DOI QR코드

DOI QR Code

경련성 감소를 위한 치료적 중재 연구

Therapeutic Intervention to Reduce Spasticity

  • 투고 : 2019.04.30
  • 심사 : 2019.05.16
  • 발행 : 2019.05.31

초록

본 연구에는 편마비가 있는 뇌졸중 환자의 환측 경직성 하지에 체외 충격파 치료를 적용하여 보행 중 무릎각도와 MAS, TUG에 미치는 영향을 알아보기 위해서 실시하였다. 본 연구는 재활 병원에서 뇌졸중으로 진단받은 후 병원에서 재활치료를 받는 환자 20명을 연구대상자로 선정하였다. 대조군(n=10)은 일반적인 물리치료인 고유 수용성 감각 신경근 촉진법을 받았으며, 실험군(n=10)은 고유 수용성 감각 신경근 촉진법(PNF) 치료 후 체외 충격파 치료(ESWT)를 손상측 하지에 적용하였다. 본 연구에서 보행을 분석하기 위해 통합운동분석장치(4D-MT, Relive, Korea)를 사용하였으며 환자의 동적균형 능력을 평가하기 위해 Timed up and go test를 실시하였고 경련성을 평가하기 위해서 MAS를 사용하였다. 본 연구의 결과에서 무릎관절의 각도는 모든 그룹이 그룹 내 비교에서 통계학적으로 유의한 차이가 있었으나(p<0.05) 그룹 간에는 통계학적으로 유의한 차이가 없었다(p>0.05). 본 연구의 결과에서 TUG는 모든 그룹이 그룹 내 비교에서 통계학적으로 유의한 차이가 있었으나(p<0.05) 그룹 간에는 통계학적으로 유의한 차이가 없었다(p>0.05). 본 연구의 결과를 바탕으로 보다 세분화된 연구가 진행되기를 바란다.

This study investigated the effect of extracorporeal shock wave therapy on the knee angle, MAS, and TUG of the affected side in patients with hemiplegic strokes. This study selected 20 patients who received rehabilitation treatment at a hospital after having been diagnosed with stroke. The control group (n=10) received the general physiotherapy (proprioceptive neuromuscular facilitation), and the experimental group (n=10) applied the extracorporeal shock wave therapy (ESWT) to the injured limb after PNF treatment. This study used an integrated kinematics analyzer (4D-MT, Relive, Korea) to analyze walking, timed up and go test to evaluate the dynamic balance ability of patients, and MAS to evaluate the spasticity. In the study results, knee angle were significantly different in all groups(p<0.05) but there was no significant difference between the groups(p>0.05). In the study results, TUG were significantly different in all groups(p<0.05) but there was no significant difference between the groups(p>0.05). Based on the results of this study, I hope that more detailed research will proceed.

키워드

참고문헌

  1. A. L. Hsu, P. F. Tang and M. H. Jan, Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke1, Archives of Physical Medicine and Rehabilitation. (2003), Vol.84, No.8, pp.1185-1193. https://doi.org/10.1016/S0003-9993(03)00030-3
  2. H. T. Sakellarides, M. A. Mital, R. A. Matza and P. Dimakopoulos, Classification and surgical treatment of the thumb-in-palm deformity in cerebral palsy and spastic paralysis, The Journal of Hand Surgery. (1995), Vol.20, No.3, pp.428-431. https://doi.org/10.1016/S0363-5023(05)80101-7
  3. F. Hummel, P. Celnik, P. Giraux and et al., Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke, Brain. (2005), Vol.128, No.3, pp.490-499. https://doi.org/10.1093/brain/awh369
  4. G. S. Griesbach, D. A. Hovda, R. Molteni, A. Wu and F. Gomez-Pinilla, Voluntary exercise following traumatic brain injury: brain-derived neurotrophic factor upregulation and recovery of function, Neuroscience. (2004), Vol.125, No.1, pp.129-139. https://doi.org/10.1016/j.neuroscience.2004.01.030
  5. S. W. Moon, J. H. Kim, M. J. Jung and et al., The effect of extracorporeal shock wave therapy on lower limb spasticity in subacute stroke patients, Annals of Rehabilitation Medicine. (2013), Vol.37, No.4, pp.461-470. https://doi.org/10.5535/arm.2013.37.4.461
  6. P. Langhorne, P. Fearon, O. M. Ronning and et al., Stroke unit care benefits patients with intracerebral hemorrhage: systematic review and meta-analysis, Stroke. (2013), Vol.44, No.11, pp.3044-3049. https://doi.org/10.1161/STROKEAHA.113.001564
  7. M. K. Sohn, K. H. Cho, Y. J. Kim and S. L. Hwang, Spasticity and Electrophysiologic Changes after Extracorporeal Shock Wave Therapy on Gastrocnemius, Annals of Rehabilitation Medicine. (2011), Vol.35, No.5, pp.599-604. https://doi.org/10.5535/arm.2011.35.5.599
  8. D. K. Sommerfeld, U. Gripenstedt and A. K. Welmer, Spasticity After Stroke: An Overview of Prevalence, Test Instruments, and Treatments, American Journal of Physical Medicine & Rehabilitation. (2012), Vol.91, No.9, pp.814-820. https://doi.org/10.1097/PHM.0b013e31825f13a3
  9. C. D. Tokuno and J. J. Eng, Gait initiation is dependent on the function of the paretic trailing limb in individuals with stroke, Gait & Posture. (2006), Vol.24, No.4, pp.424-428. https://doi.org/10.1016/j.gaitpost.2005.09.012
  10. R. Kitatani, K. Ohata, Y. Aga and et al., Descending neural drives to ankle muscles during gait and their relationships with clinical functions in patients after stroke, Clinical Neurophysiology. (2016), Vol.127, No.2, pp.1512-1520. https://doi.org/10.1016/j.clinph.2015.10.043
  11. C. L. Yen, R. Y. Wang, K. K. Liao, C. C. Huang and Y. R. Yang, Gait training induced change in corticomotor excitability in patients with chronic stroke, Neurorehabil Neural Repair. (2008), Vol.22, No.1, pp.22-30. https://doi.org/10.1177/1545968307301875
  12. A. Santamato, M. F. Micello, F. Panza and et al., Extracorporeal shock wave therapy for the treatment of poststroke plantar-flexor muscles spasticity: a prospective open-label study, Topics in Stroke Rehabilitation. (2014), Vol.21, No.Supplement-1, pp. S17-S24. https://doi.org/10.1310/tsr21S1-S17
  13. Y. W. Kim, W. H. Chang, N. Y. Kim and et al., Effect of extracorporeal shock wave therapy on hamstring tightness in healthy subjects: a pilot study, Yonsei Medical Journal. (2017), Vol.58, No.3, pp.644-649. https://doi.org/10.3349/ymj.2017.58.3.644
  14. S. Yamaya, H. Ozawa, H. Kanno and et al., Low-energy extracorporeal shock wave therapy promotes vascular endothelial growth factor expression and improves locomotor recovery after spinal cord injury", Journal of Neurosurgery, (2014), Vol.121, No.6, pp.1514-1525. https://doi.org/10.3171/2014.8.JNS132562
  15. B. Zorner, L. Filli, M. L. Starkey and et al., Profiling locomotor recovery: comprehensive quantification of impairments after CNS damage in rodents, Nature Methods. (2010), Vol.7, No.9, pp.701-708. https://doi.org/10.1038/nmeth.1484
  16. J. W. Lance, The control of muscle tone, reflexes, and movement: Robert Wartenbeg Lecture, Neurology. (1980), Vol.30, No.12, pp.1303-1303. https://doi.org/10.1212/WNL.30.12.1303