EMG Biofeedback을 이용한 닫힌사슬운동이 슬개대퇴통증증후군의 생체역학적 특성에 미치는 영향

강재영 동신대학교 일반대학원 2012 국내석사

<초 록> EMG biofeedback을 이용한 닫힌사슬운동이 슬개대퇴통증증후군의 생체역학적 특성에 미치는 영향 강 재 영 동신대학교 대학원 물리치료학과 지도교수 : 김 경 윤 본 연구는 슬개대퇴통증증후군(patellofemoral pain syndrome, PFPS)을 가진 대상자에서 내측사선광근의 선택적 강화를 위해 EMG biofeedback을 이용한 닫힌사슬운동이 슬개대퇴관절의 통증, 기능적 능력, 하지의 생체 역학적 특성, 근육의 기능적 특성에 미치는 영향을 규명하기 위해 실시하였다. 연구대상자는 선정기준에 맞는 30명의 PFPS를 가진 대상자를 대조군(Ⅰ), 닫힌사슬운동군(Ⅱ), EMG biofeedback을 이용한 닫힌사슬운동군(Ⅲ)으로 각 10명씩 무작위 배정하였으며, 주 3회(30분) 6주 동안 중재하였다. 중재 전·후에 시각적 통증 척도(visual analog scale, VAS), 기능적 능력 척도(Kujala patellofemoral score, KPS), 하지의 생체 역학적 검사 그리고 근전도 분석을 통해 결과는 다음과 같은 결과를 얻었다. 시각적 통증 척도와 기능적 능력 척도에서 Ⅰ군과 비교 시 Ⅱ군, Ⅲ군에서 유의한 차이를 나타냈고(p<.01), Ⅱ군과 Ⅲ군 간에서는 유의한 차이를 나타내지 않았다. 하지의 생체 역학적 검사 항목 중 슬괵근 길이 변화와 무릎 굴곡 각도가 0° 일 때 Q-각의 변화에서는 유의한 차이가 없었으나, 무릎 굴곡 각도가 60° 일 때 Q-각의 변화에서는 Ⅰ군과 비교 시 Ⅲ군에서 유의한 차이를 나타냈다(p<.01). 근전도 분석의 모든 항목 중 %최대수의적수축력(%MVC)과 최대수의적수축 시 중앙주파수(median frequency), 내측사선광근/외측광근 근활성비에서는 모든 군 간에 유의한 차이를 나타냈고(p<.001), 스쿼트 자세를 하는 동안 중앙주파수와 내측사선광근/외측광근 근활성비에서는 Ⅰ군과 비교 시 Ⅱ군과 Ⅲ군에서 각각 유의한 차이를 나타냈다(p<.05). 본 연구 결과 PFPS를 가진 대상자에게 치료 효율성을 높이기 위하여 닫힌사슬운동 시 해당 근육의 실시간 생체정보가 제공되는 EMG biofeedback을 이용하여 근 활성도를 자가 조절함으로서 근 조절 반응능력을 향상시켜 하지의 생체 역학적 변화 및 근 기능이 향상됨을 정량화시켜 비교, 분석 하였다. 추후 다양한 재활 훈련 프로그램 내에 EMG biofeedback을 활용함으로서 환자가 치료의 주체가 될 수 있는 한 가지 방안을 제시한 것으로 생각된다. <ABSTRACT> The Effect of Closed Kinetic Exercise using EMG Biofeedback on Biomechanical Characteristics in Patellofemoral Pain Syndrome Kang, Jae-young Dept. of Physical Therapy Graduate School of Dongshin University Supervised by Professor Kim, Kyung-yoon The purpose of this study was to investigate the effect of patellofemoral joint pain, functional ability, biomechanical characteristics of lower extremity, and functional characteristics of muscle during the closed kinetic chain exercise using EMG biofeedback for the selective training of vastus medialis oblique(VMO) in subjects with patellofemoral pain syndrome(PFPS). Thirty participants that meet the criteria were studied. Paticipants were randomly allocated into control group(Group I, n=10), closed kinetic chain group(Group II, n=10), and closed kinetic chain using EMG biofeedback group(Group III, n=10). Intervention was performed in three groups three times a week for six weeks. Before and after the experiment, they were measured by visual analog scale(VAS), kujala patellofemoral score(KPS), lower extremity biomechanics, and EMG analysis. The results of this study are as follows. There were some significant differences in VAS and KPS on group II and group III compared with group I(p<.01). There was no significant difference on hamstring muscle and Q-angle at knee flexion angle 0°. But there were some significant differences on group III compared with group I on Q-angle at knee flexion 60°(p<.01). There were some significant differences on %maximum voluntary contraction(%MVC), median frequency(MDF), VMO/vastus lateralis(VL) activity ratio among all groups during MVC(p<.001). There were significant differences on group II and group III compared with group I on MDF and VMO/VL ratio during squats.(p<.05). The result of this study is that subjects with PFPS improved ability to adjust muscle response by doing self control of muscle activity when they performed closed kinetic chain exercise using the EMG biofeedback that provides real-time biometric information of selected muscles in order to increase the efficiency of treatment. And then biomechanical change of lower extremity and improvement of muscle function were quantitated, compared and analyzed. In the future it will be considered as suggesting a plan that patient will be main agent of treatment by using EMG biofeedback in various rehabilitation training programs.

시각적 바이오피드백을 이용한 흉추가동성 운동이 요통환자의 통증과 균형에 미치는 영향

우경석 고려대학교 의용과학대학원 2019 국내석사

This study was done to assess the changes in low back pain when the thoracic mobility exercise program with visual biofeedback using a laser beam for static standing balance and pain. The research object 44 people were selected from low back patients whom it visits in subject of Gyeonggi-do S hospital rehabilitation medicine and they were randomly divided into two groups with 22 subjects for the thoracic mobility exercise program with visual biofeedback group and 22 subjects for the thoracic mobility exercise program without visual biofeedback group. Both exercise programs were done 2 times a week for 8 weeks, and the subjects were tested for Visual Analogue Scale, Thoracic Mobility Test, Static Standing Balance Test and Skin Distraction Test. All the subjects were reassessed with the same measurements at a pre-study examination and 8 weeks after the study. The data analysis was done using SPSS ver. 20 for windows to ensures the data collection and it was carried out based on statistical significant level of 5%. Paired-t test and independent t-test was used to compare before and after treatment. As a result of data analysis, Visual Analogue Scale shows statistically significant decrease on thoracic mobility exercise program with visual biofeedback batter than thoracic mobility exercise program without visual biofeedback. Thoracic Mobility Test shows statistically significant increase on thoracic mobility exercise program with visual biofeedback batter than thoracic mobility exercise program without visual biofeedback. Static Standing Balance Test shows statistically significant increase on thoracic mobility exercise program with visual biofeedback batter than thoracic mobility exercise program without visual biofeedback. Skin Distraction Test was not significant difference between thoracic mobility exercise program with visual biofeedback and thoracic mobility exercise program without visual biofeedback. In conclusion, the thoracic mobility exercise program with visual biofeedback compared to the thoracic mobility exercise program without visual biofeedback demonstrated decrease Visual Analogue Scale, increased Thoracic Mobility and Static Standing Balance. Therefore, Improving thoracic spine mobility may be effective in decreasing low back pain and improving lumbar function in low back pain patients. The thoracic mobility exercise program with visual biofeedback improves the ability to maintain the right posture which eventually leads to improvement in efficiency of movement and Static Standing Balance can be retrieved.

실시간 초음파 영상과 표면 근전도를 이용한 시각적 바이오피드백이 어깨관절 벌림 시 가시위근 두께와 중간 어깨세모근 활성도에 미치는 영향

이동우 대구대학교 대학원 2019 국내석사

(초 록) 본 연구의 목적은 정상 남자 성인에 있어서 어깨관절 벌림 시 실시간 초음파 영상과 표면 근전도를 이용한 시각적 바이오피드백이 가시위근 두께와 중간 어깨세모근 활성도에 어떠한 영향을 미치는지 알아보고, 어깨관절 벌림 시 효과적인 시각적 바이오피드백 방법을 확인하고자 실시하였다. 본 연구의 대상자들은 최근 2년간 어깨관절에 관하여 의학적 치료를 받지 않은 건강한 성인 남성 17명을 대상으로 선정하였다. 어깨관절 벌림 시 각 조건은 시각적 피드백을 적용하지 않은 어깨관절 벌림, 실시간 초음파를 통한 가시위근 두께 영상을 시각적 바이오피드백으로 적용한 어깨관절 벌림 그리고 실시간 표면 근전도를 사용해 중간 어깨세모근 활성도를 시각적 바이오피드백으로 적용한 어깨관절 벌림으로 설정하였으며, 실험 대상자들은 어깨뼈면을 따라서 어깨관절 벌림을 30도에서 60도까지 시행하였다. 시각적 바이오피드백을 적용하지 않은 어깨관절 벌림을 시행한 후, 두 가시 시각적 바이오피드백을 무작위 순서로 배치하여 실시하였으며, 시각적 바이오피드백을 적용한 어깨관절 벌림 측정 전 10분간의 익숙화 훈련을 실시하였다. 각 조건 간 학습효과 및 이월효과를 줄이기 위하여 15분간 휴식을 제공하였다. 각 조건간의 비교를 위하여 대상자들의 우세 측 팔의 가시위근의 근 두께, 중간 어깨세모근과 위 등세모근의 근 활성도 그리고 가시위근 두께 변화에 따른 중간 어깨세모근 활성도를 측정하였다. 가시위근 두께는 초음파 진단 장비를 이용하여 측정하였고, 중간 어깨세모근과 위 등세모근의 근 활성도는 무선 표면 근전도를 이용하여 측정하였다. 가시위근 두께 변화에 대한 중간 어깨세모근 활성도는 가시위근 두께 변화량을 중간 어깨세모근 활성도에 대해 나눈 값을 사용하였다. 자료 분석은 일요인 반복 측정 분산분석을 사용하였으며, 각 조건 간의 비교를 위하여 사후분석으로 최소유의차검정을 사용하였다. 본 연구의 결과, 초음파를 적용한 어깨관절 벌림과 표면 근전도를 적용한 어깨관절 벌림에서 가시위근 두께가 시각적 바이오피드백을 적용하지 않은 어깨벌림 보다 유의하게 증가하였다. 위 등세모근 활성도는 시각적 바이오피드백을 적용하지 않은 어깨관절 벌림과 시각적 바이오피드백을 적용한 어깨관절 벌림 간의 유의한 차이를 나타내지 않았다. 하지만, 표면 근전도를 적용한 어깨관절 벌림에서 중간 어깨세모근 활성도가 시각적 바이오피드백을 적용하지 않은 어깨관절 벌림 보다 유의하게 감소하였다. 가시위근 두께 변화에 대한 중간 어깨세모근 활성도에서는 초음파를 적용한 어깨관절 벌림과 표면 근전도를 적용한 어깨관절 벌림에서 시각적 바이오피드백을 적용하지 않은 어깨관절 보다 값이 유의하게 감소하였다. 가시위근 두께 측정에 대한 측정자내 신뢰도는 급내상관계수 값 범위 0.97에서 0.99로 높은 신뢰도를 나타내었다. 결과적으로, 중간 어깨세모근의 활성을 감소시키고, 가시위근의 활성을 증가 시키는 방법으로 실시간 초음파 영상과 표면 근전도를 이용한 방법 모두 효과적인 시각적 바이오피드백으로 적용 될 수 있으리라 생각된다. 또한, 실시간 초음파 영상과 표면 근전도를 이용한 시각적 바이오피드백이 가시위근 손상 시 재활에 필요한 가시위근의 근력강화 훈련에 효과적으로 적용될 수 있을 것이라 기대된다. (Abstract) The purpose of this study was to determine the immediate effects of visual biofeedback on the thickness of the supraspinatus muscle and activity of the middle deltoid muscle during shoulder abduction, when using real-time ultrasonographic imaging and surface electromyogram. This study was performed in healthy adult males. Seventeen subjects volunteered to participate in this study. Each subject performed shoulder abduction from 30° to 60° on the scapular plane under three conditions, with the thickness of the supraspinatus muscle being imaged using real-time ultrasonographic biofeedback (SRUB), middle deltoid muscle activity being measured using surface electromyogram biofeedback (MsEB) and without visual biofeedback. The sequence of shoulder abductions using visual biofeedback was performed in a random order. Subjects were familiarized with the abduction for ten minutes before performing each shoulder abduction using visual biofeedback. Fifteen minutes of rest time were allowed between SRUB and MsEB shoulder abduction to avoid any learning or carry-over effects. Supraspinatus muscle thickness was measured using ultrasonic diagnostic equipment. Middle deltoid and upper trapezius muscle activity was measured using surface electromyogram. The activity value obtained for the middle deltoid muscle was divided by the value obtained for supraspinatus muscle thickness to calculate the middle deltoid muscle activity with respect to the change in supraspinatus muscle thickness. The data were analyzed using one-way repeated measure analysis of variance and least significant difference test was used as a post-analysis. The results of this study showed that there was a significant increase in supraspinatus muscle thickness during shoulder abduction performed using SRUB and MsEB compared to that during shoulder abduction performed without visual biofeedback. No significant differences were seen in the upper trapezius muscle activity during shoulder abduction with and without visual biofeedback. However, the middle deltoid muscle activity was significantly decreased during MsEB shoulder abduction compared to that during shoulder abduction without visual biofeedback. In addition, The middle deltoid muscle activity with respect to supraspinatus muscle thickness change significantly decreased during shoulder abduction with SRUB and MsEB compared to that during should abduction without visual biofeedback. The intraclass correlation coefficient of the intrarater examination showed a high level of reliability (value range from .97 to .99). The results of this study suggest that both, SRUB and MsEB, can effectively decrease middle deltoid muscle activity and increase supraspinatus muscle thickness during shoulder abduction. The results also suggested that visual biofeedback using the SRUB and MsEB methods can be effectively used to strengthen the supraspinatus muscle for rehabilitation when the supraspinatus muscle is damaged.

Relaxation Training Assisted by Auditory Heart Rate Feedback: The Effect of Non-deceptive False Interventions in Biofeedback Training

Shevelenko, Elena Sungkyunkwan University 2022 국내석사

With the growing number of people experiencing daily stress, especially during the COVID-19 pandemic, there is a need for development of effective techniques for stress management that would be more accessible to everyone. Utilizing biofeedback training, a widely used technique for mental distress, this paper attempts to find an effective way to manage stress at home. Guided by an open label placebo approach, the psychological and physiological effect of listening to heartbeat was investigated by comparing three types of auditory heart rate feedback: accurate, false (slow), and false (slow) heartbeat with open label. By doing so, we test the assumption that expensive equipment with precise heart rate measurement is a must to practice effective biofeedback. During the experiment, 60 healthy individuals underwent a short-term stress inducing task in a controlled lab setting. After completing the stress task, participants were exposed to the auditory heart rate feedback. Physiological data was collected using the Polar H10 Heart Rate Monitor chest strap. The subjective reports of state anxiety/stress and the perceived experience of stress management were obtained through the questionnaire. Implications of the findings in HCI and health promotion were discussed along with suggestions for further research. The author of this thesis is a Global Korea Scholarship scholar sponsored by the Korean Government. 코로나19 감염병이 활개치는 요즘 같은 시기에 매일 스트레스를 경험하는 사람들이 증가하고 있다. 따라서 누구도 어디에서도 쉽게 접근할 수 있는 스트레스 관리를 위한 효과적인 기술의 개발이 필요하다. 본 연구는 정신적 고통을 없애기 위해 널리 사용되고 있는 기술인 바이오피드백 훈련을 활용하여 집에서도 고가 장비 없이 스트레스를 효과적이게 관리하는 방법을 찾고자 하였다. 심박수 피드백을 3가지 실험 조건(실제 심박수, 플라시보 심박수 그리고 오픈 라벨 플라시보 심박수)으로 나누어 바이오피브백 훈련이 주는 심리적 및 생리학적 효과가 무엇인지를 연구하고자 하였다. 60명의 건강한 피험자들은 통제된 실험실 환경에서 단기적 스트레스를 유발하는 테스크를 실행한 후, 심박수 바이오피드백 이완훈련을 마쳤다. 실험 조건에 따라 들려주는 심박수 바이오피드백은 1) 실제 심박수 소리 2) 플라시보 (느린) 심박수 소리 3) 오픈 라벨 플라시보 (느리고 공개된) 소리로 제공되었다. 피험자들의 생리학적 데이터는 Polar H10 Heart Rate Monitor 스트랩을 사용하여 실시간으로 측정되었고, 실험 종료 후 피험자들은 자기 스트레스 레벨과 심박수 바이오피드백에 대한 평가를 자기보고 형식으로 작성하였다. 본 연구 결과는 HCI 분야 및 건강 증진 분야에 많은 영향을 미칠 것으로 예상되며 추후 연구에 대한 제안이 논의되었다. 논문작성자는 한국정부초청장학금 (Global Korea Scholarship)을 지원받은 장학생임.

A study on movement control strategy during kinetic control test in subjects with chronic low back pain

강남구 인제대학교 일반대학원 2023 국내박사

Stabilization of the trunk and pelvis is important in subjects with chronic low back pain (CLBP), and appropriate trunk stabilization exercises are recommended to increase trunk and pelvic stability. However, trunk stabilization exercises could result in excessive lumbo-pelvic tilt and rotation. Owing to uncontrolled movements, improved movement control strategies are necessary for trunk stability in subjects with CLBP. Therefore, the coordination of the lumbo-pelvic complex and coactivation of the local and global muscles of the trunk and pelvis are important factors during trunk stabilization exercise. However, only few studies have compared the applied effects of trunk stabilization movement strategies to increase the coordination and coactivation of the trunk and pelvis muscles during exercise, such as changes in breathing pattern and leg posture and the use of biofeedback. Thus, we examined 1) the transverse abdominis (TrA), external oblique (EO), multifidus (MF), and gluteus maximus (GM) muscle activities and pelvic tilt and rotation angles in healthy subjects with or without the abdominal draw-in maneuver (ADIM) and abdominal bracing (AB) method during four-point kneeling arm and leg lifting (FKALL) exercises; 2) the muscle activities of the internal oblique (IO), EO, MF, and GM muscles, and the pelvic tilt and rotation angles with 120 flexion of the supporting leg or 30 abduction of the lifting leg; and 3) the effect on the use of biofeedback to enhance the abdominal muscle activity and control the pelvic rotation angle with and without the ADIM. The first study compared 28 healthy subjects with and without the ADIM and AB breathing methods during FKALL exercises in terms of muscle activities of the trunk and gluteal muscles and the pelvic tilt and rotation angles. Electromyography (EMG) and a real-time motion sensor were used to measure the pelvic angles of the trunk. The ADIM method significantly increased the TrA and GM muscle activity during the FKALL exercises, but the EO muscle activity showed no significant differences between the ADIM and AB methods. By contrast, both breathing methods showed a significant decrease in pelvic rotation angle. In the second study, 28 healthy subjects performed 120 flexion of the supporting leg or 30 abduction of the lifting leg during a four-point kneeling position. The abdominal and gluteal muscle activities were then measured on EMG, and the target bar was applied to maintain the leg flexion or abduction during the measurement of the pelvic tilt and rotation angles by attaching a real-time inclinometer. The IO and EO muscle activities did not change with the leg flexion or abduction movements. However, significant differences in the MF and GM muscle activities were found with 120 flexion of the supporting leg and 30 abduction of the lifting leg. No significant differences in pelvic tilt and rotation angles were found with the changes in leg movements. In the third study, 15 healthy subjects and 15 subjects with CLBP were measured the muscle activities of the abdominal and lower back muscles during the FKALL exercises those with the using stretch sensors or visual biofeedback and those with the ADIM. A real-time angular gyroscope was used to measure the adjustment of the pelvic rotation angle using visual biofeedback devices. The muscle activities of the TrA, MF, and ES muscles on both sides and the pelvic rotation angles were measured using a real-time motion sensor. When tactile biofeedback was applied with ADIM using stretch sensors and only visual biofeedback, significant differences in the bilateral TrA, MF, and ES muscle activities were observed in the subjects with CLBP. In addition, the pelvic rotation angles significantly decreased in the subjects with the ADIM using a stretch sensor and those without the ADIM using visual biofeedback in both groups. On the basis of the results of this study, the ADIM method is recommended for selective contraction of the TrA muscles during trunk stabilization exercises, and AB could be used to strengthen the GM muscle. Moreover, trunk stabilization exercises with adjustment of the hip angle may be applied to strengthen the muscles around the lumbo-pelvic complex. Applying biofeedback in trunk stabilization exercises for subjects with CLBP may provide an effective and immediate increase in stability of the abdominal and lower back muscles. Therefore, this study suggests that when applying an exercise program for people with CLBP, changes in breathing pattern and hip posture and selective application of biomechanical biofeedback during FKALL exercises should be considered. 만성 요통 대상자들에게서 몸통과 골반의 안정화는 중요하며 이러한 안정성 증가를 위해 적절한 몸통 안정화 운동이 추천되고 있다. 몸통 안정화 운동 시 과도한 허리 골반 경사, 돌림 등이 발생할 수 있으며 이러한 원치 않는 움직임 조절을 위해 몸통과 골반의 협응된 움직임과 복부 및 골반 주위의 소근육과 대근육 간에 동시 활성화는 중요하다. 그러나 몸통 안정화 운동 동작 중 안정화 증가를 위해 호흡의 변화, 운동 동작의 변화, 그리고 바이오 피드백 등의 적용 효과를 비교해 본 연구는 부족한 실정이다. 그러므로 본 연구는 대표적인 몸통 안정화 운동 중 하나인 네발기기 자세에서 팔-다리 들기 동작 시 1) 몸통 안정화 적용을 위한 복부 드로우-인과 브레이싱 호흡 방법에 대한 복부 근활성도 및 골반 경사와 회전 각도 비교, 2) 지지측 다리와 드는 다리 동작 변화에 따른 복부 및 큰볼기근 근활성도 및 골반 경사와 회전 각도 비교, 3) 스트레치 센서와 움직임 제어 센서를 적용한 바이오 피드백 적용에 따른 복부 근 활성도와 골반 회전 각도에 미치는 영향에 대하여 알아보고자 하였다. 첫번째 연구에서는 28명의 건강한 성인을 대상으로 네발기기 자세에서 팔-다리 들기 동작 시 복부 드로우-인과 브레이싱 호흡 방법에 따른 몸통과 큰볼기근의 근활성도 및 골반 경사와 회전 각도를 비교하였다. 몸통과 큰 볼기근의 근활성도와 골반의 움직임 각도 측정을 위해 근전도와 실시간 각속도계를 부착하여 사용하였다. 호흡 방법 중 복부 드로우-인 기법에서 배가로근의 근활성도에서 유의한 증가를 보였으며 큰볼기근은 복부 드로우-인 및 브레이싱 방법 모두에게서 유의한 차이를 나타냈다. 또한 배바깥빗근은 호흡 방법에 따라 차이를 나타나지 않았다. 그러나 두 가지 호흡 방법 모두에게서 골반 회전 각도가 유의하게 감소한 것을 알 수 있었다. 두번째 연구에서는 28명의 건강한 성인을 대상으로 네발기기 자세에서 팔-다리 들기 동작 동안 각각 지지측 다리의 굽힘 120도와 올리는 다리의 벌림 30도 시 복부 및 큰볼기근의 근활성도와 골반 경사 및 회전 각도를 측정하였으며 다리의 굽힘과 벌림 각도 유지를 위해 기준 막대를 적용하였으며 근전도를 통한 근활성도 측정과 실시간 각속도계를 부착하여 골반 경사 및 회전 각도를 측정하였다. 배바깥빗근과 배속빗근의 근활성도는 다리 각도 변화에 따른 차이를 보이지 않았으나 뭇갈래근 에서 다리 굽힘 120도와 다리 벌림 30도시 유의한 차이를 보였으며 큰볼기근도 다리 굽힘과 벌림 시 유의하게 증가된 것을 확인할 수 있었다. 골반 경사와 회전 각도에서는 다리 동작 변화와 상관없이 유의한 차이는 없었다. 세번째 연구에서는 15명의 건강한 성인과 15명의 만성 요통 대상자를 두 그룹으로 나누어 스트레치 센서를 활용하여 배가로근의 수축을 유도하게 하고 또한 실시간 각속도계를 부착하여 각도의 변화를 시각 피드백으로 조절하면서 네발기기 자세에서 팔-다리 들기 운동을 실시하였다. 근 활성도는 배가로근, 뭇갈래근, 허리세움근에 대하여 측정을 하였으며 실시간 각속도계를 통해 골반의 회전 각도를 측정하였다. 스트레치 센서와 각속도계를 이용한 바이오 피드백 적용 시 배가로근 및 뭇갈래근 에서 유의한 차이가 있었으며 허리 세움근에서는 유의한 차이를 보이지 않았다. 골반 회전 각도는 두 가지 바이오 피드백 모두에게서 유의한 감소를 보였다. 본 연구 결과를 바탕으로, 복부 드로우-인은 몸통 안정화 운동 중 배가로근의 선택적 수축을 위해 추천되고, 브레이싱은 큰볼기근의 강화를 위해 사용될 수 있으며, 뭇갈래근과 큰볼기근 등 안정화 근육의 활성화 증가와 목적에 따라 다리 굽힘 및 벌림이 적용될 수 있으며 만성 요통 대상자를 위한 몸통 안정화 운동 시 바이오 피드백은 복부 드로우-인과 같은 효과적이고 즉각적인 효과를 제공할 수 있다. 따라서 네발기기 자세에서 팔-다리 들기와 같은 몸통 안정화 운동 중 호흡방법, 다리 위치 변화, 바이오 피드백의 선택적 적용을 고려하는 것을 제안할 수 있다.

緊張性 頭痛에 미치는 EMG biofeedback과 弛緩 訓鍊의 相對的 效果

한인순 全北大學校 1987 국내석사

This study compared frontal is electromyographic ( EMG ) biofeedback (N=10) with progressive muscle relaxation training (N=10) in the treatment of tension headache. Biofeedback group received contingent EMG feedback with instruction to lower muscle activity using the auditory feedback Relaxation training group was instructed to practice taped progressive muscle relaxation procedure. All subjects were required to record their daily headache activities on headache diary. The results indicated that both procedure were highly effective and nearly equivalent for reducing frontal is EMG levels and headache complaints. The multiple regression analyses indicated that there were significant negative correlations between improvement and scores on the BDI and the anxiety subscale of SCL-90-R, but correlation between improvement and scores on the internal-external control scale was not significant in the relaxation training group In the biofeedback group, there were significant negative correlations between improvement and scores on the BDI but not significant for scores of anxiety subscale, and significant positive correlation between improvement and scores of internal-external control scale. These findings suggest that there is in more need of research concerning predictors of treatment effects than direct comparison of effect of EMG biofeedback with relaxation training Since the costs for any of these treatments on a fee-for-service basis would be considerable, it would certainly seem advantageous to be able to predict who is 1ikely to respond effectively to each treatment.

복합운동과 균형운동 훈련이 만성 뇌졸중 환자의 균형 및 보행특성에 미치는 영향

정명균 高麗大學校 大學院 2011 국내박사

The Effects of Combined Exercise and Balance Exercise Training on Balance and Gait pattern in Chronic Stroke Patients Jeong, Myeong kyun Department of Sport & Leisure Studies Graduate School Korea University The purpose of this study is to examine the effect of balance and gait with chronic stroke patients who lack of brain neural plasticity by carrying on exercise of combined, balance and conservative for 12 weeks(50 minutes a day 5 times a week). The subjects of this study were 24 chronic stroke patients and they were divided into three groups: combined exercise(n=8), balance exercise(n=8) and conservative exercise group(n=8). The linear parameters(cadence, velocity, stride length, step length, single support, double support), kinematics(motion of hip flexion, knee flexion, ankle flexion, pelvis anterior tilt) and kinetics(moment of hip flexion, knee flexion, ankle flexion) were measured in characteristics of gait and overall, anterior/posterior and medial/lateral in those of balance. There was the conclusion of gait factors except for factors in balance by analysing changes in characteristics of paretic and non-paretic as follows. 1) Characteristics of balance There was a more significant difference(p<.001) in combined exercise about overall balance in the result of between-group differences in balance change caused by exercise methods than balance and conservative exercise. But, there were no significant differences about anterior/posterior and medial/lateral balance. 2) Characteristics of gait (1) Change of the linear parameters There were more significant differences(p<.05) in combined exercise and conservative exercise about single support in the paretic side in the result of between-group differences in the linear parameters caused by exercise methods and more significant difference(p<.01)was found in combined exercise about double support in the non-paretic side than balance and conservative exercise. But, there were no significant differences in cadence, gait velocity, stride length, paretic and non-paretic side. No meaningful differences were also made in the non-paretic side of single and paretic side of double support. (2) Kinematic change There were more significant differences(p<.01~.001) in combined exercise about maximum hip flexion in the paretic and non-paretic sides in the result of between-group differences in the kinematic change caused by exercise methods than balance and conservative exercise. Compared to balance and conservative exercise, high effects(p<.05~.001) were also found in combined exercise by testing of maximum knee, ankle flexion moments and maximum pelvic anterior tilt in the paretic and non-paretic sides. There was more meaningful difference(p<.05) in combined exercise about minimum ankle flexion in the non-paretic side in the result of between-group differences in the kinematic change caused by exercise methods than balance and conservative exercise. However, no significant difference was found about minimum ankle, knee flexion and minimum pelvic anterior tilt in the paretic and non-paretic sides. There was also no meaningful difference in minimum ankle flexion in the paretic side. (3) Kinetic change There was more significant difference(p<.05) in conservative exercise about ankle flexion moment in the non-paretic side in the result of between-group differences in the kinetic change caused by exercise methods than combined and balance exercise. In conclusion, no differences were appeared for 12 weeks of combined exercise and balance exercise in chronic stroke patients but, ability to balance in the overall and gait characteristics and balance exercises were significantly higher compared to the balance and conservative movement. Key words: Combined exercise, Balance, Gait, Biofeedback.

Assisting Walking in Individuals with Chronic Stroke Using Exoskeletons

Nguyen, Thu M. ProQuest Dissertations & Theses Stanford Universit 2022 해외박사(DDOD)

소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.

Stroke often results in hemiparesis and gait asymmetries, such as spatial, temporal, or kinematic asymmetries between the paretic and nonparetic legs. Asymmetric gaits have been correlated with higher metabolic cost, slower walking speeds, and lower mobility. These gaits can also cause joint pain due to repetitive high loads on the nonparetic limb. For these reasons, physical therapists try to decrease gait asymmetries, and their interventions have been shown to be effective. However, sessions are expensive, limiting access. More automated rehabilitation techniques have been developed, but they have not been more effective than conventional physical therapy. A better understanding of the mechanisms driving gait asymmetry could allow for the development of more targeted, effective, and accessible gait interventions.In my doctoral research, I first studied the correlation between step length asymmetry and metabolic cost in individuals with chronic stroke and in unimpaired participants. Participants were tasked with altering their step length asymmetry using biofeedback. All participants were able to significantly alter their step length asymmetry. Unimpaired participants self-selected a symmetric step length asymmetry that correlated to the lowest energy cost. However, for individuals with chronic stroke, metabolic cost minimization did not explain self-selected step length asymmetry. I then built a unilateral knee-ankle exoskeleton emulator that can actuate knee flexion, knee extension, and ankle plantarflexion. I designed a knee position controller to track desirable knee kinematics and demonstrated the mechatronic capabilities of the emulator system on one unimpaired participant and one participant with chronic stroke. The knee position controller was able to prevent negative impacts at the knee when plantarflexion torques were applied, and the position controller could track different desired knee trajectories with low tracking error.The results from these studies could better inform the design of future rehabilitation tools and assistive devices. Our results suggest that metabolic energy consumption probably will not be a barrier to therapists who seek to improve step length asymmetry. Additionally, we found that active ankle plantarflexion assistance can cause increased knee extension which might lead to long-term tissue damage with constant use. Assistive devices simultaneously assisting the ankle and knee could prevent these poor knee responses. This might allow for a more comfortable application of larger magnitude ankle torques which could potentially improve metabolic reductions. These projects have led to a new experimental tool that can be used to discover beneficial participant-specific assistance strategies for individuals with chronic stroke.

Integrated biofeedback system with respiration training method for stress management

오, 만경 부산대학교 2013 국내박사

With global challenge, currently considerable research is being directed toward developing methodologies for controlling emotion or releasing stress. An applied branch of the basic field of psychophysiology, known as biofeedback, has been developed to fulfill clinical and non-clinical needs related to stress management. Therefore, the combination of modern biofeedback theories with mature body sensor networks (BSNs) technologies for stress management of common population is undoubtedly meaningful. Therefore, in this work, a full-featured, integrated biofeedback system has been designed and implemented based on the generalized BSNs. In order to realize stress level assessment, we also proposed a new stress assessment model, and established multiple regression stress model based on the physiological relationship between cortisol, HRV and stress response. Furthermore, a simplified RFT training procedure has been designed and integrated to our biofeedback system for voluntary respiration feedback training. In order to evaluate the efficiency of well-designed biofeedback system, stress assessment model and simplified RFT biofeedback training, extensive in-situ and ambulatory experiment paradigm have been designed elaborately. The results in all of the experiments suggested that our biofeedback system was appropriate for stress management in the manner of self assessment and feedback training, and capable of enhancing the ANS synchronization and stress coping ability. We believe that the combination of proposed biofeedback system and the mathematical stress model could facilitate the research and development activities for ubiquitous and low-cost stress management for common population.

가상환경을 이용한 EEG biofeedback 훈련이 주의력 및 충동성에 미치는 영향

문병희 중앙대학교 대학원 2001 국내석사

The present study examined the effects of the EEG biofeedback training using virtual environments on attention and impulsivity. To increase attention and decrease impulsivity, the present study used the EEG biofeedback training. In addition, to increase training effect and shorten period, virtual environments are used. The 34 participants were composed of male adolescents of asylum, and were divided into three group : ⑴ EEG biofeedback training using virtual environments group (VE group), ⑵ EEG biofeedback training group (non-VE group), ⑶ control group. The VE group was trained by the biofeedback using virtual environments, and the non-VE group was trained by the biofeedback using computer over 8 sessions. The control group did not enforce any special training. The training criterion is enhancement of EEG activity in the 15-18Hz rhythms. The Continuous Performance Test(CPT) had been conducted before and after the training. To analyze the data, 3(VE group/non-VE group/control group : between subject variable)×2(pre/post training : within subject variable) repeated-measures ANOVA have been performed. The results of this study were as follows : First, VE group significantly decreased reaction time, but didn't increase both hits and perceptual sensitivity. Second, VE group didn't decrease both commissions and response bias. This result means that the EEG biofeedback training using virtual environments significantly improved information processing capacity and selectiveness of attention, but didn't improve sustained attention, readiness, and discrimination. Also, this result means that the training didn't decrease both inhibition ability of motor responses and response tendency of impulsivity. 본 연구는 가상환경을 이용한 EEG 바이오피드백 훈련이 주의력 및 충동성에 미치는 영향을 알아보았다. 본 연구에서는 주의력을 증진시키고, 충동성을 감소시키기 위하여 EEG Biofeedback 훈련을 이용하였다. 또한, 훈련효과를 증가시키고, 훈련기간을 단축시키기 위하여 가상환경을 이용하였다. 피험자는 법무부 산하 보호관찰기관에 수용 중인 34명의 청소년을 대상으로 각각 3집단으로 구성하였다 : ⑴ 가상환경 EEG Biofeedback 훈련집단(VE 집단), ⑵ EEG Biofeedback 훈련집단(non-VE 집단), ⑶ 통제집단. VE 집단은 가상환경을 이용한 바이오피드백 훈련을 8회기 동안 받았고, non-VE 집단은 컴퓨터를 이용한 바이오피드백 훈련을 8회기 동안 받았다. 통제집단은 훈련을 받지 않았다. 훈련에 사용된 강화의 기준은 15-18Hz 대역의 EEG 활동을 강화하는 것이었으며, 훈련 전후에 연속수행과제검사를 실시하였다. 자료를 분석하기 위하여 3(VE 집단/non-VE 집단/통제집단 : 피험자간변인)×2(훈련 전후 : 피험자내 변인) 반복측정 ANOVA를 실시하였다. 본 연구의 결과는 다음과 같다 : 첫째, VE 집단의 반응시간이 유의미한 감소를 보였으나, 정반응수와 지각민감도는 증가하지 않았다. 둘째, VE 집단의 오경보오류수와 반응편파도는 감소하지 않았다. 이러한 결과는 가상환경을 이용한 EEG Biofeedback 훈련이 주의력에서 정보처리능력과 선택적 주의력은 증가시켰으나, 지속적 주의력, 준비성, 변별력 등은 증가시키지 못했음을 의미한다. 또한, 충동성에서 운동반응의 제지능력, 반응경향성 등을 감소시키지 못했음을 의미한다.