• 한국콘텐츠학회논문지
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• 제20권6호
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• pp.114-123
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• 2020

본 연구는 뇌졸중 환자에게 하지 근력강화 프로그램이 균형, 보행 및 상지 기능에 미치는 효과에 대해서 알아보았다. 신경계 손상 환자가 있는 병원을 기반으로 해서 하지 근력 강화에 대한 연구 방법을 만들어서 진행하였고, 무작위대조시험을 적용하였다. 24명의 뇌졸중 환자를 두 군으로 분류하였다. 하지 근력 강화 프로그램그룹 (Lower extremity strengthening program group, LESPG) (12명)과 트레드밀 훈련그룹 (Treadmill trainig group, TTG) (12명)으로 실험하였다. LESPG는 마비측에 하지 근력 강화프로그램을 수행하였다. TTG는 하루 30분 동안 트레드밀 운동을 적용하였다. 평가 도구는 일어나서 보행 검사(Timed Up and Go test, TUG), 기능적 보행평가 (Functional Gait Assessment, FGA) 및 뇌졸중 상지 기능검사(Manual Function Test, MFT)를 적용하였다. 균형, 보행 및 상지 기능에 대한 두 군 간의 TUG, FGA 및 MFT 점수는 LESPG가 TTG보다 유의한 차이가 있었다(p<.01). 4주간의 하지 근력강화 프로그램의 효과는 뇌졸중 후 편마비 환자의 균형, 보행 및 상지 기능에 효과가 있었다.

• 대한한방내과학회지
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• 제38권2호
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• pp.118-124
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• 2017

Objective: This study describes the case of a patient with a left basal ganglia (BG) infarct who had made almost a complete recovery upon discharge from the hospital in 2014 but who was re-admitted after 31 months with a worsened hemiplegic gait. Methods: The patient had undergone no rehabilitation treatment in the 31 months since his discharge. When the patient was re-admitted to our hospital in 2017, stance and gait data were collected on the patient using a treadmill gait analysis system. In addition, the patient underwent a manual muscle test (MMT) evaluation, and his Motricity index (MI) and modified Barthel index (MBI) scores were recorded. After rehabilitation for one month, the patient was reassessed, and the results were compared to those on the day of re-admission and those recorded in 2014. Results: Compared to the 2014 evaluation results, the patient's stance parameters and gait parameters had worsened at re-admission. However, there was no significant change in the patient's MMT grade or MI and MBI scores in comparison to the results of the 2014 evaluation. After one month of rehabilitation, the patient was re-evaluated again, but there was no significant change in comparison to the evaluation results at re-admission. Conclusion: Some of the stroke patients who have passed six months since the onset of their stroke may require ongoing rehabilitation although the functions of them is almost recovered. Because there is a possibility that recovered functions get worse again without any rehabilitation for a long time. And once the recovered functions get worse, re-recovery of them is not easy.

• 대한물리의학회지
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• 제12권3호
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• pp.99-104
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• 2017

PURPOSE: Gait disturbances in patients with hemiplegic stroke involve asymmetry of stance time. Step box training is used to supplement the limitations of stair walking training and increasing the torque value of the paralyzed lower leg's strength. This study aimed to investigate whether step-up training on unstable support could change walking ability in patients with chronic stroke. METHODS: Thirty stroke patients were randomly assigned to the step-up training group (experimental group), that performed training on an unstable surface, and the control group, that performed training on a stable surface. Walking speed, step length, and cadence were measured before and after training. Paired t-tests were used to compare pre- and post-intervention data, while the independent samples t-test was used to determine intergroup differences. Values of p < .05 were considered statistically significant. RESULTS: There was a significant difference in walking ability before versus after the intervention in both groups, although the experimental group showed greater differences than the control group (walking velocity by 8.1%; step length of the non-paralyzed side by 6.9%, respectively; p<.05). CONCLUSION: Step-up training might be more effective on an unstable surface than on a stable surface for increasing walking speed and step length of the non-paralyzed side.

• The Journal of Korean Physical Therapy
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• 제27권5호
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• pp.332-338
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• 2015

Purpose: The purpose of this study was to examine the effect of postural control and locomotion on improvement of two point discrimination (TPD), stereognosis (ST) through somatosensory training (SST) on the upper limb (UL). Methods: The subjects were 20 hemiplegia patients who have problems with unilateral neglect after stroke. The patients were divided into two groups, the experimental group (EG) and the control group (CG). In the EG, SST for TPD, ST was performed 18 times, three times a week for six weeks, together with physical therapy (PT) and occupational therapy (OT). In the CG conventional PT and OT without SST was performed for six weeks. Several assessment tools were used in comparison of groups; two point discrimination test (TPDT) on forearm (F), thenar (T), hypothenar (TH), thumb tip (TH-T), index finger tip (IN-T), stereognosis test (ST), postural assessment scale for stroke (PASS), and clinical test of sensory interaction on balance (CTSIB) and timed up and go test (TUG). Results: In the CG, conventional PT and OT resulted in statistically improved TPDT (F), ST, PASS, and TUG. In the EG, SST resulted in statistically improved TPDT (F, T, HT, TH-T, IN-T), ST, PASS, and TUG. TPDT-T, ST, and CTSIB with length of displacement with eye open (LDEO) also showed significant improvement between the groups. Conclusion: In both groups TPDT ST, PASS and TUG, and SST had effects on the UL and TPDT, ST and static postural control had greater effects compared with the PG. Therefore, we could assume that TPD and ST are very important in performing human activities including postural control and locomotion.

• 한국전문물리치료학회지
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• 제19권3호
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• pp.98-104
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• 2012

The aim of this study was to examine the effects of repeated passive movement (RPM) of different velocities on the improvement of knee joint position sense (JPS) in post-stroke patients with hemiplegia, thereby investigate the possibility of clinical application in the initial stage of rehabilitation for patients with post-stroke hemiplegia. Thirteen hemiplegic patients participated in this study. For the subjects' knee JPS tests, a passive angle reproduction test and an active angle reproduction test were performed prior to and after the intervention, which involved 30 repetitions of passive full-range-of-motion flexion and extension exercise of the knee joints at randomized degrees of $0^{\circ}/s$, $45^{\circ}/s$, and $90^{\circ}/s$. Paired t-test analysis was done in order to compare changes in the pre- and post-intervention knee JPS. One-way repeated analysis of variance was used in order to compare changes in JPS after intervention at three different movement velocities. The level of significance was set at .05. The result was that the subjects' post-intervention knee JPS significantly improved after the RPM exercise at a $45^{\circ}/s$ and a $90^{\circ}/s$ relative to the RPM exercise $0^{\circ}/s$ (p<.05). JPS changes with RPM intervention at the rapid velocity of $90^{\circ}/s$ were most increased, suggesting the most effective enhancement in knee JPS is with intervention at the velocity (p<.05). Therefore, RPM intervention at a half or higher velocity improved stroke patients' knee JPS. During the initial stage of rehabilitation for patients with post-stroke hemiplegia, the efficient application of the RPM exercise at a half or higher velocity will be possible.

• 한국전문물리치료학회지
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• 제18권3호
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• pp.8-15
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• 2011

Abdominal muscle plays a crucial role in postural control and respiration control. However, thickness of abdominal muscle in the paretic side of a hemiplegic patient has not been reported in previous studies. The purpose of this research was to compare lateral abdominal muscle thickness between the nonparetic and paretic side in patients with chronic stroke using rehabilitative ultrasound imaging. Twenty two patients with chronic stroke participated in this study. Absolute thickness of transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) was measured at the end of inspiration and expiration during quiet breathing, and relative thickness was calculated (thickness of each muscle as a percentage of total muscle thickness). Ultrasound imaging was recorded three times and the average value was determined for statistical analysis. Differences in absolute and relative lateral abdominal muscle thickness between the nonparetic and paretic side were assessed with paired t-tests. Absolute muscle thickness of the paretic side TrA was thinner than that of the nonparetic side at the end of inspiration and expiration during quiet breathing. Relative muscle thickness of the paretic side TrA was thinner than the paretic side only at the end of expiration during quiet breathing (p>.05). Therefore, it is necessary to strength TrA in patients with chronic stroke during physical therapy intervention. Further study is needed whether physical therapy intervension will induce TrA thickness in patients with chronic stroke in prospective study design.

• 대한통합의학회지
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• 제2권4호
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• pp.49-58
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• 2014

Purpose : The purpose of this study was to research the effects on resistance CKC & OCK exercise method on lower limb muscle activity, in chronic stroke patients. Method : In this study, 18 patients with stroke caused by hemorrhage or infarction were participated. resistance exercise method was conducted in tow different group : one is a close kinetic chain exercise(CKC) group and the other is an open kinetic chain exercise(OKC) group. CKC with physical therapy was applied to 9 patients, and OKC with physical therapy was applied to 9 patients. Under the researcher's guidance, exercise for CKC and OKC group carried out 3 times a week for 30 minutes during 4weeks. Result : There was significantly different for the vastus lateralis, tibialis anterior and gastrocnemius muscle activity within the intervention period both group. The vastus lateralis, tibialis anterior and gastrocnemius muscle activity was significantly increased within the CKC group. The vastus leteralis and tibialis anterior muscle activity was significantly increased within the OKC group. Conclusion : It was confirmed in this study that the CKC exercise was more effective than OKC exercise in improving lower limb muscle activity of chronic stroke patients. This study seggested that CKC may be suitable for individuals with a chronic stroke. furthermore study should be made a lot of researches regarding in other method and varying conditions for many hemiplegic patients.

• 대한물리의학회지
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• 제15권1호
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• pp.105-112
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• 2020

PURPOSE: This study examined the effects of Interactive Metronome training on the plantar pressure and fall efficacy in chronic stroke patients. METHODS: Twenty-two hemiplegic patients were allocated randomly to an experimental group and control group. The experimental group received conventional physical therapy and emphasized weight-bearing interactive metronome training, whereas the control group received conventional physical therapy. The training was performed three times per week, 40 minutes per each session, for a total of seven weeks. The plantar pressure was assessed using the contact area and contact pressure, whereas the fall efficacy was assessed using the FES (Fall Efficacy Scale), ABC (Activities-specific Balance Confidence scale) and FOFQ (Fear of Falling Questionnaire). RESULTS: After training, a significant increase was observed in the paretic side of the contact area and the paretic and non-paretic side of contact pressure in both groups (p<.05). The between-group differences in the changes before and after training were statistically significant in the paretic side of the contact pressure (p<.05). After training, both the FES of the between-group and ABC of the experimental group were increased significantly (p<.05), but the between-group differences in the changes before and after training were not statistically significant in the FES, ABC, and FOFQ (p>.05). CONCLUSION: Interactive Metronome training is considered an effective treatment for improving the contact pressure of the paretic side in chronic stroke patients.

• 한국산학기술학회논문지
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• 제12권8호
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• pp.3555-3562
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• 2011

본 연구는 이중과제 훈련이 만성 뇌졸중 환자의 자세안정성과 균형능력에 미치는 효과를 알아보고자 하였다. 실험을 위해 모집 된 이동 가능한 25명의 편마비 환자를 무작위화 하여 이중과제 훈련군 13명과 대조군 12명으로 나누었다. 두 그룹 모두 6주간 주 5회 일 30분의 일반적인 물리치료를 시행하였으며, 추가적으로 이중과제 훈련군은 6주간 주3회 일 50분의 이중과제 훈련을 실시하였다. 훈련 전후 체간손상척도, 자세조절능력과 눈을 뜨고 감은 상태에서의 자세동요를 측정하였다. 연구 결과 이중과제 훈련군에서 자세안정성과 균형능력이 유의하게 향상되는 것을 확인할 수 있었다(p<0.05). 본 연구의 결과를 통하여 이중과제 훈련이 만성뇌졸중 환자에게 효과적인 운동방법이 될 수 있을 것이라 생각한다.

• The Journal of Korean Physical Therapy
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• 제29권1호
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• pp.1-6
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• 2017

Purpose: This study aimed to demonstrate reduction in stroke symptoms by analyzing the changes in respiratory function and activities of daily living (ADL) after respiratory muscle strengthening exercise in patients who had a stroke and thereby, propose an efficient exercise method. Methods: Twenty patients with hemiplegic stroke were divided into two groups, with 10 patients in each. The control group (CG) received the traditional exercise therapy, and the experimental group (EG) received the traditional exercise therapy combined with expiratory muscle strengthening training. The training continued for 6 weeks, 5 days a week. Forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1) were measured with a spirometer, $SpO_2$ was measured with a pulse oximeter, and ADL were assessed by using the modified Barthel index (MBI). A paired t test was applied to compare the differences before and after the intervention, and an independent t test was used to compare the differences between the groups. The level of statistical significance was set as ${\alpha}=0.05$. Results: The changes in the FVC and FEV1 values within the group showed significant differences only in the EG (p<0.01). The between-group difference was statistically significant only for FVC and FEV1 in the EG (p<0.01). The changes in $SpO_2$ and MBI within the group showed significant differences only in the EG and CG (p<0.01). Between-group differences were statistically significant only for $SpO_2$ and MBI in the EG (p<0.05). Conclusion: The interventions with active patient involvement and combined breathing exercises had a positive impact on all the functions investigated in this study.