뇌졸중 환자들의 한국판 Tinetti-보행 척도의 측정자간,절대적 신뢰도와 동시 타당도

안승헌 ( Seung Heon An ),이동건 ( Dong Geon Lee ),이윤복 ( Yun Bok Lee ),이규창 ( Gyu Chang Lee ) 대한물리의학회 2014 대한물리의학회지 Vol.9 No.2

PURPOSE: The purpose of this study was to investigate the inter-rater?absolute reliability and the concurrent validity of the Tinetti-gait scale that was translated into Korean for chronic stroke patients. METHODS: Fifty-two patients with post-stroke participated in this study. Inter-rater reliability was analyzed by Intraclass Correlation Coefficient (ICC3,1) and Kappa coefficient, and absolute reliability was analyzed by the Standard Error of Measurement (SEM), and the Minimal Detectable Change (MDC). Concurrent validity was analyzed by correlating between the Tinetti-gait scale and physical functions. The physical functions were measured by using the Dynamic Gait Index(DGI), 10m walking test(10WT), One Leg Standing Test of affected/non-affected side(OLST), Sit to Stand test(STS), (Fugl Meyer assessment of Lower Extremity(FM-LE). RESULTS: The inter-rater reliability of the Tinetti-gait scale was high; ICC(3,1) =.91 (95% CI=.85∼.95) (very reliable), the range of Kappa coefficient were .73∼.92 (substantial∼good). The inter-rater agreement of the each item in Tinetti-gait scale ranged from .74 to .92 (95 % CI=.59∼.95) (reliable∼very reliable). The SEM and MDC were .56 and 1.55, respectively. In the results of concurrent validity, there were moderate positive correlation between Tinetti-gait scale and DGI (r=.78), 10WT (r=.74), OLST (r=.65∼.73), FM-LE (r=67). And there was moderate negative correlation between Tinetti-gait scale and STS (r=-79) (p<.01). CONCLUSION: The Tinetti-gait scale(Korean version) was a reliable and valid tool to measure gait ability in patients with chronic stroke. Thus, it could be a useful tool for examining a gait ability of post-stroke patients. Further study should be conducted to investigate the usability to predict fall risk of post-stroke patients of the Tinetti-gait scale.

파킨슨 환자들의 질환등급, 균형, 낙상 및 보행능력 평가척도 고찰

김창환 ( Chang Hwan Kim ),김미영 ( Mi Young Kim ),임비오 ( Bee Oh Lim ) 한국운동역학회 2015 한국운동역학회지 Vol.25 No.4

Objective : The purpose of the study was to investigate and compare the differences between Parkinson``s disease rating, balance, fall and gait scales. Results : Parkinson``s disease rating scales include the Hoehn-Yahr Scale and the Unified Parkinson``s Disease Rating Scale (UPDRS). The Hoehn-Yahr Scale can measure disease rates easily; however it is not sensitive enough to evaluate the disease’s process and management. UPDRS’s advantage is in it’s higher inter-reliability score; however it is more complicated to use. Parkinson``s balance scales are comprised of the Berg Balance Scale (BBS) and the Activities-Specific Balance Confidence Scale (ABC). BBS has the advantage in that it is cheaper to measure and simple in use. ABC’s advantage is especially in it’s ability to measure higher functional levels; however it is more difficult measure responses due to scores appearing in both extremes. The Fall Efficacy Scale (FES) and The Survey of Activities and Fear of Falling in the Elderly (SAFE) are Parkinson``s fall scales. FES’s leverage over SAFE is that it is simpler to measure; however it does not coincide with responses which proves disadvantageous in measuring balance loss in high-level Parkinson``s patients. SAFE’s advantage is in it’s simpler use and ability to be utilized without encountering the fear of fall; however it’s at a disadvantage in regards to its use with multilateral aspects providing insufficient inspection. Lastly, the Dynamic Gait Index (DGI) and the Functional Gait Assessment (FGA) are Parkinson``s gait scales. DGI is advantageous in its ability to test gait ability when exposed to a variety of external environments; however it is disadvantageous in that it registers higher scores with activities. FGA’s advantage is in it’s dynamic balance test; however it at a disadvantage with those unable to walk. Conclusion : A researcher of Parkinson``s patients must choose each scale while considering their positive and negative characteristics

노인에서 Berg 균형 척도, 보행 변수, 그리고 넘어짐과의 관계

이현주,이충휘,유은영 한국전문물리치료학회 2002 한국전문물리치료학회지 Vol.9 No.3

This study examined the correlations among the Berg Balance Scale, which is a clinical tool used to evaluate balance ability, spatiotemporal parameters of gait, and falling; determined the parameters most closely related to falling; and identified a discriminatory parameter and its predictability. Thirty-four subjects aged 72 to 92 years participated in this study. Following a questionnaire survey about falling, the Berg Balance Scale and spatiotemporal parameters of gait were measured. The results revealed that the incidence of falls increased with aging and an accompanying reduction in the flexion range of motion of the hip joint. The gait characteristics of elderly people who fell easily included a slower walking speed, shorter stride, and longer stance time than other elderly. When the cutoff score was set at 45, the Berg Balance Scale was able to identify correctly those individuals who truly have experience of falling than when the cutoff score was set at 39. But when the cutoff score was set at 39, the scale's specificity identifying correctly those individuals who truly have not experience of falling was higher than at the cutoff score of 45. Therefore, the Berg Balance Scale is an appropriate screening method in a clinical setting for the early detection of elderly people at risk of falling. In conclusion, elderly people with a Berg Balance Scale score below 45 are the most likely to fall owing to their decreased balance ability.

뇌졸중 환자의 체간 조절 수준이 균형과 보행 및 기능적 수행 능력에 미치는 영향

안승헌(Seung-heon An),정이정(Yi-jung Chung),박세연(Sei-yeon Park) 한국전문물리치료학회 2010 한국전문물리치료학회지 Vol.17 No.2

The aim of this study was to investigate correlations of the Trunk Control Test (TCT), Postural Assessment Scale for Stroke (PASS-TC), and Trunk Impairment Scale (TIS) and to compare the TCT, PASS-TC, TIS and its subscales in relation to balance, gait and functional performance ability after stroke. Sixty-two stroke patients attending a rehabilitation program participated in the study. Trunk control was measured with the use of TCT, PASS-TC, TIS balance (Berg Balance scale; BBS), gait ability (10 m walk test), functional performance ability (Timed Up and Go Test; TUG) and the mobility part of the Mdified Barthel index(MBI), Fugl Meyer-Upper/Lower Extremity (FM-U.L/E). The scatter-plot (correlation coefficient) was composed for the total scores of the TCT, PASS-TC, and TIS. The multiple regression analysis was performed to evaluate the impact of trunk control on balance, gait, and functional performance ability. Twenty eight participants (45.2%) and twenty participants (32.3%) obtained the maximum score on the TCT and PASS-TC respectively; no subject reached the maximum score on the Trunk Impairment Scale. There were significant correlations between the TIS and TCT (r=.38, p

경직성 양하지 뇌성마비 아동의 소아균형검사와 보행변수 간의 상관관계

고명숙(M. S. Ko),박소연(S. Y. Park),이남기(N. G. Lee) 한국재활복지공학회 2016 재활복지공학회논문지 Vol.10 No.4

소아균형검사(Pediatric Balance Scale)는 경증이나 중증의 운동손상을 지닌 학령기 아동에게 사용할 수 있는 균형검사도구이다. 본 연구의 목적은 경직성 양하지 뇌성마비 아동을 대상으로 소아균형검사와 시공간적 보행변수간의 상관관계를 알아보고자 하였다. 소아균형검사는 앉은 자세에서 일어나기, 선 자세에서 앉기, 의자에서 의자로 이동하기, 잡지 않고 서 있기, 한 다리로 서 있기, 제자리에서 360° 회전하기, 뒤돌아보기 등 총 14개 항목으로 구성하고, 시공간적 보행변수는 보행속도 및 보폭, 보거리, 보격, 분속수, 양하지 지지 시간을 포함한다. 모든 대상자들은 독립적으로 보행이 가능한 경직성 양하지 뇌성마비 아동이며, 숙련된 소아물리치료사에 의해 소아균형검사와 시공간적 보행변수를 측정하였다. 소아균형검사와 시공간적 보행변수 간의 상관관계를 분석하기 위해 피어슨 상관분석을 사용하였고, 통계학적 유의수준은 0.05로 설정하였다. 소아균형검사의 총점(r=.49∼.58)과 세부항목 중선 자세에서 앉기(r=.48∼.60)와 선 자세에서 왼쪽/오른쪽 어깨 뒤로 돌아보기(r=.47∼.53), 선 자세에서 바닥에 물건 집어 들기(r=.52∼.69)는 보행속도와 보폭, 보거리, 분속수의 각 변수 사이에 모두 유의한 양의 상관관계를 보였으며, 소아균형검사의 대부분 항목이 양하지 지지 시간 간의 매우 높은 음의 상관관계(r=-.48∼-.92)를 보여주고 있다. 이는 소아균형검사와 시공간적 보행변수는 높은 상관관계를 가진 것을 관찰 할 수 있었으며, 소아균형검사를 통해 뇌성마비 아동의 보행수준을 예견하는데 유용하게 적용될 것이다. The Pediatric Balance Scale (PBS) was balance measurement equipment for school-age children with mild to moderate motor impairments. The aims of this study are to examine the correlation between PBS and spatiotemporal gait parameter and to identify the walking function with cerebral palsy through balance scale. The PBS consists of 14 items such as sitting of standing, standing to sitting, transfers, standing unsupported, standing on one foot, turning 360 degrees, turing to look behind, etc., and the spatiotemporal parameters include walking speed, stride length, step length, step width, cadence, double-limb support. All subjects were independently ambulatory children with spastic diplegic cerebral palsy, and they were assessed on PBS and spatiotemporal gait parameters by an experienced pediatric physical therapist. Pearson"s correlation coefficient was used to assess the correlation between PBS and spatiotemporal gait parameters, and the level of significance was set at α = 0.05. Total score of PBS(r=.49∼.58), standing to sitting(r=.48∼.60), turning to look behind(r=.47∼.53), and pick up object(r=.52∼.69) were positively correlated with walking speed, stride length, step length, and cadence. Most items of the PBS were negatively correlated with double-limb support(r=-.48∼-.92). These findings suggest that the pediatric balance scale can be applied to estimate gait function level for children with spastic diplegic cerebral palsy.

파킨슨병 환자의 임상평가척도와 관성신호 특성 간 상관성 분석

김태희,조하은,최희우,최평화,이원재,양희승,심우섭 한국정밀공학회 2023 한국정밀공학회지 Vol.40 No.7

In this study, the Inertial Measurement Unit (IMU) signals and clinical evaluation scales for Parkinson's disease were correlated. The study included 16 patients diagnosed with Parkinson's disease. Each subject was evaluated based onKorean Mini-Mental State Examination (KMMSE), Unified Parkinson's Disease Rating Scale (UPDRS) part 3, New Freezing of Gait Questionnaire (NFOGQ) parts 2 & 3, and Hoehn & Yahr Scale (H&Y). All subjects performed the Time Up and Go test by attaching IMU sensors to both ankles and torso. Based on the tilting angle of torso and the time of first step, the freezing and non-freezing windows were determined. Seven IMU features involving the ankle signals were calculated in the specific window. Spearman’s correlation analysis of clinical evaluation scales was performed. As a result, the freezing index and power of locomotion band (0.3-3 Hz) were recommended to determine UPDRS part 3. Also, the intensity of the locomotion band facilitated evaluation of NFOGQ part 3 regardless of freezing of gait.

뇌졸중 환자에서 Dynamic Gait Index와 Berg Balance Scale 및 Timed Up & Go 검사간의 상관관계

이상호,황병용,Lee, Sang-Ho,Hwang, Byoung-Yong 대한물리치료과학회 2008 대한물리치료과학회지 Vol.15 No.3

The purpose of this study was to compare the relationship among the Dynamic Gait Index(DGI), Berg Balance Scale(BBS) scores, Timed Up & Go Test(TUG), and subject characteristics. The subjects were fifteen stroke with hemiplegia were chosen in the Konyang University Hospital. Dynamic balance was measured Dynamic Gait Index(DGI), and balance was measured using Berg Balance Scale(BBS). Timed Up & Go Test(TUG) was used to evaluate functional mobility. Data were analyzed using Spearman correlation. There was significant correlated among Dynamic Gait Index(DGI), Berg Balance Scale(BBS) and Timed Up & Go Test(TUG)(p<.01). The correlation among subject characteristics and Dynamic Gait Index(DGI), Berg Balance Scale(BBS), Timed Up & Go Test(TUG) score was significant result in r = -.527 from Dynamic Gait Index(DGI) and pathogenesis(p<.05). There were no significant statistical differences among the types of spasticity and Dynamic Gait Index(DGI), Berg Balance Scale(BBS), Timed Up & Go Test(TUG). The comparison among the sex, type of hemiplegia, pain, pathogenesis and Dynamic Gait Index(DGI), Berg Balance Scale(BBS), Timed Up & Go Test(TUG) score was significant result in pathogenesis(p<.05). The results of this study showed that there was high correlations among the Dynamic Gait Index(DGI) and balance test of people with stroke.

파킨슨 환자들의 질병등급척도가 보행에 미치는 영향

김미영(MiYoungKim),김창환(ChangWhanKim),임비오(BeeOhLim) 한국체육학회 2013 한국체육학회지 Vol.52 No.4

파킨슨 환자들의 증상과 징후를 평가하는 척도 중에서, 연구적 관점에서 가장 널리 사용되는 호엔야르 척도 등급별로 실제 보행 동작에서 나타나는 보행의 변화에 관한 평가를, 보다 체계적으로 확립하기 위한 연구가 필요하다고 판단되어 본 연구를 수행하였다. 본 연구의 목적은 파킨슨 환자들의 호엔야르 척도 등급별로 보행의 차이를 규명하는 데 있다. 연구 대상자는 파킨슨 진단을 받은 50세 이상 환자 33명(등급별 11명씩)을 대상으로 보호자와 담당의사의 실험 참가 동의를 얻어 선정하였다. 파킨슨 환자의 시-공간적인 보행변인 및 발의 압력분포 변인들은 게이트라이트 보행분석 시스템을 사용하여 측정하였다. 통계적 유의성 검증은 호엔야르 등급 척도 1, 2, 3등급 3집단을 독립변인으로 하는 일원변량분석을 실시하였으며, 사후검정은 Scheffe 방식을 사용하였다. 파킨슨 환자들은 스텝 시간에서 호엔야르 등급 3등급이 2등급보다 더 길게 나타났으며, 사이클 시간에서 호엔야르 등급 3등급이 1, 2등급보다 더 길게 나타났다. 또한, 파킨슨 환자 호엔야르 척도 3등급 환자들은 1, 2등급 환자들에 비해 보행 속도는 느리고, 보폭은 짧고, 보간은 더 넓고, 보각은 더 크게 하면서 걸었다. 마지막으로, 내외측 1, 7구역에서 최대 압력이 나타난 시간이 더 빨리 나타났으며, 발의 후족에서 시간에 대한 각 지역의 압력의 합, 압력분포 활성 지역 및 발의 최대압력이 더 작게 나타났다. 결론적으로, 파킨슨 환자 호엔야르 척도 3등급 환자들은 1, 2등급 환자들에 비해 비정상적인 보행 특성을 보였다. The purpose of this study was to investigate the effects of Hoehn-Yahr scale on the gait with Parkinson's patients. Thirty three parkinson's patients were recruited in the study. Spatio-temporal and foot pressure variables was investigated using GAITRite pressure sensor system. Each footprint was divided into 12 equal trapezoids and after that the hindfoot, midfoot and forefoot analysis was developed. The ratio of variance of within-subjects and between-subjects was verified by One-way ANOVA and post-hoc was carried out by the method of Scheffe. The results showed that the Hoehn-Yahr 3 scale group were significantly decreased in velocity and stride length while increased step time, cycle time, step width and toe-out angle compared to the Hoehn-Yahr 1 or/and 2 scale group. The peak time of Hoehn-Yahr scale 3 scale group were significantly more faster of medial and lateral part of 1 trapezoid footprint compared to the Hoehn-Yahr 1 or/and 2 scale group. The P*t, active area and peak pressure of Hoehn-Yahr scale 3 scale group were significantly decreased at hindfoot compared to the Hoehn-Yahr 1 or/and 2 scale group. In conclusion, the Hoehn-Yahr 3 scale group showed abnormal gait characteristics compared to the Hoehn-Yahr 1 or/and 2 scale group.

동적탄력튜빙 보행훈련 프로그램이 만성 파킨슨병 환자의 자세정렬과 보행능력과 삶의 질에 미치는 영향 : 사례연구

이동률(Dong-Ryul Lee) 한국엔터테인먼트산업학회 2021 한국엔터테인먼트산업학회논문지 Vol.15 No.8

본 연구에서는 만성 파킨슨병 환자의 동적탄력튜빙 보행 훈련 (I, II)이 자세정렬, 보행, 삶의 질에 미치는 영향을 조사하였다. 총 3명의 만성 파킨슨병 환자를 모집하여 사례 연구를 시행하였다(Hoehn 및 Yahr 1-3단계 각 1명). 동적탄력튜빙 보행 훈련 (I 및 II)은 파킨슨병 환자에게 하루 30분, 주 5일, 5주 동안 25세션 적용되었다. 본 연구의 효과를 알아보기 위해, 자세정렬검사, 근 활성도검사, 보행분석 및 파킨슨병 환자의 삶의 질을 평가하였다. Dynamic tubing 보행 훈련(I, II) 중재 후 몸통 굽힘은 감소되었다. 또한 초기 접촉기(IC)에서 중간 디딤기(Mst)까지 보행 시 넙다리네갈래근, 뒤넙다리근, 앞정강근(TA)의 근 활성도가 증가하고 장딴지근의 근활성도가 감소하였다. 척추세움근(ES T12, L3)의 근활성도는 H&Y Ⅰ, Ⅲ 단계에서 증가하고 H&Y Ⅱ단계에서 감소하였다. 압력 중심(COP) 매개변수인 보행선의 길이, 한 발 지지선, 앞/뒤 위치, 좌우대칭 값이 개선되었다. 시공간 보행 매개변수인 보폭, 보폭, 의 속도는 증가하고 분당걸음수는 감소되었다. 나아가 파킨슨 병 환자의 삶의 질도 개선되었다. 이러한 연구 결과를 바탕으로 동적탄력튜빙 보행훈련 (I 및 II)은 약물 내성이 절반으로 감소된 5년 이상된 만성 파킨슨병 환자의 자세, 보행, 삶의 질을 개선하기 위한 새로운 접근 방식으로 적용될 수 있을 것이다. The present study investigated the effects of dynamic tubing gait training(I and II) on the postural alignment, gait, and quality of life in chronic patients with Parkinson"s disease. This study is based on the case study that recruited a total of 3 patients with chronic Parkinson"s disease (Hoehn and Yahr Stage of 1 to 3 each one person). Dynamic tubing gait training (I and II) applied to chronic patients with Parkinson"s disease for 25 sessions, 30 minutes a day, 5 days a week, over 5 weeks period. To investigate the effects of this study, evaluating using the postural alignment test, muscle activity tests, gait analysis, and quality of life scale for patient with Parkinson’s disease. After the intervention of Dynamic tubing gait training (I and II), Trunk flexion was decreased. Also, during walking from initial contact (IC) to mid stance (Mst), muscle activity of Quadriceps, Hamstring, and Tibialis Anterior (TA) was increased and muscle activity of Gastrocnemius was decreased. The muscle activation of Erector Spinae (ES T12, L3) was increased in the H&Y Ⅰ and Ⅲ stages and decreased in the H&Y Ⅱ stage. Length of gait line, single support line, ant/post position and lateral symmetry of center of pressure (COP) parameters improved. The spatio-temporal gait parameters including of step length, stride length, and velocity was increased, and cadence decreased. Further the quality of life of patients with Parkinson’s disease was improved. Based on these findings, Dynamic tubing gait training (I and II) could be applied as a new approach to improve posture, gait, quality of life in chronic patients with Parkinson"s disease for more than 5 years, whose drug resistance is halved.

Evaluation of Gait Assistive Devices in Patients with Parkinson`s Disease

( Mi Young Kim ),( Bee Oh Lim ) 한국운동역학회 2016 한국운동역학회지 Vol.26 No.3

Objective: There are no guidelines for choosing appropriate gait assistive devices. The aim of this study was to evaluate gait assistive devices in patients with Parkinson``s disease. Method: We evaluated 15 individuals with Parkinson``s disease who did or did not use one of two different devices including canes and two-wheeled walkers. Data were collected using the GAITRite system. Results: Participants in the group using canes and two-wheeled walkers had significantly increased double support time and decreased gait velocity, normalized gait velocity, and stride length compared with those who did not. Participants who used a two-wheeled walker had significantly decreased gait velocity, normalized gait velocity, and stride length compared with those who used a cane. Furthermore, participants who used a two-wheeled walker had significantly decreased coefficients of variation for step time, stride length, and swing time compared with those who used a cane. Conclusion: Our results indicated that the two-wheeled walker offered the most consistent advantages for decreasing the risk of falling.