뇌신경재활 영역에서 치매의 이해와 역할

김연희 대한뇌신경재활학회 2015 뇌신경재활 Vol.8 No.1

Dementia is defined as a primary decline of intellect and/or comportment due to a structural and chemical brain disease to the point that customary activities of daily living (ADLs) become compromised. Korean society is rapidly becoming an aging society where average age increases, and dementia is becoming more prevalent. Therefore, prevention, early de- tection, and proper management of dementia patients are health- and social-care priorities of Korean society. Neurorehabilitationist means a specialist for rehabilitative care of neurologically compromised patients including stroke, traumatic brain injury, degenerative brain disease, and dementia. However, the role of neurorehabilitationists for the diag- nosis and treatment of dementia are not well established compared to that of neurologist and psychiatrist. Therefore, this article deals a role of neurorehabilitationist for proper management of patients with dementia in a way that preventing the functional deterioration as well as reduction of national welfare burden.

저산소성 허혈성 뇌손상 후 재활치료

이자호,오병모 대한뇌신경재활학회 2014 뇌신경재활 Vol.7 No.1

The number of survivors after hypoxic-ischemic encephalopathy has been increasing due to recent progressin medical system and care. Impairment after injury ranges from mild memory deficit to vegetative stateor death. Cognitive impairment is particularly common in the survivors, because the hippocampus andmedial temporal lobe are vulnerable to ischemic insult. Medication and cognitive rehabilitation shouldbe initiated to minimize the impact of various cognitive deficits. Instead of Glasgow-Pittsburgh CerebralPerformance Categories, which is insensitive to functional change, standardized functional assessmenttools should also be used in research as well as in rehabilitation settings.

아급성기 뇌졸중 환자에서의 상지 재활 로봇 치료의 효과

주민철,박효인,노세응,김지희,김현준,장철환 대한뇌신경재활학회 2014 뇌신경재활 Vol.7 No.2

Objective: To investigate the effects of robot-assisted arm training on motor and functional recovery of upper limb in patients with subacute stroke. Method: Thirty one subacute stroke patients were randomly divided into 2 groups. Robot-assisted arm training group received robot-assisted therapy using ArmeoⓇSpring (Hocoma Inc., Zurich, Switzerland) for thirty minutes per day and five times every week during four weeks while control group received conventional arm training with same duration and frequency as robotic group. Outcome measures were used manual muscle test (MMT) for motor strength, Fugl-Meyer assessment (FMA), Manual function test (MFT) for arm function, Korean-modified Barthel index (K-MBI) for activities of daily living, Korean-mini mental state examination (K-MMSE) and Computerized Neuro-Cognitive Function test software-40 (CNT-40) for cognitive function. All recruited patients underwent these evaluations before and after four weeks robot-assisted arm training. Results: Robot-assisted training on upper limb after subacute stroke showed improvement on motor strength, arm function, and activities of daily living. But change values in terms of MMT, FMA, MFT, K-MBI exhibited a no statistically significant difference compared with conventional group (p>0.05). Conclusion: In patients with upper limb deficits after subacute stroke, Robot-assisted arm training was considered to facilitate motor and functional recovery of upper limb. But robot-assisted arm training did not significantly improve motor and arm function at 4 weeks compared with conventional arm training group. Further research is required about the comparison of conventional rehabilitation therapy group and the questions about the duration, severity of stroke.

메타가소성 개념

유우경 대한뇌신경재활학회 2014 뇌신경재활 Vol.7 No.1

The concept of metaplasticity entails a change in the physiological or biochemical state of synapsesthat alters their ability to generate synaptic plasticity by integrating individual synaptic events. Thecharacteristics of metaplasticity would be the fact that those synaptic changes last in certain periodtime with association of activity in time, homosynaptically or heterosynaptically. Recently introducednon-invasive brain stimulation enables us to observe the metaplastic changes in vivo, which would giveus a insight in developing new effective therapeutic approach based on synaptic plasticity andmetaplasticity.

편마비환자에서 로봇 보조 상지 재활치료의 효과

서한길,범재원,오병모,한태륜 대한뇌신경재활학회 2014 뇌신경재활 Vol.7 No.1

Objective: To investigate the effects of short-term robot-assisted upper limb training on hemiplegicpatients compared to conventional physical therapy. Method: This study was a prospective, single-blinded, randomized controlled trial. Eighteen hemiplegicpatients due to brain lesions were randomly assigned to: (1) robot-assisted upper limb training andconventional upper limb physical therapy for 30 min a day, respectively (Robot group); or (2) conventionalupper limb physical therapy for 30 min twice a day (Conventional group). All interventions were providedfor 2 weeks, 5 times a week. Each patient was evaluated at pre- and post-treatment by the Fugl-Meyerassessment-upper extremity (FMA-UE), Jebsen hand function test (JHFT), grip power, modified Barthelindex-upper extremity (MBI-UE), line bisection test, and Albert test. Results: The Robot group showed significant improvement in FMA-UE (pre: 13.22 ± 14.20, post: 21.67± 15.84; p = 0.018), MBI-UE (pre: 14.33 ± 7.42, post: 16.56 ± 6.95; p = 0.041), and line bisectiontest (pre: 25.15 ± 34.48, post: 14.93 ± 28.38; p = 0.043). The Conventional group showed significantimprovement only in MBI-UE (pre: 9.22 ± 6.06, post: 15.56 ± 6.19; p = 0.008). The improvementin MBI-UE was larger in the Conventional group than Robot group (6.33 ± 3.28 vs. 2.22 ± 2.49; p= 0.014). Conclusion: This study suggests that short-term robot-assisted upper limb training may improve upperlimb function in hemiplegic patients. However, proper physical therapy may be needed to transferimproved upper limb function to activity of daily living. In addition, goal-directed reaching tasks usinga robot are expected to be a treatment option for hemineglect.

Morning Walk®-Assisted Gait Training Improves Walking Ability and Balance in Patients with Ataxia: a Randomized Controlled Trial

Chul Jung,김대열,권사라,전민호,김자영,Sung Hyun Kim 대한뇌신경재활학회 2020 뇌신경재활 Vol.13 No.3

This study aimed to investigate walking ability and balance improvement of patients with ataxia caused by brain lesions after end-effector type robot (Morning Walk®)-assisted gait training. This study randomly assigned 19 patients to one of two groups: 30 minutes of Morning Walk® training with 1 hour of conventional physiotherapy (Morning Walk® group; n = 10) or 1.5 hours of conventional physiotherapy (Control group; n = 9). Five treatment sessions per week were given for 3 weeks. The primary outcomes were walking ability and balance, which were assessed by the functional ambulation category (FAC) and Berg Balance Scale (BBS), respectively. The secondary outcomes included 10-meter Walk Test (10mWT), Rivermead Mobility Index (RMI), Motricity Index (MI), and Modified Barthel Index (MBI). At baseline, there was no statistically significant difference between the two groups except MBI. After the treatment, the Morning Walk® group showed significant improvement in the FAC, BBS, 10mWT, RMI and MBI. The control group showed significant improvement in the BBS, 10mWT, RMI and MBI. Inter-group comparison demonstrated that the ∆FAC, ∆10mWT and ∆RMI of the Morning Walk® group were significantly higher than those of the control group. Our results suggest that the patients with ataxia receiving Morning Walk®-assisted gait training might improve greater in walking ability and balance than those trained with conventional physiotherapy.

치매의 인지재활

이주강 대한뇌신경재활학회 2015 뇌신경재활 Vol.8 No.1

Cognitive rehabilitation refers to the cognition-based approaches that aim to induce people with cognitive impairment to achieve or maintain an optimal level of psychological and social functioning. Many models and definitions of cognitive rehabilitation exist. In this review, cognitive rehabilitation would be briefly reviewed as three categories; cognitive stim- ulation, cognitive training and cognitive rehabilitation. Cognitive stimulation is a range of group activities and discussions targeting general enhancement of cognitive and social functioning. Cognitive training is guided practice of standardized cognitive task-sets according to the individual levels. Cognitive rehabilitation is an individual approach using rehabilitation strategy for cognitively disabled person. Goal-setting is essential and emphasis is on improving performance in everyday life.

뇌졸중 환자에서 로봇 보조 상지 재활의 임상적 결과·

김정수,박시운,이용석,서효진 대한뇌신경재활학회 2015 뇌신경재활 Vol.8 No.1

Objective: We conducted a retrospective data analysis to review the results of robot-assisted arm rehabilitation in post stroke patients during past 2 years and find out positive influences of the outcomes. Method: We measured improvements of arm function longitudinally in a group of sixty-four stroke patients, who partici- pated in the robot-assisted arm therapy from January 2012 to December 2013. Treatment session lasted 30 to 40 minutes, 2 to 5 times a week. For at least more than one month, we used the InMotion2.0 (Interactive Motion Technologies, Watertown, MA, USA) and measured outcomes with the Fugl-Meyer assessment-upper extremity (FMA-UE), Korea-modified Barthel index (K-MBI) and InMotion robot arm evaluation index. Also, analysis on the subgroup was carried out. Results: Following the robot-assisted arm rehabilitation, FMA-UE, K-MBI and InMotion robot arm evaluation index were significantly improved compared to baseline. Mean FMA-UE and K-MBI gain were 4.22 ± 0.76, 7.63 ± 1.18 in each. However, in the subgroup analysis, the group with less intensity treatment (640 repetition) did not show any significant improvement. Conclusion: This is an observational study showing improvements in arm function following robot-assisted arm re- habilitation compared to baseline, which was significant only in the subgroup who received the intervention longer and more intensity.

Pelizaeus-Merzbacher Disease with PLP1 Exon 1 Duplication, Previously Misdiagnosed as Cerebral Palsy: a Case Report

Lee Su Ji,Kim Tae Yong,Hong Seungbeen,Byun Justin,조성래 대한뇌신경재활학회 2021 뇌신경재활 Vol.14 No.2

Pelizaeus-Merzbacher disease (PMD) is a X-linked recessive disorder with dysmyelination in central nervous system caused by proteolipid protein 1 (PLP1) gene mutation. We report a case of PMD with PLP1 exon 1 duplication, previously misdiagnosed as cerebral palsy (CP). A 25-year-old male previously diagnosed as CP visited our clinic with progressive weakness and spasticity of bilateral lower limbs. Next generation sequencing revealed hemizygous duplication of exon 1 in PLP1. Additionally, multiplex ligation-dependent probe amplification assay of the patient's mother showed the same mutation, which could finally confirm the diagnosis as PMD. This patient received comprehensive rehabilitation program, and helped the patient to achieve functional improvement. Proper diagnosis and therapeutic plan will be needed for the patients with PMD, before diagnosing CP rashly.

Treatment and Rehabilitation for Traumatic Brain Injury: Current Update

Min Ji Hong,신용일 대한뇌신경재활학회 2022 뇌신경재활 Vol.15 No.2

Traumatic brain injury (TBI) is an acquired injury to the brain caused by external mechanical forces, which can cause temporary or permanent disability. TBI and its potential long-term consequences are serious public health concerns. This review seeks to provide updated information on the current methods of management of patients with TBI to improve patient care.