뇌졸중 환자의 상지 움직임 시 기저면의 넓이에 따른 체간 근육의 선행적 자세 조절과 자세 안정성에 관한 연구

김보람 대구가톨릭대학교 대학원 2016 국내석사

The purpose of this study is to investigate electromyographic characteristics of anticipatory postural adjustment, posterior and anterior trunk muscles and the movement of center of gravity (COG) according to the different widthes in the base of support (BOS) during the performance of non-paretic upper limb flexion tasks, in subjects with hemiparesis after stroke. 30 hemiplegia patients volunteered to participate in this study. Movement were performed for 10 trials during each of various widths of BOS (shoulder - width double leg stance, narrow base double leg stance, tandem stance) at 1.2Hz frequency. Electromyography was used to determine muscle activation and Biorescue was used to measure characteristics of the movement of COG. Surface bipolar electrodes were applied over the non-paretic side deltoid anterior, non-paretic side latissimus dorsi, both rectus abdominis, both internal oblique, both erector spinae. The Data were analyzed by repeated one-way ANOVA, Duncan’s post hoc test and Person’s correlation coefficient, and paired t-test. The result were as follows: 1) There were significant difference with two muscles activation time in each BOS(p<0.05). 2) There were significant difference with characteristics of the COP in each BOS (p<0.05). 3) There were significant correlation with the trunk muscles activation time between non-paretic side and paretic side(p<.005). The erector spinae muscle was faster activation time on the contralateral side than on the ipsilateral side to the flexing arm. Rectus abdominis, Internal oblique muscles was more activation time on the ipsilateral side than on the contralateral side to the flexing arm. On the other hand, The erector spinae muscle was faster activation time on the ipsilateral side than on the contralateral side to the extensing arm. Rectus abdominis, Internal oblique muscles was more activation time on the contralateral side than on the ipsilateral side to the extensing arm. The results of study show that individuals with stroke demonstrated a delay of APAs in the muscles on both sides of the body, and the width of the BOS influences on recruitment and anticipatory postural adjustment of trunk muscles.

엎드린 교각운동 자세와 네발기기 자세에서 견갑골 전인 운동 시 견갑골 익상 유무에 따른 전거근과 체간 근육의 근활성도 비교

김희곤 대구대학교 2016 국내석사

Recently, trunk stabilization exercises have been attracting a lot of interest with regard to the shoulder; however, the evidence is insufficient. This study was conducted to determine the impact according to the difference of lifting legs during scapular protraction in prone-bridge position and quadruped position as a typical lumbar stabilization exercises for subjects with winging scapula. Forty subjects (20 healthy adults, 20 winging scapula) participated in the experiment. Surface EMG records were collected from upper trapezius muscle, serratus anterior muscle, the ratio of serratus anterior and upper trapezius activation(SA/UT), right and left external oblique and internal oblique muscle. The presence or absence of scapular winging was measured using an electronic digital caliper to determine the distance for scapula medial border to be lifted to the rear. Both the two groups respectively conducted two leg support, lifting the leg on the dominant side, lifting the leg on the non-dominant side, including scapular protraction in quadruped position and prone-bridge position. To compare the muscle activity difference according the difference in lifting legs in the two groups, two-way ANOVA was used. To compare the individual groups according to their conditions, two-way ANOVA was also used. To find out the differences between the two groups as a result of the two-way ANOVA, the Bonferroni correction was used(α=0.017). The statistical significance level α was set at 0.05. The results of this study found that in the comparison between the two groups, the winging scapula group showed a significant decrease in the ratio of serratus anterior and upper trapezius activation(SA/UT), whereas a significant increase in upper trapezius and internal obliques. Healthy adults exhibited no significant difference in the ratio of serratus anterior and upper trapezius activity(SA/UT); however, the winging scapula group revealed an significant increase during the lifting of the leg on the dominant side. In addition, the lifting of the leg on the dominant side found the highest muscle activity in serratus anterior muscle, external oblique muscle on the dominant side, and internal oblique muscle on the non-dominant side. The muscle activity of shoulder and trunk muscles significantly increased more in prone-bridge position than in quadruped position. Thus, from the results, scapular protraction and lifting the leg on the same side are considered to be the most efficient movement to subjects with winging scapula. In addition, the appropriate interaction of external and internal oblique muscles is believed to have a positive impact on subjects with winging scapula. 최근 어깨와 관련하여 체간 안정화 운동이 관심을 받고 있으나 근거는 많이 부족한 실정이다. 본 연구의 목적은 익상 견갑골을 가진 대상자에게 일반적인 허리 안정화 운동인 엎드린 교각운동 자세와 네발기기 자세에서 견갑골 전인 운동을 할 때 다리 들기 차이에 따른 전거근과 체간 근육에 미치는 영향을 알아보기 위해 실시되었다. 정상성인 20명과 익상 견갑골을 가진 대상자 20명이 실험에 참여하였다. 표면 근전도 기록은 견갑골 전인 운동 동안 상부 승모근, 전거근, 전거근과 상부 승모근의 근활성비, 좌우 외복사근, 내복사근으로부터 수집되었다. 어깨뼈 익상 유무는 견갑골 내연이 후방으로 들리는 거리를 electronic digital caliper를 이용해 측정하였다. 두 그룹 모두 네발기기 자세와 엎드린 교각운동 자세에서 견갑골 전인을 포함하여 두발지지, 우세측 다리 들기, 비우세측 다리 들기를 각각 실시하였다. 두 그룹과 다리 들기 차이에 따른 근활성도 차이를 비교하기 위해 이원배치 분산분석(two-way ANOVA)을 사용하였고, 각 그룹의 조건에 따른 비교를 위하여 이원배치 분산분석(two-way ANOVA)을 사용하였다. 분산분석 결과 집단 간의 차이를 알아보기 위해 본페로니 교정(Bonferroni correction)을 사용하였다(유의수준 α=0.017). 통계학적 유의수준 α는 0.05로 하였다. 본 연구의 결과 두 그룹 간 비교에서 익상 견갑골 그룹에서 전거근과 상부 승모근의 근활성비가 유의하게 감소하였고, 상부 승모근과 내복사근의 근활성도는 유의하게 증가하였다. 정상인은 다리 들기 차이에 따라 전거근과 상부 승모근의 근활성비는 유의한 차이가 없었으나, 익상 견갑골 그룹에서는 우세측 다리를 들 때 유의하게 증가하였다. 또한 우세측 다리 들기 시 우세측 전거근과 우세측 외복사근, 비우세측 내복사근에서 가장 높은 근활성도를 보였다. 어깨 및 체간 근육의 근활성도는 네발기기 자세보다 엎드린 교각운동 자세에서 유의하게 증가하였다. 따라서, 이러한 결과를 볼 때 익상 견갑골을 가진 대상자에게 전거근 강화 목적으로 견갑골 전인 운동과 동시에 동측 다리를 드는 것이 가장 효과적인 운동으로 제시될 수 있을 것으로 사료된다. 또한 외복사근과 내복사근의 적절한 상호작용이 익상 견갑골을 가진 대상자에게 긍정적인 영향을 미칠 것으로 사료된다.

동적 균형 조절 시 체간 및 하지 근육의 활성도 변화

원미희 을지대학교 보건대학원 2011 국내석사

본 연구는 건강한 성인 남녀 20명(남 10명, 여 10명)을 대상으로 동적 균형 조절 시 측정 환경에 따른 체간 및 하지 근육의 활성도 변화를 알고자 실시하였다. 연구대상자는 실험 참여에 동의한 건강한 성인 남녀 20명을 동적 체 평형 장치를 이용해 개안(開眼)의 닫힌 사슬 상태에서 목표점이 있을 시, 개안의 닫힌 사슬 상태에서 목표점이 없을 시, 폐안(蔽眼)의 닫힌 사슬 상태에서 균형 유지 시 나타나는 체간 및 하지 근의 활성도의 비율을 측정하였다. 모든 측정 시 각각의 동작 수행 중 표면 근전도 시스템을 사용해 좌․우측의 복직근, 외복사근, 흉최장근, 다열근, 내측광근, 대퇴이두근, 내측비복근, 및 전경골근 으로부터 근 활성도를 측정하였으며, 측정 결과를 최대 수의적 등척성 수축(maximum voluntary isometric contraction; MVIC)시 생성되는 근 활성도에 대한 비율(%MVIC)로 표준화 하였다. 실험을 통해 수집된 모든 자료에 대해 Window용 SPSS 통계프로그램(Version 18.0)을 이용하여 평균과 표준편차를 산출하였고, 개안의 닫힌 사슬 상태에서 목표점이 있을 시, 개안의 닫힌 사슬 상태에서 목표점이 없을 시, 폐안의 닫힌 사슬 상태에서 균형 유지 시 각각의 근 활성도를 비교하기 위해 반복 측정 일원 변량분석(Repeated Measures One Way ANOVA)을 사용하여 근 활성도의 변화에 대한 차이를 검증하였으며, 이에 대해 Tukey의 사후검증을 실시하였다. 모든 통계적 유의수준은 α=.05로 설정하였다. 전반적으로 닫힌 사슬 상태에서의 동적 균형 조절 시 개안의 닫힌 사슬 상태에서 목표점이 있을 시와 개안의 닫힌 사슬 상태에서 목표점이 없을 시에는 유의한 차이가 없었다(p>.05). 개안의 닫힌 사슬 상태에서 목표점이 있을 시와 폐안의 닫힌 사슬 상태에서 균형 유지 시에는 좌측 외복사근, 좌․우 다열근, 좌․우 내측광근, 좌측 대퇴이두근, 좌․우 전경골근, 좌․우 내측비복근에 유의한 차이를 보였다(p<.05). 개안의 닫힌 사슬 상태에서 목표점이 없을 시와 폐안의 닫힌 사슬 상태에서 균형 유지 시 좌측 외복사근, 좌측 흉최장근, 좌․우 다열근, 좌․우 내측광근, 좌측 대퇴이두근, 좌․우 전경골근, 좌․우 내측비복근에 유의한 차이를 보였다(p<.05). 이상의 결론을 종합하여 볼 때 개안과 폐안의 동적 균형 조절 시 각각의 근육의 활성도 변화를 보였으며 이는 시각이 동적 균형에 미치는 영향을 보여주었다.

프랭크운동에서 견관절 각도에 따른 체간 근육 활성도 비교

황종하 대구가톨릭대학교 보건의료과학대학원 2014 국내석사

The purpose of this study was to investigate to compare trunk muscle activities according to shoulder anlgles while Prank exercises. Twenty five healthy individuals (15 males, 10 females) participated and performed with three conditions ; 1) 60˚ plank exercise 2), 90˚plank exercise, 3) 120˚plank exercise. The surface electromyography (sEMG) was used to measure the electrical activities of rectus abdominis (RA), external oblique (EO), internal oblique(IO), and erector spinae (ES) muscles. The repeated one-way ANOVA was used to compare the Normalized EMG activities and the level of significance was set at=0.05. The results showed that there was a significant differences rectus abdominis and internal oblique EMG activity according to shoulder angles (p<0.05). There were significant difference external oblique and rectus abdominis , internal oblique and external oblique at 60˚ and 90˚ according to the angles between muscles' activities(p<0.05). The 60˚ plank exercise and 90˚ plank exercise were enhanced external oblique. Therefore, difference shoulder's angle while plank exercises should be recommended for useful strengthening trunk muscles which individually wanted.

자세변화에 따른 플렉시-바 운동이 정상 성인의 체간 근육 활성화에 미치는 영향

정준섭 대구가톨릭대학교 2013 국내석사

The purpose of this study was to assess the effect of flexi-bar exercise and non flexi-bar exercise on trunk muscles activity according to posture change. Twenty healthy adults volunteered to participate in this study. Subjects were required to complete following flexi-bar exercise. There were three exercise postures: posture 1, quardruped posture; posture 2, side-bridge posture; posture 3, standing posture. Surface electromyography from selected trunk muscles was normalized to maximum voluntary isometric contraction. The electromyography activity of the subjects' right trunk muscles was recorded during each exercise. There was no significant difference to rectus abdominis muscle activity between flexi-bar exercise and non flexi-bar exercise (p > 0.05). The external oblique, internal oblique, erector spinae muslces activity showed significant difference between flexi-bar exercise and non flexi-bar exercise (p < 0.05). The quardruped posture showed significantly the highest activity in flexi-bar exercise. An independent t-test was used to determine the effect between flexi-bar exercise and non flexi-bar. A two way ANOVA test was used to determine the interaction according to two bar exercises and three postures. Thus, to enhance training intensity and exercise performance in trunk muscles activity, the use of tool such as flexi-bar will be useful for trunk muscles activation.

실내용 승마기구 운동 시 발목자세에 따른 체간 및 대퇴근육 근 활성도 비교 분석

노현주 대구가톨릭대학교 대학원 2015 국내석사

The purpose of this study was to assess the effects of robo-horseback riding with changes of ankle posture on muscle activities of trunk and lower limb in healthy adults. Twentynine healthy adults (13 males, 16 females) participated and performed the robo-horseback riding at two ankle postures (Dorsi flexion:DF,, neutral posture: NP). The surface electromyography (sEMG) was used to measure the electrical activities of trunk muscles (rectus abdominis [RA], erector spinae [ES]) and lower limb muscles (rectus femoris [RF], adductor magnus [AM]). The paired-t-test was used to compare the Normalized EMG activites and the level of significance was set at=0.05 The result of this study was showed that there was a significantly difference in all muscle activities were significantly higher under the DF condition than under the NP conditions in both speeds. There was a significantly muscle activity difference in each posture of execise in rectus abdominis (p<0.002), erector spine (p<0.003), rectus femoris (p<0.000) and adductor magnus (p<0.000).Therefore, this study suggests that there were significant differences in the chages of ankle posture on muscle activities of trunk and lower limb in healthy adults. DF condition can be introduced the most efficiency posture at muscle acitivities of trunk and lower limb in robo-horseback riding.

Effects of core stabilization on lumbar segmental instability in patients with low back pain

노동국 Graduate School, Yonsei University 2014 국내박사

The purpose of this study was to evaluate the differing effects of lumbar extension (LE) with and without the abdominal drawing-in maneuver (ADIM) on pain, lumbar segmental stability, and mobility in patients with mechanical low-back pain. In total, 40 participants (18 males, 22 females; mean age = 34.5 years, standard deviation = 9.1) were recruited from the outpatient unit of a local rehabilitation medicine clinic. Participants were randomly assigned to two groups: combined LE + ADIM and LE alone. The LE + ADIM and the LE groups performed 30-min sessions 3 days/week for 8 weeks, for a total of 24 sessions. All participants were tested twice, before and after the 8-week training period. Lumbar intersegmental displacement (LID), intervertebral (IV) angle, total lumbar extension (TLE) angle, abdominal muscles thickness, trunk muscle strength, core performance (CP), a visual analog scale (VAS), pain location scale (PLS), modified Oswestry Disability Index (MODI), Fear and Avoidance Beliefs Questionnaire (FABQ), and Hospital Anxiety Depression Scale (HADS) were used to evaluate lumbar segmental instability, pain, centralization pattern, and physical and psychosocial functioning. Analysis of covariance (ANCOVA) with the pre-intervention value as the covariate was used to determine group differences in pre- to post-test changes. The significance level was set at α = 0.05. LID and IV angle at L5?S1 were significantly decreased in the LE + ADIM group versus the LE group (p < 0.05). IV angles at L3?L4, transverse abdominis (TrA) muscle thickness at rest and during contraction and their ratio, the preferential activation ratio, the trunk muscle ratio, and CP were significantly increased in the LE + ADIM group versus the LE group (p < 0.05). VAS, PLS, MODI, and FABQ scores significantly decreased in the LE + ADIM group versus the LE group (p < 0.05). Thus, the results of this study suggest that LE with ADIM was more effective in decreasing peripheral pain and improving segmental core stability than was conventional LE exercise alone.

Differential effects of abdominal drawing-in maneuver, abdominal bracing, and dynamic neuromuscular stabilization on core stability and motor control in adults with core instability

이재진 Graduate School, Yonsei University 2014 국내석사

The purpose of this study was to compare the effects of the abdominal drawing-in maneuver (ADIM), abdominal bracing (AB), and dynamic neuromuscular stabilization (DNS) on core stability, diaphragm movement, abdominal muscle thickness, and external oblique (EO) electromyography (EMG) amplitude in adults with core instability. Forty-one subjects (male = 34; mean age ± standard deviation = 21.07 ± 2.34) with core instability participated in this study. The subjects performed ADIM, AB, and DNS in random order. A Simi Aktisys and Pressure Biofeedback Unit (PBU) were utilized to measure core stability, an ultrasound with 3.5㎒ was utilized to measure diaphragm movement and ultrasound with 10㎒ was utilized to measure abdominal muscles thickness and surface EMG was utilized to measure EO amplitude. A one-way repeated measures analysis of variance (ANOVA) was used to determine the statistical significance of the core stability, diaphragm movement, abdominal muscles thickness, and EO amplitude across the four test conditions (rest, ADIM, AB, DNS). The significance level was set at α = 0.05. Core stability was significantly increased in DNS and AB compared to ADIM and rest (p < 0.05). Core stability tended to increase more in DNS than AB but the change was not statistically significant. Diaphragm descending movement was significantly increased in DNS compared to ADIM and AB (p < 0.05). TrA and IO thickness were significantly increased in DNS and ADIM compared to rest and AB (p < 0.05). EO amplitude was significantly increased in AB compared to rest, ADIM, and DNS. Therefore, the results of this study suggest that DNS was the most effective technique to provide core stabilization via balanced coactivation of the diaphragm and TrA with relatively less contraction of EO.

Bringing high-temperature gas chromatography-mass spectrometry into the metabolite profiling of lipoidal hormones

정현진 연세대학교 대학원 2012 국내박사

Lipoidal hormones including steroids, fatty acids, eicosanoids, endocannabinoids and their conjugates are play important roles in energy storage, structural composition of the biological membranes, and many metabolic processes. Especially, cholesterol and its ester derivatives are main components of cell membranes, and the regulation of cholesterol homoeostasis is vital importance for cell structure and function. It is achieved through cellular responses which allow an adequate supply of cholesterol while avoiding overaccumulation, which may be toxic to the cells and cause development of cardiovascular events. To improve the feasibility of an analytical protocol for profiling of lipoidal hormones, the study was examined with the high-temperature gas chromatography-mass spectrometry (HTGC-MS) coupled to trimethylsilyl (TMS) derivatization. The simultaneous determination of steroid-fatty acid esters (SFEs), including cholesteryl esters (CEs), without de-conjugation in biological samples is one of critical issues in steroidogenesis and lipid metabolism. The HTGC-MS method showed better detectability of lipophilic compounds, in particular, SFEs and CEs, which have poor chromatographic properties on a conventional GC-MS analysis. In targeted metabolite profiling, the optimized solid-phase extraction (SPE), hybrid solid-phase extraction-protein precipitation (H-PPT) and ultrasonication were employed for minimizing matrix effects and maximizing extraction yields in profiling of lipoidal hormones from lipid-rich biological specimens such as plasma, tissue and hair. In addition, H-PPT using methanol was effective to remove phospholipids and triacylglycerides, and to increase extraction efficiencies of cholesterols and CEs. A database-dependent HTGC-MS based analysis was also developed for non-targeted metabolite profiling, focusing on 230 steroids, 24 fatty acids, 9 eicosanoids, 10 endocannabinoids, 17 SFEs and 5 CEs. This method was conducted with HTGC separation of biological metabolites, statistical clustering and an in-house database (DB) searching. The metabolite profiling of lipoidal hormones including steroids and SFEs through the developed analytical method and DB was applied for comparing and evaluating biological changes related on lipid metabolism, such as cardiovascular events and androgenic hair-loss.