목적 : 국내·외에서 보고된 뇌졸중 환자 대상의 운전 시뮬레이터 훈련 연구의 체계적 고찰을 통해 연구 경향과 대상자 특성, 사용 방법 및 시뮬레이터를 통한 중재의 효과성에 대해 알아보고자 한다. 연구방법 : RISS, PubMed 등의 데이터베이스를 이용하여 선정 기준에 부합하는 5편의 국내·외 연구를 검색하였 다. 분석 대상 연구들은 연구의 근거 기반 질적 수준 분석 모델에 따라 분류하였고, 임상적 분석 방법인 P.I.C.O 방법에 따라 분석하여 정리하였다. 결과 : 고찰한 연구는 총 5개로 근거 수준은 I, IV였다. 연구 대상자는 뇌졸중 환자로 운전 시뮬레이터 훈련 중재 를 통해 운전 기능 향상의 효과를 살펴보았으며, 중재 결과 다양한 영역에서의 향상이 보고되었음을 확인할 수 있었고, 1편의 논문을 제외한 4편의 논문에서 운전 기능의 유의미한 향상을 보고하였다. 결론 : 시뮬레이터를 이용한 중재는 많은 연구를 통해 효과가 입증되고 있었다. 추후 연구 대상자를 더욱 다양하 게 하여 도로 주행 능력 및 다양한 영역에서의 기능 향상을 위한 운전재활 연구가 지속적으로 이루어져야 할 것이다.

목적 : 본 연구는 뇌졸중 환자에게 원격재활이 일상생활활동과 삶의 질에 미치는 효과를 알아보고자 하였다. 연구방법 : 뇌졸중 환자들을 대상으로 원격재활 중재를 사용하여 효과성을 검증한 국내외 무작위 실험연구 중, 2000년 1월에서 2022년 1월 사이에 출판된 논문들로 분석하였다. 검색을 위한 학술 데이터베이스 로는 Embase, MEDLINE, PubMed, RISS를 사용하였고, PEDro 척도를 사용하여 연구의 질을 평가하 였다. 메타분석은 샘플 수, 평균, 표준 편차와 같이 통계학적 수치를 사용하여 분석을 시행하였다. 결과 : 검색 결과 최종 10편의 무작위 대조 임상시험 연구가 선정되었고, PEDro 척도를 이용하여 연구의 질을 평가한 결과 6점 이상에 해당되었다. 참여대상자의 총 인원은 실험군이 343명, 대조군이 332명이 었다. 효과크기는 Cohen의 d값과 램덤효과 모델로 산출하였다. 분석 결과, 원격재활이 뇌졸중 환자의 일상생활활동에 향상에는 0.22 (95% Confidence Interval[CI]: -0.02 – 0.46; p = 0.07)로 유의한 차 이를 보이지 않았으나, 원격재활 프로그램에 일상생활활동 훈련이 포함된 중재들은 뇌졸중 환자의 일상 생활활동에 0.48 (95% CI: 0.15 – 0.81; p = 0.004)로 중간 효과크기가 있는 것으로 나타났다. 그리 고 뇌졸중 환자의 삶의 질 향상에는 0.68(95% CI: -1.24 – 2.59; p = 0.49)로 유의한 변화를 보이지 않았다. 결론 : 본 연구를 통해 원격재활 프로그램에 일상생활활동 훈련이 포함된 경우, 뇌졸중 환자의 일상생활활 동에 효과가 있는 걸 알 수 있었다. 또한 원격재활이 뇌졸중 환자의 삶의 질 향상에는 유의한 차이를 보 이지 않았지만 본 연구를 통해 뇌졸중 환자에게 제공되는 원격재활의 일상생활활동과 삶의 질에 대한 문헌들을 종합적으로 분석하여 효과를 알아보았다는데 의미가 있다.

Background: Trunk movements are an important factor in activities of daily living; however, these movements can be impaired by stroke. It is difficult to quantify and measure the active range of motion (AROM) of the trunk in patients with stroke. Objects: To determine the reliability and validity of measurements using a digital goniometer (DG) and smart phone (SP) applications for trunk rotation and lateral flexion in stroke patients. Methods: This is an observational study, in which twenty participants were clinically diagnosed with stroke. Trunk rotation and lateral flexion AROM were assessed using the DG and SP applications (Compass and Clinometer). Intrarater reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals. Pearson correlation coefficient was used to determine the validity of the DG and SP in AROM measurement. The level of agreement between the two instruments was shown by Bland–Altman plot and 95% limit of agreement (LoA) was calculated. Results: The intrarater reliability (rotation with DG: 0.96–0.98, SP: 0.98; lateral flexion with DG: 0.97–0.98, SP: 0.96) was excellent. A strong and significant correlation was found between DG and SP (rotation hemiplegic side: r = 0.95; non-hemiplegic side: r = 0.90; lateral flexion hemiplegic side: r = 0.88; non-hemiplegic side: r = 0.78). The level of agreement between the two instruments was rotation (hemiplegic side: 23.02° [LoA 17.41°, –5.61°]; non-hemiplegic side: 31.68° [LoA 23.87°, –7.81°]) and lateral flexion (hemiplegic side: 20.94° [LoA 17.48°, –3.46°]; non-hemiplegic side: 27.12° [LoA 18.44°, –8.68°]). Conclusion: Both DG and SP applications can be used as reliable methods for measuring trunk rotation and lateral flexion in patients with stroke. Although, considering the level of clinical agreement, DG and SP could not be used interchangeably for measurements.

Background: The purpose of this study was to investigate whether the function of stroke patients could be improved by simultaneously performing bridging and masticating exercises. And, this was tested by examining whether the effects of arousal and cognitive improvement due to mastication muscle activity could affect exercise ability. Objectives: To compare the effects, the movement of the center of pressure and the stability limit change were measured using a balance analysis platform (BT4). Design: Randomized controlled trial. Methods: In this study, 36 chronic stroke patients were randomly assigned to either single training group of the bridging exercise or combined training group that performed both the bridging exercise and the mastication exercise. The exercise was performed for thirty minutes a day, three times a week, for eight weeks. Results: In both groups, the static balance ability improved after exercise, but the dual-task training group had a better improving effect on the distance and area of the center of pressure while the eyes was open. The dynamic balance ability also improved after exercise, and the dual-task training was more effective in reducing forward, left, and right movements, but not in backward movement. Conclusion: The importance of mastication was recognized in the rehabilitation of chronic stroke patients, and it can be expected to use mastication to improve balance in stroke patients in the future.

Background: Although various conventional approaches have been employed to reduce spasticity in neurological rehabilitation, only a few studies have shown scientific evidence for its effectiveness. Thus, we introduced a different concept (Ueda method) of rehabilitation therapy that can complement the limitations of conventional therapy. Objects: This study aimed to investigate the immediate effects of the application of the Ueda method on patients with spasticity after stroke via an electrophysiological study. Methods: We conducted a randomized double-blind pilot study in two rehabilitation hospitals involving 30 stroke patients who were randomly allocated to the Ueda (n = 15) and convention (n = 15) groups. Electromyographic data of six examined muscles in both upper extremities of all patients were recorded. The A-ApA index and activation ratios of upper extremity muscles were evaluated and compared between the groups to confirm post-intervention changes in upper-extremity flexor spasticity and flexion synergies. Repeated-measures analysis of variance was conducted to confirm the therapeutic effect (2 × 2) as a function of group (Ueda vs. convention) and time (pre-/post-intervention) on all outcome measures (p < 0.05). Results: In the Ueda group, the mean A-ApA index values differed significantly before and after the intervention (p = 0.041), indicating a weak evidence level; however, the effect size was medium (d = –0.503). The interaction effects of the A-ApA index between the Ueda and convention groups and between pre-intervention and post-intervention stages were significant (p = 0.012). The effect size was large (np 2 = 0.220). In the Ueda group, the activation ratios of the anterior deltoid fiber significantly decreased after the intervention in all reaching tasks. Conclusion: The Ueda method reduces upper-extremity flexor spasticity and changes its synergy in stroke patients and should be considered a rehabilitation therapy for spastic stroke patients.

목적 : 작업기반 가정방문 작업치료 중재를 통해 신경행동 문제와 일상생활활동 및 작업수행에 미치는 영향을 알아보고자 하였다. 연구방법 : 본 연구는 14명을 모집하여 무작위 배분으로 실험군 7명, 대조군 7명을 나누었고, 대조군은 사전·사후 평가만 실시하였고, 실험군은 주 2회, 총 8회기동안 작업기반 가정방문 작업치료 중재를 제공 하였다. 결과 : 작업치료 중재를 실시한 실험군에서 전반적 신경행동손상의 감정적/정서적 장애, 그 밖의 장애 항목과 구체적 신경행동손상의 조직화/순서화 항목에서 유의미한 장애 감소가 나타났으며, 일상생활활동 옷 입기 항목에서도 유의미한 기능 증진이 나타났다. 작업수행에서는 수행도와 만족도 항목에서도 유의미한 증진이 나타났으며, 중재를 실시하지 않은 대조군에서는 모든 항목에서 유의미한 변화가 나타나지않았다. 결론 : 작업기반의 가정방문 작업치료 중재를 실시하여 신경행동 문제와 일상생활활동 및 작업수행의 변화를 확인하였다. 본 연구를 지역사회에 거주하는 뇌졸중 환자를 위해 다양한 중재를 적용하기 위한 근거로 활용하길 권고한다.

목적 : 본 연구의 목적은 뇌졸중으로 입원한 환자를 대상으로 국제 기능ㆍ장애ㆍ건강 분류(International Classification of Functioning, Disability and Health(ICF) 핵심지표(core-set)에 따른 인지 요인과 참여 간에 상관관계를 확인하고, 참여에 영향을 미치는 인지 요인을 분석하고자 하였다. 연구방법 : 본 연구의 독립변수는 뇌졸중 환자의 인지 요인이며, 세부적으로는 의식수준, 지남력, 기억력,주의집중, 언어영역, 구성능력, 계산능력, 사고력, 실행기능으로 지정하였다. 그 중 지남력, 기억력, 주의집중, 언어영역, 구성능력, 계산능력, 사고력 평가는 신경행동학적 인지상태 검사(Korean Neurobehavior Cognitive Status Examination; K-NCSE), 실행기능은 Kims 전두엽-관리기능 신경심리검사 II(Kims Frontal-Executive Function Neuropsychology Test II; K-FENT II)를 사용하였다. 종속변인은 참 여 영역으로 두 개의 종속변수(일상적 활동, 사회적 역할)가 지정되었고, 일상적 활동과 사회적 역할로 구분하여 한글판 Life-Habits assessment 3.1(Korean version LIFE-H 3.1)을 사용하였다. 통계분 석은 SPSS 25.0을 통해 상관관계분석, 다중회귀분석을 사용하였다. 결과 : 모든 인지 요인은 참여와의 상관관계에서 통계적으로 유의하였다. 뇌졸중 환자의 인지 요인과 일 상적 활동 간의 상관관계는 언어영역(r = .527, p < .001), 실행기능(r = .488, p < .001), 계산능력 (r = .477, p < .001) 순으로 높게 나타났고, 사회적 역할은 언어영역(r = .481, p < .001), 기억력 (r = .480, p < .001), 주의집중(r = .460, p < .001) 순으로 나타났다. 다중회귀분석의 결과로는 일 상적 활동은 언어영역(t = 4.00, p < .001)과 구성능력(t = 2.85, p < .01), 사회적 역할은 언어영역 (t = 2.36, p < .05)과 기억력(t = 2.35, p < .05)이 통계적으로 유의하였다. 결론 : 본 연구를 통해 뇌졸중 환자의 참여에 영향을 미치는 다양한 인지 요인을 확인할 수 있었다. 따라 서 본 연구는 뇌졸중 환자의 참여 향상을 위한 각 인지 요인을 예측하고, 보다 정확한 중재 계획을 수립 하기 위한 기초자료로 활용될 수 있을 것이다.

Background: Foot drop is a common symptom in stroke patients. Tape applications are widely used to manage foot drop symptoms. Previous studies have evaluated the effects of static and dynamic balance and gait on foot drop using kinesiology tape; however, only few studies have used dynamic tape application in stroke patients with foot drop. Objects: The purpose of this study was to investigate the immediate effects of dynamic taping, which facilitates the dorsiflexor muscle, on static and dynamic balance and gait speed in stroke patients with foot drop. Methods: The study included 34 voluntary patients (17 men, 17 women) with stroke. The patients were randomly assigned to the experimental group (n = 17), wherein dynamic taping was used to facilitate the dorsiflexor muscle, or the control group (n = 17), wherein kinesiology taping was used. Before the taping application, velocity average, path-length average, Berg balance scale, and timed up and go test (TUG) were recorded to measure static and dynamic balance, whereas the 10-meter walk test (10MWT) was used to measure gait speed. After the taping application, these parameters were re-evaluated in both groups. Repeated measure analysis of variance was used. Statistical significance levels were set to α = 0.05. Results: Except for the 10MWT scores in the control group, significant differences were noted in all the parameters measured for static and dynamic balance and gait speed between the pre and post-test (p < 0.05). However, the parameters showed significant interaction effects between group and time in the TUG and 10MWT (p < 0.01). Conclusion: These results indicate that compared with kinesiology taping, dynamic taping used in chronic stroke patients with foot drop had a more significant effect on dynamic balance and gait speed.

Background: To restore the trunk function of stroke patients who tend to experience trunk weakness, a single exercise intervention is usually applied. However, problems with the trunk remain even after such an intervention. To overcome this challenge, combining other intervention methods with an exercise is suggested during training. Objectives: To investigate the effect of breathing based abdominal draw-in technique on the thickness of the transversus abdominis muscle and trunk control in stroke patients. Design: Randomized controlled study. Methods: After designating a group that will perform the abdominal draw-in technique as Experimental Group I and another group that will perform the breathing based abdominal draw-in technique as Experimental Group II, the thickness of the transversus abdominis muscle and the trunk impairment scale (TIS) of the subjects were measured as pre-tests before the interventions and as post-tests after the six week intervention period. Results: In the within group comparison, there was a significant change in the thickness of the transversus abdominis muscle for both groups while the subjects performed the abdominal draw-in technique; a significant change was also noted in their TIS (P<.05) (P<.01). However, in the inter-group comparison, a significant difference was found only in the TIS between the two groups (P<.05). Conclusion: After the application of the breathing based abdominal draw-in technique, an efficient contractile response was observed even in the muscles around the abdomen of the subjects, which indicates that this technique is an intervention method that can more effectively improve trunk control.

목적 : 본 연구는 급성기 뇌졸중 환자의 일반적 특성과 인지기능에 따른 공간관계지각을 비교함으로써 의료기관 등에서 작업치료 중재 수립 시 참고할 수 있는 기초자료를 제시하고자 하였다. 연구방법 : 본 연구는 의료기관에 입원한 뇌졸중 환자 36명을 대상으로 하였다. 평가는 미네소타 공간관계 지각 검사(Minnesota Spatial Relations Test; MSRT), 한국판 몬트리올 인지평가(Korean version of Montreal Cognitive Assessment; MoCA-K)를 사용하였다. 일반적 특성과 인지기능에 따른 공간관계 지각을 비교하기 위해 Independent samples t-test와 One-way analysis of variance를 이용하여 분 석하였다. 결과 : 급성기 뇌졸중 환자의 일반적 특성 중 연령대(p < .01), 발병기간(p < .05), 손상측 뇌반구(p < .01), 유/무학(p < .05)과 인지기능(p < .01)에 따른 MSRT 수행시간에서 통계학적으로 유의미한 차이 를 보였다. 수행시간을 비교하면 70대 이상이 40대 이하보다(연령대), 1개월 미만이 3개월 이상보다(발 병기간), 오른쪽이 왼쪽보다(손상측 뇌반구), 무학이 유학보다(유/무학) 더 소요되었다. 또한, 인지기능 이 저하된 환자의 수행시간이 정상 환자보다 더 소요되었다. 결론 : 본 연구를 통해 급성기 뇌졸중 환자의 연령대, 발병기간, 손상측 뇌반구, 유/무학과 인지기능에 따라 공간관계지각이 다르다는 것을 알 수 있었다. 향후에는 뇌졸중뿐만 아니라 다른 질환을 가진 환자를 대상으로 한 연구가 진행되기를 바라며, 본 연구의 결과가 작업치료 중재 수립에 도움이 되기를 기대한다.

The emergency diesel generator of a nuclear power plant is a emergency AC power source that starts up within 10 seconds when a LOOP(Loss Of Off-site Power) occurs and supplies power to essential safety facilities. In this study, factors affecting start signal input time, engine rotation start time, 30% of engine rated speed, 80% of engine rated speed were studied to secure starting reliability. As a result, it was found that the section before the 30% of engine rated speed was affected by the mechanical management status from the start signal to the fuel oil linkage system. After the 30% of engine rated speed section, it was the maximum fuel supply section, and the time reduction effect through management improvement was insignificant.

목적 : 본 연구는 재활병원에 입원중인 뇌졸중 환자를 대상으로 작업기반 임파워먼트 증진프로그램을 적용하여 회복탄력 성과 생활만족도에 미치는 영향을 알아보고자 한다. 연구방법 : 본 연구는 뇌졸중 환자를 대상으로 단일군 사전-사후 비교검사 설계이다. 한국판 간이정신상태검사(MMSE-K) 로 대상자를 선별한 후 대상자 15명을 선정하였다. 임파워먼트 프로그램은 4주간, 주2회 30분씩 진행하였다. 중재 전·후 측정을 위한 도구로 임파워먼트 척도(Empowerment Scale), 한국형 회복탄력성 척도(Korean Version of Connor- Davidson Resilience Scale), 생활만족도조사(Life Satisfaction Survey)를 사용하였다. 자료 분석은 SPSS version 21.0을 사용하였다. 대상자의 일반적 특성은 기술통계, 작업기반 임파워먼트 증진프로그램 중재 전, 후 평균을 비교하기 위해 대응표본 t-test를 통하여 중재 전후의 변화를 확인하였다. 결과 : 첫째, 임파워먼트에 유의한 향상이 있었고, 자기존중-자기효능, 힘-무기력, 지역사회참여 및 자율성 항목에서 유의한 차이를 보였다. 둘째, 회복탄력성에 유의한 향상을 보였으며 강인성 항목에서 유의한 차이를 보였다. 셋째, 생활만 족도에 유의한 향상이 있었으며 의식주, 인간관계, 사회생활 및 여가생활, 행복감, 자율성 및 자아감 항목에서 유의한 차이를 보였다. 결론 : 작업기반 임파워먼트 증진프로그램은 뇌졸중 환자의 치료에 있어 임파워먼트와 회복탄력성, 생활만족도 향상에 긍정적인 효과를 주며 자발적인 참여를 유도할 수 있는 중재법으로 작업치료 영역에서 고려해볼 수 있다.

Background: Stroke patients have dosiflexor weakness. Functional electrical stimulation (FES) for motor and sensory threshold stimulation has been applied to patients with stroke. Objectives: To investigate effects of FES intervention for motor and sensory threshold on balance and gait in subacute patients with stroke. Design: A randomized controlled trial. Methods: In all, 34 patients with subacute stroke were recruited and randomly assigned to the motor threshold (MTG, n=17) and sensory threshold group (STG, n=17). The measured variables were static balance (BioRescue), dynamic balance (BBS), and gait (TUG test). The study period was 5 weeks, twice a day, 5 days a week. Results: There was a significant difference in all variables except the speed variable (open eye Romberg test) after the intervention; MTG improved more significantly except for the speed variable of the Romberg test (open eye). BBS score increased significantly only in the MTG group after the intervention, and the increase was more significant in the MTG group than in the STG group. The TUG test significantly decreased in both groups after the intervention, and the decrease was more significant in the MTG group than in the STG group. Conclusion: FES for motor threshold applied to patients with subacute stroke appears to be more effective in improving balance and gait ability than FES for sensory threshold.

Background: The chin tuck exercise is a therapeutic approach for improving swallowing function in patients with dysphagia. However, the clinical evidence of the effect is still lacking. Objectives: To investigate the effect of a multidirectional chin tuck exercise on swallowing function in patients with post-stroke dysphagia. Design: A two-group prospective study. Methods: In total, 14 patients with post-stroke dysphagia were enrolled and assigned to either the experimental or control group. The experimental group performed the chin tuck exercise in the vertical and diagonal directions, whereas the control group performed the exercise only in the vertical direction. The intervention was performed 20 minutes a day, 5 times a week, for 4 weeks. Videofluoroscopic Dysphagia Scale (VDS) and Penetration–Aspiration Scale (PAS) scores determined via a videofluoroscopic swallowing study were the outcome measures used for evaluating swallowing function. Results: Post-intervention, the experimental group exhibited significantly better improvement in the pharyngeal phase score of VDS and PAS score than the control group. Conclusion: This study demonstrated that the multidirectional chin tuck exercise is more effective than the vertical chin tuck exercise in improving the swallowing function in patients with post-stroke dysphagia.

Background: Patients with stroke may show impaired balance due to the limited range of motion of the ankle resulting from abnormal soft tissues surrounding the ankle joint. Changes in the viscoelasticity of soft tissues and decreased mobility of the ankle impair the balance and lead to problems in the daily life of patients with stroke. Joint mobilization and stretching are effective methods of improving balance by increasing the viscoelasticity of soft tissues and range of motion of the ankle. Objectives: To effects of ankle joint mobilization and calf muscle stretching on balance in patients with stroke. Design: A randomized controlled trial. Methods: A total of 20 patients with stroke were randomly assigned into two groups. The joint mobilization group (JMG) underwent anteroposterior joint mobilization of the talocrural joint, while the stretching group (SG) received calf muscle stretching. Functional reach test (FRT), berg balance scale (BBS), and timed up and go test (TUG) were used to assess balance. Results: The FRT, BBS, and TUG results significantly improved in the JMG and SG after invention (P<.05). However, the improvements were greater in the JMG group than those in the SG group (P<.05). Conclusion: Joint mobilization was an effective intervention to improve soft tissue performance and range of motion of the ankle, thereby improving balance in patients with stroke.

목적 : 본 연구는 초기 뇌졸중 환자에서 휠체어 기술 훈련 프로그램 적용이 휠체어 기술 능력, 휠체어 추진 속도, 일상생활수행력에 미치는 효과를 알아보고자 실시하였다. 연구방법 : 초기 뇌졸중 환자 18명을 실험군과 대조군으로 무작위 배정하였다. 두 군 모두 일반적인 재활치료를 실시하였으며, 추가적으로 실험군에는 휠체어 기술 훈련을, 대조군에는 기립기를 통한 서기 훈련을 각 1일 30분, 주 3회, 총 3주간 실시하였다. 중재 전·후 휠체어 기술 능력을 측정하기 위해 휠체어 기술 검사 (Wheelchair Skills Test; WST), 휠체어 추진 속도(Wheelchair Propulsion Velocity; WPV), 한국판 수정 된 바델 지수(Korean version of Modified Barthel Index; K-MBI)을 사용하였다. 결과 : 3주 중재 후, 두 그룹에서 중재 전·후 WST, WPV, K-MBI에서 유의한 차이가 나타났으며(p < .05), 중재 후 두 그룹 간 변화량의 차이는 WST와 WPV에서 유의한 차이가 나타났다(p < .05). 결론 : 본 연구 결과 휠체어 기술 훈련 프로그램이 초기 뇌줄중 환자의 휠체어 기술 능력과 휠체어 추진 속도를 향상 시킬 수 있는 중재 방법으로 나타났다. 그러므로 휠체어 기술 훈련 프로그램은 독립적인 독립적 보행이 불가한 초기 뇌졸중 환자에게 안전하고 효율적인 이동 능력을 제공할 수 있는 중재 방법으로 사용될 수 있을 것이다.

Background: Masticating is an activity that is free from temporal or spatial constraints, with an advantage that it can be combined easily with other treatment methods. While several studies have reported a positive effect of the intervention of chewing using the jaw on postural stability, only a few studies were conducted on stroke patients. Objectives: To investigated the effects of masticating chewing gum on the static and dynamic balancing of stroke patients. Design: Randomized cross-over study design. Methods: Nineteen stroke patients were randomly assigned to the chewing group or control group. BT4 was used to measure the static and dynamic balancing abilities. Pre-test measurements were taken before mastication of chewing gum, and post-test measurements were taken after 2 days. The stroke patients in the chewing group were guided to sit on a chair and chew gum for 3 min, and their balancing abilities were simultaneously measured. The balancing abilities of the control group patients were measured while they sat at rest without masticating chewing gum. Results: The chewing group showed significant increases in the measures of static balance (i.e., C90 area, trace length, X mean, and Y mean). In the between-group comparison, the measures of static balance were significantly higher in the chewing group than in the control group. Conclusion: These findings suggest that masticating chewing gum enhanced the static balancing ability of stroke patients. Thus, gum chewing should be considered a viable clinical intervention to control posture in stroke patients.