The Effects of Changing the Respiratory Muscles and Acoustic Parameters on the Children With Spastic Cerebral Palsy

체간 조절을 통한 앉기 자세 교정이 경직형 뇌성마비 아동들의 호흡근과 음향학적 측정치들의 변화에 미치는 효과

  • Kim, Sun-Hee (Dept. of Rehabilitation Science, Graduate School, Daegu University) ;
  • Ahn, Jong-Bok (Dept. of Speech Language Pathology & Audiology, Kaya University) ;
  • Seo, Hye-Jung (Dept. of Rehabilitation Therapy, Bobath Children's Hospital) ;
  • Kwon, Do-Ha (Dept. of Speech Language Pathology, Daegu University)
  • 김선희 (대구대학교 일반대학원 재활과학과) ;
  • 안종복 (가야대학교 언어치료청각학과) ;
  • 서혜정 (보바스 어린이 병원 재활치료실) ;
  • 권도하 (대구대학교 언어치료학과)
  • Received : 2009.04.01
  • Accepted : 2009.05.01
  • Published : 2009.05.21

Abstract

The purpose of this study was to investigate the effects postural changes on respiratory muscles and acoustic parameters of the children with spastic cerebral palsy. Nine children with spastic cerebral palsy who required assistance when walking were selected. The ages of the children ranged from 6 to 9 years old. The phonation of the sustained vowel /a/ and the voice qualities of each child such as fundamental frequency($F_0$; Hz), pitch variation (Jitter; %), amplitude variation (Shimmer; %) and noise to harmonic ratio (NHR) were analyzed by Multi-Dimensional Voice Program (MDVP). The muscle activity of three major respiratory muscles: pectoralis major muscle, upper trapezius muscle and rectus abdorminalis muscle, were measured by examining the root mean square (RMS) of the surface EMG to investigate the impact of changes in the adjusted sitting posture of each subject. However, the RMS of pectoralis major muscle showed a significant differences (p<.05). Secondly, there were no significant differences in $F_0$, Jitter and Shimmer between pre and post posture change, but there was a significant difference in NHR (p<.05). The data were collected in each individual; once prior and once after the sitting posture change. The data were analyzed by Wilcoxon signed ranks-test using SPSS version 14.0 for Windows. The findings of this study were as follows; Firstly, the RMS of upper trapezius and rectus abdorminalis muscle were not significant different between pre and post sitting posture changes. From the result, it is concluded that changes in the adjusted sitting posture decreases the abnormal respiratory patterns in the children with spastic cerebral palsy which is characterized by the hyperactivity of the respiratory muscles in breathing. Also, there is increased on the voice qualities in children with spastic cerebral palsy.

Keywords

References

  1. 고도훙, 정옥란 등. 음성 및 언어 분석기기 활용법; MDVP의 실제와 활용. 서울, 한국문화사, 2001.
  2. 김선희. 체간과 머리 자세 조정을 이용한 호흡 및 조음기관 훈련 프로그램이 뇌성마비 아동의 구어 기초능력 향상에 미치는 효과. 대구대학교 재활과학대학원, 석사학위논문, 2000.
  3. 김선희, 안종복, 권도하. 경직형 뇌성마비 아동들의 섭식 기능과 조음정확도 간의 상관연구. 언어치료연구. 2008;17(4):1-16.
  4. 김숙희, 김현기, 신용일. 음향학적 분석을 통한 뇌성마비 아동의 호흡 및 구강 운동 전.후 치료 효과. 음성과학. 2008;15(2):131-141.
  5. 김혜경, 권도하. 호흡근 강화 훈련 프로그램이 경직형 뇌성마비 아동의 구어산출에 미치는 효과. 언어치료연구. 2005;14(2):89-109.
  6. 박래준, 주정열, 오정림. 발성장애가 있는 경직형 뇌성마비아동의 자세조절 호흡운동이 폐활량과 호흡근 근전도 변화에 미치는 영향. 언어치료연구. 2005;14(2):205-216.
  7. 유재연. 자세조정이 뇌성마비 학생의 조음 개선에 미치는 효과. 대구대학교 대학원, 석사학위논문, 1999.
  8. 장수정. 경직형 뇌성마비아동의 씹기 운동기능과 무의미 일음절어 명료도의 상관관계. 이화여자대학교대학원, 석사학위논문, 2005.
  9. 전병운, 서정은. 호흡 및 구강운동훈련이 경직형 뇌성마비아동의 자음정확도와 발성 호기 시간에 미치는 효과. 한국지체부자유아교육학회지. 2007;49:135-160.
  10. 조명숙. 체간과 머리자세조정이 경직형 뇌성마비 아동의 최대발성지속시간에 미치는 효과. 단국대학교 특수교육대학원, 석사학위논문, 2006.
  11. 홍정선, 이해덕. 뇌성마비아 호흡의 문제점과 치료. 한국보바스학회지. 1997;2(2):126-137.
  12. Wilson Arboleda BM., Frederick AL. Considerations for maintenance of postural alignment for voice production. J Voice. 2008:2(1):90-99.
  13. Bobath Centre. Course Note. London. The Bobath Centre, 1993.
  14. de Mayo T, Mirulles R, Barren) D. et al. Breathing type and body position effects on sternocleidomastoid and suprahyoid EMG activity. J Oral Rehabil. 2005;32(7):487-494. https://doi.org/10.1111/j.1365-2842.2005.01453.x
  15. Ferrand CT. 언어임상을 위한 음성과학(한글판). 한지연, 최양규 역. 서울, 시그마프레스, 2007.
  16. Gisel EG., Alphonce E. Ramsay M. Assessment of ingestive and oral praxis skills: Children with cerebral palsy vs. controls. Dysphagia. 2000;15(4):236-244. https://doi.org/10.1007/s004550000033
  17. Hardy JC. Cerebral Palsy. Upper Saddle River, NJ: Prentice-Hall. 1983.
  18. Joseph K, Richardson CA, Pamianpour M, et al. EMG activity of trunk muscles and torque output during isometric axial rotation exertion: a comparison between back pain patients and matched controls. J Orthopaedic Research. 2002;20(1):112-121. https://doi.org/10.1016/S0736-0266(01)00067-5
  19. Kent RD. Ball MJ. Voice quality measurement San Diego, Singular Publishing Group, Inc., 2000.
  20. Neumann DA. 근골격계의 기능해부 및 운동학(한국판). 김경, 김기열 등 역, 서울, 정담미디어, 2002.
  21. Kera T, Maruyama H. The Effect of posture on res-piratory activity of abdominal muscles. J Physiol Anthropol Appl Human Sci. 2005;24(4):259-265. https://doi.org/10.2114/jpa.24.259