집중적인 흉부가동성운동이 뇌졸중 환자의 폐기능과 보행기능에 미치는 영향 = The Effects of Intensive Chest Mobility Exercise on Increasing Pulmonary Function and Gait in Stroke Patients

국문 초록 (Abstract)

본 연구의 목적은 만성 뇌졸중 환자에서 폐기능과 보행 능력에 대한 집중적인 흉부가동성 운동의 효과를 알아보고자 하였다. 본 연구의 대상자는 뇌졸중으로 인한 편마비환자 27명이었으며, 대상자들은 실험군(14명)과 대조군(13명)으로 무작위 배정되었다. 실험군의 대상자들은 2주 동안 주 5일, 1시간씩 집중적인 흉부가동성운동을 시행하였다. 대상자들의 폐기능은 흉곽확장 정도와 폐기능(노력성 폐활량, 1초 노력성 호기량, 노력성 폐활량에 대한 1초 노력성 호기량 비)에 대한 검사를 통해 측정되었으며, 보행 능력은 일어나 걸어가기 검사, 10m 보행 검사, 6분 보행 검사를 사용하여 평가되었다. 모든 측정은 중재 전과 후에 시행되었다. 본 연구의 결과는 실험군의 대상자들이 대조군의 대상자들에 비해 흉곽확장 정도와 1초 노력성 호기량에서 유의하게 더 향상된 것으로 나타났으며(p < .05), 또한 일어나 걸어가기 검사, 10m 보행, 6분 보행에서도 실험군의 대상자들이 유의하게 증진된 것으로 나타났다(p < .05). 이러한 결과는 집중적인 흉부가동성운동이 만성 뇌졸중 환자들의 폐기능과 보행
능력에 도움이 된다는 것을 의미한다.

다국어 초록 (Multilingual Abstract)

The objective of this study was to identify the effects of intensive chest mobility exercise on chest and walking functions of patients with post-stroke hemiparesis. A total of 27 subjects were recruited and randomly assigned to an
experimental (EG) (n1=14) or control (CG) (n2=13) group. All subjects underwent the routine rehabilitation procedure, and EG subjects additionally underwent an intensive chest mobility exercise protocol for 1-hour daily, 5 times a week, for 2 weeks (a total of 10 sessions). Before and after the intervention, chest function was determined by measuring chest expansion length, forced vital capacity (FVC),
force expiratory volume at one second (FEV1), and FEV1/ FVC, and walking function was assessed using the timed up and go test (TUG), 10m walk test (10MWT), and 6-min walk test (6MWT). The EG subjects showed, significant
differences in pre-test and post-test measurements of chest expansion length, FEV1, TUG, 10MWT, and 6MWT (p < 0.05), whereas the CG subjects showed no
significant differences (p >0.05). The EG subjects had significantly greater posttest chest expansion length when compared to the CG (p < 0.05). Between-group
comparison showed, significant differences in the change of chest expansion length, FEV1, TUG, 10MWT, and 6MWT (p < 0.05). These findings suggest that an intensive chest mobility exercise may be beneficial for enhancing the chest
and walking functions of patients with post-stroke hemiparesis.

목차 (Table of Contents)

• Ⅰ. 서론 2
• Ⅱ. 연구 방법 4
• Ⅲ. 연구 결과 7
• Ⅳ. 논의 9
• Ⅴ. 결론 및 제언 13

참고문헌 (Reference)

1 심재훈, "흉부 유연성 운동이 척추측만증 환자의 폐활량과 흉곽 확장에 미치는 영향" 한국전문물리치료학회 9 (9): 145-156, 2002

2 이전형, "호흡운동이 뇌졸중 환자의 흉곽 확장과 폐 기능에 미치는 영향" 대한물리치료학회 21 (21): 25-32, 2009

3 김재현, "호흡기계 물리치료가 뇌졸중환자의 폐기능 증진에 미치는 영향" 대한물리치료학회 12 (12): 133-144, 2000

4 박민철, "호흡곤란 환자에서 검사자세와 흉곽 가동성에 따른 최대기침유량, 최대흡기/호기압력의 변화" 특수교육재활과학연구소 49 (49): 75-89, 2010

5 김진호, "재활의학" 삼화출판사 1996

6 김경, "자세변화에 따른 피드백 호흡훈련이 뇌졸중 환자의 흉곽용적과 폐기능에 미치는 영향" 특수교육재활과학연구소 49 (49): 57-74, 2010

7 신정빈, "뇌졸중의 합병증 Post-stroke Complication" 대한가정의학회 23 (23): 13-22, 2002

8 이주현, "뇌졸중 환자에서 6분간 걷기검사의 신뢰도" 9 (9): 39-44, 2005

9 권용철, "노인용 한국판 Mini-Mental State Examination(MMSE-K)의 표준화 연구 제1편: MMSE-K의 개발" 대한신경정신의학회 28 (28): 125-135, 1989

10 전용진, "경수손상환자들의 폐기능 향상을 위한 흡기 및 호기 호흡운동 방법의 효과 비교" 한국전문물리치료학회 17 (17): 9-16, 2010

11 Liu, J., "Use of the six-minute walk test post stroke: Is there a practice effect?" 89 (89): 1686-1692, 2008

12 Sciaky, A., "Treatment of acute cardiopulmonary conditions, In Essentials of cardiopulmonary physical therapy, ed 2" WB Saunders 2001

13 Chen, G., "Treadmill training with harness support: selection of parameters for individuals with poststroke hemiparesis" 43 (43): 485-498, 2006

14 Macko, R. F., "Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke" 36 (36): 2206-2211, 2005

15 Lehnert-Schroth, C., "Three-dimensional treatment for scoliosis: A physiotherapeutic method for deformities of the spine" The Martindale Press Palo Alto 2007

16 Kisner, C., "Therapeutic exercise: Foundation and techniques" F. A. Davis Co 2002

17 Ng, S. S., "The timed up and go test: Its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke" 86 (86): 1641-1647, 2005

18 Kaltenborn, F. M., "The spine: Basic evaluation and mobilization techniques" Olaf Norlis Bokhandel 1993

19 Katz-Leurer, M., "The influence of early aerobic training on the functional capacity in patients with cerebrovascular accident at the subacute stage" 84 (84): 1609-1614, 2003

20 Oostveen, E., "The forced oscillation technique in clinical practice: methodology, recommendations and future developments" 22 (22): 1026-1041, 2003

21 Engel, R. M., "The effect of combining manual therapy with exercise on the respiratory function of normal individuals: A randomized control trial" 30 (30): 509-513, 2007

22 Stephenson, J. L., "The effect of arm movements on the lower limb during gait after a stroke" 31 (31): 109-115, 2010

23 Hans, R. W., "The effect of an exercise program on vital capacity and rib mobility in patients with idiopathic scoliosis" 16 (16): 88-93, 1991

24 Graham, J. V., "The Bobath concept in contemporary clinical practice" 16 (16): 57-68, 2009

25 Cahalin, L. P., "The 6-minute walk test predict peak oxygen uptake and survival in patients with advanced heart failure" 110 (110): 325-332, 1996

26 Dean, C. M., "Task-related circuit training improves performance of locomotor tasks in chronic stroke: A randomized controlled pilot trial" 81 (81): 409-417, 2000

27 Ivey, F. M., "Task-oriented treadmill exercise training in chronic hemiparetic stroke" 45 (45): 249-259, 2008

28 American Thoracic Society, "Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease" 152 (152): 77-121, 1995

29 Hermann, D. M., "Sleep-related breathing and sleep-wake disturbances in ischemic stroke" 73 (73): 1313-1322, 2009

30 Dobkin B. H., "Short-distance walking speed and timed walking distance: redundant measures for clinical trial?" 66 (66): 584-586, 2006

31 Thierry, T., "Short-and long term effects of out patient rehabilitation in patients with COPD: A randomized trial" 109 (109): 207-212, 2000

32 Humberstone, N., "Respiratory evaluation: Respiratory assesment and respiratory treatment, In Cardiopulmonary physical therapy, ed 3" Mosby-Year Book 1995

33 Hunt, S. M., "Reliability of a population survey tool for measuring perceived health problems: A study of patients with osteoarthrosis" 35 (35): 297-300, 1981

34 Courbon, A., "Relationship between maximal exercise capacity and walking capacity in adult hemiplegic stroke patients" 85 (85): 436-442, 2006

35 Holland, S. A., "Pulmonary function testing, In Foundations of Respiratory Care" Thomson Learning 2002

36 Carr, M., "Physiological effects of exercise on stroke survivors" 9 (9): 57-64, 2003

37 Manning, H. L., "Pathophysiology of dyspnea" 333 (333): 1547-1553, 1995

38 Bendstrup, K. E., "Out-patient rehabilitation improves activities of daily living, quality of life and exercise tolerance in chronic obstructive pulmonary disease" 10 (10): 2801-2806, 1997

39 Estenne, M., "Lung volume restriction in patients with chronic respiratory muscle weakness: the role of microatelectasis" 48 (48): 698-701, 1993

40 American Thoracic Society, "Lung function testing: selection of reference values and interpretative strategies" 144 (144): 1202-1218, 1991

41 Riolo, L., "Is there evidence that strength training could help improve muscle function and other outcomes without reinforcing abnormal movement patterns or increasing reflex activity in a man who has had a stroke?" 83 (83): 844-851, 2003

42 Bohannon, R. W., "Important of four variables of walking to patients with stroke" 14 (14): 246-250, 1991

43 Chen, G., "Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds" 22 (22): 51-56, 2005

44 Skinner, J. S., "Exercise testing & exercise prescription for special cases: Theoretical basis and clinical application" Lippincott Williams & Wilkins 2005

45 MacKay-Lyons, M. J., "Exercise capacity early after stroke" 83 (83): 1697-1702, 2002

46 Umberger, B. R., "Effects of suppressing arm swing on kinematics, kinetics, and energetics of human walking" 41 (41): 2575-2580, 2008

47 Shimura, K., "Effects of proprioceptive neuromuscular facilitation on the initiation of voluntary movement and motor evoked potentials in upper limb muscles" 21 (21): 101-113, 2002

48 Kashihara, H., "Effects of mild supine exercise during 20 days bed rest on maximal oxygen uptake rate in young humans" 616 : 19-26, 1994

49 Andrews, A. W., "Distribution of muscle strength impairments following stroke" 14 (14): 79-87, 2000

50 Goldie, P. A., "Deficit and change in gait velocity during rehabilitation after stroke" 77 (77): 1074-1082, 1996

51 Rochester, D. F., "Contractility of the in situ diaphragm: assessment based on dimensional analysis, In Respiratory Muscles and Their Neuromuscular Control" Marcel Dekker 1987

52 Lanini, B., "Chest wall kinematics in patients with hemiplegia" 168 (168): 109-113, 2003

53 Frownfelter, D., "Cardiovascular and pulmonary physical therapy: Evidence and Practice, 4 ed" Mosby 2006

54 Kelly, J. O., "Cardiorespiratory fitness and walking ability in subacute stroke patients" 84 (84): 1780-1785, 2003

55 "British Thoracic Society Standards of Care Subcommittee on Pulmonary Rehabilitation. Pulmonary rehabilitation" 56 (56): 827-834, 2001

56 Cowell, L. L., "Benefits of aerobic exercise for the paraplegic a brief review" 18 (18): 501-508, 1986

57 Geiger, R. A., "Balance and mobility following stroke: Effects of physical therapy interventions with and without biofeedback/forceplate training" 81 (81): 995-1005, 2001

58 Jang, S. K., "Assessment and measurement, ed 2" DaiHak publishing company 1996

59 Duncan, P. W., "Adherence to post acute rehabilitation guidelines is associated with functional recovery in stroke" 33 (33): 167-177, 2002