Background: Various functional tests such as upper quarter Y-balance test (UQYBT) are used to evaluate shoulder stability and mobility in clinical or sports fields. Previous studies have been conducted to determine the correlation between the scapular or trunk muscle and UQYBT. However, the correlation between UQYBT and hip flexor, which can be considered as a core muscle, has not been confirmed. Objects: To verify the relationship between the UQYBT and scapular muscle (scapular protractor and lower trapezius [LT]), trunk muscle, and hip flexor strengths in healthy male participants. Methods: A total of 37 healthy male participants were recruited and underwent UQYBT in the push-up posture. The isometric strength of the scapular protractor, LT, trunk flexor and extensor, and hip flexors were measured using a smart KEMA strength sensor (KOREATECH Inc.). Results: The superolateral direction of the UQYBT was moderately to strongly related to trunk extensor (r = 0.443, p < 0.01), scapular protractor (r = 0.412, p < 0.05), LT (r = 0.436, p < 0.01), and both sides of the hip flexors (supporting-side: r = 0.669, p < 0.01; non-supporting- side: r = 0.641, p < 0.01). The inferolateral direction of the UQYBT was moderately related to the scapular protractor (r = 0.429, p < 0.01), LT (r = 0.511, p < 0.01), and both sides of hip flexors (supporting-side: r = 0.481, p < 0.01; non-supporting-side: r = 0.521, p < 0.01). The medial direction of the UQYBT was moderately to strongly related with the scapular protractor (r = 0.522, p < 0.01), LT (r = 0.541, p < 0.01), and both sides of hip flexors (supporting-side: r = 0.605, p < 0.01; non-supporting-side: r = 0.561, p < 0.01). Conclusion: This study showed that the strength of the scapular muscles, trunk muscles, and hip flexor muscles correlated to the UQYBT. Therefore, the strength of not only the scapular and trunk muscles but also the hip flexor muscles should be considered to improve the UQYBT.

Background: Despite the fact that aquatic exercise is one of the most popular alternative treatment methods for children with cerebral palsy (CP), there are few research regarding its effectiveness. Objects: The purpose of this study was to examine the effects of aquatic exercise on upper extremity function and postural control during reaching in children with CP. Methods: Ten participants (eight males and two females; 4–10 years; Gross Motor Function Classification System levels II–IV) with spastic diplegia were recruited to this study. The aquatic exercise program consisted of four modified movements that were selected from the Halliwick 10-point program to enhance upper extremity and trunk movements. The participants attended treatment two times a week for 6 weeks, averaging 35 minutes each session. The Box and Block Test (BBT), transferring pennies in the Bruininks-Oseretsky Test (BOT), and pediatric reaching test (PRT) scores were used as clinical measures. Three-dimensional motion analysis system was used to collect and analyze kinematic data. Differences in BBT and BOT values among pre-treatment, post-treatment, and retention (after 3 weeks) were analyzed using a Friedman test. In addition, the PRT scores and variables (movement time, hand velocity, straightness ratio, and number of movement units) from the three-dimensional motion analysis were tested using a Wilcoxon signed-rank test. The significance level was established at p < 0.05. When the results appeared to be statistically significant, a post-hoc test for multiple comparisons was performed with the Wilcoxon signed-rank test. Results: All clinical measures, which included BBT, transferring pennies of BOT, and PRT, were significantly increased between pre-intervention and post-intervention scores and between pre-intervention and retention scores after treatment (p = 0.001). Three-dimensional motion analysis mostly were significantly improved after treatment (p = 0.001). Conclusion: Aquatic exercise may help to improve body function, activity, and participation in children with varying types of physical disabilities.

Background: Scapular dyskinesis may cause not only rotator cuff (RC) tear but also weakness of the upper extremity, studies on scapular dyskinesis that may occur after RC repair is still lacking. Objects: To determine whether scapular dsykinesis was present in patients after arthroscopic RC repair and to investigate the influence of passive scapular stabilization on upper extremity strength. Methods: A total of 30 patients after RC repair participated in this study. To compare the scapula of the arthroscopic RC repair shoulder and the contralateral shoulder, the winged scapula (WS) was measured using a scapulometer and scapular dyskinesis was also classified by type. Fixed instruments for muscle strength measurements were used to measure upper extremity muscle strength differences depending on passive scapular stabilization position or natural scapular position. A chi-square test, an independent t-test and a 2-way mixed measures analysis of variance (ANOVA) was used as statistical analysis. In analyses, p < 0.05 was deemed to be statistically significant. Results: Postoperative shoulder had a significant association with scapular dyskinesis and the WS compared to the contralateral shoulder (F = 0.052, p < 0.01). Postoperative shoulder, muscle strength in the shoulder abduction (p < 0.01), elbow flexion (p < 0.01) and forearm supination (p < 0.05) were significantly greater in the scapular stabilization position than in the scapular natural position. Conclusion: Patients underwent arthroscopic RC repair had a significant association with scapular dyskinesis and muscle strength was improved by a passive scapular stabilization position, therefore scapular stabilization is important in rehabilitation program.

Background: Although various conventional approaches have been employed to reduce spasticity in neurological rehabilitation, only a few studies have shown scientific evidence for its effectiveness. Thus, we introduced a different concept (Ueda method) of rehabilitation therapy that can complement the limitations of conventional therapy. Objects: This study aimed to investigate the immediate effects of the application of the Ueda method on patients with spasticity after stroke via an electrophysiological study. Methods: We conducted a randomized double-blind pilot study in two rehabilitation hospitals involving 30 stroke patients who were randomly allocated to the Ueda (n = 15) and convention (n = 15) groups. Electromyographic data of six examined muscles in both upper extremities of all patients were recorded. The A-ApA index and activation ratios of upper extremity muscles were evaluated and compared between the groups to confirm post-intervention changes in upper-extremity flexor spasticity and flexion synergies. Repeated-measures analysis of variance was conducted to confirm the therapeutic effect (2 × 2) as a function of group (Ueda vs. convention) and time (pre-/post-intervention) on all outcome measures (p < 0.05). Results: In the Ueda group, the mean A-ApA index values differed significantly before and after the intervention (p = 0.041), indicating a weak evidence level; however, the effect size was medium (d = –0.503). The interaction effects of the A-ApA index between the Ueda and convention groups and between pre-intervention and post-intervention stages were significant (p = 0.012). The effect size was large (np 2 = 0.220). In the Ueda group, the activation ratios of the anterior deltoid fiber significantly decreased after the intervention in all reaching tasks. Conclusion: The Ueda method reduces upper-extremity flexor spasticity and changes its synergy in stroke patients and should be considered a rehabilitation therapy for spastic stroke patients.

Background: Push-up are effective exercises for shoulder stability. Previous studies have documented the effects of support plane and hand position and width on muscle activities during a push-up. Objects: This study aimed to investigate the changes in muscle activities in the upper extremity when performing the standard and the knee-flexed push-up with different hand shapes. Methods: A total of twenty-six healthy males participated in this study. Three different hand shapes (finger abduction, finger adduction, and fists) and two types of push-up posture (standard and knee-flexed push-up) were set as the independent variables. Electrograms were used to measure the muscle activity of the upper trapezius (UT), triceps brachii (TB), pectoralis major (PM), and serratus anterior (SA). Each participant performed the randomly assigned push-up to the sound of the metronome. The mixed-effect linear regression model was used to detect the changes in muscle activities after changing the hand shape and push-up posture. Statistical significance was set at α = 0.05. Results: The UT muscle activity was statistically significantly higher when performing push-up with fists than finger abduction (p = 0.035) or finger adduction (p = 0.044). During the standard push-up, the muscle activity in all muscles was that the push-up with fists showed the highest muscle activity compared to the finger abduction (p < 0.01) and finger adduction (p < 0.01). Regardless of the shape of the hand, UT had the lowest muscle activity compared to other muscles (p < 0.001). In contrast, the SA muscle had the highest muscle activity among four muscles during the standard push-up. Conclusion: Based on the results of this study, we suggest hand shape is related to the difficulty level of push-up either in the standard or the knee-flexed push-up, especially in the push-up with fists. In addition, knee push-up can be recommended as shoulder musclestrengthening exercises for individuals with low shoulder muscle strength.

목적 : 본 연구는 일상생활 활동을 보조하기 위한 상지 보조기기 중재 연구의 대상자, 적용된 보조기기의 유형 및 동향, 중재 결과를 도출하기 위한 종속 변인 및 평가도구에 대해 알아보고자 하였다. 연구방법 : 문헌검색은 국내・외 데이터베이스인 RISS, KCI, Scopus, Web of Science를 이용하였다. 문헌선택은 Preferred Reporting Items for Systematic Reviews and Meta-Analysis(PRISMA)흐름도 에 따라 진행하였다. 최종적으로 14편의 연구를 분석대상으로 선정하였다. 최종 선정된 논문은 근거를 기반으로 한 연구의 질적 수준(hierarchy of level of evidence for evidence-based practice)분석모델과 Critical Appraisal Skills Programme Case Control Checklist(CASP Case Control Checklist)를 활용하여 근거 수준과 적용된 방법론의 질을 평가하였다. 결과 : 전체 14편의 연구 중, 7편의 논문이 근거 수준 Level 3인 단일집단 비 무작위 연구였으며, 12편의 연구가 CASP case control checklist의 모든 항목을 충족하였다. 근육병 장애인을 대상으로 상지 보조 기기를 적용한 연구가 6편으로 가장 많았다. 적용된 보조기기는 암 서포트가 5편, 로보틱 암이 4편이었 으며, 비교적 최근일수록 로보틱스, 3D 프린팅 등 고도화된 기술과 융합되었다. 중재 결과를 도출하기 위하여 설정된 종속변수로는 상지 수행력이 31.7%, 상지 기능이 29.3%를 차지하였다. 결론 : 본 연구를 통해 일상생활 활동 보조를 위한 상지 보조기기 연구와 서비스의 방향성을 제시하고자 하였다. 향후에는 체계적인 연구 설계를 기반으로 높은 근거 수준의 연구가 이루어져야 할 것이며, 실사용자와 보호자를 대상으로 보조기기 사용이 미치는 다양한 요소에 대한 효과성 검증이 이루어져야 할 것이다.

Background: The CKCUES test evaluates the functional performance of the shoulder joint. The CKCUES test scores CKC exercises of the upper limbs to examine shoulder stability. Although the CKCUES test provides quantitative data on functional ability and performance, no study has determined the relationship between CKCUES scores and SA and TB muscle strength. Objects: The objective of this study is to determine the relationship between the CKCUES test scores and the strength of the SA and TB muscles in the CKCUES and unilateral CKCUES tests. Methods: Sixty-six healthy male volunteers participated in the study. A Smart KEMA strength sensor measured SA and TB muscle strength. Two parallel lines on the floor indicated the initial hand placement to start CKCUES tests. For 15 seconds, the subject raises one hand and reaches over to touch the supporting hand, then returns to the starting position. Results: The correlation between the CKCUES test scores and the strength of the SA was strong (r = 0.650, p < 0.001), and the TB was moderate (r = 0.438, p < 0.001). The correlation between the unilateral CKCUES test and the strength of the SA of the supporting side was strong (r = 0.605, p < 0.001), and swing side was strong (r = 0.681, p < 0.001). The correlation between the unilateral CKCUES test and the strength of the TB of the supporting side was moderate (r = 0.409, p < 0.001), and swing side was moderate (r = 0.482, p < 0.001). Conclusion: Our study showed that the CKCUES test had a strong association with isometric strength of SA and moderate association with that of TB. These findings suggest that the CKCUES test can evaluate the function of the SA. Moreover, the unilateral CKCUES test can evaluate unilateral shoulder function.

목적 : 본 연구의 목적은 최근 10년간 뇌졸중 환자의 상지기능 회복을 위해 사용된 가상현실 중재들에 대해 알아보고 체계적으로 고찰을 실시하고자 한다. 연구방법 : 2010년 1월부터 2020년 12월까지 Research Information Sharing Service(RISS), Koreanstudies Informatin Service System(KISS), DBpia, PubMed, ScienceDirect, Scopus의 온라 인 데이터 베이스에 등록된 논문을 검색하였다. 최종적으로 18개의 Randomized Controlled Trials(RCT) 논문을 대상으로 PICO 방법을 사용하여 분석하였다. 결과 : 뇌졸중 환자의 상지기능 회복을 위해 사용된 가상현실 중재방법은 9개였고, 총 18회 사용되었다. 그중 Nintendo Wii가 4회(22.22%), 가상현실 프로그램이 4회(22.22%)로 가장 많았다. 연구 분석 결과 뇌졸중 환자의 상지기능 향상에 Nintendo Wii와 가상현실 프로그램이 효과적인 것으로 나타났다. 결론 : 뇌졸중 환자의 상지기능 향상을 위한 가상현실 중재방법의 종류와 빈도를 제시하였고 가장 많이 사용되는 Nintendo Wii와 가상현실 프로그램의 중재 방법에 대한 근거 논문들을 중재 방법, 중재 기간 및 횟수, 중재효과를 표로 만들어 제시하였다. 결과는 임상 치료사들이 치료방법 및 기간, 평가도구를 선택하는데 근거 자료로 사용할 수 있을 것이다.

Background: Weakness of the abdominal and mid thoracic muscles the lead to thoracic kyphosis of stroke patients. The trunk muscles activity of stroke patients is significantly related to upper extremity. Objectives: To investigate the effect of seated exercise of thoracic and abdominal muscles on upper extremity function and trunk muscles activity in stroke patients. Design: One-group pretest-posttest design. Methods: A total of 27 stroke patients were recruited. All stroke patient were given seated abdominal exercise (posterior pelvic tilt exercises) and thoracic exercise (postural-correction exercise). All exercises were conducted for 30 minutes, three times a week for four weeks. The manual function test (MFT) and electromyography (EMG) were measured, and EMG electrodes were attached to thoracic paraspinal muscles and lower rectus abdominal muscles. EMG signal is expressed as %RVC (reference voluntary contraction). Results: Experimental group showed significant increases in abdominal muscles, paraspinal muscles activity and MFT total score, items of arm motion (forward elevation of the upper extremity, lateral elevation of the upper extremity, touch the occiput with the palm) in MFT after four weeks. Conclusion: These results suggest that, in stroke patients, seated exercise of thoracic and abdominal muscles contribute to improve trunk muscles activity and upper extremity function in stroke patients.

본 연구에서는 호흡 운동으로 인한 상지의 운동 인공물을 억제하기 위해 고정 기구를 제작하고 사용 여부에 따른 유용성을 검증하였다. 검사 방법은 검사 부위에 따른 운동 인공물의 영향을 평가하기 위해 상지를 상완, 팔꿈치, 전완으로 구분하였다. 영상분석은 위상 부호화 방향의 배경영역에서 평균 신호 값 측정을 통해 운동 인공물의 발생 정도를 평가하였다. 고정 기구를 사용하지 않은 상태에서 상지 MRI 영상들을 획득한 검사 결과, 검사 부위에 따라 운동 인공물이 유의미한 차이가 있는 것으로 나타났다(p<0.00). 팔꿈치에서 측정한 평균 신호들은 전완 부위와 비교하여 1.05~1.11배가 상승했지만, 특히 상완 부위에서 측정한 신호는 2.2~2.5배로 상당히 큰 증가를 했다. 또한, 고정 기구를 사용한 상태에서 획득한 영상의 평균 신호 값들은 정 기구를 사용하지 않은 상태와 비교해 모든 부위에서 감소하였다(p<0.05). T1w에서 부위 별로 상완 62.68%, 팔꿈치 39.78%, 전완 47.03% 줄어들었고, T2w에서도 상완 58.22%, 팔꿈치 38.22%, 전완 46.49%로 각각 감소하였다. 본 연구 결과 제작된 고정 기구의 사용은 상지의 모든 부위에서 운동 인공물이 억제되었다(특히 상완에서 58.22~62.68%). 상지 MRI 검사에서 고정 기구의 사용은 영상 변수조절 없이 호흡에 의한 운동 인공물을 감소시킬 수 있으며 운동 인공물과 관련된 재검사를 방지할 수 있어 수검자의 편의 및 업무 효율을 증대시키는 데 큰 도움이 될 수 있다.

목적 : 본 연구는 short thumb opponens splint 착용이 분만성 상완 신경총 손상 아동의 상지 기능과 손 기능에 미치는 효과를 알아보고자 실시하였다. 연구 방법 : 분만성 상완 신경총 손상으로 진단 받은 11세 남성 아동 1명을 대상으로, 증례 보고 방법 중 (single-subject experimental research design) ABA’ 설계를 사용하였다. 총 20회기로 매주 1회기씩 20주간 진행하였다. 기초선 5회기는 중재 없이 평가하였고 중재기 10회기는 하루 6시간 short thumb opponens splint를 착용 하는 중재를 실시한 후 평가하였다. 추적기 5회기는 중재 없이 평가하였다. 평가는 손기능 평가를 위한 상자와 나무토막 검사(Box and Block Test; BBT), 상지 기민성 검사(nine-hole pegboard test)와 분만성 상완 신경총 손상 환자의 상지 기능 평가를 위한 Mallet scale, active movement scale 검사를 통해 변화를 알아보았다. 결과 : short thumb opponens splint 중재 결과, 상지 기능(Mallet scale, active movement scale)과 손기능(BBT, nine-hole pegboard test)은 중재 전에 비해 유의하게 향상되었다. 결론 : short thumb opponens splint 착용이 분만성 상완 신경총 손상 아동의 상지 기능과 손기능향상에 효과가 있다는 것을 확인하였고, 향후 분만성 상완 신경총 손상 환자의 임상적 중재의 기초 자료로 활용될 수 있을 것이다.

Background: Despite muscle latency times and patterns were used as broad examination tools to diagnose disease and recovery, previous studies have not compared the dominant arm to the non-dominant arm in muscle latency time and muscle recruitment patterns during reaching and reach-to-grasp movements. Objects: The present study aimed to investigate dominant and non-dominant hand differences in muscle latency time and recruitment pattern during reaching and reach-to-grasp movements. In addition, by manipulating the speed of movement, we examined the effect of movement speed on neuromuscular control of both right and left hands. Methods: A total of 28 right-handed (measured by Edinburgh Handedness Inventory) healthy subjects were recruited. We recorded surface electromyography muscle latency time and muscle recruitment patterns of four upper extremity muscles (i.e., anterior deltoid, triceps brachii, flexor digitorum superficialis, and extensor digitorum) from each left and right arm. Mixed-effect linear regression was used to detect differences between hands, reaching and reach-to-grasp, and the fast and preferred speed conditions. Results: There were no significant differences in muscle latency time between dominant and non-dominant hands or reaching and reach-to-grasp tasks (p>.05). However, there was a significantly longer muscle latency time in the preferred speed condition than the fast speed condition on both reaching and reach-to-grasp tasks (p<.05). Conclusion: These findings showed similar muscle latency time and muscle activation patterns with respect to movement speeds and tasks. Our findings hope to provide normative muscle physiology data for both right and left hands, thus aiding the understanding of the abnormal movements from patients and to develop appropriate rehabilitation strategies specific to dominant and non-dominant hands.

목적 : 본 연구는 인지 중재 비율을 조절한 점진적 관찰감소 동작관찰훈련과 기존의 동작관찰훈련에 대한 상지기능 변화를 비교하여 효율적인 중재 방법을 알아보고자 실시하였다. 연구방법 : 14명의 만성 뇌졸중 환자를 대상으로 7명의 실험군은 점진적 관찰감소 동작관찰훈련을, 7명의 대조군은 기존의 동작관찰훈련을 주 3회, 30분씩, 4주간 실시하였고 각 군은 기존에 실시하던 전통적 작업치료 및 물리치료 역시 시행하였다. 상지 운동기능의 사전, 사후 평가는 울프운동기능검사(Wolf Motor Function Test; WMFT), 상지기능장애 설문지(Disabilities of the Arm, Shoulder and Hand; DASH), 상자와 나무토막 검사(Box and Block Test; BBT)를 사용하였고, 각 군의 중재 전과 후의 차이는 윌콕슨 부호 순위검정(Wilcoxon signed-ranks test), 두 군 간의 중재 후 효과 비교는 맨 휘트니검정(Mann-Whitney U test)을 사용하여 분석하였다. 결과 : 점진적 관찰감소 동작관찰훈련군과 기존의 동작관찰훈련군은 모두 WMFT, DASH, BBT에서 통계적으로 유의한 변화가 있었다(p<.05). 점진적 관찰감소 동작관찰훈련군과 기존의 동작관찰훈련군의 상지기능 변화량 비교에서는 WMFT의 소요시간과 DASH의 점수에서 점진적 관찰감소 동작관찰훈련군이 더 많은 변화 가 있었으며 통계적으로 유의한 차이가 있었다(p<.05). 결론 : 본 연구 결과 중재기간에 따라 인지 중재 비율을 고려한 점진적 관찰감소 동작관찰훈련이 기존의 동작관찰훈련보다 상지기능 향상에 효과적이었다는 것을 알 수 있었다. 따라서 만성 뇌졸중 환자의 상지기능 향상을 위한 동작관찰훈련의 중재 시 인지비율을 고려한 중재 전략이 필요하다.

목적 : 작업치료중재를 통한 유방암 환자의 신체기능과 근 활성도 및 삶의 질에 미치는 효과를 알아보고자 하였다. 연구방법 : 본 연구는 유방암 환자 15명을 대상으로 스트레칭, 치료적 활동 및 일상생활활동으로 구성된 작업 치료중재 프로그램을 40분씩 주 2회 총 12주 동안 실시하였다. 신체기능은 한국판 간이 피로 평가지 (Korean version of Brief Fatigue Inventory; BFI-K), 기본 호흡곤란 지표(Baseline Dyspnea Index; BDI)를, 근 활성도는 surface Electromyoghraphic (sEMG)를, 그리고 암 치료 관련 기능적 평가 - 유방 암(Functional Assessment Cancer Therapy-Breast; FACT-B)를 통하여 삶의 질을 측정하였다. 결과 : 신체기능에서 피로도와 호흡곤란 정도는 감소하였으며(p<.01), 근 활성도는 앞쪽․중간 어깨세모근, 큰가슴 근의 복장갈비머리 부분, 가시아래근에서 유의하게 증가하였다(p<.05). 삶의 질은 총점과 하위 영역 중 Physical Well-Being(PWB), Functional Well-Being(FWB), Breast Cancer Subscale(BCS)가 통계적 으로 유의한 차이를 나타냈다 (p<.001). 결론 : 중재 후 신체기능과 근 활성도, 삶의 질 모두에서 향상을 보였으며 이는 작업치료 중재가 유방절제 술 환자의 회복에 도움이 될 것으로 생각된다.

목적 : 과제 기반의 거울치료가 뇌졸중 환자의 상지 운동 기능과 일상생활 상지사용 회복에 미치는 효과를 알아보고자 한다. 연구방법 : 본 연구에서 사용된 연구 설계는 사전-사후 대조군 설계이다. 연구의 대상자는 뇌졸중 편마비 진 단을 받은 실험군 8명, 대조군 10명으로 이루어져 있다. 모든 대상자는 중재 기간 동안 동일한 수준의 일반 적 재활치료를 받았고 실험군은 과제 기반의 거울치료를 추가로 적용받았다. 과제 기반의 거울치료는 4주 간, 주 5회, 1회 30분씩 총 20회기로 구성되었다. 결과 분석은 기술 통계와 피셔 정확검정(Fisher's exact test), 윌콕슨 부호순위 검정(Wilcoxon signed-rank test), 만-휘트니 U검정(Mann-Whitney U test) 시행하였다. 결과 : 사전 평가에서의 집단 간 차이는 나타나지 않았다. 중재 후, 과제 기반의 거울치료를 적용한 실험군에 서는 Fugl-Meyer Motor Assessment(FMA), Action Research Arm Test(ARAT), Motor Activity Log(MAL), 팔꿈치 관절 움직임의 순발력, 부드러움에서 매우 유의한 효과를 나타내었다. 일반적 재활치료 만 받은 대조군에서는 실험군과 마찬가지로 ARAT와 MAL의 점수 증가를 보였으나, FMA 점수와 팔꿈치 관절 움직임에서의 질적 향상은 나타나지 않았다. 집단 간 비교에서는 FMA, ARAT, MAL, 팔꿈치 관절 움직임의 순발력, 부드러움에서 유의한 차이를 보였다. 결론 : 과제 기반의 거울치료를 이용한 중재가 뇌졸중 환자의 상지 운동 기능과 일상생활상지사용 회복에 효과가 있음을 확인하였다.

Background: Shoulder stabilization commonly involves two components: the glenohumeral stabilization exercise (GSE) and scapular stabilization exercise (SSE). Despite the fact that the shoulder stabilization has advantageous merit, to our knowledge, only a few studies have compared the superior of the GSE and the SSE. Objects: The purpose of this study was to assess the effects of GSE in patients with nonspecific shoulder pain. Methods: Thirty subjects with nonspecific shoulder pain were randomly divided into an experimental group and control group, each with 15 patients. The experimental group used an GSE, whereas the control group did SSE. All subjects were measured in shoulder stability, scapular symmetric alignment, pain, muscle power, and range of motion before and after the intervention. Results: GSE resulted in significantly better shoulder stability (p=.046, from 8.67±7.54 score to 13.93±9.40) in the experimental group compared with SSE in the control group. However, no significant effects were observed for scapular symmetric alignment including the angles of inferior scapular distance (p=.829) and inferior scapular height difference (p=.735), pain (p=.113), muscle power including shoulder flexion (p=.723) and abduction (p=.897) and range of motion including shoulder flexion (p=.853) and abduction (p=.472). Conclusion: These findings suggest that GSE may be more effective in increasing the shoulder stability than the SSE in patients with nonspecific shoulder pain, probably through a centralization effect on the shoulder mechanism.

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.

This study evaluated and compared the effectiveness on upper motor extremity function between proprioceptive neuromuscular facilitation which has been frequently used in clinical practice, and action observation training in terms of improving upper motor extremity function. A study with a single-subject design (A-B-C-A') was conducted with a patient who was diagnosed with left hemiplegia. A repeated-measure analysis was conducted to assess results of the Wolf Motor Function Test (WMFT), Box and Block Test (BBT), and grip and pinch strength test performed daily in the study for 4 weeks. The results of the analysis indicated that the WMFT score, BBT score, grip strength, and pinch strength were improved from 29.60 to 39 (24.10%), from 1.67 to 4.93 each (EA) (66.22%), from 2.06 to 2.66 libras (lbs) (22.61%), and from 1.57 to 1.93 lbs (18.94%), respectively, from the baseline period to treatment period B. The values were improved from 29.60 to 42.20 (29.86%), from 1.67 to 7 EA (76.21%), from 2.06 to 3.47 lbs (40.57%), and from 1.57 to 1.67 lbs (6.12%), respectively, from the baseline period to treatment period C. From treatment period B to treatment period C, the WMFT score, BBT score, and grip strength were improved from 39 to 42.20 (7.58%), from 4.93 to 7 EA (29.56%), and from 2.66 to 3.47 lbs (23.20%), respectively, but pinch strength was decreased from 1.93 to 1.67 lbs (15.83%). In conclusion, proprioceptive neuromuscular facilitation and action observation training both have positive effects on upper extremity motor function. However, we suggest that the posttreatment effect of action observation training was better than that of proprioceptive neuromuscular facilitation.

본 글은 거울신경세포시스템에 대한 신경학적 기전에 대하여 알아보고 이에 근거한 동작관찰훈련에 대한 문헌 고찰을 통해 임상에서 신경계환자의 재활치료에 있어 치료적 접근법으로써 사용될 수 있음을 제안하기 위해 작성되었다. 거울신경세포시스템은 특정한 동작의 움직임이나 다른 개체가 움직이는 것을 관찰할 때 활동하는 신경세포를 말하며, 인간의 운동앞이랑, 아래마루엽과 아래이마이랑, 마루엽영역, 위 관자엽고랑을 포함하는 배쪽운동앞겉질에 존재한다고 알려져 있다. 이러한 신경학적 근거에 따라 사용되 고 있는 치료방법에는 동작관찰훈련이 있는데, 동작을 관찰하고 관찰한 동작을 다시 모방하여 반복적으 로 훈련하는 방법이며, 다른 사람의 행동을 관찰함으로써 형태와 동작을 이해하고, 선택하고 모방하여 운동학습의 단계까지 이르는 훈련방법을 말한다. 현재 동작관찰훈련의 치료적 효율성과 임상적용에 대해 서는 관련 연구들이 진행되고 있으며, 해당 연구들에서 기능향상의 효과가 있음이 보고되고 있다. 이러 한 동작관찰훈련방법은 불가능한 움직임보다는 가능한 움직임, 즉 실제 사람의 손의 움직임을 관찰하는 직접적인 방법이나 목적지향적인 과제에 대해서 관찰을 시킬 때 더욱 활성화 시킬 수 있다. 이러한 거울 신경세포에 근거한 동작관찰훈련은 치료적 측면을 떠나 퇴원 후 가정에서도 지속적으로 수행하기 용이 하고, 경제적으로도 비용절약에 효과적인 방법이라 할 수 있겠다. 따라서 본 글에서는 이러한 거울신경 세포시스템에 대한 신경학적 근거에 대해 알아보고 그와 함께 거울신경세포시스템에 근거한 동작관찰훈 련을 적용한 연구를 고찰함으로써 신경계재활치료영역에 있어서 그 효율성과 치료적 적용 가능성에 대 해 알아보고자 한다.

목적:본 연구는 전통적인 치료와 비교했을 때, 강제 유도 운동치료가 편마비를 가진 뇌성마비 아동의 상지 기능에 미치는 효과를 메타분석을 통해 알아보고자 한다. 연구방법:국내외 검색엔진을 이용하여 자료를 수집하였으며, 2006년∼2013년까지 게재된 14편의 연구를 선정하였다. 선정기준에 적합한 논문을 대상으로 PEDro score를 사용하여 질적 평가를 실시하였으며, 상지기능의 사전-사후 평균과 표준편차, 표본수를 사용하여 메타분석을 실시하였다.결과:선정된 14편의 연구는 PEDro score가 6점 이상이었으며, 연구 참여자는 527명이었다. 효과크기 분석 결과 환측 상지의 운동 능력, 사용빈도 및 질에서는 “큰 효과크기”를 나타내었고 통계적으로 유의한 수준이었다(p<.001). 또한 분리된 움직임, 잡기 능력, 시각 운동 통합 능력에서는 “보통 효과크기”를 나타내었으며 통계적으로 유의하였다(p<.05).결론:강제 유도 운동치료는 전통적인 치료보다 편마비를 가진 뇌성마비 아동의 상지 기능 회복에 있어 더 효과적임을 알 수 있었다. 이것은 임상에서 편마비를 가진 뇌성마비 아동의 상지 기능을 회복하기 위한 치료 방법으로 객관적인 근거가 될 수 있다.