Background: In the stroke patients with the characteristics of hemiplegic gait, turning direction of the affected and unaffected side influences turning time. Therefore, it is important to investigate the walking response to turning directions in stroke patients. Objects: This study aimed to measure the walking time while turning direction in hemiplegic patients depending on balance ability measured by Berg Balance Scale. Methods: A group of forty-five subjects with stroke (Berg Balance Scale score≥46 were twenty-eight, Berg Balance Scale score≤45 were seventeen) were enrolled in this study. Subjects were asked to perform the Timed Up and Go test. Testing indications included two directions for turning in each subject. These indications were for turning toward the affected and unaffected side in stroke patients. The duration of total analysis duration, sit to stand phase, stand to sit phase, mid-turning phase, and end turning phase were recorded. The obtained data were analyzed by using paired t-test and Wilcoxon signed rank test in the group that are below and above 45 points of Berg Balance Scale score. The significance level was set at ɑ=.05. Results: There were significant increase time in the analysis duration and end turning phase duration while subjects were turned the unaffected side in stroke patients that presented a Berg Balance Scale score≤45 (p<.05). However, the comparison between the affected side and the unaffected side in the stroke patients with Berg Balance Scale score≥46, revealed no significant differences of the measured parameters. Conclusion: This finding should be suggested in the specific definition of turning direction for evaluation with Timed Up and Go test in the Berg Balance Scale score≤45, and other intervention for hemiplegic patients need to be suggested the direction of turning during walking training program.

Background: Many studies regarding task-oriented training have recently demonstrated functional improvement in patients with post-stroke hemiparesis. The task-oriented approach is very diverse, and chronic stroke patients must have access to a sustained systematic treatment program to enhance their walking ability. Objectives: This study aimed to compare the effects of the task-oriented circuit training and treadmill training on walking function and quality of life in patients with chronic stroke. Methods: Fourteen patients with chronic stroke volunteered for this study. The subjects were randomly divided into a task-oriented circuit training group and a treadmill training group with 7 patients in each. Each training regimen was performed for 30 min a day and 3 days a week for 4 weeks. Assessment tools included the Timed Up-and-Go Test (TUGT), 10-m Walk Test, 6-min Walk Test (6MWT), and the Stroke Impact Scale (SIS). Results: The change in results of the TUGT, 6MWT, and SIS measured prior to and following the training regimens appeared to be significantly different between the two groups (p<.05). In addition, after the intervention, significant differences were found for all parameters in the task-oriented circuit training group and for the TUGT, 6MWT, and SIS in the treadmill training group (p<.05). Conclusion: The findings suggest that task-related circuit training and treadmill training may be helpful to improve walking function and quality of life of patients with post-stroke hemiparesis. Additionally, a task-related circuit training program may achieve more favorable outcomes than a treadmill program.

The purpose of this study was to assess the effects of Ankle exercise on balance ability of stroke patients. Participants' balance ability were measured prior to the training and they conducted ankle exercise. As for ankle exercises, ankle stretching training and ankle muscle strengthening training were performed for 10 minutes respectively. They did warm up exercise for 5 minutes and then ankle exercise for 20 minutes. And then they did cooldown exercise for 5 minutes. Their balance ability was measured after 9 weeks. According to the results of analyzing the change of balance ability that timed up and go and Berg balance scale score significantly improved but in the control group it did not significantly decrease. In comparison between the groups, Berg balance scale score significantly improved in the ankle exercise group compared to the control group. Ankle exercise performed by stroke patients are considered to be effective in improving balance ability.

Background: Posture balance control is the ability to maintain the body’s center of gravity in the minimal postural sway state on a supportive surface. This ability is obtained through a complicated process of sensing the movements of the human body through sensory organs and then integrating the information into the central nervous system and reacting to the musculoskeletal system and the support action of the musculoskeletal system. Motor function, including coordination, motor, and vision, vestibular sense, and sensory function, including proprioception, should act in an integrated way. However, more than half of stroke patients have motor, sensory, cognitive, and emotional disorders for a long time. Motor and sensory disorders cause the greatest difficulty in postural control among stroke patients. Objects: The purpose of this study is to determine the effect of visual and somatosensory information on postural sway in stroke patients and carrying out a kinematic analysis using a tri-axial accelerometer and a quantitative assessment. Methods: Thirty-four subjects posed four stance condition was accepted various sensory information for counterbalance. This experiment referred to the computerized dynamic posturography assessments and was redesigned four condition blocking visual and somatosensory information. To measure the postural sway of the subjects’ trunk, a wireless tri-axial accelerometer was used by signal vector magnitude value. Ony-way measure analysis of variance was performed among four condition. Results: There were significant differences when somatosensory information input blocked (p<.05). Conclusion: The sensory significantly affecting the balance ability of stroke patients is somatosensory, and the amount of actual movement of the trunk could be objectively compared and analyzed through quantitative figures using a tri-axial accelerometer for balance ability.

목적 : 지역사회기반 중재가 뇌졸중환자의 일상생활활동에 미치는 효과에 대한 근거를 제공하고자 하였다. 연구방법 : 체계적 고찰과 메타분석방법을 사용하였다. 데이터베이스는 PubMed, MEDLINE, Cochran CENTRAL, RISS, 국회도서관을 사용하여 자료를 수집하였고 각 연구의 질 평가는 PEDro Scale을 사 용하였다. 두 명의 저자가 독립적으로 자료수집 및 질 평가를 실시하였다. 포함기준에 맞는 연구는 7편 의 연구가 최종적으로 포함되었다. 분석은 대상 논문의 실험군 및 대조군의 대상자 수, 평균, 표준편차를 사용하여 메타분석을 실시하였다. 결과 : 대상자는 388명 이었다. 메타분석을 실시한 결과 일상생활활동에 대한 중재 효과크기는 2.63으로 지역사회기반 중재가 뇌졸중 환자의 일상생활활동에 효과적이었다. 결론 : 지역사회기반 중재가 뇌졸중 환자의 일상생활활동에 효과적임을 알 수 있었다. 연구결과는 뇌졸중 환자를 위한 지역사회 중재에 대한 근거로 제시할 수 있으며, 근거를 기반으로 다양하고, 폭넓은 지역사 회기반 중재가 이루어져야 할 것이다.

Previous studies have investigated stepping over obstacles in treadmill walking training (TWT-OS) and treadmill walking training (TWT) alone for walking capacity not considering real physical activity. As such, we investigated the effects of TWT-OS on physical activity and changes in different levels of physical activity based on community ambulation in stroke patients. Thirty subjects were randomly assigned to either the experimental group or the control group, with 15 and 15 subjects, respectively. However, one subject from the control group was excluded because of inadequate treatment sessions. All subjects underwent routine physical therapy in the form of treadmill walking. The subjects in the experimental group underwent simultaneous training in obstacle-stepping while walking on the treadmill for 30 min/day, five times/week, for four weeks. Subjects were given a three-axis accelerometer to wear at the hip on a belt for one-week pre- and post-training physical activity. Step counts for seven days, average daily step counts, and the average of minutes spent in sedentary, light, and above moderate activity were chosen as outcome measures of physical activity. No significant differences between the groups were found in terms of step counts for seven days, average daily activity, or daily activity spent at sedentary levels after four-week interventions. However, the average daily activity spent at light levels (-42.60 min vs. -6.71 min) was significantly lower in the experimental group than in the controls. Conversely, average daily activity spent at above moderate levels was higher (19.86 min vs. 11.07 min) (p<.05) after adjusting for each baseline value. Significant pre- and post-training differences were found in all variables of the experimental group (p<.05). Thus, TWT-OS could improve physical levels above moderate activity as a community-oriented task more than simple repetitive waking on a treadmill, and it could provide an opportunity for patients ambulatory after stroke to participate in the community again.

The purpose of this study was to compare the effects of underwater treadmill gait training (UTGT) and overground treadmill gait training (OTGT) on the gait, balance ability and pulmonary function of stroke patients. Twenty subjects were recruited for this study. The subjects were randomly assigned to two groups: UTGT (n1=10) and OTGT (n2=10). The 10 m walk test (10 MWT), Berg Balance Scale, Timed Up and Go (TUG) test, center of pressure, pulmonary function of forced vital capacity (FVC), forced expiratory volume after 1 sec (FEV1) and FEV1/FVC were measured before and after 4 weeks of training. Both groups undertook the gait training for 30 min a day, 3 times a week, for 4 weeks, and rating of perceived exertion of the groups were measured and compared. All the studied variables were significantly improved in both groups (p<.05) at the end of the study, except in the FEV1 of OTGT (p>.05). There was significant between-group difference in all of the variables, except in the 10 MWT (p>.05). These findings suggest that UTGT is more effective than OTGT in improving the balance and pulmonary functions of stroke patients.

The purpose of this study was to find which spatiotemporal gait parameters gained from stroke patients could be predictive factors for the gait part of Tinetti Performance-Oriented Mobility Assessment (POMA-G). Two hundred forty-six stroke patients were recruited for this study. They participated in two assessments, the POMA-G and computerized spatiotemporal gait analysis. To analyze the relationship between the POMA-G and spatiotemporal parameters, we used Pearson’s correlation coefficients. In addition, multiple linear regression analyses (stepwise method) were used to predict the spatiotemporal gait parameters that correlated most with the POMA-G. The results show that the gait velocity (r=.67, p<.01), cadence (r=.66, p<.01), step length of the affected side (r=.49, p<.01), step length of the non-affected side (r=.53, p<.01), swing percentage of the non-affected side (r=.47, p<.01), and single support percentage of the affected side (r=.53, p<.01) as well as the double support percentage of the non-affected side (r=-.42, p<.01) and the step-length asymmetry (r=-.64, p<.01) correlated with POMA-G. The gait velocity, step-length asymmetry, cadence, and single support percentage of the affected side explained 67%, 2%, 2%, and 1% of the variance in the POMA-G, respectively. In conclusion, gait velocity would be the most predictive factor for the POMA-G.

The purpose of this study was to evaluate the effects of mobilization of the sciatic nerve on hamstring flexibility, lower limb strength, and gait performance in patients with chronic stroke. This study was a randomized clinical trial with a crossover design. Sixteen subjects were recruited for this study. The subjects were randomly divided into two intervention groups and underwent either of the following two interventions: sciatic nerve mobilization or static stretching of the hamstring. We assessed hamstring flexibility, lower limb strength, and gait performance using a digital inclinometer, a hand-held dynamometer, and the 10-meter walk test, respectively. Subjects had a 24-hour rest period between each session in order to minimize carryover effects. Measurements for each test were assessed prior to and immediately after the intervention sessions. Using a two-way analysis of variance test with repeated measures, data from the two trials were analyzed by comparing the differences between both techniques. The level of statistical significance was set at .05. Sciatic nerve mobilization resulted in significantly better knee extensor strength (p=.023, from 15.32±5.98 to 18.16±6.95 ㎏) and knee flexor strength (p=.011, from 7.80±4.80 to 8.15±4.24 ㎏) in the experimental group than in the control group. However, no significant effects of static stretching of the hamstring were observed on hamstring flexibility from the ankle plantar flexion (p=.966) and ankle neutral positions (p=.210) and on gait performance (p=.396). This study indicated that the sciatic nerve mobilization technique may be more effective in muscle activation of the knee extensor muscle and knee flexor muscle than hamstring static stretching technique in patients with chronic stroke.

Objective : The main purpose of this study was to analyze the structural relationship among factors that have an impact on Health-Related Quality of Life (HRQOL) in three groups: A stroke patient group (Exp 1), high-risk stroke patient group (Exp 2), and a normal control group.Methods : For this survey, we conducted a secondary analysis using ‘the fifth Korea national health and nutrition examination survey (2010-2011)’, and investigated 2,293 elderly people over 65 years in age.Results :The results were as follows: HRQOL had a significant difference among groups (control›Exp2›Exp1) (p<.05). In the total effect of the experimental 1 groups, their HRQOL was significantly affected by their mental health (β=.425), self-rated health (β=.391), and medical health (β=.290)(p<.05). In the total effect of the experimental 2 group, their HRQOL was significantly by their self-rated health (β=.425), medical health (β =.272), mental health (β=.249), and functional health (β=.234) (p<.05). In the total effect of the control group, their HRQOL was significantly affected by their self-rated health (β=.398) and mental health (β=.184)(p<.05).Conclusion : In conclusion, this study suggested two matters to improve the HRQOL in people with or without a stroke. First, to improve the HRQOL in people suffering from senility, a different approach is needed according to whether the person has had or not had a stoke. Particularly in stroke patients, we should treat both their physical disability and mental health. Second, regardless of whether they have had a stroke, their HRQOL is influenced strongly by their self-rated level of health, and therefore an improvement of HRQOL will be induced by promoting positive health behaviors.

Objective : The purpose of this study was to determine the effects of ocular training on visual perception ability and eye-hand coordination of patients after a stroke.Methods : The subjects this study were ten stroke patients who have trouble with handling visual perception. The experimental group received both upper extremity function training and ocular motor training. The control group received upper extremity function training, and Developmental Test of Visual Perception-Adolescent and Adult (DTVP-A) and Visual Object Space Perception Battery (VOSP) were used to measure their visual perception, whereas Minnesota Manual Dexterity Test (MMDT) and CMS-10 were used to measure their eye-hand coordination before and after intervention.Results : The two groups both showed an increase in visual perception and eye-hand coordination after intervention, but the experiment group showed a significantly greater increase than the control group (p<.05). Differences in groups showed significantly increase with experimental group in form constancy of DTVP-A, total score of VOSP and moving part of MMDT (p<.05).Conclusion : The two groups both showed an increase in visual perception after intervention, but there was a greater improvement within the experimental group, which performed ocular training. As a result, it can be predicted that ocular motor training may be helpful in recovering and increasing the abilities of strok patients.

Objective : This study examined the impact of a sixteen-week time-use intervention perio on the depression and rehabilitation motivation of stroke patients with psychological difficulties.Methods : Ten stroke patients who were divided into an experimental group and a control group participated in this study from May 2014 to August 2014. Depression changes were measured using a Beck Depression Inventory (BDI), and their rehabilitation motivation was evaluated using the Rehabilitation Motivation Scale.Results : The results of the present study showed that the experimental group and control group presented significant differences before and after intervention in terms of their depression and rehabilitation motivation. However, after intervention, the depression and rehabilitation motivation did not differ between the two groups.Conclusion : The results of this study indicate that time-use intervention was effective in improving the depression and rehabilitation motivation of stroke patients, and therefore time-use intervention with occupational therapy will be useful as a clinical method for improving their level of depression and rehabilitation motivation.

Objective : The purpose of this study was to verify leisure motivation and participation restrictions effect on level of leisure activity in stroke patients.Methods : Since 12 November 2014 until 19 December, we have collected a data about participation restrictions, a leisure motivation, and Korean Activity Card Sort (K-ACS) Targeting 125 inpatients/outpatients who were diagnosed with stroke that are over 55 years old. For the data analysis, we implemented a descriptive statistic, a pearson correlation coefficient, and a multiple regression analysis.Results : The study shows that the stroke patients’ level of current leisure activity showed a significant correlation with a leisure motivation and participation restrictions. The leisure motivation in subordinate area, it manifest a correlation that is significant in learn, self-development, a health, and social. And it showed a significant of personally restrictions in subordinate area of participation restrictions. The element that effects on a level of current leisure activity, it resulted as personal restrictions, learn and social of leisure motivation, the explanation ability was analysed as to 20.0%.Conclusion : Need to utilize an intervention method to maintain a healthy life in participating a leisure activity for the stroke patients, and it is needed of an approach towards restrictions elements and motivator for the leisure intervention.

Objective : This study examined effect of Dynavision training on visual attention while conducting tasks after a stroke, and performed an eye-tracker analysis.Methods : Across an ABAB single-subject research design, three stroke patients conducted Dynavision training during the intervention period, and the eye-tracker evaluated their visual attention after each session. A visual analysis was conducted using a graph, and the changes in the values were analyzed through two standard deviations and the trend line.Results : The values of eye fixation, eye saccade, and eye scan-path remained high within the two standard deviation band more than twice during the intervention and reversal intervention period. The trend line for the intervention and reversal intervention period was steep. The trend line for the percentage of correct answers on paper was increased during the reversal baseline period. In addition, the trend for the line reversal intervention period was steeper than for the intervention period.Conclusion : Dynavision training after a stroke affected the visual attention while conducting tasks, and an eye-tracker evaluation was more objective than a pencil-paper evaluation.

This study aimed to determine the effects of Rhythmic Auditory Stimulation (RAS) using music and a metronome on the gait of stroke patients. 13 female and 15 male volunteers were randomly allocated to two groups: namely a group to receive RAS using music and a metronome group (the experimental group; n1=14) and a group to receive RAS using a metronome only (the control group; n2=14). The affected side was the left side in 15 subjects and the right side in 13 subjects. The mean age of the subjects was 56.6 years, and the mean onset duration of stroke was 8.6 months. Intervention was applied for 30 minutes per session, once a day, 5 times a week for 4 weeks. To measure the patients’ gait improvement, we measured gait velocity, cadence, stride length, double limb support using GAITRite, body center sway angle using an accelerometer, and Timed Up-and-Go test. Functional Gait Assessment were conducted before and after the experiment. The paired t-test was used for comparisons before and after the interventions in each group. Analysis of covariance was used for comparisons between the groups after the interventions. Statistical significance was set at α=.05. Within each of the two groups, significant differences in all of the dependent variables before and after the experiment (p<.05) were observed. However, in the comparison between the two groups, the experimental group showed more significant improvements in all dependent variables than the control group (p<.05). Our results also suggest that in applying RAS in stroke patients, the combination of music and a metronome is more effective than using a metronome alone in improving patients’ gait.

The purpose of this study was to investigate the effect of multi joint-joint position sense (MJ-JPS) training on joint position sense, balance, and gait ability in stroke patients. A total of 18 stroke patients participated in the study. The subjects were allocated randomly into two groups: an experimental group and a control group. Participants in the experimental group received MJ-JPS training (10 min) and conventional treatment (20 min), but participants in the control group only received conventional treatment (30 min). Both groups received training for five times per week for six weeks. MJ-JPS is a training method used to increase proprioception in the lower extremities; as such, it is used, to position the lower extremities in a given space. MJ-JPS measurement was captured via video using a Image J program to calculate the error distance. Balance ability was measured using Timed Up and Go (TUG) and the Berg Balance Scale (BBS). Gait ability was measured with a 10 m walking test (10MWT) and by climbing four flights of stairs. The Shapiro-Wilk test was used to assess normalization. Within-group differences were analyzed using the paired t-test. Between-group differences were analyzed using the independent t-test. The experimental group showed a significant decrease in error distance (MJ-JPS) compared to the control group (p<.05). Both groups showed a significant difference in their BBS and 10MWT results (p<.05). The experimental group showed a significant decrease in their TUG and climbing results (p<.05), but the control group results for those two tasks were not found to be significant (p>.05). There was significant difference in MJ-JPS and by climbing four flights of stairs on variation of pre and post test in between groups (p<.05), but TUG and BBS and 10MWT was no significantly (p>.05). We suggest that the MJ-JPS training proposed in this study be used as an intervention to help improve the functional activity of the lower extremities in stroke patients.

목적 : 본 연구의 목적은 로봇(Amadeo®)을 이용한 왼손의 능동 보조 운동이 뇌졸중 환자의 편측무시에 미치는 영향을 알아보는 것이다. 연구방법 : 본 연구는 만성 뇌졸중 환자 3명을 대상으로 하였으며, 다중 기초선 개별실험연구 설계를 사용 하였다. 연구기간 동안 대상자별 실험설계는, 대상자 1은 기초선 3회, 중재기 12회, 대상자 2는 기초선 5회, 중재기 10회, 대상자 3은 기초선 7회, 중재기 8회로, 대상자간 기초선과 중재기 회기 수는 다르나 총 회기 수는 15회로 일정하였다. 각 중재기간 동안 로봇을 이용하여 회기 당 30분씩 왼손의 능동보조 운동을 시행하였다. 기초선과 중재기간에는 편측무시 평가를 위해 선 나누기 검사(Line Bisection Test; LBT)와 알버트 검사(Albert’s Test)를 시행하였고 일상생활에서의 편측무시 정도를 평가하기 위해 중재 전, 후에 Catherine Bergego Scale (CBS)을 사용하였다. 결과 : 중재 전과 비교하여 모든 대상자에서 로봇보조치료 후에 선 나누기 검사, 알버트 검사, CBS 점수 가 향상되었다. 결론 : 본 연구 결과, 로봇을 이용한 왼손의 능동 보조 운동은 뇌졸중 환자의 편측무시 감소에 비교적 긍 정적인 영향을 준 것으로 확인되었다.

목적 : 본 연구에서는 뇌졸중 환자에게 Cognitive Orientation to daily Occupational Performance (CO-OP) 접근법을 적용하여 작업수행 향상에 효과가 있는지 알아보고자 하였다. 연구방법 : 연구대상은 외래재활치료를 받고 있는 2명이었고, 연구디자인은 ABA 개별 실험 연구설계로 실 시하였다. 기초선 기간(A)은 자료가 안정되는 시기까지 2회기, 중재 기간(B)은 주 2회 60분 동안 8회기, 재기초선 기간(A’)은 중재 후 기초선과 동일하게 2회기 실시하였다. 작업수행 향상을 검증하기 위해 총 세 가지 활동을 선정하였는데, 2개는 CO-OP접근법으로 훈련을 실시하였고, 나머지 1개 활동은 일반화를 알 아보기 위해 훈련하지 않았다. 결과측정 도구는 활동에 대한 수행의 질을 평가하는 Performance Quality Rating Scale (PQRS)과 수행 기술 및 독립성을 평가하는 Assessment of Motor and Process Skills (AMPS)을 사용하였다. 결과 분석은 작업수행의 질은 시각적 분석으로, 수행 기술 및 독립성은 AMPS 9 프로그램을 사용하여 비교하였다. 결과 : 작업수행의 질은 대상자 A와 B 모두에서 CO-OP접근법으로 훈련한 두 과제 모두 기초선에 비해 중재 기간에 향상되었고, 재기초선 기간에도 유지되었으며, 훈련하지 않는 과제도 수행의 질이 유지되는 경향을 보였다. 작업수행 기술의 독립성은 대상자 A는 기초선에 비해 운동기술은 0.35로짓, 처리기술은 0.04로짓 증가되었으며, 대상자 B는 운동기술 0.31로짓, 처리기술 0.55로짓 증가하였다. 결론 : CO-OP접근법은 뇌졸중 환자의 작업수행을 증진시킬 수 있는 중재방법이며, 지역사회에 거주하는 뇌졸중 환자에게 적용하여 긍정적인 결과를 도출할 수 있었다.

목적 : 본 연구에서는 연하장애를 동반한 뇌졸중 환자를 대상으로 저항성 고개 숙이기 운동이 연하기능에 미치는 영향을 알아보고자 하였다. 연구방법 : 본 연구는 뇌졸중 환자 58명을 무작위로 저항성 고개 숙이기 운동군과 두부거상 운동군으로 할당하였다. 실험군은 저항성 고개 숙이기 운동을 실시하였다. 반면 대조군은 두부거상 운동을 실시하였 으며 중재기간은 하루 15분간 일 2회, 주 5회, 6주 간 실시하였다. 결과 : 본 연구 결과 실험군과 대조군 모두 비디오 투시 연하장애 척도(Videofluoroscopic Dysphagia Scale; VDS)의 총 점수와 인두기 점수, 침습-흡인 척도(Penetration-Aspiration Sclae; PAS) 그리고 기능적 구강 섭취 척도(Functional Oral Intake Scale; FOIS) 모두에서 유의한 향상을 보였다(p<.05). 하지만 두 군의 중재 전-후 변화량을 비교한 결과 비디오 투시 연하장애 척도와 침습-흡인 척도에서 유의한 차이를 보였다(p=.04, p=.00). 결론 : 본 연구를 통해 저항성 고개 숙이기 훈련은 기존에 연하치료의 교정적 방법으로 사용되고 있던 두 부거상 운동과 유사한 효과가 있음을 확인하였다.