• Title/Summary/Keyword: Stroke Rehabilitation

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Effects of Intensive Neuro Rehabilitation Intervention on the Motor Function Recovery and Balance in Stroke Patients

  • Lee, Je-Hyeok;Choi, Jong-Duk
    • Journal of the Korean Society of Physical Medicine
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    • v.11 no.4
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    • pp.41-47
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    • 2016
  • PURPOSE: The purpose of this study was to investigate the effects of differences in exercise time arrangement on the functional recovery of the lower limbs and balance of stroke patients. METHODS: The subjects of this study were 100 patients who were hospitalized in two hospitals located in Gyeonggi-do. Before the experiment, 60 of these patients who met the inclusion criteria and did not meet the exclusion criteria were randomly divided into an experimental group (n = 30), whose exercise time was concentrated, and a control group (n = 30), whose exercise time was diffuse. The two groups underwent six weeks of physical and occupational therapy four times a day for five days a week. One session of therapy took 30 minutes, including three sets of physical therapy and one set of occupational therapy. The rest time between the sessions was different for each group. The experimental group had five minutes of rest between each therapy session, and the control group had two hours of rest time between each session. The Fugl-Meyer assessment (FMA), an assessment of each patient's limit of stability (LOS), and a timed up and go test (TUG) were used as test tools. RESULTS: Both groups showed statistically significant increases in their FMA results, LOS measurements, and TUG results. The FMA results of the experimental group were significantly higher than those of the control group. CONCLUSION: Thus, concentrated exercise time was more effective than diffuse exercise time for the recovery of motor function.

Review of Prevention of Hemipelegic Shoulder Subluxation After Stroke (뇌졸중 편마비환자의 견관절 아탈구 예방에 관한 고찰)

  • Han, Jin-Tae;Kweon, Oh-Hyun;Shin, Hyung-Soo
    • Journal of the Korean Society of Physical Medicine
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    • v.2 no.2
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    • pp.243-250
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    • 2007
  • Purpose : Shoulder subluxation is a very common problem in patients with hemiplegia with stroke. Prevention of the low tone subluxed shoulder has been an issue for physical therapists working with neurological patients for many years. Methods : This study reviewed the literature to definite the management and a cause of shoulder subluxation with hemiplegia patients after stroke. Various modalities have been suggested for realigning the glenohumeral joint, but their use is controversial. The purpose of this paper is to review critically the evidence base in order to inform the clinical decision-making process for physiotherapists working in neurology. Results : Literature has identified supports, strapping and functional electrical stimulation(FES) in the management of low tone shoulders. Following review of this evidence it is suggested that there is a lack of reliable and valid research evidence on which to base conclusions. The modalities with the best supporting evidence for realigning the low tone subluxed glenohumeral joint are the triangular sling, Harris hemi sling and the Rolyan humeral cuff used in a standing position and the lap board and arm trough while the patient is sitting. However, due to soft tissue adaptation with associated lack of movement, over-correction and the need for careful patient positioning these supports need to be evaluated for each patient and should be used only in appropriate situations. Conclusion : Similarly, there is a lack of evidence on the effects of long-term use to this equipment. Electrical stimulation is also thought to have potential in the treatment to subluxed low tone shoulders but additional research is required to clarify the parameters for use and the long-term effects of these forms of management.

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The relationship between smoking and stroke by general characteristics : using the 6th Korea national health and nutrition examination survey (일반적 특성에 따른 흡연과 뇌졸중의 관련성 : 제6기 국민건강영양조사 이용)

  • Nam, Younghee;Jung, Hyunjung;Kim, Yesoon
    • Journal of Digital Contents Society
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    • v.19 no.7
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    • pp.1323-1331
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    • 2018
  • The purpose of the study was to determine the general characteristics that affect strokes caused by smoking, to provide basic data and political grounds for preventing strokes. Data were used from the 6th (2015) of the National Health and Nutrition Survey. Among the study participants were 2,146 smokers and 132 strokers. Data were analyzed using SPSS ver. 21.0. The findings of the study were as follows: strokes increased the odds ratio 1.7 times(p<0.001) when smoking was performed, and the risk factors for strokes caused by smoking were statistically significant in age(p=0.008, p=0.10), education level(p=0.003, p=0.008), hypertension(p<0.001), and subjective health conditions(p=0.008). Therefore, it is necessary to develop health education contents using smart devices and a consistent national health policy to reduce the occurrence and risk of stroke.

The Convergence Effect of Task-Oriented Training and Vibration Stimulation, Transcranial Direct Current Stimulation to Improve Upper Limb Function in Stroke (뇌졸중 환자의 상지기능 개선을 위한 과제 지향적 훈련과 진동 자극, 경두개 직류 전류 자극의 융합 효과)

  • Kim, Sun-Ho
    • Journal of the Korea Convergence Society
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    • v.11 no.9
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    • pp.31-37
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    • 2020
  • The purpose of this study was to investigate the Effect of transcranial direct current stimulation convergence task-oriented training combined with vibration stimulation on hand dexterity and upper limb function in stroke patients. One time 30 minutes 5 times a week for 4 weeks. experimental group of transcranial direct current stimulation convergence task-oriented training combined with vibration stimulation and control group of the task-oriented training combined with vibration stimulation were divided into 10 members. Hand dexterity and upper limb recovery were measured. The experimental group and the control group showed significant improvement in hand dexterity and grasping(p<.05), grasping, and gross movement(p<.05). The experimental group showed a significant improvement in hand dexterity and grasp and grip than the control group. Effect size showed more than small effect in all evaluation items. Based on the results of this study, it is considered that more effective and efficient rehabilitation treatment can be performed in the clinic.

A Case Report of Intervention Strategy applied ICF Tool about Floor to Stand and Stand to Floor for Stroke Patient (ICF Tool을 적용한 뇌졸중 환자의 바닥에 앉고 일어서기에 대한 중재전략의 증례)

  • Yun, Tae-Won;Kim, Tae-Yoon
    • Journal of Korean Physical Therapy Science
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    • v.18 no.1
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    • pp.33-49
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    • 2011
  • The process of physical therapy uses a problem-solving approach to enhance a patients's functioning status. The International Classification of Functioning, Disability and Health(ICF) is the common concept for the functioning in the world. Physical therapists require the ability to identify problems, formulate hypothesis, and plan intervention strategies through clinical reasoning. In the clinical process, physical therapists need to use standard and common languages in speech and in documentation. The purpose of this study was to suggest the process of making strategy for efficient intervention, examining and evaluating the functional problem of the person with stroke using ICF tools. For the first step in this process model, therapists could list the information relating to functional problems used by the ICF Core set and then could identify the interaction among the problems using the ICF assessment sheet. For the next step, therapist is needed to make the hypothesis and hypothesis testing, and then set a primary functional goals and therapeutic goals in detail after prioritizing the problems to be managed based on the problem list. Finally, after setting the identified problems as the purpose of intervention through the hypothesis testing, therapist could do some intervention after making a plan to solve these problems, and find out the outcomes using the ICF evaluation display. This report illustrates how to apply the process based on ICF concept into physical therapy practice. Making a decision for the most efficient intervention requires that therapists use the clinical reasoning process based on ICF concept.

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Efficacy of PNF Group Exercise Program in Chronic Stroke (만성 뇌졸중 환자에 대한 PNF 집단 운동프로그램의 효과)

  • Kim, Soo-Min;Bae, Sung-Soo
    • PNF and Movement
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    • v.3 no.1
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    • pp.1-15
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    • 2005
  • Objective : The purpose of this study was to evaluate the influence of a community based group exercise intervention on motor functional capacity. To evaluate the immediate(post-treatment) effects after 6-weeks exercise program on the group exercise intervention(PNF and Circuit exercise). Methods : Subjects-Included persons with stroke who were living in the community. Thirty-seven subjects were randomly assigned to the PNF, Circuit exercise and control group participated in a repeated measures design that evaluated the subjects with pre-treatment, post-treatment(6 weeks). Functional ability outcome measures assessed the motor assessment scale(MAS) and EMG. Both treatment groups participated in exercise cJass three times a week for 6 weeks. Group programs focused on balance, functional motor capacity and walking ability. The PNF program was modified PNF pattem and techniques with emphasis on functional tasks when possible, as well as stretching of the more affected limb particularly in the more affected shoulder. The Circuit program with subjects completing practice at a selies of work station as well as participating in walking races and relay with other members of the group. Results : Compared with the control group, the treatment group had larger improvements in the motor function ability after 6 weeks treatment and Post-treatment test scores were more significant than the pre-treatment score. 1. Motor function were assessed by using MAS, sit to stand, walking and upper function were assessed pre-treatment versus post-treatment measures revealed a statically significant(p<.05). There were significant differences between the groups. Compared with the control group, the treatment group had larger improvements. 2. In the treatment groups, demonstrated difference in the electromyographic activation of biceps, triceps, quadriceps and tibialis anterior muscles on the paretic side in the response to the reaching arm movement and stepping motion in stance. The difference in muscle activation improvement were not statically significant. Conclusion : The results of this study showed that the PNF and Circuit group exercise intervention can improve motor functional ability. This study suggests that the PNF and Circuit exercise programs is appropriate for community-based group exercise principles. It leads to gain and maintain potential function for disabled persons after stroke in the community.

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Relationship between Ipsilateral Motor Deficits on the Less-Affected Side and Motor Function Stage on the Affected Side

  • Son, Sung Min;Nam, Seok Hyun;Kang, Kyung Woo;Kim, Dae Hyun
    • The Journal of Korean Physical Therapy
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    • v.30 no.6
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    • pp.234-238
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    • 2018
  • Purpose: Aim of this study was to investigate whether there are ipsilateral motor deficits for visuospatial accuracy and fine movements by making a comparison between stroke patients and healthy subjects. We examined whether ipsilateral motor deficits are influenced by the level of functional movements and muscle strength of the upper and lower extremities of the affected side. Methods: Thirty post-stroke subjects and 20 normal aged matched subjects were recruited. Outcome measures for less-affected side were the tracking task and nine-hole pegboard test. Fugl-Meyer test and motricity index were applied for the measurement of functional movements and muscle strength of affected side. Results: Tracking task and nine-hole pegboard test was significantly different between control and experimental group. In terms of accuracy index according to tracking, the experimental group showed a lower accuracy index in the MCP joint than the control group. However, there were no significant difference relation between the level of motor function of the affected side and the motor deficit level of ipsilateral side. Conclusion: Ipsilateral motor deficits may have significant clinical implications. It needs to be noted that although many patients, families, and medical staff are focused only on motor deficits of the affected side, motor deficits of the sound side can cause difficulties in daily living movements requiring delicate movements. In addition, there was no significant correlation between the level of motor function of the affected side and motor deficits of the sound side.

Interrater Reliability of Upper Extremity Function Assessment on Stroke (뇌졸중 환자에 대한 상지기능 평가도구의 검사자간 신뢰도)

  • Hwang, Seong-Soo;Kim, Pu-Reum;Won, Ji-In;Yoo, Seon-Ju;Yoon, Jun-Byung;Lee, Keun-Woo;Lee, Wang-Jae
    • PNF and Movement
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    • v.10 no.1
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    • pp.1-7
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    • 2012
  • Purpose : To verify the interrater reliability of upper extremity function assessment among three tools(Wolf motor function test, Motor assessment scale, Fugl-meyer assessment scale). Methods : The subjects of this study 40 (20 was physical therapists and 20 was physical therapy students). For the test one patients with chronic hemiparesis after stroke participated in the study. The Wolf Motor Function Test consists of 16 functional tasks. The motor assessment scale consists of 3 functional tasks. The fugl-meyer assessment scale consists of 8 functional tasks. All test sessions were videotaped and scored by 40 subjects. Analysis : The data was analysis by SPSS PC 14.0 with Cronbach alpha Coefficients, intraclass Correlation Coefficients Kendall tau-b value. Results : WMFT was highly scored in Cronbach's value, Cronbach's ${\alpha}=0.819$ that means high interrater reliability among assessment. WMFT was highly scored all items in p-value except one item, that means high p-value between therapists and students. WMFT was highly scored in Intrarater correlation coefficient (ICC) = 0.79, that means high interrater reliability of each examination item. WMFT was low index of coincidence from all items, MAS was low index of coincidence from a tim and FMA was low index of coincidence from 4 items. Conclusion : The interrater reliability of WMFT were compared with MAS, FMA and highly verified. WMFT can be more useful tool among upper extremity function assessment.

A Study on the Balance of Stroke Patients According to Kneeling Squat Exercise and Standing Squat Exercise Positions (무릎스쿼트 운동과 스쿼트 운동 자세에 따른 뇌졸중 환자의 균형 비교 연구)

  • Go, Gwan-Hyeok;Kim, Byeong-Jo
    • Journal of The Korean Society of Integrative Medicine
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    • v.10 no.4
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    • pp.1-9
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    • 2022
  • Purpose : The purpose of this research is to propose a more efficient exercising method by measuring and comparing the movement of center of pressure (COP) while hemiplegic stroke patients perform kneeling squat exercise and squat exercise. Methods : 17 hemiplegic stroke patients were instructed to perform kneeling squat exercises and squat exercises, and the research was designed as a cross-over study. For data collection, a pressure distribution measurement platform (PDM) was used to measure the movement area, length, speed, and distance from the center of the X-axis of center of pressure. The data was then analyzed through a paired t-test. Results : Kneeling squat exercises have been found to have a significantly smaller center of pressure movement area compared to that of squat exercise(p<.001), and the center of pressure movement length of kneeing squat exercise has also been found to be relatively shorter (p<.001). Moreover, kneeling squat exercises have been found to have a significantly slower center of pressure movement speed than squat exercise (p<.001), and kneeing squat exercise center of pressure movement distance from the center of the X-axis has been found to be significantly small (p<.001). Conclusion : Kneeling squat exercises have significantly decreased amounts of center of pressure movement area, distance, and speed compared to squat exercises. Also, the center of pressure movement distance from the center of the X-axis was relatively closer. This result seems to derive from patients performing their motions with wide base surfaces while being refrained from using unstable ankle joints during kneeing squat exercise. Therefore, it can be concluded that kneeing squat exercises show relatively balanced center of pressure movements between the paralyzed and non-paralyzed sides because kneeling squats show smaller shakes in the center of pressure.

Electromyography Triggered Training System for Wrist Rehabilitation (근전도 트리거 손목 재활 훈련 시스템 개발)

  • Kim, Younghoon;Le, DuyKhoa;Chee, Youngjoon;Ahn, Kyoungkwan;Hwang, Changho
    • Journal of Biomedical Engineering Research
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    • v.34 no.3
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    • pp.148-155
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    • 2013
  • This study is about the development of the wrist rehabilitation system for the patient who has limited capability of movement after stroke. Electromyography triggered training system (ETTS) can play the role between complete passive training and patient activating training system. Surface EMG was measured on pronator teres muscle and biceps brachii muscle for wrist pronation and supination. Our system detects whether the subject makes muscular effort for pronation or supination or nothing in every 50 ms. When the effort level exceeds the preset percentage of maximal voluntary contraction, the motor rotates according to the direction of the intention of the subject. EMG triggers the motor rotation for the wrist rehabilitation training until the preset angle. To evaluate its performance, the maximum voluntary contraction level was measured for 4 subjects at first. With the audio-visual instruction to rotate the wrist (pronation or supination) the subjects made effort to follow the instruction. After calculating root mean square (RMS) for 50 ms, the controller determines whether there was muscular effort to rotate while holding the motor. When there was an effort to rotate, the controller rotates the motor 0.8 degree. By comparing the RMS values from two channels of EMG, the controller determines the rotational direction. The onset delay is $0.76{\pm}0.24$ s and offset delay is $0.65{\pm}0.22$ s for pronation. For supination the onset delay is $1.24{\pm}0.41$ s and offset delay is $0.77{\pm}0.22$ s. The system responded fast enough to be used for rehabilitation training. The controller perceived the direction of rotation 100% correctly for the pronation and 97.5% correctly for supination. ETTS was developed and the fundamental functions were validated for normal subjects. The clinical validation should be done with patients for real world application. With ETTS, the subjects can train voluntarily over the limitation of the range of motion which increases the effectiveness of the rehabilitation training.