Awareness and satisfaction of therapeutic goals on functional status in persons with hemiparetic stroke

안시내,Jeong-Weon Lee,Sujin Hwang 물리치료재활과학회 2018 Physical therapy rehabilitation science Vol.7 No.1

Objective: Setting therapeutic goals assist to identify patient priorities and predict problem that may arise in performing daily and functional activities. Goal setting is associated with improved rehabilitation outcomes in individuals with hemiparetic stroke. This study was conducted to assess the effects of having awareness and satisfaction of goals on the functional status of individuals with hemiparetic stroke. Design: Cross-sectional study. Methods: Eighty-one people who had been diagnosed with stroke participated in this study. The study was conducted through a face-to-face surveys to identify participants’ awareness and satisfaction of goals and standard assessment tools were used to evaluate patients’ functional status. This study measured functional status through three clinical measures including the manual function test (MFT), Berg Balance scale (BBS), and modified Barthel index (MBI). Results: In participants with hemiparetic stroke, the MBI, BBS, and MFT scores were significantly higher in the participants who were aware of the therapeutic goal than in those who were unaware (p<0.05). The MBI, BBS, and MFT scores were not significant between the participants who were satisfied with the goal and those who were unsatisfied. Conclusions: This study suggests that having awareness in therapeutic goal-setting could lead to improvement of functional status in those with hemiparetic stroke. This study highlights how goal-setting can have a positive effect on persons with hemiparetic stroke.

뇌졸중 환자의 인지적 전략개발 중심 중재가 수행기술에 미치는 효과 비교 : 무작위 비교연구

안시내 보건의료산업학회 2016 보건의료산업학회지 Vol.10 No.3

Objectives : The aim of this study was to compare a treatment focusing on the physical function to an intervention focusing on a cognitive strategy in stroke patients which improves their performance skills of daily activities. Methods : This study design was a randomized control trial selecting 43 people with stroke patients. This study consisted of a control group, which received conventional occupational therapy focusing on physical function, and an experimental group which was trained to develop a cognitive strategy by themselves. Both groups each received 10 sessions of the treatment. This study compared the skills for performing daily activities before and after the intervention and analyzed the data with SPSS Ver. 18.0. Results : This study showed a significant improvement in all performance skills in the experimental group (p<.05). There was no statistically significant difference in the performance skills before and after the intervention in the control group (p>.05). Conclusions : It was verified that stroke patients to develop a cognitive strategy by themselves is more effective than to improve the physical function in performance skills for daily activities.

CO-OP접근법이 뇌졸중 환자의 작업수행에 미치는 효과 : 예비연구

안시내,유은영 대한작업치료학회 2015 대한작업치료학회지 Vol.23 No.2

목적 : 본 연구에서는 뇌졸중 환자에게 Cognitive Orientation to daily Occupational Performance (CO-OP) 접근법을 적용하여 작업수행 향상에 효과가 있는지 알아보고자 하였다. 연구방법 : 연구대상은 외래재활치료를 받고 있는 2명이었고, 연구디자인은 ABA 개별 실험 연구설계로 실 시하였다. 기초선 기간(A)은 자료가 안정되는 시기까지 2회기, 중재 기간(B)은 주 2회 60분 동안 8회기, 재기초선 기간(A’)은 중재 후 기초선과 동일하게 2회기 실시하였다. 작업수행 향상을 검증하기 위해 총 세 가지 활동을 선정하였는데, 2개는 CO-OP접근법으로 훈련을 실시하였고, 나머지 1개 활동은 일반화를 알 아보기 위해 훈련하지 않았다. 결과측정 도구는 활동에 대한 수행의 질을 평가하는 Performance Quality Rating Scale (PQRS)과 수행 기술 및 독립성을 평가하는 Assessment of Motor and Process Skills (AMPS)을 사용하였다. 결과 분석은 작업수행의 질은 시각적 분석으로, 수행 기술 및 독립성은 AMPS 9 프로그램을 사용하여 비교하였다. 결과 : 작업수행의 질은 대상자 A와 B 모두에서 CO-OP접근법으로 훈련한 두 과제 모두 기초선에 비해 중재 기간에 향상되었고, 재기초선 기간에도 유지되었으며, 훈련하지 않는 과제도 수행의 질이 유지되는 경향을 보였다. 작업수행 기술의 독립성은 대상자 A는 기초선에 비해 운동기술은 0.35로짓, 처리기술은 0.04로짓 증가되었으며, 대상자 B는 운동기술 0.31로짓, 처리기술 0.55로짓 증가하였다. 결론 : CO-OP접근법은 뇌졸중 환자의 작업수행을 증진시킬 수 있는 중재방법이며, 지역사회에 거주하는 뇌졸중 환자에게 적용하여 긍정적인 결과를 도출할 수 있었다. Objective : This research was conducted to plan a strategy on the activities for stroke patients who want to improve, and to use the strategy to find out how it influences the occupational performance when applying Cognitive Orientation to a daily Occupational Performance (CO-OP) method approach. Methods : From September to October of 2014, two local outpatient rehabilitation targets diagnosed as suffering a stroke were selected to execute an ABA single-subject research design. It took two sessions for the data to become stable for use as a baseline (A). It took 10 sessions of 60 minutes per session, twice a week, for intervention. Finally, it took two sessions for the data to become stable for the baseline’ (A’). For the goal task, three activities were selected from COPM. Two activities executed intervention training through the CO-OP method approach. No training was selected as the other activity to determine a generalization, and the baseline, intervention, and baseline' were measured once each. For the outcome measurement, a Performance Quality Rating Scale (PQRS), which evaluates the quality of performance, and an Assessment of Motor and Process Skills (AMPS), which evaluates the independence and performance skill, were used. The quality of the performance was determined through a visual analysis, whereas the occupational performance and independence performance used the AMPS 9 program for an analysis and comparison. Results : The quality of the occupational performance increased during intervention compared to the baseline for the two tasks through the CO-OP approach method for subject A. Baseline’ (A’) was also maintained without training. For the independence of the occupational performance skill, subject A showed 0.35 logit in exercise skill, and 0.04 logit in handling skill. Subject B showed 0.31 logit in exercise skill, and 0.55 logit in handling skill. Conclusion : Based on the above outcome, the CO-OP method approach was shown to be an intervention method that can increase the occupational performance of stroke patients. It can also increase the effect on local stroke patients.

A review of cognitive orientation to daily occupational performance with stroke

안시내 물리치료재활과학회 2017 Physical therapy rehabilitation science Vol.6 No.4

Objective: The self-decisions of the client regarding the meaningful work as a therapeutic approach of client-orientation. The Cognitive Orientation to daily Occupational Performance (CO-OP) is an occupation-oriented problem-solving approach. The purpose of this study was to describe the goals and intervention protocols of CO-OP in those affected by stroke. Design: A systematic review. Methods: Using EBSCOhost, PubMed, and ProQuest databases, we searched studies published in the past decade that utilized the CO-OP intervention. An initial search revealed 71,171 potential articles. After applying our search criteria to screen the titles, abstracts, and full-text, we included 7 articles that met our inclusion and exclusion criteria. In this study, we used the patient, intervention( s), comparison, outcome method to analyze the 7 selected studies. We analyzed the frequency of goals and intervention protocols. Results: Seven articles met our selection criteria; these studies included participants with an almost normal cognitive function from inpatient and outpatient rehabilitation facilities. CO-OP was used for 237 goals; the most used goal was the instrumental activities of daily living. The training procedure used 3 types of self-selecting goals in the activities. One of the goals was not trained, but was only evaluated to determine the generation effect. The most common outcome measurements included the Canadian Occupational Performance Measure and the Performance Quality Rating Scale. Conclusions: This research provided information about the effectiveness of CO-OP and selecting the correct evaluation tool to assess the efficiency of the intervention. This study suggests that treatment with CO-OP in occupational therapy is effective and that it outlines common protocols.

편마비 환자의 팔 기능 회복에 인지운동치료의 효과

안시내,이정원 한국인지운동치료협회 2009 한국신경인지재활치료학회지 Vol.1 No.-

Objective: This study has been carried out to review the case which adopted the method of cognitive therapeutic exercise(CTE) requiring the highly complicated function of the brain for the purpose to recover the functional ability of upper limb in patient with capsular hemiplegia caused by cerebral infarction. Methods: The subject of this study was a right-handed male aged of 52 with right hemiplegia affected by cerebral infarction of left posterior limb which occurred on Apr. 22, 2009. CTE had been conducted every two time a week during the period of four weeks which lasted from Jun. 2, 2009 to Jul. 3, 2009 and each treatment proceeded for 30 minutes. During the four weeks of treatment, FIM, MFT and CTE assessment were analyzed on the basis of before and after each treatment to find out the effect of kinesitherapy. Results: The grades of FIM obtained before treatment were 76 points. However, the grades were 84 points after the first CTE was applied and 86 points after the second treatment. In MFT, the grades were 3 points before the application of CTE and the grades led to 7 points after the first treatment and 9 points after the second treatment. All of these results show that the CTE has contributed to the improvement of the motor ability. When it comes to CTE profile, the findings showed that there were improvements in pathological features, cognitive behavior, linguistic ability and attentiveness. Conclusion: It is concluded that application of CTE for the patient with capsular hemiplegia caused by cerebral infarction has positive influences on the recovery of upper limb function and improved movement patterns. 목적: 본 연구는 편마비 환자에게 새로운 치료접근 방법으로써 인지운동치료를 적용하여 일상생활활동 및 팔 기능 회복에 미치는 효과를 알아보는 것이다. 방법: 본 연구의 대상자는 2009년 4월 22일 발병한 좌측 내포 후부(posterior limb)의 뇌경색으로 인해 우측 편마비가 된 남자 환자로 52세이며 오른손잡이였다. 환자는 2009년 6월 2일부터 2009년 7월 3일까지 주 2회 30분씩 총 4주 동안 팔에 대한 인지운동치료를 시행하였다. 연구절차는 4주의 치료기간 내에 치료 전, 치료 후 1차, 치료 후 2차 재평가를 동일한 방법으로 시행하였다. 평가는 인지운동 프로파일 및 일상생활동작은 MBI를 사용하였으며, 팔 기능은 MFT를 사용하여 치료의 효과를 비교하였다. 또한 사진영상을 이용한 운동패턴에 대한 시각적 동작분석을 실시하였다. 결과: 인지운동 프로파일에 있어서 병리적 특성, 인식양상, 언어양상, 주의양상에서 질적인 변화를 보였다. 인지운동치료 전과 비교하여 치료 후에는 MBI 점수가 31점 향상되었다. 팔 기능 평가에 있어서 인지운동치료 전 3점에 비해 치료 후에 9점으로 증가되었다. 또한 시각적 동작분석 상에 운동패턴의 질적인 향상이 있었다. 결론: 편마비 환자에게 인지운동치료는 일상생활활동 및 팔 기능 회복에 효과가 있었다. 또한 운동패턴에 있어서 질적인 향상을 보였다. 따라서. 인지운동치료는 편마비 환자의 팔 기능 회복에 유용한 접근법이 될 수 있는 가능성을 제시해 준다.

뇌졸중 환자의 주관적 신체이미지가 기능적 능력에 미치는 영향

안시내 한국인지운동치료협회 2019 한국신경인지재활치료학회지 Vol.11 No.2

The effect of body image on the ability of balance and upper limb function through the body recognition of stroke patients was investigated. Fifty-nine patients with strokes were selected. In order to evaluate the body recognition of the subjects, the subjects were evaluated by dividing the joint posture image and the pressure image. A Berg balance test was performed to evaluate the balance ability, and a manual function test was performed to evaluate the upper extremity function. Pearson correlation analysis and regression analysis were performed to examine the effect of body image on functional ability. The statistical significance level was set to 0.05. The body image through the body recognition of stroke patients was significantly correlated with the balance ability of the lower extremity joint position among the joint position images, and the degree of upper and lower limb joint position was significantly correlated with the upper and lower limb function (p<.05). In pressure images, upper and lower limb images were correlated with balance ability (p<.05), and upper limb function was correlated with pressure in the back, hip, and ankle (p<.05). Postural images in the ankle joint affected balance ability and pressure images in the back affected upper limb function (p<.05). The purpose of this study was to investigate the effects of body image on the balance and upper extremity function of stroke patients. 목적: 뇌졸중 환자의 신체인식을 통한 자신의 신체 이미지정도가 균형 능력 및 상지 기능에 미치는 영향을 조사하였다. 방법: 대상자 선정기준에 해당되는 뇌졸중 환자 59명을선정하였다. 연구 대상자의 신체인식을 신체 이미지의 정도로 평가하기 위해 관절 자세 이미지와 압력 이미지로 나누어서 평가하였다. 균형 능력의 평가로는 버그 균형 검사(Berg Balance Test)를 실시하였으며, 상지 기능에 대한 평가로는상지 기능 검사(Manual Function Test)를 실시하였다. 신체이미지와 기능적 능력간의 상관성을 알아보기 위해 Pearson 상관분석과 신체 이미지가 기능적 능력에 미치는 영향을알아보기 위해 회귀분석을 실시하였다. 통계학적 유의수준은 0.05로 설정하였다. 결과: 뇌졸중 환자의 신체인식을 통한 신체 이미지는 관절자세 이미지 중에서 하지 관절 자세의 정도가 균형 능력과유의한 상관성이 있었고, 상지와 하지 관절 자세의 정도는상지 및 하지 기능과 모두 유의한 상관성이 있었다(p<.05). 압력 이미지에서는 상지와 하지의 이미지 정도가 균형 능력과 모두 상관성이 있었고(p<.05), 상지 기능은 등, 엉덩이, 발목에서의 압력과 상관성이 있었다(p<.05). 발목 관절에서의 자세 이미지는 균형 능력에 영향을 주고, 등에서의 압력이미지는 상지 기능에 영향을 주는 것으로 나타났다(p<.05). 결론: 본 연구는 뇌졸중 환자의 신체인식을 통한 신체이미지 정도가 균형 및 상지 기능에 미치는 영향을 조사하여뇌졸중 환자의 신체 인식에 대한 재활 치료에 대한 근거를마련하였다.

경도인지장애 환자의 수단적 일상생활활동에 대한 고찰

안시내 대한신경계작업치료학회 2013 재활치료과학 Vol.2 No.2

본 연구는 최근 많은 관심이 되고 있는 경도인지장애 환자의 특징과 수단적 일상생활활동에 대해 알아봄으로써 임상가들에게 작업치료에서 경도인지장애환자를 평가 및 치료하는데 도움이 되고자 하 였다. 현재 치매환자를 위한 작업치료는 매우 활발하게 이루어지고 있으나 치매로 전환될 위험이 높 은 경도인지장애 환자에 대하여 작업치료적 접근은 아직 이루어지지 않고 있다. 본 고찰에서는 정상 노인과 감별하기 어려운 경도인지장애 환자의 작업영역 중 수단적 일상생활활동에 대해 초점을 맞추 어야 한다는 근거들을 다루었으며, 경도인지장애 환자가 치매로 발전하는 것을 예방하기 위해서는 수 단적 일상생활활동에 대한 고려가 필수적으로 이루어져야 함을 고찰하였다. 결론적으로, 치매로 발전 될 가능성이 높은 위험 집단인 경도인지장애 환자군의 작업영역을 고려한 수단적 일상생활활동에 대 한 주기적인 평가와 그에 따른 작업치료적 개입이 필요할 것으로 보인다.

뇌졸중 환자에서 시간경과에 따른 환측 도형인지능력의 변화

안시내,최지은 한국인지운동치료협회 2010 한국신경인지재활치료학회지 Vol.2 No.-

Objective: This study is aimed to investigate on which changes of shape cognitive abilities are showed at unilateral paralyzed patients according to time lapses, and what effects are influenced to recovery degrees such as cognitive function, upper extremity function, recovery phase, and daily life action etc. Methods: Research objects were 17 unilateral paralyzed patients with 12 males and 5 females who have hospitalized and discharged from the D hospital located in Banghak-dong, Seoul during July-October 2010. Objects were composed of 9 right paralyzed patients and 8 left ones. For these patients, reevaluation was carried out after 6 months from executing initial evaluation. This study observed and compared cognitive abilities to 9 figures having various lengths and thicknesses of alphabet T and I panels along with ○,△,□ ones from sagittal section and forehead one by using tablet. The study compared with recovery degrees such like cognitive function with MMSE-K, upper extremity function with MFT, recovery phase with Brunnstrome, and daily life actions with MBI. Results: First, there were a little difference in graphic cognitive abilities between initial evaluation and reevaluation at forehead section, but it was not significant. In sagittal section, graphic cognitive abilities between initial evaluation and reevaluation showed significant differences from distances along with sum of directions and distances(P<.05). Second, changes of functional recovery levels according to time lapses did not show significant differences at all items such as cognitive function, upper extremity function, recovery phase, and daily life actions etc. Third, in the graphic cognitive abilities between right paralyzed patients and left ones according to time lapses, right paralysis was higher with average 1.92 point at forehead section, average 1.95 at sagittal section than left one, and showed significant differences(P<.05). Also, there were differences at the time of reevaluation, but it was not significant. Conclusion : This study lighted up a fact that there were differences in changes of graphic recognition according to time lapses. However, it is necessary to clear up cognitive process`s characteristics of unilateral paralyzed patients who have not considered till now further concretely along with various aspects through additional researches. 목적: 본 연구의 목적은 편마비 환자의 도형인식능력이 시간경과에 따라 어떠한 변화를 보이며, 인지기능,상지기능,회복단계,일상생활활동등의회복정도와 어떠한 영향을 미치는지 알아보고자 하는 것이다. 방법: 2010년 7월부터 10월 기간 내에 서울시 방학동에 소재한D병원에 입·퇴원 한17명의 편마비 환자를 대상으로 남자 12명 여자 5명이다. 대상자는 우측 편마비 환자는 9명, 좌측 편마비 환자는 8명이다. 이 환자들은 초기평가를 실시 한 후 6주경과 후 재평가를 실시하였다.타블렛을 이용하여 ○,△, □패널과 알파벳T와I패널의다양한길이와 두께를 가진9개의 도형을 인식하는 능력을 시상면과 이마면에서 관찰및비교 하였다. MMSE-K로 인지기능, MFT로 상지기능, Brunnstrome 회복단계, MBI로 일상생활활동에 대한 기능회복 정도와 비교를 하였다. 결과: 첫째, 이마면에서 초기평가와 재평가 사이에 도형인지능력에 다소 차이를 보였지만 유의하지 않았다. 시상면에서 초기평가와 재평가 사이에 도형인지능력에는 거리 및 방향과 거리의 합계에서 유의한 차이를 보였다(P<.05). 둘째, 시간경과에 따른 마비측의 기능회복 수준의 변화는 인지기능,상지기능,회복단계, 그리고 일상생활 수준 등 모든 항목에서 유의한 차이를 보이지 않았다.셋째,시간경과에 따른 오른마 비와 왼마비 환자 집단 간의 도형인지능력이 초기평가에서는 오른마비가 왼마비보다 이마면에서 평균 1.92점, 시상면에서 평균 1.95점 높았고 유의한 차이를 보였으며(P<.05), 재평가 때에는 차이는 있었지만 유의하지 않았다. 결론: 본 연구로 통해 시간경과에 따라 도형인식 변화가 있는지에 대한 차이가 있다는 것은 밝혔지만 추가적 연구로 다양한 양상과 지금까지 고려되지 않는 편마비 환자의 인지과정 특성을 더 세밀히 밝힐 필요가 있다.

청년기와 중년기 정상성인의 시지각 기능에 대한 비교

안시내 청주대학교 보건의료과학연구소 2022 보건의료과학연구 Vol.10 No.2

This study compared the visual perception function of adult and middle-aged adult. The participants of this study were 59 normal adult and middle-aged adult. In this study visual perception function was evaluated through Motor-Free Visual Perception Test-Third Edition (MVPT-3). For interpretation of the evaluation results, raw scores, percentiles, and standard scores were calculated, and the standard scores and percentiles were ranked compared to the 30-34 year old age group presented in the MVPT-3 manual. As a result of the study, there was no statistically significant difference in the raw scores, percentiles, and standard scores of visual perception functions in the adult group and the middle-aged adult group evaluated by MVPT-3 (p>.05). There was no statistically significant difference in standard scores and percentile rankings when compared with the visual perception function of 30-34 year old age group suggested by this assessment tool (p>.05). The results of this study are meaningful in that they presented comparative data on the visual perception functions in adult and middle-aged adult group.

자폐스펙트럼 장애 아동에게 목표관리 훈련이 양측활동에 미치는 영향: 예비연구

안시내 한국인지운동치료협회 2018 한국신경인지재활치료학회지 Vol.10 No.2

The study has compared normally developed children and children who were diagnosed as autism spectrum in goal management training them to observe the effect. The research was conducted to four normally developed children and four children who were diagnosed as autism spectrum, and all subjects were provided with identical goal management training. The children and the caregivers have selected desired objectives activity, and all three activities were followed by goal management training. Intervention periods were conducted ten times in total, two times a week for five weeks, and eight subjects in the two groups were trained one on one by the researcher. The training time was 40 minutes for every session. The descriptive statistics and frequency analysis were used as the statistical method, and the Mann-Whitney test, the nonparametric statistical analysis, was conducted to compare the difference between the two groups. Goal management training for two groups did not show a statistically significant difference in terms of the performance status of Canadian Occupational Performance Measure (p>.05). In the summary of Bruininks-Oseretsky Test of Motor Proficiency (2nd) which evaluates the motor skill, there was a statistically significant difference between the autism spectrum disorder group and normal group (p<.05). Additionally, the two groups showed a statistically significant difference in eye-hand coordination sub-test among Developmental Test of Visual Perception (2nd) which evaluates the visual perception performance (p<.05). The research has confirmed the applicability of goal management training to children with autism spectrum compared to the normally developed children, and it has confirmed the effectiveness of the training. 목적: 본 연구는 정상 발달아동과 자폐스펙트럼으로 진단받은 아동에게 목표관리 훈련을 실시하여 그 효과를 비교하였다. 방법: 연구대상자는 정상 발달아동 4명과 자폐스펙트럼으로 진단 받은 아동 4명을 대상으로 실시하였으며, 모든 대상자에게 동일한 목표관리 훈련을 제공하였다. 아동 및 보호자가원하는 목표활동을 선정하여 3가지 활동에 모두 목표 관리훈련을 실시하였다. 중재기간은 총 10회로 주 2회씩 5주 동안진행되었으며, 두 그룹의 총 8명의 대상자에게 연구자가 1:1로각 대상자에게 40분씩 목표 관리 훈련을 실시하였다. 통계방법으로는 기술통계와 빈도분석을 사용하였으며, 두 그룹의차이를 비교하기 위해 비모수 통계분석인 Mann-Whitney 검정을 실시하였다. 통계학적 유의수준은 0.05로 설정하였다. 결과: 목표관리 훈련은 두 그룹에서 COPM의 수행도에서는 통계학적으로 유의하게 차이가 없었다(p>.05). 목표 관리훈련은 운동기능을 평가하는 BOT-2의 총점에서 자페스펙트럼 장애 그룹과 정상아동 그룹 간에 통계적으로 유의한 차이가 있었다(p<.05). 또한 시지각 기능을 평가하는 DTVP에서도 양측 활동을 하는 눈손협응 하위검사에서 자폐스펙트럼아동과 정상아동 그룹간에 통계적으로 유의한 차이가 있었다(p<.05). 결론: 본 연구는 정상아동과 비교하여 자페스펙트럼 아동에게 목표관리 훈련을 적용가능성을 확인하였으며, 그 효과성도 확인하였다.