신경계 재활의 전통적 중재와 대안적 중재 방법에 대한 문헌 고찰

심재광,최호석 한국신경근육물리치료학회(구 한국신경근육재활학회) 2015 한국신경근육재활학회지 Vol.5 No.1

This paper is a review conducted to provide an overview of the history of the past and contemporary rehabilitation methods for patient with damaged central nerves. Neurorehabilitation is a complex medical process which an aim to facilitate a recovery from a nervous system injury, and to minimize and/or compensate for functional impairments arising from it. By focusing on all aspects of a person's wellbeing, neurorehabilitation offers a series of therapies from the psychological to occupational, teaching or re-training the patients on mobility skills, communication processes, and other aspects of that person's daily routine. Current viewpoint represents a paradigm shift in clinical intervention, and clinicians have differently considered the details of intervention for the nervous and musculoskeletal impairments. Such concepts require to see the overall history of physical therapy, we interpreted the hidden meaning in the history of physical therapy. The current and future physical therapists will be to look at the patients as a comprehensive perspective. Medical instruments have continuously been developed. However, it may not be competed by senior physical therapists working for a long time in rehabilitation field. It’s probably useless to find only a way to treat a variety of patients with neurological impairments, representing optimal effects of rehabilitation, because definite answer to the therapy does not exist and their symptoms should be handled case-by-case. Thus, we need to take the advantages of functional evaluation, and they will be integrated into intervention.

건강한 성인의 하지 근력에 대한 8주간의 리컴번트 사이클의 운동 효과

배수연,전인철,황병훈,김기송,양노열 한국신경근육물리치료학회(구 한국신경근육재활학회) 2023 한국신경근육재활학회지 Vol.13 No.3

This study aimed to compare the changes in muscle strength of the hip, knee, and ankle joints by conducting the recumbent cycle (RC) in high intensity interval training (HIIT) mode for four weeks. Thirty-six healthy subjects participated in this study. The subjects were trained for 24 sessions, 40 minutes per session, and three times a week. The hip flexor strength (HFS), hip extensor strength (HES), hip abductor strength (HAS), knee flexor strength (KFS), knee extensor strength (KES), ankle dorsiflexor strength (ADS), and ankle plantar flexor strength (APS) were measured using Micro FET. Paired t-tests were used to clarify significant differences in lower extremity strength before and after training. The statistical significance level was set at α=0.05. All subjects completed all exercise sessions. The values of HFS, HES, HAS, KFS, KES, ADS, and APS were significantly greater than the muscle strengths before exercise (p<0.001). These findings suggest that training using RC in HIIT mode increases the HFS, HES, KFS, KES, ADS, and APS of the lower extremity joints.

Comparison of Knee Push-up Plus Exercise Versus Knee Push-up Plus Exercise with Isometric Shoulder Extension on Scapular Muscle Activities in Subjects with Rounded Shoulder Posture

Chi-hun Lee,Heon-seock Cynn,A-reum Shin,Seung-min Baik,Woochol Joseph Choi,Ji-hyun Lee 한국신경근육물리치료학회(구 한국신경근육재활학회) 2023 한국신경근육재활학회지 Vol.13 No.3

Excessive activity of the upper trapezius (UT) muscle contributes to a rounded shoulder posture (RSP) through abnormal rotation of the scapula that weakens the lower trapezius (LT) and serratus anterior (SA) muscles. This study compared the effects of knee push-up plus (KPP) exercise and KPP with isometric shoulder extension (KPPISE) exercise on the activities of LT, SA, and UT, and lower trapezius/upper trapezius (LT/UT) and serratus anterior/upper trapezius (SA/UT) activity ratios in subjects with RSP. Twenty subjects with RSP performed KPP and KPPISE. Electromyography was used to examine the muscle activity and a caliper, to measure the RSP. The paired t-test was used to compare the effect of KPP and KPPISE exercises on LT, SA, and UT activities, as well as LT/UT and SA/UT activity ratios in subjects with RSP. The LT and SA muscle activities significantly increased during KPPISE exercises than during KPP exercise (p=.004, p=.001; respectively). In contrast, the UT muscle activity significantly decreased during KPPISE exercise than after KPP exercise (p=.001). The LT/UT and SA/UT activity ratios increased significantly during KPPISE exercise than during KPP exercise (both p=.001). The KPPISE exercise may be an effective way to increase the LT and SA activity while reducing UT activity in subjects with the RSP.

뇌손상을 가진 편측무시 환자에게 전산화 인지재활치료가 시·공간 지각, 시야 및 집중력, 시각기억에 미치는 효과

정연규,김원철 한국신경근육물리치료학회(구 한국신경근육재활학회) 2021 한국신경근육재활학회지 Vol.11 No.3

This study aimed to compare the effects of computerized-assisted cognitive rehabilitation (CACR) and conventional rehabilitation (CR) on visuospatial perception, visual field and attention, and visual memory in patients with unilateral spatial neglect. Forty-eight patients with unilateral spatial neglect were randomly assigned to either the experimental group (n=23) or the control group (n=25). The experimental group received CACR intervention using RehaCom software, including saccadic eye movement, visual field, and visual-motor coordination training, whereas the control group received CR, including hemispheric activation approach, mental imagery training, and vibration therapy. Interventions for the experiemntal and control groups were performed for average 30 minutes, five times per week for four weeks. Outcome measures comprised Motor-free visual perception test (MVPT) and line bisection test (LBT) for visuospatial perception, visual span test (VST) for evaluating visual field and attention, and Visual recognition test (VRT) for evaluating visual memory. Evaluations were performed before and after the intervention. In between- group comparison, improvements on MVPT, VST, and VRT scroes after the intervention were statistically significantly different between the groups (p<.01). In within-group comparison, both groups showed statistically significant improvement in all variables after the intervention (p<.01). These findings suggest that the CACR may be beneficially used to enhance visuospatial perception, visual field and attention, and visual memory for patients with the unilateral spatial neglect caused by brain damage. Further studies will be needed to warrant our results.

3-Sided Virtual Reality Mild Cognitive Impairment Rehabilitation Training Platform : An Update

Ji-su Park,Dae-kil Choi,Jae-min Park,Yun-seok Choi,Jae-woo Suk,Hae-mi Ji,Tae-hyung Yoon 한국신경근육물리치료학회(구 한국신경근육재활학회) 2020 한국신경근육재활학회지 Vol.10 No.1

The purpose of this study is to examine the types and methods of virtual reality (VR) rehabilitation and their clinical effects, and to introduce recently developed VR rehabilitation methods. VR rehabilitation is largely divided into desktop type VR, third person type VR, and immersive type VR, and various companies have already introduced several such products. In addition, a VR rehabilitation method that surrounds the anterior, left, and right sides of a patient on three or all four sides have recently been introduced that has the advantage of providing a variety of sensory stimuli in an environment similar to real life. These devices vary in price, size, and sense of immersion. To date, VR rehabilitation has mainly been applied to adults with brain damage, including stroke, as well as to individuals with cerebral palsy, dementia, or mild cognitive impairment. VR rehabilitation positively contributes to improvements in their physical function, cognitive function, mental function, and daily living activities for two reasons. First, virtual reality-based rehabilitation provides continuous multisensory stimulation to the brain’s cognitive and motor areas through dynamic interaction with an environment similar to real life. This can positively contribute to the improvement of cognitive, physical, and mental functions through a direct effect on brain restructuring or plasticity. In addition, VR rehabilitation can induce active participation in rehabilitation by evoking fun and interest in patients, using a variety of contents. Thus, active rehabilitation can not only increase the time spent participating in rehabilitation but also improve compliance, which can aid in successful rehabilitation.

문제-기반 균형 운동이 실조형 뇌성마비 아동의 기능적 수행에 미치는 영향 : 증례 보고

유성호,오덕원 한국신경근육물리치료학회(구 한국신경근육재활학회) 2020 한국신경근육재활학회지 Vol.10 No.1

The purpose of this study was to identify the effects of a problem-based balance exercise program on functional performance in ataxic cerebral palsy. A subject was 15 years old male with cerebellar ataxic cerebral palsy caused by brain tumor. To assess changes in function, gross Motor function measure (GMFM), timed up and go test (TUG), Korean version of the scale for the assessment and rating of ataxia (K-SARA), dynamic gait index (DGI). His own problems were identified from th use of Pediatric Balance Scale. A problem- based balance exercise program consisted of four tasks: (1) standing with feet together, (2) standing with one foot in front, (3) retrieving object from floor, and (4) placing alternate foot on stool. A subject performed this exercise program for average 30-min per day, three days weekly for four weeks (a total of 12 sessions). Values of the GMFM. TUG, K-SARA, and DGI appeared to be noticeably improved after the intervention. These findings indicate that problem-based balance exercise program might be helpful to improve balance function of children with cerebellar ataxia. The problem-based balance exercise based on performance was clinically feasible to facilitate a recovery of the balance and motor function of cerebellar ataxia children with cerebral palsy. Further studies need in this field.

수정된 퀸즈칼리지 스텝 검사의 최대산소 섭취량에 대한 상관관계 분석

김진섭 한국신경근육물리치료학회(구 한국신경근육재활학회) 2020 한국신경근육재활학회지 Vol.10 No.1

The purpose of this study was to find correlations among the Queen’s college step test, modified Queen’s college step test, graded exercise test to predict 85% VO2max. Sixteen University students volunteered for this study. All participants were assessed by three tests. The data were analyzed using one way repeated analysis of variance, and Pearson product moment correlation. The results revealed that estimated VO2max values were significantly different among the three assessments (p<.05). In post-hoc test, the Queen’s college step test value was higher than other two tests. However, there was no significant difference between modified Queen’s college step test and graded exercise test (p>.05). In addition, graded exercise test had a significant correlation with the modified Queen’s college step test (p<.05). Therefore, modified Queen’s college step test may be considered as an appropriate assessment tool to predict submaximal oxygen consumption of normal adults.

앉은 자세에서 일어나 걷기 훈련이 만성 뇌졸중 환자의 발목 선행적 자세 조절과 다중 과제 수행력에 미치는 효과 : 사례군 연구

박재만 한국신경근육물리치료학회(구 한국신경근육재활학회) 2020 한국신경근육재활학회지 Vol.10 No.1

Sit-to-walk (STW) movement is a complex task characterized by starting one step before reaching a full standing posture and maintaining the body moment forward until the end of the movement. The purpose of this study was to provide an efficient interventional perspective in close proximity to daily life for improving the function of patients with chronic stroke by providing information on the positive effects of sit-to-walk training. Two patients with chronic stroke volunteered for this study. The STW training fior Subject 1 and the sit-to-stand training for Subject 2 were performed an average 30 minutes per day, 3 times a week for 4 weeks (a total of 12 sessions). Measurements included electromyographic analysis (muscle activity and onset time) on vastus medialis, bicepps femoris, tibialis anterior, and soleus, and timed up and go (TUG) test. With respect to anticipatory postural adjustments before and after training, the tibialis anterior muscle onset time of Subject 1 and 2 decreased from 1.09 to .63 seconds and from 2.46 to 1.25 seconds, respectively. In relation to multi-task performance, the TUG test with a motor task decreased by 5.90 seconds for Subject 1 and 12.03 seconds for Subject, respectively. These findings suggest that the STW training might be considered as a part of functional movement re-education close to everyday life in rehabilitation programs of stroke patients and as higher difficulty training.

경도인지장애와 일반 고령자의 보행조건에 따른 하지의 관절간 보행 동역학과 지절내 협응비교

김택훈,이준영 한국신경근육물리치료학회(구 한국신경근육재활학회) 2023 한국신경근육재활학회지 Vol.13 No.3

This study was suggested that speed, variability of gait variables could be used to predict mild cognitive impairment (MCI). The slow gait speed was also thought to be a risk factor for cognitive impairment, including MCI. The variability provides flexibility when adjusting to perturbations in the environment and is fundamental to changing coordination patterns during locomotion. The purpose of this study was to investigate the differences in lower extremity joint coordination, gait variability, and gait dynamics compared to normal elderly people, and to confirm the possibility of early diagnosis of MCI. In the walking speed of MCI decreased significantly in outdoor walking compared to indoor walking, and there was a decrease in the range of motion of each joint in the gait cycle in the MCI than in the 40s group. In the knee and ankle joint, there was difficulty in phase shift between or within the gait cycle. The cross-correlation coefficient of the gait cycle during this period was significantly low. In the comparison of hip and knee joint coordination between groups, there was a decrease in joint coordination in the MCI, and the variation of hip-knee angle plot within the each groups was high in the MCI. The cognitive impairment can be decreased gait speed, decreased joint coordination, and increased gait variability, especially in outdoor environments.

그라스톤을 이용한 연부조직가동술과 근에너지기법이 발목관절 가동성과 장딴지근 깃각 및 압통에 미치는 영향

한바다,심재훈,이형렬 한국신경근육물리치료학회(구 한국신경근육재활학회) 2020 한국신경근육재활학회지 Vol.10 No.1

This study aimed to identify alterations in the pennation angle of the gastrocnemius, active ankle dorsiflexion range-of-motion and pressure pain threshold in response to passive stretching(PS), instrument assisted soft tissue mobilization (IASTM) using Graston, and muscle energy technique (MET). Twenty-four people with no orthopedic or neurological diseases volunteered to participate in the study. Their both legs were allocated either the PS, IASTM, or MET groups, 16 in each. Outcome measure included the pennation angle of the gastrocnemius, active ankle dorsiflexion range-of-motion and pressure pain threshold. Intervention was a 4 repetitions of 30-sec stretch for the PS group, a 2-min sweeping the soft tissue for the IASTM, and a 8 repetitions of isometric contraction and 7-sec relaxation for the MET group. As a result of this study, pre- and post-treatment changes in the pennation angle and range-of-motion were significantly different for the three groups(p<.01). Pre- and post-treatment changes in the pressure pain threshold were significantly different for the IASTM and MET groups(p<.05). But not different for the PS groups(p>.05). There were found statistically significant differences in the active ankle dorsiflexion ROM between the PS group and the others.(p<.05). This study suggests that IASTM and MET are more recommended than PS to increase the active ankle dorsiflexion ROM effectively.