고유수용성 운동조절이 뇌졸중 환자의 균형 및 보행에 미치는 영향

다국어 초록 (Multilingual Abstract)

This study was performed for effects of intervention of somatosensory training, visual feedback training, and activity of daily living(ADL) which influenced on the change of functional gait component, postural muscular activation, balance index with hemiplegic patients caused by cerebrovascular accident(CVA).
Three groups of adult hemiplegia(N=36) were allocated randomly in this study : experimental groupⅠ(somatosensory training; SST), experimental groupⅡ(visual feedback traing; VFT) and control group(ADL).
The therapeutic exercise program was provided to experimental groups for 8 weeks(5 times a week) and no intervention was provided to control group.
Measurements of pre and post experiment were gait velocity, cadence, step length, step length asymmetry ratio, single support time asymmetry ratio, functional ambulation profile(FAP) which demonstrate temporal-spatial parameter of gait component.
For measuring muscular activation, the transverse abdominis, erector spinae, tibialis anterior, soleus, medial & lateral gastrocnemius were detected and balance index was assessed using BBS, TUG, FRT.
The results were as follows.

1.The gait velocity was statistically increased in the SST and VFT groups (p<.05) but there was no significant increase in the control group(p>.05). Among three groups, there was no significant difference in the change of gait velocity(p>.05).
2.The gait cadence was statistically increased in the SST and VFT groups(p<.05) but there was no significant increase in the control group(p>.05). Among three groups, there was no significant difference in the change of gait cadence(p>.05).
3.The step length was statistically increased in the SST and VFT groups(p<.05) but there was no significant increase in the control group(p>.05). Among three groups, there was no significant difference in the change of step length(p>.05).
4.The step length asymmetry ratio was decreased in SST, VFT, and control groups but there was no significant difference(p>.05). Among three groups, there was no significant difference in the change of step length asymmetry ratio(p>.05).
5.The single support time asymmetry ratio was decreased in SST and control groups, but there was no significant difference(p>.05), and single support time asymmetry ratio was slightly increased in VFT group. Among three groups, there was no significant difference in the change of single support time asymmetry ratio(p>.05).
6.The functional ambulation profile(FAP) was significantly increased in SST, VFT groups(p<.05), and there was no significant increase in the control group(p>.05). Among three groups, there was significant difference in the change of FAP(p<.05).
7.The activation of transverse abdominis was significantly increased in SST, VFT groups(p<.05), and there was slightly decrease in the control group. Among three groups, there was no significant difference in the change of activation of transverse abdominis(p>.05).
8.The activation of erector spinae was significantly decreased in SST group(p<.05), and there was decrease in the VFT and control groups,
but there was no significant difference. Among three groups, there was significant difference in the change of activation of erector spinae (p<.05).
9.The activation of tibialis anterior was significantly increased in SST and VFT groups(p<.05), and there was no significant increase in the control groups(p>.05). Among three groups, there was no significant difference in the change of activation of tibialis anterior(p>.05).
10.The activation of soleus was significantly decreased in SST group(p<.05), and there was slightly increase in the VFT group but there was no significant increase in the control groups(p>.05). Among three groups, there was no significant difference in the change of activation of soleus(p>.05).
11.The activation of medial gastrocnemius was significantly decreased in SST group(p<.05), and there was no significant difference in the VFT and control groups(p>.05). Among three groups, there was no significant difference in the change of activation of medial gastrocnemius(p>.05).
12.The activation of lateral gastrocnemius was not significantly decreased in SST and VFT groups(p>.05), and there was slight increase in the control group. Among three groups, there was no significant difference in the change of activation of lateral gastrocnemius(p>.05).
13.The score of BBS was significantly increased in SST and VFT groups(p<.05), and there was no increase in the control group(p>.05). Among three groups, there was no significant difference in the change of the score of BBS(p>.05).
14.The TUG was significantly decreased in SST and VFT groups(p<.05), and there was slight increase in the control group. Among three groups, there was significant difference in the change of the TUG(p<.05).
15.The FRT was not significantly increased in SST, VFT and control groups(p>.05). Among three groups, there was no significant difference in the change of the FRT(p>.05).
The results of this study showed that in comparison of pre and post changes, the SST group has noticeable changes than other groups in parameter of temporal-spatial gait, postural muscle activation and balance index. Especially, FAP, muscle activation of elector spinae and TUG revealed statistically significant differences among three groups(SST, VFT, and control groups).
These results mean sensory feedback resulted by SST provides functional motor control through effective muscle activation, balance, and postural control patients with stroke, and therefore proper response about environmental changes and various tasks could be made.
Comprehensive research is required about a point of time and duration for intervention, provided environment, choice of tasks in clinical approach for functional recovery patients with stroke.

목차 (Table of Contents)

• I. 서 론 1
• 1. 연구의 배경 1
• 2. 연구 목적 4
• 3. 연구 가설 5
• 4. 연구의 제한점 6
• 5. 용어의 정의 7
• 1) 보행요소 7
• (1) 유각기 7
• (2) 입각기 7
• (3) 보행속도 7
• (4) 분속수 7
• (5) 보장 7
• (6) 단하지 지지기 7
• (7) 평균 표준화 속도 7
• (8) 기능적 보행지수 7
• 2) 기능적 보행지수 8
• 3) 시간적-공간적 보행요소 비대칭율 9
• 4) 변화율 9
• II. 이론적 배경 10
• 1. 균형조절 10
• 2. 고유수용성 운동조절 12
• 3. 체성감각계 14
• 4. 시각 되먹임 15
• 5. 근 활성 17
• 6. 체간 안정성 19
• 7. 정상 보행 21
• 8. 뇌졸중 환자의 보행 23
• Ⅲ. 연구 방법 25
• 1. 연구 대상 25
• 2. 연구 기간 25
• 3. 연구 설계 26
• 4. 측정 및 도구 28
• 1) 보행 측정 28
• 2) 근 활성도 측정 28
• 3) 균형력 측정 29
• (1) Berg Balance Scale(BBS) 29
• (2) Time Up & Go Test(TUG) 29
• (3) Functional Reach Test(FRT) 30
• 4) 수정된 운동기능사정척도(MMAS) 30
• 5) 수정된 Ashworth 척도(MAS) 31
• 5. 연구 절차 32
• 1) 체성감각 운동프로그램 33
• 2) 시각 되먹임 운동프로그램 34
• 6. 자료 처리 35
• Ⅳ. 연구 결과 36
• 1. 연구 대상자의 특성 36
• 2. 체성감각 운동군과 시각 되먹임 운동군, 대조군의 보행 38
• 1) 보행속도 38
• 2) 분속수 41
• 3) 보장 44
• 4) 보장 비대칭율 47
• 5) 단하지 지지시간 비대칭율 50
• 6) 기능적 보행지수 53
• 3. 체성감각 운동군과 시각 되먹임 운동군, 대조군의 근 활성 56
• 1) 복횡근 56
• 2) 척추기립근 59
• 3) 전경골근 62
• 4) 가자미근 65
• 5) 내측 비복근 68
• 6) 외측 비복근 71
• 4. 체성감각 운동군과 시각 되먹임 운동군, 대조군의 균형지수 74
• 1) Berg Balance Scale(BBS) 74
• 2) Timed Up & Go Test(TUG) 77
• 3) Functional Reach Test(FRT) 80
• Ⅴ. 고 찰 83
• Ⅵ. 결 론 102
• 참고문헌 105
• 영문초록 120