Background:Active trigger points (TrPs) of the suboccipital muscles greatly contribute to the occurrence of chronic tension-type headache, with increased sensitivity of TrPs and facilitated referred pain.Objects:This study aimed to investigate whether the integration of high-frequency diathermy into suboccipital release is more beneficial than the use of suboccipital release alone.Methods:Thirty subjects were assigned to either experimental group-1 (EG-1) to undergo suboccipital release combined with high-frequency diathermy (frequency: 0.3 MHz, and electrode type: resistive electronic transfer), or EG-2 to undergo suboccipital release alone, or the control group (CG) with no intervention, with 10 subjects in each group. The assessment tools included the headache impact test 6 (HIT-6), perceived level of tenderness, neck disability index, and neck mobility. Intervention was performed for 10 minutes, twice per week, for 4 weeks, and measurements were performed before and after the interventions.Results:The between-group comparison of the post-test values and changes between pretest and post-test showed significant differences for all parameters at p<.05, except for the left-to-right lateral bending range. In the post hoc test, EG-1 showed significant differences for the parameters in comparison with the CG, while no significant differences in the perceived tenderness level, on both temporal regions, were found between EG-2 and CG. Furthermore, the HIT-6 score and perceived tenderness level, in the right temporal region, showed significant differences between EG-1 and EG-2. In the within-group comparison, EG-1 and EG-2 appeared to be significantly different between pretest and post-test (p<.05), except for the perceived tenderness level in the right temporal region, with significance for the EG-1 group only (p<.05).Conclusion:These findings suggest that the suboccipital release technique may be advantageous to improve headache, tenderness, and neck function and mobility, with more favorable effects with the incorporation of high-frequency diathermy.

목적 : 본 연구는 만성 뇌졸중 환자를 대상으로 자세 조절이 일상생활동작 수행능력과 근 긴장도 변화 및 상지기 능 수행에 어떠한 영향을 미치는지 알아보고자 하였다． 연구방법 : 본 연구를 위하여 국립재활원에 입원한 41명의 뇌졸중 환자를 대상으로 모든 환자들은 자세조절 평가 척도(Postural Assessment Scale stroke, PASS), 일상생활동작 수행능력 측정 도구(Modified Barthel Index, MBI), 긴장도 사정 척도(Tone Assessment scale, TAS), Fugl-Meyer 평가 척도(Fugl-Meyer Assessment scale－upper extremity) 등을 이용하였고 자료 분석은 피어슨 상관분석(pearson correlation coefficient), 단계적 다중 회귀분석(stepwise multiple regression）을 실시하였으며 내적 일치도를 알아보기 위하여 Cronbach's alpha Coefficient를 구하였다． 결과 : PASS항목에서 가장 기능이 좋은 것은 지지하여 서기로 나타났으며，가장 기능이 낮은 것은 환측으로 서기였고，MBI항목에서 가장 기능이 좋은 것은 의자／침상 이동이며， 가장 기능이 낮은 것은 목욕하기로 나타났다．PASS의 모든 항목은 MBI, FM-UE, TAS와 유의한 상관관계(r=-33~91, p<.05~01）가 있으며，FM-U/E와 MBI(r=.35, p<.05), TAS- 안정(r=.-40, p,<．0.1), 연합항목(r=-.39,p<.05)에서 유의한 상관관계가 있는 것으로 나타났다．내적 일치도는 Cronbach's a=.86로 높게 나타났으며，PASS의 합과 자세유지 항목 (r=.90 p<.01)의 합，자세변화 항목(r=.93,p<.01)의 합은 유의한 상관관계가 있었으며，자세유지 항목의 합과 자세변화 항목의 합 간에는 유의한 상관관계(r=.69,p<.01)가 있었다．PASS 항목 중 누운자세에서 건측으로 돌기와 바닥에서 볼펜집어 올리기가 각각 ADL과 상지 기능을 예견하는데 가장 중요한 변수(R2=.95, R2=.56)임을 알 수 있었다． 결론 : PASS는 일상생활동작 수행 능력과 근 긴장도 및 상지기능수행 간에 유의한 상관관계가 있는 것으로 나타나 뇌졸중 환자의 기능적 독립성을 예측할 수 있는 지표가 될 수 있을 것이다．

The purpose of this study was to investigate the effect of proprioceptive neuromuscular facilitation (PNF) approach on the spasticity of affected side in patients with hemiplegia. Three subjects with hemiplegia participated in this study. In single-subject research design (a multiple baseline across individuals) was employed in this study. The intervention program including PNF to the unaffected side was introduced for 30 minutes each day during each intervention phase. Muscle tone of affected side was measured with Tone Assessment Scale, and active hip abduction distance of affected side was taken with the subject supine. And then the muscle tone and the hip abduction distance were measured again 30 minutes later following the intervention. The results showed that the PNF application had some beneficial effects on both muscle tone and active hip abduction. This result suggest that PNF application to non-paretic limb can be effective in reducing muscle tone and improving hip abduction range on paretic limb in persons with hemiplegia. However, further research is needed to prove the effect of PNF application on functional improvement.