Earticle

목적 : 본 연구는 만성 뇌졸중 환자를 대상으로 자세 조절이 일상생활동작 수행능력과 근 긴장도 변화 및 상지기 능 수행에 어떠한 영향을 미치는지 알아보고자 하였다． 연구방법 : 본 연구를 위하여 국립재활원에 입원한 41명의 뇌졸중 환자를 대상으로 모든 환자들은 자세조절 평가 척도(Postural Assessment Scale stroke, PASS), 일상생활동작 수행능력 측정 도구(Modified Barthel Index, MBI), 긴장도 사정 척도(Tone Assessment scale, TAS), Fugl-Meyer 평가 척도(Fugl-Meyer Assessment scale－upper extremity) 등을 이용하였고 자료 분석은 피어슨 상관분석(pearson correlation coefficient), 단계적 다중 회귀분석(stepwise multiple regression）을 실시하였으며 내적 일치도를 알아보기 위하여 Cronbach's alpha Coefficient를 구하였다． 결과 : PASS항목에서 가장 기능이 좋은 것은 지지하여 서기로 나타났으며，가장 기능이 낮은 것은 환측으로 서기였고，MBI항목에서 가장 기능이 좋은 것은 의자／침상 이동이며， 가장 기능이 낮은 것은 목욕하기로 나타났다．PASS의 모든 항목은 MBI, FM-UE, TAS와 유의한 상관관계(r=-33~91, p<.05~01）가 있으며，FM-U/E와 MBI(r=.35, p<.05), TAS- 안정(r=.-40, p,<．0.1), 연합항목(r=-.39,p<.05)에서 유의한 상관관계가 있는 것으로 나타났다．내적 일치도는 Cronbach's a=.86로 높게 나타났으며，PASS의 합과 자세유지 항목 (r=.90 p<.01)의 합，자세변화 항목(r=.93,p<.01)의 합은 유의한 상관관계가 있었으며，자세유지 항목의 합과 자세변화 항목의 합 간에는 유의한 상관관계(r=.69,p<.01)가 있었다．PASS 항목 중 누운자세에서 건측으로 돌기와 바닥에서 볼펜집어 올리기가 각각 ADL과 상지 기능을 예견하는데 가장 중요한 변수(R2=.95, R2=.56)임을 알 수 있었다． 결론 : PASS는 일상생활동작 수행 능력과 근 긴장도 및 상지기능수행 간에 유의한 상관관계가 있는 것으로 나타나 뇌졸중 환자의 기능적 독립성을 예측할 수 있는 지표가 될 수 있을 것이다．

Objective : The purposes of this study were to find correlations among Postural Assessment Scale for Stroke, MBI, Tone Assessment Scale, FM-U/E, and to predict MBI, FM-U/E: from subscales of Postural Assessment Scale Stroke. Methods : The subjects were 41 stoke patients of the Korea national Rehabilitation Center in Seoul. All patients were assessed on Postural control was measured with the use of the Postural Assessment Scale Stroke, ADL(by the Modified Barthel Index), Tone(by the Tone Assessment Scale), performance function of U/E(by the Fugl-Meyer assessment), The data were analyzed using Pearson product correlation. Postural Assessment Scale for Stroke(PASS)scale between other clinical and instrumental index, multiple stepwise regression analyses were performed to identify prognostic factors for ADL incline, Cronbach's alpha coefficient to identify Internal Consistency on PASS scale. Results : The highest level was standng with support, the lowest level was standing on paretic leg on PASS scale. The highest level was chair/bed transfer, the lowest level was bathing on MBI. All items of the Postural Assessment Scale, were significantly correlated with MBI, FM-U/E, TAS(r=-.33~.91 p<.05~,01). There were significant correlations between MBI-U/E and MBI(r=.35, p<.05), TAS-rest(r=-.40, p<.01), TAS-asso(r=-.39, p<.05). The Internal Consistency (Cronbach a=0.86) was very high, indicating that the PASS is homogeneous and is likely to produce consistent response. Furthermore, the sums of maintaining position items and of changing-position items were strongly correlated(r=.69, p<.01) and there were significant correlations between sums of PASS and sums of maintaining position items(r=.90, p<.01), changing-position items(r=.93, p<.01). The Supine to nonaffected side lateral and Standng picking up a pencil from the floor of PASS items was the strongest variance(R2=.95, R2=.56) of the predicting ADL function, performance of function U/E. Conclusion : The PASS is suited to the assessment of postural control abilities, it demonstrated an acceptable for the evaluation of functional recovery of stroke patients in clinical practices.

Objective : The purpose of this study was establishing clinical norms of TEMPA Korean version for Korean adult population in addition to identifying characteristics of hand function by age and gender based on the collected data. Methods : A total of 138 healthy adults between ages 20 and 59 were recruited by continuous sampling. All subjects had been employed TEMPA Korean version and Jarmar dynamometer and pinch gauge to evaluate hand function and strength. Results : The results showed that there were no statistically significant difference in overall hand function among the age groups and between genders. Also, while there were no significant differences in overall speed and qualitative movement, age groups of 40s and 50s showed a declining tendency in speed in some of the tasks. Also, hand strength increases up to 40s and start declining from the 50s, but most results did not show significant differences among the age groups. Conclusion : Normative data of TEMPA Korean version for Korean adult population was established, therefore, it can be used in clinical setting and research as evidence based.Furthermore, occupational therapists need to consider about the signs of decline in hand function and strength in middle-aged adults and to provide education programs to maintain their hand function.

Objective : This study aimed to identify the characteristics of hand function according to age and sex in older adults. Methods : This study included 103 healthy adults aged ≥60 years. The Korean version of TEMPA was used to assess hand function and a Jamar dynamometer and pinch gauge were used to assess hand and pinch strength in all participants. Results : The results of hand function assessment showed that speed of task execution (mean = 121.32 s, SD = 18.07 s in subjects aged 60-69; mean = 144.97 s, SD = 28.43 s in subjects aged 70-79; and mean = 160.93 s, SD = 38.33 s in subjects aged ≥80, p < .001) and fine movement (mean score = -.14, SD = .40 in subjects aged 60-69; mean score = -.63, SD = 1.07 in subjects aged 70-79; and mean score = -.57, SD = .65 in subjects aged ≥80, p = .01) decreased significantly with age. The male group showed better speed of task execution (mean = 133.54, SD =22.83 in males vs. mean = 150.55, SD = 39.89 in females, p < .01) and fine movement (mean score = -.16, SD = .37 in males vs. mean score = -.46, SD =.58 in females, p < .01) than the female group. Hand strength also decreased significantly with age (p < .05, to p < .001). Conclusion : Occupational therapists should be aware of the decline in hand function (especially speed of task execution and fine movement) and strength in older adults, as well as the need to provide interventions to treat this decline.

Objective To investigate the effects of adjuvant mental practice (MP) on affected upper limb function following a stroke using three-dimensional (3D) motion analysis.Methods In this AB/BA crossover study, we studied 10 hemiplegic patients who had a stroke within the past 6 months. The patients were randomly allocated to two groups: one group received MP combined with conventional rehabilitation therapy for the first 3 weeks followed by conventional rehabilitation therapy alone for the final 3 weeks; the other group received the same therapy but in reverse order. The MP tasks included drinking from a cup and opening a door. MP was individually administered for 20 minutes, 3 days a week for 3 weeks. To assess the tasks, we used 3D motion analysis and three additional tests: the Fugl-Meyer Assessment of the upper extremity (FMA-UE) and the motor activity logs for amount of use (MAL-AOU) and quality of movement (MAL-QOM). Assessments were performed immediately before treatment (T0), 3 weeks into treatment (T1), and 6 weeks into treatment (T2).Results Based on the results of the 3D motion analysis and the FMA-UE index (p=0.106), the MAL-AOU scale (p=0.092), and MAL-QOM scale (p=0.273), adjuvant MP did not result in significant improvements.Conclusion Adjuvant MP had no significant effect on upper limb function following a stroke, according to 3D motion analysis and three clinical assessment tools (the FMA-UE index and the two MAL scales). The importance of this study is its use of objective 3D motion analysis to evaluate the effects of MP. Further studies will be needed to validate these findings.

Objective To evaluate quality of life (QOL), upper extremity function and the eff ect of lymphedema treatment in patients with breast cancer related lymphedema. Method Th e basic data comprised medical records (detailing age, sex, dominant side, location of tumor, cancer stage, operation record, cancer treatment and limb circumferences) and questionnaires (lymphedema duration,satisfaction, self-massage). Further to this, we measured upper extremity function and QOL, administered the DASH (Disabilities of Arm Shoulder and Hand outcome measure) and used the EORTC (European Organization for Research and Treatment of Cancer)-QLQ-C30 and the EORTC-QLQ-Br23. Results of these were calculated as main outcome variables. Results The questionnaire responses and arm circumferences of 59 patients with breast cancer related lymphedema were analyzed. In the DASH questionnaire, it was found that the older the lymphedema patient was, the lower their upper extremity function. On the EORTC-QLQ, patients with metastasis had significantly lower scores in physical functioning and role functioning. In terms of upper extremity circumference, there was a signifi cant upper extremity size reduction after lymphedema treatment. Conclusion Th ere were several dissociations between some subscales of quality of life questionnaires and those of upper extremity functions. Upper extremity function was correlated with the age of breast cancer patients and QOL was infl uenced by M-stage. Lymphedema treatment was found to be eff ective in reducing edema in patients with breast cancer related lymphedema.

Objective: The purpose of this study was to investigate whether there is a difference in the brain connectivity in mental practice and physical performance of training bilateral upper extremity function. Method: The subject performed activities involving mental tasks and physical exercise for bilateral upper extremity functioning during each phase of EEG measurements. The subject performed a symmetrical task(lifting a box and placing it back) that involved moving both arms at the same time and an asymmetrical task(opening and closing a bottle cap) in order to perform functional tasks. EEG electrodes were attached to Fp1, Fp2, F3, F4, T3, T4, P3, and P4. Data analysis was performed using Cross-Line Mapping for correlational analyses between EEG electrode pairs. Conclusion: This study found that the brain connectivity patterns of symmetrical and asymmetric upper extremity tasks have similar patterns for the motor and sensory area, and that the correlation of the physical practice is generally higher than that of the mental practice.

Objective To determine the effects of combining robot-assisted game training with conventional upper extremity rehabilitation training (RCT) on motor and daily functions in comparison with conventional upper extremity rehabilitation training (OCT) in stroke patients.Methods Subjects were eligible if they were able to perform the robot-assisted game training and were divided randomly into a RCT and an OCT group. The RCT group performed one daily session of 30 minutes of robot-assisted game training with a rehabilitation robot, plus one daily session of 30 minutes of conventional rehabilitation training, 5 days a week for 2 weeks. The OCT group performed two daily sessions of 30 minutes of conventional rehabilitation training. The effects of training were measured by a Manual Function Test (MFT), Manual Muscle Test (MMT), Korean version of the Modified Barthel Index (K-MBI) and a questionnaire about satisfaction with training. These measurements were taken before and after the 2-week training.Results Both groups contained 25 subjects. After training, both groups showed significant improvements in motor and daily functions measured by MFT, MMT, and K-MBI compared to the baseline. Both groups demonstrated similar training effects, except motor power of wrist flexion. Patients in the RCT group were more satisfied than those in the OCT group.Conclusion There were no significant differences in changes in most of the motor and daily functions between the two types of training. However, patients in the RCT group were more satisfied than those in the OCT group. Therefore, RCT could be a useful upper extremity rehabilitation training method.

Objective To investigate the effect of intravenous infusion of peripheral blood mononuclear cells (mPBMC) mobilized by granulocyte-colony stimulating factor (G-CSF) on upper extremity function in children with cerebral palsy (CP).Methods Fifty-seven children with CP were enrolled. Ten patients were excluded due to follow-up loss. In total, 47 patients (30 males and 17 females) were analyzed. All patients’ parents provided signed consent before the start of the study. After administration of G-CSF for 5 days, mPBMC was collected and cryopreserved. Patients were randomized into two groups 1 month later. Twenty-two patients were administered mPBMC and 25 patients received normal saline as placebo. Six months later, the two groups were switched, and administered mPBMC and placebo, respectively. Quality of Upper Extremity Skills Test (QUEST) and the Manual Ability Classification System (MACS) were used to evaluate upper motor function.Results All subdomain and total scores of QUEST were significantly improved after mPBMC and placebo infusion, without significant differences between mPBMC and placebo groups. A month after G-CSF, all subdomain and total scores of QUEST were improved. The level of MACS remained unchanged in both mPBMC and placebo groups. Conclusion In this study, intravenously infused mPBMC showed no significant effect on upper extremity function in children with CP, as compared to placebo. The effect of mPBMC was likely masked by the effect of G-CSF, which was used in both groups and/or G-CSF itself might have other neurotrophic potentials in children with CP.

Objective : This study aimed to investigate the effect of simultaneous application of peripheral nerve sensory stimulation and task-oriented training on the improvement of upper extremity motor function after stroke. Methods : This study included 29 patients with hemiplegia. The 14 subjects were in the peripheral nerve sensory stimulation and task-oriented training group for 4 weeks (30 min/d, 5 d/wk), while the 15 control group subjects underwent only task-oriented training for the same duration. The outcome measures were the percentage of voluntary baseline muscle contractions of the wrist and shoulder and Box and Block Test, grip and pinch strength, and Action Research Arm Test. Results : After 4 weeks, muscle activity of extensor carpi radialis, flexor carpi radialis and grip strength and Action Research Arm Test were significantly higher in the experimental group. Conclusion : Simultaneous application of the peripheral nerve sensory stimulation and task-oriented training was found to be superior to task-oriented training for improving upper extremity motor function of adults with stroke.

This study aimed to assess the effects of an aquatic bilateral exercise program on upper extremity function in a child with hemiplegic cerebral palsy (CP). The participant was a 5-year-7-month-old girl diagnosed with left spastic hemiparetic CP. A single-subject A-B-A experimental design was employed. Outcome measures included the Melbourne assessment and assessment of motor and process skills (AMPS) to evaluate upper extremity functions, as well as changes in shoulder and elbow flexion angles during reaching tasks. The intervention consisted of an aquatic bilateral exercise program based on the Halliwick 10-point program. Following the intervention, Melbourne assessment scores improved by 45.38%, with gains maintained during the follow-up phase (23.69%). Additionally, mean shoulder and elbow flexion angles changed from 64.86° to 69.21° and from 125.29° to 140.34° after the intervention, respectively. In the AMPS, the ADL (actvie daliy living) motor skill score increased from 0.54 points before the intervention to 0.84 points after the intervention. However, the ADL process skill score decreased from 0.90 to 0.71 points. These findings suggest that aquatic bilateral exercise may be beneficial for improving upper extremity function in hemiplegic CP. Further studies are warranted in this area.

We aimed to conduct a systematic literature review with a meta-analy-sis to investigate whether virtual reality (VR) approaches have benefi-cial effects on the upper extremity function and independent activities of stroke survivors. Experimental studies published between 2007 and 2017 were searched from two databases (EBSCOhost and PubMed). This study reviewed abstracts and assessed full articles to obtain evi-dence on qualitative studies. For the meta-analysis, the studies that es-timated the standardized mean between the two groups analyzed the statistical values necessary for calculating the effect size. The present study also evaluated the statistical heterogeneity. In total, 34 studies with 1,604 participants were included, and the number of participants in each study ranged from 10 to 376. Nine studies were assessed to evalu-ate the quantitative statistical analysis for 698 patients with hemiparetic stroke. The results of the meta-analysis were as follows: The overall ef-fect size was moderate (0.41, P<0.001). The 95% confidence interval ranged from 0.25 to 0.57. However, no significant heterogeneity and publication bias were observed. The results of this study showed that VR approaches are effective in improving upper extremity function and independent activities in stroke survivors.

본 연구의 목적은 가상현실 훈련이 아급성 뇌졸중 환자의 상지기능과 일상생활활동에 미치는 효과를 규명하는 것이다. 아급성기 뇌졸중 환자 18명이 본 연구에 참여하였다. 모든 대상자는 실험군 9명과 대조군 9명으로 배정되었다. 두 군은 하루 30분, 주 5회, 4주 동안 보편적인 작업치료를 받았다. 실험군은 가상현실 훈련을 회기 마다 30분 더 받았으며, 대조군은 보편적인 작업치료를 회기 마다 30분 더 받았다. 결과 측정은 중재 전과 후에 Fugl-Meyer 평가와 한국판 수정바델지수에 의해 수행되었다. 연구 결과, 실험군은 중재 후 Fugl-Meyer 평가 점수와 한국판 수정바델지수 점수에서 유의한 향상을 보였다(p<.05). 대조군은 Fugl-Meyer 평가의 어깨/팔꿈치/전완, 손목, 손 하위항목과 한국판 수정바델지수에서 유의한 향상을 보였다(p<.05). 중재 후 실험군은 대조군보다 Fugl-Meyer 평가의 총점, 손목과 손 하위항목에서 유의하게 더 큰 향상을 보였다(p<.05). 이러한 결과들은 가상현실 훈련이 아급성기 뇌졸중 환자의 상지기 능 향상에 긍정적인 효과를 나타낼 수 있음을 시사한다.

The aim of this study was to investigate the effects of virtual reality training on upper extremity function and activities of daily living in patients with sub-acute stroke. The present study enrolled 18 patients with sub-acute stroke. All subjects were assigned into either the experimental group (n=9) or control group (n=9). Both groups received conventional occupational therapy for 30 minutes/day, 5 times a week, for 4 weeks. Additionally, the experimental group performed virtual reality training in each session for 30 minutes/day, and the control group conducted conventional occupational therapy in each session for 30 minutes/day. The outcome measures were performed through the Fugl-Meyer Assessment (FMA) and the Korean-modified Barthel Index (K-MBI) before and after intervention. In results, the experimental group showed significant improvements in the scores of FMA and K-MBI after intervention (p<.05). The control group showed significant improvements in the shoulder/elbow/forearm, wrist, and hand sub-domains of the FMA and K-MBI (p<.05). After intervention, the experimental group showed significantly greater improvements in the total score and in the wrist and hand sub-domains of the FMA than control group (p<.05). These findings suggest that virtual reality training may have positive effects on the improvements of upper extremity function in patients with sub-acute stroke.

Stroke is one of the main causes of death and disability in adults, and after stroke, patients are left with various symptoms such as motor paralysis, gait disturbance, sensory abnormalities, and cognitive impairment. In particular, despite receiving intensive rehabilitation treatment, 55-75% of post-stroke patients remain impaired in upper extremity function, which reduces the quality of life. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment that has the effect of adjusting cortical excitability according to frequency. This literature review was conducted to provide a more diverse clinical basis for applying rTMS to stroke patients in the future for recovery of upper extremity function. The databases of PubMed and Embase were searched using combinations of the following terms: stroke AND upper extremity AND transcranial magnetic stimulation. 10 randomized controlled trials (RCTs) that met the inclusion criteria were included in this literature review and extracted data included sample size, sample characteristics, study design, rTMS protocol, and outcome measurement. All included studies applied rTMS to M1 (primary motor cortex). 10 studies included in this literature review reported that HF-rTMS (High-frequency rTMS) or iTBS (intermittent theta-burst stimulation) to the ipsilateral M1 and LF-rTMS (Low-frequency rTMS) to the contralateral M1 resulted in significant improvements in upper extremity assessments, so this literature review suggests that rTMS is beneficial for the recovery of upper extremity function in stroke patients.

The purpose this study was to investigate the effect of action observa-tion physical training (AOPT) on the functioning of the upper extremities in children with cerebral palsy (CP), using an evaluation framework based on that of the International Classification of Functioning, Disabili-ty and Health (ICF). The subjects were divided into an AOPT group and a physical training (PT) group. AOPT group practiced repeatedly the ac-tions they observed on video clips, in which normal child performed an action with their upper extremities. PT group performed the same ac-tions as the AOPT group did after observing landscape photographs. The subjects participated in twelve 30-min sessions, 3 days a week, for 4 weeks. Evaluation of upper extremity function using the following: the power of grasp and Modified Ashworth Scale for body functions and structures, a Box and Block test, an ABILHAND-Kids questionnaire, and the WeeFIM scale for activity and participation. Measurements were performed before and after the training, and 2 weeks after the end of training. The results of this study showed that, in comparison with the PT group, the functioning of the upper extremities in the AOPT group was significantly improved in body functions and activity and participa-tion according to the ICF framework. This study demonstrates that AOPT has a positive influence on the functioning of the upper extremi-ties in children with CP. It is suggested that this alternative approach for functioning of the upper extremities could be an effective method for rehabilitation in children with CP.

목적 : 본 연구는 로봇보조 치료가 뇌졸중 환자의 상지기능에 미치는 영향을 알아보고자 하였다. 연구방법 : 뇌졸중 편마비 환자를 대상으로 발병 12개월 이내의 입원 환자 4명과 발병 12개월 이후의 외래 환자 7명에게 각각 5～6주간 로봇보조 치료를 실시하였다. 로봇보조 치료는 상지기능 훈련을 위한 다양 한 운동프로그램을 가지고 있는데, 그 중 앞으로 팔 뻗기 훈련을 통해 환자의 능력에 적합한 운동모드를 치료사가 선택하여 이루어졌다. 환자는 30분간 3차원의 피드백을 제공하는 모니터를 바라보며 앞으로 팔 뻗기 운동을 반복적으로 수행하였다. 대상자들의 상지기능 변화를 위해 장악력 검사(Grip strength test), 한글판 울프운동기능검사(Korean-Wolf Motor Function Test: K-WMFT), 상자와 나무토막검사(Box & Block Test: BBT)와 팔 뻗기 수행시간을 중재 전·후에 측정하였다. 결과 : 로봇보조 치료를 통한 상지기능의 변화를 살펴보기 위해 중재 전·후의 측정값의 변화량을 비교하여 살펴본 결과, 연구 대상자 모두에서 결과값의 향상을 보였다. 통계적인 유의성을 확인하기 위해 윌콕슨 부호 순위 검증을 실시한 결과, 외래환자의 장악력과 상지기능, 기민성, 수행시간에서 유의한 차이를 보 였고(p<0.05), 입원 환자의 경우에는 통계학적으로 유의한 차이를 보이지 않았다(p>0.05). 결론 : 로봇보조 치료가 뇌졸중 환자의 상지기능 회복에 긍정적인 영향을 주는 것을 알 수 있었다. 따라서 향후 본 연구를 기초로 작업치료 영역에서도 로봇보조 치료를 통한 중재적 접근이 필요할 것으로 생각되 며, 뇌졸중 환자의 기능회복을 위한 로봇보조 치료의 유용한 사용이 기대된다.

Objective : The purpose of this study is to assess effects of Robot-assisted therapy on function of upper extremity in stroke patients. Method : A total of 11 patients suffered from stroke participated in this study. Inpatients of 4 people and outpatients of 7 people divided by 12 months conducted Robot-assisted therapy for 5∼6 weeks. Therapists selected appropriate exercise mode to patients, and patients Patients performed the reaching exercise was repeated with looking monitor provided 3-dimensional feedback. Before and after treatment of upper extremity functions was compare by Wolf Motor Function(K-WMFT), Box & Block Test(BBT), Dynamometer, average execution time. Result : Grip power, K-WMFT, BBT, average performance times were promoting in all subjects, and only showed statistically significant changes in outpatients. But outpatients did not show statistically significant changes in inpatients. Conclusion : Robotic-assisted therapy in stroke patients have a positive impact on upper extremity function that could confirm that. In the future, Robots-assisted therapy is expected to be useful for stroke patients in the area of occupational therapy

본 연구의 목적은 뇌졸중 환자의 상지기능, 일상생활활동, 치료적 몰입과 삶의 질 간의 상관관계를 알아보고, 삶의 질에 영향을 미치는 요인을 파악하기 위함이다. 총 13개 병원에서 입원중인 뇌졸중 환자 249명을 대상으로 상지기능, 일상생 활활동, 치료적 몰입과 삶의 질을 치료사와 연구자가 평가하였다. 그 결과, 뇌졸중 환자의 상지기능(r=.312, p<.001), 일상생 활활동(r=.605, p<.001), 치료적 몰입(r=.525, p<.001)이 양의 상관관계를 나타내었다. 그리고 뇌졸중 환자의 삶의 질에 영향 을 미치는 요인을 분석한 결과, 치료적 몰입(β=.344, p<.001), 일상생활활동(β=.293, p<.001), 발병기간(β=.145, p<.05)은 뇌졸 중 환자의 삶의 질에 유의한 영향을 미치는 변수로 확인되었으며, 이들 요인은 삶의 질을 35.9% 설명하는 것으로 나타났다 (F=35.736, p<.001). 이를 통하여 치료적 몰입은 삶의 질에 영향을 미치는 중요한 요인임을 확인할 수 있었으며, 향후 치료적 몰입에 대한 계속적인 연구가 요구된다.

The purpose of this study was to analyzed the correlation between upper extremity function, activities of daily living, quality of life and therapeutic flow in stroke clients and identify the factors influencing therapeutic flow. Total 249 stroke patients from 13 hospitals were measure at therapist and researcher for upper extremity function, activities of daily living, therapeutic flow and quality of life. Factors that affect the quality of life correlation as s result of positively correlated with upper extremity function(r=.312, p<.001), activities of daily living(r=.605, p<.001), therapeutic flow(r=.525, p<.001). And the effect on quality of life in stroke clients variables affecting therapeutic flow(β=.344, p<.001), activities of daily living(β=.293, p<.05) and Time since of onset(β=.145, p<.05) were the order of analysis. The regression model explained 35.9% of variances(F=35.736, p<.001). Therefore, it was found that therapeutic flow in stroke clients is an important factor for quality of life, future therapeutic flow study will continue to be needed.

목적 : 본 연구에서는 뇌졸중 환자에게 손상측 손의 주먹 쥐기 동작을 실시하여 동측 경상 운동 발현 유무를 확인하고, 동측 경상 운동과 손상측 상지 기능의 관계를 비교해 보고자 하였다. 연구방법 : 2개의 전자 악력계를 이용하여 손상측 손으로 대상자가 할 수 있는 최대의 힘으로 주먹 쥐기를 10초 동안 유지하는 것을 시행한 후 동측 경상 운동을 측정하고, 동측 경상 운동의 유무에 따라서 경상 운동이 나타나는 환자군 15명과 경상 운동이 나타나지 않는 환자군 15명으로 구분하였다. 경상 운동의 유무에 따른 손상측상지의 기능을 비교하기 위해서 퍼글-마이어 평가, 퍼듀 페그보드 검사, 악력 측정을 실시하였다. 결과 : 동측 경상 운동이 나타나는 환자군과 경상 운동이 나타나지 않는 환자군의 집단 간의 손상측 상지 기능의 비교에서 퍼글-마이어 평가, 퍼듀 페그보드 검사, 악력 모두에서 통계학적으로 유의한 차이를 보였다(p<.05). 동측 경상 운동이 나타나는 환자군이 경상 운동이 나타나지 않는 환자군보다 상지의 전반적인 기능에서 좋지 않은 것으로 나타났다. 결론 : 뇌졸중 이후에 나타나는 동측 경상 운동은 상지 기능에 좋지 않은 영향을 미치는 것을 알 수 있고, 운동 결함이 있는 동측 경상 운동이 나타나는 환자에서 뇌졸중 이후 회복 과정의 임상적 양상을 알 수 있다. 따라서 뇌졸중 환자의 평가와 치료에 있어서 동측 경상 운동을 고려해야 하며, 앞으로 뇌졸중 환자에서 경상 운동의 지속적인 평가와 치료적 중재에 관한 연구가 필요할 것이다.

Objective : Ipsilateral mirror movements (MMs) are involuntary movements of one limb during voluntary unilateral movements of the opposite limb. MM decreases in the course of motor development, but may reappear in adults suffering from brain damage after a stroke. The purpose of this study is to measure MM and compare the relationship between ipsilateral MM and the motor function of the affected upper extremity in stroke patients. Methods : Fifteen stroke patients with MM and fifteen stroke patients without MM were selected for this study. Two dynamometers were used during a squeezing task in order to measure the intended movements from the active hand as well as MM from the opposite hand. The upper extremity's motor function was measured using Fugl-Meyer Assesment (FMA), Purdue Pegboard Test (Purdue), and grip strength. Results : There was a significant difference in the upper extremity's motor function according to FMA, Purdue, and grip strength, depending on the presence of MM. The motor deficit of patients with MM was significantly greater than that of patients without MM. Conclusion : The findings show that stroke patients with MM have a significant motor deficit. The observation of ipsilateral hand MMs with greater motor deficit may suggest that these MMs represent a clinical sign of the restorative processes after a stroke. Therefore, the evaluation of MM can be useful for the assessment and treatment of stroke patients. Further studies are needed to attempt temporal assessments and develop a treatment intervention of MM after a stroke

본 연구에서는 거울되먹임치료를 이용하여 뇌졸중 환자의 상지 근육 활성도와 상지 기능적 평가에 미치는 효과에 대하여 알아보고자 하였다. 환자는 거울되먹임 치료군 8명과 동작관찰 훈련군 8명으로 나누어 총 8주간 주 5 회, 30분간 시행하였고, 상지 기능을 평가하기 위해 뇌졸중 기능회복 평가와 도수 기능 검사를 이용하였다. 위등세모 근, 중간어깨세모근, 위팔두갈래근, 노쪽손목굽힘근, 긴노쪽손목폄근의 근활성도를 평가하기 위해 표면 근전도 시스템 을 이용하였고, 연구 결과 노쪽손목굽힘근을 제외한 위등세모근, 중간어깨세모근, 위팔두갈래근, 긴노쪽손목폄근의 근 활성도와 뇌졸중 기능회복 검사, 도수 기능 검사 점수에서 대조군과 실험군 모두 전, 후 유의한 차이를 보였다. 이에 따라 거울되먹임 치료가 동작관찰 훈련보다 상지 근활성도와 상지 기능을 향상시키는데 효과적임을 알 수 있었다.

The purpose of this study was to find out the effect that muscle activity of upper extremity and functional test in the case of the stroke patient by using the feedback mirror therapy. Sixteen subjects were recruited and randomly divided into two groups. one group was trained feedback mirror therapy and other group was action observation training. This process was carried out five times a week for eight weeks. To upper extremity test was used to MFT, FMA and in order to test UT, DM, BB, FCR, ECRL used to muscle activity. After the training, exclude FCR an upper extremity motor function of target showed significant difference between two groups and especially an experimental group showed significant muscle activity and MFT, FMA score improvement of UT, DM, BB, ECRL. Therefore, feedback mirror therapy is more upper extremity motor function and muscle activity improvement effect than action observation training.

본 연구의 목적은 국소 진동 자극과 양측성 팔 훈련의 융합 중재를 뇌졸중 환자에게 적용했을 때, 팔 기능 개선에 미치는 영향을 알아보는 것이다. 20명의 뇌졸중 환자를 국소 진동 자극과 양측성 팔 훈련의 융합 중재를 실시한 실험군 과 양측성 팔 훈련만 실시한 대조군으로 나누어, 회기 당 30분씩 4주간, 총 20회 실시하였다. 진동자극은 실험군의 손상 측 팔에 훈련이 이루어지는 30분간 적용되었다. 평가는 손상 측 팔의 회복정도와 양측 팔 의 사용량, 양손 사용의 수행 의 질과 만족도를 측정하였으며, 대응표본 t-검정을 사용하여 그룹 내, 공분산 분석을 사용하여 그룹 간 비교를 하였다. 연구 결과, 실험군은 대조군보다 손상 측 팔의 기민성과 손상 측의 사용량에서 유의한 차이의 변화를 보였다. 효과 크기 는 모든 항목에서 작은 효과 크기 이상의 차이를 보였다. 본 연구를 통해, 국소 진동 자극과 양측성 팔 훈련의 융합 중재가 뇌졸중 환자의 팔 기능 회복을 위한 효율적 중재로써 임상에서 사용 될 수 있을 것으로 생각된다.

The purpose of this study was to investigate the convergence effect of focal vibration stimulation and bilateral upper limb training on the recovery of upper limb function when applied to stroke patients. For 20 stroke patients, divided into an experimental group that performed convergence intervention with focal vibration stimulation and bilateral upper limb training, and a control group who performed only bilateral upper limb training. It was conducted 20 times for 4 weeks, 30 minutes per session. Vibration stimulation was applied to the affected side of the experimental group for 30 minutes during training. Results were measured for the degree of recovery of the affected upper limb function, amount of use on the affected and unaffected sides, the quality and satisfaction in performance on use of both upper limbs. Comparisons were made within groups using a paired-sample t-test and between groups using covariance analysis. As a result of the study, the experimental group showed a significant difference in dexterity and the amount of use on the affected than the control group. The effect size was more than the small effect size in all evaluation items. Through this study, it is thought that the convergence intervention of focal vibration stimulation and bilateral upper limb trainingcan be used clinically as an effective intervention for the recovery of arm function in stroke patients.

목적 : 본 연구에서는 뇌졸중 환자 중에서 편측무시가 있는 군과 없는 군 각각에 대해 4주간의 거울치료를 적용하여 그 효과를 알아보고자 하였다. 또한 거울치료를 통하여 상지의 기능 향상과 일상생활동작에 어 떠한 효과가 있는지에 대해서도 알아보고자 한다. 연구방법 : 창원시 C병원에 입원하여 작업치료를 받는 성인 편마비 환자로써 편측무시가 있는 환자 10명, 편측무시가 없는 환자 10명, 총20명을 대상으로 실시하였고 치료사와 1:1로 30분씩 주5회 총 4주간 걸쳐 거울치료 프로그램을 실시하였다. 편측무시 유무를 확인하고 거울치료 중재 전, 후 비교를 위해 알버트 검사를 사용하였다. 상지기능평가로써 Fugl-Meyer motor function Assessment(FMA), Box & Block Test(BBT)을 사용하였으며 일상생활활동평가는 Functional Independence Measure(FIM)를 사용하였다. 결과 : 거울치료는 편측무시를 가진 뇌졸중 환자에게 효과가 있었다(p<.05). 또한 뇌졸중환자의 편측무시 유 무에 관계없이 상지기능과 일상생활활동에 효과가 있었다(p<.05). 결론 : 거울치료가 뇌졸중 환자의 마비측 상지기능과 일상생활활동 능력을 향상시킬 뿐만 아니라 편측무시 증상을 가지고 있는 뇌졸중 환자에게서도 편측무시 감소를 보였다. 결론적으로 거울치료는 편측무시 감 소를 보일 뿐만 아니라 뇌졸중 환자의 기능적인 회복과 일상생활활동 수행능력 향상을 위한 치료방법으 로써 임상에서 유용하게 적용될 수 있을 것이라 사료된다.

Objective : We tested the effect of mirror treatment on patients with and without unilateral neglect over a period of 4 weeks. We also wanted to know the effect of mirror treatment with regards to improving upper extremity function and dealing with activities of daily living. Methods : Subjects were 10 hemiplegia patients with unilateral neglect and 10 hemiplegia patients without unilateral neglect. They visited the department of occupational therapy. We performed mirror treatment for 30 minutes, 5 times a week for 4 weeks. We used Albert Test to compare our results from before and after the treatment, Fugl-Meyer motor function Assessment(FMA) and Box & Block Test(BBT) for upper extremity function, and Functional Independence Measure(FIM) for activities of daily living. Results : The results showed that mirror treatment had an effect on stroke patients with unilateral neglect. The treatment also had an effect on upper extremity function and activities of daily living regardless of unilateral neglect. Conclusion : The mirror treatment showed improvements on upper extremity function and activities of daily life as well as a reduction in the unilateral neglect after a stroke. In conclusion, the mirror treatment is useful for recovering function and improvement and for helping the patients complete activities of daily living.