• 한국전문물리치료학회지
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• 제28권1호
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• pp.36-46
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• 2021

Background: It is reported that the proprioceptive sensation of patients with neck pain is reduced, and neck sensory-motor control training using visual feedback is reported to be effective. Objects: The purpose of this study is to investigate how sensorimotor control training for the cervical spine affects pain, function, and psychosocial status in patients with chronic cervical pain. Methods: The subjects consisted of 36 adults (male: 15, female: 21) who had experienced cervical spine pain for more than 6 weeks. An exercise program composed of cervical stabilization exercise (10 minutes), electrotherapy (10 minutes), manual therapy (10 minutes), and cervical sensorimotor control training (10 minutes) was implemented for both the experimental and the control groups. The cervical range of motion (CROM) and head repositioning accuracy were assessed using a CROM device. In the experimental group, the subjects wore a laser device on the head to provide visual feedback while following pictures in front of their eyes; whereas, in the control group, the subjects had the same training of following pictures without the laser device. Results: There were no statistically significant differences between the two groups in pain, dysfunction, range of motion, or psychosocial status; however, post-test results showed significant decreases after 2 weeks and 4 weeks compared to baseline (p < 0.01), and after 4 weeks compared to after 2 weeks (p < 0.01). The cervical joint position sense differed significantly between the two groups (p < 0.05). Conclusion: In this study, visual feedback enhanced proprioception in the cervical spine, resulting in improved cervical joint position sense. On the other hand, there were no significant effects on pain, dysfunction, range of motion, or psychosocial status.

• 대한의용생체공학회:의공학회지
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• 제28권1호
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• pp.139-147
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• 2007

The aim of this study was to evaluate effects of short-tenn repetitive-bilateral excercise on the activation of motor network using functional magnetic resonance imaging (fMRI). The training program was performed at 1 hr/day, 5 days/week during 6 weeks. Fugl-Meyer Assessments (FMA) were performed every two weeks during the training. We compared cerebral and cerebellar cortical activations in two different tasks before and after the training program: (1) the only unaffected hand movement (Task 1); and (2) passive movements of affected hand by the active movement of unaffected hand (Task 2). fMRI was performed at 3T with wrist flexion-extension movement at 1 Hz during the motor tasks. All patients showed significant improvements of FMA scores in their paretic limbs after training. fMRI studies in Task 1 showed that cortical activations decreased in ipsilateral sensorimotor cortex but increased in contralateral sensorimotor cortex and ipsilateral cerebellum. Task 2 showed cortical reorganizations in bilateral sensorimotor cortex, premotor area, supplemetary motor area and cerebellum. Therefore, this study demonstrated that plastic changes of motor network occurred as a neural basis of the improvement subsequent to repetitive-bilateral excercise using the symmetrical upper-limb ann motion trainer.

• 대한정형도수물리치료학회지
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• 제7권2호
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• pp.23-39
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• 2001

Dysfunction of the anterior and dorsal muscles of the trunk have been studied in relation to low back pain of many years. Many muscles of the trunk are capable of contributing to the stabilization and protection of the lumbar spine, recent evidence has suggested that transversus abdominis may be critically involved and has been the focus of rehabilitation. The delay in onset of contraction of trunk muscles associated with movement of the upper or lower limb in patients with low back pain indicates a significant deficit in the automatic motor command for control of disturbance to the spine. The function of transversus abdominis has been largely ignored in the evaluation of spinal stabilization and protection. The most essential stabilizing muscles for the lumbar column are the transversus abdominis and the multifidus. Sling exercise therapy(SET) concept consists of a system of diagnosis and treatment. The system of diagnosis involves testing the muscle's tolerance through progressive loading in open and close kinetic chains. The SET system contains elements such as relaxation, increasing the range of movement, traction, training the stabilizing musculature, sensorimotor exercises, training in open and close kinetic chains, dynamic training of the mobilizing musculature, cardiovasc+ular exercises, group exercise, personal exercise at home. Sensorimotor training is an essential element of the SET concept. The emphasis is on closed kinetic chain exercises on an unstable surface, thereby achieving optimum stimulation of the sensorimotor apparatus.

• 한국전문물리치료학회지
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• 제24권2호
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• pp.58-65
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• 2017

Background: Children with cerebral palsy (CP) have impaired postural control, but critically require the control of stability. Consequently, therapeutic interventions for enhancing postural control in children with CP have undergone extensive research. One intervention is sensorimotor training (SMT) using a Flexi-bar, but this has not previously been studied with respect to targeting trunk control in children with CP. Objects: This study was conducted to determine the effect of SMT using a Flexi-bar on postural balance and gait performance in children with CP. Methods: Three children with ambulatory spastic diplegia (SD) participated in the SMT program by using a Flexi-bar for forty minutes per day, three times a week, for six weeks. Outcome variables included the pediatric balance scale (PBS), trunk control movement scale (TCMS), 10 meter walking test (10MWT), and 3-dimensional movement coordination measurement. Results: The SMT provided no statistically significant improvement in PBS, TCMS, 10MWT, or 3-dimensional movement coordination measurement. However, positive changes were observed in individual outcomes, as balance and trunk control movement were improved. Conclusion: SMT using a Flexi-bar may be considered by clinicians as a potential intervention for increasing postural balance and performance in children with SD. Future studies are necessary to confirm the efficacy of Flexi-bar exercise in improving the functional activity of subjects with SD.

• 한국전문물리치료학회지
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• 제26권2호
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• pp.49-60
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• 2019

Background: After stroke, in order to improve gait function, it is necessary to increase the muscle strength and to enhance the propriocetive function of the lower extremity. Objects: This study aimed to compare the effects of open kinetic chain (OKC) versus closed kinetic chain (CKC) isokinetic exercise of the hemiparetic knee using the isokinetic equipment on lower extremity sensorimotor function and gait ability in patients with chronic stroke. Methods: Thirty participants with chronic hemiplegia (> 6 months post-stroke) were randomly divided into 2 equal groups: CKC group and OKC group. Patients from both groups attended conventional physiotherapy sessions 3 times a week for 6 weeks. Additionally, subjects from the CKC group performed isokinetic exercise using the CKC attachment, while those from the OKC group performed isokinetic exercise using the OKC attachment. The isokinetic knee and ankle muscles strength, position sense of the knee joint, and spatiotemporal gait parameters were measured before and after interventions. Results: The knee muscles peak torque/body weight (PT/BW) and hamstring/quadriceps (H/Q) ratio significantly increased in both groups (p<.01). In particular, ankle plantarflexors PT/BW, position sense of the knee, gait velocity, and spatial gait symmetry significantly improved in the CKC group (p<.01, p<.05, p<.01, and p<.01, respectively). Conclusion: CKC isokinetic exercise can be an effective therapeutic intervention for the improvement of sensorimotor function of the lower extremity and gait functions, such as gait velocity and symmetry. CKC position in isokinetic strength training is effective to improve functional ability in patients with chronic stroke.

• 동의신경정신과학회지
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• 제29권2호
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• pp.79-97
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• 2018

Objectives: The purpose of this systematic review was to investigate the clinical effects of neurofeedback training on reducing anxiety. Methods: Eight databases were used to extract clinical reports on neurofeedback intervention for anxiety reduction published until 2016. We analyzed the characteristics of selected studies and evaluated biases using the Risk of Bias (RoB) assessment. Results: A total of 22 clinical trials were extracted for the analysis. The risk of bias in most studies was high or unclear. The Chinese Classification of Mental Disorders-3 (CCMD-3) was the most frequently used diagnostic criteria, the Hamilton Rating Scale for Anxiety (HAMA) was the most frequently used assessment tool, and the alpha wave activity increase, sensorimotor rhythm (SMR), and theta wave training were the most frequently used intervention methods. All papers showed a statistically significant decrease of anxiety symptoms; however, significant adverse events were not reported. Conclusions: Neurofeedback intervention might be beneficial for reducing anxiety. However, the quality of the studies used in the analysis was low, and the heterogeneity of the population and interventions was revealed. Therefore, more scientifically designed clinical studies regarding neurofeedback training are required.

• The Journal of Korean Physical Therapy
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• 제24권6호
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• pp.409-413
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• 2012

Purpose: Rehabilitative devices are used to enhance sensorimotor training protocols, for improvement of motor function in the hemiplegic limb of patients who have suffered a stroke. Sensorimotor integration feedback systems, included with these devices, are very good therapeutic frameworks. We applied this approach using electrical stimulation in stroke patients and examined whether a functional electric stimulation-assisted biofeedback therapy system could improve function of the upper extremity in chronic hemiplegia. Methods: A prototype biofeedback system was used by six subjects to perform a set of tasks with their affected upper extremity during a 30-minute session for 20 consecutive working days. When needed for a grasping or releasing movement of objects, the functional electrical stimulation (FES) stimulated the wrist and finger flexor or extensor and assisted the patients in grasping or releasing the objects. Kinematic data provided by the biofeedback system were acquired. In addition, clinical performance scales and activity of daily living skills were evaluated before and after application of a prototype biofeedback system. Results: Our findings revealed statistically significant gradual improvement in patients with stroke, in terms of kinematic and clinical performance during the treatment sessions, in terms of manual function test and the Purdue pegboard. However, no significant difference of the motor activity log was found. Conclusion: Hemiplegic upper extremity function of a small group of patients with chronic hemiparesis was improved through two weeks of training using the FES-assisted biofeedback system. Further research into the use of biofeedback systems for long-term clinical improvement will be needed.

• The Journal of Korean Physical Therapy
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• 제15권3호
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• pp.202-222
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• 2003

Chronic upper extremity hemiparesis is a leading cause of functional disability after stroke. The purpose of this study were to identify effects of a 6weeks repetitive bilateral arm training on upper motor function and the reorganization of motor network. Four chronic stroke patients participated in this study. They performed for 6 consecutive weeks, 3 days a week, 30 minutes a day. In the single group study, four 5-minute periods per session of bilateral arm training were performed with the use of a custom-designed arm training machine. The results of this study was as follows. 1. Following the 6weeks period of RBAT, patient exhibited a improvement in FMA and BBT. 2. Following the 6weeks period of RBAT, it showed improvement in reaching time, symbol digit substitution and finger tapping speed of KCNT. 3. fMRI activation after RBAT showed a focal map in lesional cortical area and perilesional motor areas. These fMRI data suggest that hemodynamics response to RBAT reflect sensorimotor reorganization in contralateral hemisphere. In conclusion, these date suggest that improved upper extremity function induced by repetitive bilateral arm training after stroke is associated with reorganization of motor network as a neural basis for the improvement of paratic upper extremity function.

• The Journal of Korean Physical Therapy
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• 제27권3호
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• pp.135-139
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• 2015

Purpose: The aim of this study was to compare EEG topographical maps in patients with chronic stroke after action observation physical training. Methods: Ten subjects were recruited from a medical hospital. Participants observed the action of transferring a small block from one box to another for 6 sessions of 1 minute each, and then performed the observed action for 3 minutes, 6 times. An EEG-based brain mapping system with 32 scalp sites was used to determine cortical reorganization in the regions of interest (ROIs) during observation of movement. The EEG-based brain mapping was comparison in within-group before and after training. ROIs included the primary sensorimotor cortex, premotor cortex, superior parietal lobule, inferior parietal lobule, superior temporal lobe, and visual cortex. EEG data were analyzed with an average log ratio in order to control the variability of the absolute mu power. The mu power log ratio was in within-group comparison with paired t-tests. Results: Participants showed activation prior to the intervention in all of the cerebral cortex, whereas the inferior frontal gyrus, superior frontal gyrus, precentral gyrus, and inferior parietal cortex were selectively activated after the training. There were no differences in mu power between each session. Conclusion: These findings suggest that action observation physical training contributes to attaining brain reorganization and improving brain functionality, as part of rehabilitation and intervention programs.

• The Journal of Korean Physical Therapy
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• 제23권2호
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• pp.85-90
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• 2011

Purpose: The contribution of the supplementary motor area (SMA) to the control of voluntary movement has been revealed. We investigated the changesin the SMA for motor learning of the reaching movement in stroke patient using functional MRI. Methods: The subject was a right-handed 55 year-old woman with left hemiparesis due to an intracerebral hemorrhage. She performed reaching movement during fMRI scanning before and after reaching training in four weeks. The motor assessment scale and surface EMG were used to evaluate the paretic upper limb function and muscle activation. Results: In the fMRI result, contralateral primary sensorimotor cortex (SM1) was activated before and after training. SMA was only activated after training. In addition, muscle activation of the paretic upper limb was similar to that of the unaffected upper limb after training. Conclusion: These findings suggest SMA is related to the execution of a novel movement pattern resulting in motor learning in stroke patients.