Therapeutic Science for Rehabilitation (재활치료과학)

Korean Society of Neurological Occupational Therapy (대한신경계작업치료학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of Task-Oriented Training With Functional Electrical Stimulation on Cervical Spinal Cord Injury Patients' Hand Function: A Single-Subject Experimental Design

기능적 전기 자극을 병행한 과제 지향적 훈련이 경수 손상 환자의 손 기능에 미치는 영향: 개별사례 연구

  • Ko, Seok-Beom (Dept. of Occupational Therapy, ROI Hospital) ;
  • Park, Hae Yean (Dept. of Occupational Therapy, College of Health Science, Yonsei University) ;
  • Kim, Jong-Bae (Dept. of Occupational Therapy, College of Health Science, Yonsei University) ;
  • Kim, Jung-Ran (Dept. of Occupational Therapy, College of Health Science, Yonsei University)
  • 고석범 (로이병원 작업치료실) ;
  • 박혜연 (연세대학교 보건과학대학 작업치료학과) ;
  • 김종배 (연세대학교 보건과학대학 작업치료학과) ;
  • 김정란 (연세대학교 보건과학대학 작업치료학과)
  • Received : 2018.01.03
  • Accepted : 2018.02.12
  • Published : 2018.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The purpose of this study was to investigate the effects of task-oriented training with functional electrical stimulation on hand function in incomplete cervical cord injury. Method : The subjects of the study were 3 adults diagnosed as incomplete cervical cord injury. The design of this study was ABA single-subject research design to compare dominant hand function of before and after intervention and detect individual effects. The experiment consisted of 30sessions, in which baseline process A1 and A2 were implemented 5 sessions each for 10sessions. Intervention B was implemented 20 sessions. The dependent variable was converted to the change of hand function every session, and Canadian Occupational Performance Measure (COPM), Jebsen-Taylor Hand Function Test(JTHFT), Wolf Motor Function Test(WMFT) were selected for outcome measurements. Result analysis was suggested through visual analysis using a graph and comparison of pre, post and follow-up intervention measurements. Results : As a result, the quality and quantity of dominant hand function increased during intervention B compared to the baseline A1 for all subjects. Baseline A2 was also maintained without training. Additionally, JTHFT, WMFT and COPM scores demonstrated improvement and maintain. The follow up JTHFT and WMFT showed increased required time on all subjects and decrease or maintain task performance and satisfaction in COPM. Conclusion : The task-oriented training with function electrical stimulation in this study has been positive effects on hand function and task performance and satisfaction.

목적 : 본 연구는 기능적 전기 자극을 병행한 과제 지향적 훈련이 불완전 경수 손상 환자의 손 기능에 미치는 영향을 알아보고자 하였다. 연구방법 : 대상자는 불완전 경수 손상 진단을 받은 성인 3명으로, ABA 설계를 사용하였으며, 연구기간 동안 기초선(A1) 5회기, 중재기(B) 20회기, 재기초선(A2) 5회기로 총 30회기 실시하였다. 중재기(B) 동안 기능적 전기 자극을 병행한 과제 지향적 훈련이 제공되었고, 모든 회기에는 손 기능을 평가하기 위해 상자와 나무토막 검사(Box and Block Test), 떨어지는 막대 잡기(Grip the falling bar)와 먹기 흉내 내기(Simulated feeding)를 측정하였으며, 기초선(A1) 전, 재기초선(A2) 후로 Canadian Occupational Performance Measure(COPM), Jebsen-Taylor Hand Function Test(JTHFT)와 Wolf Motor Function Test(WMFT)를 실시하여 중재 효과를 살펴보았다. 결과 : 모든 대상자는 상자와 나무토막 검사(Box and Block Test), 떨어지는 막대 잡기(Grip the falling bar)와 먹기 흉내 내기(Simulated feeding)를 통해 기초선(A1)보다 중재기(B)에서 우세 손 기능이 향상되었고, 재기초선(A2)에서 그 효과가 유지되었다. 재기초선(A2) 후 COPM, JTHFT와 WMFT의 결과, 우세 손 기능의 향상과 과제 수행도와 만족도의 향상을 보였다. 결론 : 기능적 전기 자극을 병행한 과제 지향적 훈련은 경수 손상 환자의 손 기능뿐만 아니라, 대상자가 선택한 훈련 과제의 과제 수행도와 만족도 향상에 효과적이다.

Keywords

References

  1. Beekhuizen, K. S., & Field-Fote, E. C. (2005). Massed practice versus massed practice with stimulation: Effects on upper extremity function and cortical plasticity in individuals with incomplete cervical spinal cord injury. Neurorehabilitation and Neural Repair, 19(1), 33-45. doi:10.1177/1545968305274517
  2. Carr, J. H., & Shepherd, R. B. (2003). Stroke rehabilitation: Guidelines for exercise and training to optimize motor skill. Tottenham, UK: Butterworth-Heinemann Medical. doi:http://dx.doi.org/10.1016/S1356-689X(03)00041-9
  3. Dobkin, B. H. (2009). Motor rehabilitation after stroke, traumatic brain, and spinal cord injury: common denominators within recent clinical trials. Current opinion in neurology, 22(6), 563. https://doi.org/10.1097/WCO.0b013e3283314b11
  4. Girgis, J., Merrett, D., Kirkland, S., Metz, G. A. S., Verge, V., & Fouad, K. (2007). Reaching training in rats with spinal cord injury promotes plasticity and task specific recovery. Brain, 130(11), 2993-3003. doi: http://doi.org.ssl.access.yonsei.ac.kr:8080/10.1093/brain/awm245
  5. Harvey, L. (2008). Management of spinal cord injuries: A guide for physiotherapists. London, UK: Elsevier Health Sciences.
  6. Hu, Y., Osu, R., Okada, M., Goodale, M. A., & Kawato, M. (2005). A model of the coupling between grip aperture and hand transport during human prehension. Experimental Brain Research, 167(2), 301-304. doi:10.1007/s00221-005-0111-1
  7. Jebsen, R. H., Taylor, N., Trieschmann, R. B., Trotter, M. J., Howard, L. A. (1969). An objective and standardized test of hand function. Archives of Physical Medicine and Rehabilitation, 50, 311-319.
  8. Kapadia, N. M., Zivanovic, V., Furlan, J., Craven, B. C., McGillivray, C., & Popovic, M. R. (2011). Functional electrical stimulation therapy for grasping in traumatic incomplete spinal cord injury: Randomized control trial. Artificial Organs, 35(3), 212-216. doi:10.1111/j.1525- 1594.2011.01216.x
  9. Law, M. C., Baptiste, S., Carswell, A., McColl, M. A., Polatajko, H., & Pollock, N. (1998). Canadian occupational performance measure. Ottawa: Canadian Association of Occupational Therapists.
  10. Lee, H. M., Yang, Y. A., Hur, J. G., & Kim, J. K. (2010). The effects of cervical spinal cord injury on patients activities of daily living and quality of life. The Journal of Korean Academy of Medicine & Therapy Science, 2(1), 87-95.
  11. Lim, P. A., & Tow, A. M. (2007). Recovery and regeneration after spinal cord injury: a review and summary of recent literature. Annals-Academy of Medicine Singapore, 36(1), 49.
  12. Lu, X., Battistuzzo, C. R., Zoghi, M., & Galea, M. P. (2015). Effects of training on upper limb function after cervical spinal cord injury: A systematic review. Clinical Rehabilitation, 29(1), 3-13. doi:10.1177/0269215514536411
  13. Lynskey, J. V., Belanger, A., & Jung, R. (2008). Activity-dependent plasticity in spinal cord injury. Journal of rehabilitation research and development, 45(2), 229. doi:10.1682/JRRD.2007.03.0047
  14. Martin, R., Johnston, K., & Sadowsky, C. (2012). Neuromuscular electrical stimulation-assisted grasp training and restoration of function in the tetraplegic hand: A case series. American Journal of Occupational Therapy, 66(4), 471-477. doi:10.5014/ajot.2012.003004
  15. Martin, R., Sadowsky, C., Obst, K., Meyer, B., & McDonald, J. (2012). Functional electrical stimulation in spinal cord injury: from theory to practice. Topics in spinal cord injury rehabilitation, 18(1), doi:28-33.10.1310/sci1801-28
  16. Mathiowetz, V., Volland, G., Kashman, N., & Weber, K. (1985). Adult norms for the Box and Block Test of manual dexterity. American Journal of Occupational Therapy, 39(6), 386-391. doi:10.5014/ajot.39.6.386
  17. Miller, R. C., Popovic, M. R., Thrasher, A. T., & Verrier, M. (2008). Functional electrical stimulation therapy improves grasping in chronic cervical spinal cord injury: Two case studies. Journal of Automatic Control, 18(2), 53-61. doi:10.2298/JAC0802053M
  18. Peckham, P. H., Marsolais, E. B., & Mortimer, J. T. (1980). Restoration of key grip and release in the C6 tetraplegic patient through functional electrical stimulation. The Journal of Hand Surgery, 5(5), 462-469. doi:https://doi.org/10.1016/S0363-5023(80)80076-1
  19. Pendleton, H. M., & Schultz-Krohn, W. (2013). The occupational therapy practice framework and the practice of occupational therapy for people with physical disabilities. In Pendleton, H. M., & Schultz-Krohn, W. (Eds.), Pedretti's occupational therapy: Practice skills for physical dysfunction (6th ed., pp. 2-13). London, UK: Elsevier Health Sciences.
  20. Popovic, M. R., Curt, A., Keller, T., & Dietz, V. (2001). Functional electrical stimulation for grasping and walking: indications and limitations. Spinal cord, 39(8), 403. doi:10.1038/sj.sc.3101191
  21. Rushton, D. N. (2003). Functional electrical stimulation and rehabilitation-an hypothesis. Medical Engineering & Physics, 25(1), 75-78. doi:http://doi.org/10.1016/S1350-4533(02)00040-1
  22. Sisto, S. A., Druin, E., & Sliwinski, M. M. (2008). Spinal cord injuries: management and rehabilitation. London, UK: Elsevier Health Sciences.
  23. Spooren, A. I. F., Janssen-Potten, Y. J. M., Kerckhofs, E., Bongers, H. M. H., & Seelen, H. A. M. (2011). ToCUEST: A task-oriented client-centered training module to improve upper extremity skilled performance in cervical spinal cord-injured persons. Spinal Cord, 49(10), 1042-1048. doi:10.1038/sc.2011.52
  24. Thrasher, T. A., Flett, H. M., & Popovic, M. R. (2006). Gait training regimen for incomplete spinal cord injury using functional electrical stimulation. Spinal Cord, 44(6), 357-361. doi:10.1038/sj.sc.3101864.
  25. Tong, R. K., Ng, M. F., & Li, L. S. (2006). Effectiveness of gait training using an electromechanical gait trainer, with and without functional electric stimulation, in subacute stroke: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 87(10), 1298-1304. doi:10.1016/j.apmr.2006.06.016
  26. Wolf, S. L., Catlin, P. A., Ellis, M., Archer, A. L., Morgan, B., & Piacentino, A. (2001). Assessing Wolf motor function test as outcome measure for research in patients after stroke. Stroke, 32(7), 1635-1639. doi: http://doi.org.ssl.access.yonsei.ac.kr:8080/10.1161/01.STR.32.7.1635.