The objective of this study was to identify the effects of pelvic tilting exercise on gait patterns of hemiplegic patients. The subjects of this study were 31 hemiplegic in- and out-patients of the Rehabilitation Hospital, Yonsei University Medical Center, from September 24, 1997 through November 5, 1997. Pre- and post-treatment change in gait patterns were measured using a ink foot-print. The data were analyzed by the paired t-test, one-way ANOVA, and independent t-test. The findings were as follows: The difference in gait patterns between pre- and post-treatment was statistically significant, with an increase in gait velocity to 7.98 cm/sec post-treatment; an increase in cadence to 7.29 steps/min; a narrowing of the base of support to 1.33 cm; an increase in step length of 3.92 cm on the less affected side and 3.73 cm on the more affected side; an increase in stride length of 5.82 cm on the less affected side and 5.92 cm on the more affected side(statistically not significant in foot angle). In relation to sex, age, cause of stroke, and laterality of paralysis, the difference in gait patterns between pre- and post-treatment was not statistically significant. Where there was no significant difference of the effects of pelvic exercise regarding the degree of spasticity, the presence of a decrease in proprioception, and the duration of treatment. In conclusion, hemiplegic pelvic tilting exercise was found to have transmitting positive effect in improving gait patterns.

The purpose of this study was to identify the relationship between sitting and standing balance in acute stroke patients and gait outcome, and to determine appropriate test times. The subjects of this study were 20 hemiplegic patients who had been hospitalized in Sangji University Oriental Medical Hospital from August 26, 1997 through November 3, 1997. Twenty patients with cerebral infarcts had sitting and standing balance assessed on the 5th day and 10th day of stroke onset. Gait outcome was assessed 5 weeks later using the MMAS (Modified Motor Assessment Scale) score. The data were analyzed by the Spearman's Rho test and Wilcoxon signed rank test. The results were as follows: 1) Correlation coefficients between sitting balance on the 5th day and 10th day after their stroke and gait outcome 5 weeks after their stroke were =0.89 and =0.83, respectively. All of the sitting balance data significantly correlated with gait outcome (p<0.05). 2) Correlation coefficients between standing balance on the 5th day and 10th day after their stroke and gait outcome 5 weeks after their stroke were =0.82 and =0.87, respectively. All of the standing balance data significant1y correlated with gait outcome (p<0.05). 3) The difference between sitting balance scores on the 5th day and 10th day after stroke onset were statistically significant (p<0.05). But the difference between standing balance scores on the 5th day and 10th day after stroke onset were not statistically significant (p>0.05). In conclusion, sitting and standing balance tests on the 5th day and 10th day after their stroke appear to be predictive of gait outcome. Also, the result of this study can provide reference for appropriate test times as an assessment of sitting and standing balance in stroke patients.

The purpose of this paper is to evaluate the fact that rehabilitation therapy helps stroke patients in the area of activities of daily living(ADL). The ADL evaluation tool used in this study is the modified Barthel Index. The subjects were 71 stroke patients who admitted rehabilitation department of Samsung Medical Center from January to September 1997. All subjects received rehabilitation therapy. The sbuject's ADL were evaluated on admission and again at the time of discharge. The results follows : 1. Using the modified Barthel Index, revealed on admission 38.26 points at discharge 68.73 points. 2. Severe disability(Barthe1 score 60 or less) were reduced from 84.5% on admission to 29.6% at discharge. Very severe disability(Barthe1 score 40 or less) were also reduced from 66.2% on admission to 12.7% at discharge. 3. The degree of change in each area of the modified Barthel Index were measured. There was an overall positive change during the admission period. The greatest change occurred in the category of dressing and transferring. The least change in donning & doffing a brace and wheelchair mobility. The modified Barthel Index used to assess the change in ADL function of stroke patients woulds seem to be very useful method. And there should be a focus on the recovery of ADL function in stroke patients receiving rehabilitation therapy.

The purpose of this study was to evaluate the cognitive perceptual performance in relation to activities of daily living in stroke patients who were treated at department of rehabilitation medicine of the Samsung Medical Center from December 5. 1996 to April 10, 1997. The cognitive perceptual performance was measured by the Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) and by the Modified Barthel Index (MBI) to evaluate activities of daily living(ADL). Sixty-seven stroke patients were the subjects in this study. Collected data analysis were completed by using t-test. ANOVA, correlation analysis, and multiple regression analysis. The following were as follow: 1. Among the subtest of the LOTCA, orientation to time, plain block design, reproduction of puzzle showed significant difference depending on patient's affected side. Orientation to time score was higher with left hemiplegic patients. Plain block design and reproduction puzzle score were higher with right hemiplegic patients. 2. Among the subtests of the MBI, dressing, ambulation, and self-care were significantly correlated with the subtests of the LOTCA in order of thinking operation, visuomotor organization, perception and orientation. 3. The result of the cognitive perceptual function affecting the MBI performance using multiple regression analysis, thinking operation was the most influential factor. The cognitive perceptual perfomance have significant correlation with activities of daily living skills. Also, it is an important factor to functional recovery after stroke. Therefore, accurate evaluation of cognitive perceptual performance after stroke with treatment of each patient's appropriate level should be done simultaneously with rehabilitation treatment to improve patient's activities of daily living skills.

This study was performed to determine the inter-rater reliability of the Chedoke-McMaster Stroke Assessment translated in Korean. This measures the physical impairments and disabilities that impact on the lives of individuals with stroke. The purposes of this measure were 1) to stage motor recovery to classify individuals in terms of clinical characteristics, 2) to predict rehabilitation outcomes, and 3) to measure clinically important change in physical function. Twenty-two subjects from physical therapy unit were assessed by two physical therapists. The ratings were compared by Spearman's rank correlation The correlation between two raters ranged from 0.85 to 0.98. Inter-rater reliability coefficient for total scores ranged from 0.95 to 0.97. This study confirms that the Chedoke-McMaster Stroke Assessment yields reliable results.

This study was designed to evaluate the sensory-perception and it's relation to activi- ties of daily living in stroke patients. The subjects were who had been treated at the Yonsei University Rehabilitation Hospital from march. 2, 1996 to oct. 10,1996. Sensory-Perception was measured by several test for evaluating wide range of per- ception and sensation(proprioceptipn). These test were MVPT, The Line Bisection Test, Bodyscheme & Body image Test, clinical test for proprioception and FIM(Functional Independence Measure) to evaluate activities of daily living. The results were as follows: 1. Visual perception and ADL( total& sub) scores were correlated significantly. 2. ADL(total& sub)scores were significantly different among groups which had been devided with sensory-perceptual function. 3. The factors significantly influencing total score and subscore of ADL were visual percept ion and sensory percept ion. From the results, it is necessary to emphasize the improvemet of sensory-perceeption besides visual perception in order to enhance ADL and functional level in stroke patients.

Physical therapists use assumptions about motor control in every aspect of their work in treating stroke patients. An understanding of the recovery process after stroke, some neural mechanism of recovery and therapeutic model is critical factor for physical therapist to evaluate and obtain a higher final stage of recovery. The purpose of this article was to review the recovery process after stroke, some neural mechanism of recovery, the role of rehabilitation in the process of recovery, therapeutic model and its limitation. This article will help understanding of recovery process. evaluation, and treatment of the stroke patients. Each therapeutic method consists of a different set of assumptions and they are not completely independent of one another. Therefore specializing in any techniques of physical therapy will not be enough to treat stroke, so we are in need of integrated approach and objective measurement instrument to adequately evaluate and treat stroke patients.

목적: 이 연구에서는 장애물 높이에 따른 만성 뇌졸중 환자의 장애물 보행 특성과 보상전략을 파악하였다. 방법: 이를 위해 두 가지 장애물 높이 조건(5cm와 15cm)에 따라 장애물 보행의 운동학적 특성을 정상인과 비교하였다. 구체적으로 장애물 보행 전 이륙 거리, 장애물 통과 시 장애물 통과 높이와 장애물 통과 후 착지 거리를 측정하 였다. 결과: 분석결과, 만성 뇌졸중 환자들은 정상인보다 보행 전 이륙 거리와 장애물 통과 후 착지 거리가 상대 적으로 짧은 것으로 나타났다. 또한, 뇌졸중 환자들은 정상인보다 장애물을 통과할 때 통과 높이가 높은 것으로 밝혀졌다. 이러한 보행 움직임 패턴은 두 가지 장애물 조건에서 모두 유사하게 나타났다. 결론: 이러한 결과는 뇌 졸중 환자들이 편측 마비로 인한 움직임 제약에 기인하는 것으로 판단된다. 또한, 신체적 장애로 인해 뇌졸중 환 자들은 장애물 보행 시 낙상을 예방하고, 안정적으로 장애물 보행을 위한 운동보상전략에서 정상인과 차이를 보 인 것으로 생각된다. 결론적으로 이 연구는 만성 뇌졸중 환자들의 운동보상 전략을 장애물 보행을 통해서 규명했 다는 점에서 현장에 유용한 시사점을 제공할 것으로 기대된다.

본 연구는 CT를 이용한 뇌혈관 추출 검사에서 이중에너지 기법을 활용하여 각 에너지 준위별 뇌혈관 조 영술의 유용성을 평가하였다. 방법은 CT 뇌혈관 조영술을 시행한 환자 15명의 DE 영상과 SE 영상을 대상으로 하였다. 영상의 분석은 MCA, 뇌실직 조직, Background에 ROI를 설정하여 평균값, 표준편차 및 SNR, CNR 값을 구하고, SE영상과 비슷하게 구현되는 에너지 영역을 알아보았다. Likert 5점 척도 육안평가를 병행한 결과 DE 40 keV와 SE 120 kVp에서 가장 선명한 MCA 영상을 확인 하였다(p>0.05). SE영상의 SNR 값은 DE영상의 40 keV에너지 준위값과 비슷하게 측정되었고, 40 keV와 50 keV의 저에너지 준위의 영상이 SNR이 높게 측정되어 고에너지 준위의 영상에 비해 대조도가 높아 뇌혈관질환을 유용하게 관찰할 수 있을 것으로 사료된다.

테니스 코트의 재질과 공의 회전에 따른 리바운드 차이를 알아보고자 하드 코트와 클레이 코트에서 각각 탑스핀, 백스핀, 그리고 플랫에 대해서 영상분석을 하였다. 다변량분석을 실시하였으며, 차이가 있는 경우 Scheffe test를 이용해 사후검정을 하였다. 연구결과, 하드 코트와 클레이 코트에서 모두 리바운드 전후의 속도와 리바운드 후 최고점의 위치에서 차이가 있는 것으로 나타났다. 이는 두 코트의 비교에서도 차이가 나타났다. 따라서 하드 코트와 클레이 코트에서 모두 탑스핀의 공에 대해서는 다소 뒤에서 빠르게 리바운드 되는 공에 대해서 준비를 하고, 백스핀의 경우에는 보다 앞에서 다소 느리게 리바운드 되는 공에 대한 준비를 하는 것이 바람직할 것으로 판단된다. 한편 백스핀과 플랫의 경우에는 클레이 코트에서는 하드 코트에 비해서 다소 느리게 올 것에 대비해 준비하는 것이 바람직할 것으로 판단된다. 정점에서 공을 치기 위해서는 하드 코트에서는 클레이 코트에 비해서 탑스핀에 대해서는 보다 앞에서 높은 지점에 타점을 두고, 백스핀의 경우에는 보다 뒤에서 낮은 위치, 그리고 플랫의 경우에는 보다 뒤에서 높은 위치를 예상하고 준비하는 것이 바람직할 것으로 생각된다.

목적: 탁구 백핸드 스트로크 과제를 적용하여 암묵적 학습의 하나인 유사학습과 명시적 학습의 결과를 비교 분석하고자 한다. 이를 통해 학교 체육 시간과 스포츠 지도 현장에서 학습자가 운동기술을 수월하게 습득하고 오래지속시킬 수 있는 효과적이고 효율적인 학습방법을 찾아 적용하고자 한다. 첫째 유사학습 집단은 습득단계에서 명시적 학습 집단과 통제집단과 차이가 있는가? 둘째 유사학습 집단은 파지단계에서 명시적 학습 집단과 통제집단과 차이가 있는가? 방법: 2016년 B시의 G중학교 스포츠 클럽 탁구반을 지원한 1학년 30명이며 연구과제는 탁구 머신기에서 나오는 공을 탁구 백핸드 스트로크로 표적을 향해 리턴하는 것이다. 동질성 검증을 위해 일원변량분석을 실시하였고 집단과 분단에 따른 학습효과 차이를 보기 위해 반복측정 분산분석을 실시하였다. 결과: 첫째, 습득단계 절대오차에서 집단 간 차이가 있었으나 가변오차, 반경오차, 방향오차에서는 집단 간 차이가 없었다. 절대오차, 가변오차, 반경오차, 방향오차는 각 집단 분단에 따른 주효과와 집단과 분단 간 상호작용 효과는 없었다. 둘째, 파지단계 절대오차, 가변오차, 반경오차, 방향오차에서 집단 간 차이가 있었고 가변오차에서 분단에 따른 주효과가 있었으나 절대오차, 반경오차, 방향오차에서는 분단에 따른 주효과가 없었다. 가변오차, 반경오차, 방향오차에서 집단과 분단 간 상호작용 효과는 없었다. 결론: 이러한 연구 결과에 비추어 볼 때 탁구 백핸드 스트로크에 암묵적 학습의 하나인 유사학습이 효과가 있다는 점을 알 수 있다. 학교 체육시간이나 스포츠 현장에서 학습자가 운동기술을 학습할 때 효율적이고 효과적인 유사학습이 기존의 명시적 학습 방법의 대안으로 유용하게 활용될 수 있을 것이다.

The incidence of ischemic stroke increases with age due to improvements in health care and living conditions. With increasing proportion of old age, the proportion of old age is rapid expansion in acute ischemic stroke patients. Young and old age groups in acute ischemic stroke patients have different risk factors and clinical features. But, many patients of old age are excluded from active treatment like thrombolysis due to hemorrhagic transformation, poorer clinical outcome etc. So we studied clinical features, risk factor, outcome in ≧80 years old patients compared with <80 years. We enrolled 1,445 patients, who diagnosed acute ischemic stroke in Chosun university hospital, from January 2013 to December 2015. Patients were divided into two groups: ≧80 years versus <80 years. We compared with two groups about risk factors, stroke subtypes, thrombolysis, complications in hospital, initial National Institutes of Health Stroke Scale (NIHSS) score, prognosis. Of the total 172 patients, 54(31.4%) patients were 80 years or older. Symptomatic hemorrhage and asymptomatic hemorrhage was not different between both groups [over 79 years patients: 4/54 (7.4%) vs. under 80 years patients: 10/118 (8.5%), p>0.302], [16.7% vs. 17.7%, p>0.701]. There were no difference in mortality and favorable prognosis at 3 months later between both groups [over 79 years patients: 5/54 (9.3%) vs. under 80 years patients: 5/118 (4.2%), p=0.290], [over 79 years patients: 13/ 21 (24.1%) vs. under 80 years patients: 56/86 (47.5%), p=0.803]. There was difference in early neurological improvement rate(improvement > NIHSS 3) and degree of improvement (NIHSS at discharge - NIHSS at admission) were significant[over 79 years patients: 24/54 (44.4%) vs. under 80 years patients: 77/118 (65.8%), p=0.012], [2.69 vs 5.55, p=0.017]. Intracranial hemorrhage(symptomatic and asymptomatic) and favorable prognosis are not different significantly between two groups. Elderly patients is not a absolute contraindication for intravenous thrombolysis. For intravenous thrombolysis in elderly ischemic stroke patients, we need more study to exclude the poor prognostic factors and to consider of gain of patients.

Horticultural therapy (HT) is the engagement of a person in gardening related indoor activities by a trained professional to achieve specific treatment goals. It was effective as an alternative medicine and played an important role in rehabilitation of stroke patients, especially in psychological aspects. While the psychological benefit has been clearly demonstrated, the evidence of the physical benefit is insufficient. We report three stroke patients treated with HT and they were evaluated from the standpoint of physical, psychological, and cognitive outcomes. HT program consisted of 10 sessions during 2 weeks with 1 hour per session. The assessment of outcomes and positron emission tomography/computed tomography (PET/CT) were performed before and after treatment. Two patients showed improvements in physical and psychological aspects. But the other patient showed no outstanding outcome. These results suggest the possibility of HT as a complement to conventional occupational therapy.

In acute stroke therapy, the effect of intravenous recombinant tissue plasminogen activator was proved in a large clinical trial 20 years ago. At that time, the required brain image was only a non-contrast computed tomography (CT) for discrimination of the presence of hemorrhagic stroke. Nowadays, CT images can be applied for prediction of outcome after treatment as well as selection of a good candidate before treatment. This review introduces the presence and the future of brain CT images in acute stroke treatment.

For patients suffering from acute ischemic stroke from cerebral artery occlusion, reperfusion is necessary to save the ischemic penumbra. Therefore, early and complete recanalization of an occluded artery is the main therapeutic goal of acute ischemic stroke. Among the many advances in management of acute ischemic stroke, thrombolysis with intravenous (IV) tissue plasminogen activator (t-PA) within 4.5 hours after symptom onset has been the only approved pharmacological therapy. However, IV t-PA has many limitations in clinical practice, low eligible patients and low recanalization rates, particularly in cases of larger proximal artery occlusions. In addition, there are many complications, including symptomatic intracranial hemorrhage (approximately 6%). In contrast, higher recanalization rates and an extended therapeutic time window have been reported for intra-arterial (IA) thrombolysis. According to studies until 2013, no studies proving the advantages of IA thrombolysis have been reported. However it was reported that studies in 2015 showed its possibility. Therefore, the purpose of this article is to cast a light on failures of previous studies, and try to assess the differences with studies in 2015. In addition, crucial points for successful IA thrombolysis will be discussed.

Purpose: Functional recovery of the paretic upper extremity post stroke continues to be one the greatest challenges faced by rehabilitation professionals. Although many tasks require the coordinated participation of both hands, rehabilitation strategies for the most part have focused on the paretic limb. This study investigated whether coupled bilateral coordinated movements and repetitive high frequency TMS enhanced upper limb corticomotor excitability and motor function poststroke. Methods: For this study, we compared the neurophysiological and behavioral changes associated with two such rehabilitation protocols: coupled bilateral training and coupled unilateral training. Twenty chronic stroke patients were randomly assigned to the two training group over 8-week period. For this experiment, transcranial magnetic stumulation, EMG, Ag/AgCI suface electrode, rehabilitation training equipment, jebsen-talyer hand function kit, box & block, and pinch & power grip test kit were used. Results: First, in the box & block and JTT task, coupled bimanual group showed a reduction in movement time in comparision to receiving coupled unilateral group. Second, in the cortical excitability within affected hemisphere, using TMS, an increased in map volume, and map number following coupled bilateral group. Overall, these finding suggest that a coupled bilateral movement and high frequency repetitive TMS protocol effective in recovering upper limb motor function and cortical excitability in chronic stroke patients.

본 연구는 만성 뇌졸중 환자 30명을 대상으로 무작위로 실험군 17명과 대조군 13명으로 나누워서 주 5회 30분씩 12주 동안 실시 하였다. 실험군은 주 4회는 일반적인 작업치료(상지기능증진치료 및 일상생활훈련)를 실시하고, 주 1회 치료정원을 이용한 원예치료 를 실시하였다. 반면에 대조군은 주 5회 일반적인 작업치료만 실시 하여, 치료정원을 이용한 원예작업치료가 삶의 질에 미치는 영향을 알아보고자 하였다. 실험결과 실험군과 대조군 모두 통계적으로 유 의하게 삶의 질 향상이 나타났지만, 실험군이 대조군보다 통계적으 로 높게 나타났다. 본 연구에서의 치료정원을 활용한 원예작업치료 프로그램은 환자가 활동을 이해하고 적절한 수준의 활동을 제시받 기 위해 작업분석 후 동기부여, 적응, 수행기술, 사회적응기술이란 4단계로 등급화(garding)하여 각 단계에 적합한 프로그램으로 구 성하였다. 치료정원에서의 원예활동프로그램을 통해 병원생활에 서 자기만족감이 향상되고, 우울감이 감소되어 삶의 질 향상으로 이어졌다고 사료된다. 이러한 결과를 통해서 만성 뇌졸중 환자에게 치료정원을 이용한 원예작업치료가 삶의 질에 미치는 영향을 주는 것으로 생각하지만, 원예작업치료 프로그램이 구체적으로 뇌졸중 환자의 삶의 질에 어떤 영향 미치고, 구체적 개선부분을 찾기엔 제 한이 있으므로 앞으로 지속적인 연구가 필요하다고 사료된다. 만성 뇌졸중 환자의 치료기간이 늘어나고 지역사회 중심의 재활치료공 간이 확대됨에 따라 장기치료계획의 수립이 필요하며 만성뇌졸중 환자가 지역사회에 생활 할 수 있는 활동 프로그램이 필요한 시기 라고 생각한다. 앞으로도 원예를 활용한 다양한 프로그램이 만성뇌 졸중 재활과정 및 삶의 질에 영향을 미칠 수 있는 연구가 필요하다 고 사료된다.