근육긴장도와 이에 영향을 미치는 체성감각계에 관한 고찰

김중휘,권용현,박정미,김중선,Kim Joong-Hwi,Kwon Yong-Hyun,Park Jung-Mi,Kim Chung-Sun 대한물리치료학회 2003 대한물리치료학회지 Vol.15 No.2

Muscle tone is the force with which a muscle resists being lengthened. Muscle tone is often tested clinically by passively extending and flexing a relaxed patient's limbs and feeling the resistance offered by the muscle. Both nonneural and neural mechanism contribute to muscle tone. Muscle tone is the mechanisms that contribute to the generation of tone in individual muscles when a person is in a relaxed state. This background level of activity changes in a certain antigravity posture muscle when we stand upright, thus counteracting the force of gravity. This increased level of activity in antigravity muscles is known as postural tone. The evidence from experiments showing that lesions of the dorsal(sensory) roots of the spinal cord reduced muscle(postural) tone is influenced by inputs from the somatosensory system. Patients with neurological damage have several state of muscle(postural) tone, which display from flaccidity to rigidity. This review article deal with muscle tone and somatosensory system acting on this. The understanding about this contribute to a better therapeutic approach for the rehabilitation of patients to have an abnormal muscle(postural) tone due to neurological damage.

플라스틱 단하지 보조기와 신발 착용이 편마비 환자의 정적 선자세 균형에 미치는 영향

김중휘,김중선,Kim, Joong-Hwi,Kim, Chung-Sun 대한물리치료학회 2001 대한물리치료학회지 Vol.13 No.2

In the patients with hemiplegia caused by stroke and TBI. postural sway is increased and open displaced laterally over the non-affected leg, reflecting asymmetry in weight bearing on lower extremities during standing balance. Recovery of symmetric weight bearing and postural stability is an important aim in physical therapy. Plastic AFO has been used for hemiplegic patients in order to help their abnormal walking patterns. Past studies have mainly focused on the AFO influences on hemiplegic walking patterns without balance function approaches. The purpose of this study was to identify the immediate effects of plastic AFO and shoes on the static balance in hemiplegic patients. The scale for static balance were weight bearing on affected leg(%), sway area(mm2), sway path(mm), maximal sway velocity(mm/s), anteroposterior sway angle($^{\circ}$ ), and lateral angle($^{\circ}$ ). Seventeen hemiplegic patients participated in this study: 13 men and 4 women, with an average age of 50.18 years. Static balance was measured using BPM(balance performance monitor; dataprint software version 5.3) under four standing condition namely bare-foot standing. standing in shoes, standing with AFO, and standing in shoes with AFO. In order to assure the statistical significance of the results, an one-way ANOVA, the independent t-test. and a pearson's correlation were applied at the .05 level of significant. The results of this study were as follows: 1) There were statistically significant differences in weight bearing(%) on the static balance between affected leg and non-affected leg(p<.01). 2) There were statistically significant differences in sway reverse frequence(Hz) in standing with AFO between affected leg and non-affected leg(p<.05). 3) Sway area(mm2) on standing in shoes with AFO was lower than bare-foot standing(p<.05), Lateral sway angle($^{\circ}$ ) on standing in shoes with AFO was lower than bare-foot standing and standing in shoes(p<.05). 4) Weight bearing in affected leg was not significantly correlated with postural sway.

뇌졸중 환자의 보행 대칭성과 기능적 균형 및 보행과의 상관관계 연구

김중휘,Kim, Joong-Hwi 대한물리치료학회 2014 대한물리치료학회지 Vol.26 No.1

Purpose: The aim of the present study was to understand the relationship between gait symmetry and functional balance, walking performance in stroke patients and to makes recommendation regarding the most suitable measure for standardization of expression of spatiotemporal gait symmetry. Methods: 45 subjects with stroke (31 men, 14 women, $57.3{\pm}10.3$ years old) participated in this study. Gait symmetry was calculated by equations of symmetry ratio (SR) and symmetry criterion (SC) for stance time, swing time, single leg support time (SLST), step length, and stride length. Spatiotemporal parameters were measured respectively by walkway system ($GAITRite^{TM}$ system). Limit of stability (LOS) by using forceplate (Balance Performance Monitor) during voluntary weight displacement and Berg Balance Scale (BBS) were measured as functional balance and Timed Up and Go test (TUG) and Functional Ambulation Category (FAC) were assessed as functional walking. Results: SR in stance time and swing time was correlation with BBS, TUG and FAC (p<0.05). SR in SLST only with BBS (p<0.01), SR in step length only with FAC (p<0.05). SC in stance time was correlation with BBS and TUG (p<0.05). SC in swing time and SLST with BBS, TUG and FAC (p<0.01), SC in step length with TUG and FAC (p<0.01), SC in stride length with BBS and FAC (p<0.01). Conclusion: Gait symmetry in spatiotemporal gait parameters provides meaningful information about functional balance and walking performance in stroke subjects. Our analysis may support the recommendations of the symmetry criterion as equation for standardization of gait symmetry.

중추유형발생기에 근거한 뇌졸중 환자의 치료적 접근

김중휘,김중선,Kim Joong-Hwi,Kim Chung-Sun 대한물리치료학회 2002 대한물리치료학회지 Vol.14 No.4

In the last years, it has become possible to regain some locomotor activity in patients with incomplete spinal cord injury (SCI) through intense training on a treadmill. The ideas behind this approach owe much to insights derived from animal studies. Many studies showed that cats with complete spinal cord transection(spinalized animals) can recover locomotor function. These observations were at the basis of the concept of the central pattern generator located at spinal level. The neural system responsible for the locomotor restoration in both cats and humans is thought to be located at spinal level and is referred to as the central pattern generator(CPG). The evidence for such a spinal CPG in human is emphasis on some recent developments which support the view that there is a human spinal CPG for locomotion. An important element in afferent inputs for both spinal injured cats and humans is the provision of adequate sensory input related locomotor, which can possibly activate and/or regulate the spinal locomotor circuitry This review article deals with the afferent control of the central pattern generator. Furthermore, the application of adequate afferent inputs related locomotor for stroke patients will be able to facilitate locomotion ability, which is automatic, cyclic, rhythmic. These insights can possibly contribute to a better therapeutic approach for the rehabilitation of gait in patients with stroke.

뇌졸중 환자에서 8자 모양 경로 보행 검사의 동시 타당도 연구

김중휘,박지원,Kim, Joong-Hwi,Park, Ji-Won 대한물리치료학회 2012 대한물리치료학회지 Vol.24 No.5

Purpose: The purpose of this study was to determine the concurrent validity between Figure-of-8 Walking Test (F8W), Berg Balance Scale (BBS), Four Squared Step Test (FSST), and Timed UP and GO Test (TUG) in patients with stroke. Methods: Forty two participants (26 men, 16 women, $55.0{\pm}11.72$) with at least three months post stroke who were able to walk at least 10 m without walking aid participated in this study. Assessment of concurrent validity between the F8W (time and steps) and BBS was performed using Spearman rank order correlation and between the F8W (time and steps), FSST and TUG assessed using Pearson correlation. Results: The time of the F8W showed correlation with BBS (r=-0.46, p<0.01), FSST (r=0.64, p<0.01), and TUG (r=0.81, p<0.01), and steps of the F8W showed correlation with BBS (r=-0.43, p<0.01), FSST (r=0.47, p<0.01), and TUG (r=0.51, p<0.01). Conclusion: The F8W is a valid measure of balance and walking skill among patients with stroke and may provide complementary information with regard to dynamic balance and functional walking for the real life of stroke patients.

뇌졸중 환자의 정적, 동적 선자세 균형 대칭성과 보행 기능의 상관관계 연구

김중휘,Kim, Joong-Hwi 대한물리치료학회 2012 대한물리치료학회지 Vol.24 No.2

Purpose: The aim of the present study was to measure the standing balance symmetry of stroke patients using a force-plate with computer system, and to investigate the correlation between the standing balance symmetry and that of the walking function in stroke patients. Methods: 48 patients with stroke (34 men, 14 women, $56.8{\pm}11.72$ years old) participated in this study. Static standing balance was evaluated by the weight distribution on the affected and the nonaffected lower limbs, sway path, sway velocity, and sway frequency, which reflected the characteristic of body sway in quiet standing. Dynamic standing balance was evaluated by anteroposterior and mediolateral sway angle, which revealed the limit of stability during voluntary weight displacement. Symmetry index of static standing balance, (SI-SSB) calculated by the ratio of the affected weight distribution for the nonaffected weight distribution, and symmetric index of dynamic standing balance (SI-SDB) by the ratio of the affected sway angle for the nonaffected sway angle. Functional balance assessed by a Berg balance scale (BBS), and the functional walking by 10m walking velocity, as well as the modified motor assessment scale (mMAS). Results: Static balance scales and SI-SSB was the only correlation with BBS (p<0.05). Dynamic balance scales and SI-DSB, not only was correlated with BBS, but also with 10m walking velocity and mMAS (p<0.01). Additionally, there was a significant difference between SI-SSB and that of SI-DSB (p<0.01). Conclusion: The balance and the walking function relate to real life in the stroke showed strong relationships with the dynamic standing balance symmetry in the frontal plane and the ability of anterior voluntary weight displacement in sagittal plane.

넙다리뒤근육에 대한 스트레칭이 근육의 뻣뻣함에 미치는 즉각적 효과

김중휘,김태호,Kim, Joong-Hwi,Kim, Tae-Ho 대한물리치료학회 2010 대한물리치료학회지 Vol.22 No.1

Purpose: Stretching exercises are commonly used in conjunction with sports and rehabilitation. Weassessed the immediate effects of stretching on passive stiffness of the hamstring muscles and knee range of motion (ROM) using three stretching techniques. Methods: A total of 45 participants were recruited. Isokinetic equipment was used to measure the passive stiffness of hamstring muscles and an inclinometer was used to measure active and passive ROM of the knee joint pre and post stretching. Stiffness was then calculated based on the incline of the torque-angle relationship. The test conditions for Group I were $3{\times}30$ seconds of static stretches using the hamstring muscle, Group II were $3{\times}30$ seconds of static stretches using the hamstring muscle with ankle dorsiflexion, and Group IIII had $3{\times}30$ seconds of active stretching. Results: Group II had significantly higher excursion of active ROM and Group IIIhad significantly higher excursion of passive muscle stiffness. All of the groups had significantly higher active and passive ROM and significantly lower muscle stiffness after stretching. The participants showed no change in hamstring muscle stiffness on the following day. Conclusion: Stretching has significant acute effects on ROM and muscle stiffness and canbe used in warm-up protocols for reducing muscle stiffness before a variety of exercise programs.

뇌졸중 환자에게 반복 경두개 자기자극 후 잔존효과 내 과제지향 훈련이 손의 강직에 미치는 영향

김중휘 ( Joong-hwi Kim ),정무근 ( Mu-geun Jeong ) 대한신경치료학회 2017 신경치료 Vol.21 No.2

Purpose The aim of this study was to find effect of task_oriented training including aftereffect after applying low frequency (1Hz) or higt frequency (10Hz) repetitive transcranial magnetic stimulation (rTMS) on hand spasticity in stroke patients. Methods Forty patients with history of stroke and upper limb hemiparesis (age at intervention: 51.3 years, time after stroke onset: 11.3 months) were studied. Forty patients were divided into four groups; task_oriented training including aftereffect after applying high frequency (10Hz) rTMS (TIAH, n=10), task_oriented training excluding aftereffect after applying high frequency (10Hz) rTMS (TEAH, n=10), task_oriented training including aftereffect after applying low frequency (1Hz) rTMS (TIAL, n=10), task_oriented training excluding aftereffect after applying low frequency (1Hz) rTMS (TEAL, n=10). The intervention was performed for four times a week, for four weeks. Results As shown by the result of the Modified Tardieu Scale (MTS), there were significant differences on follow up test in the hand spasticity of the TIAH group, wheras there was a significant difference on during intervention (between baseline and 4 weeks) in those of the TEAL group. Furthermore, results of motor evoked potentials (MEPs) showed significant differences in all four groups. Conclusion The 4 weeks protocol of TIAH seems effective in improving hand spasticity in upper limb hemiparesis after stroke.

기능적 자기공명영상을 이용한 구심성 및 원심성 근 수축에 따른 뇌 활성도 분석

김중선,김중휘,박민규,박지원,Kim, Chung-Sun,Kim, Joong-Hwi,Park, Min-Kyu,Park, Ji-Won 대한물리치료학회 2010 대한물리치료학회지 Vol.22 No.2

Purpose: Behavior and movement are accomplished by voluntary contractions of skeletal muscles. There are three types of muscle contractions: concentric, isometric and eccentric. The aim of our study was to determine whether there is a difference in the cortical activation pattern between concentric contraction and eccentric contraction of the wrist extensor muscle. Methods: Four healthy right-handed volunteers without any previous history of physical or neurological illness were recruited. fMRI scanning was done during 4 repeated blocks of concentric and eccentric exercise of the wrist joint. Subjects exercised for 12 seconds and then rested for 12 seconds before beginning the second set of exercises. To determine the excitability of cortical neurons during exercise, voxel count and intensity index were analyzed. Results: For right hand movements, when concentric contractions of the right wrist were done, only the left primary motor area was activated. In contrast, during eccentric contraction, both the primary motor area and secondary motor area were activated. For left hand movements, both concentric and eccentric contractions induced only the supplementary motor cortex and the contralateral primary motor cortex. Conclusion: During eccentric contractions, both the primary motor area and secondary motor area are activated in ipsilateral and contralateral brain areas. Thus, eccentric contractions require more complex and difficult movements than concentric contractions do.

앞십자인대 재건술 후 엉덩관절 벌림근 강화운동이 근력과 보행에 미치는 영향

박병준,김중휘,Park, Byung-Joon,Kim, Joong-Hwi 대한물리치료학회 2014 대한물리치료학회지 Vol.26 No.5

Purpose: The purpose of this study was to investigate the effect of strengthening exercises of hip abductors on muscle strength and ambulation for patients with ACL reconstruction. Methods: The subjects were randomly assigned to the intervention group (general exercise plus strengthening of hip abductors) or the control group (general exercise without the strengthening of hip abductors). Both groups participated in a six-week exercise protocol after the surgery for ACL reconstruction. The knee strength test (quadriceps, hamstring, hip abductor) and gait analysis were performed in pretest and post-test. Results: Muscle strength was measured using the Biodex system III model (Biodex Medical System, Inc, NY, US). The results showed no significant difference in knee strength (quadriceps, hamstring) between the two groups (p>0.05), however, there was a significant difference in hip abductors (p<0.05). The gait analysis was measured with Gaitrite system (CIR System Inc, US). Results of comparison between groups showed a significant increase in the step length of both groups. (p<0.05), and there was a significant difference in the affected leg of the intervention group(p<0.05). Conclusion: Exercise of hip abductors for patients with ACL reconstruction provides significant benefits with respect to improvement of muscle strength in hip abductors, increasing the stride. This result indicates that a training program designed for ACL reconstruction patients should include strengthening of the hip abductor. We think that further study is needed to determine the relationship of hip muscles and knee joint for patients with ACL reconstruction.