• 한국전문물리치료학회지
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• 제13권3호
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• pp.84-91
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• 2006

The purpose of this study was to investigate the effect of submerged relaxation therapy for the spasticity on the affected side in three subjects with post-stroke hemiparesis. A single-subject alternating design with multiple baselines across individuals was employed in this study. Each subject alternately participated in a range of motion exercises on the mat and in the pool, and relaxation exercises in the pool. The muscle tone of the affected side was measured using the tone assessment scale (TAS). Measurements were made immediately and one hour following the intervention. The findings showed a therapeutic effect of submerged relaxation exercise on reducing spasticity for all subjects. The effect of submerged relaxation exercise on decreasing muscle tone was maintained for one hour measurements after the submerged relaxation exercise, although the mean TAS score assessed one hour after intervention was higher than that assessed immediately. The results of this study suggest that submerged relaxation exercise has a positive effect on decreasing spasticity on the affected side in persons suffering from post-stroke hemiparesis. Future research on submerged relaxation exercise should focus on objective evaluation and functional the aspects relevant to activities of daily living.

• 한국산학기술학회논문지
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• 제13권3호
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• pp.1129-1137
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• 2012

본 연구의 목적은 뇌졸중 환자의 족관절 저측굴근 경직에 대하여 Myotonometer와 surface Electromyography(sEMG)를 이용하여 경직의 정량적 평가에 유용한 지표를 알아보고, 이 지표들과 임상적으로 평가되는 modified Ashworth scale(MAS)과의 관계를 알아보고자 하였다. 족관절 저측굴근의 경직평가는 물리치료사 5명(임상경력 5년이상)이 MAS를 이용하여 MAS 2, 3, 4 해당 군에 각 5명씩을 무작위로 15명씩 배정하였다. 각 군의 조직탄성과 근활성 측정은 Myotonometer와 sEMG로 이완(relaxed)상태와 최대 수의적 수축(contracted)상태에서 측정하였다. 연구 결과, MAS 등급이 높아짐에 따라 이완과 수축상태 간의 조직저항도 전위차와 근활성도의 차이는 작아졌고, 상관관계 분석에서도 MAS 등급이 높아질수록 이완 시보다 수의적 수축 시 실린더가 받는 낮은 강도에서의 상관성이 더 높아짐을 확인할 수 있었다. 따라서 Myotonometer는 경직을 평가하는 방법으로 다양한 인체의 관절에 비교적 쉽게 적용할 수 있으며 경직의 변화를 민감하게 반영할 수 있어 보다 객관적이고 정량적인 경직의 평가 도구로 사용될 수 있을 것이다.

• 대한물리의학회지
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• 제5권3호
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• pp.487-498
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• 2010

Purpose : To investigate the immediate effects of transcutaneous electrical nerve stimulation(TENS) on the spasticity and the balance in the stroke patients. Methods : 26 subjects with spasticity over lower limbs were allocated randomly into two groups : (1) TENS group, (2) placebo-TENS group. TENS was applied on the both gastrocnemius for 60 minutes(100 Hz, 0.25 ms, 2 times sensory threshold). The modified Ashworth Scale(MAS) and Manual Muscle Tester were used to assess the spasticity of the ankle plantar flexors. Static balance under three conditions was measured by force-plate; in (1) the condition of standing with eyes opened, (2) with eyes closed and (3) the condition of standing on unstable surface with eyes opened. Results : When compared with the pre and post TENS application, TENS showed significant reduction of ankle spasticity in MAS and MMT measurement. Also, Application of high-frequency TENS improved the balance under three conditions. Conclusion : A single session of TENS to stroke patients could reduce spasticity and improve the balance.

• Journal of Korean Neurosurgical Society
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• 제43권4호
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• pp.182-185
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• 2008

Objective : The purpose of the present study is to assess the long-term results of microsurgical dorsal root entry zonotomy (MDT) for the treatment of medically intractable upper-extremity spasticity. Methods : The records of nine adult patients who underwent MDT by one operating neurosurgeon from March 1999 to June 2004 were retrospectively reviewed by another investigator who had no role in the management of these patients. In all patients, MDT was performed on all roots of the upper limb (from C5 to T1) for spasticity of the upper extremity. The degree of spasticity was measured by the Modified Ashworth Scale (grade 0-4). Severity of the pain level was determined using the Numeric Rating Scale (NRS, score 0-10). Also, patient satisfaction of the post-operative outcome was assessed. Results : Comparing the preoperative and postoperative spasticity using the Modified Ashworth Scale, we observed improvement in all patients, particularly in five of the nine patients (55.6%) who improved by three grades over an average of 66.4 months (range, 40-96). Regarding patient satisfaction, seven patients (77.8%) had affirmative results. None of the patients experienced severe, life-threatening, postoperative complications. We observed a decrease in the intensity of painful spasms to less than three scores as measured by NRS in all four patients with associated pain. Conclusion : This study shows that MDT provides significant, long-term reduction of harmful spasticity and associated pain in the upper limbs.

• Physical Therapy Rehabilitation Science
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• 제9권2호
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• pp.67-73
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• 2020

Objective: The purpose of this study was determine the effect of Balance Trainer training with Transcutaneous Electrical Nerve Stimulation (TENS) on spasticity and balance in persons with chronic stroke. Design: Randomized controlled trial. Methods: A total of 30 subjects with hemiparetic stroke were recruited and randomly divided into the Balance Trainer training with TENS group (n=15) and Balance Trainer training with placebo TENS group (n=15). The Balance Trainer training with TENS group practiced additional Balance Trainer training with TENS for 30 minutes a day, 5 days per a week during 4 weeks and the Balance Trainer training with placebo TENS group practiced additional Balance Trainer training with placebo TENS for the same period. Spasticity and balance were assessed by ability (static balance, dynamic balance) and were measured before and after the 4-week programs. Results: The result of spasticity and dynamic balance were improved significantly in both groups (p<0.05). The Balance Trainer training with TENS group showed significantly greater improvement in spasticity of the gastrocnemius & dynamic balance, compared to the Balance Trainer training with placebo TENS group (p<0.05). The Balance trainer training with TENS group showed a significant improvement in static balance, especially during the eye-closed condition (p<0.05). Conclusions: The Balance Trainer training with TENS was effective in improving spasticity and balance in subjects with chronic stroke. Based on these results, it is suggested that Balance Trainer training with TENS could clinically be used more actively in conjunction with conventional physical therapy.

• 한국산학기술학회논문지
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• 제12권7호
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• pp.3109-3116
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• 2011

본 연구는 뇌병변으로 상지경직이 관찰되는 환자를 대상으로 자극방식에 따른 진동자극이 경직에 미치는 영향에 대하여 알아보고자 하였다. 뇌병변으로 인해 상지경직이 있는 21명의 환자가 연구에 참여하였고, 실험군 I: 길항근(상완삼두근)자극, 실험군II: 주동근(상완이두근)자극, 실험군III: 동시(상완삼두근 및 상완이두근)자극에 각 7명씩을 배정하여 진동자극을 실시하였다. 척수운동신경원 흥분성을 알아보기 위해 Neuro-EMG_Micro를 이용한 F파를 자극전, 자극 직후, 자극 10분 후, 자극 20분 후에 측정하였고, 임상적 평가로는 MAS(Modified Ashworth Scale)와 MFT(Manual Function Test)를 자극 전, 자극 20분 후에 평가하였다. 본 연구의 결과, MAS는 세군 모두 유의한 감소를 나타냈고, F파 진폭 및 F/M비에서는 세군 모두에서 자극 직후에서부터 유의한 감소를 나타냈으며, 실험군III에서 시간 경과상 변화량이 가장 크게 나타났다. MFT에서는 실험군II와 III에서 유의한 증가를 나타냈으며 특히, 실험군III에서 기능적 변화량이 가장 크게 나타났다. 이러한 결과는 경직근에 대한 진동자극시 경직 주동근이나 길항근에 대한 단일 자극 방식보다는 동시자극 방식이 척수운동신경원의 흥분성 감소 및 상지 운동 기능 향상에 더 효과적임을 확인할 수 있었다.

• 대한물리의학회지
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• 제5권3호
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• pp.477-485
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• 2010

Purpose : The clinical scale to assess spasticity of muscle was wildly used the modified Ashworth scale (MAS). But reliability of the MAS has been controverted for ambiguity among the grades. The purpose of this study was to establish the inter-rater reliability of the modified MAS (MMAS) translated into Korean in stroke patients. Methods : Twenty-five patients (sixteen men and nine women) with hemiplegia (ten right and fifteen left) were measured by two raters who were physical therapist in the rehabilitation hospital. The raters assessed spasticity of shoulder adductor, elbow flexor, wrist flexor, hip adductor, knee extensor, and ankle plantar flexor in the same patients according to ratings criteria of the MAS and the MMAS. Results : For the inter-rater reliability of the MAS, two raters agreed on 57.3% and the Kappa values were moderate ($\kappa$=0.41) between two rater. The inter-rater reliability of the MAS was fair for the wrist flexor and the hip adductor and moderate for the other muscles. The intra-rater reliability was good for the shoulder adductor and the knee extensor and moderate for the other muscles. For the inter-rater reliability of the MMAS, two raters agreed on 84.7% and the Kappa values were good ($\kappa$=0.78) between two rater. The inter-rater reliability of the MMAS was moderate for the hip adductor, and good for the shoulder adductor and the wrist flexor, and very good for the other muscles. The intra-rater reliability was good for the wrist flexor and the hip adductor and very good for the other muscles. Conclusion : This study suggests that the MMAS translated into Korean is reliable test scale for the spasticity with stroke patients in the clinical field.

• The Journal of Korean Physical Therapy
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• 제23권6호
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• pp.31-36
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• 2011

Purpose: This pilot case series study aimed to evaluate the efficacy of continuous radiofrequency (CRF) application on dorsal root ganglia (DRG) to reduce spasticity of spinal cord lesion (SCL) patients. Methods: We performed CRF procedures on DRG in 8 subjects (7 males; mean age 39 years, range 31-53 years) with intractable spasticity that impeded activities of daily living and caregiving, although they had maximal tolerable doses of anti-spastic medications and active rehabilitative treatment. All subjects underwent CRF (90 seconds at $90^{\circ}C$) at multiple lumbosacral and/or cervical DRG. Muscle tone of the extremities was measured by the modified Ashworth scale (MAS) before and one month after procedures. Functional goals were established at baseline, and subjects' satisfaction levels were categorized one month after procedures. Results: A total of 54 CRF treatments were performed in 8 patients. In all patients, we found some improvement in muscle tone measured by the MAS. Six patients reported themselves satisfied with their current status at one month's post-treatment, and 2 patients were fairly satisfied with their gait pattern. In 3 patients, neuropathic pain was present after CRF on DRG. In 1 lumbar case, the pain subsided after several days, and the other 2 cervical cases suffered from tolerable neuropathic pain treated with anti-convulsant medication. Conclusion: CRF on DRG might be a promising alternative treatment to reduce spasticity in SCL patients. Further well-designed clinical trials on the efficacy and safety of CRF application on DRG are needed.

• 한국콘텐츠학회논문지
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• 제11권3호
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• pp.262-270
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• 2011

본 연구는 swiss ball LSE에 따른 하지 경직도, 균형 및 보행에 관한 효과를 알아보고자 BBS, FRT, 수정된 Ashworth 척도(MAS), TUG 측정 분석 하였다. 대상자는 H병원에서 입원 또는 통원치료를 받고 있는 뇌졸중 환자 중 선정기준에 적합한 34명을 고전적 신경물리치료군 17명, swiss ball LSE 실시군에 17명씩 할당하여 하지의 균형능력은 BBS와 FRT, 경직도는 MAS, 보행능력은 TUG를 사용하여 비교 분석하였다. Swiss ball LSE군에서 BBS와 FRT는 유의하게 증가하였으며, MAS와 TUG는 유의하게 감소하였다. 또한 군간의 비교에서는 FRT와 MAS에서 유의한 차이가 나타났다. 결과적으로 swiss ball LSE는 뇌졸중 환자의 하지 근경직, 균형능력 및 보행능력을 회복시킬 수 있는 것으로 사료된다.

• 한국전문물리치료학회지
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• 제29권2호
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• pp.147-155
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• 2022

Background: Although various conventional approaches have been employed to reduce spasticity in neurological rehabilitation, only a few studies have shown scientific evidence for its effectiveness. Thus, we introduced a different concept (Ueda method) of rehabilitation therapy that can complement the limitations of conventional therapy. Objects: This study aimed to investigate the immediate effects of the application of the Ueda method on patients with spasticity after stroke via an electrophysiological study. Methods: We conducted a randomized double-blind pilot study in two rehabilitation hospitals involving 30 stroke patients who were randomly allocated to the Ueda (n = 15) and convention (n = 15) groups. Electromyographic data of six examined muscles in both upper extremities of all patients were recorded. The A-ApA index and activation ratios of upper extremity muscles were evaluated and compared between the groups to confirm post-intervention changes in upper-extremity flexor spasticity and flexion synergies. Repeated-measures analysis of variance was conducted to confirm the therapeutic effect (2 × 2) as a function of group (Ueda vs. convention) and time (pre-/post-intervention) on all outcome measures (p < 0.05). Results: In the Ueda group, the mean A-ApA index values differed significantly before and after the intervention (p = 0.041), indicating a weak evidence level; however, the effect size was medium (d = -0.503). The interaction effects of the A-ApA index between the Ueda and convention groups and between pre-intervention and post-intervention stages were significant (p = 0.012). The effect size was large (n_p² = 0.220). In the Ueda group, the activation ratios of the anterior deltoid fiber significantly decreased after the intervention in all reaching tasks. Conclusion: The Ueda method reduces upper-extremity flexor spasticity and changes its synergy in stroke patients and should be considered a rehabilitation therapy for spastic stroke patients.