체중현수 트레드밀 보행 훈련에서 환측 신발 Inserts 착용이 만성 편마비 환자의 서기 균형 및 보행 양상에 미치는 영향 = The Effects of Put on the Shoe Inserts to the Affected Limb and Weight Suspension Treadmill Training on Standing Balance and Gait Pattern in Hemiplegic Chronic Stroke Patients

다국어 초록 (Multilingual Abstract)

The purpose of this study was to investigate the effectiveness of standing balance and gate pattern with putting on the shoe Inserts during weight suspension treadmill training in chronic hemiplegia with walking wounded. Sixteen patients with chronic hemiplegia who can gate with putting on shoe insert were randomly divided experimental group(8 people)-with putting on shoe insert and control group(8 people)-without putting on shoe insert. Each subject participated in weight suspension treadmill training 30 min per day, 5 times a week for 8 weeks. Standing balance, muscle strength, Motricity Index, TUG, walking velocity, cadence, single support, Double support, step length, stride length, BOS were measured and compared before and after intervention. The changes between pre- and post exercise were analyzed using analyses of paired t-test with SPSS(ver12.0) There were very significant differences in Bohannon standing balance (p<.001), Motricity index(p<.01) and TUG(p<.01), step length(p<.001), stride length(p<.01), BOS (p<.001) in experimental group. Whereas the control group did not show any significant differences. These results show that putting on the shoe Inserts maybe helpful to enhance standing balance and visual spatial related of gate variable during weight suspension treadmill training in chronic hemiplegic stroke patients.

국문 초록 (Abstract)

본 연구는 편마비 환자의 신발 내 Inserts를 착용한 만성 편마비 환자 16명을 무작위로 선별하여 총 8주간 트레드밀 보행훈련을 통해 서기균형과 보행 양상에 미치는 효과를 검정하였다. 본 연구 대상자는 신발 Inserts를 착용하고 체중현수 트레드밀 훈련한 그룹(n=8)과 단독으로 체중현수 트레드밀을 훈련한 그룹(n=8)으로 다음과 같은 결과를 얻었다. 첫째, Bohannon의 서기균형 점수에서는 신발 내 Inserts를 착용한 그룹에서 훈련 전보다 훈련 후 증가하였고, 체중현수 트레드밀 단독으로 훈련한 그룹에서도 유의한 증가를 보였다. 둘째, Motricity와 TUG는 Inserts를 착용한 그룹에서 각각 훈련 전 보다 훈련 후 매우 유의하게 향상되었다. 셋째, 체중현수 트레드밀 훈련 전후의 시간적 보행 변수인 보행속도, 분속수, 단하지 지지기, 양하지 지지기는 신발 내 Inserts를 착용한 그룹에서 기능 향상이 있었다. 넷째, 체중 현수 트레드밀 훈련 전, 후의 공간적 보행 변수인 보장, 활보장, 지주기저면은 신발 내 Inserts를 착용한 그룹에서 기능 향상을 보였다. 이상의 결과로 체중현수 트레드밀 훈련에서 신발 내 Inserts의 착용한 그룹이 서기균형, 시간적, 공간적 보행 변수와 관련하여 단독으로 트레드밀 훈련을 한 그룹에 비하여 효과적이었다.

참고문헌 (Reference)

1 김준성, "편마비 환자에서 전자체중계를 이용한 체중부하의 연구" 24 (24): 1055-60, 2000

2 백남종, "편마비 보행 시 단하지 보조기의 보정효과" 21 (21): 658-668, 1997

3 Laufer,Y., "Weight- bearing shifts of hemiparetic and healthy adults upon stepping on stairs of various heights" 14 (14): 125-9, 2000

4 Hesse,S., "Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects" 80 (80): 421-7, 1999

5 Martin,R.S., "Treadmill training with partial weight support in nonambulatory patients with cerebral palsy" 81 (81): 301-06, 2000

6 Hesse, S., "Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients" 26 (26): 976-81, 1995

7 Brunt,D., "The relation between limb loading and control parameters of gait initiation in persons with stroke" 76 (76): 627-34, 1995

8 Yavuzer,G., "The effects of balance training on gait late after stroke: a randomized controlled trial" 20 (20): 960-9, 2006

9 Buurke,J.H., "The effect of walking aids on muscle activation patterns during walking in stroke patients" 22 (22): 164-70, 2005

10 Laufer,Y., "The effect of walking aids on balance and weight-bearing patterns of patients with hemiparesis in various stance positions" 83 (83): 112-22, 2003

11 Rodriguez,G.M., "The effect of shoe wedges and lifts on symmetry of stance and weight bearing in hemiparetic individuals" 83 (83): 478-82, 2002

12 Chaudhuri,S., "The effect of shoe lifts on static and dynamic postural control in individuals with hemiparesis" 81 (81): 1498-1503, 2000

13 Dean,C,M., "Task related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial" 81 (81): 409-17, 2000

14 Suteerawattananon,M., "Supported treadmill training for gait and balance in a patient with progressive supranuclear palsy" 82 (82): 485-95, 2002

15 Bohannon,R.W., "Standing balance and function over the course of acute rehabilitation" 76 (76): 994-6, 1995

16 Bonan, I. V., "Reliance on visual information after stroke. Part I: Balance on dynamic posturography" 85 (85): 268-73, 2004

17 Eng,J.J., "Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke" 88 (88): 1138-44, 2002

18 Lin,M.R., "Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people" 52 (52): 1343-8, 2004

19 Trueblood,P.R., "Partial body weight treadmill training in persons with chronic stroke" 16 (16): 141-53, 2001

20 Danielsson, A., "Oxygen consumption during treadmill walking with and without body weight support in patients with hemiparesis after stroke and in healthy subjects" 81 (81): 953-7, 2000

21 Bohannon,R.W., "Ordinal and timed balance measurements: reliability and validity in patients with stroke" 7 : 9-13, 1993

22 Demeurisse,G., "Motor evaluation in vascular hemiplegia" 19 (19): 382-9, 1980

23 Bohannon,R.W., "Importance of four variables of walking to patients with stroke" 14 (14): 246-50, 1991

24 Hesse, S., "Immediate effects of therapeutic facilitation on the gait of hemiparetic patients as compared with walking with and without a cane" 109 (109): 515-22, 1998

25 Pohl,M., "Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients" 20 (20): 324-30, 2006

26 Olney,S.J., "Hemiparetic gait following stroke. Part I: Characteristics" 4 : 136-48, 1996

27 Aruin,A.S., "Hanke, T., Chaudhuri, G., Harvey, R., Rao, N. (2000). Compelled weight bearing in persons with hemiparesis following strokes: the effect of a lift and goal-directed balance exercise" 37 (37): 65-72, 2000

28 Richards,C.L., "Gait in stroke: assessment and rehabilitation" 15 (15): 833-55, 1999

29 Titianova,E.B., "Gait characteristics and functional ambulation profile in patients with chronic unilateral stroke" 82 (82): 778-86, 2003

30 Goldie,P.A., "Gait after stroke: initial deficit and changes in temporal patterns for each gait phase" 82 (82): 1057-65, 2001

31 Kitisomprayoonkul, W., "Effects of shoe lift on weight bearing in stroke patients" 88 (88): S79-84, 2005

32 Yung-Hui,L., "Effects of shoe inserts and heel height on foot pressure, impact force, and perceived comfort during walking" 36 (36): 355-62, 2005

33 Cauraugh,J.H., "Coupled rehabilitation protocols and neural plasticity: upper extremity improvements in chronic hemiparesis" 22 (22): 337-47, 2004

34 Perry,J., "Classification of walking handicap in the stroke population" 26 (26): 982-9, 1995

35 Miller,E.W., "Body weight support treadmill and overground ambulation training for two patients with chronic disability secondary to stroke" 82 (82): 53-61, 2002

36 Hsu A,L., "Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke" 84 (84): 1185-93, 2003

37 Steffen,T.M., "Age-and gender -related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds" 82 (82): 128-37, 2002

38 Visintin,M., "A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation" 29 (29): 1122-28, 1998