뇌졸중 환자 대상 작업치료 계획 설정 경험에 관한 연구

안시내(Si-Nae Ahn) 한국인지운동치료협회 2023 한국신경인지재활치료학회지 Vol.15 No.1

편마비 환자의 팔 기능 회복에 인지운동치료의 효과

안시내(Si-Nae Ahn),이정원(Jeong-Weon Lee) 한국인지운동치료협회 2009 한국신경인지재활치료학회지 Vol.1 No.1

목 적 본 연구는 편마비 환자에게 새로운 치료접근 방법으로써 인지운동치료를 적용하여 일상생활활동 및 팔 기능 회복에 미치는 효과를 알아보는 것이다. 방 법 본 연구의 대상자는 2009년 4월 22일 발병한 좌측 내포 후부(posterior limb)의 뇌경색으로 인해 우측 편마비가 된 남자 환자로 52세이며 오른손잡이였다. 환자는 2009년 6월 2일부터 2009년 7월 3일까지 주 2회 30분씩 총 4주 동안 팔에 대한 인지운동치료를 시행하였다. 연구절차는 4주의 치료기간 내에 치료 전, 치료 후 1차, 치료 후 2차 재평가를 동일한 방법으로 시행하였다. 평가는 인지운동 프로파일 및 일상생활동작은 MBI를 사용하였으며, 팔 기능은 MFT를 사용하여 치료의 효과를 비교하였다. 또한 사진영상을 이용한 운동패턴에 대한 시각적 동작분석을 실시하였다. 결 과 인지운동 프로파일에 있어서 병리적 특성, 인식양상,언 어양상, 주의양상에서 질적인 변화를 보였다. 인지운동치료 전과 비교하여 치료 후에는 MBI 점수가 31점 향상되었다. 팔 기능 평가에 있어서 인지운동치료 전 3점에 비해 치료 후에 9점으로 증가되었다. 또한 시각적 동작분석 상에 운동 패턴의 질적인 향상이 있었다. 결 론 편마비 환자에게 인지운동치료는 일상 생활활동 및 팔 기능 회복에 효과가 있었다. 또한 운동패턴에 있어서 질적인 향상을 보였다. 따라서, 인지운동치료는 편마비 환자의 팔 기능 회복에 유용한 접근법이 될 수 있는 가능성을 제시해 준다. Objective : This study has been carried out to review the case which adopted the method of cognitive therapeutic exercise(CTE) requiring the highly complicated function of the brain for the purpose to recover the functional ability of upper limb in patient with capsular hemiplegia caused by cerebral infarction. Methods : The subject of this study was a right-handed male aged of 52 with right hemiplegia affected by cerebral infarction of left posterior limb which occurred on Apr. 22, 2009. CTE had been conducted every two time a week during the period of four weeks which lasted from Jun. 2, 2009 to Jul. 3, 2009 and each treatment proceeded for 30 minutes. During the four weeks of treatment, FIM, MFT and CTE assessment were analyzed on the basis of before and after each treatment to find out the effect of kinesitherapy. Results : The grades of FIM obtained before treatment were 76 points. However, the grades were 84 points after the first CTE was applied and 86 points after the second treatment. In MFT, the grades were 3 points before the application of CTE and the grades led to 7 points after the first treatment and 9 points after the second treatment. All of these results show that the CTE has contributed to the improvement of the motor ability. When it comes to CTE profile, the findings showed that there were improvements in pathological features, cognitive behavior, linguistic ability and attentiveness. Conclusion : It is concluded that application of CTE for the patient with capsular hemiplegia caused by cerebral infarction has positive influences on the recovery of upper limb function and improved movement patterns.

뇌졸중 환자의 신경인지재활치료에 대한 고찰

안시내(Si-Nae Ahn) 한국인지운동치료협회 2020 한국신경인지재활치료학회지 Vol.12 No.1

목적: 뇌졸중 환자에게 적용한 신경인지재활치료에 대한치료효과를 고찰을 통해 알아보기 위함이다. 방법: 본 연구의 목적에 따라 한국신경인지재활치료학회지에 투고된 총 96편의 논문을 검색하여 논문의 제목과 초록을 검토하였다. 연구 선정 포함기준과 배제기준에 따라 34편의 문헌을 선별하였다. 선별된 논문의 원문을 검토하여 최종적으로 31편이 분석 논문으로 선정되었다. 선정된 문헌의질적 분류와 연구대상, 중재방법, 측정방법, 연구결과를 분석하였다. 또한 최종 선정된 31편의 연구에서 사용된 독립변수, 종속변수, 중재기간, 치료시간, 측정도구에 대한 빈도분석을실시하였다. 결과: 뇌졸중 환자에게 적용한 신경인지재활치료에 적용된 연구설계는 사례연구가 23편으로 가장 많았고, 독립변수는 인지운동치료가 13편으로 가장 많았으며, 종속변수는상지기능이 15편으로 가장 높은 빈도를 나타냈다. 신경인지재활치료를 제공하는 중재기간은 4주가 10편으로 가장 많았고, 치료시간은 회당 30분이 가장 많았다. 선정된 연구에서사용된 측정도구는 뇌졸중 환자의 상지기능을 측정하는MFT와 일상생활활동을 측정하는 MBI가 높은 빈도를 나타냈다. 결론: 본 연구는 신경인지재활치료를 뇌졸중 환자를 대상으로 적용한 연구에 대한 고찰로 치료 효과 확인 및 임상에적용할 수 있는 자료를 제시하였다. The purpose of the study is to examine the treatment effects of neurological cognitive rehabilitation applied to stroke patients. According to the purpose of this study, a total of 96 papers submitted to the Journal of Korean Society of Neurocognitive Rehabilitation were searched and the title and the abstract of the papers were reviewed. 31 papers were selected as papers for analysis. The qualitative classification and research subjects, arbitration methods, measurement methods, and research results of the selected literature were analyzed. In addition, frequency analysis was performed on independent variables, dependent variables, arbitration periods, treatment time, and measurement tools. The study applied to neurological cognitive rehabilitation treatment for stroke patients had the largest number of case studies with 23, the most frequent independent variable were cognitive exercise treatments with 13 studies, and the most frequent dependent variable was upper limb functions with 15 studies. The intervention period was the highest with 10 sessions in four weeks. The measurement tools used in the selected study showed high frequency of MFT and MBI. This study examined effectiveness of treatment through review of the study on applying neurocognitive rehabilitation treatment to stroke patients and presents data that can be applied to clinical trials.

뇌졸중 환자의 인지기능에 따른 균형능력의 차이

안시내(Si Nae Ahn),나은진(Eun Jin Nah) 한국인지운동치료연구회 2017 한국신경인지재활치료학회지 Vol.9 No.1

목적: 본 연구는 뇌졸중 환자의 인지기능 수준에 따라 균형 능력에 차이가 있는지 알아보았다. 방법: 뇌졸중 환자 62명을 모집하여, 인지기능 수준을 평가하고, 균형능력에 대한 평가를 실시하였다. 인지기능과 동적 및 정적 균형능력의 평가 결과를 상관성을 확인하고, 상관성이 높은 정적 균형능력에 대해 인지기능의 그룹별 비교를 실시하였다. 통계방법은 기술통계와 상관분석 및 일원배치 분산분석을 사용하였다. 결과: 본 연구의 대상자는 62명으로 오른쪽 편마비 35명(56.4%), 왼쪽 편마비 27명 (43.5%)이었다. 인지기능과 동적 균형능력 (TST)의 상관관계는보통정도의 상관관계를 나타냈다 (r=.315, p<.05). 인지기능과 정적 균형능력 (BBS)의 상관관계는 중간정도의 상관관계를 나타냈다 (r=.416, p<.05). 인지수준에 따른 3그룹과 정적 균형 능력의 비교에서는 인지기능이 높은 그룹에서 정적 균형이 통계적으로 더 높게 나타났다 (p<.05). 결론: 본 연구는 인지능력에 따른 균형능력의 차이가 있음을 검증하였으며, 특히 인지능력이 높을 수록 정적 균형이 높음을 확인하였다. The purpose of this study was to determine whether there is a difference in balance ability according to the level of cognitive function in stroke patients. A total of 62 stroke patients were recruited and assessed for cognitive function and balance. The correlation between the cognitive function and the evaluation results of the dynamic and static balance ability was confirmed, and the cognitive functions were compared with each other in the highly correlated static balance ability. Statistical methods used here were descriptive statistics, correlation analysis, and one-way ANOVA. The subjects were 62 in total, and they consist of 35 right-sided hemiplegic patients (56.4%) and 27 left-sided hemiplegic patients (43.5%). The correlation between cognitive function and dynamic balance ability (TST) showed a moderate correlation (r = .315, p <.05). The correlation between cognitive function and static balance ability (BBS) showed a moderate correlation (r = .416, p <.05). In comparison of static balance in three cognitive groups, the balance of higher cognitive group was statistically higher(p <.05). This study proved that the balance function differed by cognitive ability. Especially, it confirmed that the higher cognitive ability the group has, the higher its static balance was.

인지운동치료가 편마비 환자의 균형 및 보행 회복에 미치는 영향

안시내(Si Nae Ahn),김윤정(Yun Jeong Kim),노은솔(Eun Sol Noh),최슬기(Seul Gi Choi) 한국인지운동치료협회 2011 한국신경인지재활치료학회지 Vol.3 No.1

Objective : The purpose of this study was to provide fundamental data about the effects of training based on the Cognitive Therapeutic Exercise on balance and gait recovery with hemiplegia Methods : The subject of this study was a male patient who suffered from hemiparesis of right side of the body and for whom a 1-hour session of Cognitive Therapeutic Exercise was administered four time a week for three weeks from September 28th to October14th, 2011. FRT(Functional Reach Test), TUG(Time up & go test) and GAITRITE system was used to compare the change between pre-and post-intervention effects. Results : Participant showed increase in change of postual balance(Functional Reach Test), change of functional gait(Time up & go test) and change of gait pattern(GAITRITE system). Conclusion : Such results suggest that Cognitive Therapeutic Exercise has a positive effect on balance and gait. This approach has positive influences on the recovery of upper limb function and improved balance and gait with hemiplegia.

뇌졸중 환자에서 신체인식에 대한 감각변환 훈련의 효과

안시내(Si Nae Ahn) 한국인지운동치료연구회 2014 한국신경인지재활치료학회지 Vol.6 No.1

뇌졸중 환자에게 신체인식을 위해 인지과정을 통한 감각변환 훈련을 적용해보고, 신체인식과 그에 따른 일상생활활동 회복에 미치는 영향을 알아보는 것이다. 방법: 본 연구는 사례연구로 인지기능은 정상이지만 신체인식의 어려움을 갖고 있는 58세 왼편마비 환자를 대상으로 실시하였다. 10주 동안 감각변환 훈련을 적용하였으며 신체인식과 일상생활의 작업수행을 측정하여 비교하였다. 중재전·후 평가로 신체인식은 인지운동프로파일로, 일상생활의 작업수행은 Assessment of Motor and Process Skills (AMPS)로 측정하였고, 시각적 분석을 통해 중재 효과를 비교하였다. 결과: 신체인식에 대한 평가로 인지운동프로파일에서 개선되는 결과를 보였다. 일상생활의 작업수행 평가결과 AMPS의 운동기술은 중재 전 0.33로짓에서 중재 후 0.64로짓으로 0.31로짓 증가하였고, 처리기술은 중재 전 0.66로짓에서 1.21로짓으로 0.55로짓 증가하였다. 결론: 뇌졸중 환자에게 인지과정을 통한 감각변환 훈련은 신체인식의 증진과 일상생활의 작업수행에 긍정적인 영향을 주었다. 향후 뇌졸중 환자의 재활에서 신체인식에 대한 훈련도 고려해야 할 것이다. This research is to find out the influences on the recovery of Activity of Daily Living (ADL) according to perception of body by applying sensory Information transfer training through cognitive process for perception of body in stroke patients. Methods: In this research, the target was on a 58 years old left hemiplegia patient who has difficulty of perception of body while having normal cognitive functions. For 10 weeks, sensory Information transfer training was applied and occupational performance of ADL and perception of body were measured and compared. For the pre--intervention and post-intervention assessment, perception of body was measured with profile of cognitive therapeutic exercise profile while occupational performance was measured with Assessment of Motor and Process Skills (AMPS), and the intervention effect was compared through visual analysis. Results: For the assessment on perception of body, cognitive exercise profile showed improvement. As a result of the occupational performance assessment of daily living, motor skill of AMPS was 0.33 before intervention and raised to 0.64 after the intervention (increasing 0.31logit), and the process skill increased 0.55 logit from 0.66 before intervention to 1.21 after intervention. Conclusion: Sensory transfer training through cognitive process to stroke patients gave positive influence in occupational performance of daily life and also increased perception of body. Training about perception of body shall be considered in rehabilitation of stroke patients in the future. (J Korean Society of Neurocognitive Rehabilitation 2014;6:47--53)

뇌졸중 환자의 신경인지재활치료에서 집단 실험연구 설계에 대한 고찰

안시내(Si-Nae Ahn) 한국인지운동치료협회 2021 한국신경인지재활치료학회지 Vol.13 No.2

The purpose of this study was to review the design of a group experimental study for neurocognitive rehabilitation of stroke patients. A total of 119 articles published from the first issue to the latest issue of the Journal of Korean Society of Neurocognitive Rehabilitation were reviewed, including the original texts of the articles. The final four articles were analyzed according to the selection and exclusion criteria of this study. The final selected articles were investigated for qualitative classification of the level of evidence and data collection. Further, frequency analysis was performed on the characteristics and variables included in the study and presented according to the patient, intervention, comparison/control, outcome method based on the extracted data. There were four group experimental studies on stroke patients published in the Journal of Korean Society of Neurocognitive Rehabilitation, and among them, one group experimental study was the most. According to the specific characteristics of stroke patients, the largest number of studies were on stroke patients with limitations in activities of daily living and impairment of upper extremity function. As a measurement tool, activities of daily life was most widely used. This study reviewed the design of a group experiment for neurocognitive rehabilitation of stroke patients and presented basic data that can be applied to evidence-based clinical trials.

편마비 환자의 팔 기능 회복에 인지운동치료의 효과

안시내 ( Si Nae Ahn ),이정원 ( Jeong Weon Lee ) 한국인지운동치료연구회 2009 한국인지신경재활치료학회지 Vol.1 No.-

목적: 본 연구는 편마비 환자에게 새로운 치료접근 방법으로써 인지운동치료를 적용하여 일상생활활동 및 팔 기능 회복에 미치는 효과를 알아보는 것이다. 방법: 본 연구의 대상자는 2009년 4월 22일 발병한 좌측 내포 후부(posterior limb)의 뇌경색으로 인해 우측 편마비가 된 남자 환자로 52세이며 오른손잡이였다. 환자는 2009년 6월 2일부터 2009년 7월 3일까지 주 2회 30분씩 총 4주 동안 팔에 대한 인지운동치료를 시행하였다. 연구절차는 4주의 치료기간 내에 치료 전, 치료 후 1차, 치료 후 2차 재평가를 동일한 방법으로 시행하였다. 평가는 인지운동 프로파일 및 일상생활동작은 MBI를 사용하였으며, 팔 기능은 MFT를 사용하여 치료의 효과를 비교하였다. 또한 사진영상을 이용한 운동패턴에 대한 시각적 동작분석을 실시하였다. 결과: 인지운동 프로파일에 있어서 병리적 특성, 인식양상, 언어양상, 주의양상에서 질적인 변화를 보였다. 인지운동치료 전과 비교하여 치료 후에는 MBI 점수가 31점 향상되었다. 팔 기능 평가에 있어서 인지운동치료 전 3점에 비해 치료 후에 9점으로 증가되었다. 또한 시각적 동작분석 상에 운동패턴의 질적인 향상이 있었다. 결론: 편마비 환자에게 인지운동치료는 일상생활활동 및 팔 기능 회복에 효과가 있었다. 또한 운동패턴에 있어서 질적인 향상을 보였다. 따라서. 인지운동치료는 편마비 환자의 팔 기능 회복에 유용한 접근법이 될 수 있는 가능성을 제시해 준다. Objective: This study has been carried out to review the case which adopted the method of cognitive therapeutic exercise(CTE) requiring the highly complicated function of the brain for the purpose to recover the functional ability of upper limb in patient with capsular hemiplegia caused by cerebral infarction. Methods: The subject of this study was a right-handed male aged of 52 with right hemiplegia affected by cerebral infarction of left posterior limb which occurred on Apr. 22, 2009. CTE had been conducted every two time a week during the period of four weeks which lasted from Jun. 2, 2009 to Jul. 3, 2009 and each treatment proceeded for 30 minutes. During the four weeks of treatment, FIM, MFT and CTE assessment were analyzed on the basis of before and after each treatment to find out the effect of kinesitherapy. Results: The grades of FIM obtained before treatment were 76 points. However, the grades were 84 points after the first CTE was applied and 86 points after the second treatment. In MFT, the grades were 3 points before the application of CTE and the grades led to 7 points after the first treatment and 9 points after the second treatment. All of these results show that the CTE has contributed to the improvement of the motor ability. When it comes to CTE profile, the findings showed that there were improvements in pathological features, cognitive behavior, linguistic ability and attentiveness. Conclusion: It is concluded that application of CTE for the patient with capsular hemiplegia caused by cerebral infarction has positive influences on the recovery of upper limb function and improved movement patterns.

선호하는 촉각 이미지가 뇌파에 미치는 영향

안시내(Si Nae Ahn),이정원(Jeong Weon Lee) 한국인지운동치료협회 2015 한국신경인지재활치료학회지 Vol.7 No.1

본 연구는 촉각을 인지할 때 선호하는 이미지에 따라뇌 활성화에 차이가 있는지를 알아보자 한다, 방법: 연구 대상자는 정상 성인 15명으로 남자 10(66.7%)명, 여자5(33.3%)명이었고, 평균 연령은 22.21±2.39세 이었다. 뇌파는 국제기준 전극법에 따라 완이마엽(F3), 오른이마엽(F4), 왼관자엽(T3), 오른관자엽(T4), 왼마루엽(P3), 오른마루업(P4), 왼뒤통수엽(O1) 오른뒤통수엽(O2) 여덟부위에 전극을 부착하였다. 뇌파의 측정은 배경뇌파, 수동적촉각 지각, 선호하는 이미지를 떠울이면서 수동적으로 촉각을 지각하는 3단계로 측정하였다. 얻어진 뇌파를 파워스펙트럼 분석을 통해 정량적 분섣하여 상대파워 값을 산출하였다, 두 조건에 따른 통계분석은 대응표분t검정을 실시하였다. 결과: 수동적으로 촉각을 탐색할 때, 양쪽 뒤통수 영역에 알파파의 유의한 차이가 있었으며, 선호하는 촉각 이미지와 수동적 탐색을 동시에 할 때 더욱 증가하였다(p<.05). 감각운동리듬에서는 영역에서 통계적으로 유의한 차이가 없었다(p<.05). 결론: 본 연구는 감정이난 정서와 관련된 선호하는 감각을 이미지를 하는 것이 뇌 활성화에 긍정적인 영향을 준다는 것을 확인할 수 있었다. This study finds out the difference in brain activation according to the preferable imagery when recognizing sense of touch. Methods: The research target was based on 15 people composed of 10 males (66.7%) and 5 females (33.3%). The average age was 22.2l±2.39. For the Electroencephalogram (BEG), was measured to eight parts including left prefrontal, right prefrontal, left temporal, right temporal, left parietal, right parietal, left occipital, and right occipital. The measurement of EEG was done in three stages of manually detecting sense of touch while thinking about the preferred image. The acquired EEG was analyzed qualitatively through power spectrum analysis to calculate the target power value. Paired t-test was executed for the statistical analysis according to two conditions. Results: When passive searching for sense of touch while imaging the preferred sense, and when searching for sense of touch passively, there was significant difference in the alpha wave to the both sides of the occipital lobe. When passive searching for the preferred image, it increased even more (p<.05). In feeling sensory motor rhythm, the area did not show significant difference (p>.05). Conclusion : This research identified that imaging the preferred senses related to feeling and emotion gives positive influence to brain activation. (J Korean Society of Neurocognitive Rehabilitation 2015;7:1-7)

뇌졸중 환자에서 시간경과에 따른 환측 도형인지능력의 변화

안시내(Si Nae Ahn),최지은(Ji Eun Choi) 한국인지운동치료협회 2010 한국신경인지재활치료학회지 Vol.2 No.1

Objective : This study is aimed to investigate on which changes of shape cognitive abilities are showed at unilateral paralyzed patients according to time lapses, and what effects are influenced to recovery degrees such as cognitive function, upper extremity function, recovery phase, and daily life action etc. Methods : Research objects were 17 unilateral paralyzed patients with 12 males and 5 females who have hospitalized and discharged from the D hospital located in Banghak-dong, Seoul during July-October 2010. Objects were composed of 9 right paralyzed patients and 8 left ones. For these patients, reevaluation was carried out after 6 months from executing initial evaluation. This study observed and compared cognitive abilities to 9 figures having various lengths and thicknesses of alphabet T and I panels along with ○,△,□ ones from sagittal section and forehead one by using tablet. The study compared with recovery degrees such like cognitive function with MMSE-K, upper extremity function with MFT, recovery phase with Brunnstrome, and daily life actions with MBI. Results : First, there were a little difference in graphic cognitive abilities between initial evaluation and reevaluation at forehead section, but it was not significant. In sagittal section, graphic cognitive abilities between initial evaluation and reevaluation showed significant differences from distances along with sum of directions and distances(P<.05). Second, changes of functional recovery levels according to time lapses did not show significant differences at all items such as cognitive function, upper extremity function, recovery phase, and daily life actions etc. Third, in the graphic cognitive abilities between right paralyzed patients and left ones according to time lapses, right paralysis was higher with average 1.92 point at forehead section, average 1.95 at sagittal section than left one, and showed significant differences(P<.05). Also, there were differences at the time of reevaluation, but it was not significant. Conclusion : This study lighted up a fact that there were differences in changes of graphic recognition according to time lapses. However, it is necessary to clear up cognitive process s characteristics of unilateral paralyzed patients who have not considered till now further concretely along with various aspects through additional researches.