기능적 활동의 수행에 대한 상상연습이 뇌졸중 환자의 편측무시와 일상생활활동에 미치는 효과

국문 초록 (Abstract)

본 연구는 손상된 사지의 기능적 활동 수행에 대한 상상연습이 뇌졸중 환자의 편측무시와 일상생활활동에 미치는 효과를 알아보는 것이었다. 연구는 개별실험연구방법(single-subject experimental research design) 중 ABA 설계 를 사용하였다. 실험은 총 18회로 구성하였으며, 기초선 과정이 5회, 상상연습을 시행한 중재 과정이 10회, 기초선 회 귀 과정은 중재 과정을 마친 2주 뒤에 3회를 측정하였다. 상상연습은 3개의 기능적인 활동(옷 입기, 화장품을 사용하 여 화장한 뒤 정리하기, 옷을 개기)을 수행하는 것으로, 각 활동에 대해서 5분씩, 1일 총 15분을 상상하도록 하였다. 편측무시는 읽기 검사, 쓰기 검사, Baking Tray Task를 사용하여 측정하였고, 일상생활활동은 COPM(Canada Occupational Performance Measure)으로 평가하였다. 연구 결과 상상연습 후 편측무시 검사의 점수가 모두 감소되었고, 일상생활활동에 대한 검사 점수도 임상적으로 유의한 효과가 있는 것으로 나타나, 상상연습이 뇌졸중 환자의 편측무 시를 감소시키고, 일상생활활동을 증진시키는 것으로 나타났다.

다국어 초록 (Multilingual Abstract)

The purpose of this study was to investigate the effect of mental practice about functional performance of affected limb to unilateral neglect and ADL(Activities of Daily Living) in person with stroke. A single subject experimental research with ABA design was employed in this study. The experiment formed 18 sessions in total: 5 sessions for baseline, 10 sessions for mental practice treatment, and 3 sessions for the second baseline. Mental practice was composed of performing 3 functional activities(dressing clothes, make-up with materials and arrangement, folding clothes). It took 5 minutes at once and 15 minutes in total daily. The unilateral neglect was measured by reading test, writing test, and Baking Tray Task. ADL was assessed by COPM. The results indicated that unilateral neglect test scores were all reduced, and the score of COPM was clinically significant. Mental practice for performing of functional activities was effective method to reduce unilateral neglect and improve ADL in person with stroke.

참고문헌 (Reference)

1 권용철, "한국판 Mini-Mental State Examination(MMSE-K)의 표준화연구" 28 (28): 125-135, 1989

2 유은영, "시각피드백을 이용한 편마비 환자의 대칭적 체중지지 훈련에 있어서 상상연습 병행의 효과" 연세대학교 대학원 2000

3 N. Smania, "Visuomotor imagery and rehabilitation of neglect" 78 (78): 430-436, 1997

4 B. C. Butler, "Visual search patterns in neglect: Comparison of peripersonal and extrapersonal space" 47 (47): 869-878, 2009

5 S. Braun, "Using mental practice in stroke rehabilitation: A framework" 22 (22): 579-591, 2008

6 G. A. Eskes, "Using limb movements to improve spatial neglect: The role of functional electrical stimulation" 24 (24): 385-398, 2006

7 I. Tsirlin, "Use of virtual reality for diagnosis, rehabilitation and study of unilateral spatial neglect: Review and analysis" 12 (12): 23-28, 2009

8 S. Saevarsson, "Unilateral neglect: A review of causes, anatomical localization, theories and interventions" 95 (95): 27-33, 2009

9 L. Cherney, "Unilateral neglect: A disorder of attention" 23 (23): 117-127, 2002

10 S. Pierce, "Treatments of unilateral neglect: A review" 83 (83): 256-268, 2002

11 K. Tham, "Training to improve awareness of disabilities in clients with unilateral neglect" 55 (55): 45-54, 2001

12 K. Tham, "Training to improve awareness of disabilities in client with unilateral neglect" 55 (55): 46-54, 2001

13 M. A. McColl, "Targeted application of the Canadian Occupational Performance Measure" 72 (72): 298-300, 2005

14 S. Ionta, "Step-by-Step: The effects of physical practice on the neural correlates of locomotion imagery revealed by fMRI" 17 (17): 216-224, 2009

15 M. Hashimoto, "Right-sided neglect influences the writing of Kanji: A case study" 111 (111): 886-888, 2009

16 L. Ekstam, "Relationship between awareness of disability and occupational performance during the first year after a stroke" 61 (61): 503-511, 2009

17 N. U. Arene, "Rehabilitation of unilateral spatial neglect and neuroimaging" 43 (43): 255-269, 2007

18 J. A. Brown, "Recovery of motor function after stroke" 157 : 223-228, 2006

19 C. M. Braun, "Psychic tonus, and body schema and the parietal lobes: A multiple lesion case analysis" 18 (18): 65-80, 2007

20 I. H. Robertson, "Prospects for the Rehabilitation of Unilateral Neglect" Lawrence Erlbaum 1993

21 T. Ann, "Occupational Therapy and Physical Dysfunction: Activities Analysis(4th ed.)" Churchill Livingstone 1996

22 K. Heilman, "Neglect and related disorders" 20 (20): 463-470, 2000

23 T. D. Punt, "Motor neglect: Implications for movement and rehabilitation following stroke" 28 (28): 857-864, 2006

24 M. Folstein, "Mini-Mental State Examination: A practical method for grading the cognitive state of patients for the clinician" 12 (12): 189-198, 1975

25 A. J. Bulter, "Mental practice with motor imagery: Evidence for motor recovery and cortical reorganization after stroke" 87 (87): S2-S11, 2006

26 T. Schenkenberg, "Line bisection and unilateral visual neglect in patients with neurological impairment" 30 (30): 509-517, 1980

27 J. Patton, "Functional restoration for the stroke survivor: Informing the effects of engineers" 15 (15): 521-541, 2008

28 P. Harding, "Functional Electrical Stimulation(FES) of the upper limb alleviates unilateral neglect: A case series analysis" 19 (19): 41-63, 2009

29 J. H. Van der Lee, "Forced use of the upper extremity in chronic stroke patient" 30 (30): 210-1216, 2000

30 E. Heremans, "Facilitation of motor imagery through movement-related cueing" 127 (127): 50-58, 2009

31 J. Toglia, "Dynamic assessment and prediction of learning potential in clients with unilateral neglect" 63 (63): 569-579, 2009

32 S. J. Page, "Cortical plasticity following motor skill learning during mental practice in stroke" 23 (23): 382-388, 2009

33 A. Gaggioli, "Computer-guided mental practice in neurorehabilitation" 145 (145): 195-208, 2009

34 H. Nakayama, "Compensation in recovery of upper extremity function after stroke: The Copenhagen stroke study" 75 (75): 852-857, 1994

35 B. Abreu, "Cognitive rehabilitation: A model for occupational therapy" 41 (41): 439-448, 1987

36 J. Munzert, "Cognitive motor process: The role of motor imagery in the study of motor representations" 60 (60): 306-326, 2009

37 M. Law, "Canadian Occupational Performance Measure" CAOT 1998

38 E. Matthias, "Attentional and sensory effects of lowered level of intrinsic alertness" 47 (47): 3255-3264, 2009

39 M. M. Mesulam, "Attentional Networks, Confusional States, and Neglect Syndromes, Principles of Behavioral Neurology, 2nd ed" 2000

40 A. Issac, "An instrument for assessing imagery of movement: The vividness of movement imagery questionnaire(VMIQ)" 10 (10): 23-30, 1986

41 M. Conson, "Action observation improves motor imagery: Specific interaction between simulative processes" 199 (199): 71-81, 2009

42 K. Tham, "A test of spatial neglect" 6 (6): 19-25, 1996