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.

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.

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.

목적 : 본 연구는 첫째, 건측상지 제한치료(Constraint-Induced Movement Therapy; CIMT)가 상지기능 향상에 미치는 효과를 검증하고자 한다. 둘째, 건측상지 제한치료 효과의 지속을 위해 가정프로그램을 실행하여 효과의 지속성을 검증하고자 한다. 셋째, 상지기능의 향상이 작업수행에 미치는 영향을 알아보고자 한다. 마지막으로 이상의 치료가 뇌졸중환자의 삶의 질(Quality of Life)에 어떠한 영향을 미치는지 분석하고자 한다. 연구방법 : 치료 과정은 3시기로 구분할 수 있다. 첫째는 병원에서 건측상지 제한치료 시기이다. 둘째는 스스로 건측상지 제한치료 시기이다. 셋째는 가정프로그램으로 건측상지 제한치료 시기이다. 자료 수집은 젭슨 상지기능 검사(Jebsen Hand Function Test)와 뇌졸중환자 삶의 질 평가도구(SS-QOL), 캐나다 작업수행모델(COPM)을 이용하여 기초선을 측정하고 각 시기별 검사를 수행하였다. 결과 : 치료결과 환측 상지의 기능적인 향상을 보였으며 작업수행(occupational performance)의 수행도 및 만족도에 긍정적인 영향을 미치는 것으로 조사되었다. 또한 가정프로그램은 환측 상지기능을 지속적으로 향상시켰으며 건측상지 제한치료의 효과를 지속시켜 주었다. 마지막으로 뇌졸중 환자의 삶의 질에 이상의 치료들이 효과적이었다. 결론 : 본 연구 결과를 통해 건측 상지 제한치료가 환측 상지의 기능적인 향상에 도움을 주었으며, 삶의 질과 작업수행의 만족도에 좋은 결과를 주었다. 향후 연구에서는 가정 프로그램 진행시 가족의 적극적인 참여가 중요하게 포함되어야 할 것이다. 또한 CIMT 및 삶의 질을 연구할 때 심리적인 요인을 중요하게 고려해야 하며, 뇌졸중 환자의 삶의 질을 측정하는 도구인 SS-QOL 척도에 대한 국내 상황에 맞는 타당도 연구가 필요하다.

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).

본 연구에서는 상지의 10개 근육에 대한 근전도 측정을 통하여 얻어진 RMS와 MPF의 변화량을 이용하여 작업-휴식 주기에 따른 피로도 특성을 분석하였다. 평균 RMS의 변화량 분석에서는 실험조건에 관계없이 전체적으로 작업 시작시점과 종결시점의 비교에서 평균 RMS값이 증가하는 경향을 보였으며, 힘 발휘 형태 중 push, pull 및 down의 경우 각각의 주동근들은 %MVC에 대해, 그리고 up의 경우 %MVC, 어깨 굴곡 그리고 팔꿈치 굴곡에 대하여 유의적인 차이를 보였다. 작업-휴식 주기에 따른 RMS변화량의 분석에서는 의무사이클이 50% 이상이 될 때 평균 RMS의 변화량이 상당히 증가함을 보여줌으로써 작업과 휴식시간의 관계가 작업에 따른 피로를 증대시키는 것으로 나타났으며, 특히 %MVC가 커질수록 이러한 의무사이클의 영향은 더욱 커지는 것으로 나타났다. MPF분석에서는 push의 척측수근굴과 up의 상완이두근이 %MVC에 대하여 유의적으로 감소하는 경향을 나타내었으며, push와 down은 10%MVC에서는 대체로 MPF값이 높은 주파수대로 전이하는 경향을 보였으며, up의 경우에는 %MVC에 관계없이 낮은 주파수대로 전이하는 경향을 보였다. 특히 up과 down에 대한 의무사이클의 분석에서는 30%MVC 이하의 작업에서는 의무사이클이 33%일 때도 감소하는 경향을 보였다.

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.

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

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.

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.

Physiological Cost Index (PCI) of walking has been widely used to predict oxygen consumption in healthy subjects or patients. The purposes of this study were to evaluate the predictability of physiological cost index of upper extremity exercise with a sander for the amount of exercise and cardiac function and to find out most efficient speed of exercise. Upper extremity exercise was conducted in 67 healthy children (age 4 -12) for 2 minutes with a sander in two different speeds, such as self selected comfortable and self selected fast speeds. Speed of sander was calculated, and heart rate were measured before and immediately after the exercise. Physiological Cost Index (PCI) of upper extremity exercise was calculated for statistical analysis. The result were as follows; 1.　Comfortable and fast speeds of the sander went up according to the increase of age, sander PCI during exercise by it, decreased as the age increased with significant difference in each group (p=0.00). The heart rate change during exercising by it, there was no significant difference. 2.　The heart rate change during the exercise by sander increased as the speed of sander increased. Linear regression equation between the heart rate change during the exercise by sander and the speed of sander were 'Y (the heart rate change by sander) = 0.332X (the speed of sander) + 12.731' (R²= 0.154). Stepwise regression showed the speed of sander affected the change of heart rate positively, and the age affected negatively (R²= 0.242, p = 0.00). 3.　The PCI during the exercise by sander decreased as the speed of sander increased. Linear regression equation between the PCI during the exercise by the sander and the speed of sander were 'Y (the PCI by sander) = -0.00495X (the speed of sander) + 2.091'(R²= 0.267), and statistic significant was recognized (p = 0.00). 4.　The speed of exercise by sander it increased as the age increased. Linear regression equation between the speed of the sander and the age were 'Y (the speed of sander) = 2.481X (the age) -0.893(R²= 0.452), and statistic significant was recognized(p = 0.00). 5.　The reliability analysis for the method of examining each PCI, showed high reliability coefficients and the value of alpha was 0.9337. In conclusion, PCI of the upper extremity exercise with a sander could be thought to predict the energy consumption from the speed of sander as there was a linear relationship between the speed of sander exercise and heart rate change with exercise. PCI of the upper extremity exercise with the self selected fast speed was most efficient. Further study with oxygen consumption analysis is recommended to apply PCI in upper extremities in patients with different pathologies in motion.

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.

본 연구의 목적은 장애물 높이에 따른 상지 팔운동 제한이 스텝안정화(stabilization step)에 영향을 주는지 알아보기 위하여 실시하였다. 연구대상자는 대학생 남자 14명, 여자 16명으로 총 30명이였으며, 평균 연령은 21.5세이었다. 스텝 안정화는 FASTEX(functional activity System for testing and exercise, Cybex Division of Lumex, Inc., USA)를 이용하여 측정하였다.

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.