Inclusive design is increasingly gaining attention, as some people find using products difficult after becoming physically impaired, despite daily use. However, making inclusive products is a challenge for designers or companies, as a lack of knowledge and tools stems their low involvement in it. Developing inclusive design tools is thus needed. This study developed criteria to assess upper extremity capabilities corresponding to specific daily activities. A questionnaire survey was conducted among 58 physiatrists and orthopedists. Non-parametric statistics were employed and medians were adopted as representative scores in the assessment criteria based on normality and reliability test results, non-normal data, and strong reliability of respondents in ranking. Consequently, an assessment tool was developed with 14 criteria (divided into range of motion and strength) and capability scores between 0 and 100, which discerned the moderately impaired from the severely disabled and fully capable. Since the doctors agreed to adopt the criteria but assign numeric values, especially for mild impairments, their capability assessment perception was likely influenced by dichotomy. To compensate for these deficits, qualitative or ergonomic approaches are considered simultaneously.

목적 : 본 연구를 통하여 뇌손상으로 인한 편마비 아동들에게 10주 동안 적용된 수정된 강제유도 운동치료가 환측 상지의 운동․감각능력 및 일상생활에서의 환측 상지 사용 빈도에 미치는 효과를 알아보고자 하였다. 연구방법 : 본 연구는 개별사례 실험 연구 방법 중 반전연구(reversal design or ABA design)로 설계되었으며, 서울장애인종합복지관에서 뇌병변으로 인한 편마비 진단을 받고 재활치료 중인 4명의 아동을 대상으로 17주간 실시되었다. 총 17주의 연구기간은 3주간의 기초선 1기간, 10주간의 치료 적용기간, 4주간의 기초선 2기간(치료후 관찰기간)으로 이루어져 있다. 치료 기간 동안 대상 아동들에게 주 5회, 하루 5시간동안 강제유도 운동치료를 적용하였다. 치료 전․후의 환측 상지의 기능을 평가하기 위해 두점 인식능력과 모노필라멘트를 사용한 촉각 검사, 멜버른 검사를 실시하였고, Motor Activity Log(MAL) 중 아동에게 적용 가능한 20항목을 발췌한 부모작성일지를 사용하여 환측 상지 사용빈도를 측정하였다. 결과 분석을 위하여 대상자별로 측정된 상지의 운동 및 감각기능과 일상생활에서 환측 상지 사용 빈도의 평균값을 기술 통계적으로 제시하고 시각적 그래프를 통하여 기초선, 치료기간과 치료 후의 차이를 비교하였다. 결과 : 수정된 강제유도 운동치료 후 편마비 아동의 상지 운동 및 감각기능과 일상생활에서의 환측 상지 사용 빈도가 치료 전에 비해 향상되었고, 이러한 치료 효과는 치료종료 후 1개월까지 유지되었다. 결론 : 본 연구 결과는 장시간의 건측 상지 운동 제한에 따른 거부감으로 인해 아동에게 적용하기 어려웠던 기존 강제유도 운동치료의 문제점을 개선한 수정된 강제유도 운동치료는 적용시간을 각 아동의 특성에 맞게 조절하여 활용한다면 임상 재활치료에서 편마비 아동의 기능회복에 효과적으로 적용될 수 있을 것으로 기대된다.

The purpose of this study was to investigate the effect of Modified Constraint-Induced Therapy (MCIT) on the effected upper extremity of children with hemiparesis. Four children with hemiparetic upper extremity caused by brain injuries were trained by MCIT for ten weeks. During the same period, all of the subjects were also involved in thirty-minute regular physical therapy and occupational therapy. During the treatment period, the unaffected upper extremities of the subjects were restrained by a specially designed hand splint or a mitten for five hours a day, five days per week. For two hours out of the five-hour restraint period, the affected upper extremities were intensively trained by performing various functional tasks, which were individually structured to emphasize use of the affected arm. A single-subject design with A-B-A reversal was employed in this study. The affected limb motor ability was evaluated by Melbourne Assessment, measuring the time to grasp and release nine pegs, and measuring grasping power. As a consequence of this study, the affected limb motor test scores of all four subjects in the baseline period were improved during the treatment period. Furthermore, the treatment effect was maintained during a one-month follow-up period. The results of this study support the assumption that MCIT is an effective therapeutic method to improve the sensory and motor abilities of hemiparetic children. It also increases the frequency of functional use of the hemiparetic hands of brain-injured children. Based on the results of this study, it can also be assumed that the modified CIT method is especially beneficial to these children by reducing the negative emotional effects of forceful restraint of the unaffected upper extremity. To optimize the functional recovery of the paretic upper extremity by CIT, the restriction period per day should be decided individually, according to the characteristics of the individual.