신경계 재활의 전통적 중재와 대안적 중재 방법에 대한 문헌 고찰

심재광,최호석 한국신경근육물리치료학회(구 한국신경근육재활학회) 2015 한국신경근육재활학회지 Vol.5 No.1

This paper is a review conducted to provide an overview of the history of the past and contemporary rehabilitation methods for patient with damaged central nerves. Neurorehabilitation is a complex medical process which an aim to facilitate a recovery from a nervous system injury, and to minimize and/or compensate for functional impairments arising from it. By focusing on all aspects of a person's wellbeing, neurorehabilitation offers a series of therapies from the psychological to occupational, teaching or re-training the patients on mobility skills, communication processes, and other aspects of that person's daily routine. Current viewpoint represents a paradigm shift in clinical intervention, and clinicians have differently considered the details of intervention for the nervous and musculoskeletal impairments. Such concepts require to see the overall history of physical therapy, we interpreted the hidden meaning in the history of physical therapy. The current and future physical therapists will be to look at the patients as a comprehensive perspective. Medical instruments have continuously been developed. However, it may not be competed by senior physical therapists working for a long time in rehabilitation field. It’s probably useless to find only a way to treat a variety of patients with neurological impairments, representing optimal effects of rehabilitation, because definite answer to the therapy does not exist and their symptoms should be handled case-by-case. Thus, we need to take the advantages of functional evaluation, and they will be integrated into intervention.

3-Sided Virtual Reality Mild Cognitive Impairment Rehabilitation Training Platform : An Update

Ji-su Park,Dae-kil Choi,Jae-min Park,Yun-seok Choi,Jae-woo Suk,Hae-mi Ji,Tae-hyung Yoon 한국신경근육물리치료학회(구 한국신경근육재활학회) 2020 한국신경근육재활학회지 Vol.10 No.1

The purpose of this study is to examine the types and methods of virtual reality (VR) rehabilitation and their clinical effects, and to introduce recently developed VR rehabilitation methods. VR rehabilitation is largely divided into desktop type VR, third person type VR, and immersive type VR, and various companies have already introduced several such products. In addition, a VR rehabilitation method that surrounds the anterior, left, and right sides of a patient on three or all four sides have recently been introduced that has the advantage of providing a variety of sensory stimuli in an environment similar to real life. These devices vary in price, size, and sense of immersion. To date, VR rehabilitation has mainly been applied to adults with brain damage, including stroke, as well as to individuals with cerebral palsy, dementia, or mild cognitive impairment. VR rehabilitation positively contributes to improvements in their physical function, cognitive function, mental function, and daily living activities for two reasons. First, virtual reality-based rehabilitation provides continuous multisensory stimulation to the brain’s cognitive and motor areas through dynamic interaction with an environment similar to real life. This can positively contribute to the improvement of cognitive, physical, and mental functions through a direct effect on brain restructuring or plasticity. In addition, VR rehabilitation can induce active participation in rehabilitation by evoking fun and interest in patients, using a variety of contents. Thus, active rehabilitation can not only increase the time spent participating in rehabilitation but also improve compliance, which can aid in successful rehabilitation.

문제-기반 균형 운동이 실조형 뇌성마비 아동의 기능적 수행에 미치는 영향 : 증례 보고

유성호,오덕원 한국신경근육물리치료학회(구 한국신경근육재활학회) 2020 한국신경근육재활학회지 Vol.10 No.1

The purpose of this study was to identify the effects of a problem-based balance exercise program on functional performance in ataxic cerebral palsy. A subject was 15 years old male with cerebellar ataxic cerebral palsy caused by brain tumor. To assess changes in function, gross Motor function measure (GMFM), timed up and go test (TUG), Korean version of the scale for the assessment and rating of ataxia (K-SARA), dynamic gait index (DGI). His own problems were identified from th use of Pediatric Balance Scale. A problem- based balance exercise program consisted of four tasks: (1) standing with feet together, (2) standing with one foot in front, (3) retrieving object from floor, and (4) placing alternate foot on stool. A subject performed this exercise program for average 30-min per day, three days weekly for four weeks (a total of 12 sessions). Values of the GMFM. TUG, K-SARA, and DGI appeared to be noticeably improved after the intervention. These findings indicate that problem-based balance exercise program might be helpful to improve balance function of children with cerebellar ataxia. The problem-based balance exercise based on performance was clinically feasible to facilitate a recovery of the balance and motor function of cerebellar ataxia children with cerebral palsy. Further studies need in this field.

수정된 퀸즈칼리지 스텝 검사의 최대산소 섭취량에 대한 상관관계 분석

김진섭 한국신경근육물리치료학회(구 한국신경근육재활학회) 2020 한국신경근육재활학회지 Vol.10 No.1

The purpose of this study was to find correlations among the Queen’s college step test, modified Queen’s college step test, graded exercise test to predict 85% VO2max. Sixteen University students volunteered for this study. All participants were assessed by three tests. The data were analyzed using one way repeated analysis of variance, and Pearson product moment correlation. The results revealed that estimated VO2max values were significantly different among the three assessments (p<.05). In post-hoc test, the Queen’s college step test value was higher than other two tests. However, there was no significant difference between modified Queen’s college step test and graded exercise test (p>.05). In addition, graded exercise test had a significant correlation with the modified Queen’s college step test (p<.05). Therefore, modified Queen’s college step test may be considered as an appropriate assessment tool to predict submaximal oxygen consumption of normal adults.

노인의 기능적 운동성 임상 평가도구 : 문헌고찰

박현주,임우택 한국신경근육물리치료학회(구 한국신경근육재활학회) 2017 한국신경근육재활학회지 Vol.7 No.1

Aging, in general, leads to changes in skeletal, collagenous, and cardiovascular tissues, body composition, nervous and immune systems, as well as the hormonal axis. As a result, most elderly people have remarkably impaired aerobic capacity/endurance, joint mobility, muscle performance, balance as well as abnormal position and gait patterns, cognitive disorders and depression. Based on age-related changes in the elderly, clinicians use measurements of the following: aerobic capacity/endurance (the 6-min walk test), position (range of motion and thoracic kyphosis index), strength (the grip strength test), gait (the 10-m walk test and dynamic gait index), balance (the Berg balance scale, timed ‘up and go’ test, and functional reach test), cognition and depression (the mini-mental state exam, activities-specific balance confidence scale, geriatric depression scale), and functional activity (the functional independence measure, Katz index of independence in activities of daily living, and modified Barthel index), as standard clinical assessment tools to establish appropriate therapeutic exercise programs for successful rehabilitation. This review describes several clinical assessment tools and elucidates implementation guidelines for the assessment of functional mobility among the elderly in clinical settings. Moreover, this review provides valuable information for clinicians and researchers for exploring the systematic evaluation strategies and optimal therapeutic programs to enhance functional mobility in the elderly.

앉은 자세에서 일어나 걷기 훈련이 만성 뇌졸중 환자의 발목 선행적 자세 조절과 다중 과제 수행력에 미치는 효과 : 사례군 연구

박재만 한국신경근육물리치료학회(구 한국신경근육재활학회) 2020 한국신경근육재활학회지 Vol.10 No.1

Sit-to-walk (STW) movement is a complex task characterized by starting one step before reaching a full standing posture and maintaining the body moment forward until the end of the movement. The purpose of this study was to provide an efficient interventional perspective in close proximity to daily life for improving the function of patients with chronic stroke by providing information on the positive effects of sit-to-walk training. Two patients with chronic stroke volunteered for this study. The STW training fior Subject 1 and the sit-to-stand training for Subject 2 were performed an average 30 minutes per day, 3 times a week for 4 weeks (a total of 12 sessions). Measurements included electromyographic analysis (muscle activity and onset time) on vastus medialis, bicepps femoris, tibialis anterior, and soleus, and timed up and go (TUG) test. With respect to anticipatory postural adjustments before and after training, the tibialis anterior muscle onset time of Subject 1 and 2 decreased from 1.09 to .63 seconds and from 2.46 to 1.25 seconds, respectively. In relation to multi-task performance, the TUG test with a motor task decreased by 5.90 seconds for Subject 1 and 12.03 seconds for Subject, respectively. These findings suggest that the STW training might be considered as a part of functional movement re-education close to everyday life in rehabilitation programs of stroke patients and as higher difficulty training.

그라스톤을 이용한 연부조직가동술과 근에너지기법이 발목관절 가동성과 장딴지근 깃각 및 압통에 미치는 영향

한바다,심재훈,이형렬 한국신경근육물리치료학회(구 한국신경근육재활학회) 2020 한국신경근육재활학회지 Vol.10 No.1

This study aimed to identify alterations in the pennation angle of the gastrocnemius, active ankle dorsiflexion range-of-motion and pressure pain threshold in response to passive stretching(PS), instrument assisted soft tissue mobilization (IASTM) using Graston, and muscle energy technique (MET). Twenty-four people with no orthopedic or neurological diseases volunteered to participate in the study. Their both legs were allocated either the PS, IASTM, or MET groups, 16 in each. Outcome measure included the pennation angle of the gastrocnemius, active ankle dorsiflexion range-of-motion and pressure pain threshold. Intervention was a 4 repetitions of 30-sec stretch for the PS group, a 2-min sweeping the soft tissue for the IASTM, and a 8 repetitions of isometric contraction and 7-sec relaxation for the MET group. As a result of this study, pre- and post-treatment changes in the pennation angle and range-of-motion were significantly different for the three groups(p<.01). Pre- and post-treatment changes in the pressure pain threshold were significantly different for the IASTM and MET groups(p<.05). But not different for the PS groups(p>.05). There were found statistically significant differences in the active ankle dorsiflexion ROM between the PS group and the others.(p<.05). This study suggests that IASTM and MET are more recommended than PS to increase the active ankle dorsiflexion ROM effectively.

고유수용성신경근촉진법을 사용한 몸통 강화 및 안정화 운동이 기저핵 뇌졸중 환자의 균형과 보행 능력에 미치는 영향

김범룡,최미호 한국신경근육물리치료학회(구 한국신경근육재활학회) 2020 한국신경근육재활학회지 Vol.10 No.1

This study aimed to determine the effects of trunk strengthening and stabilization exercise using proprioceptive neuromuscular facilitation (PNF) on the balance and walking ability in patients with basal ganglia stroke. Five patients with basal ganglia stroke volunteered for this study. PNF trunk strengthening and stabilization exercise was performed for average 30 minutes per day, five times a week for four weeks (a total of 20 sessions). Outcome measures included one-leg standing test (OLST), Berg balance scale (BBS), and tandem walking test (TWT) for balance function, and 10 meters walk test (10WMT) for walking function. Significant improvements were found for the OLST, BBS, TWT, and 10WMT scores after the intervention (p<.05). These results suggest that trunk strengthening and stabilization exercise using the PNF may be favorably used for patients with basal ganglia stroke.

음악 기반한 과제지향 슬링운동 프로그램이 만성 뇌졸중 환자의 근수행력, 일상생활 기능 및 보행능력에 미치는 영향 : 단일사례연구

임진구,나규민,박현주 한국신경근육물리치료학회(구 한국신경근육재활학회) 2019 한국신경근육재활학회지 Vol.9 No.1

The purpose of this study is to examine how the task-oriented sling exercise based on rhythm affects patients with chronic stroke. We used a study with a single-subject design (A-B-A'). Two patients with chronic stroke participated in this study. Stretching/strengthening and task-oriented function exercises based on music using the sling were performed one hours per day for 8 times during intervention phase(B). Outcome measure included grip strength, range of motion(ROM), modified bathel index(MBI), berg balance scale(BBS), 10meter walk test(10MWT) and 6minute walk test(6MWT). After the intervention, the strength of grip strength, ROM, activities of daily living, balance and walking function of all patients was remarkably increased after the training, and these gains were positively maintained at 2-weeks follow-up phase. This result have shown that the task-oriented sling exercise basced on music might improve muscle performance, activities of daily living and gait function for patients with chronic stroke.

뇌손상을 가진 편측무시 환자에게 전산화 인지재활치료가 시·공간 지각, 시야 및 집중력, 시각기억에 미치는 효과

정연규,김원철 한국신경근육물리치료학회(구 한국신경근육재활학회) 2021 한국신경근육재활학회지 Vol.11 No.3

This study aimed to compare the effects of computerized-assisted cognitive rehabilitation (CACR) and conventional rehabilitation (CR) on visuospatial perception, visual field and attention, and visual memory in patients with unilateral spatial neglect. Forty-eight patients with unilateral spatial neglect were randomly assigned to either the experimental group (n=23) or the control group (n=25). The experimental group received CACR intervention using RehaCom software, including saccadic eye movement, visual field, and visual-motor coordination training, whereas the control group received CR, including hemispheric activation approach, mental imagery training, and vibration therapy. Interventions for the experiemntal and control groups were performed for average 30 minutes, five times per week for four weeks. Outcome measures comprised Motor-free visual perception test (MVPT) and line bisection test (LBT) for visuospatial perception, visual span test (VST) for evaluating visual field and attention, and Visual recognition test (VRT) for evaluating visual memory. Evaluations were performed before and after the intervention. In between- group comparison, improvements on MVPT, VST, and VRT scroes after the intervention were statistically significantly different between the groups (p<.01). In within-group comparison, both groups showed statistically significant improvement in all variables after the intervention (p<.01). These findings suggest that the CACR may be beneficially used to enhance visuospatial perception, visual field and attention, and visual memory for patients with the unilateral spatial neglect caused by brain damage. Further studies will be needed to warrant our results.