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뇌성마비 아동의 대동작운동기능 수준에 따른 흉곽발달 양상
정지운,고주연,Jung, Jee Woon,Ko, Joo Yeon 대한물리치료학회 2013 대한물리치료학회지 Vol.25 No.5
Purpose: The purpose of this study was to provide quantitative data regarding development of the chest wall in children with cerebral palsy (CP) according to Gross Motor Function Classification System (GMFCS) levels and age using the radiological image diameter measurement method. Methods: Subjects included 112 children with CP and 110 healthy children, All of the children underwent simple chest x-ray. The diameters of the upper chest ($D_{apex}$) and lower chest ($D_{base}$) were measured on the anteroposterior (AP) view of a chest x-ray, and the $D_{apex}$ to $D_{base}$ ratio was calculated. Chest wall ratios were compared among children with CP at GMFCS levels I ~ III, GMFCS levels IV and V, and healthy children. Results: The results showed significant differences between the upper and lower chest wall diameters of children with CP at GMFCS levels IV and V, and healthy children (F=4.54, p=0.01; F=3.20, p=0.04). Results of comparison between the chest wall ratios of children with CP and healthy children, showed that the upper chest walls of healthy children were significantly larger in children younger than 48 months (p<0.05), and both the upper and lower chest walls of healthy children were significantly larger compared to children with CP in children older than 48 months (p<0.05). Conclusion: Radiographic measurement for examination of chest wall development is relatively simple, and the results yield quantitative data on development of the chest wall for children with CP. In addition, therapeutic interventions may be considered based on the results.
뇌성마비 아동의 체간 전기 자극이 대동작운동기능과 체간근 활성화에 미치는 영향
정지운,송 브라이언 병 한국장애인재활협회 2012 재활복지 Vol.16 No.1
This study was designed to determine the effectiveness of functional electrical stimulation over the trunk in improving gross motor function and trunk muscle activity in children with cerebral palsy who displayed poor trunk control. The subjects were 20 children with cerebral palsy, who were in the age of 26 to 80 months and were randomized into two groups, functional electrical stimulation and control group. Both group had neuro-developmental technique(NDT) treatments for 4 weeks, Experimental group had additional Functional Electronic Stimulator(FES) over the abdomen and posterior back muscles. The control group had additional Transcutaneous Electronic Nerve Stimulator(TENS) over the abdomen and posterior back muscles. The gross motor function and trunk muscle activity was measured before and after the program. Surface electromyography studies were used on the trunk muscles activity while they were sitting before and after treatment. Gross motor function score-Gross Motor Function Measure(GMFM) was also used to evaluate the sitting posture. The following results were obtained. First, in comparison of the changes of muscle activity before and after experiment, experimental group was increased more than control group but there was significant difference between the two groups(p<.05). Second, in comparison of change of GMFM before and after experiment, experimental group and control group were increased in the all areas, but there was significant difference in sitting areas between the two groups(p<.05). This study suggests that functional electrical stimulation showed it can affect the sitting posture ability and trunk muscle activities. Therefore, it can be useful in trunk functional rehabilitation for the children with cerebral palsy. 본 연구는 앉기 자세와 체간근 조절의 어려움이 있는 뇌성마비 아동을 대상으로 체간근육에 기능적 전기 자극 적용 후 체간근 활성량과 대동작 기능에 미치는 영향에 대하여 연구하였다. 연구 대상은 평균 연령이 26월 이상부터 80개월 미만인 20명의 뇌성마비 아동을 대상으로 실험군과 대조군 각각 10명씩 무작위 배정을 하였다. 실험군과 대조군은 4주간 신경발달치료를 받았고, 실험군은 복부와 배부신전근에 기능적 전기 자극 치료를 추가적으로 적용하였다. 대조군은 경피신경자극과 신경발달치료를 적용하였다. 각 대상자는 실험전과 후에 체간 활성도와 대동작 운동기능을 측정하였고, 체간근 활성도는 표면 근전도를 통해 실험 전·후 앉기 자세동안 측정하였다. 대동작 운동기능 평가는 대동작 기능평가를 통해 측정하였고, 다음과 같은 결과를 얻었다. 첫째, 기능적 전기 자극이 뇌성마비 아동의 체간근 활성화에 미치는 효과를 알아보기 위해 실험 전․후 체간근 활성화의 변화를 비교해 본 결과, 실험군의 경우 체간근육 모두 활성도가 유의하게 증가하였고,(p<.05). 또한 두 집단 간 모든 체간 근육 중 오른쪽 목신전근을 제외한 체간근육에서 유의한 차이가 있었다(p<.05). 둘째, 기능적 전기 자극이 뇌성마비 아동의 대동작 기능 변화에 미치는 효과를 알아보기 위해 실험 전․후 대동작 기능평가의 변화를 비교해 본 결과, 실험군과 대조군의 모든 영역에서 점수가 증가하였고 실험군의 경우 모든 영역에서 유의하게 증가하였다(p<.05). 또한 두 집단 간 차이를 비교한 결과 앉기 영역에서만 유의한 차이가 있었다(p<.05). 이와 같은 결과로 볼 때, 뇌성마비 아동의 체간 기능적 전기 자극치료는 체간근 활성도와 대동작 기능에 치료적 효과를 제시하고 있으므로 뇌성마비 아동의 근 활성도 그리고 기능적 움직임 발달을 위한 재활치료서 적절하게 활용될 수 있다.