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This study was designed to get normative data of normal subjects by MFT(Manua1 Func-tion Test). The subjects were 95 normal adults. The results are as follows: 1. Mean scores of left and right MFS(Manua1 Function Score) were respectively 97.43 and 98.13. 2. MFS was higher on right upper extremity function than on left upper extremity function. 3. MFS was not significantly different between male and female. 4. Both left and right MFS (Manual Function Score) was significantly negative correlation with age.

목적 : 뇌성마비 아동의 상지기능을 향상시키기 위해 국내에서 사용되고 있는 중재방법의 종류와 그 효과를 체계적 고찰방 법을 사용하여 국내에서 사용되는 치료경향을 제시하고자 한다. 연구방법 : 연구 대상은 2008년 이후로 국내학회지에 게재된 연구를 대상으로 하였다. 누리미디어(DBpia), 스콜라 (Scholar), 한국사회과학데이터(KSDC), 학술연구정보서비스(RISS), 그리고 한국학술정보(KISS)의 데이터베이스를 사용하여 ‘뇌성마비’, ‘상지 기능’, ‘손 기능’의 검색어를 사용하였다. 총 12개의 연구로 근거의 질적 수준, 방법론적 질적 수준으로 분석한 후 대상자(Patient), 중재(Intervention), 대조(Comparison), 결과(Outcome)의 PICO로 제시 하였다. 결과 : 분석에 포함된 연구에서 근거기반 실행의 질적 수준은 수준 Ⅳ와 수준 Ⅴ가 가장 많았고, 방법론적 질적 수준은 ‘우수’의 연구가 가장 많았다. 대상자는 편마비 아동을 대상으로 한 연구가 가장 많았고, 실험설계는 단일대상연구 및 사례연구가 높았다. 중재의 종류는 강제유도운동치료가 가장 많았고, 평가는 젭슨테일러 손기능 검사 빈도가 높았다. 총 11개의 연구에서 뇌성마비 아동의 상지기능에서 유의한 향상 또는 긍정적인 효과가 나타났다. 결론 : 국내에서 뇌성마비 아동의 상지기능을 향상시키기위해 다양한 중재방법이 시행되어 왔다. 앞으로 마비 유형별에 따른 중재방법에 대한 연구와 근거의 질적수준이 높은 연구가 지속적으로 이루어져야 할 것이다.

Objective : The purpose of this study is to examine the effects of therapeutic interventions on upper extremity function of children with cerebral palsy using systematic review methods and to suggest intervention trends in Korea. Methods : The subjects of the study were the researches published in the Korean Journal since 2008. Total 12 studies were selected through Korean research database engine such as DBpia, Scholar, KSDC, KISS and RISS for the systematic review. Key words were ‘cerebral palsy’, ‘upper extremity function’ and ‘hand function’. The results of this study were analyzed by qualitative level and methodological quality level of evidence, and the results of each study were analyzed according to the PICO approach, that is Patient, Intervention, Comparison and Outcome. Results : For the level of evidence, Grade Ⅳ and Ⅴ were most frequent. In terms of methodological quality, majority of the studies showed ‘Fair’ level. The subjects were the children with hemiplegia, and Single-subjects designs and case studies were frequent experimental design. Constraint-induced movement therapy (CIMT) was most frequently conducted among the intervention studies, and Jebsen-Taylor Hand Function Test was most frequently used evaluation tool. Eleven studies showed that the upper limb functions were significantly improved or were positively effective. Conclusion : Various intervention methods have been implemented to improve the upper limb functions of children with cerebral palsy. In the future, studies on intervention methods based on the type of paralysis and studies with high quality of evidence should be conducted in Korea.

PURPOSE: To investigate the effect of virtual reality (VR)-based upper extremity (UE) training on UE function, visual perception, and brain activity in a child with spastic cerebral palsy (CP). METHODS: A 14-year-old girl with spastic CP participated in this study. Immersive VR-based Leap Motion Ⓡ UE training was applied for 6 weeks, with 24 sessions conducted 4 times a week. UE function (grip strength, pinch strength, Jebsen-Taylor hand function test, Purdue pegboard test), visual perception (motor-free visual perception test-3), and brain activity (electroencephalography) were measured before and after the intervention. RESULTS: Following the VR-based UE training, improvements were observed in the participant's grip strength, pinch strength, Jebsen-Taylor hand function test, Purdue pegboard test, and visual perception. Electroencephalography analysis showed a decrease in alpha wave band power and an increase in beta wave band power. CONCLUSION: VR Leap Motion UE training improved UE function and visual perception and augmented the participant's attention and concentration in a child with spastic CP.

Purpose: This study aimed to investigate changes in upper extremity joints and leisure satisfaction in children with brain lesions through sports stacking activities. Methods: A sports stacking program was conducted on three children with brain lesions who had upper extremity joint limitations and joint range of motion lower than the normal range. It was conducted 10 times, 1 to 2 times a week, 40 minutes each time. Upper extremity joint angles were measured using a goniometer in the order of shoulder, elbow, wrist, and fingers, and leisure satisfaction was measured using a smile evaluation. Results: As a result of measuring the upper extremity joint angles, all three children showed slight angle changes in the shoulder, elbow, and wrist areas. Differences in joint angles appeared differently for each child. Smile evaluation results were evaluated in various psychological, educational, and physical aspects. Only child A was evaluated for Smile Evaluation No. 1. Conclusion: Sports stacking activities changed the upper extremity function of children with brain lesion disorders and showed differences in psychological, physical, and educational aspects of leisure satisfaction. As this is a short-term study result, the change in upper extremity function is minimal, but if sports stacking activities are continued, it will be a rehabilitation program that can prevent upper extremity dysfunction and improve physical strength. Accordingly, continuous attention should be paid to increasing accessibility and enjoyment of daily life according to individual characteristics and level.

Objective: The purpose of this review was to investigate whether motor imagery training has an effect on the recovery of upper extremity function in individuals with hemiparetic stroke or not. Design: A systematic review and meta-analysis. Methods: PubMed and three other databases were searched up to December 18th, 2018 and randomized controlled trials (RCTs) evaluating motor imagery training on upper extremity function in persons with a diagnosis of hemiparetic stroke were included. This review selected the following information from each study: surname of the first author, published year, nation, population, intervention, therapeutic intensity of intervention, therapeutic comparison, outcome measures, additional therapy, summary of results, and descriptive statistics of outcome measures. Results: This review selected seventeen RCTs with 487 stroke survivors and the following intervention methods: six motor imagery training with additional therapeutic technology, two motor imagery training with additional modified constraint-induced therapy, four mirror therapy, and five motor imagery training. Ten RCTs were eligible for meta-analysis after systematic review. The motor imagery group were more effective than the control group based on the Fugl-Meyer assessment (3.43; 95% confidence interval [CI], 1.65 to 5.22; heterogeneity [$chi^2=8.03$, df=8, $I^2=0%$], test of overall effect Z=3.76; test for subgroup differences [$chi^2=2.56$, df=2, $I^2=21.8%$]) and the Action Research Arm Test (1.32; 95% CI, -8.12 to 10.76; heterogeneity [$Tau^2=70.74$, $chi^2=15.22$, df=3, $I^2=80%$], test of overall effect Z=3.76). Conclusions: The results of this review suggests that motor imagery shows positive effectiveness on improving upper extremity function in persons with hemiparetic stroke.

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.

PURPOSE: This study's aim was to investigate the effects of an action observational training in subactue stroke patients with moderate impairment. METHODS: 22 participants (men=13, women=9) with hemiparesis were randomly assigned to action observation training group or task-oriented training group. Patients in both group underwent a patient-specific multidisciplinary rehabilitation program. Participants in the action observation group (mean age, $62.78{\pm}9.85$) were asked to watch the video scene, in the knowledge that they would then attempt to perform the same movement task after watching. The control group (mean age, $61.49{\pm}8.64$) practiced the same tasks, without watching the video. To evaluate upper limb function, the upper extremity part of the Fugl-Meyer Assessment upper extremity and the Box and Block Test were used. The modified Barthel index was used to assess ADLs, and the modified Ashworth scale were used to assess spasticity in the upper extremity. RESULTS: The action observational training group exhibited greater changes in the Fugl-Meyer assessment upper extremity (P<0.05; 95% CI, 0.929 - 6.403), the Box and Block test (P<0.05; 95% CI, 0.086 - 5.913), and the modified Barthel index (P<0.01; 95% CI, 2.483 - 12.627) between groups. And the modified Ashworth scale (P>0.05; 95% CI, -0.402 to 0.624) did not show significantly different between groups. CONCLUSION: These findings suggest that action observational training may be more helpful to improve upper-extremity function than physical training only in subactue patients with moderate impairment after stroke.

Background: Despite the fact that aquatic exercise is one of the most popular alternative treatment methods for children with cerebral palsy (CP), there are few research regarding its effectiveness. Objects: The purpose of this study was to examine the effects of aquatic exercise on upper extremity function and postural control during reaching in children with CP. Methods: Ten participants (eight males and two females; 4-10 years; Gross Motor Function Classification System levels II-IV) with spastic diplegia were recruited to this study. The aquatic exercise program consisted of four modified movements that were selected from the Halliwick 10-point program to enhance upper extremity and trunk movements. The participants attended treatment two times a week for 6 weeks, averaging 35 minutes each session. The Box and Block Test (BBT), transferring pennies in the Bruininks-Oseretsky Test (BOT), and pediatric reaching test (PRT) scores were used as clinical measures. Three-dimensional motion analysis system was used to collect and analyze kinematic data. Differences in BBT and BOT values among pre-treatment, post-treatment, and retention (after 3 weeks) were analyzed using a Friedman test. In addition, the PRT scores and variables (movement time, hand velocity, straightness ratio, and number of movement units) from the three-dimensional motion analysis were tested using a Wilcoxon signed-rank test. The significance level was established at p < 0.05. When the results appeared to be statistically significant, a post-hoc test for multiple comparisons was performed with the Wilcoxon signed-rank test. Results: All clinical measures, which included BBT, transferring pennies of BOT, and PRT, were significantly increased between pre-intervention and post-intervention scores and between pre-intervention and retention scores after treatment (p = 0.001). Three-dimensional motion analysis mostly were significantly improved after treatment (p = 0.001). Conclusion: Aquatic exercise may help to improve body function, activity, and participation in children with varying types of physical disabilities.

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: The purpose of this study was to evaluate the effect of virtual reality (VR)-based core stabilization exercise on upper extremity function, postural control, and depression among persons with stroke with hemiplegia. Design: Randomized controlled trial. Methods: This study was conducted with the inclusion of 24 participants and were randomly assigned to either the VR-based trunk stability exercise group (n=12) or control group (n=12). The VR-based trunk stability exercise group performed core stabilization exercises in a VR environment for 30 minutes. Meanwhile, the control group conducted general core stabilization exercises for 30 minutes. The participants trained 3 times a week for 4 weeks. The manual functional test (MFT), Box and Block Test (BBT), Berg Balance Scale (BBS), Trunk Impairment Scale (TIS), the Geriatric Depression Scale (GDS) were used to assess all participants before and after the intervention. Results: The VR-based core stabilization exercise group had a significant improvement in upper extremity function (MFT, BBT) and postural control (BBS) compared with the control group (p<0.05). The VR-based core stabilization exercise showed a significant difference after intervention in the TIS and GDS scores (p<0.05), but they did not significantly differ between the two groups. Conclusions: The result showed that VR-based core stabilization exercise can be effective in improving upper extremity function and postural control among patients with stroke more than the sole application of general physical therapy.

Objective: The aim of this review is to explore the latest intervention trends and effects of EMG-triggered functional electrical stimulation on the upper extremity functions in stroke patients. Design: Systematic review on clinical trials. Methods: A systematic literature search was performed to identify clinical trials evaluating the effects of EMG-triggered functional electrical stimulation (EMG-FES) and task-oriented EMG-triggered FES on the hand functions in stroke patients. Literature review was conducted with the following key words: hand function, functional electrical stimulation, task-oriented, stroke. Results: Ten clinical trials were included; 8 of them were randomized controlled trial, 1 was block-randomized, and 1 was a pre-post comparison study. A positive effect of electrical stimulation was reported in the patient groups that were treated with functional electrical stimulation combined with specific tasks, and volitional muscle contraction-triggered stimulation that was synchronized with tasks. Motor capabilities of the hand and arm were improved after the rehabilitation. Conclusions: EMG-triggered electrical stimulation may be more effective than non-triggered electrical stimulation in facilitating the hand functions in stroke patients in terms of muscle strength and voluntary muscle contraction of the paretic hand and arm. Triggered electrical stimulation can be even more effective when it is combined with specific tasks.

Objective: The purpose of this study was to investigate the effects of a combination of progressive scapular stabilization exercises, neck and thoracic spine mobilization, and thermoelectric physical therapy on pain, range of motion, muscle strength, and function in patients with acute whiplash injury. Design: A randomized controlled trial design. Methods: A total of 24 subjects were included in this study. They were randomly assigned to an experimental group (n=12) that performed scapular stabilization exercises, neck and thoracic spine mobilization, and physiotherapy, and a control group (n=12) that only performed neck and thoracic spine mobilization and physiotherapy. The pre-test was conducted before the intervention and consisted of a total of 12 treatment sessions of 60 minutes each, three times a week. A posttest was conducted 4 weeks later. Pain, range of motion, muscle strength, and function were assessed before and after intervention. Results: The results of the study showed that there was a significant difference in pain reduction and range of motion and muscle strength improvement in the experimental group, and a significant difference was also found between the experimental group and the control group in terms of functional evaluation. Conclusions: The combination of exercise therapy and joint mobilization technique and physical therapy resulted in greater improvements in pain, range of motion, strength, and function assessment, contributing to improved overall function.

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

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 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: Contralateral seventh cervical nerve transfer (contralateral C7 transfer) is a newly attempted method to restore upper extremity motor function in the patients with spastic arm paralysis. The aim of this study was to investigate the effects of contralateral C7 transfer on upper extremity motor function in the patients with spastic hemiplegia after stroke. Design: A retrospective cohort study. Methods: Thirty-four patients with spastic hemiplegia after stroke was investigated. All patients registered between January 2020 and February 2021. The subjects were assessed on upper extremity motor function, cognition, and spasticity before and after contralateral C7 transfer. The upper extremity motor function was measured using the Fugl-Meyer upper extremity scale and box & block test. The cognition and spasticity were assessed by Korean version mini mental state examination (K-MMSE) and modified Ashworth scale from baseline to 8 weeks after the surgery. Results: The Fugl-Meyer upper extremity scale and modified Ashworth scale were significantly improved after contralateral C7 transfer (p<0.05). However, box & block test and K-MMSE were no significant changes after the surgery (p>0.05). Conclusions: This study suggested that the contralateral C7 transfer was a feasible and practical approach to improve upper extremity motor function in the patients with spastic hemiplegia after stroke, but further study is required to identify the long-term effects after the contralateral C7 transfer.

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.

Purpose: The purpose of this study was to resolve, in an efficient manner, the mechanoreceptor problems of the part far from the paretic upper extremity in stroke patients, as well as to provide clinical basic data of an intervention program for efficient neurodynamic in stroke patients, by developing a rhythmic neurodynamic exercise program and verifying functional changes depending on the increase in the upper extremity nerve conduction velocity. Methods: Samples were extracted from 18 patients with hemiplegia, caused by stroke, and were randomly assigned to either the experimental group I for the general upper extremity neurodynamic (n=9) and the experimental group II for rhythmic upper extremity neurodynamic (n=9). An intervention program was applied ten times per set (three sets one time) and four times a week for two weeks (once a day). As a pre-test, changes in the upper extremity nerve conduction velocity and functions were assessed, and two weeks later, a post-test was conducted to re-measure them in the same manner. Results: The wrist and palm sections of the radial nerve and the wrist and elbow sections of the median nerve, as well as the wrist, lower elbow, upper elbow, and axilla sections of the ulnar nerve had significant differences with respect to the upper extremity nerve conduction velocity between the two groups (p<0.05)(p<0.01), and significant differences were also found in the upper extremity functions (p<0.05). Conclusion: Rhythmic neurodynamic accelerated the nerve conduction velocity more in broader neural sections than the general neurodynamic. In conclusion, rhythmic neurodynamic was proven to be effective for improving the functions of upper extremity.

Purpose: This study attempts to understand the effect of stabilization exercise of biofeedback scapular on muscle activity and functional evaluation of the upper extremity in stroke patients. Methods: Patients were divided into two groups; a biofeedback scapular stabilization exercise group comprised of 8 patients and a task-oriented training group including another 8 patients, and 30-minute exercise was performed 5 times a week for 8 weeks. Electromyogram was used to measure muscular activity of lower trapezius, deltoid middle, and serratus anterior. Fugl-Meyer Assessment and Manual Function Test were used to evaluate functions of the muscles mentioned. Results: Significant difference was observed in the comparison group before and after exercise in muscular activity of lower trapezius, deltoid middle, and serratus anterior, Fugl-Meyer Assessment, and Manual Function Test. Conclusion: Therefore, we could see that biofeedback scapular stabilization exercise is more effective than task-oriented training in facilitating muscle activation and functional capacity of upper limb.