과제지향훈련 및 부가적인 TENS 중재가 만성 뇌졸중 환자의 상지 근활성, 운동기능 및 경직에 미치는 효과

조휘영 ( Cho Hwi-young ),정진화 ( Jung Jin-hwa ),정경심 ( Jung Kyoung-sim ),인태성 ( In Tae-sung ) 대구대학교 특수교육재활과학연구소 2016 특수교육재활과학연구 Vol.55 No.3

본 연구는 만성뇌졸중 환자에게 과제지향훈련 및 부가적인 TENS(transcutaneous electrical nerve stimulation) 중재가 상지의 근활성, 운동기능 그리고 경직에 미치는 효과를 규명하기 위하여 실시되었다. 단일맹검 및 사전 무작위 임상시험으로 진행되었으며, 24명의 만성 뇌줄중 환자는 무작위로 실험군(n=12)과 대조군(n=12)로 배정되었다. 실험군은 과제지향훈련을 4주간 주5회, 총 20회 시행하였고, 과제수행 전 30분간 TENS자극을 마비측 팔에 적용받았다. 대조군은 동일한 과제지향훈련을 수행하였고, 속임 TENS자극을 받았다. 근활성은 표면 근전도를 이용하였고, 상지의 운동기능을 측정하기 위하여 Fugl-Meyer 상지 검사를 이용하였다. 또한 경직을 측정하기 위하여 Modified Ashworth Scale(MAS)를 사용하였다. 중재 후 실험군과 대조군 모두에서 근활성이 유의하게 증가하였고, 상지의 운동기능이 유의하게 향상되었다. 또한 경직도 유의한 개선을 보였다. 실험군은 대조군에 비하여 긴노쪽손목폄근과 운동기능 그리고 팔꿉 굽힘근의 경직을 유의하게 개선하였다. 본 연구는 과제지향훈련은 만성 뇌졸중 환자의 근활성 증가, 운동기능개선 그리고 경직 중재에 효과적이며, 부가적인 TENS 중재는 이를 더욱 효과적으로 향상시킴을 증명하였다. This study investigated the efficacy of task-related training (TRT) combined with Transcutaneous Electrical Nerve Stimulation (TENS) on the improvement of upper limb muscle activation, motor function and spasticity of upper extremity in chronic stroke patients. This study designed as a pilot randomized clinical trial study. 24 inpatients with chronic stroke were recruited and randomly assigned into two group: the experimental group (n=12) and the control group (n=12). Subjects in the experimental group received high-frequency TENS for 30 minutes on wrist and elbow extensors, while the control group received placebo-TENS stimulation that was not real electrical stimulation. All participants in both groups conducted task-relate training for 30 minutes after TENS application five days a week for four weeks (20 sessions). The primary outcomes of upper limb muscle activation were measured by surface electromyography (EMG), and Fugl-Meyer upper extremity scale (FMUE) was used to assess motor function of upper extremity. Modified ashworth scale (MAS) was used to identify spasticity. The measurements were performed before and after the 4 weeks intervention period. Both groups showed significant improvements in muscle activation, motor function, and spasticity after intervention. Especially, the experimental group shows a significant differences in muscle activation of extensor carpi radialis longus, FMUE, and spasticity on elbow flexor compared to the control group. Our findings indicate that TRT is effective to improve muscle activity, motor function and spasticity in paretic upper limb of chronic stroke patients, and additional TENS application makes this more efficient.

고빈도 경피신경전기자극이 편마비 환자의 하지 경직과 균형에 미치는 즉각적 효과

조휘영 ( Hwi Young Cho ),인태성 ( Tae Sung In ),이순현 ( Soon Hyun Lee ),이규창 ( Gyu Chang Lee ),신원섭 ( Won Seob Shin ),이용우 ( Yong Woo Lee ),송창호 ( Chang Ho Song ) 대한물리의학회 2010 대한물리의학회지 Vol.5 No.3

Purpose:To investigate the immediate effects of transcutaneous electrical nerve stimulation(TENS) on the spasticity and the balance in the stroke patients. Methods:26 subjects with spasticity over lower limbs were allocated randomly into two groups : (1) TENS group, (2) placebo-TENS group. TENS was applied on the both gastrocnemius for 60 minutes(100 Hz, 0.25 ms, 2 times sensory threshold). The modified Ashworth Scale(MAS) and Manual Muscle Tester were used to assess the spasticity of the ankle plantar flexors. Static balance under three conditions was measured by force-plate; in (1) the condition of standing with eyes opened, (2) with eyes closed and (3) the condition of standing on unstable surface with eyes opened Results:When compared with the pre and post TENS application, TENS showed significant reduction of ankle spasticity in MAS and MMT measurement. Also, Application of high-frequency TENS improved the balance under three conditions. Conclusion:A single session of TENS to stroke patients could reduce spasticity and improve the balance.

만성 뇌졸중 환자들의 Sit to Stand Test의 임상적 유용성

조휘영 ( Hwi Young Cho ),안승헌 ( Seung Heon An ),이윤복 ( Yun Bok Lee ),홍현화 ( Hyun Hwa Hong ),이규창 ( Gyu Chang Lee ) 대한물리의학회 2013 대한물리의학회지 Vol.8 No.4

PURPOSE: This study is designed as a retrospective study, and identified the clinical usability of Sit to Stand (STS) test for predicting of fall incidence in stroke patients who experienced a fall within 1 year. METHODS: Between July 2011 and November 2012, 69 inpatients with stroke in K rehabilitation hospital were participated under voluntarily signing the informed consent form. STS test and 10m walk test (10MWT) were used to assess the muscle strength of lower-extremity and walking velocity, respectively. Also, we tested dynamic balance and motor function of lower-extremity in affected-side using with the Berg balance scale (BBS) and the Fugl-Meyer assessment of lower extremity (FM-L/E). METHODS: There were significant differences between subjects with fall-experienced group and without subjects without fall-experienced group in STS test, 10MWT, BBS scores and FM-L/E. STS test significantly showed a negative correlation between 10MWT (r=-.657), BBS (r=-.512), and FM-L/E (r=-.563). And, 10MWT have a influence on the performance of STS test (the capacity of explanation = 20%). The cut-off value of STS performance predicting falls experience is ≥14.36 seconds (sensitivity=76%; specificity=79%, area under curve=.785). According to logistic regression analysis of falls experience, subjects ≥14.36 s showed that 4.164 times (odd ratio) increased in falls than subjects < 14.36 s in STS test. CONCLUSION: This study demonstrated that STS test may be a useful tool predicting and measuring falls in patients with stroke. Further study will be needed to elucidate the kinematic analysis of STS test and the relationship between physical activity level and falls in stroke patients.

경피신경전기자극이 근피로에 의한 자세균형과 근수축력의 변화에 미치는 효과

조휘영(Cho, Hwi-Young),이순현(Lee, Sun-Hyun),인태성(In, Tae-Sung),강선희(Kang, Sun-Hee),이동엽(Lee, Dong-Yeop),송창호(Song, Chang-Ho) 한국산학기술학회 2010 한국산학기술학회논문지 Vol.11 No.11

근피로는 자세균형과 근수축력의 악화를 유발하여 다양한 근골격계 손상을 초래한다. 본 연구는 하퇴삼두근 에 근피로 유발에 의한 자세불균형과 근수축력 저하에 경피신경전기자극이 미치는 효과를 알아보고자 하였다. 2010년 3월부터 4개월간 전정계통과 시각계통에 문제가 없는 20명의 건강한 성인을 대상으로 반복운동 수행을 통하여 비복 근에 근피로를 유발하였고, 유발 후 즉시 경피신경전기자극을 적용하였다. 근피로 및 경피신경전기자극에 의한 자세 균형과 근수축력의 변화를 측정하기 위하여 자세동요 이동거리와 속도, 최대수의수축력을 사용하였다. 근피로 유발에 의하여 자세동요 이동거리 및 속도의 증가와 근수축력의 저하가 나타났다(p<.05). 근피로가 유발된 비복근에 경피신경 전기자극의 적용은 근피로에 의한 자세동요와 근수축력을 유의하게 개선하였다(p<.05). 이와 같은 연구결과를 통하여 족저굴곡근의 근피로는 자세균형과 근수축력에 관여되고, 경피신경전기자극은 근피로에 의한 자세불균형 및 근수축력 저하에 효과적임을 증명하였다. 경피신경전기자극은 일상생활에서 흔히 유발되는 근피로의 중재에 경피신경전기자극 이 효과적인 중재 방법으로 사용될 수 있을 것으로 사료된다. Muscle fatigue often induces deterioration of postural balance and muscle contraction, such as strength or maximal voluntary contraction(MVC). This study was to investigate the effects of transcutaneous electrical stimulation(TENS) applied to the fatigued muscles on postural imbalance and decline in muscle strength following fatigue of triceps surae. For the 4 months from March, 2010, twenty healthy subjects without vestibular disease and visual disturbance were recruited and induced muscle fatigue of triceps surea performed by repeated voluntary contraction. TENS was applied to gastocnemius immediately after development of muscle fatigue. Postural sway length, velocity and MVC were recorded under these conditions: pre-fatigue, post-fatigue, and TENS application to fatigued muscle during post-fatigue. Muscle fatigue increased postural imbalance as expressed by sway length and velocity and decreased muscle contraction(p<.05), while TENS improved the postural imbalance and MVC following muscle fatigue during stance(p<.05). The results suggested that fatigue on plantar flexor is associated with postural balance and muscle contraction, and TENS application to fatigued muscle was effective in improving postural imbalance and decline in muscle strength following muscle fatigue. TENS will be an effective method in exercise, working environment and daily life.

중추신경발달치료를 이용한 몸통 안정화 운동이 뇌졸중 환자의 허리부위 근 활성도와 균형에 미치는 효과

심현보,조휘영,최원호,Shim, Hyun-Bo,Cho, Hwi-young,Choi, Won-Ho 대한물리치료학회 2014 대한물리치료학회지 Vol.26 No.1

Purpose: The aim of this study was to identify the effects of the lower trunk stabilization exercise using neurodevelopmental technique (NDT) on muscle activity in lumbar region and balance in the patients with hemiplegia. Methods: Fifteen participants were allocated in two groups: NDT group (n=8) or control group (n=7). NDT group performed NDT exercise program, while control group conducted walking exercise. Both interventions were given for 30 minutes a day, 3 times a week, for 5 weeks. To measure the muscle activity in rectus abdominis (RA), external oblique (EO) and internal oblique (IO), electromyography (EMG) was used. And, Timed-Up and Go (TUG) test and Berg-Balance Scale (BBS) were performed to assess balance before and after intervention. Results: NDT group showed a significant improvement of muscle activity in RA and EO, while control group did not show significant changes in three muscles. Also, there was a significant difference in muscle activity of RA and EO between two groups. In BBS and TUG test, participants in two groups showed significant improvements after intervention. Especially, significant difference was observed in TUG test between two groups (p<.05). Conclusion: This study demonstrated that NDT exercise is an effective intervention to improve the muscle activity in trunk region and to increase balance in patients with stroke. Thus, we suggested that NDT exercise program would be a treatment intervention in stroke rehabilitation.

장기간 고빈도 경피신경전기자극이 뇌졸중 환자의 하지 경직 및 균형에 미치는 영향

인태성(In, Tae-Sung),조휘영(Cho, Hwi-Young),이순현(Lee, Sun-Hyun),이동엽(Lee, Dong-Yeop),이재국(Lee, Jae-Kuck),송창호(Song, Chang-Ho) 한국산학기술학회 2011 한국산학기술학회논문지 Vol.12 No.4

본 연구는 장기간의 고빈도 경피신경전기자극이 뇌졸중 환자의 하지 경직 및 균형 개선에 미치는 효과를 알 아보고자 하였다. 하지에 경직이 유발된 26명의 대상자를 기본적인 재활을 수행하는 상태에서 무작위로 TENS군(14 명)과 속임 TENS군(12명)으로 배정하였다. 경피신경전기자극은 4주간 주 5회, 1회당 30분씩 경직이 유발된 양측 비복 근에 적용하였다. MAS와 도수근력계를 이용하여 발목 족저굴곡근의 경직을 측정하였다. 균형의 측정은 힘판을 이용 하여 세 가지 자세(눈을 뜬 상태의 기립자세, 눈을 감은 상태의 기립자세, 불안정한 면에서 눈을 뜬 상태의 기립자세) 에서 누적된 자세동요의 이동거리를 측정하였다. 4 주간의 치료 후 양측 군 모두 경직과 균형의 유의한 개선을 나타 냈다(p<.05). 특히, TENS군은 속임 TENS군에 비하여 경직의 유의한 감소를 나타냈다(p<.05). 따라서 장기간 고빈도 경피신경전기자극은 뇌졸중 환자의 경직 감소와 균형 개선에 더욱 효과적인 중재 방법으로 사용될 수 있을 것으로 사료된다. The purpose of this study was to investigate effects of the long-term high-frequency transcutaneous electrical nerve stimulation(TENS) on the spasticity and the balance in chronic stroke patients. Twenty-six subjects with spasticity over lower limbs were allocated randomly into two groups under standard rehabilitation: (1) TENS group, (2) placebo-TENS group. TENS stimulation was applied on the both the gastrocnemius for 30 minutes, 5 days a week for 4 weeks(100 Hz, 0.25 ms, 2 times sensory threshold). The Modified Ashworth Scale(MAS) and Hand-held manual muscle tester were used to assess the ankle plantarflexor spasticity. Balance function under three conditions was measured by using force-plate and the amount of postural sway was assessed; in (1) the condition of standing with eyes opened, (2) with eyes closed and (3) the condition of standing on unstable surface with eyes opened. Both groups showed significant improvement in spasticity and balance function after treatment for 4 weeks(p<.05). Especially, TENS group showed a significant reduction of spasticity compared to placebo-TENS group(p<.05). These results suggested that additional stimulation of a long-term high-frequency TENS to standard rehabilitation induced an improved balance function and a spasticity reduction. The long-term application of high-frequency TENS will be an effective intervention for reducing spasticity and increasing balance ability in the chronic stroke patients.

중간볼기근 강화 운동 시 하지 정렬이 엉덩관절 벌림근의 근활성도 및 근동원 순서에 미치는 영향

신승환 ( Seung-hwan Shin ),신호진 ( Ho-jin Shin ),조휘영 ( Hwi-young Cho ) 대한신경치료학회 2021 신경치료 Vol.25 No.3

Purpose The purpose of this study was to investigate the effects of alignment of the lower extremity during hip abduction exercise and clamshell exercise. Methods The subjects were twenty healthy men without low back pain or lower limb pain. Subjects performed four gluteus medius exercises: hip abduction (AB), hip abduction with the alignment of the lower extremity (AB-AL), clamshell (CLAM), clamshell with the alignment of lower extremity (CLAM-AL). Surface EMG was used to measure hip abductor muscle activity and recruitment pattern from the five muscles: gluteus medius (Gmed), tensor fascia latae (TFL), gluteus maximus upper fiber (GmaxU), gluteus maximus lower fiber (GmaxL), and quadratus lumborum (QL). Results TFL EMG activity was significantly greater in AB than in AB-AL (p>.05). Gmed was significantly greater in CLAM than in CLAM-AL. Gmed, TFL, QL were significantly greater AB than CL. GmaxU, GmaxL were significantly greater CLAM than AB (p>.05). In the recruitment pattern, there was a difference between AB and CLAM (p<.05). However, In both exercises, there was no difference according to lower extremity alignment (p<.05). Conclusion It is recommended to perform the exercise in consideration of the type of exercise and the alignment of the lower extremity according to the aim of training.

감각 되먹임 종류가 건강한 성인 남성의 올바른 앉은 자세 학습에 미치는 영향

신호진 ( Ho-jin Shin ),김성현 ( Sung-hyeon Kim ),조휘영 ( Hwi-young Cho ) 대한물리의학회 2021 대한물리의학회지 Vol.16 No.4

PURPOSE: The growing number of people exposed to a static sitting posture has resulted in an increase in people with a poor posture out of the optimally aligned posture because of the low awareness of a correct sitting posture. Learning the correct sitting posture by applying sensory feedback is essential because a poor posture has negative consequences for the spine. Therefore, this study examined the effects of the sensory feedback types on learning correct sitting posture. METHODS: Thirty-six healthy adult males were assigned to a visual feedback group, a tactile feedback group, and a visuotactile feedback group to learn the correct sitting posture by applying sensory feedback. The spine angle, muscle activity, and muscle thickness were measured in the sitting position using retro-reflexive markers, electromyography, and ultrasound immediately after, five minutes, and 10 minutes after intervention. RESULTS: The intervention time was significantly shorter in the visuotactile feedback group than the visual feedback group (p < .05). Compared to the pre-intervention, the repositioning error angles of the thoracic and lumbar vertebrae of all groups were reduced significantly immediately after intervention and after five minutes. After 10 minutes, there was a significant difference in the thoracic and lumbar repositioning error angles of the tactile feedback group and the visuotactile feedback group (p < .05). No significant difference was noted at any time compared to the pre-intervention in all groups (p > .05). CONCLUSION: The use of tactile and visuotactile feedback in intervention to correct the sitting posture is proposed.

저항성 운동과 그룹 운동을 병합한 프로그램이 뇌성마비 아동의 균형능력, 파악력 및 삶의 질에 미치는 영향

김성현 ( Sung-hyeon Kim ),신호진 ( Ho-jin Shin ),함석찬 ( Suk-chan Hahm ),박선욱 ( Sun-wook Park ),조휘영 ( Hwi-young Cho ),이민구 ( Min-goo Lee ) 대한물리의학회 2020 대한물리의학회지 Vol.15 No.4

PURPOSE: Cerebral palsy is a common cause of disability in children, requiring constant rehabilitation. Improving balance in children with cerebral palsy helps to alleviate daily movement and the quality of life. This study examines a program that combines Resistance Exercise and Group Exercise, and investigates the effect on trunk control ability, balance ability, maximum grip strength, and quality of life of children with cerebral palsy. METHODS: Totally, 9 children with cerebral palsy participated in this study. Resistance exercise was performed for 8 weeks, 40 minutes every day. Group Exercise was conducted for 8 weeks, 40 minutes each Sunday. All participants were evaluated by the Korean version of the trunk control measurement scale, pediatric reach test, grip strength test, and KIDSCREEN-52. RESULTS: The trunk control ability was significantly improved in all subcategories (p < .05). In the pediatric reach test, the left and right directions were significantly improved (p < .05). Maximum grip strength was significantly improved in both hands (p < .05). The quality of life significantly improved in total score, physical well-being, general moods, self-perception, autonomy, relationship with parents, and home life (p < .05). CONCLUSION: Considering the encouraging results, we propose to use Resistance Exercise and Group Exercise as programs other than rehabilitation treatment in hospitals, to improve motor function and quality of life of children with cerebral palsy.

여성 노인의 자세 정렬과 시공간 보행 변수 사이의 연관성

김성현 ( Sung-hyeon Kim ),신호진 ( Ho-jin Shin ),서혜림 ( Hye-rim Suh ),정경심 ( Kyoung-sim Jung ),조휘영 ( Hwi-young Cho ) 대한물리의학회 2020 대한물리의학회지 Vol.15 No.3

PURPOSE: Aging causes changes in the postural alignment and gait due to changes in the nervous and musculoskeletal systems. On the other hand, the relationship between the changes in posture alignment and gait is unclear. This study examined the relationship between the postural alignment and spatiotemporal gait parameters in Korean elderly women. METHODS: Thirty-two-healthy elderly women participated in this study. All subjects were assessed for their posture alignment and gait ability. Stepwise multiple linear regression was performed to determine to what extent the postural alignments could explain the spatiotemporal gait parameters. RESULTS: Coronal head angle was moderately correlated with the velocity (r = -.51), normalized velocity (r = -.46) and gait-stability ratio (r = .58) (p < .05). The trunk angle was moderately correlated with the normalized velocity (r = -.32) and gait-stability ratio (r = .32) and weakly correlated with the velocity (r = -.28) (p < .05). The coronal shoulder angle was moderately correlated with the swing phase (r = -.57), stance phase (r = .56), single limb stance (r = -.56) and double limb stance (r = .51) (p < .05). The coronal head angle and trunk angle accounted for 36% of the variance in velocity, 33% variance in normalized velocity and 46% variance in the gait-stability ratio (p < .05). The coronal shoulder angle accounted for 32% variance in the swing phase, 32% variance in the stance phase, 31% variance in the single limb stance and 26% variance in the double limb stance (p < .05). CONCLUSION: Changes in posture alignment in elderly women may serve as a biomarker to predict a decrease in walking ability due to physical aging.