목적 : 본 연구는 만성뇌졸중 환자에게 휴대전화를 이용한 원격재활이 상지운동기능, 균형감각과 일상생활활동 수행능 력에 미치는 영향을 알아보고자 하였다. 연구방법 : 발병 2년 이상 경과된 만성뇌졸중 환자 20명을 무작위 할당을 통해 실험군(10명)과 대조군(10명)으로 구분 하였다. 실험군과 대조군 모두에게 자가운동프로그램을 주 5회, 총 8주간 실시하였다. 자가운동프로그램과 함께 실험 군에는 휴대전화를 이용한 원격재활 중재를 적용하였으며, 대조군에는 스스로 확인할 수 있는 일일점검표를 제공하였 다. 중재 전·후 대상군들의 기능을 측정하기 위해 Fugl-Meyer 평가 척도, 버그균형검사, 상자와 나무토막 검사, 운동 활동지표, 수정된 바델지수를 사용하였다. 결과 : 휴대전화를 이용한 원격재활 중재가 제공된 실험군은 상지기능, 균형감각 및 일상생활활동 수행능력에서 유의하 게 향상된 반면(p<.05), 대조군에서는 유의한 변화를 보이지 못했다(p>.05). 또한 중재 전·후의 변화량, 수행도와 만 족도 모두 대조군에 비해 실험군에서 통계적으로 유의하게 높은 것으로 나타났다(p<.05). 결론 : 본 연구는 휴대전화를 이용한 원격재활이 만성뇌졸중 환자의 상지기능, 균형감각 및 일상생활활동 수행에 효과적 임을 지지하며, 국내 임상적 상황에서 원격재활의 가능성을 제시하였다.

The objective of this study was to evaluate the effects of mirror therapy on motor function recovery following a stroke through a systemic review and meta-analysis. In total, nine of the 48 studies were identified from search engines between 1997 and 2011, as well as from a review of the reference lists of each identified study. The quality of each study was assessed using Jadad scale, and the effect size was calculated as a Cohen's effect size using MetaAnalyst (Beta 3.13). The overall effect size of the mirror therapy was 2.005 (95% confidence interval=1.041~2.970) in a random-effects model. This finding suggests that mirror therapy is beneficial for improving motor function following a stroke. The results from the subgroup analysis according to categorical variables were as follows: First, the effect size was larger for an onset time of less than 1 year (1.166) than for a duration of 1 year or more (.668). Second, the effect size of unpublished dissertations (1.610) was larger than published articles (1.221). Third, motor recovery of upper extremities (1.609) had a greater effect than motor recovery of lower extremities (.903). The major limitation of this study is the relatively small study population. Therefore, further individual studies of mirror therapy should be conducted in order to generalize the effects. In addition, mirror therapy supervised by a physical therapist should be recognized as a potential approach to manage motor function following a stroke and recommended to patients to improve their motor function.

목적 : 만성 경직성 편마비 환자에서 보툴리눔 독소 근 주입 후 상지 운동기능 개선을 알아보고자 하였다. 연구방법 : 뇌졸중 발병 후 12개월 이상이 경과된 만성기 편마비 환자 18명을 대상으로 환측 상지의 요측수근굴근, 척측수근굴근, 심지굴근, 천지굴근에 보툴리눔 독소를 각각 25 단위 주사하였다. 평가는 주사 전, 주사 2주 후와 8 주 후의 상지 기능 변화 및 동작 분석을 시행하였다. 상지의 경우 수정 에쉬워스 척도와 도수 근력 평가, 뇌졸중 상 지 기능 평가, 수지의 파악력 및 측면 집기력을 평가하였고 정량 분석을 위하여 3차원 동작 분석기를 이용하여 손 목관절의 최대 굴곡-최대 신전, 손바닥 두드리기, 검지 두드리기, 30cm 추적운동의 동작을 분석하였다. 결과 : 보툴리눔 독소를 주사 후 마비측 수지의 파악력, 측면 집기력에서는 유의한 변화가 없었으나 손목관절의 신 전, 수지의 신전 근력, 뇌졸중 상지 기능 평가에서 유의한 호전이 관찰되었다(p<.05). 3차원 동작 분석기를 이용한 상지 기능의 평가에서 손목관절 최대 굴곡-손목관절 신전 동작의 관절운동범위에서 유의한 호전이 관찰되었으며 손목관절 최대 굴곡-손목관절 신전 동작 및 손바닥 두드리기와 검지 두드리기 동작에서 진동수의 유의한 증가와 변이도의 유의한 감소는 관찰되지 않았으나 진폭의 유의한 증가가 관찰 되었다(p<.05). 결론 : 만성 경직성 편마비 환자에서 환측 상지에 대한 보툴리눔 독소 치료는 상지 운동기능 개선에 유의한 효과를 보였다.

This study was implemented to verify the feasibility of motor function recovery and the appropriate period for therapy. The research began with spinal laminectomy of 40 white rats of Sprague-Dawley breed and induced them spinal crush injury. Following results were obtained by using the modified Tarlov test (MTT), Basso, Beattle, Bresnahan locomotor rating scale (EBB scale) and modified inclined plate test (MIPT). First, the measurement using the MTT confirm that the most severe aggravation and degeneration of functions are observed two days after induced injury, and no sign of neuromotor function recovery. Second, better scores were achieved by open-ground movement group on BBB locomotor rating scale test, and weight-bearing on inclined plate group show better performance on MIPT. Third, both BBB and MIPT scale manifested the peak of motor function recovery during 16th day after the injury and turn into gradual recovery gradient during 16th to 24th. Fourth, the control group showed functional recovery, however, the level of recovery was less significant when compared with group open-ground movement group and weight-bearing on inclined plate group. Hence, it was clearly manifested that the lumbar region of the spinal cord had shown the best performance when its functions were measured after the execution of specific physical training; therefore it indicated the possibility of learning specific task even in damaged lumbar regions. Thus it is expected to come out with better and more effective functional recovery if concentrated physical therapy was applied starting 4 days after the injury till 16 days, which is the period of the most active recovery.

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.

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.

The purpose of this study was to identify the relationship between motor and mental status and functional status, and to determine appropriate test times. Using the Modified Motor Assessment Scale(motor status) and the Modified Barthel Index(functiona1 status), the Glasgow Coma Scale(menta1 status), we tested 9 stroke patients. 1 week. 1 month after their stroke. Three measures are reliable and valid. We used the Sperman correlation coefficient(r) and Wilcoxon signed rank test to analyze the data. MMAS scores at 1 month correlated significantly with MBI scores at 1 month(r=0.89). But GCS scores at 1 month did not correlate significantly with MBI scores at 1 month. All data of MMAS at 1 month correlated significantly with MBI scores at 1 month. But only verbal response score among GCS scores at 1 month correlated significantly with MBI scores at 1 month(r=0.86). The difference of MMAS, GCS. MBI scores between 1 week and 1 month after stroke onset were statistically significant(p(0.05). This study suggested that the mental status had more impact on functional recovery than motor status at 1 week after their stroke. Also, the motor status had more impact on functional recovery than mental status at 1 month after their stroke. But the mental and motor status should be considered together in predicting the functional recovery status of stroke patients.

Purpose: Functional recovery of the paretic upper extremity post stroke continues to be one the greatest challenges faced by rehabilitation professionals. Although many tasks require the coordinated participation of both hands, rehabilitation strategies for the most part have focused on the paretic limb. This study investigated whether coupled bilateral coordinated movements and repetitive high frequency TMS enhanced upper limb corticomotor excitability and motor function poststroke. Methods: For this study, we compared the neurophysiological and behavioral changes associated with two such rehabilitation protocols: coupled bilateral training and coupled unilateral training. Twenty chronic stroke patients were randomly assigned to the two training group over 8-week period. For this experiment, transcranial magnetic stumulation, EMG, Ag/AgCI suface electrode, rehabilitation training equipment, jebsen-talyer hand function kit, box & block, and pinch & power grip test kit were used. Results: First, in the box & block and JTT task, coupled bimanual group showed a reduction in movement time in comparision to receiving coupled unilateral group. Second, in the cortical excitability within affected hemisphere, using TMS, an increased in map volume, and map number following coupled bilateral group. Overall, these finding suggest that a coupled bilateral movement and high frequency repetitive TMS protocol effective in recovering upper limb motor function and cortical excitability in chronic stroke patients.

본 연구의 목적은 만성 뇌졸중 환자를 위한 상지 움직임의 시간적 협응성에 따른 양측성 협응 운동의 효과를 검증하고자 하였다. 본 연구에서는 대칭적 움직임(동일 위상)을 포함한 양측성 협응 운동이 비대칭적 양측성 협응 운동 보다 만성 뇌졸중 환자의 상지 운동기능회복에 보다 효과적일 것이다라는 가설을 설정하였다. 이러한 연구 목적을 달성하기 위해 중다기초선 단일피험자 연구설계로 총 4명의 만성 뇌졸중 환자들이 각각 2명씩 대칭과 비대칭적 양측성 훈련에 참여하였으며, 운동학적 측면과 기능적 측면에서 훈련의 효과를 살펴보았다. 피험자들은 4회와 8회의 단측성 훈련을 수행하고 대칭과 비대칭 양측성 훈련으로 전환하여 8회와 4회의 훈련을 실시하였다. 그 결과, 대칭적 훈련 집단은 기능적 뻗기 평가에서 비대칭적 훈련 집단보다 최대속도가 증가하고 운동시간이 감소한 것으로 나타났다. JTT 세부과제에 대한평가에서는 훈련집단에 따른 일관성있는 결과를 제시하지 못하였다. 그러나 근위관절과 관련된 JTT 전체시간에서는 대칭적 훈련 집단이 비대칭적 훈련 집단보다 수행시간이 감소한 것으로 나타났다. 이러한 결과를 통해 대칭적 양측성 운동이 양측성 협응 운동을 구성하는 주요 변인일 가능성을 제시하고 있다.

본 연구의 목적은 양측성 단일 운동 훈련이 만성 뇌졸중 노인의 상지 운동기능회복에 어떠한 영향을 주는지 살펴보고 손상측 대뇌 운동피질 활성화에 미치는 영향에 대해 검증하고자 하였다. 이러한 연구 목적을 달성하기 위해 총 10명의 만성 뇌졸중 노인들이 양측성 훈련과 단측성 훈련에 각각 5명씩 참여하였으며, 실험을 위해 동작분석 시스템, 경두개자기자극기, 근전도 기기, 재활훈련도구가 사용되었다. 훈련과제는 나무 말뚝 옮기기, 나무 팩 맞추기, 그리고 물 마시기 모방 과제로 구성하여 주 2회 총 16회의 훈련을 실시하였다. 그 결과, 양측성 훈련 집단은 기능적 뻗기 검사에서 최대속도가 증가하였으며, 운동시간이 감소한 것으로 나타났다. 기능적 검사에서도 씨앗 옮기기, 무거운 물건 옯기기 과제에서 수행시간이 감소한 것으로 나타났다. 또한 경두개자기자극기를 활용한 신경생리적 검사에서도 130%, 140%, 그리고 150% 자극 강도에서 운동유발전위의 크기가 증가한 것으로 나타났다. 이러한 결과를 통해 양측성 단일 운동 훈련이 손상측 상지의 운동기능회복과 대뇌 운동피질 활성화에 긍정적인 효과가 있는 것으로 알 수 있다.