목적 : 본 연구의 목적은 뇌졸중 환자의 우울, 재활동기, 일상생활동작과 삶의 질 간의 상관관계를 종합적으로 파악하여 재활에 관여하는 작업치료사들에게 뇌졸중 환자의 삶의 질을 향상시킬 수 있는 임상적 개입방향을 제시하는데 도움을 주고자 하는데 있다. 연구방법 : 본 연구는 2008년 6월 7일부터 2008년 8월 1일까지 14개 종합병원, 2개 재활전문병원, 1개 장애인종합복지관의 MMSE-K 24점 이상인 뇌졸중 환자를 대상으로 설문지(BDI, 장애인의 재활동기 측정도구, MBI, SS-QOL)를 이용해 자료를 수집하였으며 총 123부를 최종적으로 분석하였다. 결과 : 우울과 삶의 질은 유의미한 높은 음의 상관관계(p<.001)를 보였으며, 일상생활동작과 삶의 질은 유의미한 양의 상관관계(p<.001)를 보였다. 삶의 질에 영향을 미치는 변수로는 우울(p<.001)과 일상생활동작(p<.001) 그리고 인구사회학적 변인 중에서 월수입(p<.05)이었으며 이들 변수는 삶의 질을 47.9% 설명하였다. 결론 : 뇌졸중 환자의 삶의 질 향상을 위하여 뇌졸중 환자의 재활에 있어서 급성기로부터 우울과 불안 등의 심리적, 정서적 문제를 정기적으로 확인, 조기에 발견하여 개입함으로써 삶의 질에 부정적으로 영향을 미치는 요소를 제거하는 노력을 기울여야 한다. 또한 일방적인 경제적 지원이 아니라 직업재활의 기회를 마련해 줄 수 있는 다양한 프로그램을 제공해 준다면 이들의 삶의 질은 더욱 높아질 것이다.

목적 : 본 연구의 목적은 국내 인지재활의 가정환경 프로그램 모델을 소개하고 프로그램 적용의 효과를 알아보기 위함이다. 연구방법 : 2005년 6월부터 12월까지 발병 후 6개월 이상 된 뇌졸중 환자로 재활치료 기관에서 정기적인 인지재활치료를 받지 않은 환자 6명을 대상으로 하였다. 가정환경 인지재활 프로그램은 전반적인 행동지침, 체계적 인지훈련 지침서, 고안된 인지활동, 독립적 일상생활활동 참여의 4개 영역으로 구성되어져 있다. 가정환경 프로그램은 가정에서 선별된 가족 구성원과 협력하여 전문치료사 2명이 체계적인 모니터와 면담을 통해 중재하고 통제하였으며 총 12주간 진행되었다. 프로그램 적용 전후 인지기능 수준과 기본적, 수단적 일상생활동작 수행 수준을 평가하고 비교하기 위해 LOTCA와 MBI, S-IADL을 시행하였다.결과 : 비모수 검증인 윌콕슨 부호순위검증을 통해 프로그램 중재 전후 인지기능 수준과 일상생활 수행력 수준을 비교한 결과 인지기능 수준을 반영하는 LOTCA 점수에서 적용 전 보다 적용 후에 유의한 향상을 보였고(p<.05), 수단적 일상생활 수행력을 반영하는 S-IADL에서 의미 있는 점수의 차이를 보였다(p<.05). 그러나 기본적 일상생활 수행력을 반영하는 MBI 점수에서는 유의한 차이를 보이지 않았다.결론 : 본 연구에서 제시한 인지재활의 가정환경 프로그램은 뇌졸중 환자에게 있어서 전반적인 인지기능의 향상과 가정환경 및 지역사회로의 적응도를 높이는데 효과적일 것으로 사료된다.

목적 : 뇌졸중 환자의 편측무시와 시각적 주의력에 대한 Dynavision의 훈련 효과를 알아보는 것이다. 연구방법 : 편측무시 증상을 나타내는 좌측 편마비 뇌졸중 환자를 대상으로 개별실험 연구 방법(single subject research design) 중 AB 설계를 사용하였다. 기초선 기간에서는 Dynavision을 이용한 치료를 하지 않고 시각적 주의력을 대변하는 Dynavision 불빛에 대한 반응 시간과 반응횟수를 4회기 동안 측정하였다. 치료 기간에는 Dynavision을 이용한 치료 후 반응시간과 반응횟수를 측정하였다. 치료 프로그램은 visual tracking, self-paced, digital flash 프로그램으로 구성하였고 3주 동안 12회기를 시행하였다. 치료 전 편측무시 증상의 변화를 알아보기 위해 선나누기 검사(line bisection test)를 실시하였다. 결과 : 대상자는 기초선 기간보다 치료 기간 동안에 시각 자극에 대한 반응횟수가 증가되었고 반응시간은 감소되었다. 또한 Dynavision 치료 후에 선나누기 검사의 오류 정도가 감소하였다. 결론 : Dynavision은 뇌졸중 환자의 편측무시 증상과 이와 관련된 시각적 주의력을 향상 시키는 치료에 유용하게 사용될 수 있는 도구이다.

The purpose of this experiment was to investigate the applicability of audio-visual modeling for improving the efficiency of rehabilitative programs by analyzing the effects of observing these various models on the capacity of stroke patients to perform upper limb activities. Twenty-one stroke patients participated in the experiment and were randomly assigned to either task modeling, sport modeling, or control group. During 2 weeks of intervention, subjects in all groups participated in the physical practice of experimental tasks. These tasks comprised of a Nine Hole Peg Test, the Jebsen-Taylor Hand Function tests, and locomotion. These tasks were performed 5 days a week, 30 min per day. In addition to the physical practice, the task modeling group observed a model performing experimental tasks and locomotive activities for 20 min, while the sport modeling group observed a model performing various sport activities for 20 min. Subjects' ability to perform the experimental tasks was measured 3 times, before, immediately after, and 1 week after the intervention. Analyses of the capacity to perform upper extremity activities displayed significant improvement from the pre-test to immediate and delayed post-tests in all groups. However, the amount of improvement was the highest in the task modeling group. The task modeling group was superior to the control group in the post-test of all experimental tasks, whereas the sport modeling group did not display significant differences from the control group. These results suggest that audio-visual modeling can be used as an effective cognitive intervention for facilitating the rehabilitation of stroke patients, and its rehabilitative effect can be maximized when the program is comprised of performance scenes directly related to the target task.

The purpose of this study was to investigate the relations between financial stress, depression, and conjugal affection and the motivation for rehabilitation. One hundred eighty-six stroke patients were included in the study and a survey with 65 questions was used. The survey includes questions to evaluate personal factors, characteristics related with physical therapy, characteristics related with disease, depression, conjugal affection, and motivation for rehabilitation. Education, employment, left hemiplegia and right hemiplegia, depression, financial stress, conjugal affection were statistically significant factors (p<.05). These variables have significant effects on motivation for rehabilitation. This study indicates that financial stress and depression need to be decreased to improve motivation for rehabilitation of stroke patients. It also indicates that the factors facilitating conjugal affection, education, and occupation need to be considered for rehabilitation programs.

Objectives : To study and compare the effects of monocular patching and half-eyes patching on the unilateral neglect of stroke patients.Methods : Eleven stroke patients with the unilateral neglect were enrolled. To these patients eight tests such as line bisection test, Albert’s test, letter cancellation test, shape cancellation test, house copying, daisy copying, clock drawing, and reading task were applied for the evalua-tion of the unilateral neglect. These tests were done without patching and with monocular and half-eyes patching respectively.Results : Eye patching methods were effective for reducing the unilateral neglect in 11.1 ∼ 57.1% of patients. Half-eyes patching was significantly effective in clock drawing test(p=.02), In general half-eyes patching was more effective than monocular patching.Conclusion : We suggest that eye patching method could be used as an effective and prac-tical way to reduce the unilateral neglect of the stroke patients.

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.

The purpose of this article was to explore the potential for the use of mental practice for the rehabilitation in persons with stroke. Clinical application of mental practice in physical medicine and rehabilitation have not flourished to the same extent as application of mental practice to sports psychology. Studies from the disciplines of kinesiology, neurophysioloy and psychology support the use of mental practice in the post-stroke population. A model is included to demonstrate how mental practice can work through motivation, cognition and neural reorganization to facilitate motor relearning and functional independence. Recent evidence using modern brain-imaging techniques suggest that motor planning during both imagined and actual movements use very similar brain centers. Influencing factors such as imaging ability, task, and method of instructions are discussed. The advantage and disadvantage of using mental practice are included. The potentials of mental practice as a method of promoting and acquiring the exercise functions of stroke patients are being recognized, and is expected to have high effectiveness as a method of improving the functions of the patients in the field of occupational therapy.

The purpose of this study was to investigate effect of robot-assisted hand rehabilitation(AmadeoⓇ) on hand motor function in chronic stroke patients. This study used a single-subject experimental design with multiple baselines across individuals. Three chronic stroke survivors with mild to sever motor impairment took part in study. Each participants had 2 weeks interval of starting intervention. Participants received robot-assisted therapy(45min/session. 3session/wk for 6wks). Finger active range of motion(AROM) was assessed by Range of Assessment program in AmadeoⓇ, and test-retest reliability was verified using Pearson correlation analysis. To investigate effect of AmadeoⓇ, finger AROM was measured immediately after each sessions and Fugl-Meyer Assessment of Upper extremity, Motor Activity Log, Nine hole peg board test and Jebsen-Taylor hand motor function test were assessed at pre-post intervention. Results were analyzed by visual analysis and comparison of pre-post tests. The test-retest reliability of Range of Assessment was good(r=.99). After robot-assisted therapy, finger AROM of participant 1, 2, and 3 was respectively improved by 18%, 3.6%, and 6% each. Hand motor function of participant 1, 3 was improved on all four tests, but not effect in participant 2. Robot-assisted hand rehabilitation could improve finger AROM and effect on hand motor function in chronic stroke patients.