• 대한간호학회지
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• 제47권1호
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• pp.1-13
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• 2017

Purpose: The purpose of this study was to examine the effects of a cognitive training program on neurocognitive task performance and activities of daily living (ADL) in patients who had a stroke. Methods: The research design for this study was a nonequivalent control group non-synchronized design. Patients were assigned to the experimental (n=21) or control group (n=21). The experimental group received a 4-week cognitive training program and usual care (i.e., rehabilitation service), while the control was received usual care only. Cognitive function was measured with a standardized neurocognitive test battery and ADL was assessed at baseline and one and two months after completion of the intervention. Repeated measures ANOVA was used to determine changes in cognitive function and ADL over 2 months. Results: The interaction of group and time was significant indicating that the experimental group showed improvement in attention, visuospatial function, verbal memory, and executive function compared to the control group which had a sustained or gradual decrease in test performance. A significant group by time interaction in instrumental ADL was also found between the experimental group with gradual improvement and the control group showing no noticeable change. Conclusion: Findings show that the cognitive training program developed in this study is beneficial in restoring cognitive function and improving ADL in patients following a stroke. Further study is needed to investigate the long-term relationship between cognitive training participation and cognitive improvement and effective functioning in daily living.

• 한국전문물리치료학회지
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• 제22권1호
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• pp.19-29
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• 2015

Impaired respiratory function is common in patients with stroke. The purpose of this study were to investigate the effectiveness of exercises and to assess forced vital capacity and peak cough flow after completion of neck stabilizing and respiratory reeducation exercises (combining diaphragmatic breathing and pursed-lip breathing exercises). The 45 participants were randomly assigned to an experimental group 1 ($n_1=15$), experimental group 2 ($n_2=15$), and a control group ($n_3=15$). All subjects performed conservative physical therapy for 30 minutes. Experimental group 1 undertook the neck stabilizing exercise and the respiratory reeducation exercise. Experimental group 2 undertook the respiratory reeducation exercise. Additional exercise did not exceed 30 minutes, five times a week for six weeks. The subjects were assessed for deep neck flexor thickness and breathing function (forced vital capacity, forced expiratory volume at one second, forced expiratory volume at one second/forced vital capacity, peak expiratory flow, and manual assisted peak cough flow) at pre-post value. The results of this study were as follows. Experimental group 1 showed a significant increase only in deep neck flexor thickness change rate (p<.05). All groups showed significant increases in forced vital capacity, forced expiratory volume at one second, and peak expiratory flow in pre-post measurement (p<.05). Experimental groups 1 and 2 showed an increase in manual assisted peak cough flow in pre-post measurement (p<.05). There was no significant difference between experimental group 1 and experimental group 2, but experimental group 1 improved more than experimental group 2 in respiratory function as a whole. In conclusion, these findings suggest that the neck stabilizing exercise in combination with the respiratory reeducation exercise can improve forced vital capacity and peak cough flow in patients with stroke.

• 대한물리의학회지
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• 제13권1호
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• pp.137-146
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• 2018

PURPOSE: This study examine the effect of community ambulation training on gait, depression and self - efficacy of stroke patients in order to develop more effective training methods of community rehabilitation. METHODS: In the experimental group, community ambulation training combined with indoor and outdoor walking was performed for 30 minutes three times a week for six weeks. In the control group, general indoor walking training was performed. The physical factors were assessed by a 10-meter walking test, six-minute walking test and community gait test. Psychological factors were assessed by the Korean version of the Epidemiology Center Depression Scale and Activity-Specific Balance Confidence Scale. RESULTS: In the 10-meter walking test, the normal walking speed was significantly improved after the intervention in both the experimental group and the control group (p<.05). However, the fast walking speed was significantly improved only in the experimental group (p <.05). ln the community gait test, the experimental group showed significant improvement (p<.05), but the control group did not. Depression and self-efficacy were significantly improved in the experimental group (p<.05) but not in the control group. CONCLUSION: Community ambulation training may improve the gait ability of stroke patients and reduce their depression and improve self-efficacy.

• 한국전문물리치료학회지
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• 제21권3호
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• pp.80-88
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• 2014

Previous studies have reported that decreased cognitive ability has been consistently associated with significant declines in performance of one or both tasks under a dual-task walking condition. This study examined the relationship between specific cognitive abilities and the dual-task costs (DTCs) of spatio-temporal gait parameters in stroke patients. The spatio-temporal gait parameters were measured among 30 stroke patients while walking with and without a cognitive task (Stroop Word-Color Task) at the study participant's preferred walking speed. Cognitive abilities were measured using Computerized Neuropsychological Testing. Pearson's correlation coefficients (r) were calculated to quantify the associations between the neuropsychological measures and the DTCs in the spatio-temporal gait parameters. Moderate to strong correlations were found between the Auditory Continuous Performance test (ACPT) and the DTCs of the Single Support Time of Non-paretic (r=.37), the Trail Making A (TMA) test and the DTCs of Velocity (r=.71), TMA test and the DTCs of the Step Length of Paretic (r=.37), TMA test and the DTCs of the Step Length Non-paretic (r=.36), the Trail Making B (TMB) test and the DTCs of Velocity (r=.70), the Stroop Word-Color test and the DTCs of Velocity (r=-.40), Visual-span Backward (V-span B) test and the DTCs of Velocity (r=-.41), V-span B test and the DTCs of the Double Support Time of Non-paretic (r=.38), Digit-span Forward test and the DTCs of the Step Time of Non-paretic (r=-.39), and Digit-span Backward test and the DTCs of the Single Support Time of Paretic (r=.36). Especially TMA test and TMB test were found to be more strongly correlated to the DTCs of gait velocity than the other correlations. Understanding these cognitive features will provide guidance for identifying dual- task walking ability.

• 대한물리의학회지
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• 제12권2호
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• pp.43-52
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• 2017

PURPOSE: This study aimed to compare the impact of exercise with that of functional electrical stimulation (FES) and transcutaneous electrical nerve stimulation (TENS) on muscle tone, calf muscle stiffness, and balance ability in patients with stroke. METHODS: Thirty patients with stroke were randomly divided into an FES group (n=15) and a TENS group (n=15), and a progressive task-oriented exercise was assigned to them. These exercises were performed non-synchronously from December 5, 2016 to January 31, 2017. Patients underwent TENS and simultaneously exercised for 30 minutes daily, 5 times a week for 4 weeks. To determine the effect of the interventions, muscle tone and stiffness of the medial and lateral region of gastrocnemius muscle were measured using the MyotonPRO instrument and balance was assessed using the Berg Balance Scale. RESULTS: Both groups revealed a significant decrease in muscle tone and stiffness of the medial part of gastrocnemius muscle before and after the interventions (p<.05). Berg Balance Scale scores increased significantly (p<.05). However, none of the other parameters were significantly different (p>.05). CONCLUSION: Our results prove that progressive task-oriented exercise along with FES and TENS decreases muscle tone and stiffness of the gastrocnemius muscle in patients with stroke and improves balance. TENS could serve as a complementary replacement for functional electrical stimulation for in-house training, as TENS poses less risk of muscle fatigue and has lesser contraindications than does functional electrical stimulation.

• Journal of Magnetics
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• 제19권2호
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• pp.192-196
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• 2014

The aim of the present study was to examine the effects of high and low frequency repetitive transcranial magnetic stimulation on motor cortical excitability and the balance function in subacute stroke patients. Twenty-four subjects were randomly assigned to either the high frequency (HF) rTMS group, or the low frequency (LF) rTMS group, with 12 subjects each. All subjects received routine physical therapy. In addition, both groups performed a total of 20 sessions of rTMS for 20 minutes, once a day, 5 times per week, for a 4-week period. In the HF rTMS group, 10 Hz rTMS was applied daily to the hotspot of the lesional hemisphere; and in the LF rTMS group, 1 Hz rTMS was applied daily to the hotspot of the nonlesional hemisphere. Motor cortex excitability was determined by motor evoked potentials, and the balance function was evaluated by use of the Balance Index (BI) and the Berg Balance Scale (BBS), before and after the intervention. The change rate in the value of each variable differed significantly between the two groups (p<0.05). Furthermore, significant differences were observed between all post-test variables of the two groups (p<0.05). In the HF rTMS, significant differences were found in all the pre- and post-test variables (p<0.05). On the other hand, in the LF rTMS, significant difference was observed only between the pre- and post-test results of BI and BBS (p<0.05). The findings demonstrate that HF rTMS can be more helpful in improving the motor cortical excitability and balance function of patients with subacute stroke treatment than LF rTMS, and that it may be used as a practical adjunct to routine rehabilitation.

• 한국전문물리치료학회지
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• 제22권4호
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• pp.8-16
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• 2015

The purpose of this study was to evaluate the effects of mobilization of the sciatic nerve on hamstring flexibility, lower limb strength, and gait performance in patients with chronic stroke. This study was a randomized clinical trial with a crossover design. Sixteen subjects were recruited for this study. The subjects were randomly divided into two intervention groups and underwent either of the following two interventions: sciatic nerve mobilization or static stretching of the hamstring. We assessed hamstring flexibility, lower limb strength, and gait performance using a digital inclinometer, a hand-held dynamometer, and the 10-meter walk test, respectively. Subjects had a 24-hour rest period between each session in order to minimize carryover effects. Measurements for each test were assessed prior to and immediately after the intervention sessions. Using a two-way analysis of variance test with repeated measures, data from the two trials were analyzed by comparing the differences between both techniques. The level of statistical significance was set at .05. Sciatic nerve mobilization resulted in significantly better knee extensor strength (p=.023, from $15.32{\pm}5.98$ to $18.16{\pm}6.95kg$) and knee flexor strength (p=.011, from $7.80{\pm}4.80$ to $8.15{\pm}4.24kg$) in the experimental group than in the control group. However, no significant effects of static stretching of the hamstring were observed on hamstring flexibility from the ankle plantar flexion (p=.966) and ankle neutral positions (p=.210) and on gait performance (p=.396). This study indicated that the sciatic nerve mobilization technique may be more effective in muscle activation of the knee extensor muscle and knee flexor muscle than hamstring static stretching technique in patients with chronic stroke.

• 대한지역사회작업치료학회지
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• 제4권2호
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• pp.53-61
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• 2014

목적 : 본 연구는 뇌졸중 환자를 대상으로 동영상 관찰훈련이 편측무시와 일상생활활동 수행능력에 미치는 영향을 알아보고자 한다. 연구방법 : 뇌졸중 진단을 받은 환자 30명을 대상으로 실험군 15명은 작업치료와 물리치료 외에 추가로 동영상 관찰훈련을 실시하였고, 대조군은 작업치료와 물리치료 외에 추가로 위상치료를 실시하였다. 치료 중재 전 후의 편측무시를 비교하기 위해 선 나누기 검사를 시행하였고, 일상생활활동 수행능력을 비교하기 위해 FIM을 시행하였다. 결과 : 동영상 관찰훈련을 시행한 집단이 위상치료를 시행한 집단에 비해 편측무시가 감소되었고, 일상생활활동 수행능력이 더 많이 향상되었다. 선 나누기 검사로 평가된 편측무시는 일상생활활동 수행능력과 통계학적으로 유의한 상관관계를 보였다. 결론 : 동영상 관찰훈련이 뇌졸중 환자의 편측무시 감소와 일상생활활동 수행능력 향상을 위한 치료방법으로써 임상에서 유용하게 적용될 수 있을 것이라 사료된다.

• 대한정형도수물리치료학회지
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• 제25권1호
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• pp.63-70
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• 2019

Background: The purpose of this study was to determine the effects of a pelvic compression belt on gait abilities and balance in subacute stroke patients. Methods: Twenty two patients with subacute were recruited and randomly assigned into two group: Two group offered conventional physical therapy and occupational therapy for five day. The group was composed of twelve patients. Participants in the experimental group were given the pelvic compression belt and conventional physical therapy, conventional occupational therapy, although conventional physical therapy and occupational therapy provided in the subjects in the control group. To assess the gait ability, the GAITRITE system was used and the Balance system SD was used to test balance. All measurements were performed before and after intervention. Results: The experimental group shows a significant improvement the cadence, velocity, step length and stride length in gait (p<.05) and show significant increase in the dynamic standing balance (p<.05). However, control group shows a significant improvement the cadence, velocity, step length and stride length in gait (p<.05), but shows no significant differences in dynamic standing balance. Furthermore, there were significant differences gait velocity, dynamic standing balance between two groups (p<.05). Conclusions: The results demonstrated that the elastic pelvic belt application is effective to improve gait velocity, dynamic balance in the subacute stroke patients. Thus, the elastic pelvic belt is seemed to be one of the potential methods to facilitate the active rehabilitation program for hemiplegia patients.

• 한국전문물리치료학회지
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• 제14권1호
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• pp.46-54
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• 2007

The purposes of the present study were to determine the difference of functional outcome, and to identify factors associated with functional difference in patients with stroke. The sample consisted of 56 stroke patients who had received physical therapy at the physical therapy unit of the Dongeui Medical Center in Busan city between January 2000 and June 2002. Stroke patients were evaluated by physical therapists 3 times; The first day in physical therapy (PT) (T1), one month after the first day in PT (T2), and two months after the first day in PT (T3). Functional status was assessed with the Functional Independence Measure (FIM) instrument, a validated instrument for documenting the severity of disability and assessing the outcome of rehabilitation treatment. Functional gain was calculated over T2-T1, T3-T1, and T3-T2. SAS statistical software was used for the analysis. The Student's t-test, paired t-test, analysis of variance (ANOVA/Tukey and Scheffe), and analysis of covariance (ANCOVA) were used to examine the functional difference in variables. Repeated measures ANOVA was also used to analyze the functional difference by time (T1, T2, and T3). Multiple regression analysis was performed to determine the effects of independent variables on the difference of functional outcome as defined by the FIM score. A total of 56 stroke patients were evaluated, their average age${\pm}$standard deviation was $61.6{\pm}9.3$ years (range: 40~81 yr). The functional status of patients who received physical therapy for about 2~3 months was significantly improved (mean FIM scores, $20.5{\pm}1.8$, $28.9{\pm}1.9$, and $8.41{\pm}1.1$ points for each time period, respectively) (p<.0001). Diabetes was significantly associated with the FIM score for T2-T1 (p<.05). The type of diagnosis was significantly associated with the FIM score for T3-T1 (p<.05). Gender, smoking, and the FIM score on admission were significantly associated with the FIM score for T3-T2 (p<.05). In conclusion, gender, smoking, diabetes, the type of diagnosis, and the FIM score on admission were significantly associated with improved FIM scores. We recommend that further research should explore the functional outcome by using larger sample sizes, longer follow-up periods, and more sensitive assessment instruments.