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가상현실 게임기반 훈련프로그램을 이용한 체간조절훈련이 아급성기 뇌졸중 환자의 균형 및 상지기능에 미치는 영향

The Effect of Trunk Control Training Using Virtual Reality Game-based Training Program on Balance and Upper Extremity Function of Subacute Stroke Patients

  • 박삼호 (대전대학교 일반대학원 물리치료학과) ;
  • 김병수 (대전대학교 일반대학원 물리치료학과) ;
  • 이명모 (대전대학교 물리치료학과)
  • Park, Sam-Ho (Dept. of Physical Therapy, Graduate School, Daejeon University) ;
  • Kim, Byeong-Soo (Dept. of Physical Therapy, Graduate School, Daejeon University) ;
  • Lee, Myung-Mo (Dept. of Physical Therapy, College of Health & Medical Science, Daejeon University)
  • 투고 : 2019.03.12
  • 심사 : 2019.05.20
  • 발행 : 2019.05.28

초록

본 연구는 가상현실 게임기반을 이용한 훈련이 아급성기 뇌졸중환자의 균형 및 상지기능에 미치는 영향에 대하여 알아보기 위하여 실시하였다. 아급성기 뇌졸중환자 30명을 가상현실 게임기반 훈련프로그램을 적용한 실험군(n=15)과 대조군(n=15)으로 무작위 배정하였다. 중재는 6주간 주 3회, 1회당 30분씩 적용하였다. 대상자의 기능 향상정도를 평가하기 위하여 중재 전 후 균형능력과 상지기능을 평가하였다. 연구결과 실험군에서 균형능력과 상지기능(FMUE), 체간 장애척도(TIS)에 유의한 향상이 있었으며(p<.05), 두 그룹 간 차이는 버그균형척도(BBS), 일어나 걷기(TUG), 체간 장애척도(TIS)에서 유의한 차이가 있었다(p<.05). 이러한 결과를 바탕으로 가상현실 게임기반 훈련 프로그램은 아급성기 뇌졸중환자에게 임상적으로 유익한 운동프로그램이라 할 수 있다.

JKOHBZ_2019_v9n5_172_f0001.png 이미지

Fig. 1. Virtual reality game based training program

Table 1. General characteristics of participants

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Table 2. Comparison of Balance ability Before and After Arbitration

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Table 3. Comparison of fugl-meyer assessment of upper extremity before and after intervention and trunk lmpairment scale

JKOHBZ_2019_v9n5_172_t0003.png 이미지

참고문헌

  1. S. B. O'Sullivan. & T. J. Schmitz. (1994). Physical rehabilitation: ssessment and treatment: FA Davis.a
  2. F. M. Campbell, A. M. Ashburn, R. M. Pickering & M. Burnett. (2001). Head and pelvic movements during a dynamic reaching task in sitting: implications for physical therapists. Archives of physical medicine and rehabilitation, 82(12), 1655-1660. https://doi.org/10.1053/apmr.2001.26818
  3. C. M. Dean, E. F. Channon & J. M. Hall. (2007). Sitting training early after stroke improves sitting ability and quality and carries over to standing up but not to walking: a randomised controlled trial. Australian Journal of Physiotherapy, 53(2), 97-102. https://doi.org/10.1016/S0004-9514(07)70042-9
  4. A. Shumway-Cook. & M. H. Woollacott. (2007). Motor control: translating research into clinical practice. Lippincott Williams & Wilkins.
  5. L. Wolfson, R. Whipple, C. A. Derby, P. Amerman & L. Nashner. (1994). Gender differences in the balance of healthy elderly as demonstrated by dynamic posturography. Journal of Gerontology, 49(4), M160-M167. https://doi.org/10.1093/geronj/49.4.M160
  6. L. Ada., S. Dorsch & C. G. Canning. (2006). Strengthening interventions increase strength and improve activity after stroke: a systematic review. Australian Journal of Physiotherapy, 52(4), 241-248. https://doi.org/10.1016/S0004-9514(06)70003-4
  7. C. J. Newsam & L. L. Baker. (2004). Effect of an electric stimulation facilitation program on quadriceps motor unit recruitment after stroke. Archives of physical medicine and rehabilitation, 85(12), 2040-2045. https://doi.org/10.1016/j.apmr.2004.02.029
  8. W. J. Hwang, M. K. Cho & Y. Chung. (2015). Relationship between anticipatory postural adjustment of the trunk, dual tasks and physical performance with chronic stroke survivors: a pilot test. Physical Therapy Rehabilitation Science, 4(1), 44-48. https://doi.org/10.14474/ptrs.2015.4.1.44
  9. B. French, L. H. Thomas, J. Coupe, N. E. McMahon, L. Connell, J. Harrison & C. L. Watkins. (2016). Repetitive task training for improving functional ability after stroke. Cochrane database of systematic reviews, (11).
  10. B. M. Quaney, J. He, G. Timberlake, K. Dodd & C. Carr. (2010). Visuomotor training improves stroke-related ipsilesional upper extremity impairments. Neurorehabilitation and neural repair, 24(1), 52-61. https://doi.org/10.1177/1545968309341646
  11. S. M. Michaelsen, R. Dannenbaum & M. F. Levin. (2006). Task-specific training with trunk restraint on arm recovery in stroke: randomized control trial. Stroke, 37(1), 186-192. https://doi.org/10.1161/01.STR.0000196940.20446.c9
  12. S. J. Page. P. Levine & A. C. Leonard. (2005). Modified constraint-induced therapy in acute stroke: a randomized controlled pilot study. Neurorehabilitation and neural repair, 19(1), 27-32. https://doi.org/10.1177/1545968304272701
  13. J. E. Deutsch, A. S. Merians, S. Adamovich, H. Poizner & G. C. Burdea. (2004). Development and application of virtual reality technology to improve hand use and gait of individuals post-stroke. Restorative neurology and neuroscience, 22(3-5), 371-386.
  14. R. B. Rosenberg-Kima & A. Sadeh. (2010). Attention, response inhibition, and face-information processing in children: The role of task characteristics, age, and gender. Child Neuropsychology, 16(4), 388-404. https://doi.org/10.1080/09297041003671192
  15. G. C. Burdea. (2003). Virtual rehabilitation-benefits and challenges. Methods of information in medicine, 42(05), 519-523. https://doi.org/10.1055/s-0038-1634378
  16. S. J. Lee & M. H. Chun. (2014). Combination transcranial direct current stimulation and virtual reality therapy for upper extremity training in patients with subacute stroke. Archives of physical medicine and rehabilitation, 95(3), 431-438. https://doi.org/10.1016/j.apmr.2013.10.027
  17. S. Downs, J. Marquez & P. Chiarelli. (2013). The Berg Balance Scale has high intra-and inter-rater reliability but absolute reliability varies across the scale: a systematic review. Journal of physiotherapy, 59(2), 93-99. https://doi.org/10.1016/S1836-9553(13)70161-9
  18. M. Katz-Leurer, I. Fisher, M. Neeb, I. Schwartz & E. Carmeli. (2009). Reliability and validity of the modified functional reach test at the sub-acute stage post-stroke. Disability and rehabilitation, 31(3), 243-248. https://doi.org/10.1080/09638280801927830
  19. D. Podsiadlo & S. Richardson. (1991). The timed "Up & Go": a test of basic functional mobility for frail elderly persons. Journal of the American geriatrics Society, 39(2), 142-148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  20. A. R. Fugl-Meyer, L. Jaasko, I. Leyman, S. Olsson & S. Steglind. (1975). The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scandinavian journal of rehabilitation medicine, 7(1), 13-31.
  21. H. Kim, J. Her, J. Ko, D. S. Park. J. H. Woo, Y. You & Y. Choi. (2012). Reliability, concurrent validity, and responsiveness of the Fugl-Meyer Assessment (FMA) for hemiplegic patients. Journal of Physical Therapy Science, 24(9), 893-899. https://doi.org/10.1589/jpts.24.893
  22. G. Verheyden, A. Nieuwboer, A. Van de Winckel & W. De Weerdt. (2007). Clinical tools to measure trunk performance after stroke: a systematic review of the literature. Clinical rehabilitation, 21(5), 387-394. https://doi.org/10.1177/0269215507074055
  23. Y. R. Yang, Y. H. Chen, H. C. Chang, R. C. Chan, S. H. Wei & R. Y. Wang. (2015). Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study. Clinical rehabilitation, 29(10), 987-993. https://doi.org/10.1177/0269215514564898
  24. G. I. Yatar & S. A. Yildirim. (2015). Wii Fit balance training or progressive balance training in patients with chronic stroke: a randomised controlled trial. Journal of Physical Therapy Science, 27(4), 1145-1151. https://doi.org/10.1589/jpts.27.1145
  25. A. L. Betker, A. Desai, C. Nett., N. Kapadia & T. Szturm. (2007). Game-based exercises for dynamic short-sitting balance rehabilitation of people with chronic spinal cord and traumatic brain injuries. Physical therapy, 87(10), 1389-1398. https://doi.org/10.2522/ptj.20060229
  26. G. S. Sim. & H. S. Jeon. (2017). Comparison of the Effects of Wii Balance Games and Mirror Self-Balancing Exercises on Knee Joint Proprioception and Balance in Chronic Stroke Patients. Physical Therapy Korea, 24(1), 30-40. https://doi.org/10.12674/ptk.2016.24.1.030
  27. G. Saposnik, R. Teasell, M. Mamdani, J. Hall, W. McIlroy, D. Cheung & M. Bayley. (2010). Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle. Stroke, 41(7), 1477-1484. https://doi.org/10.1161/STROKEAHA.110.584979
  28. T. Ikai, T. Kamikubo, I. Takehara, M. Nishi & S. Miyano. (2003). Dynamic postural control in patients with hemiparesis. American journal of physical medicine & rehabilitation, 82(6), 463-469. https://doi.org/10.1097/01.PHM.0000069192.32183.A7
  29. S. H. You, S. H. Jang, Y. H. Kim, M. Hallett, S. H. Ahn, Y. H. Kwon & M. Y. Lee. (2005). Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: an experimenter-blind randomized study. Stroke, 36(6), 1166-1171. https://doi.org/10.1161/01.STR.0000162715.43417.91
  30. G. J. Lehman, T. Gordon, J. Langley, P. Pemrose & S. Tregaskis. (2005). Replacing a Swiss ball for an exercise bench causes variable changes in trunk muscle activity during upper limb strength exercises. Dynamic Medicine, 4(1), 6. https://doi.org/10.1186/1476-5918-4-6
  31. S. H. Yu & S. D. Park. (2013). The effects of core stability strength exercise on muscle activity and trunk impairment scale in stroke patients. Journal of exercise rehabilitation, 9(3), 362. https://doi.org/10.12965/jer.130042
  32. G. B. Song & E. C. Park. (2016). Comparison of the Effects of Task-oriented training and Virtual reality training on upper extremity function, balance ability, and depression in stroke patients. Journal Korean Society of Physical Medicine, 11(1), 115-125. https://doi.org/10.13066/kspm.2016.11.1.115