한국엔터테인먼트산업학회논문지 (Journal of Korea Entertainment Industry Association)

  • 제15권1호
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  • Pages.171-180
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  • 2021
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  • 1976-6211(pISSN)
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  • 2384-017X(eISSN)
한국엔터테인먼트산업학회 (The Korea Entertainment Industry Association)
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라이프케어 증진을 위한 동적탄력튜빙 보행훈련이 뇌졸중 환자의 균형에 미치는 영향

Effect of Dynamic Tubing Gait Training for Life-Care on Balance of Stroke Patients

  • 이선영 (씨티재활의학과 요양병원) ;
  • 이동률 (호남대학교 물리치료학과)
  • 투고 : 2020.12.16
  • 심사 : 2021.01.25
  • 발행 : 2021.01.31
⟨ 이전 논문 다음 논문 ⟩

초록

본 연구는 라이프케어 증진을 위한 동적탄력튜빙 보행훈련(Dynamic Tubing Gait, DTG II)이 만성 뇌졸중 환자의 균형에 미치는 영향을 알아보았다. 본 연구는 10명의 만성 뇌졸중 환자를 대상으로, DTG II 프로그램을 일일 30분씩 1회, 주 5회, 5주간 총 25회 실시하였다. 균형향상을 위한 DTG II 프로그램의 효과를 알아보기 위해 표면근전도(배바깥빗근, 척주세움근, 엉덩허리근, 큰볼기근), 골반 3축의 대칭지수 검사(경사, 대각선, 회전), 동적보행지수 검사(DGI)를 중재 전과 후에 시행하였다. 본 연구의 결과, 초기디딤기와 중간디딤기에서 큰 볼기근의 중재 전·후 비교에서 통계적으로 유의한 차이를 보였다(p<.05). 골반의 대칭지수(SI)는 대각선 SI와 회전 SI에서 중재 전·후 비교에서 통계적으로 유의한 차이를 보였다(p<.05). 동적보행지수(DGI)에서 중재 전·후 비교에서 통계적으로 유의한 차이를 보였다(p<.05). 본 연구결과를 통해 라이프케어 증진을 위한 DTG II 프로그램이 만성 뇌졸중 환자의 몸통근육의 근활성과 골반의 대각선 움직임과 회전 움직임의 대칭성을 향상시킴으로써 만성 뇌졸중 환자의 동적 균형 능력을 향상된 것을 알 수 있었다. 따라서 만성 뇌졸중 환자의 라이프케어 증진을 위한 균형능력 향상을 위해 동적탄력튜빙 보행훈련을 중재법의 하나로 권장한다.

The present study investigated the effects of dynamic tubing gait (DTG II) program on the balancing ability for the promotion of life care of patients with chronic stroke. In the study, 25 sessions of DTG II program (30 minutes per session, 5 sessions per week, for a total of 5 weeks) were applied to 10 patients with chronic stroke. To determine the effects of DTG II program for improving balance, surface electromyography(external oblique, erector spinae, iliopsoas, gluteus maximus), symmetry index test on three pelvic axes, and dynamic gait index test were performed before and after the intervention. The results showed statistically significant differences between preand post-intervention measurements of the gluteus maximus muscle at early and mid-stance phases(p<.05). The pelvic symmetry index differed significantly between pre- and post-intervention measurements of diagonal and rotational movement(p<.05). Comparison of dynamic gait index also showed statistically significant differences between pre- and post-intervention measurements(p<.05). Based on these findings, it was determined that the DTG II program was able to improve the balancing ability of patients with chronic stroke by activating their trunk muscles and improving the symmetry of diagonal pelvic movement and rotation. Therefore, DTG II program is recommended as an interventional method to improve life-care through improving the balancing ability of patients with chronic stroke.

키워드

참고문헌

  1. Nyberg, L., & Gustafson, Y.(1997). Fall prediction index for patients in stroke rehabilitation. Stroke, 28(4): 716-721. https://doi.org/10.1161/01.STR.28.4.716
  2. Borucki, S.J., Weaver, H.B., & Reding, M.R. (1993). Falls associated with stroke rehabilitation. Archives of Physical Medicine and Rehabilitation, 74(6): 670. https://doi.org/10.1016/0003-9993(93)90237-5
  3. Weerdesteijn, V.G.M., Niet, M.D., Van Duijnhoven, H.J., & Geurts, A.C.(2008). Falls in individuals with stroke.
  4. Geurts, A.C., de Haart, M., van Nes, I.J., & Duysens, J.(2005). A review of standing balance recovery from stroke. Gait & posture, 22(3): 267-281. https://doi.org/10.1016/j.gaitpost.2004.10.002
  5. 이동률(2020). 가상현실과 힘판을 통한 시각적 되먹임 트레드밀 보행훈련이 뇌졸중 환자의 보행능력과 삶의 질에 미치는 영향. 한국엔터테인먼트산업학회논문지, 14(3): 363-373.
  6. Gray, V.L., Ivanova, T.D., & Garland, S.J. (2012). Control of fast squatting movements after stroke. Clinical neurophysiology, 123(2): 344-350. https://doi.org/10.1016/j.clinph.2011.07.003
  7. Lamontagne, A., Richards, C.L., & Malouin, F.(2000). Coactivation during gait as an adaptive behavior after stroke. Journal of Electromyography and Kinesiology, 10(6): 407-415. https://doi.org/10.1016/S1050-6411(00)00028-6
  8. Pereira, L.M., Marcucci, F.C.I., de Oliveira Menacho, M., Garanhani, M.R., Lavado, E.L., & Cardoso, J.R.(2011). Electromyographic activity of selected trunk muscles in subjects with and without hemiparesis during therapeutic exercise. Journal of Electromyography and Kinesiology, 21(2): 327-332. https://doi.org/10.1016/j.jelekin.2010.10.003
  9. Mauritz, K.H.(2004). Gait training in hemiparetic stroke patients. European Journal of Physical and Rehabilitation Medicine, 40(3): 165.
  10. Vearrier, L.A., Langan, J., Shumway-Cook, A., & Woollacott, M.(2005). An intensive massed practice approach to retraining balance post-stroke. Gait & posture, 22(2): 154-163. https://doi.org/10.1016/j.gaitpost.2004.09.001
  11. Inman, V.T., & Eberhart, H.D.(1953). The major determinants in normal and pathological gait. JBJS, 35(3): 543-558. https://doi.org/10.2106/00004623-195335030-00003
  12. Chang, M., Slater, L.V., Corbett, R.O., Hart, J.M., & Hertel, J.(2017). Muscle activation patterns of the lumbo-pelvic-hip complex during walking gait before and after exercise. Gait & posture, 52: 15-21. https://doi.org/10.1016/j.gaitpost.2016.11.016
  13. Hesse, S., Reiter, F., Jahnke, M., Dawson, M., Sarkodie-Gyan, T., & Mauritz, K. H.(1997). Asymmetry of gait initiation in hemiparetic stroke subjects. Archives of physical medicine and rehabilitation, 78(7): 719-724. https://doi.org/10.1016/S0003-9993(97)90079-4
  14. 김병조(2006). 편마비환자의 정적 골반경사각에 따른 보행 비대칭율의 차이에 대한 연구. 대한물리치료학회지, 18(3): 1-7.
  15. Davies, P.M.(1990). Right in the middle: selective trunk activity in the treatment of adult hemiplegia. Springer Science & Business Media.
  16. Niam, S., Cheung, W., Sullivan, P.E., Kent, S., & Gu, X.(1999). Balance and physical impairments after stroke. Archives of physical medicine and rehabilitation, 80(10): 1227-1233. https://doi.org/10.1016/S0003-9993(99)90020-5
  17. Sackley, C.M.(1991). Falls, sway, and symmetry of weight-bearing after stroke. International disability studies, 13(1): 1-4. https://doi.org/10.3109/03790799109166267
  18. Woollacott, M., & Shumway-Cook, A.(2002). Attention and the control of posture and gait: a review of an emerging area of research. Gait & posture, 16(1): 1-14. https://doi.org/10.1016/S0966-6362(01)00156-4
  19. 손보영, 방요순(2014). 오타고 운동프로그램이 뇌졸중 환자의 신체기능과 낙상 효능감 및 두려움 정도에 미치는 영향. 한국엔터테인먼트산업학회논문지, 8(4): 187-197.
  20. 김민정, 조한규, 선우성, 김성원, 조홍준(1999). 양로원 노인에 있어서의 낙상의 발생률과 관련 요인. 보건연구정보센터, 3(4): 29-38.
  21. In, T., Jin, Y., Jung, K., & Cho, H.Y.(2017). Treadmill training with Thera-Band improves motor function, gait and balance in stroke patients. NeuroRehabilitation, 40(1): 109-114. https://doi.org/10.3233/NRE-161395
  22. Veneri, D.(2011). Combining the treatment modalities of body weight support treadmill training and Thera-Band: a case study of an individual with hemiparetic gait. Topics in stroke rehabilitation, 18(4): 402-416. https://doi.org/10.1310/tsr1804-402
  23. hyun Baek, K., & won Lim, H.(2019). Effect of Spiral Elastic Band on Gait Function in Patients with Chronic Stroke. The Journal of Korean Physical Therapy, 31(4): 169-175. https://doi.org/10.18857/jkpt.2019.31.4.169
  24. Son, S.M., Hwang, Y.T., Nam, S.H., & Kwon, Y.(2019). Motor Skill Learning on the Ipsi-Lateral Upper Extremity to the Damaged Hemisphere in Stroke Patients. The Journal of Korean Physical Therapy, 31(4): 212-215. https://doi.org/10.18857/jkpt.2019.31.4.212
  25. Noskin, O., Krakauer, J.W., Lazar, R.M., Festa, J.R., Handy, C., O'Brien, K.A., & Marshall, R.S.(2008). Ipsilateral motor dysfunction from unilateral stroke: implications for the functional neuroanatomy of hemiparesis. Journal of Neurology, Neurosurgery & Psychiatry, 79(4): 401-406. https://doi.org/10.1136/jnnp.2007.118463
  26. 이동률(2013). Effects of dynamic tubing gait training on knee joint neuromuscular control and kinematics during locomotion in children with cerebral palsy. 연세대학교 박사학위논문.
  27. Damiano, D.L., Kelly, L.E., & Vaughn, C.L.(1995). Effects of quadriceps femoris muscle strengthening on crouch gait in children with spastic diplegia. Physical therapy, 75(8): 658-667. https://doi.org/10.1093/ptj/75.8.658
  28. Lee, D.R., You, J.H., Lee, N.G., Oh, J.H., & Cha, Y.J.(2009). Comprehensive Hand Repetitive Intensive Strengthening Training (CHRIST)-induced morphological changes in muscle size and associated motor improvement in a child with cerebral palsy: an experimenter-blind study. NeuroRehabilitation, 24(2): 109-117. https://doi.org/10.3233/NRE-2009-0460
  29. Lee, D.R., You, S.H., Lee, N.G., Yoo, I.G., Jung, M.Y., & Han, B.S.(2010). Strength training-induced changes in muscle size and motor improvement in bilateral schizencephaly: an experimenter-blind case report with 3-month follow-up. Physical Therapy Korea, 17(4): 77-87.
  30. Friel, K.M., Heddings, A.A., & Nudo, R.J. (2000). Effects of postlesion experience on behavioral recovery and neurophysiologic reorganization after cortical injury in primates. Neurorehabilitation and neural repair, 14(3): 187-198. https://doi.org/10.1177/154596830001400304
  31. Lang, C.E., MacDonald, J.R., & Gnip, C.(2007). Counting repetitions: an observational study of outpatient therapy for people with hemiparesis post-stroke. Journal of Neurologic Physical Therapy, 31(1): 3-10. https://doi.org/10.1097/01.NPT.0000260568.31746.34
  32. Nudo, R.J., Wise, B.M., SiFuentes, F., & Milliken, G.W.(1996). Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct. Science, 272(5269): 1791-1794. https://doi.org/10.1126/science.272.5269.1791
  33. Liebenson, C.(2005). Sensory-motor training-an update. Journal of Bodywork and Movement Therapies, 9(2): 142-147. https://doi.org/10.1016/j.jbmt.2005.01.001
  34. Page, P.(2006). Sensorimotor training: A "global" approach for balance training. Journal of bodywork and movement therapies, 10(1): 77-84. https://doi.org/10.1016/j.jbmt.2005.04.006
  35. 이재웅, 구현모(2019). 만성 뇌졸중 환자의 비마비측 발바닥굽힘근 근피로가 보행 시 양측 하지 근육의 활성도에 미치는 영향. 대한물리의학회지, 14(3): 127-133. https://doi.org/10.13066/kspm.2019.14.3.127
  36. 이온, 정진욱(2016). Borg 10 단계 비율척도의 운동 강도 설명력에 관한 연구. 운동과학, 25(2): 92-99.
  37. Lee, J.J., & You, J.S. H.(2017). Effects of Novel Guidance Tubing Gait on Electromyographic Neuromuscular Imbalance and Joint Angular Kinematics During Locomotion in Hemiparetic Stroke Patients. Archives of Physical Medicine and Rehabilitation, 98(12): 2526-2532. https://doi.org/10.1016/j.apmr.2017.04.018
  38. Shin, Y.K., Lee, D.R., Kim, D.H., Lee, J.J., You, S.J.H., Yi, C.H., & Jeon, H.S.(2014). Effects of novel tubing gait on neuromuscular imbalance in cerebral palsy. NeuroRehabilitation, 35(3): 587-596. https://doi.org/10.3233/nre-141154
  39. Criswell, E.(2010). Cram's introduction to surface electromyography. Jones & Bartlett Publishers.
  40. Knutson, L.M., Soderberg, G.L., Ballantyne, B.T., & Clarke, W.R.(1994). A study of various normalization procedures for within day electromyographic data. Journal of electromyography and kinesiology, 4(1): 47-59. https://doi.org/10.1016/1050-6411(94)90026-4
  41. Viteckova, S., Horakova, H., Polakova, K., Krupicka, R., Ruzicka, E., & Brozova, H.(2020). Agreement between the GAITRite® System and the Wearable Sensor BTS G-Walk® for measurement of gait parameters in healthy adults and Parkinson's disease patients. PeerJ, 8: e8835. https://doi.org/10.7717/peerj.8835
  42. Lim, S.Y., & Lee, W.H.(2018). Effects of pelvic range of motion and lower limb muscle activation pattern on over-ground and treadmill walking at the identical speed in healthy adults. Journal of physical therapy science, 30(4): 619-624. https://doi.org/10.1589/jpts.30.619
  43. Jonsdottir, J., & Cattaneo, D.(2007). Reliability and validity of the dynamic gait index in persons with chronic stroke. Archives of physical medicine and rehabilitation, 88(11): 1410-1415. https://doi.org/10.1016/j.apmr.2007.08.109
  44. Whitney, S.L., Poole, J.L., & Cass, S.P.(1998). A review of balance instruments for older adults. American Journal of Occupational Therapy, 52(8): 666-671. https://doi.org/10.5014/ajot.52.8.666
  45. Falla, D., & Hodges, P.W.(2017). Individualized exercise interventions for spinal pain. Exercise and sport sciences reviews, 45(2): 105-115. https://doi.org/10.1249/jes.0000000000000103
  46. Mun, K.R., Guo, Z., & Yu, H.(2016). Restriction of pelvic lateral and rotational motions alters lower limb kinematics and muscle activation pattern during over-ground walking. Medical & biological engineering & computing, 54(11): 1621-1629. https://doi.org/10.1007/s11517-016-1450-8
  47. Kuo, A.D.(2007). The six determinants of gait and the inverted pendulum analogy: A dynamic walking perspective. Human movement science, 26(4): 617-656. https://doi.org/10.1016/j.humov.2007.04.003
  48. Chockalingam, N., Chatterley, F., Healy, A.C., Greenhalgh, A., & Branthwaite, H.R.(2012). Comparison of pelvic complex kinematics during treadmill and overground walking. Archives of physical medicine and rehabilitation, 93(12): 2302-2308. https://doi.org/10.1016/j.apmr.2011.10.022
  49. Lamoth, C.J., Daffertshofer, A., Meijer, O.G., & Beek, P.J.(2006). How do persons with chronic low back pain speed up and slow down?: Trunk-pelvis coordination and lumbar erector spinae activity during gait. Gait & Posture, 23(2): 230-239. https://doi.org/10.1016/j.gaitpost.2005.02.006
  50. Myers, T.W.(1996). The'anatomy trains'. Journal of Bodywork and Movement Therapies, 1(2): 91-101. https://doi.org/10.1016/S1360-8592(97)80010-1
  51. 홍성일, 방대혁, 신원섭(2014). 탄성밴드를 이용한 측방 보행 훈련이 뇌졸중 환자의 보행 및 균형에 미치는 영향. 대한물리치료학회지, 26(5): 372-378.
  52. Wong, M.S., Cheng, J.C., Lam, T.P., Ng, B.K., Sin, S.W., Lee-Shum, S.L., Chow, D.H. & Tam, S.Y.(2008). The effect of rigid versus flexible spinal orthosis on the clinical efficacy and acceptance of the patients with adolescent idiopathic scoliosis. Spine, 33(12): 1360-1365. https://doi.org/10.1097/BRS.0b013e31817329d9
  53. Duval, K., Luttin, K., & Lam, T.(2011). Neuromuscular strategies in the paretic leg during curved walking in individuals post-stroke. Journal of neurophysiology, 106(1): 280-290. https://doi.org/10.1152/jn.00657.2010
  54. Winstein, C.J.(1991). Knowledge of results and motor learning-implications for physical therapy. Physical therapy, 71(2): 140-149. https://doi.org/10.1093/ptj/71.2.140