. 45 stroke patients participated in a study of the effects on hemiplegic spasticity of EA, TENS and NMES. Spasticity was measured by modified Ashworth scale on the upper extremity and tissue compliance measurement, penetration mm/kg, on Susamni(LI10) area at just before and after stimulation, and 30 minutes, 1 hour, 2 hours and 24 hours after stimulation. The acupuncture points were applied to Kokchi(LI11), Susamni(LI10), Hapkok(LI4) and Oegwan(TE5) of the affected limb. The electrodes were placed unilaterally on LI11 to LI10 and TE5 to LI4. EA with biphasic wave, 60Hz, 0.4 msec pulse duration and low intensity was applied continuously for 20 minutes. TENS with high frequency, low intensity was applied. NMES was applied with spasticity program for 20 minutes. Each electric stimulation was done on extensor muscles group of forearm for 20 minutes. EA and NMES groups were found to produce a statistically significant decrease(p〈0.05) of spasticity and these effects lasted up to 30 minutes after stimulation. There was no definite correlation between the modified Ashworth scale and tissue compliance measurement. But tissure compliance method was found to be possible as a quantitative measurement on spasticity. There was no significant correlation between the effects of EA and NMES and the characteristics of patient, but significant correlation between the effects of EA and NMES and the modified Ashworth scale.

• The Journal of Korean Physical Therapy
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• 제27권5호
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• pp.332-338
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• 2015

Purpose: The purpose of this study was to examine the effect of postural control and locomotion on improvement of two point discrimination (TPD), stereognosis (ST) through somatosensory training (SST) on the upper limb (UL). Methods: The subjects were 20 hemiplegia patients who have problems with unilateral neglect after stroke. The patients were divided into two groups, the experimental group (EG) and the control group (CG). In the EG, SST for TPD, ST was performed 18 times, three times a week for six weeks, together with physical therapy (PT) and occupational therapy (OT). In the CG conventional PT and OT without SST was performed for six weeks. Several assessment tools were used in comparison of groups; two point discrimination test (TPDT) on forearm (F), thenar (T), hypothenar (TH), thumb tip (TH-T), index finger tip (IN-T), stereognosis test (ST), postural assessment scale for stroke (PASS), and clinical test of sensory interaction on balance (CTSIB) and timed up and go test (TUG). Results: In the CG, conventional PT and OT resulted in statistically improved TPDT (F), ST, PASS, and TUG. In the EG, SST resulted in statistically improved TPDT (F, T, HT, TH-T, IN-T), ST, PASS, and TUG. TPDT-T, ST, and CTSIB with length of displacement with eye open (LDEO) also showed significant improvement between the groups. Conclusion: In both groups TPDT ST, PASS and TUG, and SST had effects on the UL and TPDT, ST and static postural control had greater effects compared with the PG. Therefore, we could assume that TPD and ST are very important in performing human activities including postural control and locomotion.

• The Journal of Korean Physical Therapy
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• 제23권3호
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• pp.13-19
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• 2011

Purpose: In real life there are both straight-paths and curved-paths. To evaluate walking ability of both kinds, a figure-8 walking test (F8WT) was developed. The aim of this study was to validate the measure in hemiplegic patients with walking difficulties and to identify correlations of curved walking ability with straight walking ability, motor function, and walking performance ability. Methods: Twenty subjects participated in this study. Curved walking was measured by a F8WT. Straight walking ability was measured by a 10-meter walking test (10MWT). Dynamic balancea bility was measured by timed up and go (TUG) tests. Walking performance ability was measured using a modified motor assessment scale (MMAS). Motor function was measured by the Fugl-Meyer assessment (FMA) scale. Data were analyzed using Pearson correlation analysis. Linear regression analyses were performed to explore other functional tests in mobility ability by F8WT time, 10MWT (dependent variable). Results: There was a significant positive correlation of F8WT time with 10MWT and TUG. There was a significant negative correlation of F8WT time with MMAS and FMA-coordination. There was a significant positive correlation of 10MWT with TUG. There was a significant negative correlation of 10MWT with MMAS and FMA-coordination. The F8WT time for curved walking ability was attributed to 10MWT for straight walking ability as 94% level of contribution. Conclusion: The results suggest that the F8WT is a good instrument for measuring walking ability because there is a robust correlation of F8WT time with 10MWT, TUG, MMAS, and FMA-coordination in hemiplegic patients who, after stroke, have a mobility deficiency.

• Physical Therapy Rehabilitation Science
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• 제5권3호
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• pp.113-119
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• 2016

Objective: The effect of abdominal expansion maneuver (AEM) and abdominal draw-in maneuver (ADIM) on postural control in an unsupported position in stroke patients. Design: Randomized controlled trial. Methods: A total of 36 persons with hemiplegic stroke participated in this study. The subjects were randomly divided into an AEM experimental group (n=12), an experimental ADIM group (n=12), and a control group (n=12). We collected the general characteristics of all subjects and the pre-test results before the intervention and after 4 weeks of the intervention. The trunk stabilization training of the ADIM and AEM group were performed 15 minutes a day, 3 times a week for 4 weeks, and general physical therapy was performed 2 times a day, 30 minutes per session, 5 times a week for all three groups. The control group received joint mobilizations, muscle strengthening, endurance strengthening, and gait exercises along with treatment of the central nervous system, such as neuro-developmental treatment, mat, and gait training. The AEM is an inspiratory phase of tidal breathing expanding the lateral lower ribcage in a lateral direction with minimal superior movements of the chest. Then the lower abdomen expands and the navel moves in an anterior-caudal direction. The ADIM is a repeated contraction and relaxation of the anal sphincter during inspiration. The navel pulls the lower abdomen to the direction of the spine without the movement of the trunk and pelvis. Results: Before and after the interventions, medial-lateral axis movement distance, anterior-posterior axis movement distance, sway mean velocity, and sway area 95% was a statistically significant change in all three groups (p<0.05). The post-hoc test showed a significant improvement in medial-lateral axis movement distance, anterior-posterior axis movement distance, sway mean velocity, and sway area in the AEM group compared with the control group, and in the ADIM group compared with the control group (p<0.05). Conclusions: In conclusion, both AEM training and ADIM training are necessary interventions to maintain the independent sitting position according to the characteristics of the patient.

• 대한물리의학회지
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• 제6권1호
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• pp.1-8
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• 2011

Purpose : The purpose of this study was to find out the effect of closed kinetic chain exercise with functional electrical stimulation(FES) of the gluteus medius on gait in stroke. Methods : 30 hemiplegic patients voluntarily participated in this study. Subjects were divided into experimental group(n=15) and control group(n=15). Experimental group was given closed kinetic chain exercise with FES of the gluteus medius and control group was given only closed kinetic chain exercise for 4 weeks. All subjects were measured 10m-walking speed, cadence, functional walking category(FAC) and modified motor assessment scale(MMAS) before and after intervention. Results : In experimental group, gait velocity, cadence, FAC and MMAS showed significant difference between pre and post test(p<.05). In control group, gait velocity, cadence and FAC showed significant difference between pre and post test(p<.05). Before intervention, gait velocity, cadence, FAC and MMAS were not significant difference between experimental group and control group(p>.05), but after intervention, gait velocity, FAC and MMAS were significant difference(p<.05). Conclusion : This study show that closed kinetic chain exercise with functional electrical stimulation(FES) of the gluteus medius is beneficial intervention for increase the wlking ability in stroke.

• 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.

• 한국콘텐츠학회논문지
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• 제10권3호
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• pp.258-265
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• 2010

본 연구는 편마비 환자 중 슬관절 과신전으로 인해 균형 및 보행 장애를 보이는 환자들에게 슬관절 움직임 제한 보조기로 과신전을 제한시킨 연구군과, 치료사의 손으로 과신전을 제한시킨 대조군으로 나누어 전통적인 물리치료를 실시해 치료 전, 후와 두 간을 비교하여, 슬관절 움직임 제한 보조기가 슬관절 과신전이 있는 편마비 환자의 균형과 보행에 미치는 영향을 알아보고자 하였다. 연구 대상은 서울 참병원에서 편마비로 인하여 편마비라고 진단 받고 입원 및 통원 치료를 하는 환자 중 슬관절 과신전을 보이는 20명을 대상으로 무작위로 연구군과 대조군으로 나누어 연구 전, 후를 BBS (Berg Balance Scale), TUG (Time Up & Go Test), 보행 능력 평가를 이용하여 측정 비교 하였다. BBS를 이용해 균형능력을 측정한 결과 연구군, 대조군 모두에서 실험 전, 후에 유의한 차이를 보였다(p<0.05). 또한 TUG를 이용한 균형능력 측정 결과에서도 연구군, 대조군 모두에서 실험 전, 후에 유의한 차이를 보였다(p<0.05). 보행 능력 검사를 이용해 보행능력 평가를 한 결과 연구군, 대조군 모두에서 실험 전, 후에 유의한 차이를 보였다 (p<0.05). 균형 및 보행능력을 주 단위로 측정한 결과 연구군과 대조군 모두에서 유의한 증가를 보였고 (p<0.05), 두군 간에는 균형능력에서만 유의한 차이가 있었다(p<0.05). 하지만 그래프상으로 봤을 때 연구군에서 균형과 보행능력의 더 많은 증가를 보였다. 본 연구 결과 슬관절 움직임 제한 보조기를 사용한 슬관절 과신전 제한 후 치료는 편마비 환자의 보행능력 증진에는 유의한 효과가 없었지만, 균형능력 증진에 유의한 효과가 있었다.

• 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).

• 디지털융복합연구
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• 제13권7호
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• pp.445-452
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• 2015

본 연구는 뇌졸중환자를 대상으로 동작관찰 디지털콘텐츠 활용교육과 동작관찰 없이 과제 지향적 작업치료를 실시하여, 뇌졸중 환자의 상지기능과 일상생활수행력에 미치는 영향에 대해 알아보았다. 뇌졸중 환자 30명을 대상으로 무작위로 실험군(동작관찰)과 대조군(과제 지향적 작업치료)으로 각각 15명씩 나누어 1주일에 5회 총 30분씩 5주간 실시하였다. 치료 중재 전과 후의 마비측 상지기능을 알아보기 위해, Jebsen-Taylor Hand Function Test (JTHFT)과 Box and Block Test (BBT)를 실시하였고, 일상생활수행을 비교하기 위해 Korean-Version of Modified Barthel Index (KMBI)를 실시하였다. 실시 결과 두 그룹 모두에서 상지기능 및 일상생활수행은 증가하였고, 그룹간의 차이는 보이지 않았다. 그러므로 동작관찰 디지털콘텐츠 활용교육과 과제 지향적 작업치료는 뇌졸중환자의 상지기능 및 일상생활수행에 긍정적인 영향을 미친다는 것을 알 수 있었다.