• 국제물리치료학회지
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• 제10권3호
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• pp.1823-1829
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• 2019

Background: Stroke patients have leg muscle weakness and impaired balance resulting in compensatory changes. To restore balance in these patients, functional training using postural strategy is needed. Objective: To examine the effects of ankle and hip strategy training on the center of pressure (COP) movement and limits of stability (LOS) in standing posture in stroke patients. Design: The study was an assessor-blinded and randomized-controlled clinical trial. Methods: Thirty patients were randomly assigned to an ankle strategy training group and a ankle/ hip strategy training group. Patients in the ankle strategy training group underwent ankle strategy exercise for 30 min, and those in the ankle/ hip strategy training group underwent 15 min of ankle strategy exercise and 15 min of hip strategy exercise. Both groups underwent training thrice a week for four weeks. Forward, backward, paretic side, and non-paretic side COP movements and LOS were measured using BioRescue. Results: After the intervention, except for the backward area in the ankle strategy training group, the COP movement area and the LOS were significantly improved in both the groups. In addition, these improvements were significantly higher in ankle/ hip strategy training group than that in the ankle strategy training group. Conclusions: Ankle strategy training in addition to hip strategy training improves COP movement (forward-backward, paretic side area, and non-paretic side area) and LOS in stroke patients.

• 한국산학기술학회논문지
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• 제13권9호
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• pp.3991-3998
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• 2012

본 연구의 목적은 만성 뇌졸중 환자에서 발목관절 각도에 따른 근 수축이 내측 비복근의 근 구조에 미치는 영향에 대해 알아보고자 하였다. 연구대상은 MAS(modified Ashworth scale) 2등급인 만성 뇌졸중 환자 10명을 대상으로 하였다. 근육 두께, 우모각, 근섬유속 길이, 최대 수의적 등척성 수축력(MVIC) 측정은 초음파 영상 촬영장치와 동력계로 이완 시(resting)와 최대 수의적 등척성 수축 시를 측정하였다. 측정결과, 근육 두께는 마비측이 정상측에 비해 유의하게 얇은 것으로 나타났고(p<.001), 발목이 저측굴곡 될수록 얇아짐을 알 수 있었다. MVIC에서는 이완 시보다 근육 두께가 유의하게 얇아지는 것을 알 수 있었다(p<.001). 우모각은 마비측이 정상측에 비해 유의하게 작은 것으로 나타났고(p<.001), 발목이 저측굴곡 될수록 커짐을 알 수 있었다. MVIC에는 이완 시보다 우모각이 유의하게 커짐을 알 수 있었다(p<.001). 근섬유속 길이는 마비측이 정상측보다 유의하게 짧은 것으로 나타났고(p<.001), 발목이 저측굴곡 될수록 짧아짐을 알 수 있었다. MVIC에는 이완 시보다 근섬유속 길이가 유의하게 짧아지는 것을 알 수 있었다(p<.001). 본 연구를 통해 만성 뇌졸중 환자에서 발목 각도에 따른 근 수축이 내측 비복근의 근 구조에 영향을 미치는 것을 알 수 있었다. 따라서, 만성 뇌졸중 환자의 영상구조적 특성을 평가하는 것은 임상적 진단과 치료에 매우 유용한 자료라 생각된다.

• The Journal of Korean Physical Therapy
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• 제35권5호
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• pp.145-150
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• 2023

Purpose: This study examined the effects of ankle control training using neuromuscular electrical stimulation (NMES), leg muscle activation, and balance in stroke patients. Methods: Thirty-one stroke patients diagnosed with cerebral infarction and cerebral hemorrhage were selected for the study. The experimental group underwent ankle control training using NMES, while the control group applied NMES to the paretic tibialis anterior muscle for 30 minutes per session, five times a week for four weeks. The muscle activity changes were measured using surface electromyography, and balance parameters were evaluated using a functional reach test (FRT). Results: The intra-group comparison of the concentric muscle activity revealed improvements in the experimental group, including paretic tibialis anterior (TA) muscle (p<0.05), medial gastrocnemius muscle (MG) (p<0.01), and lateral gastrocnemius muscle (LG) (p<0.05), as well as MG (p<0.05), LG (p<0.05), soleus muscle (p<0.05) of the non-paretic side, and soleus muscle symmetry index (p<0.05). The intra-group comparison of the eccentric muscle activity showed improvements in the experimental group, including MG (p<0.01) and LG (p<0.01) of the paretic side, as well as MG (p<0.01), LG (p<0.01) of the non-paretic side, and LG symmetry index (p<0.01). The intra-group comparison of the functional reach test revealed significant differences in the test results in the experimental and control groups (p<0.05). Conclusion: Ankle control training using NMES had a positive effect on the changes in muscle activation and improved balance in patients with stroke.

• 한국전문물리치료학회지
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• 제4권1호
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• pp.39-47
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• 1997

The purpose of this investigation was to examine the influence of head and neck(HN) position in the transverse plane on the static production of elbow extension force in the involved(paretic) upper extremity of patients with hemiparesis. On this study, thirty patients who had experienced a cerebrovascular accident were matched with neurologically intact subjects. Force of static elbow extension was tested with a hand-held dynamometer, twice with the HN rotated toward the paretic side and twice with the HN rotated toward the non-paretic side. Elbow extension force differed significantly with the HN in the two position in patients with hemiparesis but not in normal persons(${\alpha}$=0.05). Results of this study support the conclusion that HN position in the transverse plane influences the production of static elbow extension force on the paretic side in patients with hemiparesis.

• 대한물리의학회지
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• 제7권1호
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• pp.87-94
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• 2012

Purpose : The purpose of this study was to examine the feasibility and efficiency of balance training program through an interactive video game regimen in people with chronic stroke. Methods : Thirty patients with chronic hemiparetic stroke were recruited. Participants were randomly assigned to either a control group (n=15) or an experimental group (n=15). The control group received the general physical therapy including of strengthening and balance exercise five times a week whereas the experimental group received a program of balance exercise with video game play based on virtual reality as well as the same typical physical therapy. The experimental group received 6 sessions for four weeks. Each session was given 5 minutes. An interactive computer game exercise regimen lasted 30 minutes without rest periods. Outcome measures for weight transfer to paretic side, non-paretic side and sit-squat-speed, sit-squat-length, sit-to-standspeed and sit-to-stand-area for the control group (n=15) and experimental group (n=15) before and after treatment were obtained by using the biorescure. Results: Outcomes demonstrated significant improvement in the experimental group compared with the control group in weight transfer to paretic side, non-paretic side and sit-squat-speed, sit-squat-length, sit-to-stand-speed. No significant training effect was showed in sit-to-stand-area between pretraining and post-training. Conclusion : An interactive computer game exercise based on task oriented approach for balance in chronic stroke were feasible. In other words, This regimen resulted in a greater improvement in dynamic balance for people with chronic stroke.

• 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.

• 대한의용생체공학회:의공학회지
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• 제45권2호
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• pp.66-74
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• 2024

This study analyzed the occurrence of abnormal muscle coactivations based on the assistance of upper limb weight during reaching task in stroke patients. Nine chronic stroke survivors with hemiplegia performed reaching tasks using a programmable haptic robot. Electromyography (EMG) coactivation levels in the upper limb muscles were analyzed using a linear model describing the activation levels of two muscles when the patient's upper limb weight was assisted at 0%, 25%, and 50%. As the upper limb weight assistance of the haptic robot decreased, the magnitude of the EMG signal in both the deltoid and biceps muscles increased simultaneously on both the paretic and non-paretic sides. However, no difference was found between the paretic and non-paretic sides when comparing the slope of the linear model describing the activation relationship between the deltoid and biceps. The aforementioned results suggest that in some stroke survivors, the deltoids, triceps, and biceps on the paretic side may not be abnormally coupled when supporting the upper limbs against gravity. Furthermore, these results suggest that the combination of haptic robots and EMG analysis might be utilized for evaluating abnormal coactivations in stroke patients.

• 한국전문물리치료학회지
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• 제9권2호
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• pp.157-168
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• 2002

The purpose of this study was to investigate the effect of proprioceptive neuromuscular facilitation (PNF) approach on the spasticity of affected side in patients with hemiplegia. Three subjects with hemiplegia participated in this study. In single-subject research design (a multiple baseline across individuals) was employed in this study. The intervention program including PNF to the unaffected side was introduced for 30 minutes each day during each intervention phase. Muscle tone of affected side was measured with Tone Assessment Scale, and active hip abduction distance of affected side was taken with the subject supine. And then the muscle tone and the hip abduction distance were measured again 30 minutes later following the intervention. The results showed that the PNF application had some beneficial effects on both muscle tone and active hip abduction. This result suggest that PNF application to non-paretic limb can be effective in reducing muscle tone and improving hip abduction range on paretic limb in persons with hemiplegia. However, further research is needed to prove the effect of PNF application on functional improvement.

• International Journal of Contents
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• 제16권1호
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• pp.57-64
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• 2020

We sought to compare upper extremity muscle activity between handwriting on paper and touchscreen with dominant and non-dominant hands in younger adults (age 23.90±1.12) and the elderly (age 75.55±5.76). Muscle activity (percent of maximum voluntary contraction) in the biceps brachii muscle, triceps brachii muscle, flexor carpi ulnaris muscle, and extensor carpi ulnaris muscle was measured using an electromyography device. As a result, our data indicate that muscle activity is lower in younger adults than the elderly. Besides, muscle activity is lower in the dominant versus non-dominant hand, and lower when writing using a touchscreen than on paper. These results can be used to support recommending touchscreens in the elderly. Also, they can be used as baseline data for comparing the performance of non-paretic side and paretic side in patients relative to the central nervous system.

• 한국전문물리치료학회지
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• 제24권3호
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• pp.10-20
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• 2017

Background: Patients with chronic stroke often shows decreased trunk muscle activity and trunk performance. To resolve these problems, many trunk stabilizing techniques including the abdominal drawing-in maneuver (ADIM) and the diaphragmatic breathing maneuver (DBM) are used to improve trunk muscle strength. Objects: To compare the effects of the ADIM and the DBM on abdominal muscle thickness, trunk control, and balance in patients with chronic stroke. Methods: This was a randomized controlled trial. Nineteen patients were randomly allocated to the ADIM ($n_1=10$) and DBM ($n_2=9$) groups. The ADIM and DBM techniques were performed three times per week for 4 weeks. The thicknesses of the transversus abdominis (TrA), internal oblique muscle, and external oblique muscles on the paretic and non-paretic sides, Trunk Impairment Scale (TIS) score, and Berg Balance Scale (BBS) score were used to assess changes in motor development after 4 weeks of training. Results: After the training periods, the TrA thickness on the paretic side, TIS score, and BBS score improved significantly in both groups compared to baseline (p<.05). TIS score was significantly greater in the DBM group than in the ADIM group (p<.05). Conclusion: This study demonstrated that ADIM and DBM are beneficial for improving TrA muscle thickness in the paretic side, trunk control, and balance ability. Intergroup comparison revealed that TIS score was significantly improved in the DBM group versus the ADIM group. Thus, DBM may be an effective treatment for low trunk muscle activity and performance in patients with chronic stroke.