뇌졸중 환자의 일상생활동작 수행에 관한 연구

박경아 ( Gyeong A Park ),은성종 ( Sung Jong Eun ),이미자 ( Mi Ja Lee ),홍재란 ( Jae Ran Hong ) 고령자.치매작업치료학회 2010 고령자.치매작업치료학회지 Vol.4 No.1

목적: 뇌졸중 환자에서 감각기능과 상지기능의 회복이 일상생활동작의 수행에 어떠한 영향을 미치는지를 알아보고자 하였다. 연구방법: 뇌졸중 진단을 받고 작업치료를 받고 있는 환자를 대상으로 치료 전 초기평가와 4주 후 재평가에 대한 자료를 분석하였다. 상지 기능은 환측 감각기능과 환측과 건측 운동기능으로 분류하여 평가하였다. 상지 감각기능에 대학 평가는 가벼운 촉각, 표재통각, 입체인지지각, 고유수용성감각검사를, 상지 운동기능의 평가는 뇌졸중상지기능평가(Manual Function Test, MFT)를, 일상생활동작 수행평가는 기능독립척도(Functional Independence Measure, FIM)를 이용하였다. 연구결과: 환측 상지의 감각기능, 환측과 건측의 운동기능, 기능독립척도에서 치료 전에 비해 치료 후 유의한 호전 양상이 관찰되었고(p<0.01). 환측 상지 감각기능이 변화와 상지 운동기능의 변화 간에도 유의한 상관관계를 보이지 않았으며, 환측 상지의 감각기능의 변화와 환측 상지의 운동기능의 변화는 기능독립척도의 유의한 상관을 보이지 않았고, 건측의 상지운동의 변화만 독립기능척도 중 이동하기영역과 r값 0.45의 약한 정적상관을 보였다(p<0.05). 결론: 뇌졸종 환자의 경우 4주 치료를 통해 상자의 감각기능과 운동기능 평가에서 향상은 나타났으나 환측의 경우 일상생활동작의 향상은 나타나지는 않았다. 이는 일상생활동작 수행시 건측 사용에 지나치게 의존한 때문으로 생각된다. 따라서 작업치료 시행 시 뇌졸중 환자의 환측 사용을 유도하는 양측성 활동을 권장하고, 기능회복을 위한 다양한 치료적 접근과 프로그램의 시도가 필요할 것으로 사료된다. Objective: The purpose of this study was to know the effect of functional improvement of upper limb on the performance of Activities of Daily Livings(ADLs) in stroke patients. Method: Thirty stroke patients who participated in the rehabilitative treatment. Upper limb`s sensory function was evaluated by light touch test, sharp & dull test, stereognosis test, proprioception test, upper limb`s motor function by Manual function test(MFT), and ADLs by Functional independence measure(FIM). The data were collected before and 4 weeks after treatment. The data were analyzed for the correlations between affected upper limb`s sensory function and affected & non-affected upper limb`s motor function, between affected upper limb`s sensory function and ADLs, between affected & non-affected upper limb`s motor function and ADLs using SPSS 12.0 program. Result: There were significant differences between before and after treatment in the sensory function of affected upper limb, motor function of affected & non-affected upper limb and performance of ADL(p<0.05). There were significant differences between before and after treatment in the sensory and motor function of affected & non-affected upper limb. But the sensory and motor function of affected upper limb hasn`t correlated with the performance of ADL`s. That is the reason why stroke patients mainly used the non-affected upper limb when the performance of ADL`s. Conclusion: Our results suggest that rehabilitative treatment program for bilateral manual activity which guided for affected upper limb function will be needed recovery in stroke patients.

양손의 동시적 활동이 뇌졸중 환자의 환측 악력에 미치는 영향

김미현(Mi Hyun Kim),김태호(Tae Ho Kim),황선정(Sun Jung Hwang),박상범(Sang Bum Park) 한국사회체육학회 2010 한국사회체육학회지 Vol.0 No.41

The purpose of this study was to investigate the applicability of bilateral activities of the upper limb for facilitating function of the affected limb by analyzing the effect of simultaneous use of both affected and unaffected limbs on grip strength in patients with stroke. In this study, the hypothesis was that the simultaneous use of affected and unaffected upper limbs would increase the grip strength of affected upper limb effectively. 20 stroke patients participated in this study. They conducted grip strength test in affected upper limb-single, unaffected upper limb-single, and bilateral upper limbs-simultaneous conditions, 2 times per each condition. To analyze the difference in grip strength by upper limb condition and performance type, two-way ANOVA analysis with repeated measurement of the last two factors was used. As a result of analysis, for affected upper limb, the grip strength in simultaneous condition was significantly higher than that of single condition. Whereas, for unaffected upper limb, the grip strength in simultaneous condition was lower than that of single condition significantly. This result suggests that it is more effective to use bilateral activities of the upper limb than unilateral activity of the upper limb as a physical intervention to facilitate affected limb`s function in patients with stroke.

Botulinum Toxin Treatment on Upper Limb Function in School Age Children With Bilateral Spastic Cerebral Palsy: One Year Follow-up

이지선,이규범,이유련,최유남,박철우,박상덕,정동화,이철상 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.3

Objective To prospectively investigate the long-term effects of botulinum toxin treatment on the upper limb function and performance of school age children with spastic bilateral cerebral palsy, who have limitations in performing activities of daily living and school activities, due to spasticity of the upper extremities.Methods Botulinum type A toxin (BoNT-A) was injected into 24 spastic upper limbs of 15 children. We used a Modified Ashworth Scale and a Modified Tardieu Scale for the evaluation of upper limb spasticity, and Quality of Upper Extremity Skills Test (QUEST), Canadian Occupational Performance Measure (COPM), and Test of Visual-Motor Skills-Revised (TVMS-R) for the evaluation of upper limb function and performance. Results Upper limb spasticity continuously decreased until the end of the one-year follow-up. Upper limb function on QUEST and COPM showed the best performance at 3 months and deteriorated slightly, but still showed a significantly better performance at 9 and 12 months than at pre-injection. In more functional nine subjects who could perform TVMS-R, the performance enhancement effects remained constant after 12 months, suggesting that the reduced spasticity led to the learning effect acquired by the repeated use of the affected upper limb. Conclusion For school age children with bilateral spastic cerebral palsy whose upper limb functions are important, BoNT-A injections seem to be of help in the performance of school activities and activities of daily living.

초기 뇌졸중 환자에서 체간 제한과 결합된 로봇 보조 상지 훈련의 효과: 무작위 대조 예비 연구

정경만 ( Kyeoung-man Jung ),정유진 ( Yu-jin Jung ) 대한신경치료학회 2017 신경치료 Vol.21 No.3

Purpose This study was to determine the effect of robot-assisted upper limb training combined with trunk restraint in early stroke patient. Methods Sixteen inpatients were randomly allocated into the experimental group (n=8), who received robot-assisted upper limb training combined with trunk restraint, and the control group (n=8), who received a robot-assisted upper limb training. Each intervention consisted of a 30 min session once a day, five times a week, for four weeks. To measure the functions of the upper limbs and performance capacities in the activities of daily living, the Fugl-Meyer assessment-upper extremity (FMA-UE), Manual function test (MFT), Korean-modified Barthel index (K-MBI) were used before after the intervention. Results The robot-assisted upper limb training combined with trunk restraint group and control group improved more significantly after intervention in FMA, MFT, K-MBI (p<.05). However, robot-assisted upper limb training combined with trunk restraint group was more effective than control group in increasing the FMA, MFT, K-MBI (p<.05). Conclusion These results suggest that robot-assisted upper limb training combined with trunk restraint is more helpful to improve upper-extremity function than robot-assisted upper limb training only early stroke patients.

모야모야병 아동의 로봇 보조 상지 훈련에 대한 효과: 사례 연구

김지우,안시내 한국인지운동치료협회 2022 한국신경인지재활치료학회지 Vol.14 No.2

The purpose of this study was to investigate the effect of robot-assisted upper limb rehabilitation training on hand and upper limb function in children with Moya-Moya disease. The intervention method used InMotion®RM, an upper limb-assisted rehabilitation robot, and the evaluation was conducted once each pre- and post-assessment, and the treatment was conducted 10 times for 30 minutes, a total of 12 sessions. The functional movement of the upper limb and hand was evaluated using the Jebsen-Taylor Hand Function Test and the program inherent in the InMotion®RM. The results were compared through a visual analysis using tables and graphs. After the training, the Jepson-Taylor Hand Function Test score improved in all areas, compared to the baseline. Evaluation using the program inherent in InMotion®RM showed improvement in the smoothness, accuracy, efficiency, and stability of upper limb movement. The results of this case study suggest that robot-assisted upper limb training is applicable to children with Moya-Moya disease and that it has a positive effect on improving the function and stability of the upper limb. In the future, more research subjects will be needed to study the method and effectiveness of robot-assisted upper limb training through group research. 목적: 본 연구는 모야모야병(MoyaMoya Disease) 아동에게 로봇 보조 상지 재활 훈련이 손과 상지 기능에 미치는영향에 대해 알아보고자 하였다. 방법: 본 연구는 모야모야병으로 인해 상지의 운동기능에 저하가 있는 아동을 대상으로 한 사례 연구(case report) 이다. 중재방법은 상지 보조 재활 로봇인 InMotion®ARM 을 사용하였으며, 중재 전과 후에 평가를 각 1회 실시하고치료는 30분씩 10회로 총 12회기 시행되었다. 상지 및 손의 기능적 움직임은 젭슨-테일러 손기능 평가도구(Jebsen - Taylor Hand Function Test)와 InMotion®ARM에 내재 된프로그램으로 평가를 실시하였다. 결과의 분석은 표와 그래프를 통한 시각적 분석을 통해 결과를 비교하였다. 결과: 로봇 보조 상지 훈련을 시행 전에 비해 중재 후에는상지의 기능적 움직임과 손기능을 젭슨-테일러 손 기능 평가도구로 측정한 결과, 모든 영역에서 점수가 향상되었다. InMotion®ARM에 내재 된 프로그램을 통한 평가 결과 상지 움직임의 부드러움, 정확도, 움직임의 효율성, 안정성이향상되었다. 결론: 본 사례 연구를 통해서 로봇 보조 상지 훈련이 모야모야병 아동에게 적용 가능성을 확인하였고, 상지의 기능과안정성 향상에 긍정적인 영향을 미치는 것을 확인하였다. 향후에는 더 많은 연구 대상자에게 그룹 연구를 통해 로봇보조 상지 훈련의 방법과 효과에 관한 연구가 필요하겠다.

국소 진동 자극과 양쪽 팔 훈련의 융합 중재가 뇌졸중 환자의 팔 기능 회복에 미치는 효과

김선호 한국융합학회 2021 한국융합학회논문지 Vol.12 No.2

본 연구의 목적은 국소 진동 자극과 양측성 팔 훈련의 융합 중재를 뇌졸중 환자에게 적용했을 때, 팔 기능 개선에 미치는 영향을 알아보는 것이다. 20명의 뇌졸중 환자를 국소 진동 자극과 양측성 팔 훈련의 융합 중재를 실시한 실험군 과 양측성 팔 훈련만 실시한 대조군으로 나누어, 회기 당 30분씩 4주간, 총 20회 실시하였다. 진동자극은 실험군의 손상 측 팔에 훈련이 이루어지는 30분간 적용되었다. 평가는 손상 측 팔의 회복정도와 양측 팔 의 사용량, 양손 사용의 수행 의 질과 만족도를 측정하였으며, 대응표본 t-검정을 사용하여 그룹 내, 공분산 분석을 사용하여 그룹 간 비교를 하였다. 연구 결과, 실험군은 대조군보다 손상 측 팔의 기민성과 손상 측의 사용량에서 유의한 차이의 변화를 보였다. 효과 크기 는 모든 항목에서 작은 효과 크기 이상의 차이를 보였다. 본 연구를 통해, 국소 진동 자극과 양측성 팔 훈련의 융합 중재가 뇌졸중 환자의 팔 기능 회복을 위한 효율적 중재로써 임상에서 사용 될 수 있을 것으로 생각된다. The purpose of this study was to investigate the convergence effect of focal vibration stimulation and bilateral upper limb training on the recovery of upper limb function when applied to stroke patients. For 20 stroke patients, divided into an experimental group that performed convergence intervention with focal vibration stimulation and bilateral upper limb training, and a control group who performed only bilateral upper limb training. It was conducted 20 times for 4 weeks, 30 minutes per session. Vibration stimulation was applied to the affected side of the experimental group for 30 minutes during training. Results were measured for the degree of recovery of the affected upper limb function, amount of use on the affected and unaffected sides, the quality and satisfaction in performance on use of both upper limbs. Comparisons were made within groups using a paired-sample t-test and between groups using covariance analysis. As a result of the study, the experimental group showed a significant difference in dexterity and the amount of use on the affected than the control group. The effect size was more than the small effect size in all evaluation items. Through this study, it is thought that the convergence intervention of focal vibration stimulation and bilateral upper limb trainingcan be used clinically as an effective intervention for the recovery of arm function in stroke patients.

급성기 뇌졸중 환자에서의 로봇 보조 상지 훈련의 효과 : 무작위 대조 예비 연구

정유진,정경만,주민철 대한작업치료학회 2017 대한작업치료학회지 Vol.25 No.2

목적 : 본 연구는 급성기 뇌졸중 환자에서 로봇 보조 상지 훈련의 효과를 알아보고자 실시하였다. 연구방법 : 2015년 6월 1일부터 2015년 8월 30일까지 전북 익산 소재의 W 대학병원에 입원한 급성기 뇌졸중 환자 14명을 실험군과 대조군으로 무작위 할당하였다. 두 군 모두 전통적인 작업치료를 실시하였다. 추가적으로 실험군에는 로봇 보조 상지 훈련을 대조군은 전통적 작업치료를 각 1일 1회 30분, 주 5회, 총 4주간 실시하였 다. 치료 중재 전·후 상지기능을 측정하기 위해 Fugl-Meyer 평가척도(Fugl-Meyer Assessment-Upper Extremity; FMA-UE), 상지 기능 검사(Manual Function Test; MFT)을 사용하였고 일상생활활동 수행능 력을 평가하기 위해 한국판 수정된 바델 지수(Korean version of Modified Barthel Index; K-MBI)을 사용하였고 장악력을 평가하기 위해 Jamar dynamometer을 사용하였다. 결과 : 4주 치료 후 두 그룹 모두에서 중재 전·후 상지 기능, 일상생활활동 수행능력, 장악력에서 유의한 차이가 나타났으며(p<.05) 중재 후 두 그룹 간 변화량의 차이에서는 모두 유의한 차이가 나타나지 않았 다(p>.05). 결론 : 본 연구 결과 로봇 보조 상지 훈련이 급성기 뇌줄중 환자의 상지 기능, 일상생활활동 수행력, 장악력을 향상 시킬 수 있는 중재 방법으로 나타났다. 그러므로 로봇 보조 상지 훈련은 뇌졸중 환자의 상지 재활에 초기부터 안정적이고 신뢰적인 장비로 표준화된 치료를 지원할 수 있는 중재 방법으로 사용될 수있을 것이다. Objective : This study was to determine the effect of Robot-assisted Upper limb Training in patients with acute stroke. Methods : Fourteen inpatients were randomly allocated into the experimental group (n=7), who received Robot-assisted Upper limb Training, and the control group (n=7), who received a conventional occupational therapy. Each intervention consisted of a 30 min session once a day, five times a week, for four weeks. To measure the functions of the upper limbs and performance capacities in the activities of daily living and grip power, the Fugl-Meyer assessment-Upper Extremity (FMA-UE), Manual Function Test (MFT), Korean-Modified Barthel index (K-MBI), Grip power were used before and after the intervention. Results : After intervention, both the groups showed significant increased FMA-UE, MFT, K-MBI, Grip power (p<.05). But change values in terms of FMA-UE, MFT, K-MBI, Grip power exhibited a no statistically significant difference compared with conventional group (p>.05). Conclusion : In patients with upper limb deficits after acute stroke, the Robot-assisted upper limb training was an effective intervention method to facilitate motor and functional recovery of upper limb. Therefore, robot-assisted upper extremity training can be used as an intervention method to support standardized treatment using stable equipment from the beginning of the upper extremity rehabilitation of stroke patients.

Effects of Upper Limb Robot Therapy on the Function of Upper Limb in Patients with Hemiplegia; pilot study

이동걸,이경보,김영동 대한신경치료학회 2016 신경치료 Vol.20 No.1

Purpose This study was to determine the effect of Upper limb robot therapy (ULRT) on upper limb function in stroke patients. Methods The subjects of this study were 3 male hemiplegic patients who voluntarily consented to participate in the study. They were received general training and ULRT during 30 minutes for each session, 5 times a week for a month. Upper limb function was evaluated by InMotion TM rehabilitation robot program and manual function test. Results The results of evaluation in 3 patients showed significant differences in Robot Initiation, Robot Power and Motion Jerk between pre and post test. Conclusion This study suggested that ULRT was effective in improvement of muscle power, flexibility and function of the upper limb.

사람 배자 상지의 신경발생과 주위 구조와의 관계

이승헌,설은영,박명철,김관식,김명희,박형우 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

Nerve innervation is important for normal development of the limb in the laboratory animals. There are only few reports on the morphogenesis of nerves in the upper limb of human embryos. In this study 20 cases of staged human embryos between Carnegie stage 11 and 23 were used to pursue the chronological relationships between the nerves and the skeleton and muscles in the developing human upper limb. Formalin-fixed embryos were dehydrated with graded alcohol, cleared with histoclear, and embedded in paraffin. Serial sections were stained with hematoxylin-eosin and trichrome. Three dimensional reconstruction models had been prepared by tracing on the blotting papers. The upper limb bud appeared at stage 12, and regularly developed during embryonic period. Primitive brachial plexus was formed at stage 14, but did not reach the limb bud. Brachial plexus entered the upper limb bud at stage 15, and branched into major nerves. Major nerves had branches at stage 17. Branches grew distally as the limb bud developed, and reached distal phalanges at stage 23.

필라테스 기구 운동 시 포지션에 따른 손목 과신전 자세가 상지와 어깨 근 활성도 및 통증에 미치는 영향

장설희,이해림,김명기 한국체육과학회 2023 한국체육과학회지 Vol.32 No.2

Purpose: This study compares and analyzes the effects of wrist hyper-extension posture on muscle activity and pain in upper limbs and shoulders when applying the Pilates exercise program to healthy adult women. Methods: The participants repeated hyper-extension posture and neutral posture of the wrist three times each using three instruments (cadillac, reformer, barrel). The activities of upper limbs muscles (post deltoid, anterior deltoid, lateral triceps, biceps brachii, and extensor carpi radialis brav is) were measured using surface electromyography. The pains of upper limbs (median wrist, lateral wrist, lateral elbow, and upper shoulder) were measured using electro algometer (FPX25). Result: The hyper-extension posture of the wrist revealed significant differences activities of post deltoid, lateral triceps, biceps brachii and extensor carpi radialis bravis muscles compared to neutral position of the wrist (p<.05). The hyper-extension posture of the wrist elicited pain on median wrist, lateral wrist, lateral elbow, and upper shoulder more earlier that neutral posture of the wrist significantly (p<.05). Conclusion: The hyper-extension posture of the wrist during the Pilates exercise program can reduce muscle activities and elicited pain on the upper limbs. Neutral posture of the wrist is important to improve muscle activities and reduce pain.