Earticle

목적 : 본 연구에서는 발달성협응장애와 발달성협응장애 아동을 대상으로 한 과제-중심 접근법을 문헌 고 찰을 통하여 알아보고자 하였다. 본론 : 본 연구는 발달성협응장애의 정의, 진단, 원인, 평가에 대한 전반적인 개요를 제시한다. 또한 신경 운동과제훈련(Neuromotor Task Training; NTT)과 인지기반작업수행(Cognitive Orientation to daily Occupational Performance; CO-OP)의 중재 전략에 대해 알아보기 위해 2000년 1월부터 2023년 9 월까지 게재된 국외 문헌 18편을 분석하였다. 선정된 문헌에서 언급된 중재의 목적은 작업치료 실행체계 4판(Occupational Therapy Practice Framework-4; OTPF-4)의 기준에 따라 분류하였다. 분류 결 과, NTT는 클라이언트 요인(client factor) 영역에 대한 목표 설정의 빈도가 높았고, CO-OP는 작업 (occupation) 영역에 대한 목표만을 설정하였다. 이러한 목표 설정의 차이는 두 중재 간 전략의 차이로 설명된다. 결론 : 발달성협응장애에 대한 전반적인 개요와 과제-중심 접근법의 중재에 대한 전략의 이해는 질환에 대한 인식도를 높이고 근거 기반 임상을 위한 기초 자료가 될 것이다.

Objective : This study aimed to provide an overview of task-oriented approaches for children with developmental coordination disorder, including its definition, diagnosis, causes, and assessment, through a literature review. Subject : Eighteen international articles published between January 2000 and September 2023 were analyzed to explore the intervention strategies of Neuromotor Task Training (NTT) and Cognitive Orientation to daily Occupational Performance (CO-OP). The objectives of the interventions mentioned in the reviewed articles were categorized according to the criteria of the Occupational Therapy Practice Framework-4 (OTPF-4). The results showed that NTT more frequently set goals in the area of client factors, while CO-OP set goals only in the area of occupation. This difference in goal setting can be explained by the strategy differences between the two interventions. Conclusion : A broader and deeper understanding of strategies for interventions with task-oriented approaches to developmental coordination disorder can increase awareness of the disorder and provide a more solid basis for evidence-based practice.

목적 : 수정된 강제유도운동치료와 양손 움직임을 위한 활동으로 구성한 과제 지향적 치료 프로그램이 뇌졸중 환자 의 상지기능과 일상생활활동에 미치는 효과를 알아보는 것이다. 연구방법 : 5명의 뇌졸중 편마비 환자들을 대상으로 수정된 강제유도운동치료를 적용하였다. 수정된 강제유도운동 치료는 3주 동안 매일 가장 활동적인 5시간 동안 건측 상지의 움직임을 제한하는 장갑을 착용하였고 제한시간 동 안 환측의 움직임을 위한 과제들을 수행하였다. 양손 움직임을 위한 활동은 건측을 제한하지 않고 일상생활활동과 밀접한 과제들을 1주 동안 수행하였다. 상지기능 변화는 뇌졸중상지기능평가(MFT)를 사용하였고 일상생활활동 의 변화는 운동처리기술평가(AMPS)를 사용하였다. 결과분석은 3번의 반복 측정된 자료의 차이를 검증하기 위해 비모수 방법인 프리드맨 검정을 사용하였고 사후 검정은 윌콕슨 쌍대비교 분석을 이용하였다. 통계적 유의수준은 .05로 하였다. 결과 : 대상자의 상지기능과 일상생활활동 수행능력은 수정된 강제유도운동치료 후와 양손 움직임을 위한 활동 후 유의하게 향상되었다. 수정된 강제유도운동치료를 실시한 후에 편마비 환자의 환측 상지기능과 일상생활활동 수 행 능력이 유의하게 향상되었고 양손움직임을 위한 과제 지향적 치료 이후에도 유의한 수준은 아니지만 긍정적인 효과가 나타났다. 결론 : 연구 결과를 통해 과제 지향적 방법이 적용된 수정된 강제유도운동치료를 실시하고 이를 통해 향상된 환측 을 기능적으로 활용하도록 양손 활동 과제를 이용하여 훈련하는 본 연구의 치료 프로그램이 뇌졸중 환자의 환측 상지 기능과 일상생활활동의 증진에 효과적임을 확인할 수 있었다.

Objective : The purpose of this study was to investigate a task-oriented approach program consisting of modified Constraint-Induced Movement Therapy (m-CIMT) and bimanual activities used to impact the affected upper extremity function and activities of daily living (ADL) performance for five stroke patients. Methods : Five subjects, each suffering from stroke hemiplegia, wore a glove to create limited movement on their unaffected hand during a three-week period during their most active 5 hours of the day, and performed tasks for a limited period of time. Their bimanual movement activity was non-limited on their unaffected side, and bimanual ADL tasks were performed during one week. An assessment of their upper extremity function was made using an adapted Manual Function Test (MFT), while their changes of ADL functions were measured using an Assessment of Motor and Process Skills (AMPS). A Friedman test with repeated measurements was used to verify the significant differences of the analysis results, and a Wilcoxon matchpaired sign-rank test was used to ascertain the differences between the subjects before and after treatment. Results : The subjects’upper extremity function and ADL performance function were significantly improved after Modified Constrain-induced Movement therapy (m-CIMT) and bimanual activity. After m-CIMT, the upper extremity function and ADL performance function of hemiplegia patients were significantly improved, even after a task-oriented approach, but no positive effects were shown at significant levels. Conclusion : Through these study results, it was found that carrying out m-CIMT and bimanual activities in an applied task-oriented approach improved the functional use of the affected side of stroke patients. This treatment program was found to effectively improve the patients’upper extremity and ADL functions.

목적 : 본 연구의 목적은 발달성협응장애 아동에게 과제중심접근 치료가 효과적인지 알아보기 위하여 문헌 분석을 통하여 중재결과를 ICF 모델로 제시하고자 하였다. 연구방법 : 대상자는 DSM-Ⅳ 진단 기준에 따라 발달성협응장애에 해당하는 0∼12세 아동으로 과제중심 중재방법인 신경운동 과제훈련과 일상 작업수행의 인지중심 접근 두 가지에 관하여 1995년 1월∼2007년 11월까지 게재된 논문을 Pubmed와 Medline을 통해 체계적 고찰(systematic review)을 하였다. 결과 : 중재 효과는 과제중심 중재결과 자료 중 17개(62.96%)가 중재효과가 있는 것으로 분석되었다. 이중 신경운동과제 훈련 접근법에서 5개(18.52%), 일상작업수행의 인지 중심 접근법에서 12개(44.44%)가 중재효과가 있는 것으로 분석되었다. ICF 모델로 제시한 결과 신체 기능 및 구조 영역을 평가한 자료가 14개(51.85%), 활동 및 참여 영역을 평가한 자료가 13개(48.15%)로 나타났다. 그러나 중재효과는 신체 기능 및 구조 영역에서 6개(22.22%)이었던 반면 활동 및 참여 영역에서 11개(40.74%)로 분석되었다. 결론 : 과제중심접근 치료가 발달성협응장애 아동에게 효과가 있는지 알아보기 위해 체계적 고찰을 하였다. 고찰 결과 과제중심접근이 ICF model의 활동 및 참여 영역에서 더 효과가 있는 것으로 나타났다. 분석 논문 수가 8개라는 제한점이 있으나, 국내작업치료분야에서 체계적 고찰을 통해 이러한 지식을 활용하고, 임상적 사용에 대한 근거를 제시할 수 있다.

Objective : The aim of this study is to suggest evidence to evaluate the effectiveness of a task-oriented approach developed for the treatment of children with developmental coordination disorder. Treatment outcomes are presented using the International Classifications of Functioning, Disability and Health (ICF). Methods : Participants had to be children diagnosed with DCD according to DSM-Ⅳ and aged 0 to 12 years old. Their intervention could be neuromotor task training and cognitive orientation to daily occupational performance. The literature search included the following electronic databases: Medline, Pubmed (January 1997 to November 2007). Results : There were 17 (62.96%) papers on the effectiveness of neuromotor task training, and 12 (44.44%) papers on the effectiveness of cognitive orientation to daily occupational performance. The results of the ICF model presented 14 (51.85%) papers on body structure & function and 13 (48.15%) papers on activity and participation. And there were 6 (22.22%) papers on the effectiveness of body structure & function and 11 (40.74%) papers on the effectiveness of activity and participation. Conclusion : This paper conducted a systematic review of the research literature that reports on the effectiveness of a task-oriented approach developed for the treatment of children with developmental coordination disorder. The results of the review presented greater effect on the activity and participation of the ICF model. There was limit of 8 journals used. But this knowledge is utilized in occupational therapy, and therefore presents evidence of practice.

This study aimed to enhance the gross motor function, gait, balance, and quality of life of school-aged children using task-oriented approach based on the school function assessment (SFA). Total of three school-aged children who were diagnosed with genetic developmental disabilities (GDD) participated in the experiment. In a pre-test, the gross motor function measure (GMFM), pediatric evaluation of disability inventory (PEDI), pediatric balance scale (PBS), and GaitRite was evaluated. Then, 12 weeks of task-oriented approach based on SFA was performed. The treatment consisted of ‘traveling’, ‘maintaining and changing positions’, ‘manipulation with movement’, ‘using materials’, ‘recreational movement’, ‘hygiene’, ‘clothing management’, ‘up/down stairs’. After the treatment, a post-test followed. Gait analysis revealed increased symmetry in both time and distance of a single step. Furthermore, GMFM and PBS measures increased for every participant. Finally, daily life dependence in PEDI decreased for every participant. We demonstrated effect of task-oriented approach in three children with GDD. The proposed treatment effectively enhanced overall GMFM, ratio between swing and stance phases, and PBS. Especially, the ratio between swing and stance phases shifted close to 4:6, which is the presumed normal ratio. Also, daily life dependence in PEDI decreased for every participant, which indicates that it has a significant effect on physical function and participation. Increasing number of participants and applying the suggested protocol to patients with GDD could be future topics.

The purpose of this study is to investigate the effect of task-oriented voluntary trunk rotation among stroke patients with unilateral neglect; the focus was to detect any reduction of unilateral neglect or increase in balancing ability. This study used a single subject experimental design with multiple baselines. Participant 1, 2 and 3 performed 4, 8 and 12 sessions each during the baseline phase, and 16, 12 and 8 sessions at the intervention, respectively. The results were assessed by using the line bisection test, Berg Balance Scale(BBS), which were separately implemented. The Line bisection scores of participant 1, 2 and 3 were improved by 38.9%, 44% and 35.9%, trunk rotation in task-oriented voluntary trunk rotation. The BBS scores of participant 1, 2 and 3 were improved by 39.6%, 31.6% and 7.7% each, compared to the baseline. The findings suggest that task-oriented voluntary trunk rotation is adaptable to clinical applications to reduce unilateral neglect and to enhance balancing ability to the target patients. Future studies with wider range of participants and longer experiment span, are required in order to strengthen the result of the research.

목적 : 상지 협응 움직임을 기반으로 한 과제중심적 접근 훈련이 발달성 협응 장애아동의 한글 글씨쓰기 능력에 미치는 영향을 알아보며 각 접근이 한글 글씨 쓰기 수행의 질과 글씨쓰기 준비기술에 미치는 영향을 비교하고자 한다. 연구방법 : 본 연구는 5~10세의 발달성 협응장애 아동 40명을 대상으로 무작위 추출을 통해 두 집단으로 나뉘어 사전-사후 검사로 진행하였다. 두 집단은 과제중심접근 중재군과 과정중심접근 중재군으로 5주 동안 40분씩 주 2회중재를 받았다. 글씨쓰기 수행은 한글 자모 쓰기 검사로 측정하고, 글씨쓰기 준비요소인 상지 운동 기능, 시 지각기능과 시 운동기능은 각각 운동 유창성 평가(Bruininks-Oseretsky Test of Motor Proficiency-2: BOT-2)중미세운동조절의 하위검사 일부, 한국판 시 지각 발달 검사(Korean-Developmental Test of Visual Perception-2: K-DTVP-2), 개정된 시 운동기술 평가(Test of Visual Motor Skills-Revised: TVMS-R)로 평가하였다. 고찰 : 본 연구는 과제중심접근법을 적용하여 발달성 협응 장애아동의 글씨쓰기 수행도를 향상시킨다는 임상적 근거를 제공하는데 의의가 있다. 또한 과정중심접근법과 과제중심접근법이 글씨쓰기 준비기술의 향상에 어떠한 영향을 끼치는 지에 대한 결과를 확인하여 보다 효과적인 글씨쓰기 중재방법을 제시하는 초석이 될 수 있을 것이라생각한다.

Objective : The purpose of this study is to investigate the impact of task-oriented approach based on upper limb coordinated movement on the ability of the Korean handwriting in children with developmental coordination disorder(DCD). Methods/Design : This randomized controlled trial designed as a pre-/post- test will compare the effectiveness of task-oriented approach and process-oriented approach on handwriting performance for children with DCD aged 5 to 10. These interventions consist of 10 training sessions and 4 assessment sessions over 7weeks. Children will be measured regard to handwriting legibility, speed and pre-handwriting skills including upper limb movement skills, visual perception and visual motor coordination. Conclusion : This is the first attempt to investigate effects of a task-oriented approach in children with DCD. The significance of this study is to provide the clinical evidences to apply the task-oriented approach improves the children’s handwriting performance. Furthermore it will also present a more effective intervention for handwriting by figuring out each approach’s impact on the improvement of pre-handwriting skills.

본 연구의 목적은 보조공학 기술을 적용한 가정환경 수정과 낙상 안전 체크리스트를 이용한 과제기반 중재를 함께 적용하는 융복합 접근법이 뇌졸중 환자의 낙상 효능감과 활동 수준에 미치는 효과를 확인하는 것이다. 뇌졸중 환자 41명 대상자(실험군 21명, 대조군 20명)는 실험군과 대조군으로 나누어졌다. 실험군에는 환경수정과 낙상 안전 체크리스트를 활용한 과제기반 중재를 4주간 적용하였다. 대조군에는 가정환경 수정만 실시하였다. 중재 전과 후에 한국형 활동분류카드(Korean Activity Card Sort, KACS), 한국형 낙상효능감 측정도구(Falls Efficacy Scale-Korean version, FES-K)를 이용하여 평가하였다. 실험군과 대조군의 낙상효능감과 활동수준의 변화량은 유의한 차이가 없었다. 실험군과 대조군은 모두 중재 이후에 낙상효능감과 활동 수준이 유의하게 향상되었다. 이러한 연구의 결과를 임상 현장에 적용하여 뇌졸중 환자가 지역사회에서 안전하게 생활하고 적극적으로 참여하는 삶을 유지할 수 있도록 지원할 수 있을 것이다.

The purpose of this study is to determine the effect of a convergence approach, which applies both home environment modification applied with assistive technology and task-oriented intervention using a fall safety checklist, on the fall efficacy and activity level of stroke patients. 41 persons with stroke(21 experimental groups and 20 control groups) were divided into experimental and control groups. The experimental group was applied environmental modification and the task-oriented intervention using the fall safety checklist for 4 weeks. The control group was provided only the environmental modification. Before and after the intervention, the Korean Activity Card Sort (KACS) and the Korean Falls Efficacy Scale-Korean version (FES-K) were used for evaluation. There was no significant difference in fall efficacy and activity level change between the experimental group and the control group. Both the experimental group and the control group significantly improved the fall efficacy and activity level after the intervention. By applying the results of this study to the clinical field, it will be possible to support stroke patients to live safely and actively participate in the community.

The purpose of this study was to assess the feasibility of task-oriented arm training for chronic hemiparetic stroke patients. The experimental design in this study was the pre-test and post-test with control group for 4-week intervention. Thirty patients with chronic hemiparetic stroke were recruited from 2 rehabilitation units. The subjects were divided randomly into experimental and control groups. The experimental group conducted task-oriented approach, involving 3 subparts of upper extremity activities, and the control group involved in the general upper extremity exercises. Functional movements of the upper extremities were assessed using clinical measures, including the Fugl-Meyer Assessment-Upper Extremity Section, Box and Block Test, and Action Research Arm Test. The score of Fugl-Meyer Assessment showed greater increases in the experimental group than in the control group after training. The improvement in Box and Block Test between pre-test and post-test measurements was significantly greater after task-oriented arm training compared to general upper extremity exercises. Action Research Arm Test scores also improved after task-oriented arm training compared to exercises in the control group. The task-oriented arm training improves the gross and fine motor activities and encouraging the use of the paretic arm through activity dependent intervention expedites the recovery of functional activities in the upper extremities for chronic hemiparetic stroke.

목적 : 본 연구에서는 발달성협응장애와 발달성협응장애 아동을 대상으로 한 과제-중심 접근법을 문헌 고찰을 통하여 알아보고자 하였다. 본론 : 본 연구는 발달성협응장애의 정의, 진단, 원인, 평가에 대한 전반적인 개요를 제시한다. 또한 신경운동과제훈련(Neuromotor Task Training; NTT)과 인지기반작업수행(Cognitive Orientation to daily Occupational Performance; CO-OP)의 중재 전략에 대해 알아보기 위해 2000년 1월부터 2023년 9월까지 게재된 국외 문헌 18편을 분석하였다. 선정된 문헌에서 언급된 중재의 목적은 작업치료 실행체계 4판(Occupational Therapy Practice Framework-4; OTPF-4)의 기준에 따라 분류하였다. 분류 결과, NTT는 클라이언트 요인(client factor) 영역에 대한 목표 설정의 빈도가 높았고, CO-OP는 작업(occupation) 영역에 대한 목표만을 설정하였다. 이러한 목표 설정의 차이는 두 중재 간 전략의 차이로 설명된다. 결론 : 발달성협응장애에 대한 전반적인 개요와 과제-중심 접근법의 중재에 대한 전략의 이해는 질환에 대한 인식도를 높이고 근거 기반 임상을 위한 기초 자료가 될 것이다.

Objective : This study aimed to provide an overview of task-oriented approaches for children with developmental coordination disorder, including its definition, diagnosis, causes, and assessment, through a literature review. Subject : Eighteen international articles published between January 2000 and September 2023 were analyzed to explore the intervention strategies of Neuromotor Task Training (NTT) and Cognitive Orientation to daily Occupational Performance (CO-OP). The objectives of the interventions mentioned in the reviewed articles were categorized according to the criteria of the Occupational Therapy Practice Framework-4 (OTPF-4). The results showed that NTT more frequently set goals in the area of client factors, while CO-OP set goals only in the area of occupation. This difference in goal setting can be explained by the strategy differences between the two interventions. Conclusion : A broader and deeper understanding of strategies for interventions with task-oriented approaches to developmental coordination disorder can increase awareness of the disorder and provide a more solid basis for evidence-based practice.

PURPOSE: This study examined the effects on the upper extremity function, muscle strength, and hand function of a task-oriented training approach using a percussion instrument for patients with chronic stroke. METHODS: Twenty-four chronic stroke patients accompanied with upper extremity hemiplegia were selected for research and were classified randomly into 12 experimental groups and 12 control groups. The experimental group performed a task-oriented approach, and the control group performed upper extremity occupational therapy. Stroke upper extremity test, Jebsen-Taylor Hand Function test, upper extremity muscle strength test, and hand muscle strength test were measured before and after training in the evaluation process. RESULTS: In the upper extremity test and Jebsen-Taylor test, there were no significant differences between the groups. In the upper extremity muscle strength test, there were significant differences in shoulder flexion, internal rotation, and elbow flexion in the experimental group. In the hand muscle strength test, there were significant differences in the grip, tip Pinch, lateral Pinch, and 3-jaw chuck in the experimental group and significant differences in only grip, tip pinch, and lateral pinch in the control group. In addition, there were significant differences in the lateral pinch compared to the amount of change. CONCLUSION: Task-oriented approach using percussion instruments for upper extremity rehabilitation in stroke patients is effective in the upper extremity function and strength, hand function, and strength.

The propose of this study was to evaluate the effect of body weight support treadmill training on the patients with chronic stroke. Body weight support(BWS) treadmill training has recently been shown to be effective for gait training following stroke, and few researchers have measured the usefulness of this intervention in enhancing function, and there are reports in which BWS overground ambulation was studied. This study were 1) to report the feasibility and patient tolerance for using a BWS system for treadmill ambulation, 2) to measure the function of patients with chronic stroke prior to and following BWS treadmill and overground ambulation training, and 3) to describe a protocol used for patient treatment progression using BWS treadmill training.