목적: 본 연구는 뇌졸중 환자를 대상으로 적용한 인지기반 작업수행(Cognitive Orientation to daily Occupational Performance, CO-OP) 중재에 대한 조건, 형태 및 효과에 대하여 체계적 고찰을 하고자 하였다. 연구방법: 2014년부터 2023년까지의 PubMed, CINAHL, EMBASE, SCOPUS, Web of Science와 한국학술 지인용색인(Korea Citation Index)에 게재된 문헌을 대상으로 체계적 분석을 시행하였다. 검색어는 (Cognitive Orientation to daily Occupational Performance OR CO-OP) AND (Stroke OR Cerebrovascular accident)이며, 총 164편 중 선정 및 배제기준에 따라 뇌졸중 환자를 대상으로 CO-OP 중재를 시행한 실험 문헌 9편을 최종 선택하여 문헌에 대해 분석하였다. 결과: 분석한 문헌 중 무작위 대조실험 연구는 6편(66.67%)으로 질적 수준이 비교적 높았다. 대상자는 뇌졸중 후 1~6개월이 가장 많았으며, 선별조건으로는 인지 및 의사소통 능력이 중요 요소임을 확인할 수 있었다. 대상자가 선택한 중재 활동 영역으로는 기본적 일상생활활동(Basic Activities of Daily Living)과 수단적 일상생활활동(Instrumental Activities of Daily Living)이 가장 많았으며, 중재기간은 4주 또는 7주, 10회기, 각 주당 3회 미만이 가장 많이 실시되고 있었다. 모든 문헌에서 작업수행 향상에 초점을 두고 있었으며, 상지기능 및 건강 상태 같은 다른 영역의 효과를 제시하고 있었다. 종속변인 평가도구는 주로 작업수행 관련이 나타났으며, 그중 캐나다작업수행측정(Canadian Occupational Performance Measure) 과 Performance Quality Rating Scale이 가장 많이 사용되고 있었다. 결론: 본 연구에서는 CO-OP 중재를 적용한 뇌졸중 환자의 특성, 선별조건, 중재 활동, 중재 효과 및 형태, 종속변인 평가도구 및 실험연구의 근거 수준을 확인하였고, 이는 뇌졸중 환자를 대상으로 한 CO-OP 중재의 연구와 교육 방향에 기초자료로 활용될 수 있을 것이다.

Background: Kinesio taping is being applied to improve ankle dorsiflexion in stroke patients. Currently, the elasticity of kinesio taping is applied in various ways. Objectives: To investigated the effect of tibialis anterior kinesio taping elasticity level on gait speed in stroke patients. Design: A randomized cross-over pilot study. Methods: A total of 12 study subjects were allowed to experience three conditions within a single group. The three conditions are strong elastic taping condition, weak elastic taping condition, and non-elastic taping condition. Study subjects were randomly assigned to each condition sequentially. For the evaluation, gait variables (cadence, gait speed, stride length) were measured 24 hours after applying the taping appropriate for each condition. Results: The strong elastic taping condition significantly increased gait variables compared to the weak elastic taping and non-elastic taping conditions (P<.05). Weak elastic taping significantly increased gait variables compared to non-elastic taping (P<.05). Conclusion: As tibialis anterior kinesio taping elasticity increased, gait variables significantly improved in stroke patients.

Background: Most studies targeting stroke patients have confirmed improvements in balance and walking using immersive and non-immersive virtual reality training programs. However, to date, there are not many studies targeting brain activation enhancement for the two training programs. Objectives: The purpose of this study is to investigate the effect of a virtual reality training program on the EEG of stroke patients according to differences in immersion. Design: A randomized controlled trial. Methods: A total of 20 stroke patients, with 10 in an immersive virtual reality training programs group (IVRG) and 10 in a non-virtual reality training programs group (NVRG) were randomly assigned to exercise three times a week for 6 weeks. EEG was measured for 2 minutes using DSI-24. Results: The intra-group difference in relative alpha waves of brain waves was not significant for both groups, and the between-group difference was not significant. Differences in EEG relative beta waves in the experiment group were significant in the Fp1, Fp2, Cz, C3, C4, P3, and O2 in the experiment group, and significant in the Cz and O2 in the control group. As a result of comparing the differences between each group before and after, there was a significant difference in the Fp1 area. Conclusion: Virtual reality training programs based on differences in immersion were found to have a positive effect on EEG. Therefore, it is believed that a virtual reality training program based on differences in immersion can be provided as a clinical intervention method for EEG.

Background: Stroke patients experience a variety of physical problems due to neurological problems, including difficulties with trunk control. Trunk taping is used to improve gait in stroke patients. Objectives: To investigated the immediate effect of thoracic and abdominal elastic taping on gait parameters (the dynamic balance and gait speed) in stroke patients. Design: Quasi experimental study. Methods: A total of 24 study subjects were randomly assigned to the experimental group (thoracic and abdominal taping, 12 people), and the control group (sham taping, 12 people). All subjects had timed up and go (TUG) test and 10 meter walk test (10MWT) measured before and after taping. Results: After taping, the TUG test and 10MWT results were significantly reduced only in the study group (P<.05). The TUG test and 10MWT results of the study group were significantly decreased compared to the control group. Conclusion: The thoracic and abdominal taping was found to improve trunk control in stroke patients, thereby improving dynamic balance and walking speed.

Background: Hemiparesis not only affects the affected side but also exerts an impact on the unaffected side. Stroke patients endure muscular weakness attributable to hemiparesis, resulting in asymmetry of muscular strength between the paralyzed and non-paralyzed sides. Objectives: To investigate the correlation between lower limb muscle strength asymmetry and functional factors in patients with stroke. Design: A cross-sectional study. Methods: A total of 58 stroke patients participated in this study. After measuring the muscle strength of both lower limbs using manual muscle testing, the asymmetry was calculated. Functional factors such as berg balance scale (BBS), timed up and go (TUG), 10-metre walk (10MW), and modified barthel index (MBI) were measured. Results: The BBS showed positive correlations with hip, knee, and ankle strength asymmetry (P<.05). The TUG showed negative correlations with hip, knee, and ankle strength asymmetry (P<.05). The 10MW showed negative correlations with hip, knee, and ankle strength asymmetry (P<.05). The MBI showed positive correlations only with hip strength asymmetry (P<.05). Conclusion: We were found that there is a more pronounced lower limb muscle strength asymmetry in the lower extremity of stroke patients, which is associated with BBS, TUG, and 10MW.

Background: As ways to optimize the mobilization of postural stability muscles for sitting up motions, arm reaching motions and head raising motions have important effects. Objectives: This study was conducted to investigate the effects of reaching to sit-up training on the trunk muscle activity, postural ability, and balance ability of patients with hemiplegia due to stroke. Design: Randomized controlled trial. Methods: This study was conducted with 18 stroke patients who met the selection criteria divided into two groups: a study group of 9 patents and a control group of 9 patients. The study group carried out reaching to sit-up training, which can promote trunk muscles and improve control through trunk interactions. The control group received general physical therapy intervention Results: The activity of the trunk muscle was significantly different before and after intervention in study and control group. The functional reaching test showed significant changes in both the study group and the control group. The timed up and go test showed a significant change in the study group. Conclusion: Reaching to sit-up training for 4 weeks showed increases in trunk muscle activity in stroke patients and was effective in improving balance ability.

Background: ErigoPro enables acute stroke patients to carry out stable weight-bearing training with gradual verticalization. Study on the effectiveness of robotic assisted treatment equipment for chronic patients is insufficient. Objectives: This study aims to investigate the effect of dynamic vertical posture training using ErigoPro on trunk alignment and balance in chronic stroke patients. Design: Randomized controlled trial. Methods: The subjects of this study were 30 patients were randomly assigned to a study group of 15 patients and a control group of 15 patients. The study intervention was carried out for 50 minutes per day consisting of 30 minutes of general neuro-physiotherapy and 20 minutes of ErogoPro training, 3 times a week for 8 weeks. Results: The study group showed difference in trunk inclination (P<.05), kyphotic angle (P<.05), lateral deviation of the spine (P<.05), thoracic angle (P<.01), timed up and go test (P<.01), Berg balance score (P<.01). There was a significant difference between the groups in the trunk inclination (P<.05), timed up and go test (P<.01), Berg balance score (P<.05). Conclusion: It could be seen that the treatment combined with ErigoPro training for 8 weeks was effective in restoring trunk alignment and improving balance ability in chronic stroke patients.

Ischemic stroke causes severe neuronal damage. Chlorogenic acid is a phenolic substance present in fruits and coffee. It also exerts neuroprotective effects against various brain injuries. The 14-3-3 family protein perform a variety of functions including metabolism, signal transduction, cell differentiation, and apoptosis. The purpose of this study is to investigate whether chlorogenic acid regulates the expression of 14-3-3 protein in stroke animal models. Ischemic stroke was induced by middle cerebral artery occlusion (MCAO) surgery. Phosphate buffered saline (PBS) or chlorogenic acid (30 mg/kg) were intraperitoneally injected to adult male rats 2 h before MCAO surgery. Adhesive-removal test was performed 24 h after MCAO surgery and cerebral cortical tissues were collected for further study. MCAO damage caused severe neurological impairment and chlorogenic acid treatment ameliorated this disorder. Our proteomic approach showed a decrease in 14-3-3 expression in MCAO animals with PBS. The decrease in 14-3-3 expression alleviated in MCAO animal with chlorogenic acid. We confirmed changes in various 14-3-3 protein isoforms, including beta/alpha, zeta/delta, gamma, epsilon, eta, and tau through reverse transcription-PCR. These results explained that chlorogenic acid regulates the expression of 14-3-3 protein in MCAO-induced cerebral ischemia. 14-3-3 is considered to be an important protein for cell survival through binding to pro-apoptotic proteins. The maintenance of 14-3-3 levels is an important event in neuroprotection against ischemic injury. Therefore, we can demonstrate that the 14-3-3 protein contributes to the neuroprotective effect of chlorogenic acid in stroke animal models.

목적 : 본 연구는 몰입형 가상현실과 비몰입형 가상현실 두 가지 형태의 가상현실 기기를 이용한 중재가 만성 뇌졸중 환자의 상지기능 향상에 미치는 효과를 알아보고자 하였다. 연구방법 : 연구 대상은 뇌졸중 발병 후 6개월 이상인 편마비 환자 3명이었다. 연구설계는 단일대상실험연 구(single-subject research design)인 AB 디자인과 교차 연구설계(alternating design)를 사용하였 다. 중재효과를 측정하기 위한 상지기능 평가는 Box and Block Test와 Fugl-Myer Assessment를 사 용하였고, 연구진행은 기초선 4회, 중재 기간 16회를 포함하여 총 20회기를 진행하였다. 연구결과는 시 각적 그래프와 2SD 구간을 설정하여 분석하였다. 결과 : 연구결과는 비몰입형과 몰입형 가상현실 중재법 모두 기초선과 비교하여 Box and Block Test, Fugl-Myer Assessment 점수가 확연히 증가하였다. 그러나 비몰입형 가상현실 중재와 몰입형 가상현 실 중재 간의 의미있는 차이는 발견할 수 없었다. 결론 : 본 연구는 몰입형 가상현실을 이용한 중재가 비몰입형 가상현실을 이용한 중재와 같이 만성 뇌졸중 대상자의 상지기능 향상에 긍정적인 효과를 줄 수 있다는 것을 확인하였다. 이러한 결과는 만성 뇌졸중 대상자들의 상지기능 향상을 목표로 하는 임상현장에서 가상현실 중재와 연구에 유용한 자료가 될 것이 라 사료된다.

In this study, the change in the mold opening stroke of important functional parts according to the 20, 50, 80, and 100% increase in the injection speed of a hydraulic 150 ton hydraulic injection molding machine was studied to verify the accuracy of the injection speed and mold opening stroke and the reproducibility of the standard deviation. The null and alternative hypotheses were confirmed by conducting hypothesis verification according to the experimental condition change using the experimental design method.

Ischemic stroke causes brain damage and neuronal cell death by depriving oxygen and nutrients and releasing excessive levels of glutamate and intracellular calcium. Epigallocatechin gallate (EGCG) is a polyphenolic compound present in green tea. It has antioxidant, anti-inflammatory, and neuroprotective effects. Hippocalcin is a calcium binding protein that regulates calcium concentration, neuronal differentiation, neuronal excitability, and neuronal cell death. In this study, we investigated whether EGCG regulates the expression of hippocalcin in neurons and astrocytes after focal cerebral ischemia. Cerebral ischemia was induced by meddle cerebral artery occlusion (MCAO). EGCG (50 mg/kg) or PBS was injected into the abdominal cavity just before MCAO surgery. Neurobehavioral tests were performed to evaluate the effect of EGCG on neurological behavioral deficits 24 h after MCAO surgery. Immunofluorescence staining was performed to evaluate the positive response to hippocalcin in the cerebral cortex after MCAO surgery. We also detected the positive reactions of neuronal nuclear protein (NeuN) and glial fibrillary acidic protein (GFAP) as markers of neuron and astrocyte, respectively. MCAO caused severe neurological impairment and EGCG treatment attenuated these impairments. MCAO damage reduced the number of NeuN-positive cells and increased the number of GFAP-positive cells. This result indicates a decrease in neurons and an increase in astrocytes. However, EGCG alleviated these changes caused by MCAO damage. MCAO reduced the number of hippocalcin-positive cells in neurons and astrocytes, and EGCG treatment attenuated these reductions. Hippocalcin exerts neuroprotective effect through regulating intracellular calcium concentration. In conclusion, EGCG regulates the expression of hippocalcin in neurons and astrocytes and has neuroprotective effects in focal cerebral ischemia.

Since the increased focus on the essential role of recovering cognitive function after stroke, cognitive rehabilitation of stroke survivors has been important. This study aimed to provide basic data on the successful cognitive rehabilitation of stroke survivors through an literature review of virtual reality cognitive rehabilitation. Methods: The literature review method of Whittemore and Knaf was used. Data was searched on papers published before April 2023, and RISS, NDSL, and KISS were used for the search. Four studies were selected for analysis. Results: The cognitive function of the experimental group applied with the virtual reality cognitive rehabilitation was significantly improved. In the three studies, cognitive function was significantly improved compared to the control group. Conclusion: Findings from the review suggest the necessity of a virtual reality cognitive rehabilitation for older stroke survivors to verify its effectiveness.

Background: Stroke is one of the causes affecting gait and balance. Taping is considered an effective method for improving balance and gait in stroke patients. Numerous studies have confirmed the functional effects of taping in stroke patients. However, there is still no consensus regarding the use of taping to improve gait and balance. Objects: The purpose of this review was to investigate the effects of taping on the balance and gait of patients with stroke through meta-analysis of studies. Methods: PubMed, Medline, Embase, Web of Science, Cochrane Review, RISS, DBPia, and Science on were used to collect articles on Kinesio and non-elastic taping. The key terms were “Stroke”, “Hemiplegia”, “Taping”, “Tape”, “Balance”, and “Gait” with cut-off of October, 2022. Taping group was compared with control groups with sham, placebo, and no taping. The outcome measures included the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and gait speed (cm/s). Eighteen studies (524 patients) were selected for the meta-analysis. Results: Overall, taping improved balance and gait in stroke patients, and Kinesio and nonelastic taping had similar effect sizes. Taping improved the BBS and TUG, and was most effective on gait speed. Contrary to the expectation that a longer duration of taping would be more affective, taping was most effective when the total taping duration was shorter than 500 minutes. In addition, the effect size of taping was greater when it was simultaneously attached to multiple locations. Conclusion: This meta-analysis supports the use of taping to improve gait and balance in stroke patients, and provides guidelines for the location, duration, and type of tape to increase taping efficiency.

목적 : 본 연구는 뇌졸중 환자가 외래 작업치료 서비스를 받기 위해 이동하는 동안 경험하는 어려움과 의존성을 현상학적 연구를 통하여 깊이 있게 이해하고 뇌졸중 환자의 이동권과 독립성 확보를 위한 자료로 제시하고자 한다. 연구방법 : 연구 대상자는 현재 재활 병원 외래 재활치료실에 통원 치료 중이며 이동성에 제한을 겪고 있는 뇌졸중 환자들 중 여성 3명, 남성 2명으로 구성하였다. 면담 기간은 2022년 9월이었으며, 자료 수집을 위하여 일대일 심층 면담으로 실시하였고 면담 내용은 녹음 및 필사로 담아 반복적으로 분석하였다. 수집된 자료 분석을 위해 현상학적 연구인 Giorgi의 방법에 따라 4단계로 분석하였다. 결과 : 뇌졸중 환자들의 이동 경험에 대해 면담한 결과, 20개의 의미단위들을 찾아내어 10개의 주요의미와 4개의 주제를 도출하였다. 4개의 주제는 일상생활의 변화, 이동의 제약, 의존적인 몸과 마음, 장애인 이동권에 대한 깜깜함이었으며, 이동과 관련되어 어려움을 겪는 뇌졸중 환자들은 개인이 처한 상황과 신체적인 기능, 주변 환경에 따라 다르게 나타났다. 결론 : 본 연구를 바탕으로 뇌졸중 환자뿐만 아니라 지역사회 내 이동에서 어려움을 겪는 모든 장애인들을 위해 물리적, 환경적 그리고 제도적 개선을 통하여 이들의 이동권을 보장하고 독립성을 향상시킬 수 있는 노력이 필요할 것으로 사료 된다.

Background: Studies using Smovey and Vibration foam rollers are mostly conducted with normal adults, breast cancer patients, and athletes. However, there are not many studies applied to stroke patients to date. Objectives: The purpose of this study is to investigate the effect of vibration exercise on the range of motion of the shoulder and knee joints in stroke patients. Design: A randomized controlled trial. Methods: A total of 36 stroke patients, with 12 in the Smovey and Vibration foam roller group (SVG), 12 in the Smovey and Non-Vibration foam roller group (SNVG), and 12 in the control group (CG) were randomly assigned to exercise three times a week for 6 weeks. The range of motion of the shoulder and knee joints was measured for each group before and after 6 weeks of exercise. For joint range of motion, shoulder flexion and extension and knee flexion and extension were measured using BPMpro. Results: In terms of the difference in time, the flexion and extension of the shoulder and the flexion and extension of the knee on the paretic side were significant in the SVG and SNVG. The CG was not significant. Shoulder flexion and extension and knee flexion and extension on the unaffected side were all insignificant. The differences between each group were significant between the SVG and the CG and the SNVG and the CG. SVG and SNVG were not significant. Conclusion: It was found that vibration exercise had a positive effect on the range of motion of the shoulder and knee joints. Therefore, it is thought that vibration exercise can be provided as a clinical intervention method for shoulder and knee range of motion.

Background: Core muscle weakness occurs due to trunk asymmetry and spinal malalignment after stroke. Core exercise is being implemented to improve trunk control and sitting position in stroke patients. Objectives: To investigated the effects of core muscle electrical stimulation on trunk control and dynamic balance in stroke patients. Design: Quasi-experimental study. Methods: A total of 30 stroke patients were recruited and divided into two groups: experimental group (core muscle electrical stimulation group) and control group (sham core muscle electrical stimulation group). Trunk impairment scale (TIS) was used to measure trunk control. BioRescue was used to measure sitting dynamic balance. Results: In both groups, all TIS scores and sitting dynamic balance abilities were improved increased significantly after intervention (P<.05). Changes in TIS scores and sitting dynamic balance abilities were significantly greater in the experimental group than the control group (P<.05). Conclusion: It was found that core muscle electrical stimulation can be used as an effective method for trunk control and balance recovery in stroke patients.

Background: In order to improve the daily life of stroke patients, it is necessary to restore walking performance. Improving gait performance is one of the main goals for stroke rehabilitation. Objectives: To investigate the change in gait parameters through evaluation of one stroke patient before, during, and after wearing the weight vest. Design: A case study. Methods: This study is an ABA study design. In principle, one assessment per day (A1) was measured three times without wearing the weight vest. Intervention assessment (B) was performed 6 times while wearing the weight vest. The second baseline evaluation (A2) was measured three times with the weight vest removed again. Results: The gait speed was increased when the weight vest was removed than when the weight vest was worn. Also, gait symmetry increased when wearing the weight vest. Conclusion: Wearing the weight vest can reduce the gait asymmetry in stroke patients and increase the gait speed after wearing the weight vest.

Background: A weight-bearing jacket during treadmill gait training is being used for rehabilitation in stroke patients. However, the effect on various gait parameters has not been confirmed. Objectives: The purpose of this study was to investigate the comparison of exercise intensity through speed increase and weight-bearing jacket during treadmill gait training to restore gait ability in stroke patients. Design: Randomized controlled trials. Methods: This study recruited 24 stroke patients. The subjects were randomly assigned to the experimental group (wearing a weight-bearing jacket during treadmill gait training, n=12) and the control group (speed increase during treadmill gait training, n=12). Gait measurement device (G-walk) was used to measure the gait parameters of the subjects. Results: Both the experimental group and control group showed a significant increase in cadence, gait speed, stride length, and gait symmetry index post intervention (P<.05). In comparison between the two groups, the experimental group showed a significant increase in the gait symmetry index post the intervention than the control group (P<.05). Conclusion: Through this study, it was found that wearing a weight-bearing jacket was a more effective method for improving the gait symmetry index than increasing speed during treadmill gait training in stroke patients.

Background: For the rehabilitation of stroke patients, it is necessary to confirm the differences in the mechanical properties of the paretic- and non-pareticside masseter muscles. Objectives: To investigate the muscle tone and stiffness of masseter muscles in patients with chronic stroke. Design: A case study. Methods: This study included 20 stroke patients. Muscle tone and stiffness of the paretic and non-paretic masseter muscles in stroke patients were measured using MyotonPRO. Measurements were performed under relaxation and masseter muscle contraction conditions. Results: There was no significant difference in the muscle tone and stiffness of the paretic and non-paretic side masseter muscles in the relaxation conditions (P>.05). In male, left hemiplegia, right hemiplegia and infatction, the nonparetic side masseter muscles showed significantly increased than musle tone and stiffness of the paretic side masseter muscles in the contraction (P<.05). In female and hemorrhage, the non-paretic side masseter muscles showed significantly increased than musle tone the paretic side masseter muscles in the contraction (P<.05). Conclusion: The muscle tone and stiffness were lower on the paretic side than on the non-paretic side during masseter muscle contraction in stroke patients; thus, muscle strengthening training was required.