Stroke is one of the most common disabilities experienced by the elderly in the community. However, stroke progresses to a chronic level, patients are discharged from medical institutions and eventually no longer receive therapeutic interventions at home. In this systematic review, we compared home-based rehabilitation (HBR) with comparison for patients with stroke. Literature published in Cumulative Index for Nursing and Allied Health Literature (CINAHL), Embase, Physiotherapy Evidence Database (PEDro), PubMed, and Google Scholar were reviewed. A total of 1,158 studies were initially retrieved. After reading the full texts, 11 articles were included in the systematic review. Quality assessment of the included studies was conducted using Risk of Bias (RoB) 2.0, and Egger’s regression test was used to evaluate publication bias. Data analysis was performed using the R studio software (R Studio). According to the quality assessment using RoB 2.0, three studies were evaluated as low risk, two as of some concern, and three as high risk. The overall effect size was moderate (0.309). The value of the balance function was a small effect size (0.201), while the value of the gait function was a moderate effect size (0.353). The values were small and moderate effect (0.154, 0.411) for the chronic and subacute conditions, respectively. According to the Egger’s regression test, no publication bias was observed. The findings of this study indicate that HBR resulted in the greatest improvement in gait function in patients with subacute stroke compared to those with chronic stroke. Therefore, the application of this intervention to patients with stroke in the community is recommended.

Background: Patients with dysphagia after stroke are treated with neuromuscular electrical stimulation (NMES), but its effect on masseter muscle thickness and bite force in the oral phase is not well known. Objectives: To investigated the effect of NMES on masseter muscle thickness and occlusal force in patients with dysphagia after stroke. Design: Two group, pre-post design. Methods: In this study, 25 patients with dysphagia after stroke were recruited and allocated to either the experimental or the control groups. Patients in the experimental group were treated with NMES to the masseter muscle at the motor level for 30 minutes and were additionally treated with traditional swallowing rehabilitation for 30 minutes. In contrast, patients in the control group were only treated with traditional swallowing rehabilitation for 30 minutes. Masseter muscle thickness was measured using ultrasonography before and after intervention, and bite force was measured using an bite force meter. Results: The experimental group showed significant improvement in masseter muscle thickness and bite force compared to the control group. Conclusion: NMES combined with traditional dysphagia rehabilitation is effective in improving masseter muscle thickness and bite force in patients with dysphagia after stroke.

Background: Patients with stroke have limited ankle range of motion (ROM) due to soft tissue abnormalities around the ankle and thus experience functional impairment. Increased muscle tension and reduced ankle ROM impair gait and hinder the activities of daily living. Joint mobilization and stretching are effective interventions that improve gait performance by enhancing the ankle ROM. Objectives: To investigate the effects of ankle joint mobilization and calf muscle stretching on gait speed and gait performance in patients with stroke. Design: This was a randomized controlled trial. Methods: Twenty patients with stroke patients were randomized into two groups. The joint mobilization group (JMG) underwent anteroposterior mobilization of the talocrural joint and the joint mobilization stretching group (JMSG) underwent calf muscle stretching in addition to joint mobilization. Gait speed and gait parameters were measured using the 10-meter walk test and the GAITRite. Results: Both the JMG and JMSG groups showed significant improvements in gait speed, affected-side step length, and cadence after the intervention (P<.05). Conclusion: Joint mobilization and stretching were effective interventions for improving gait performance by enhancing ankle function in patients with stroke.

Background: Kinesiology taping (KT) is a method that helps immediately increase muscle activation, strength and joint stability by being attached to various skeletal muscles and structures of the body. Objectives: To investigate the effect of KT applied below the hyolaryngeal complex on the movement of the hyolaryngeal complex during swallowing in patients with dysphagia after stroke. Design: One-group, pre-post design. Methods: Twenty individuals with dysphagia after stroke participated in this study. KT was applied to the sternum and both clavicles from the hyolaryngeal complex. We analyzed the motion of the hyolaryngeal complex during swallowing with and placebo KT and KT using the Image-J software with videofluoroscopic swallowing study. In addition, a 0-to-10 numerical rating self-report scale was used to check the required effort and resistance felt during swallowing. Results: KT condition showed that the anterior and superior movement of the hyoid bone during swallowing was significantly lower than placebo KT (P<.05, all). Also, KT condition showed that the anterior and superior movement of the larynx during swallowing was significantly lower than placebo KT (P<.05, all). In result of statistical comparison between KT group and placebo KT group, the KT group showed significantly higher self-report scale score than the placebo KT group in terms of two category; the required effort and resistance felt (P<.05, all). Conclusion: This study demonstrated that KT applied below the hyolaryngeal complex inhibits the anterior and superior movement of hyoid bone and larynx during swallowing of patients with dysphagia after stroke.

목적 : 본 연구는 완곡추적 안구운동과 경부신전근 진동자극법의 결합중재가 만성 뇌졸중 환자의 편측무시와 일상생활활동 수행에 미치는 영향을 확인하는 것이다. 연구방법 : 본 연구는 발병 후 6개월 이상 지난 3명의 뇌졸중 편측무시 환자를 대상으로 하였으며, 단일대상연구 방법 중 ABAC디자인으로 연구를 진행하였다. 연구는 기초선(A1) 1주, 중재기(B) 2주, 기초선(A2) 1주, 그리고 중재기(C) 2주로 총 6주간 진행되었으며, 중재기(B)에서는 완곡추적 안구운동(Smooth Pursuit Eye Movement; SPEM)의 단일중재를, 중재기(C)에서는 경부신전근 진동자극법(Neck Muscle Vibration; NMV)과 SPEM의 결합중재를 실시하였다. 평가는 매회기 선 나누기 검사와 벨 테스트(Bells test)를 실시하였으며, 한국판 캐서린 버지고 척도(Korean-Catherine Bergego Scale; K-CBS)와 한국판 일상생활활동 중심 작업기반 신경행동 평가(Korean version of ADL-focused Occupation-based Neurobehavioral Evaluation; K-A-ONE)를 기초선(A1)의 첫 회기와 각 중재기의 마지막 회기에 시행하였다. 결과 : 연구결과 SPEM과 NMV를 단일 또는 결합하여 적용하였을 때 편측무시의 지필검사(선 나누기 검사와 벨 테스트)와 관찰적 검사(K-CBS와 K-A-ONE)에서 편측무시가 개선됨을 확인하였고, 특히 결합중재시에 더 효과가 좋았던 것으로 나타났다. 그리고 편측무시가 개선됨에 따라 일상생활활동의 수행(K-A-ONE)에서도 향상을 보였는데, 편측무시 환자의 일상생활을 저해하는 신경행동 손상은 편측무시 뿐만 아니라 공간관계나 마비와 같은 손상 등이 영향을 미치는 것으로 나타나 다양한 신경행동 손상의 중재를 포함하는 포괄적인 재활프로그램을 계획해야함을 확인하였다. 결론 : 본 연구를 통해 SPEM과 NMV의 결합중재가 만성 뇌졸중 환자의 편측무시를 감소시키고 일상생활 활동 수행을 향상시키는데 효과적인 중재라는 것을 확인하였다.

Background: Patient-centered care has recently become highly recommended, because it can improve health outcomes more effectively than problem-oriented care. The goal attainment scale (GAS) is one of the methods used for patient-centered care. It was originally developed as an outcome measurement tool, but it can also be used as a therapeutic intervention when setting quantifiable patient-centered goals. Objects: We sought to identify the effect of setting patient-centered goals on rehabilitation outcomes in patients with subacute stoke using GAS. Methods: Overall, 46 subjects with subacute stroke were divided into experimental (n1=23) and control (n2=23) groups. Subjects in both groups attended physical therapy sessions five times a week for four weeks. Those in the experimental group set goals using goal-attainment scaling. The mobility of each subject was evaluated using the Rivermead mobility index (RMI); daily-living activities, using the K-modified Barthel index (K-MBI); participation, using the Hopkins rehabilitation-engagement rating scale (HRERS); satisfaction, using the patient-satisfaction scale (PSS). Results: Subjects in the experimental group experienced more significant increases in RMI, HRERS, and PSS than those in the control group (p<.05, p<.05 and p<.01, respectively). After four weeks, GAS scores of the experimental group had increased more significantly than those of baseline (p<.01). Conclusion: Setting patient-centered goals is effective in improving the mobility and satisfaction of patients with subacute stoke. Setting patient-centered goals needs to be performed more frequently in clinical settings.

Robot-assisted rehabilitation therapy has been used to increase physical function in post-stroke patients. The aim of this meta-analysis was to identify whether robot-assisted gait training can improve patients’ functional abilities. A comprehensive search was performed of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), Academic Search Premier (ASP), ScienceDirect, Korean Studies Information Service System (KISS), Research Information Sharing Service (RISS), Korea National Library, and the Korean Medical Database up to April, 2014. Fifteen eligible studies researched the effects of robot-assisted gait training to a control group. All outcome measures were classified by International Classification of Functioning, Disability, and Health (ICF) domains (body function and structures, activity, and participation) and were pooled for calculating the effect size. The overall effect size of the robot-assisted gait training was .356 [95% confidence interval (CI): .186∼.526]. When the effect was compared by the type of electromechanical robot, Gait Trainer (GT) (.471, 95% CI: .320∼.621) showed more effective than Lokomat (.169, 95% CI: .063∼.275). In addition, acute stroke patients showed more improvement than others. Although robot-assisted gait training may improve function, but there is no scientific evidence about the appropriate treatment time for one session or the appropriate duration of treatment. Additional researchers are needed to include more well-designed trials in order to resolve these uncertainties.

목적 : 본 연구의 목적은 문항반응이론에 기초한 라쉬모형을 적용하여 뇌졸중 외래환자의 일상생활수행 평가도구를 개발하는 것이다. 연구방법 : 연구 대상자는 뇌졸중 외래환자로 169명이었다. 조사방법은 사전연구에서 항목의 중요도로 수집된 23개의 일상생활수행 평가항목으로 구성된 설문지를 사용하였다. 조사자료는 전국 18개 재활기관에서 작업치료사가 평가한 결과를 수집하여 Winsteps 프로그램으로 라쉬분석을 하였다. 결과 : 7개 항목이 부적합한 항목으로 판정되었으며, 16개 항목이 적절한 항목으로 채택되었다. 뇌졸중 외래환자의 일상생활 수행능력은 -6.32~6.23 로짓으로 표시할 수 있으며, 표준화점수로 표시하기 위한 변환식은 "점수=(로짓점수+6.32)/(6.32+6.23)100" 이었다. 일상생활 수행능력을 평가하기위한 항목을 난이도 순서에 따라 배열하였다. 가장 어려운 항목은 보행영역의 '계단 오르내리기' 항목이었으며, 가장 쉬운 항목은 식사하기 영역의 '음료 마시기’항목이었다. 결론 : 라쉬분석을 이용하여 개발된 뇌졸중 외래환자의 일상생활수행 평가도구는 신뢰도와 타당도가 입증된 객관적인 도구이다.

목적 : 문항반응이론에 기초한 Rasch모형을 적용하여 뇌졸중 입원환자의 일상생활수행 평가도구를 개발하는 것이다． 연구방법 : 2002년 8월 5일부터 2005년 4월 20일까지 전국 18개 재활기관에서 뇌졸중 입원환자 308명을 대상으로，작업치료사가 평가한 6개 영역의 23개 항목으로 구성된 설문지 결과를 수집하여 Winsteps 프로그램으로 라쉬분석하였다． 결과 : 3개 항목이 부적합한 항목으로 판정되었으며，남은 20개 항목의 난이도 순서를 배열하였다．뇌졸중 입원환자의 일상생활 수행능력은 -6.77~6.73 로짓으로 표시할 수 있으며，표준화점수로 표시하기 위한 변환식은 "점수 =（로짓점＋6.77)/ (6.77+6.73) 100" 이었다．평가항목의 난이도는 가장 어려운 항목은 보행영역의 ‘계단 오르내리기’ 항목이었으며，가장 쉬운 항목은 식사하기 영역의 ‘음료 마시기’ 항목 이었다． 결론 : 라쉬분석을 이용한 뇌졸중 입원환자의 일상생활수행 항목의 적합도와 난이도에 관한 결과제시로 개발되었으며，신뢰도와 타당도가 입증된 객관적인 평가도구이다．