본 연구에서는 교통사고나 뇌졸중 등에 의해 상지의 장애를 가지는 장애인을 대상으로 하여, 인터넷의 브라우저와 같은 소프트웨어를 사용 할 수 있는 컴퓨터 인터페이스로서 자이로센서를 이용한 무선 자이로 마우스시스템를 개발하고, 임상평가를 통해 그 유용성을 확인하고자 한다. 시스템 개발에 있어서 주안점은, 첫째, 장애인의 경우 휠체어나 침대에 누워서 마우스 조작을 할 수 있도록 시스템의 무선화하는 것, 둘째, 착탈의 용이성과 미관을 위하여 센서를 헤드 밴드에 삽입하는 것, 셋째, 컴퓨터 운영체제에게 클릭신호를 전달하기 위하여, C5~C6 환자들의 경우에는 클릭 스위치를 사용하고, C4환자의 경우에는 고개의 끄덕임을 검출하도록 하는 것이다. 개발된 시스템을 척수손상으로 인한 상지 장애인을 대상으로 평가실험을 실시하였다. 그 결과 시행횟수가 증가할수록 상하/좌우 이동시의 목표위치에 대한 실제위치의 오차가 감소하고, 1분당 클릭률이 증가하는 경향을 확인하였다. 이로부터, 개발된 무선 자이로마우스 시스템은 환자의 반복사용을 통해 그 유용성이 증가할 것을 알 수 있다.

목적 : 본 연구를 통하여 뇌손상으로 인한 편마비 아동들에게 10주 동안 적용된 수정된 강제유도 운동치료가 환측 상지의 운동․감각능력 및 일상생활에서의 환측 상지 사용 빈도에 미치는 효과를 알아보고자 하였다. 연구방법 : 본 연구는 개별사례 실험 연구 방법 중 반전연구(reversal design or ABA design)로 설계되었으며, 서울장애인종합복지관에서 뇌병변으로 인한 편마비 진단을 받고 재활치료 중인 4명의 아동을 대상으로 17주간 실시되었다. 총 17주의 연구기간은 3주간의 기초선 1기간, 10주간의 치료 적용기간, 4주간의 기초선 2기간(치료후 관찰기간)으로 이루어져 있다. 치료 기간 동안 대상 아동들에게 주 5회, 하루 5시간동안 강제유도 운동치료를 적용하였다. 치료 전․후의 환측 상지의 기능을 평가하기 위해 두점 인식능력과 모노필라멘트를 사용한 촉각 검사, 멜버른 검사를 실시하였고, Motor Activity Log(MAL) 중 아동에게 적용 가능한 20항목을 발췌한 부모작성일지를 사용하여 환측 상지 사용빈도를 측정하였다. 결과 분석을 위하여 대상자별로 측정된 상지의 운동 및 감각기능과 일상생활에서 환측 상지 사용 빈도의 평균값을 기술 통계적으로 제시하고 시각적 그래프를 통하여 기초선, 치료기간과 치료 후의 차이를 비교하였다. 결과 : 수정된 강제유도 운동치료 후 편마비 아동의 상지 운동 및 감각기능과 일상생활에서의 환측 상지 사용 빈도가 치료 전에 비해 향상되었고, 이러한 치료 효과는 치료종료 후 1개월까지 유지되었다. 결론 : 본 연구 결과는 장시간의 건측 상지 운동 제한에 따른 거부감으로 인해 아동에게 적용하기 어려웠던 기존 강제유도 운동치료의 문제점을 개선한 수정된 강제유도 운동치료는 적용시간을 각 아동의 특성에 맞게 조절하여 활용한다면 임상 재활치료에서 편마비 아동의 기능회복에 효과적으로 적용될 수 있을 것으로 기대된다.

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.

The purpose of this study was to analyze the presence of ipsilesional movement deficit, with segmental performance in each proximal or distal upper extremity. The visuoperceptual complex task of the ipsilesional upper extremity was investigated in patients with unilateral brain damage and a control group of healthy sex-age-matched controls. Tracking movements were tested in the proximal and distal upper extremities. Movements were measured by the accuracy index, which was normalized to each subject's own range of motion and took into account any differences between subjects in the excursion of the tracking target. The findings revealed that stroke patients experienced difficulties with tracking movement of both proximal and distal segments in the upper extremities on the so-called "non-affected side", irrespectively of the extent of patient's age, time since onset, or severity of contralateral upper extremity. Therefore, the unilateral brain damage affected ipsilateral motor function of the proximal and distal upper limbs in the performance of complex motor tasks, requiring central processing and the higher order cognitive function in the integrity of both hemispheres.

This study was designed to determine the effects of different widths in the base of support (BOS) on trunk and lower extremity muscle activation during upper extremity exercise. Twenty-seven healthy male subjects volunteered for this study. Exercises were performed for a total of 10 trials with a load of 10 repetitions maximum (10 RM) for each of the various widths of BOS (10 cm, 32 cm, 45 cm). The width of a BOS is the distance between each medial malleoli when a subject was in a comfortable standing position. Electromyography was used to determine muscle activation. Surface bipolar electrodes were applied over the tibialis anterior, medial gastrocnemius, biceps femoris, rectus femoris, gluteus maximus, upper rectus abdominis, and elector spinae muscle. Electromyographic (EMG) root mean square (RMS) signal intensity was normalized to 5 seconds of EMG obtained with a maximal voluntary isometric contraction (MVIC). The data were analyzed by atwo-factor analysis of variance (ANOVA) with repeated-measures () and Bonferroni post hoc test. The results were as follows: (1) There were significant differences in the width of the BOS (p=.006). (2) The post hoc test showed significant differences with the BOS between 10 cm and 32 cm, between 10 cm and 45 cm and between 32 cm and 35 cm (p=.008, p=.003, p=.011). (3) There was no interaction with the BOS and muscle. (p=.438) There were no significant differences in the muscle activation (p=.215).

The purpose of this study was to research the effects of vocalization on upper extremity motion during occupational performance and to compare non-meaning and meaning vocalization. Experiments were performed on 30 subjects. They had no medical history of neurological problems with their upper extremities. Using a tea cup, a tea tray, and a tea spoon, they set a table during vocalization. We used meaning and non-meaning vocalization with the subjects. An example of meaning vocalization would be naming something, and an example of non-vocalization would be saying, "Ah." We used a 3-D analysis system called CMS-HS. We analyzed the motion in the angular velocity and acceleration of the elbow while recording performance time. The results of this study showed that vocalization enhanced the angular velocity and acceleration of the elbow, and also enhanced performance time. In short, vocalization improved upper extremity motion by making it faster and smoother. There were no significant differences between meaning and non-meaning vocalization.

본 연구는 상지운동 동안에 복부에 적용된 압력이 요부와 복부의 근피로도에 미치는 영향을 알아보았다. 연구대상자는 성인 남자 5명이었다. 연구대상자가 10 repetitions maximun (RM) 무게의 아령을 이용하여 1분 동안 상지운동을 수행 시 0 mmHg, 저압(30 mmHg), 중압(70 mmHg), 고압(100 mmHg)의 외부 압력이 복부에 적용되었고, 복직근, 외복사근, 내복사근, 척추기립근에서 근전도 자료가 수집되었다. 주파수 분석을

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 investigate the changes of the activities of daily living (ADL) by the motor learning program for upper extremity in stroke patients. The subjects were sixty-two members who were treated at the department of occupational therapy. The ADL were measured with Functional Independence Measure (FIM). The result's were as fol1ows; 1. The ability to perform daily activities after treatment was significantly increased independent of age, gender, cause, affected side and speech disability (p<.01). The differences between the pre-treatment and the post-treatment was no significant correlation to sex, cause, affected side and duration of treatment, but the speech disability was significant. Therefore the pre-treatment scores and post-treatment scores were significantly different. 2. The variation of the pre-treatment and the post-treatment in the detail item to the performance of daily life of the stroke patients through the upper extremity motor learning program was significantly increased in self-care, sphincter control, locomotion, mobility, communication and social cognition (p<.01) Consequently, The motor learning program for upper extremity significantly improved the performance level of all ADL areas in stroke patients.

Thirty normal adults were tested to measure the electrical activity of the anterior (AD), middle (MD), and posterior portion (PD) of the deltoid muscle and sternal portion of the pectoralis major muscle (PM) during the performance of four upper extremity PNF diagonal patterns with elbow flexion angle in , , and . The PNF patterns in which these muscles function optimally have been theoretically advanced by Kabat and further described by Knott and Voss. They theorize that the MD should be most active with shoulder flexion, abduction, and external rotation (D2F); the PD with shoulder extension, abduction, and internal rotation (D1E); the AD with shoulder flexion, adduction, and external rotation (D1F); and the PM with shoulder extension, adduction and internal rotation (D2E). The patterns were performed through range of motion, with an isometric contraction performed in the shortened range. When the EMG activity of AD, MD, PD and PM in its optimal patterns was measured, it does not have significant difference among fixed elbow flexion angle , , and (p>.05). In addition, suggestions were made for study of patients who exhibit imbalance of muscle strength and have muscle weakness.

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.

The purpose of this case study was to introduce a myoelectric hand prosthesis for upper extremity amputee and prosthetic training program. Limb loss can result from disease, injury, or congenital causes. Trauma has been increasingly important role as the cause of amputaion in young, vigorous, and otherwise healthy individuals. The higher the level of amputation the greater the functional loss of the part, and the more the amputee must depend on the prostheis for fuction and cosmesis. Myoelectrical control of prostheses is a recent development and has been steadily gaining in clinical use over the past 20 years. Such a prosthesis uses signals from muscle contraction within the stump to activate a battery driven moter that operates specific component fuctions of the prosthesis. This twenty years old male case was operated a right above-elbow amputation due to tracffic accident and admitted to Yonsei Rehabilitaion hospital for the preprosthetic and prosthetic training. The case was able to successfully complete his myoelectric hand prosthesis training in the February of 1995.