• The Journal of Korean Physical Therapy
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• 제15권3호
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• pp.202-222
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• 2003

Chronic upper extremity hemiparesis is a leading cause of functional disability after stroke. The purpose of this study were to identify effects of a 6weeks repetitive bilateral arm training on upper motor function and the reorganization of motor network. Four chronic stroke patients participated in this study. They performed for 6 consecutive weeks, 3 days a week, 30 minutes a day. In the single group study, four 5-minute periods per session of bilateral arm training were performed with the use of a custom-designed arm training machine. The results of this study was as follows. 1. Following the 6weeks period of RBAT, patient exhibited a improvement in FMA and BBT. 2. Following the 6weeks period of RBAT, it showed improvement in reaching time, symbol digit substitution and finger tapping speed of KCNT. 3. fMRI activation after RBAT showed a focal map in lesional cortical area and perilesional motor areas. These fMRI data suggest that hemodynamics response to RBAT reflect sensorimotor reorganization in contralateral hemisphere. In conclusion, these date suggest that improved upper extremity function induced by repetitive bilateral arm training after stroke is associated with reorganization of motor network as a neural basis for the improvement of paratic upper extremity function.

• The Journal of Korean Physical Therapy
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• 제27권3호
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• pp.135-139
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• 2015

Purpose: The aim of this study was to compare EEG topographical maps in patients with chronic stroke after action observation physical training. Methods: Ten subjects were recruited from a medical hospital. Participants observed the action of transferring a small block from one box to another for 6 sessions of 1 minute each, and then performed the observed action for 3 minutes, 6 times. An EEG-based brain mapping system with 32 scalp sites was used to determine cortical reorganization in the regions of interest (ROIs) during observation of movement. The EEG-based brain mapping was comparison in within-group before and after training. ROIs included the primary sensorimotor cortex, premotor cortex, superior parietal lobule, inferior parietal lobule, superior temporal lobe, and visual cortex. EEG data were analyzed with an average log ratio in order to control the variability of the absolute mu power. The mu power log ratio was in within-group comparison with paired t-tests. Results: Participants showed activation prior to the intervention in all of the cerebral cortex, whereas the inferior frontal gyrus, superior frontal gyrus, precentral gyrus, and inferior parietal cortex were selectively activated after the training. There were no differences in mu power between each session. Conclusion: These findings suggest that action observation physical training contributes to attaining brain reorganization and improving brain functionality, as part of rehabilitation and intervention programs.

• 대한물리치료과학회지
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• 제18권1호
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• pp.79-84
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• 2011

Background: The purpose of this study was to investigate differences in balancing ability and weight bearing between paretic and non-paretic. Methods: Subjects of the study were consisted of 30 acute hemiplegia patients(paretic 15, non-paretic 15) who were receiving rehabilitation therapy in hospital. Weight shifting was quantitatively evaluated to determine the ability of patients to and during conscious weight shifting on the Gaitview. Independent t-test was utilized to detect the mean difference between the groups. Results: 15 patients with stroke were able to shift more weight onto the paretic leg. And pressure ratio of right hemiplegia was significantly difference on the nonparetic leg, pressure ratio of left hemiplegia was significantly difference onto the paretic leg. Conclusions: Patients with left hemiplegia who was cortical lesions in the right hemisphere were able to shift more body weight onto their paretic leg. These patients should be encouraged to practice shifting their weight towards their non-paretic leg to improve their balance.

• 재활치료과학
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• 제5권2호
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• pp.11-22
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• 2016

목적: 본 연구는 국외 뇌졸중 환자에게 적용한 한 말초감각신경자극의 효과에 대하여 고찰하기 위한 것으로 국외 학술지를 대상으로 체계적 문헌고찰 연구방법을 시행하였다. 연구방법: 2015년 10월 이전까지 국외 학술지에 게재된 논문을 Pubmed를 통하여 검색하였다. 주요 검색 용어로는 'peripheral nerve stimulation', 'electrical stimulation', 'sensory stimulation', 'somatosensory stimulation', 'stroke', 'hemiplegia', 'hemiparesis' 와 'hand', 'arm', 'upper limb'를 사용하였다. 최초 검색된 논문은 501편이었으나 선정 및 배제기준을 거쳐 10편의 연구가 선정되었다. 결과: 임상적으로 널리 사용되고 있는 말초감각신경자극은 뇌졸중 환자들에게 적용이 될 때에 보다 다양한 중재방법으로 연구에 적용이 되고 있었다. 말초감각신경자극치료는 뇌졸중 환자의 상지 기능에 효과를 나타냈으며, 대뇌피질의 활성화에도 긍정적인 영향을 나타냈다. 결론: 본 연구는 말초감각신경자극치료의 적용에 대한 근거를 제시하며, 향후 국내연구에서는 다양한 중재방법을 적용하여 말초감각신경자극의 효과를 더 정확하게 측정을 할 수 있는 방법에 대한 연구가 필요하다.

• Physical Therapy Rehabilitation Science
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• 제9권4호
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• pp.318-323
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• 2020

Objective: Reacquisition of motor functions following stroke depends on interhemispheric neural connections. The intervention highlighted in the present case is an insight for augmenting motor recovery by stimulating the lesioned area and adjacent areas governing the motor behaviour of an individual. The purpose of this study was to determine the changes in the motor and cognitive outcomes through multi target stimulation of cortical areas by application of multichannel transcranial direct current stimulation (M-tDCS) in a stroke survivor. Design: A case report. Methods: The patient was a participant of a trial registered with the clinical trial registry of India (CTRI/2020/01/022998). The patient was intervened with M-tDCS over the left primary motor cortex i.e. C3 point and left dorsolateral prefrontal cortex i.e. F3 point with 0.5-2 mA intensity for the period of 20 minutes. SaeboFlex-assisted task-oriented training, functional electrical stimulation over the lower extremity (LE) to elicit dorsiflexion at the ankle and eversion of the foot, and conventional physiotherapy rehabilitation including a tailored exercise program were performed. Outcome assessment was done using the Fugl-Meyer assessment scale (FMA) for the upper and lower extremity (UE and LE), Montreal Cognitive Assessment (MOCA), Wisconsin Gait Scale (WGS) and the Stroke Specific Quality of Life (SSQOL) measures. Assessment was taken at Day 0, 15 and 30 post intervention. Results: Improvement was observed in all the outcome measures i.e FMA (UE and LE), MOCA, SSQOL and WGS across the span of 4 weeks. Conclusions: M-tDCS induced improvement in motor functions of the UE and LE, gait parameters and cognitive functions of the patient.

• The Korean Journal of Pain
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• 제36권4호
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• pp.408-424
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• 2023

Central post-stroke pain (CPSP) is an incapacitating disorder that impacts a substantial proportion of stroke survivors and can diminish their quality of life. Conventional therapies for CPSP, including tricyclic antidepressants, anticonvulsants, and opioids, are frequently ineffective, necessitating the investigation of alternative therapeutic strategies. Repetitive transcranial magnetic stimulation (rTMS) is now recognized as a promising noninvasive pain management method for CPSP. rTMS modulates neural activity through the administration of magnetic pulses to specific cortical regions. Trials analyzing the effects of rTMS on CPSP have generated various outcomes, but the evidence suggests possible analgesic benefits. In CPSP and other neuropathic pain conditions, high-frequency rTMS targeting the primary motor cortex (M1) with figure-eight coils has demonstrated significant pain alleviation. Due to its associaton with analgesic benefits, M1 is the most frequently targeted area. The duration and frequency of rTMS sessions, as well as the stimulation intensity, have been studied in an effort to optimize treatment outcomes. The short-term pain relief effects of rTMS have been observed, but the long-term effects (> 3 months) require further investigation. Aspects such as stimulation frequency, location, and treatment period can influence the efficacy of rTMS and ought to be considered while planning the procedure. Standardized guidelines for using rTMS in CPSP would optimize therapy protocols and improve patient outcomes. This review article provides an up-to-date overview of the incidence, clinical characteristics, outcome of rTMS in CPSP patients, and future perspective in the field.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.419-422
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• 2014

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset headache with focal neurologic deficit and prolonged but reversible multifocal narrowing of the distal cerebral arteries. Stroke, either hemorrhagic or ischemic, is a relatively frequent presentation in RCVS, but progressive manifestations of subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction in a patient is seldom described. We report a rare case of a 56-year-old woman with reversible cerebral vasoconstriction syndrome consecutively presenting as cortical subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction. When she complained of severe headache with subtle cortical subarachnoid hemorrhage, her angiography was non-specific. But, computed tomographic angiography showed typical angiographic features of this syndrome after four days. Day 12, she suffered mental deterioration and hemiplegia due to contralateral intracerebral hematoma, and she was surgically treated. For recurrent attacks of headache, medical management with calcium channel blockers has been instituted. Normalized angiographic features were documented after 8 weeks. Reversible cerebral vasoconstriction syndrome should be considered as differential diagnosis of non-aneurysmal subarachnoid hemorrhage, and repeated angiography is recommended for the diagnosis of this under-recognized syndrome.

• The Journal of Korean Physical Therapy
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• 제17권3호
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• pp.421-428
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• 2005

The tenn 'Brain plasticity' has been identified that our central nervous system is continuously being adapted and modulated according to environmental needs and demands, and has been used to encompass the multifarious mechanisms related to learning, development, and recovery from damage to the nervous system. The purpose of this study was to demonstrate cortical reorganization in a 26-year-old right-handed hemiparetic patient with traumatic primary motor cortex (M1) injury, using functional MRI (fMRI). The unaffected (left) primary sensori-motor cortex centered on the precentral knob was activated during unaffected (right) hand movements. However, the medial area of the injured M1 was activated during affected (left) hand movements. It seems that the motor function of the affected hand in this patient was reorganized into the medial area of the injured precentral knob. These investigations provide a great useful information and clinical evidences with the specialized clinician in stroke physical therapy about patient's prognosis and therapeutic guidelines.

• 재활치료과학
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• 제7권2호
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• pp.9-16
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• 2018

목적 : 본 연구의 목적은 뇌손상 환자의 신경학적 변화 측정도구인 뇌전도의 측정도구 및 방법, 평가와 분석방법을 알아봄으로써 임상영역에서 뇌전도 측정 시 기초자료를 제시하는 것에 있다. 연구방법 : 전자 데이터 베이스인 Pubmed, Science Direct를 사용하였으며, 주요검색 용어로 'Electroencephalography', 'stroke', 'intervention OR training'을 사용하였다. 결과 : 뇌전도는 두뇌-컴퓨터 인터페이스(Brain-computer interface)를 이용하여 재활의 효과를 뇌의 활성화 상태 변화로 측정할 수 있는 도구로 기능적 뇌 재조직화 매커니즘을 확인할 수 있는 것으로 나타났다. 뇌전도 측정도구의 경우 다양한 채널, 전극의 형태 및 전극 부착 부위로 구성되어 있으며, 결과해석에 사용되는 주파수 또한 다양하게 나타났다. 결론 : 뇌전도는 중재에 대한 효과성을 신경학적으로 확인할 수 있을 뿐만 아니라 효율적인 작업치료를 위한 중재전략을 마련하는데 사용될 수 있을 것으로 사료된다.

• The Korean Journal of Physiology and Pharmacology
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• 제21권1호
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• pp.55-64
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• 2017

Progressive memory impairment such as that associated with depression, stroke, and Alzheimer's disease (AD) can interfere with daily life. In particular, AD, which is a progressive neurodegenerative disorder, prominently features a memory and learning impairment that is related to changes in acetylcholine and abnormal ${\beta}$-amyloid ($A{\beta}$) deposition in the brain. In the present study, we investigated the effects of dehydroevodiamine HCl (DHED) on cognitive improvement and the related mechanism in memory-impaired rat models, namely, a scopolamine-induced amnesia model and a $A{\beta}_{1-42}$-infused model. The cognitive effects of DHED were measured using a water maze test and a passive avoidance test in the memory-impaired rat models. The results demonstrate that DHED (10 mg/kg, p.o.) and Donepezil (1 mg/kg, p.o.) ameliorated the spatial memory impairment in the scopolamine-induced amnestic rats. Moreover, DHED significantly improved learning and memory in the $A{\beta}_{1-42}$-infused rat model. Furthermore, the mechanism of these behavioral effects of DHED was investigated using a cell viability assay, reactive oxygen species (ROS) measurement, and intracellular calcium measurement in primary cortical neurons. DHED reduced neurotoxicity and the production of $A{\beta}$-induced ROS in primary cortical neurons. In addition, similar to the effect of MK801, DHED decreased intracellular calcium levels in primary cortical neurons. Our results suggest that DHED has strong protective effects against cognitive impairments through its antioxidant activity and inhibition of neurotoxicity and intracellular calcium. Thus, DHED may be an important therapeutic agent for memory-impaired symptoms.