The purpose of this study was to investigate the effect of Modified Constraint-Induced Therapy (MCIT) on the effected upper extremity of children with hemiparesis. Four children with hemiparetic upper extremity caused by brain injuries were trained by MCIT for ten weeks. During the same period, all of the subjects were also involved in thirty-minute regular physical therapy and occupational therapy. During the treatment period, the unaffected upper extremities of the subjects were restrained by a specially designed hand splint or a mitten for five hours a day, five days per week. For two hours out of the five-hour restraint period, the affected upper extremities were intensively trained by performing various functional tasks, which were individually structured to emphasize use of the affected arm. A single-subject design with A-B-A reversal was employed in this study. The affected limb motor ability was evaluated by Melbourne Assessment, measuring the time to grasp and release nine pegs, and measuring grasping power. As a consequence of this study, the affected limb motor test scores of all four subjects in the baseline period were improved during the treatment period. Furthermore, the treatment effect was maintained during a one-month follow-up period. The results of this study support the assumption that MCIT is an effective therapeutic method to improve the sensory and motor abilities of hemiparetic children. It also increases the frequency of functional use of the hemiparetic hands of brain-injured children. Based on the results of this study, it can also be assumed that the modified CIT method is especially beneficial to these children by reducing the negative emotional effects of forceful restraint of the unaffected upper extremity. To optimize the functional recovery of the paretic upper extremity by CIT, the restriction period per day should be decided individually, according to the characteristics of the individual.

We assessed whether the use of a symmetrical upper limb motion trainer in daily repetitive training for a 6-week period reduced spasticity and improved motor function in three chronic hemiparetic patients. Upper limb motor impairment and disability were measured by the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS) and Manual Muscle Test (MMT), respectively. The electromyography (EMG) of the affected hand was recorded during isometric wrist flexion and extension. In all patients, FMA and MMT scores were significantly improved after the 6-week training. However, MAS scores of the affected wrist spasticity did not change considerably. Onset and Offset delays in muscle contraction significantly decreased in the affected wrist. The co-contraction ratio of flexor and extensor muscles significantly increased after the 6-week training. Onset and offset delays of the muscle contraction and co-contraction ratio correlated significantly with the patients' FMA. This study showed that repetitive, symmetric movement training can improve upper limb motor functions and abilities in chronic hemiparetic patients. Also, the EMG assessment of motor response is likely to provide insights into mechanisms and treatment strategies for motor recovery in chronic hemiparetic patients.

이 연구의 목적은 뇌성마비 아동에게 앉은 자세에서 현수를 이용하여 체중지지를 해주었을 때 상지기능에 어떠한 영향을 미치는지 알아보는 것이다. 연구대상자는 뇌성마비 아동 5명과 뇌종양 아동 1명이었다. 연구대상자에게 harness를 착용하여 부분적 체중지지를 하기 전과 착용한 상태에서 손 뻗기 동작을 3차원 동작분석기를 이용하여 어깨관절과 손뻗기 동작에 걸린 시간을 측정하였고, Box and Block 검사를 실시하여 체중지지 전과 착용 시 상지 기능을

Objective : The purpose of this paper was to study the effect of involved upper extremity’s motor function recovery on Activities of Daily Living in subject with hemiplegia by using Fugl-Meyer Assessment (FMA) as a motor recovery test and Functional Independence Measure (FIM) as a functional test.Method : The subjects of the study were 20 stroke patients who were admitted in KeiMyung University Dongsan Medical Center from November, 2002 to April, 2003. Data were analyzed for wilcoxon signed-rank test, mann-Whitney U test, spearman’s rho using SPSS/PC+ program. Result : The results of the study was as follow;1. Involved upper extremity’s motor function and independence of ADL is significantly differ-ence after occupational therapy(p<.05).2. Involved upper extremity’s motor function recovery is not significantly correlated in-dependence of ADL. but, motor FIM and FMA is significantly correlated after occupational therapy(r=.461).3. Involved upper extremity’s motor function recovery is significantly difference in lesion site and not significant difference in sex, involved side (p<.05).4. Independence of ADL is not significant difference in lesion site, sex, involved side(p>.05).Conclusion : The results suggest that lesion site maybe a factor to predict involved upper extremity’s motor recovery and require various occupational therapy program according to lesion site.

Objective : This study was conducted to assess the changes in the functional levels of affected upper extremities after treating patients with brain injury by intensive CIMT (Constraint-Induced Movement Therapy). Method : Design was single-subject experimental reversal design (A-B-A). Subjects was 6 persons with brain injury (F: 1, M: 5), mean age (57.0±9.6). Intensive CIMT was performed over 6 hours a day for 2 weeks. Box and block test and nine hole pegboard were used for assessment of affected upper extremity function before and after intervention. Results : Compared baseline 1, functional level in both intervention and baseline 2 revealed improved functional levels. In addition, carry over effect was shown in baseline 2 period. Conclusion : Intensive CIMT based on task-oriented activity is considered to be effective because it decrease the time to use the paretic limb and thereby overcomes the “learned nonuse”.

The purpose of this study was to examine the effect of the upper limb nerve mobilization (ULNM) on functional recovery of upper extremity in hemiplegic patients following stroke. Twenty patients who had functional impairment on upper extremity were participated. Subjects were randomly divided into two groups: Control group (n=10) received traditional physical therapy only for 4 weeks; Experimental group (n=10) received ULNM treatment along with traditional physical therapy for the same period. Upper extremity functions were assessed by manual muscle test (MMT), modified Ashworth scale (MAS), and Fugl-Meyer assessment (FMA) before and after the treatment. In both experimental and control group, upper extremity functions were significantly improved in MMT (p<.01) and FMA (p<.01), however only experimental group showed significant improvement in FMA after the treatment (p<.05). Moreover, experimental group showed significantly greater improvement than control group in MMT (p<.05), MAS (p<.05), and FMA (p<.05). We conclude that the upper extremity functions is a useful additional therapeutic technique for the effective treatment of upper extremity deficits in hemiplegic patients.

The purpose of this study is to first to evaluate the function of the involved upper extremity of adult hemiplegia in relation to the hand dexterity with the uninvolved hand by using Manual Function Test(MFT) to measure the function of the involved upper extremity and Grooved Peg Board Test to assessment the hand dexterity with the uninvolved hand. Second to evaluate the hand dexterity with the uninvolved hand of adult hemiplegia in relation to activities of daily living(ADL) by using Functional Independence Measure(FIM) to measure the ADL. The subjects in this study were 21 stroke patients who were admitted for intensive treatment at Department of Rehabilitation in Asan Medical Center from September to November, 1998. Data were analyze for wilcoxon signed ranks test and Spearman correlation coefficients using SPSS/PC+ program. The results of this study are : 1) Statistically MFT score at admission showed significant correlation with MFT score at discharge (p < 0.01). 2) Statistically the hand dexterity with the uninvolved hand at admission showed si-gnificant correlation with the hand dexterity with the uninvolved hand at discharge(p< 0.01). 3) The function of the involved upper extremity and the hand dexterity with the un-involved hand are poorly related variables in stroke patients(p < 0.01). 4) The function of the involved upper extremity and independence in ADL are poorly related variables in stroke patients(p < 0.01). 5) The hand dexterity with the uninvolved hand and independence in ADL are poorly related variables in stroke patients(p < 0.01). 6) In the relationships between FIM score at admission and FIM score at discharge; there were no significant differences(p < 0.01). It was difficult to compare the measured hand dexterity with the uninvolved hand in stroke patients as well as to assess the hand dexterity with the same side hand in normal, for it is in the variation between the current data used for this study and the standard data obtained from Lafayatte Instrument Company. The activities of daily liv-ing of the hemiplegic patient are largely dependent on their uninvolved hand which is thought to be vital for the rehabilitation of the hemiplegic patients. Therefore, occupa- tional therapy program in stroke patients should include improving skills of uninvolved hand.

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.

We assessed the function of the both hands and arms of the hemiplegic patients by MFT(Manua1 Function Test) and ADL score of the hemiplegic patients by FIM(Func- tional Independence Measure) and investigate its significance. The subjects of this study were 34 patients who had been hospitalized Rehabilitation Hospital, Yonsei University College of Medicine. The results are as follows ; 1. MFS(Manua1 Function Score) of both uninvolved upper limbs and involved upper lim- bs were significantly correlated with total FI M score. 2. The shoulder abduction, touch hand to the back , pegboard sub-items of MFT on the uninvolved upper limbs were significantly correlated with total FIM score. 3. The all sub-items of MFT on the involved upper limbs were significantly correlated with total FIM score. 4. The function of both uninvolved upper limbs and involved upper limbs by MFT were significantly correlated with self care, mobility, locomotion. According to the above results, MFT shows the functional status of the hemiplegic patients relatively well.

This paper presents a force control based on the observer without taking any force or torque measurement from the robot which allows realizing more stable and robust human robot interaction for the developed multi-functional upper limb rehabilitation robot. The robot has four functional training modes which can be classified by the human robot interaction types: passive, active, assistive, and resistive mode. The proposed observer consists of internal disturbance observer and external force observer for distinctive performance evaluation. Since four training modes can be quantitatively identified as impedance variation, position-based impedance control with feedback and feedforward controller was applied to the assistive training mode. The results showed that the proposed sensorless observer estimated cleaner and more accurate force compared to the force sensor and the impedance controller embedded with the proposed observer completed the assistive training mode safely and properly.

본 연구의 목적은 양측성 재활운동프로그램을 통한 상지기능의 향상 정도를 운동기능 평가와 운동학적 측정을 통해 규명하는 것이다. 19명의 만성 뇌졸중 환자가 연구에 참여하였으며, 양측성 재활운동 그룹과 단측성 재활운동 그룹으로 무선할당하여 12주간의 재활운동을 실시하였다. 재활운동 프로토콜은 T-바 밀고 당기기, 손목 들어올리기, 암-컬(arm-curl), 전완 비틀기, 손가락 사다리의 5가지 세부 운동방법으로 구성되며, 양측성 재활운동 그룹은 각각의 운동과제를 수행할 때 환측 상지와 정상측 상지를 동시에 같은 방향으로 움직이도록 하였다. 단측성 재활운동 그룹은 운동과제를 환측 상지만을 사용하여 수행하였다. 훈련그룹에 따른 재활운동참여 효과를 비교하기 위하여, Fugl-Meyer Assessment, Box and Block Test, 그리고 3차원 영상 분석을 사용하였다. FMA와 BBT는 환측 상지의 기능적 움직임을 평가하기 위해 사용되었으며, QUALISYS 3차원 영상분석 시스템은 뻗기 동작 수행시 환측 상지의 운동학적 변인을 측정하기 위해 사용되었다. 연구결과 모든 그룹에서 재활운동참여를 통해 FMA 점수와 BBT 점수가 유의하게 향상되었으며, 운동시간과 저크코스트는 유의하게 감소되었다. 또한 양측성 재활운동 그룹의 경우 단측성 재활운동 그룹에 비해 저크코스트에서 더 큰 감소를 보였다. 이러한 결과를 통해 재활운동참여의 긍정적 효과와 양측성 재활운동프로토콜의 유용성을 확인 할 수 있었다.

본 연구의 목적은 양측성 단일 운동 훈련이 만성 뇌졸중 노인의 상지 운동기능회복에 어떠한 영향을 주는지 살펴보고 손상측 대뇌 운동피질 활성화에 미치는 영향에 대해 검증하고자 하였다. 이러한 연구 목적을 달성하기 위해 총 10명의 만성 뇌졸중 노인들이 양측성 훈련과 단측성 훈련에 각각 5명씩 참여하였으며, 실험을 위해 동작분석 시스템, 경두개자기자극기, 근전도 기기, 재활훈련도구가 사용되었다. 훈련과제는 나무 말뚝 옮기기, 나무 팩 맞추기, 그리고 물 마시기 모방 과제로 구성하여 주 2회 총 16회의 훈련을 실시하였다. 그 결과, 양측성 훈련 집단은 기능적 뻗기 검사에서 최대속도가 증가하였으며, 운동시간이 감소한 것으로 나타났다. 기능적 검사에서도 씨앗 옮기기, 무거운 물건 옯기기 과제에서 수행시간이 감소한 것으로 나타났다. 또한 경두개자기자극기를 활용한 신경생리적 검사에서도 130%, 140%, 그리고 150% 자극 강도에서 운동유발전위의 크기가 증가한 것으로 나타났다. 이러한 결과를 통해 양측성 단일 운동 훈련이 손상측 상지의 운동기능회복과 대뇌 운동피질 활성화에 긍정적인 효과가 있는 것으로 알 수 있다.