목적: 본 연구의 목적은 뇌손상 환자의 자기인식 정도를 측정하기 위해 Prigatano 등(1986)이 개발한 Patient Competency Rating Scale (PCRS)를 한국어로 번안한 Korean version of the Patient Competency Rating Scale (K-PCRS)의 타당도 및 신뢰도를 연구하기 위함이다. 연구방법: PCRS 원 문항에 대해 번역 및 역번역 과정, 사전 이해도 검증, 문항 적합성 검증을 거쳐 K-PCRS의 예비문항을 구성하였고, 실험군 뇌손상 환자 62명, 보호자 60명, 치료사 62명을 대상으로 수집한 자료에 대해 신뢰도를 분석하였다. 또한 구성타당도 검증을 위해 탐색적, 확인적 요인분석 및 K-PCRS와 우울증과의 상관성을 확인하였으며, 대조군 참여자 60명과 참여자 가족 60명을 비교하여 K-PCRS의 변별타당도를 확인하였다. 결과: 탐색적 요인분석 결과, 5개 요인이 추출되었으나 마지막 요인에서 0.40이상의 요인 부하량이 확인되지 않아, 원척도에서 제시한 4요인을 고정하여 분석하였고 확인적 요인분석 결과 적정수준의 적합도를 보여 K-PCRS의 4요인 모형이 지지되었다. 또한 K-PCRS와 K-BDI의 상관성 분석결과 K-PCRS의 환자-보호자의 불일치 점수와 K-BDI와의 상관계수는 0.2, 환자-치료사의 불일치 점수와 Korean-Beck Depression Inventory (K-BDI)와의 상관계수는 0.4로 모두 음의 상관성을 보였다. 대조군과의 비교를 통한 변별타당도 분석결과 실험군과 대조군의 K-PCRS 총점은 유의한 차이가 있었으며(p < 0.05) 실험군의 환자-보호자 불일치 평균과 대조군의 참가자-가족의 불일치 평균에서도 유의한 차이가 있었다(p < 0.05). 신뢰도 분석 결과 환자용, 보호자용, 임상가용 K-PCRS의 Cronbach α계수는 환자용 0.947이었고, 보호자용 0.946, 임상가용 0.958로 높은 상관계수를 보였다. 결론: 본 연구에서 K-PCRS의 타당도 및 신뢰도를 확인하였으며, 향후 뇌손상 환자의 자기인식 정도를 객관적으로 평가하기 위해 K-PCRS가 활용될 수 있기를 기대한다.

목적 : 본 연구의 목적은 후천성 뇌손상 환자의 집행기능 장애에 대한 메타인지중재 효과를 연구한 무작위 임상대조군연구를 대상으로 체계적 문헌연구를 실시하여 중재 내용을 추출하고 결과를 분석하여 최신의 근거를 알아보기 위함이다. 연구방법 : 본 연구는 검색 엔진으로 PubMed, Excerpta Medica Database(EMBASE), Cumulated Index in Nursing and Allied Health Literature(CINAHL), 한국학술지인용색인(Korea Citation Index; KCI), 한국학술정보(Korean Studies Information Service System; KISS), 한국교육학술정보원(Research Information Sharing Service; RISS)를 사용하여 2015년 1월부터 2022년 11월까지 출판된 국내ㆍ외 문헌 을 검색하였다. PRISMA checklist에 따라 문헌을 선택하여 최종적으로 7편의 문헌을 분석하였고, PICOS 방식을 사용하여 결과를 제시하였다. 최종 선정된 문헌은 PEDro scale을 사용하여 연구의 질적 수준을 평가하 였다. 결과 : 검색된 611편의 문헌 중 7편(n = 347)이 최종적으로 선정되었고, 연구의 질적 수준은 7편 모두 ‘좋음’ 이었다. 집행기능과 일상생활활동 및 참여 평가에서 중재 이후 그룹간 유의미한 차이가 있었던 중재는 Cognitive Orientation to daily Occupational Performance, Error-Based Learning이었다. 결론 : 본 연구는 후천적 뇌손상 환자를 대상으로 한 메타인지중재 연구들 중, 잘 설계된 무작위임상대조 군연구를 선정하고 분석하여 중재에 대한 체계적 문헌연구의 근거수준을 높였다는 점에서 임상적인 의 미가 있다. 그러므로 후천성 뇌손상 환자의 집행기능 장애를 다루기 위한 메타인지중재를 제공하는 과정 에서 기초자료로 활용될 수 있을 것이다.

목적 : 운전능력에 필요한 인지능력을 평가하기 위해 다양한 신경심리학적 인지평가도구를 사용한 연구와는 달리 운전상황인식에 초점을 맞추어 개발한 컴퓨터 기반 운전상황인식 과제의 타당성을 입증하고자 한다. 연구방법 : 인지평가도구와 운전상황인식 간에 상관관계와 운전상황인식 과제에 대한 인지요소의 설명력을 조사하여 공인타당도를 분석하였다. 운전상황인식 정도를 알아보기 위하여 실험에 사용한 도구는 컴퓨터 기반 운전상황인식 과제이다. 신경학적 인지능력을 평가하기 위해서는 한국형 간이정신상태검사(Mini- Mental State Examination for Korean; MMSE-K)와 웩슬러 성인 지능검사(Korean Wechsler Aadult Intelligence Scale-Ⅳ; K-WAIS-Ⅳ)중 작업기억 검사 항목과 기호쓰기(coding subtest)를 실시하였다. 시각주의 검사로 별지우기 검사도구를 적용하였고, 기호잇기검사(Trail Making Test A, B; TMT A, B) 를 실시하였다. 뇌졸중과 외상성 뇌손상 환자 73명이 실험에 참여하였다. 운전상황인식 전문가, 교통사고 처리 전문가, 작업치료사에게 컴퓨터 기반 운전상황인식 과제를 시연하고 내용타당도를 검증받았고 작업치 료사에게 운전사황인식 과제의 적합성을 검증받았다. 결과 : 인지 평가도구와 운전상황인식 과제 간에 상관관계와 설명력이 가장 높은 인지평가로는 웩슬러 성 인 지능검사의 기호쓰기이다. TMT와 별지우기 검사, 순서화, 작업기억도 운전상황인식과 관련성이 있으 며 설명력 있는 변인이다. 운전상황인식 과제를 사용한 전문가들은 이 과제가 운전상황인식을 평가하고 운전관련 인지를 평가하는데 적합하다고 하였다. 결론 : 컴퓨터 기반 운전상황인식 과제는 정보처리속도, 선택주의, 주의이동, 작업기억과 같은 기초적인 인 지능력과 상관관계가 있고 인지 측면에서 운전능력을 파악할 수 있는 평가과제로 적합하다.

The purpose of this study was to investigate the effect of visual feedback on the postural control of stroke patients, by systematically varying conditions of visual feedback [eye-open condition (EO) vs. eye-closed condition (EC)], and base-support (both-side support, affected-side support, and unaffected-side support). In this study, we allocated 41 stroke patients with no damage in the cerebellum and visual cortex who can walk at least 10 meters independently, and 35 normal adults who have no experience of stroke to the control group. Both groups were asked to perform a "sit-to-stand" task three to five times, and their postural control ability was measured and compared in terms of asymmetric dependence (AD) instead of the traditional symmetric index (SI) in the literature. The results showed that although both subject groups maintained better postural control in the EO condition than in the EC condition, the patient group appeared to be more stable in EC than in EO when they were required to perform the task of the support condition given on the affected side. These results implied that visual feedback can impair stroke patients' postural control when it is combined with a specific support condition.

목적 : 뇌졸중은 감각, 지각 및 운동 기능의 손상과 같은 여러 신경학적 증상을 나타내는 질환이지만, 대체적인 환자들의 경우에서 앉기, 서기, 보행과 같은 자세 조절에서 좋은 균형능력을 가진다. 그러나 일반적인 뇌졸중 환자의 자세 조절과는 달리, 손상되지 않은 상지 또는 하지를 사용하여 정상측에서 마비측 방향으로 환자 스스로 강하게 밀거나, 이러한 자세를 바로 잡는 외부적 힘에 대해서도 강하게 대항하는 왜곡된 자세를 보이는 특징적인 증상을 보이는데, 이를 밀기증후군이라 한다. 본 연구는 이러한 원인으로 추정되는 여러 임상적 양상과 뇌손상 크기 및 부위가 밀기증후의 정도에 미치는 영향을 연구하고자 하였다. 연구방법 : 연구 대상은 밀기증후 척도를 이용하여 앉기 및 서기 자세에서 밀기증후를 보이는 뇌졸중 환자 17명을 대상으로 하였다. 임상적 양상의 평가는 Motricity Index(MI), 감각 검사, 뇌손상의 크기 및 부위가 측정되었다. 특히, 뇌손상의 크기는 의료영상저장정보시스템을 이용하여 분석하였고, 뇌손상 부위는 MRIcro 프로그램을 이용하여 각 대상자의 손상 부위를 하나의 표준화된 뇌 영상 위에 합산하여 분석하였다. 결과 : 편측 무시 증상의 유무와 좌우측 뇌반구 손상에 따른 밀기 증후의 정도의 차이는 통계적으로 유의한 차이를 보이지 않았다(p>.05). MI, 뇌손상 크기, 나이 및 감각의 각각의 여러 임상적 지표간의 상관관계 분석에서, 밀기증후의 정도는 감각의 손상 정도에서만 통계적으로 유의한 상관관계를 보였다(p<.05). 각 대상자의 뇌손상 부위를 합산한 영상에서 손상된 부위가 가장 많이 중첩되어지는 위치는 속섬유관, 방사관, 궁상 섬유속로 나타났다. 결론 : 밀기증후를 보이는 뇌졸중 환자에서 증상의 정도는 하지의 근력, 편측 무시, 뇌손상의 크기, 좌우측 뇌반구의 차이와 관련성이 없으나, 감각의 소실 정도와는 통계적으로 유의한 관련성을 가지고 있었다. 또한, 속섬유막, 방사관, 궁상 섬유속의 손상으로 발생할 가능성이 많은 것으로 추정된다. 따라서 밀기증후의 증상은 감각을 비롯하여, 감각과 운동의 통합과 관련된 신경학적 손상으로 인한 것으로 생각된다.

Theoretical framework of motor learning is used to enhance perceptual motor skill in physical therapy intervention, which can be subdivided into two main types-explicit and implicit. The purpose of this study was to examine whether stroke patients with unilateral brain damage learn implicitly a motor skill using the arm ipsilateral to the damaged hemisphere. Speculation then followed as to the formation of therapeutic plans and instructions provided to patients with stroke. 20 patients with stroke and 20 normal participants were recruited. All the subjects practiced serial reaction time tasks for 30 minutes a day and retention tests on the following day. The tasks and tests involved pressing the corresponding buttons to 4 colored circles presented on a computer screen as quickly and accurately as possible. Patients with stroke responded more slowly than controls. However, both groups showed decreased reaction time in the experimental and retention periods. Also, there was no significant difference between both groups regarding explicit knowledge of consecutive order. Therefore, patients with stoke had the ability to learn implicitly a perceptual motor skill. Prescriptive instruction using implicit and explicit feedback may be beneficial for motor skill learning in physical therapy intervention for patients with brain damage.

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.

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”.

Objectives: This study was conducted to evaluate the validity of the Korean Computerized Neuro-psychological Test in measurement of cognitive functioning in patients with brain damage. Methods: Eight tests of Korean Computerized Neuro-psychological Test, (1) Simple Reaction time, (2) Choice Reaction time, (3) Color Word Vigilance, (4) Digit Classification, (5) Digit Addition, (6) Symbol Digit Substitution, (7) Digit Span, (8)Finger Tapping Speed, were administered to the 30 patients who had impairments in cognitive function. Mini Mental State Examination-K (MMSE-K), and Purdue Pegboard Test were also administered compare with the computerized tests. Results: It was found that Choice Reaction time, Color Word Vigilance, Digit Classification, Digit Addition, Symbol digit Substitution, and Digit Span of computerized tests were acceptable in the patients who had MMSE-K score of 20 and more than 20. And Simple Reaction Time was found to be a useful test in the patients with MMSE-K score of less than 20. MMSE-K scores were highly correlated with Choice Reaction time, Color Word Vigilance, Digit Classification, Digit Span of computerized test. The scores of Purdue Pegboard were also highly correlated with the scores of Finger Tapping Speed, In computerized tests, Choice Reaction time, Color Word Vigilance, Digit Classification, and Digit Span were correlated with each other. Conclusions: The results suggested that Korean Computerized Neuro-psychological Test was found to be a useful test in measurement and rehabilitation of patients with cognitive impairments.

Objective: This study was conducted to develop Korean version of Modified Mini-Mental Status (3MS) Examination and to examine it’s validity and reliability in patients with brain injuries. Method: The 3MS was administered to 24 patients with brain injuries from Jan. 1 to Apr. 30 in 2001 at two university hospitals in Korea. The instruments used for evaluating validity and reliability of 3MS were Mini-Mental Status Examination (MMSE), Neurobehavioral Cognitive Status Examination (NCSE), and Modified Barthel Index (MBI). Results: Test-retest reliability of 3MS was excellent (r=0.97), and Interitem correlation coefficients ranged from 0.49 to 1.00. The score changes between the two tests were not related with the gender, level of education, and the duration after the brain injury. When items of 3MS were compared with the items of NCSE to evaluate the construct validity, correlation coefficients ranged from 0.43 to 0.73. When the NCSE was used as a gold standard to evaluate cognitive dysfunction, optimal cutoff scores analyzed by the Receiver Operating Characteristic curves for 3MS and MMSE were 68 and 22, respectively. The sensitivity and specificity of both 3MS and MMSE were the same at 80% and 89.5%, respectively. Conclusion: This study showed that the 3MS was a valid and reliable instrument to screen cognitive dysfunction in patients with brain injuries.

Objective: The purpose of this study was to investigate the effects of cognitive function and Activities of Daily Living (ADL) improvement with Traumatic Brain Injury(TBI) and Stroke patient through Computer Assisted Cognitive Rehabilitation (CACR) program within specific approach and hierarchial approach training program. For this investigation CACR training was administered to 14 patients diagnosed of TBI and Stroke. Method: The CACR was given to the subject patient for 1months, 5times a week and each stimulation lasted 30 minutes. Cognitive function and activities of daily living were compared pre-CACR program with post-CACR program by MMSE and FIM . Results: Summarizing the results of this investigation; 1. Statistically significant improvement in 8 items of MMSE and 11 items of FIM was found after the application of CACR program training. 2. Cognitive function showed the spastically significant improvement after CACR program within specific approach and hierarchial approach training program 3. Activities of daily living showed the statistically significant improvement after CACR program within specific approach and hierarchial approach especially hierarchial approach more statistically significant increased than specific approach.

뇌 손상 후 급성기에 기능의 자발적인 회복이 일어나지만 환자들은 환측의 상지를 잘 사용하지 못하게 된다. 그 결과 원하는 움직임을 억제하는 상황을 발생시키는데 이것을 학습 무사용 증후군(learned nonu se syndrome)이라 한다. 이러한 학습 무사용 증후군을 치료하기 위해 억제-유도 치료(constraint-induced therapy)가 고안되었다. 억제-유도 치료는 연속되는 몇 주간에 걸쳐 매일 많은 시간 동안 건측의 상지를 묶어두고 환

The purpose of this case is to find effectiveness of improvement of cognitive function with head injury patients through Computer-Assisted Cognitive Rehabilitation(CACR) program within various training programs. The subjects were three inpatient persons with head injury on Rehabilitation Hospital in Yonsei University and aged 28 and 14 and 2 woman and another man. It was used PSS CogRehab program during 15 days. Cognition, perception and activities of daily living(ADL) were compared pre-CACR with post-CACR by LOTCA, MVPT and MBI. According to this case study, in spite of short-term period, the subjects had changed of performance skills of cognition, perception and activities of daily living. Results were as follows : 1. LOTCA score of 3 cases showed increasing change after CACR performance, especially perception and visuoperception organization were increased. 2. Raw score was increased and processing time was controlled adjustable of MVPT within 3 cases. 3. MBI score of 3 cases were improved, especially dressing, feeding and toileting were improved each one step.

The purposes of this study were to identify the influence of visual perception disorder to brain demaged patients and to found out the interrelationship between the lesion of brains and MVPT items. The subjects were 50 brain demaged patients and 29 normal people. Motor-free Visual Perception Test(MVPT) and Mini-Mental Status Examination (MMSE) were used to evaluate the visual perceptions of the both. The data were collected from January 1998 to March 1999. Compare the results of raw scores the among MVPT items of normal group & the brain demaged patients groups, significant differences were found in all level of age group. The difference of raw score in the third age group (70∼80) most significant. The results also indicated that there were some differences in the scores of Korean normal grops and the standard of MVPT suggested by AJOT. The result suggest , There is a need to develope MVPT that is suitable for Korean sujects.

The purpose of this study was to determine the validity and the of the Neurobehavioral Cognitive Status Examination(NCSE) to ascertain its value in the cognitive functional evaluation of brain-injured patients. The NCSE, uses as an independent test to evaluate cognitive function within five major areas: language, construction, memory, calculation, and reasoning. And the examination separately assesses levels of consciousness, orientation, and attention. The instrument quickly identifies intact areas of functioning, yet provides more detailed assessment in areas of dysfunction. The level of cognitive is classified as unimpaired and mild, moderate, severe impaired. Standardization data are provided for 42 braininjured patients, age ranged from 24 to 76 years. In the validity study, the NCSE subtest was significantly correlated with associated Mini Mental State Examination-Korean version(MMSE-K) test, except for attention, naming, construction. The specificity score of the traumatic brain-injured patients were higher than those of the stroke patient group in attention, construction, calculation. The mean score of stroke patients were significantly higher than those of the traumatic brain-injured group in orientation. In the inter-rater and test-retest reliability, the screen Kendall's τb and Metry pearson's correlation statistics were indicating a good internal consistency. The NCSE demonstrated an acceptable validity and reliability for the evaluation of cognitive functional capacity of brain-injured patients in clinical practice.