진동자극이 뇌졸중 환자의 얕은손가락굽힘근의 근전도 활동과 손 기민성에 미치는 영향

국문 초록 (Abstract)

목적 : 본 연구의 목적은 뇌졸중 환자의 얕은손가락굽힘근에 진동자극을 적용하는 것이 손의 기민성을 향상시키고 얕은손가락굽힘근의 개시와 종료 시간을 단축시키는데 도움이 되는지를 알아보는 것이었다. 연구방법 : 본 연구는 개별실험연구방법 중 ABA 연구 설계를 이용하였다. 총 실험회기는 24회로 기초선 과정, 중재 과정, 기초선 회기 과정으로 나누어 각 8회기씩 진행하였다. 중재기간 동안 진동자극은 환측의 얕은손가락굽힘근에 적용되었다. 상자와 블록 검사(Box and Block Test; BBT), 그리고 컵을 쥐기 및 놓기 과제를 수행하는 동안 얕은손가락굽힘근의 개시시간과 종료시간을 측정하였다. 결과 : BBT 점수는 기초선 과정에 비교하였을 때 중재기간 동안 유의하게 증가되었으며(p<.05), 과제 수행 동안 얕은손가락굽힘근의 개시시간과 종료시간은 중재 기간 동안 유의하게 단축되었다(p<.05). 이 러한 경향은 회귀 과정 동안에도 긍정적으로 유지되었다. 결론 : 이러한 결과는 진동자극이 이환된 손의 기민성을 향상시키고 물건을 쥐고 놓는 동안 손과 얕은손가 락굽힘근의 활성 형태를 향상시키는데 긍정적으로 사용될 수 있다는 것을 의미한다.

다국어 초록 (Multilingual Abstract)

Objective : This study aimed at determining whether the application of vibration stimulation over the flexor digitorum superficialis can be helpful in improving the hand dexterity and reducing the onset and end times of the muscle contraction. Methods : We used a single-subject experimental A-B-A design. The experimental sessions were divided into three phases: baseline, intervention, and withdrawal, with eight sessions in each phase. In the intervention phase, the vibration stimulation was applied over the flexor digitorum superficialis muscle of the affected side. Measurements included a box and block test (BBT), and the onset and end times of the muscle while gripping and releasing a cup. Results : During the intervention phase, the BBT score was clinically and significantly increased when compared to the baseline (p<.05), and this improvement was maintained during the withdrawal phase with no intervention. Further, there were significant decreases for the delay in the onset and end times of the flexor digitorum superficialis (p<.05), and these trends were favorably maintained during the withdrawal phase. Conclusion : Our findings suggest that vibration stimulation may be helpful in enhancing the dexterity of the affected hand post stroke, and optimizing the activation patterns of flexor muscles of the wrist and hand while grasping and releasing objects.

목차 (Table of Contents)

• 국문초록
• Ⅰ. 서론
• Ⅱ. 연구 방법
• 1. 연구 대상
• 2. 연구 설계
• 3. 연구 도구 및 측정 방법
• 4. 연구 과정
• 5. 분석 방법
• Ⅲ. 연구 결과
• Ⅳ. 고찰
• Ⅴ. 결론
• 참고문헌
• Abstract

참고문헌 (Reference)

1 정이정, "최대 등척성 수축시 표면근전도에서 근 수축 개시점 결정을 위한 기법들의 신뢰도" 한국전문물리치료학회 10 (10): 51-62, 2003

2 배세현, "진동자극 방식이 뇌병변 환자의 상지경직에 미치는 영향" 한국산학기술학회 12 (12): 3109-3116, 2011

3 배세현, "상지경직에서 신장자극 및 진동자극이 척수운동신경원의 흥분성 변화에 미치는 영향" 동신대학교 대학원 2011

4 이택영, "뇌졸중환자의 환측 상지 기능이 건측 손의 기민성에 미치는영향" 7 (7): 56-67, 1999

5 황성수, "냉·온수적용이 편마비 환자의 손기민성에 미치는 영향" 9 (9): 65-73, 2011

6 Folstein, M. F., "‘Minimental state’ : A practical method for grading the cognitive state of patients for the clinician" 12 (12): 189-198, 1975

7 Roelants, M., "Whole body vibration induced increase in leg muscle activity during different squat exercises" 20 (20): 124-129, 2006

8 Sheean, G., "Upper motor neurone syndrome and spasticity : Clinical management and nerophysiology" Cambridge University Press 12-78, 2001

9 Kasai, T., "The effects of wrist muscle vibration on human voluntary elbow flexion-extension movements" 90 (90): 217-220, 1992

10 Foran, J. R., "Structural and mechanical alterations in spastic skeletal muscle" 47 : 713-717, 2005

11 Carr, J. H., "Stroke rehabilitation" Elservier 2003

12 Di Fabio, R. P., "Reliability of computerized surface electromyography for determining the onset of muscle activity" 67 (67): 43-48, 1987

13 Hammond, M. C., "Recruitment and termination of electromyographic activity in the hemiparetic forearm" 69 (69): 106-110, 1988

14 Desrosiers, J., "Performance of the unaffected upper extremity of elderly stroke patients" 27 : 1564-1570, 1996

15 Trombly, C. A., "Occupational therapy for physical dysfunction" Lippincott Williams & Wilkins 2002

16 Cromwell, F. S., "Occupational therapist manual for basic skill assessment : Primary prevocational evaluation" Fair Oaks Printing 1976

17 Griffin, M. J., "Handbook of human vibration" Elsvier 171-220, 2004

18 Mathiowetz, V., "Grip and pinch strength : Normative data for adults" 66 (66): 69-74, 1985

19 Shirahashi, I., "Functional vibratory stimulation on the hand facilitates voluntary movements of a hemiplegic upper limb in a patient with stroke" 30 (30): 227-230, 2007

20 Portney, L., "Foundations of clinical research : Applications to practice" Prentice Hall 223-264, 2000

21 Ottenbacher, K. J., "Evaluating clinical change : Strategies for occupational and physical therapists" Lippincott Williams & Wilkins 117-119, 1986

22 Basmajian, J. V., "Electrode placement in electromyographic biofeedback, In Biofeedback: Principles and Practice for Clinicians" Lippincott Williams & Wilkins 369-382, 1989

23 Conrad, M. O., "Effects of wrist tendon vibration on targeted upper-arm movements in poststroke hemiparesis" 25 (25): 61-70, 2011

24 Ageranoti, S. A., "Effects of vibration on hypertonia and hyperreflexia in the wrist joint of patients with spastic hemiparesis" 42 (42): 24-33, 1990

25 Rees, S., "Effects of vibration exercise on muscle performance and mobility in an older population" 15 (15): 367-381, 2007

26 Issurin, V. B., "Effect of vibratory stimulation on maximal force and flexibility" 12 (12): 561-566, 1994

27 Seo, N. J., "Delays in grip initiation and termination in persons with stroke : Effects of arm support and active muscle stretch exercise" 101 : 3108-3115, 2009

28 Chae, J., "Delay in initiation and termination of muscle contraction, motor impairment, and physical disability in upper limb hemiparesis" 25 : 568-575, 2002

29 Gemperline, J. J., "Characteristics of motor unit discharge in subjects with hemiparesis" 18 : 1101-1114, 1995

30 Kaufmann, R. A., "Biomechanical analysis of flexor digitorum profundus and superficialis in grip strength generation" 36 (36): 128-132, 2007

31 Cordo, P., "Assisted Movement with Enhanced Sensation(AMES) : Coupling motor and sensory to remediate motor deficits in chronic stroke patients" 23 (23): 67-77, 2009

32 Noma, T. S., "Anti-spastic effects of the direct application of vibratory stimuli to the spastic muscles of hemiplegic limbs in post-stroke patients" 23 (23): 623-631, 2009

33 Perotto, A. O., "Anatomical guide for the electromyographer : The limbs and trunk" Charles C Thomas 1994

34 Lebedev, M. A., "Analysis of the interference electromyogram of human soleus muscle after exposure to vibration" 23 (23): 57-65, 1991

35 Canning, C. G., "Abnormal muscle activation characteristics associated with loss of dexterity after stroke" 176 (176): 45-56, 2000