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소아 가정방문 물리치료의 인식도와 수요도에 관한 설문조사
최선영 ( Sun Young Choi ),윤장원 ( Jang Whon Yoon ) 한국전문물리치료학회 2013 한국전문물리치료학회지 Vol.20 No.3
본 연구는 소아 가정방문 물리치료에 관한 인식도와 수요도, 견해를 알아보기 위해 전국의 인구분포도에 대비하여 소아 물리치료사와 보호자, 의사를 대상으로 설문조사를 실시하였고 다음과 같은 결과를 얻었다. 첫째, 모든 집단이 소아 가정방문 물리치료에 대해인식도는 낮았으나 각 집단 모두 빠른 시일 내에 필요하다는 의견을 보였다. 둘째, 소아 가정방문 물리치료의 참여·이용에 대한 의사여부에서 모든 집단이 높은 참여·이용률을 보였다. 셋째, 운영방안에 대해서는 모든 집단이 의사의 처방이 필요하다고 하였고, 소아 가정방문 물리치료를 시행할 소아 물리치료사로 6∼10년의 임상자격조건을 원하였다. 치료비용에서는 물리치료사는 현재 치료비보다 2배를, 보호자는 현재 치료비와 동일하게를, 의사는 현재 치료비보다 1.5배에 많은 분포를 보였다. 물리치료사, 보호자, 의사 모두 현재와 동일한치료횟수와 1시간의 치료 소요시간을 선호하였다. 이상을 종합해보아 소아 가정방문 물리치료에 대한 인식도는 낮으나 수요도와 참여·이용률이 높음을 알 수있었다. 이렇게 높은 수요도와 참여·이용률을 보이는 소아 가정방문 물리치료를 제도적으로 정립하기 위해서는 실효성을 검증할 수 있는 일정기간의 시범사업을 통해 많은 연구와 조사가 필요하며, 먼저 소아 가정방문 물리치료와 관련된 관계자들의 의견을 충분히 수렴하고 이를 반영하여 소아 가정방문 물리치료 제도 정립을 위해 현재 의료 시스템의 정비가 이루어져야 할 것이다. Pediatric home-based physical therapy (PHBPT) provides professional rehabilitation programs at the patient`s home, where the activities of daily life are actually performed. PHBPT also allows to avoid the difficulties of transporting children with disabilities to the clinic. Despite these advantages, PHBPT is not yet widely practiced in Korea. There is little objective information regarding the opinions of the main stakeholders on PHBPT. To investigate the awareness and demand of PHBPT among the main stakeholders, 41 pediatric physical therapists (PT) (of 60 contacted) were recruited from different regions of Korea on the basis of the regional population distribution. The recruited PTs completed their questionnaires and also participated in collecting questionnaires from 35 medical doctors (MD) with whom they worked and from randomly selected 201 parents of children with disabilities recruited. The overall response rate was 85.5%. The awareness of PHBPT differed between PTs (95.1%) and parents (67.2%) (p<.001). The survey showed that 82.9% of MDs had at least heard about PHBPT. Significantly more parents (83.5%) than MDs (57.1%), and 70.0% of PTs, wanted to start PHBPT service immediately (p<.001). Significantly more parents (90.0%) than PTs (73.2%) were willing to participate in PHBPT (p<.001). Opinions on the details of policies and procedures (i.e., necessity for prescription, treatment cost, and treatment frequency) differed among the respondent groups, but all favored a minimal qualification of 6∼10 years of pediatric experience and a treatment session duration of 1 hour. These findings provide objective information to support health service administrators to understand the current demand and develop feasible policies and procedures of PHBPT in Korea.
An Application of Constraint-Induced Therapy in Patients With Chronic Hemiparesis After Brain Injury
Park, Ji-won,Kim, Jong-man,Kim, Yun-hee 한국전문물리치료학회 2001 한국전문물리치료학회지 Vol.8 No.4
뇌 손상 후 급성기에 기능의 자발적인 회복이 일어나지만 환자들은 환측의 상지를 잘 사용하지 못하게 된다. 그 결과 원하는 움직임을 억제하는 상황을 발생시키는데 이것을 학습 무사용 증후군(learned nonuse syndrome)이라 한다. 이러한 학습 무사용 증후군을 치료하기 위해 억제-유도 치료(constraint-induced therapy)가 고안되었다. 억제-유도 치료는 연속되는 몇 주간에 걸쳐 매일 많은 시간 동안 건측의 상지를 묶어두고 환측 상지를 사용하게 하여 기능을 반복 학습하게 함으로써 기능을 증진시키는 방법이다. 이미 여러 연구자들이 경두개 자기자극(transcranial magnetic stimulation), 움직임 관련 피질전위(movement-related cortical potential), 기능적 자기공명 영상기법(functional magnetic resonance imaging) 등을 통하여 억제-유도 치료 후 운동피질영역에서의 재조직화를 보고함으로써 기능 증진과 관련된 회복 기전을 뒷받침하고 있다. 억제-유도 치료의 영역은 확대되어 뇌졸중, 척수손상, 고관절 치환술 후로 하지에서의 기능증진을 위하여 연구가 진행되고 있으며 특히 뇌졸중 후 실어증 환자에서 새로운 방법으로 제시되고 있다. 따라서, 억제-유도 치료는 신경학적인 손상 후 움직임의 재활에 있어서 치료-유도를 통한 중추신경계의 회복에 효과적으로 작용할 수 있다.
Jung, Young-jong 한국전문물리치료학회 2001 한국전문물리치료학회지 Vol.8 No.4
근위축성 측색 경화증(amyotrophic lateral sclerosis: ALS) 환자에게 있어 호흡기능 장애는 죽음에 이르게 하는 주요 원인 중 하나이다. 본 연구는 근위축성 측색 경화증이 있으며 호흡기능이 약화되어 있는 51세의 여성 환자를 대상으로 호흡운동 치료를 시행한 후 폐기능(pulmonary function)이 증진되었는지를 알아보자 실시하였다. 연구 대상자는 6주간의 호흡운동 치료 프로그램에 참여하였다. 호흡운동 치료 프로그램은 횡경막 호흡(diaphragmatic breathing), 복부근육강화(abdominal muscles strengthening), 지갑입술 호흡(pursed lip breathing), 그리고 동기 유발성 흡기폐활량계(incentive spirometer)를 이용한 흡기운동 등으로 구성되었다. 폐기능 검사는 이동식 호흡측정기(spirometer: MICROSPIROHI-198)를 이용해서 시행하였다. 또한 하지 에르고미터(cycle-ergometer)를 이용해 운동 시간을 측정함으로써 폐기능의 증진 여부를 알아보았다. 연구 대상자는 6주간의 호흡운동 치료 기간 동안 노력성 폐활량(forced vital capacity: FVC)과 정상 예측치에 대한 노력성 폐활량의 비율(percentage of the predicted forced vital capacity: %FVC), 그리고 하지 에르고미터의 운동 시간에 있어 현저한 증가를 보였다. 그러나 노력성 폐활량에 대한 1초간 노력성 폐활량 비(FEV1/FVC)에 있어서는 약간의 감소를 보였다. 근위축성 측색 경화증 환자에게 6주간의 호흡운동 치료를 실시한 결과, 폐기능의 증진에 효과적임을 알 수 있었으며, 앞으로 더 많은 연구 대상자에게 그 효과를 알아보는 연구가 필요할 것이다.
( Ki Song Kim ),( Jung Hwa Choi ),( Yoon Ghil Park ) 한국전문물리치료학회 2011 한국전문물리치료학회지 Vol.18 No.4
The purpose of this study was to investigate the changes in the flexicurve kyphosis index (KI), the flexicurve lordosis index (LI) and the distance from the inferior angle of the scapula to the nearest vertebral spinous process (DS), as a dependent variable of scapular protraction, after applying of adolescents with thoracic hyperkyphosis using three different garments. A repeated measures design was used. Ten adolescents (15.8±1.0 years) with thoracic hyperkyphosis (40.1±3.7 Cobb angle) were recruited from a university hospital. A flexicurve ruler was used to measure KI and LI and a scoliometer was used to measure DS under three different conditions: wearing-a hospital garment (HG), wearing-a sham garment (SG), and wearing-an experimental garment (EG). KI under EG condition was significantly decreased compared with that wearing the HG. However, there was no significant difference between wearing the SG and HG. LI when wearing the EG was significantly increased compared with that when wearing HG. However, there was no significant difference under SG and HG conditions. DS when wearing the EG was significantly decreased compared with wearing HG. However, there was no significant difference between the SG and HG. The results of this study show that the EG was effective in decreasing KI, but not effective in decreasing LI. Hence, the effect of the EG for correcting sagittal spine angle in adolescents with thoracic hyperkyphosis is still debatable. However, since we showed that DS decreases in the EG, this method could be applied in correcting the scapular protraction.
( Jung Suk Rob ) 한국전문물리치료학회 2011 한국전문물리치료학회지 Vol.18 No.4
The purpose of this study was to investigate the effect of attentional focus and distance of external focus on the performance of balance task of upper extremity. Subjects (N=30) held a stick (2 m) and maintained it horizontally. All of the subjects performed balance task of upper extremity under four different attentional focus conditions: focus on hand (internal focus), marker at 10 cm inside of hand (external focus 1), marker at 10 cm outside of hand (external focus 2), marker at 20 cm outside of hand (external focus 3). The mean velocity of the bar (mm/s) and the muscle activity of biceps brachii (%RVC) were measured. They were decreased when the subjects focused on external focuses compared to internal focus and decreased as distance of attentional focus from body increased (p<.05). There were significant differences between groups (p<.05); internal focus-external focus 1, internal focus-external focus 2, internal focus-external focus 3, external focus 2-external focus 3. These results showed that external focus is more effective than internal focus in enhancing motor performance and focusing on more distant attentional focus results in enhanced motor performance promoting the utilization of more automatic control mechanisms.
Assessment of the Influence of Physical Impairments on Activities in Persons With Stroke
( Young Keun Woo ) 한국전문물리치료학회 2011 한국전문물리치료학회지 Vol.18 No.4
The aim of this study was to analyze the relationship between physical impairments and daily activities on the basis of the outcome measurements in stroke patients. Seventy-six stroke patients participated in this study. Two physical therapists evaluated 3 clinical common measurements, i.e., the Fugl-Meyer Assessment (FMA), the Berg Balance Scale (BBS), and the Functional Independence Measure (FIM). Multiple regression analysis was used, as the dependent variables were the BBS and FIM; the independent variables were post-stroke duration, FMA of Upper Extremity (FMU), and FMA of Lower Extremity (FML). In the regression equation of the BBS, the coefficient of determination (R2) was .383, and the FML was found to be the most important variable for determining the BBS score. In the regression equation of the FIM, R2 was .531, and the FML was found to be the most important variable for determining the FIM. These results suggest that there is a need to determine the function of activities on the basis of the physical impairments of stroke patients. More variable measurement tools on the levels of body function and structure, as well as activity limitations are required.
수동적 요추 신전 검사와 엎드린 상태에서 요추 불안정성 검사의 신뢰도와 타당도
사재민 ( Jae Min Sa ),김선엽 ( Sun Yeop Kim ) 한국전문물리치료학회 2011 한국전문물리치료학회지 Vol.18 No.3
The purpose of this study was to establish the reliability and validity of the passive lumbar extension (PLE) test and prone instability test (PIT). Thirty-three subjects (14 males, 19 females) with lower back pain enrolled in the study and the subjects were divided into 2 groups (positive and negative instability groups) on the basis of radiographies of flexion and extension. Reliability was determined by the kappa results showed that the reliability of the PLE test was higher than the PIT (intra-rater reliability: k .86 and k .81, interrater reliability: k .65 and k .62) and the validity of the PLE test was also higher than the PIT (sensitivity: 91% and 62%, specificity: 95% and 85% positive likelihood ratio: 20.00 and 4.10, negative likelihood ratio: .10 and .45). In conclusion, we think that the PLE test was a more reliable and valid method for lumbar instability than the PIT.