지도를 이용한 길 찾기 훈련이 성인 뇌졸중환자의 인지기능과 일상생활동작에 미치는 영향

국문 초록 (Abstract)

본 연구는 지도를 이용한 길 찾기 훈련이 뇌졸중 환자의 인지기능과 일상생활동작 수행능력 증진에 효과적인 방법인지를 알아보고자 하였다. 뇌졸중으로 인해 편마비 진단을 받은 7명의 환자를 대상으로, 병원에 서 지도를 이용한 길 찾기 훈련을 일주일에 3회씩 2주간 실시하였다. 중재 전후 인지기능과 일상생활 동작수행 능력은 로웬스타인 작업치료인지평가(Loewenstein Occupational Therapy Cognitive Assessment, LOTCA)와 기능적 독립 평가(Functional Independence Measure, FIM)로 측정하였다. 연구 결과, 지도를 사용하여 길 찾기 훈련에 참여한 대상자에게서 인지요소의 하위 영역 중 시지각 영역과 공간지각 영역의 공간관계 항목에서 통계학적으로 유의한 증가를 보였다(p<.05). 또한, 일상생활동작의 하위 영역 중 이동하기 영역의 걷기/의자차타기 항목, 사회적인지 영역의 문제해결능력 항목에서 통계학적으로 유의한 증가를 보였다(p<.05). 따라서 본 연구 결과를 바탕으로, 뇌졸중 환자의 인지기능과 일상생활동작 수행능력 증진에 있어서 지도를 이용한 길 찾기 훈련의 적용 가능성을 확인해 볼 수 있었다.

다국어 초록 (Multilingual Abstract)

The purpose of this study is to investigate the effectiveness of the way-finding exercise using a map in rehabilitation of cognitive function and activities of daily living in patients with a stroke. For the seven patients diagnosed with hemiplegia from a stroke, we executed the way-finding exercise using a map in the hospital, three times a week for two weeks. Loewenstein Occupational Therapy Cognitive Assessment(LOTCA) and Functional Independence Measure(FIM) were used to measure the cognitive function and performance of activities of daily living before and after intervention. For the visual perception area and the spatial relations of the spatial perception area of LOTCA, scores were significantly higher than before intervention(p<.05). For the walk/wheelchair of locomotion area and the problem solving of the social cognition area of FIM, scores were significantly higher than before intervention(p<.05). The results of this study show that a way-finding exercise for patients with a stroke is a useful therapeutic approach by enhancing cognitive function and performance of activities of daily living.

목차 (Table of Contents)

• 요약
• Abstract
• I. 서론
• Ⅱ. 연구방법
• Ⅲ. 결과
• Ⅳ. 고찰
• Ⅴ. 결론
• 참고문헌

참고문헌 (Reference)

1 오현수, "후급성기 뇌손상 환자를 위한 인지재활 프로그램의 개발" 한국간호과학회 35 (35): 270-281, 2005

2 백지영, "인지기능의 전이 훈련이 뇌경색과 뇌출혈 환자의 인지기능과 운동기능 회복에 미친 효과" 9 (9): 11-24, 2001

3 김명선, "인지 신경과학과 신경심리학" 시그마프레스 2008

4 김선미, "요양시설 거주자와 지역사회 노인의 인지기능 및 일상생활 수행능력 비교연구" 1 (1): 95-103, 1998

5 김신미, "신체적 활동프로그램이 치매노인의 인지기능 및 일상생활수행능력에 미치는 효과" 23 (23): 17-31, 2003

6 김창윤, "신경행동학적 인지상태 검사의 임상적용을 위한 연구 : 60세 이상의 연령군을 대상으로" 33 (33): 1329-1341, 1994

7 방요순, "상지 운동학습에 의한 뇌졸중 환자의 일상생활동작 수행능력의 변화" 한국전문물리치료학회 10 (10): 85-98, 2003

8 최하영, "뇌경색 환자에서 인지 및 지각기능과 일상생활 독립성" 대한재활의학회 31 (31): 630-635, 2007

9 권용철, "노인용 한국판 Mini-Mental State Examination(MMSE-K)의 표준화 연구. 구분점 및 진단적 타당도" 28 (28): 508-513, 1989

10 권효석, "길찾기 능력 검사의 개발 및 타당화 연구" 한국심리학회 24 (24): 1-10, 2005

11 방요순, "과제 지향적 활동이 성인 뇌졸중 환자의 인지기능과 일상생활동작에 미치는 영향" 대한작업치료학회 15 (15): 49-62, 2007

12 박수미, "경도인지장애환자의 가상환경내 길 찾기 학습능력과 시공간 기능에 관한 연구" 2 : 1357-1362, 2008

13 R. S. Rosenbaum, "Where to? Remote Memory for Spatial Relations and Landmark Identity in Former Taxi Drivers with Alzheimer's and Encephalitis" 17 : 446-462, 2005

14 J. Kaplan, "Visuospatial Deficit After Right Hemisphere Stroke" 36 : 314-321, 1982

15 S. E. Kober, "Virtual Reality in Neurologic Rehabilitation of Spatial Disorientation" 10 : 1-13, 2013

16 R. Canovas, "Virtual Reality Tasks Disclose Spatial Memory Alterations in Fibromyalgia" 48 : 1273-1278, 2009

17 S. Koenig, "Virtual Reality Rehabilitation of Spatial Abilities After Brain Damage" 144 : 105-107, 2009

18 M. K. Holden, "Virtual Reality Environments for Motor Rehabilitation: Review" 8 : 187-211, 2005

19 S. A. Livingstone, "Virtual Environment Navigation Tasks and the Assessment of Cognitive Deficits in Individuals with Brain Injury" 185 : 21-31, 2007

20 T. Hartley, "The Well-worn Route and the Path Less Traveled: Distinct Neural Bases of Route Following and Wayfinding in Humans" 37 : 877-888, 2003

21 T. Zaehle, "The Neural Basis of the Egocentric and Allocentric Spatial Frame of Reference" 1137 : 92-103, 2007

22 J. H. Carr, "Stroke Rehabilitation: Guidelines for Exercise and Training to Optimize Motor Skill" Butterworth-Heinemann 2003

23 N. Burgress, "Spatial Memory : How Egocentric and Allocentric Combine" 10 : 551-557, 2006

24 B. M. Brooks, "Route Learning in a Case of Amnesia: a Prelominary Investgation into the Efficacy of Training in a Virtual Environment" 9 : 63-76, 1999

25 B. Freishtat, "Perceptual and Cognitive Dysfunction in the Adult Stroke Patient: A Manual for Evaluation and Treatment" Slack Inc 1986

26 C. A. Trombly, "Occupational Therapy for Physical Dysfunction" Willams & Wilkins 1995

27 L. Carelli, "Neuropsychological and Virtual Reality Assessment in Topographical Disorientation" 144 : 230-233, 2009

28 M. van Asselen, "Neural Correlates of Human Wayfinding in Stroke Patients" 1067 : 229-238, 2006

29 M. V. Asselen, "Neural Correlates of Human Wayfinding in Stroke Patients" 1067 : 229-238, 2006

30 M. L. Rusconi, "Long-Lasting Topographical Disorientation in New Environments" 273 : 57-66, 2008

31 N. Katz, "Loewenstein Occupational Therapy Cognitive Assessment(LOTCA) Battery for Brain-Injured Patients: Reliability and Validity" 43 : 184-192, 1989

32 A. K. Kim, "Locating Oneself on a Map in Relation to Person Qualities and Map Characteristics: Spatial Cognition VI" Springer-Verlag 2008

33 F. D. Rose, "Learning and Memory in Virtual Environments: a Role in Neurorehabilitation? Question(Occational Answer) from the University of East London" 10 : 345-358, 2001

34 E. A. Maquire, "Knowing Where and Getting There : A Human Navigation Network" 280 : 921-924, 1998

35 M. Sohlberg, "Introduction to Cognitive Rehabilitation: Teory and Practice" The Guilford Press 1989

36 H. Eichenbaum, "Hippocampal Representation in Place Learning" 10 : 3531-3542, 1990

37 D. Bohbot, "Hippocampal Fucnction and Spatial Memory: Evidence from Functional Neuroimaging in Healthy Participants and Performance of Patients with Medial Temporal Lobe Resection" 18 : 419-425, 2004

38 A. C. Cotter, "Functional Assessment Scales : a Study of Person with Multiple Sclerosis" 71 : 870-875, 1990

39 S. Serrano, "Frequency of Cognitive Impairment Without Dementia in Patients With Stroke: A Two Year Follow-up Study" 38 : 105-110, 2007

40 J. Weisman, "Evaluating Architectural legibility: Way-finding and the Built Environment" 13 : 189-204, 1981

41 M. J. Nadolne, "Ecologic Validity in Neuropsychological Assessment: Prediction of Wayfinding" 7 : 675-668, 2001

42 K. Rockwood, "Disease Progression in Vascular Cognitive Impairment : Cognitive, Functional and Behavioral Outcomes in the Consortium to Investigate Vascular Impairment of Cognition(CIVIC)Cohort Study" 252 : 106-112, 2007

43 김은주, "Correlations between Cognitive Function and Functional Ability in Strokes using MMSE and FIM" 한국콘텐츠학회 5 (5): 86-90, 2009

44 G. Iaria, "Cognitive Strategies Dependent on the Hippocampus and Caudate Nucleus in Human Navigation: Variability and Change with Practice" 23 : 5945-5952, 2003

45 J. B, Hochstenbach, "Cognitive Recovery After Stroke: A 2-year Follow-up" 84 (84): 1499-1504, 2003

46 T. K. Tatemichii, "Cognitive Impairment After Stroke : Frequency, Patterns, and Relationship to Functional Abilities" 57 : 202-207, 1994

47 T. W. McAllister, "Cognitive Functioning in the Affective Disorder" 22 : 527-586, 1981

48 F. D. Rose, "A Preliminary Investigation into the Use of Virtual Environments in Memory Retraining after Vascular Brain Injury : Indications for Future Strategy?" 21 : 548-554, 1999