목적 : 본 연구는 급성기 뇌졸중 환자에서 동작관찰 체간훈련이 체간조절능력, 균형, 일상생활수행능력에 미치는 효과를 알아보고자 실시하였다. 연구방법 : 2017년 7월 3일부터 2018년 4월 30일까지 전북 익산 소재의 W 대학병원에 입원한 급성기 뇌졸중 환자 14명을 실험군과 대조군으로 무작위 할당하였다. 두 군 모두 일반적인 물리·작업치료를 실시하였다. 추가적으로 실험군에는 동작관찰 체간훈련을, 대조군은 풍경관찰 체간훈련을 각 1일 1회 30 분, 주 5회, 총 3주간 실시하였다. 치료 중재 전·후 체간조절능력을 측정하기 위해 체간 손상 척도 (Trunk Impairment Scale; TIS), 균형능력을 측정하기 위해 수정된 기능적 팔 뻗기 검사(Modified Functional Reach Test; M-FRT)와 버그균형척도(Berg Balance Scale; BBS)를 사용하였고, 일상생활활동 수행능력을 평가하기 위해 한국판 수정된 바델 지수(Korean version of Modified Barthel Index; K-MBI)을 사용하였다. 결과 : 3주 중재 후, 두 그룹에서 중재 전·후 체간조절능력, 균형, 일상생활수행능력에서 유의한 차이가 나타났으며 (p<.05), 중재 후 두 그룹 간 변화량의 차이는 TIS와 M-FRT에서 유의한 차이가 나타났다(p<.05). 결론 : 본 연구 결과 동작관찰 체간훈련이 급성기 뇌줄중 환자의 체간조절능력, 균형, 일상생활수행능력을 향상시킬 수 있는 중재 방법으로 나타났다. 따라서 기립 훈련기에서 동작관찰 체간훈련은 급성기 뇌졸중 환자에게 능동적이고 동적인 체간훈련을 제공할 수 있는 새로운 중재 방법으로 사용될 수 있을 것이다.

The aim of this study was to investigate correlations of the Trunk Control Test (TCT), Postural Assessment Scale for Stroke (PASS-TC), and Trunk Impairment Scale (TIS) and to compare the TCT, PASS-TC, TIS and its subscales in relation to balance, gait and functional performance ability after stroke. Sixty-two stroke patients attending a rehabilitation program participated in the study. Trunk control was measured with the use of TCT, PASS-TC, TIS balance (Berg Balance scale; BSS), gait ability (10 m walk test), functional performance ability (Tuned Up and Go Test TUG) and the mobility part of the Modified Barthel index (MBI), Fugl Meyer-Upper/Lower Extremity (FM-U․L/E). The scatter-plot (correlation coefficient) was composed for the total scores of the TCT, PASS-TC, and TIS. The multiple regression analysis was performed to evaluate the impact of trunk control on balance, gait, and functional performance ability. Twenty eight participants (45.2%) and twenty participants (32.3%) obtained the maximum score on the TCT and PASS-TC respectively; no subject reached the maximum score on the Trunk Impairment Scale. There were significant correlations between the TIS and TCT (r=.38, p<.01), PASS-TC (r=.30, p<.05), TCT and PASS-TC (r=.59, p<.01). Stepwise multiple regression analysis showed that the BBS score (β=.420～.862) had slightly more power in predicting trunk control than the . TIS-dynamic sitting balance, TUG and the MBI-mobility part. This study clearly indicates that trunk control is still impaired in stroke patients. Measures of trunk control were significantly related with values of balance, gait and functional performance ability. The results imply that management of trunk rehabilitation after stroke should be emphasized.

The purpose of this study was to investigate the effects postural changes on respiratory muscles and acoustic parameters of the children with spastic cerebral palsy. Nine children with spastic cerebral palsy who required assistance when walking were selected. The ages of the children ranged from 6 to 9 years old. The phonation of the sustained vowel /a/ and the voice qualities of each child such as fundamental frequency(F0; Hz), pitch variation (Jitter; %), amplitude variation (Shimmer; %) and noise to harmonic ratio (NHR) were analyzed by Multi-Dimensional Voice Program (MDVP). The muscle activity of three major respiratory muscles: pectoralis major muscle, upper trapezius muscle and rectus abdorminalis muscle, were measured by examining the root mean square (RMS) of the surface EMG to investigate the impact of changes in the adjusted sitting posture of each subject. However, the RMS of pectoralis major muscle showed a significant differences (p<.05). Secondly, there were no significant differences in , Jitter and Shimmer between pre and post posture change, but there was a significant difference in NHR (p<.05). The data were collected in each individual; once prior and once after the sitting posture change. The data were analyzed by Wilcoxon signed ranks-test using SPSS version 14.0 for Windows. The findings of this study were as follows; Firstly, the RMS of upper trapezius and rectus abdorminalis muscle were not significant different between pre and post sitting posture changes. From the result, it is concluded that changes in the adjusted sitting posture decreases the abnormal respiratory patterns in the children with spastic cerebral palsy which is characterized by the hyperactivity of the respiratory muscles in breathing. Also, there is increased on the voice qualities in children with spastic cerebral palsy.

Anticipatory postural adjustments is an example of the ability of the central nervous system to predict the consequence of the mechanical effect of movement on posture and helps minimize a forth coming disturbance. The aim of this study was to evaluate the sequence of activation of the trunk muscles during the performance of hip and shoulder movement and to determine the relationship between anticipatory activity and subjects' motor and functional status in subjects with hemiplegia post stroke. Twenty-four poststroke hemiparetic patients enrolled in this study. Electromyographic activity of the lumbar erector spinae, latissimus dorsi, and of the obliquus internus muscles was recorded bilaterally during flexion of both arm and from the rectus abdominis, obliquus externus, and obliquus internus muscles during flexion of both hip. Onset latencies of trunk muscles were partially delayed in the subjects with hemiplegia post stroke (p<.05). With upper limb flexion, the onset of erector spinae muscle and latissimus dorsi muscle activity preceded the onset of deltoid on both side respectively (p<.05). A similar sequence of activation occurred with lower limb flexion. Also the onset of external oblique muscle and rectus abdominis muscle activity preceded the onset of rectus femoris muscle on both side (p<.05). Major impairments in the activity of trunk muscles in hemiparetic subjects were manifested in delayed onset between activation of pertinent muscular pairs. These problems were associated with motor and functional deficits and warrant specific consideration during physical rehabilitation of post stroke hemiparetic patients.

목적 : 본 연구에서 뇌졸중 환자의 체간 조절(PASS, TCT)과 균형(BBS, FM-B) 및 일상생활동작(MBI)과의 관련성과 각 변수들과의 영향력을 알아보고자 하였다. 연구방법 : 본 연구는 뇌졸중으로 인한 편마비 진단을 받은 환자 43명을 대상으로 체간 조절 평가(Postural Assessment Scale for Stroke : PASS, Trunk Control Test : TCT), 균형 평가(Berg Balance Test : BBS, Fugl-Meyer Assessment - Balance : FM-B), 일상생활동작 평가(Modified Barthel Index : MBI)등을 이용하였고, 자료 분석은 피어슨 상관 분석(pearson correlation coefficient)과 단계적 다중 회귀분석(stepwise multiple regression)을 이용하였다. 결과 : PASS 자세 유지, 자세 변환, 총합은 TCT와 r=.78～.96(p<.01)으로 체간 조절 평가 도구간에 매우 유의한 상관관계가 있는 것으로 나타났다. PASS, TCT는 BBS, FM-B(r=.65～.82), MBI(r=.75～.79)에서 유의한 상관관계가 있었으며(p<.01), BBS, FM-B는 MBI(r=.77～.78)와 유의한 상관관계가 있었다(p<.01). FM-B와 BBS는 r=.84(p<.01)로 유의한 상관관계가 있는 것으로 나타났다. MBI의 보행 항목이 PASS 자세유지, 자세변환, 총합, FM-B(p<.001), TCT, BBS에 가장 영향력을 주는 것으로 나타났으며(p<.01), PASS의 지지없이 서기 항목이 MBI, FM-B, TCT, BBS에 가장 영향력을 주는 것으로 나타났다(p<.001). PASS 총합은 MBI에 가장 영향력을 주는 것으로 나타났다(p<.01). PASS 세부 항목 중 개인 위생, 목욕하기, 화장실 사용, 계단 오르기, 보행, 의자․침상 이동은 지지 없이 서기가 가장 영향을 주는 것으로 나타났으며(p<.001), 식사하기는 누운자세에서 테이블 가장자리에 앉기(p<.001), 옷입기는 환측으로 돌아눕기(p<.01)가 가장 영향력을 주는 것으로 나타났다. 결론 : PASS, TCT, BBS, FM-B, MBI간에 유의한 관련성을 보였으며 변수들과의 인과관계 분석을 통하여 예측 가능한 변수들을 제시 하였다. 또한 환자의 기능적 회복과 재활 치료 후 결과를 예측하거나 영향을 줄 수 있는 변수를 찾아내어 그에 대한 집중적인 치료의 병행이 환자의 성공적인 재활 치료를 위한 전략이 될 수 있을 것이다. 추후 임상적인 평가도구로서 적극적인 활용과 그 유용성에 대한 연구가 필요하다.

Anticipatory postural adjustments are pre-planned by the central nervous system (CNS) before the activation of agonist muscles in the limbs, and minimize postural sway. Most previous studies on this topic have focused on upper-limb movement, and little research has been conducted on lower-limb movement. The purpose of this study was to investigate the recruitment order of left and right trunk muscles during limb movement. Fifteen healthy subjects (10 male, 5 female) were enrolled. Electro-myographic signals were recorded on the muscles of: (1) deltoid, lumbar erector spinae, latissimus dorsi and internal oblique during shoulder flexion, (2) rectus femoris, rectus abdominis, external oblique and internal oblique during hip flexion. During right upper limb flexion, the onset of left erector spinae muscle and left internal oblique muscle activity preceded the onset of right deltoid by 8.09 ms and 19.83 ms, respectively. But these differences were not significant (p>.05). A similar sequence of activation occurred with lower limb flexion. The onset of left internal oblique muscle activity preceded the onset of right rectus femoris muscle by 28.29 ms (p<.05). The onset of right internal oblique muscle activity preceded the onset of left rectus femoris muscles by 23.24 ms (p<.05). The internal oblique muscle was the first activated during limb movement. Our study established the recruitment order of trunk muscles during limb movement, and explained the postural control strategy of the trunk muscles in healthy people. We expect that this study will be used to evaluate patients with an asymmetric recruitment order of muscle activation due to impaired CNS.