• 대한물리치료과학회지
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• 제27권1호
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• pp.1-8
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• 2020

Background: This study analysed the effect of the fall prevention education activities on balance, fall efficacy, activities of daily living (ADL) of sub-acute stroke patients. Design: Randomized controlled trial. Methods: The subjects of the study were 24 subacute patients, who have onset period of less than 6 months. They are randomly allocated in the conventional therapy group (n=12) and fall prevention education group (n=12) and observed with frequency for 5 times a week for four weeks. Measuring took place before and after the experiment leading to following results of the Fall efficacy scale (FES), Berg balance scale (BBS) and Functional Independence Measure (FIM). Results: FES, BBS and FIM score was significantly greater in the post-test than in the pre-test in both groups (p<0.01). Independent t-test confirmed that the fall prevention education group showed much greater improvement change in the FES, BBS and FIM score than conventional therapy group (p<0.05). Conclusion: The present study demonstrated the importance of clinical contribution of the fall prevention education in the individuals with subacute stroke patients to the balance, fall efficacy and ADL following the stroke rehabilitation.

• Physical Therapy Rehabilitation Science
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• 제3권1호
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• pp.7-12
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• 2014

Objective: The purpose of this study was to investigate the effects of a three dimensional balance trainer in combination with a video-game system and visual feedback on balance recovery and gait function in subacute stroke patients. Design: Randomized controlled trial. Methods: Twenty-three subacute stroke patients were assigned to either an experimental (n=12) or a control group (n=11) using a random permuted block design and sealed envelopes. The experimental group received additional 3-dimensional balance training combined with visual feedback and a game program for 30 min/day, 5 days/week for 4 weeks. Both groups received 30-min of conservative physical therapy sessions based on neurodevelopmental therapy. Before and after the 20 sessions, walking abilities were evaluated by the the GaitRite system and balances were evaluated using the Berg Balance Scale (BBS). The Trunk Impairment Scale (TIS) was used to assess trunk muscle performances. Results: After the 4-week intervention, BBS and TIS scores were significantly increased in both groups (p<0.05), and increases in these scores were significantly greater in the experimental group (p<0.05). After the 4-week intervention, gait speed and cadence were significantly increased in both groups (p<0.05), and as was observed for BBS and TIS scores, changes of gait speed and cadence were significantly greater in the experimental group (p<0.05). Conclusions: The study shows that the 3-dimensional balance trainer combined with visual biofeedback and a video-game system provides a therapeutic means for improving balance and gait ability in subacute stroke patients.

• PNF and Movement
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• 제18권1호
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• pp.23-34
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• 2020

Purpose: To explore the effects of action observation combined with modified constraint-induced movement therapy on upper-extremity function and the activities of daily living in subacute stroke patients. Methods: Twenty-four subacute stroke patients were randomly assigned to the experimental group or the control group (n = 12 each). Both groups received therapy based on motor learning concepts, including repetitive and task-specific practice. The experimental group watched video clips for 10 minutes related to tasks performed during modified constraint-induced movement therapy while the control group watched videos unrelated to upper-extremity movement. These programs were performed for 40 minutes a day five times a week for four weeks. Their scores on the Fugl-Meyer assessment of upper extremities (FMA-UE), the action research arm test (ARAT), a motor activity log (amount of use [AOU] and quality of movement [QOM]), and the modified Barthel index (MBI) were recorded. Results: In both groups, all variables were significantly different between the pre-test and post-test periods (p < 0.05). The post-test variables were significantly different within each group (p < 0.05). In the experimental group, the changes between pre-test and post-test scores in the FMA-UE (14.39 ± 4.31 versus 6.31 ± 4.63), the ARAT (16.00 ± 4.73 versus 11.46 ± 3.73), MAL-AOU (1.57 ± 0.15 versus 1.18 ± 0.28), and MBI (27.54 ± 4.65 versus 18.08 ± 8.52) were significantly higher than those of the control group (p < 0.05). Conclusion: These findings suggest that action observation combined with modified constraint-induced movement therapy may be a beneficial rehabilitation option to improve upper-extremity function in subacute stroke patients with moderate impairment.

• 융합정보논문지
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• 제9권5호
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• pp.172-179
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• 2019

본 연구는 가상현실 게임기반을 이용한 훈련이 아급성기 뇌졸중환자의 균형 및 상지기능에 미치는 영향에 대하여 알아보기 위하여 실시하였다. 아급성기 뇌졸중환자 30명을 가상현실 게임기반 훈련프로그램을 적용한 실험군(n=15)과 대조군(n=15)으로 무작위 배정하였다. 중재는 6주간 주 3회, 1회당 30분씩 적용하였다. 대상자의 기능 향상정도를 평가하기 위하여 중재 전 후 균형능력과 상지기능을 평가하였다. 연구결과 실험군에서 균형능력과 상지기능(FMUE), 체간 장애척도(TIS)에 유의한 향상이 있었으며(p<.05), 두 그룹 간 차이는 버그균형척도(BBS), 일어나 걷기(TUG), 체간 장애척도(TIS)에서 유의한 차이가 있었다(p<.05). 이러한 결과를 바탕으로 가상현실 게임기반 훈련 프로그램은 아급성기 뇌졸중환자에게 임상적으로 유익한 운동프로그램이라 할 수 있다.

• 중환자간호학회지
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• 제14권1호
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• pp.50-62
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• 2021

Purpose : This study examined the effects of an integrated management program on physical function, cognitive function, and depression in patients with subacute stroke. Methods : A nonequivalent control group design was adopted. The participants were assigned to either the experimental group (n=20) or control group (n=23). The experimental group received an 8-week integrated management program and standard rehabilitation service (i.e., physical therapy and occupational therapy), while the control group received the standard rehabilitation service only. Physical function was measured as gait speed and balance ability using the Berg Balance Scale (BBS). Cognitive function was measured with neuro-behavioral cognitive status examination (NCSE), and depression was measured using the Beck Depression Inventory-II (BDI-II). Repeated measure ANOVA was used to determine changes in physical function, cognitive function, and depression over 8-weeks. Results : The interaction between group and time was significant, indicating that the experimental group showed improvement in gait speed, balance ability, cognitive function (linguistic ability, linguistic memory, reasoning), and a decrease in depression compared to the control group. Conclusion : These results indicate that the integrated management program developed herein was beneficial in restoring physical function, cognitive function, and depression in subacute stroke patients.

• 대한물리의학회지
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• 제8권2호
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• pp.245-252
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• 2013

PURPOSE: The aim of this study is to verify the effectiveness of modified constraint-induced movement therapy(mCIMT) on upper function and activities of daily living in people with subacute stroke patients. METHODS: Eighteen participants, with subacute stroke that were randomly assigned to either the experimental group(n=9) or the control group(n=9). For subjects from the experimental group modified Constraint-Induced Movement Therapy was performed. exercise program, the patient trained in affected side upper extremity with restricted non-affected side for 1 hour and using in activity daily living for 4 hours for five times per week, during 4 weeks. For subjects from the control group, conventional upper extremity training was performed. Outcomes such as the box and block test(BBT), Fugl-Meyer motor function assessment(FMA), and modified Barthel index(MBI) were measured before and after training. Between-group and within-group comparisons were analyzed by using Independent t-test and Paired t-test respectively. RESULTS: These finding suggest that experimental group was significant increase in BBT, FMA, MBI(p<.05). In comparison of two group, experimental group was high upper function and activity daily living than control group. CONCLUSION: This study showed experimental group can be used to improve upper function and activity daily living than control group. Thus it indicates that mCIMT will be more improved through the continued upper extremity exercise program.

• Annals of Clinical Neurophysiology
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• 제1권2호
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• pp.99-105
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• 1999

Background and Objectives : The Motor evoked potentials (MEP) study may be useful in the evaluation of the degree of impairment in the motor nervous system and in the determination of the prognosis. The purpose of this study is to evaluate the status of central nervous system in acute and subacute state of cerebral ischemia by comparing the changes of MEP in the initial and follow-up study. Methods : Twenty patients with hemiparesis caused by ischemic stroke were recruited for this study. We tested MEP within 7 days and followed-up after 14 days after symptom onset. The cerebral motor cortex area, cervical area for upper extremity and lumbar area for lower extremity were stimulated by transmagnetic stimulator. The central motor conduction time(CMCT) was measured with the difference in MEP caused by stimulating the vertical area and spinal area. The CMCT of hemiparetic patients were classified into three groups-normal, delayed, and no evoked MEP groups. Results : The CMCT in hemiparetic side of acute ischemic stroke patients were singnificantly delayed (P < 0.05) compared with the control group. The CMCT of hemiparetic side in the follow-up study showed no sinificantly difference in comparison to the control group. The prognosis of motor improvement was better in the groups of delayed MEP than the groups of no evoked MEP. Conclusion : The CMCT of hemiparetic and contralateral sides were delayed in acute ischemic stroke, compared with control group and were returned to normal boundaries in subacute state. But in the most cases with no MEP response in the initial study, also showed no MEP response in the follow-up study. The recovery occurred in the subacute state in cases with mild hemiparesis, whereas recovery did not occur in the subacute stage in case with severe hemiparesis.

• Annals of Clinical Neurophysiology
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• 제14권2호
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• pp.64-71
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• 2012

Background: It is generally accepted that upper motor neuron (UMN) lesion can alter lower motor neuron (LMN) function by the plasticity of neural circuit. However there have been only few researches regarding the axonal excitability of LMN after UMN injury especially during the acute stage. The aim of this study was to investigate the nerve excitability properties of the LMNs following an acute to subacute supratentorial corticospinal tract lesion. Methods: An automated nerve excitability test (NET) using the threshold tracking technique was utilized to measure multiple excitability indices in median motor axons of 15 stroke patients and 20 controls. Testing of both paretic and non-paretic side was repeated twice, during the acute stage and subacute stage. The protocols calculated the strength-duration time constant from the duration-charge curve, parameters of threshold electrotonus (TE), the current-threshold relationship from sequential sub-threshold current, and the recovery cycle from sequential supra-threshold stimulation. Results: On the paretic side, compared with the control group, significant decline of superexcitablity and increase in the relative refractory period were observed during the subacute stage of stroke. Additionally, despite the absence of statistical significance, a mildly collapsing in ('fanning in') of the TE was found. Conclusions: Our results suggest that supratentorial brain lesions can affect peripheral axonal excitability even during the early stage. The NET pattern probably suggests background membrane depolarization of LMNs. These features could be associated with trans-synaptic regulation of UMNs to LMNs as one of the "neural plasticity" mechanisms in acute brain injury.

• PNF and Movement
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• 제19권3호
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• pp.351-359
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• 2021

Purpose: This purpose of this study was to investigate the effects of initial cognitive status on the recovery of functional status in patients with subacute stroke. Methods: The participants were 111 patients with subacute stroke, divided into two groups: mini-mental state examination (MMSE) <20 (n=49) group and MMSE ≥20 (n=62) group. Clinical evaluation scores were collected before and after rehabilitation. The repeated measurements ANOVA was used to confirm the changes in functional status before and after intervention in the two groups. Changes in functional status within the group were examined through a paired test. A Pearson correlation coefficient analysis was performed to identify the correlation between MMSE change amount and functional status score. Results: In each of the two groups, according to the initial cognitive status, the clinical evaluation score increased statistically significantly, but there was no difference between the two groups in the degree of significant increase. When examining the correlation between the MMSE change amount, according to the initial cognitive state and the functional state score change amount, it was found, only in the group with MMSE <20, that the larger the change in the MMSE score, the greater the functional state change of Berg balance scale, Rivermead Mobility Index, and motor assessment scale. This did not apply to the group with MMSE ≥20. Conclusion: Initial cognitive status should be considered when setting the patient's goal, and considering cognitive improvement when constructing a rehabilitation program is thought to have a positive effect on rehabilitation services.

• 대한물리의학회지
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• 제18권3호
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• pp.55-64
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• 2023

PURPOSE: Examine the effects of auditory feedback and functional electrical stimulation on balance, walking ability, and lower extremity function of subacute stroke patients. METHODS: Twenty-seven subjects diagnosed with subacute stroke within six months were randomly divided into three groups: test group 1, which performed walking exercises with auditory feedback and functional electrical stimulation; test group 2, which performed walking exercises only with functional electrical stimulation; control group applied only functional electrical stimulation, with nine subjects each. RESULTS: There were significant pre- to post-intervention differences in BBS in the gait training group with auditory feedback and functional electrical stimulation treatment, and significant pre- to post-intervention differences in BBS, sit-to-stand time, and average step speed in the gait training group with functional electrical stimulation, but no statistically significant differences in between-group comparisons. CONCLUSION: Gait training with auditory feedback and functional electrical stimulation can improve the balance and gait performance in stroke patients. Therefore, in the future, gait training with auditory feedback and functional electrical stimulation therapy may be suggested as a gait rehabilitation training tool for stroke patients.