Earticle

목적 : 본 연구는 지역사회 만성 뇌졸중 환자를 대상으로 원격동작관찰훈련이 상지 기능과 근 활성도에 미치는 영향을 알아보고자 실시하였다. 연구방법 : 2023년 8월부터 2024년 2월까지 대전광역시 소재의 재활병원에서 외래재활을 받지 않고 다른 기관에서도 치료를 계획하지 않은 대상자 6명을 실험군으로, 병원 내에서 외래재활치료를 받는 대상자 5명을 대조군으로 선정하였다. 실험군은 원격재활을 기반으로 한 원격동작관찰훈련을 하였고, 대조군은 실험군과 동일한 과제를 수행하는 외래재활치료를 진행하였다. 치료에 대한 중재는 1일 1회 30분, 주 3회, 총 4주간 실시하였고, 치료 중재 전과 후의 상지 기능을 측정하기 위해 ARAT 평가척도(Action Research Arm Test)와 MFT 평가척도(Manual Function Test)를 사용하였고, 근 활성도를 평가하기 위해 표면 근활성도 평가척도인 sEMG (Surface Electromyography)를 사용하였다. 결과 : 두 집단 각각의 중재 전과 후 결과 상지기능과 근 활성도 일부 항목에서 유의한 차이를 보였으며(p < 0.05), 중재 후 두 집단 간에서는 상지기능과 근 활성도에서 유의한 차이를 보이지 않았다(p < 0.05). 결론 : 본 연구에서의 결과로 원격동작관찰훈련이 지역사회 만성 뇌졸중 환자에게 외래재활치료와 유사하게 기능 향상을 시킬 수 있는 중재방법이자, 접근성과 경제적인 이점이 있어 지역사회 만성 뇌졸중 환자에게는 효율적인 방법으로 제시될 수 있다.

Objective: This study aimed to investigate the effects of remote motion observation training on upper limb function and muscle activity in community-based patients with chronic stroke. Methods: Six participants who did not receive outpatient rehabilitation were selected as the experimental group, and five participants who received outpatient rehabilitation were included in the control group. The intervention was conducted for 30 min a day, three times a week, for four weeks. Upper limb function was measured using the Action Research Arm Test (ARAT) and Manual Function Test (MFT) scales, and muscle activity was assessed using surface electromyography (sEMG). Results: Both groups showed significant differences in upper limb function and muscle activity (p < .05). However, after the intervention, no significant differences were observed between the two groups (p < .05). Conclusion: Remote action observation training can be an effective intervention for improving function in community-based patients with chronic stroke, similar to outpatient rehabilitation therapy. Additionally, it offers accessibility and economic benefits to patients.

목적 : 본 연구는 뇌졸중 환자를 대상으로 수행된 상지기능 관련 과제 지향적 중재 연구를 체계적으로 고찰하고, 병원 환경과 지역사회 환경에서 이루어진 과제 지향적 중재의 특징과 차이를 비교·분석하고자 한다. 연구방법 : 문헌 검색은 PubMed, Embase, Web of Science 데이터베이스를 이용하였으며, 검색어는 ("stroke" or "brain attack") and ("upper limb" or "upper extremity") and (“task oriented” or “task related” or “task-oriented”) and ("intervention" or "program" or "rehabilitation" or "therapy")를 사용하였다. 선정 및 배제 기준에 따라 33편의 연구를 선정하였다. 결과 : 병원에서는 주로 급성기 및 아급성기 환자를 대상으로 복합 과제 지향적 중재가 단독 지향적 중재보다 많이 이루어졌으며, 그중 전기자극치료와 병행된 중재가 많이 이루어졌다. 반면, 지역사회에서는 주로 만성기 환자를 대 상으로 전기자극치료와 병행된 중재가 많이 진행되었다. 실험군의 전·후 비교와 실험군-대조군 간의 비교 모두에서 유의미한 향상을 보인 중재는 병원과 지역사회 환경 모두에서 부가 중재와 병행된 과제 지향적 접근이었다. 결론 : 본 연구는 뇌졸중 환자의 상지기능 증진을 위해 과제 지향적 중재 연구를 체계적으로 고찰하였다. 분석 결과 병원과 지역사회 모두에서 전·후 및 집단 간 비교에서 긍정적인 효과가 나타났으며, 이는 과제 지향적 접근이 임상 에서 적용 가능한 중재 전략임을 시사한다.

Objective : This study aimed to review systematically task-oriented interventions targeting upper limb function in stroke patients and to compare and analyze the differences between interventions conducted in hospital and community settings. Methods : Literature researches were performed using the PubMed, Embase, and Web of Science databases with the following key words: ("stroke" OR "brain attack") AND ("upper limb" OR "upper extremity") AND (“task oriented” OR “task related” OR “task-oriented”) AND ("intervention" OR "program" OR "rehabilitation" OR "therapy"). A total of 33 studies was included. Results : In hospital settings, task-oriented interventions were primarily conducted with acute and subacute stroke, most frequently as stand-alone interventions, followed by interventions combined with other therapies. In community settings, interventions were mainly conducted with electrical stimulation. Among the included studies, those reporting significant improvements in both pre-post comparisons and comparisons between experimental and control groups were predominantly task-oriented interventions combined with other therapies, regardless of the setting. Conclusion : This study reviewed systematically that task-oriented interventions improved upper limb function in stroke patients. Task-oriented interventions, especially with other therapies, are effective in both hospital and community settings.

목적 : 본 연구는 몰입형 가상현실과 비몰입형 가상현실 두 가지 형태의 가상현실 기기를 이용한 중재가 만성 뇌졸중 환자의 상지기능 향상에 미치는 효과를 알아보고자 하였다. 연구방법 : 연구 대상은 뇌졸중 발병 후 6개월 이상인 편마비 환자 3명이었다. 연구설계는 단일대상실험연 구(single-subject research design)인 AB 디자인과 교차 연구설계(alternating design)를 사용하였 다. 중재효과를 측정하기 위한 상지기능 평가는 Box and Block Test와 Fugl-Myer Assessment를 사 용하였고, 연구진행은 기초선 4회, 중재 기간 16회를 포함하여 총 20회기를 진행하였다. 연구결과는 시 각적 그래프와 2SD 구간을 설정하여 분석하였다. 결과 : 연구결과는 비몰입형과 몰입형 가상현실 중재법 모두 기초선과 비교하여 Box and Block Test, Fugl-Myer Assessment 점수가 확연히 증가하였다. 그러나 비몰입형 가상현실 중재와 몰입형 가상현 실 중재 간의 의미있는 차이는 발견할 수 없었다. 결론 : 본 연구는 몰입형 가상현실을 이용한 중재가 비몰입형 가상현실을 이용한 중재와 같이 만성 뇌졸중 대상자의 상지기능 향상에 긍정적인 효과를 줄 수 있다는 것을 확인하였다. 이러한 결과는 만성 뇌졸중 대상자들의 상지기능 향상을 목표로 하는 임상현장에서 가상현실 중재와 연구에 유용한 자료가 될 것이 라 사료된다.

Purpose: The purpose of this study was to investigate the effect of intervention using immersive and non-immersive virtual reality devices on the improvement of the upper limb function in 3 participants with chronic stroke. Methods: The design used a combination of an AB design and an alternating design to compare the effects of both intervention types based on a single-subject research design. The dependent variables were the upper limb functions, and BBT and FMA were applied as the evaluation tools. The study consisted of 20 sessions given during a total of 7 weeks including four sessions of a baseline period and 16 sessions of an intervention period. Results: As the results indicate, it was first confirmed that virtual reality intervention had a positive effect on improvements of the upper limb function of chronic stroke patients. All dependent variables measured during the intervention period exceeded the 2SD interval of the measured value during the baseline period. Second, there was no significant difference between non-immersive virtual reality intervention and immersive virtual reality intervention. Conclusion: The results of this study show that intervention using immersive and non-immersive virtual reality can have a positive effect on improvements of upper limb function of chronic stroke subjects.

This study aimed to identify the effects of modified constraint-induced therapy (mCIMT) on upper limb’s function and walking in cerebral palsy. Study was carried out by using an ABA design with baseline, intervention, and follow-up phases. And a subject was a child with left hemiplegic cerebral palsy. The mCIMT with unaffected side restricted by a plastic splint was performed averaging five 5 hours per day for 5 weeks. Subjects underwent an intensive training to affected upper limb for 2 hours and performed daily routine activities for 3 hours. Outcome measures included the box and block test, coin transfer test, one-leg test, and walking velocity. After the intervention, values were improved in all parameters, and gains were maintained during the follow-up phase. These findings suggest that mCIMT is helpful to enhance the function of affected upper limb, balance, and walking. Further studies will be continued to warrant the findings of present study.

The purpose of this study was to demonstrate the effects of a group mirror therapy on upper limb and sensory functions in community-living individuals with chronic stroke. Seven patients with chronic stroke living in the community volunteered for this study, and they underwent a group mirror therapy. Measurements were made with Fugl-Meyer assessment (FMA) and monofilament test, which were evaluated before and after the intervention, and 2-week follow-up. A group mirror therapy was performed for average 90 minutes daily, 5 times a week for 2 weeks (a total of 10 sessions), consisting of trainings for the upper extremity: Warm-up, main training (active range of motion exercise and functional task training), and cool-down. A Friedman test was used to compare the changes of measurement values. The results of the study showed that FMS scores were statistically significantly improved after intervention, and gain was maintained at the 2-week follow-up (p<.05). However, there was not significantly different for the monofilament test scores after the intervention and the follow-up, despite of positive change after the intervention (p>.05). These findings suggest that a group mirror therapy might be beneficially used to improve the upper limb function of patients with stroke. Further studies with robust design warrant study results.

The purpose of this study was to determine the clinical effects of trunk stabilization exercise in patients with stroke via searching previous studies and orgarnizing their results on arm function, balance and walking. Literature review was conducted on the domestic journals published from 2010 to 2020. The journals were divided into 3 categories by physical function as follows: upper limb function, balance, and walking ability. 18 journals were finally included and the PICO (Patient, Intervention, Comparison, Outcomes) method was used for systematic analysis. 16 of the 18 journals applied the experiment to the experimental group and the control group, while others were carried out in a single group. Regarding the functions, four journals were on both upper limb function and balance, seven journals were on the only balance control, and seven journals were on both balance and gait ability. As a result, journals showed that trunk stabilization exercise has significant improvements in balance and walking ability. We suggested that trunk stabilization exercise may be helpful for improving the upper limb function, balance and gait ability in patients with chronic stroke.

목적 : 본 연구는 뇌졸중 환자의 상지기능과 일상생활동작 향상을 위해 적용된 과제 지향적 접근 연구들을 체계적 고찰과 메타분석으로 연구결과들을 비교 분석하였다. 이 결과들을 통해 앞으로의 과제 지향적 접 근의 방향을 제시하고자 하였다. 연구방법 : 분석 자료는 2000년 1월부터 2018년 8월까지 MEDLINE, CINAHL, Pubmed 데이터베이스를 사용하여 선정기준에 적합한 17편의 무작위 실험 연구를 수집하였다. 선정된 연구들은 질적 평가(Pedro score)와 Patient, Intervention, Comparison, Outcome(PICO)를 사용하여 체계적으로 정리하였다. 그 후 각 연구들의 중재 형식을 참고하여 평균, 표준편차, 표본수를 사용하여 메타분석을 실시하였다. 결과 : 선정된 17편의 연구는 Pedro score 5점 이상의 연구로 다양한 과제 지향적 접근을 통하여 상지기 능과 일상생활동작을 증진시키고자 하였다. 과제 지향적 접근의 중재 형식은 횟수 강도 등을 통제하는 반복강화형, 기계적 장치나 보조기 등을 사용하는 조합형, 환자별 특성 및 목표 등을 참고한 환자맞춤형 의 3가지로 분류하였다. 과제 지향적 접근이 상지기능에 미치는 영향은 큰 효과크기를 보였으며, 중재 형식에 따른 분석에서는 환자맞춤형은 큰 효과크기, 조합형과 반복강화형은 중간 효과크기를 보였다. 과 제 지향적 접근의 일상생활활동에 대한 영향은 중간 효과크기를 나타내었다. 결론 : 환자의 기능 향상을 위한 과제 지향적 접근은 일관되고 정형화된 과제 보다 다양한 자극과 환자 중 심의 목표, 환경, 피드백을 활용하여 과제의 다양성을 강화할수록 보다 높은 치료적 효과를 기대할 수 있다.

Objective: In this study, a task-oriented approach (TOA) applied to improve the upper limb function and daily life activities of stroke patients is systematically reviewed and meta-analyzed. Next, the direction of task-oriented research is presented. Methods: Data from 17 RCT studies from January 2000 to August 2018 were collected using the MEDLINE, CINAHL, and PubMed databases. Then, after a systematic analysis using the Pedro score and PICO, data from each study were used to conduct a meta-analysis. Results: The 17 studies showed improvements in upper limb functions and daily living activities using various TOAs. We found three types of TOA, namely, a repeat reinforcement type, a combination type, and a patient-tailored type. The influence of a TOA on the upper limb functions had a large effect size. In our analysis of the intervention type, the patient-tailored type had a large effect size, whereas the combination and reinforcement types showed moderate effect sizes. The influence of the TOA on the activities of daily living showed a moderate effect size. Conclusion: When applying a TOA, the effectiveness of treatment can increase as the diversity is enhanced by utilizing various stimuli, goals, environments, and feedback.

가상현실 훈련은 신체 기능을 개선하기 위한 중재로 제안되었다. 그러나 급성 뇌졸중 환자의 ADL 개선에 초점 을 둔 가상현실 훈련의 효과는 명확하지 않다. 본 연구의 목적은 급성 뇌졸중 환자의 손 기능 및 일상생활활동(ADL)에 대한 가상 현실 훈련의 효과를 조사하는 것이다. 급성 뇌졸중 환자 16명이 본 연구에 포함되었다. 실험 군(VRA군)은 각 세션마다 ADL에 중점을 둔 30분의 가상현실 훈련을 받았으며, 통제군은 30분의 보편적인 가상현실 훈련을 받았다. 피험자의 손기능과 ADL을 조사하기 위해 JTHFT(Jebsen-Tylor Hand Function Test)와 K-MBI (Korean Modified Barthel Index)를 각각 사용했다. 두 그룹 모두 중재 후 마비측과 비마비측의 손기능 및 K-MBI 총점에서 유의미한 개선을 보였다. 실험군은 통제군보다 중재 후 K-MBI의 자가관리 영역에서 유의하게 큰 향상을 보였다. 이러 한 결과는 급성 뇌졸중 환자에서 ADL에 중점을 둔 가상 현실 훈련이 기존의 가상 현실 훈련보다 자기관리에 더 나은 영향을 줄 수 있음을 시사한다.

The virtual reality training has been suggested as an intervention to improve physical function. But, the effects of virtual reality training focused on improving ADL in patients with acute stroke are unclear. Purpose of this study was to examine the effect of virtual reality training on hand function and activities of daily living (ADL) in patients with acute stroke. Sixteen patients with acute stroke were included in this study. The experimental group (VRA group) received 30 minutes of virtual reality training focused on ADL for each session, while the control group received 30 minutes of conventional virtual reality training. To examine the hand function and ADL of the subjects, the study used Jebsen-Tylor Hand Function Test (JTHFT) and Korean Modified Barthel Index (K-MBI), respectively. Both groups showed significant improvements in hand function of affected and unaffected sides, and in K-MBI total score before and after the intervention. The experimental group showed significantly greater improvements in the self-care domain of K-MBI after intervention than the control group. These findings suggest that the virtual reality training focused on ADL may have a better effect on self-care than conventional virtual reality training in patients with acute stroke.

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.

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 examine the contribution of perceived upper limb function to participation and activity among community-dwelling people with chronic stroke.Methods: A cross-sectional study was conducted with eighty-one people with stroke aged ≥50 years. The outcome measures included the Oxford Participation and Activities Questionnaire (Ox-PAQ), Arm Activity Measure (ArmA), Wolf Motor Function Test (WMFT), Timed Up and Go Test (TUG), and Geriatric Depression Scale (GDS).Results: Correlation analyses revealed that perceived upper limb function, as measured using the ArmA, had the strongest and most significant correlations with the levels of participation and activity, as measured using the Ox-PAQ, among all of the tested variables (rs=0.35?0.59, p<0.01). Multiple linear regression analyses also showed that perceived upper limb function significantly associated the levels of participation and activity, accounting for 2.0% to 9.0% of the variance in the Ox-PAQ scores. The final model, which included TUG time, the GDS score, the WMFT score, and the ArmA score, could explain 54% and 28% of the variance in the routine activities and social engagement subscales of the Ox-PAQ, respectively. The model including the GDS score, the WMFT score, and the ArmA score explains 32% of the variance in the emotional well-being subscale of the Ox-PAQ. Conclusion: Perceived upper limb function is a crucial determinant of participation and activity among community-dwelling people with chronic stroke. It could thus be a target component of stroke rehabilitation interventions to facilitate participation and activity after stroke.

Objective To prospectively investigate the long-term effects of botulinum toxin treatment on the upper limb function and performance of school age children with spastic bilateral cerebral palsy, who have limitations in performing activities of daily living and school activities, due to spasticity of the upper extremities.Methods Botulinum type A toxin (BoNT-A) was injected into 24 spastic upper limbs of 15 children. We used a Modified Ashworth Scale and a Modified Tardieu Scale for the evaluation of upper limb spasticity, and Quality of Upper Extremity Skills Test (QUEST), Canadian Occupational Performance Measure (COPM), and Test of Visual-Motor Skills-Revised (TVMS-R) for the evaluation of upper limb function and performance. Results Upper limb spasticity continuously decreased until the end of the one-year follow-up. Upper limb function on QUEST and COPM showed the best performance at 3 months and deteriorated slightly, but still showed a significantly better performance at 9 and 12 months than at pre-injection. In more functional nine subjects who could perform TVMS-R, the performance enhancement effects remained constant after 12 months, suggesting that the reduced spasticity led to the learning effect acquired by the repeated use of the affected upper limb. Conclusion For school age children with bilateral spastic cerebral palsy whose upper limb functions are important, BoNT-A injections seem to be of help in the performance of school activities and activities of daily living.

Purpose: This study describes the effects of kicking a ball training on balance and upper limb function in chronic hemiplegia. Methods: Thirty chronic stroke patients were randomly selected; Kicking a ball (n=10), Treadmill gait (n=10), Stepping on the ground group (n=10). The Short Physical Performance Battery (SPPB) for balance and Foot Scan for weight distribution. Upper limb function was measured by the Manal Function Test (MFT). This treatment was performed five times a week for a total of 4 weeks. Results: Kicking group was significantly increased in SPPB (p<0.05) and MFT (p<0.05) between pretest vs post test and pretest vs follow-up. Conclusion: Kicking a ball was effective for improving weight acceptance on the paretic leg, balance and upper limb function. However, In terms of balance, the core stabilization that affected the upper extremity function was not evaluated. Thus, additional research may help determine correlation between core stability and upper limb function to improve balance.

Purpose: This study reviewed the literature to determine the effects of clinical applicability of virtual reality (VR) on the upper limb function, balance, and gait ability of chronic stroke patients. Methods: A literature review was conducted on domestic journals published from 2010 to 2025. The journals were divided into three categories based on the physical function: upper limb function, balance, and gait ability. Thirty-five journals were ultimately included, and PICO (Patient, Intervention, Comparison, and Outcomes) was used for systematic analysis. Results: Among the 35 journals, 30 reported using a non-immersive VR intervention for the upper-limb function, balance, and gait ability. The others used an immersive VR intervention for only the upper-limb function. Regarding the functions, 16, five, two, four, and eight journals covered only the upper limb function, only balance, only gait ability, both upper limb function and balance, and both balance and gait ability, respectively. Most studies reported that VR intervention could improve the functions, including the upper limb, balance, and gait. Only one study reported no significant improvement in either balance or gait ability. Conclusion: VR intervention would help improve the upper limb function, balance, and gait ability in patients with chronic stroke.

Objective: The aim of this preliminary study was to investigate the effects of virtual reality combined with balance training on upper limb function, balance, and activities of daily living (ADL) in persons with acute stroke. Design: Randomized controlled trial. Methods: Fourteen acute stroke survivors were recruited and randomly assigned into two groups: the experimental group (n=7) and the control group (n=7). Both groups performed the conventional rehabilitation therapy for 30 minutes a day, 5 times a week, for 4 weeks. Additionally, the experimental group conducted the virtual reality training for 30 minutes on an unstable surface during each session, whereas the control group performed balance training for 30 minutes on a stable surface. All measurements were performed before and one day after intervention. Upper limb function, balance, and ADL were assessed using the Manual Function Test (MFT), the Berg Balance Scale (BBS), and the Korean version of the Modified Barthel Index (K-MBI), respectively. Results: Both groups showed significant improvements in MFT, BBS, K-MBI after intervention (p<0.05). There were no significant differences between the experimental and control groups with respect to MFT, BBS, and K-MBI after intervention. The experimental group showed a greater decrease in fall risk (BBS<45) after intervention than the control group (p<0.05). Conclusions: These findings suggest that virtual reality combined with balance training has a better effect on balance improvement than virtual reality training alone in persons with acute stroke.

Objective To Investigate the synergic effects of short-term constraint-induced movement therapy (CIMT) and visual biofeedback training (VBT) in subacute stroke patients.Methods Thirty-two subacute stroke patients were enrolled and randomly assigned to one of three groups: short-term CIMT with VBT, VBT only, and control groups. We applied CIMT for an hour daily during VBT instead of the ordinary restraint time, referred to as ‘short-term’ CIMT. Short-term CIMT with VBT group received simultaneous VBT with CIMT, whereas the VBT the only group received VBT without CIMT for an hour a day for 2 weeks. The control group received conventional occupational therapy (OT) alone. Patients underwent the Purdue Pegboard Test, the JAMAR grip strength test, the Wolf Motor Function Test, the Fugl-Meyer Assessment (upper extremity), Motricity index and the Korean version of Modified Barthel Index test to evaluate motor functions of the hemiplegic upper limb at baseline, post-treatment, and 2 weeks after treatment.Results No significant differences were observed between short-term CIMT with VBT and VBT only groups. Both groups showed significantly higher scores compared to the control group in the WMFT and FMA tests. However, the short-term CIMT with VBT group showed significant improvement (p<0.05) compared with the control group in both grasp and pad pinch at post-treatment and 2 weeks after treatment while the VBT only group did not.Conclusion Short-term CIMT with VBT group did not show significant improvement of hemiplegic upper limb function of subacute stroke patients, compared to VBT only group. Larger sample sizes and different restraint times would be needed to clarify the effect.

Objective: This study aimed to investigate the upper limb strength, active joint range of motion (AROM), and upper limb function in persons with chronic stroke using virtual reality training in combination with upper limb sensory stimulation. Design: Two-group pretest-posttest design. Methods: 20 subjects were divided into two groups of 10, the sensory motor stimulation and virtual reality training (SMVR) and virtual reality training (VR) groups. The training was conducted for 30 minutes per session, three times a week for 8 weeks.The participants' upper limb strength was measured via the hand-held dynamometer, joint angle AROM was measured via dual inclinometer, function was measured using the Jebson-Taylor hand function test and the manual function test. Results: Significant differences were observed in all groups before and after the training for upper extremity strength, AROM, and function (p<0.05). Between the two groups, the SMVR group showed significant improvement in muscle strength, AROM, and Jebsen-Taylor hand function test scores compared with the VR groups (p<0.05). Conclusions: In this study, we confirmed that sensory stimulation and VR had positive effects on upper extremity strength, AROM, and function of persons with chronic stroke. The results suggest that in the future, VR in combination with sensory stimulation of the upper limb is likely to become an effective method (a rehabilitation training program) to improve the upper limb function of persons with chronic stroke.

Musculoskeletal disorders substantially impacts physical activity, men-tal state, and quality of life (QOL). Generally, comprehensive assessment of upper limb function requires measures of impairment or disability as well as health-related quality of life. A growing number of outcome in-strument have been introduced to evaluate upper limb function and dis-ability, and these measures can be categorized as patient- or clinician- based, and as condition specific or general health-related QOL evalua-tions. The upper limb outcome instruments reviewed in this article as-sess different aspect of upper limb conditions, and the measures are affected by differences in cultural, psychological, and gender aspect of illness perception and behavior. Therefore, physician should select/in-terpret the outcome instruments addressing their primary purpose of research. Information about regional instruments for upper limb condi-tion and health-related QOL in upper limb disorder may help us in deci-sion-making for treatment priority or in interpretation of the treatment outcomes.