자연과학편 : 운동기능회복을 위한 운동재활과 뇌신경 가소성 -뇌졸중 후 운동기능회복 극대화를 위한 원리와 적용-

김상범(SangBumKim) 한국체육학회 2007 한국체육학회지 Vol.46 No.3

뇌졸중에 의한 뇌손상은 일상적인 신체활동을 위한 수의적인 움직임을 불가능하게 하여, 실제적인 불구상태를 야기하는 가장 주요한 원인 중의 하나이다. 비록 뇌졸중 후, 즉시적인 운동기능의 회복이 일어나긴 하지만, 연구보고에 의하면 단지 15% 미만의 뇌졸중 환자들이 정상상태로 회복된다고 보고하고 있다. 다행이도, 뇌 손상과 관련된 이후 진행되는 자생적인 뇌신경 재 조직화와 아울러, 특정한 운동피질영역의 기능은 개별적인 운동경험에 의해 변화될 수 있다. 이러한 뇌신경 가소성은 뇌졸중 후 환자들의 다양한 형태의 운동 재활트레이닝을 위한 중요한 암시점을 제공하고 있다. 본 리뷰논문은 상지의 효과적인 운동기능회복은 운동제어 및 학습의 이론적인 배경과 양수 협응 운동원리에 기초한 활동의존 재활기법의 효용성을 제안한다. 행동적이고 신경생리학적인 기전에 기초한 양측성 운동트레이닝은 만성 뇌졸중 환자들의 상지 운동기능회복에 효과적인 방법으로 제시되고 있다. 차후 연구들을 통해, 만성 뇌졸중 환자의 운동기능 재활을 위해 사용된 양수협응 운동기법이 대뇌 피질의 가소성에 미치는 효과와 그 효용성이 명확히 규명될 것을 기대한다. Stroke is a leading cause of substantial disability and disrupts the voluntary control of motor action required for every day life. Even though spontaneous recovery of motor function would be happened, research data showed that fewer than 15% of individuals recovered normal motor function in the hemiplegic upper limb disfunction Fortunately, in addition to brain injury-related reorganization, specific motor cortex functions can be modified by individual motor experiences. Such brain neural plasticity provide major implications for the type of rehabilitative training on the post-stroke patients. This review proposes that activity-dependent intervention based on the theoretical background of motor control & learning and interlimb coordination principles gain significant results for motor recovery of upper limb. Based upon behavioral and neurophysiological mechanisms, bilateral movement training/practice has shown great premise toward chronic stroke recovery in the upper extremity. Further research will clarify the contribution of interlimb synergies to cortical neural plasticity for chronic stroke rehabilitation and substantiate the efficacy of bilateral movements intervention for maximal motor recovery.

Motor Function Recovery in Stroke Patients with Corona Radiata Infarct: 4 Case Studies

김중선,권중원 대한물리치료학회 2010 대한물리치료학회지 Vol.22 No.3

Purpose: The aim of this study was to use fMRI and clinical prognosis criteria to evaluate therapeutic interventions in stroke patients with corona radiata infarct and acquire fundamental information about recovery mechanisms. Methods: Four subjects (2 men, 2 women) who had strokes with corona radiata infarct were recruited. For all subjects, motor functions such as motricity index (MI), modified brunnstrom classification (MBC), functional ambulatory category (FAC), and bathel index (BI) were evaluated. Evaluations were done at least 4 times over a period of approximately 6~7 months from stroke onset. We compared the final evaluation with the first. Results: All patients with corona radiata infarct showed improvement in motor outcomes with the passing of time. The strength of all patients improved from zero or trace levels to normal or good levels in the MI (Motricity Index) test. Other motor outcomes including the modified brunnstrom classification (MBC), the functional ambulatory category (FAC), and the bathel index (BI) also improved with the passing of time. Conclusion: Stroke patients with corona radiata infarcts change for the better over time. Therefore, one can introduce clinical interventions by the aspect of progress in functional motor recovery. Purpose: The aim of this study was to use fMRI and clinical prognosis criteria to evaluate therapeutic interventions in stroke patients with corona radiata infarct and acquire fundamental information about recovery mechanisms. Methods: Four subjects (2 men, 2 women) who had strokes with corona radiata infarct were recruited. For all subjects, motor functions such as motricity index (MI), modified brunnstrom classification (MBC), functional ambulatory category (FAC), and bathel index (BI) were evaluated. Evaluations were done at least 4 times over a period of approximately 6~7 months from stroke onset. We compared the final evaluation with the first. Results: All patients with corona radiata infarct showed improvement in motor outcomes with the passing of time. The strength of all patients improved from zero or trace levels to normal or good levels in the MI (Motricity Index) test. Other motor outcomes including the modified brunnstrom classification (MBC), the functional ambulatory category (FAC), and the bathel index (BI) also improved with the passing of time. Conclusion: Stroke patients with corona radiata infarcts change for the better over time. Therefore, one can introduce clinical interventions by the aspect of progress in functional motor recovery.

Promotion of Motor Recovery by Anodal Continuous and Low Amplitude Cortical Stimulation in Rat Stroke Model

Seong-Keun Moon,Chung-Yong Yang,Se-Eung No,Eun-Young Kim,Seoul Lee,Soon-Ah Park,Gyung-Jae Oh,Hyoung-Ihl Kim,Joon-Ho Song,Min-Cheol Lee,Yong-Il Shin 한국실험동물학회 2007 Laboratory Animal Research Vol.23 No.1

Electrical stimulation is assumed to augment the adaptive plasticity of the neighboring brain around the region of stroke and to enhance motor recovery in stroke models. The purpose of this study is to evaluate the effects of anodal cortical stimulation for enhancement of motor recovery in rat stroke model. This study used a photothrombotic model of stroke to examine the behavioral effect of cortical stimulation. Sprague-Dawley rats were trained on a task of single pellet reaching (SPR) before surgery. Photothrombosis was applied on the sensorimotor cortex contralateral to paw predominance using rose bengal dye and cold light. Unipolar electrode was implanted at the border between infarct area and normal brain, followed by anodal continuous low voltage stimulation was delivered for 3 weeks. Daily SPR tasks were performed to evaluate the motor recovery using 'Behavior-Stimulation box'. Anodal electrical stimulation not only prompted earlier start of motor recovery but also improved final recovery. It also eliminated "inflammatory dip" of motor deficit. Low voltage electrical stimulation showed no adverse effect in stroke models. It is concluded that low voltage anodal continuous cortical stimulation can remarkably enhance motor recovery in photothrombotic stroke models.

Prediction of Motor Function Recovery after Subcortical Stroke: Case Series of Activation PET and TMS Studies

Se Hee Jung,백남종,Yu Kyeong Kim,김상은 대한재활의학회 2012 Annals of Rehabilitation Medicine Vol.36 No.4

Objective: To examine whether the pattern of brain activation induced by a motor task and the motor responses to transcranial magnetic stimulation (TMS) have prognostic implications for motor recovery after stroke.Method: Ten patients with first-ever subcortical stroke (55.7±17.3 years, 5 ischemic and 5 hemorrhagic) underwent 2 FDG PET studies under different conditions (1: rest, 2: activation with a specific motor task) at 37.7±25.2 days after stroke. The regions showing more than a 10% increase in glucose metabolism on subtraction images during activation and rest were considered to be significantly activated. Cortical excitability of intracortical inhibition (ICI) and intracortical facilitation (ICF) were assessed using the TMS from both abductor pollicis brevis muscles within 7 days of PET scans. Recovery of motor function was assessed at the point of the neurological plateau. Results: The presence of a motor response at the plegic site to TMS and normal intracortical inhibition, and facili-tation patterns in the unaffected hemisphere were found to be related to good recovery. An association between an ipsilesional activation on PET and good motor recovery was also observed, but this was significantly weaker than that between TMS measured cortical excitability and motor recovery. Conclusion: Integrity of the ipsilesional corticospinal pathway, normalized contralesional intracortical excitability, and task-related activation in the ipsilesional hemisphere were found to predict post-stroke motor recovery signifi-cantly.

A Comparative Study on Recovery of Motor Function in Stroke Patients with Corona Radiata Infarcts and Intracerebral Hemorrhage

김중선,박상영,권중원 대한물리치료학회 2010 대한물리치료학회지 Vol.22 No.6

Purpose: Our goal was to determine the difference in motor recovery between two stroke types: the corona radiata (CR)infarct type and the intracerebral hemorrhage (ICH) type, by using assessment methods for motor functions. Methods: Forty subjects who were diagnosed as having had a stroke with an infarct (men: 11, women: 9, mean age:62.25±7.59) or a stroke with an ICH (men: 12, women: 8, mean age: 59.75±6.11) were recruited. In all subjects, motor functions of the affected extremities were measured 2 times: at stroke onset (initial) and 6 months after the onset (final) by the motricity index (MI), the modified Brunnstrom classification (MBC), and functional ambulatory category (FAC). We compared the final assessment with the initial one. Results: Motor functions of all patients improved with the passing of time. All scores of motor function assessment in the ICH type were higher than in the infarct type. Comparing the initial assessment with the final one, upper MI and MBC scores of the upper extremities were significantly different between the two stroke types (p<0.05), but lower MI and FAC scores of the lower extremities were not (p>0.05). Conclusion: These findings imply that patterns of motor recovery in patients with either the infarct type or the ICH type of stroke change for the better over time. The degree of motor recovery in the ICH type was better than in the infarct type. Therefore, one can introduce clinical interventions by the aspect of progress in functional motor recovery.

A Comparative Study on Recovery of Motor Function in Stroke Patients with Corona Radiata Infarcts and Intracerebral Hemorrhage

( Chung-sun Kim ),( Sang-young Park ),( Jung-won Kwon ) 대한물리치료학회 2010 대한물리치료학회지 Vol.22 No.6

Purpose: Our goal was to determine the difference in motor recovery between two stroke types: the corona radiata (CR) infarct type and the intracerebral hemorrhage (ICH) type, by using assessment methods for motor functions. Methods: Forty subjects who were diagnosed as having had a stroke with an infarct (men: 11, women: 9, mean age: 62.25±7.59) or a stroke with an ICH (men: 12, women: 8, mean age: 59.75±6.11) were recruited. In all subjects, motor functions of the affected extremities were measured 2 times: at stroke onset (initial) and 6 months after the onset (final) by the motricity index (MI), the modified Brunnstrom classification (MBC), and functional ambulatory category (FAC). We compared the final assessment with the initial one. Results: Motor functions of all patients improved with the passing of time. All scores of motor function assessment in the ICH type were higher than in the infarct type. Comparing the initial assessment with the final one, upper MI and MBC scores of the upper extremities were significantly different between the two stroke types (p< 0.05), but lower MI and FAC scores of the lower extremities were not (p >0.05). Conclusion: These findings imply that patterns of motor recovery in patients with either the infarct type or the ICH type of stroke change for the better over time. The degree of motor recovery in the ICH type was better than in the infarct type. Therefore, one can introduce clinical interventions by the aspect of progress in functional motor recovery.

A Comparative Study on Recovery of Motor Function in Stroke Patients with Corona Radiata Infarcts and Intracerebral Hemorrhage

Kim, Chung-Sun,Park, Sang-Young,Kwon, Jung-Won The Korean Society of Physical Therapy 2010 대한물리치료학회지 Vol.22 No.6

Purpose: Our goal was to determine the difference in motor recovery between two stroke types: the corona radiata (CR) infarct type and the intracerebral hemorrhage (ICH) type, by using assessment methods for motor functions. Methods: Forty subjects who were diagnosed as having had a stroke with an infarct (men: 11, women: 9, mean age: $62.25{\pm}7.59$) or a stroke with an ICH (men: 12, women: 8, mean age: $59.75{\pm}6.11$) were recruited. In all subjects, motor functions of the affected extremities were measured 2 times: at stroke onset (initial) and 6 months after the onset (final) by the motricity index (MI), the modified Brunnstrom classification (MBC), and functional ambulatory category (FAC). We compared the final assessment with the initial one. Results: Motor functions of all patients improved with the passing of time. All scores of motor function assessment in the ICH type were higher than in the infarct type. Comparing the initial assessment with the final one, upper MI and MBC scores of the upper extremities were significantly different between the two stroke types (p<0.05), but lower MI and FAC scores of the lower extremities were not (p>0.05). Conclusion: These findings imply that patterns of motor recovery in patients with either the infarct type or the ICH type of stroke change for the better over time. The degree of motor recovery in the ICH type was better than in the infarct type. Therefore, one can introduce clinical interventions by the aspect of progress in functional motor recovery.

Motor Function Recovery in Stroke Patients with Corona Radiata Infarct: 4 Case Studies

( Chung-sun Kim ),( Jung-won Kwon ) 대한물리치료학회 2010 대한물리치료학회지 Vol.22 No.3

Purpose: The aim of this study was to use fMRI and clinical prognosis criteria to evaluate therapeutic interventions in stroke patients with corona radiata infarct and acquire fundamental information about recovery mechanisms. Methods: Four subjects (2 men, 2 women) who had strokes with corona radiata infarct were recruited. For all subjects, motor functions such as motricity index (MI), modified brunnstrom classification (MBC), functional ambulatory category (FAC), and bathel index (BI) were evaluated. Evaluations were done at least 4 times over a period of approximately 6~7 months from stroke onset. We compared the final evaluation with the first. Results: All patients with corona radiata infarct showed improvement in motor outcomes with the passing of time. The strength of all patients improved from zero or trace levels to normal or good levels in the MI (Motricity Index) test. Other motor outcomes including the modified brunnstrom classification (MBC), the functional ambulatory category (FAC), and the bathel index (BI) also improved with the passing of time. Conclusion: Stroke patients with corona radiata infarcts change for the better over time. Therefore, one can introduce clinical interventions by the aspect of progress in functional motor recovery.

Motor Function in the Late Phase After Stroke: Stroke Survivors’ Perspective

Lina Bunketorp-Käll,Marcela Pekna,Milos Pekny,Hans Samuelsson,Christian Blomstrand,Michael Nilsson 대한재활의학회 2020 Annals of Rehabilitation Medicine Vol.44 No.5

Objective To examine the association between observer-assessed functional status and perceived recovery in the late phase after stroke. The study also aimed to determine whether observer-assessed functional improvements as a result of horse-riding therapy (H-RT) are related to enhanced perception of stroke recovery. Methods This is a descriptive correlational study using data derived from a three-armed randomized controlled trial in which 123 individuals were enrolled, among whom 43 received H-RT for 12 weeks. The measures included the Modified Motor Assessment Scale, Berg Balance Scale, Timed Up and Go, timed 10-m walk, and perceived recovery from stroke indicated by item #9 in the Stroke Impact Scale (version 2.0). Spearman rank order correlation (rs) was used in the analyses. Results There were moderate to strong positive or negative correlations between all four observer-assessed motor variables and participants’ ratings of perceived late-phase stroke recovery at trial entrance, ranging from rs=-0.49 to rs=0.54 (p<0.001). The results of the correlational analyses of variable changes showed that, after the end of the H-RT intervention, both self-selected and fast gait speed improvement were significantly correlated with increments in self-rated stroke recovery (rs=-0.41, p=0.01 and rs=-0.38, p=0.02, respectively). Conclusion This study provided data supporting the association between individual ratings of self-perceived recovery after stroke and observer-assessed individual motor function. The results further demonstrate that enhancement in perceived stroke recovery after completing the intervention was associated with objectively measured gains in both self-selected and fast gait speed.

척수 손상 쥐에 실시한 특정 과제 운동이 운동 행동에 미치는 영향

전경희 ( Kyoung Hee Jun ) 한국전문물리치료학회 2011 한국전문물리치료학회지 Vol.18 No.1

This study was implemented to verify the feasibility of motor function recovery and the appropriate period for therapy. The research began with spinal laminectomy of 40 white rats of Sprague-Dawley breed and induced them spinal crush injury. Following results were obtained by using the modified Tarlov test (MTT), Basso, Beattle, Bresnahan locomotor rating scale (BBB scale) and modified inclined plate test (MIPT). First, the measurement using the MTT confirm that the most severe aggravation and degeneration of functions are observed two days after induced injury, and no sign of neuromotor function recovery. Second, better scores were achieved by open-ground movement group on BBB locomotor rating scale test, and weight-bearing on inclined plate group show better performance on MIP. Third, both BBB and MIPT scale manifested the peak of motor function recovery during 16th day after the injury and turn into gradual recovery gradient during 16th to 24th. Fourth, the control group showed functional recovery, however, the level of recovery was less significant when compared with group open-ground movement group and weight-bearing on inclined plate group. Hence, it was clearly manifested that the lumbar region of the spinal cord had shown the best performance when its functions were measured after the execution of specific physical training; therefore it indicated the possibility of learning specific task even in damaged lumbar regions. Thus it is expected to come out with better and more effective functional recovery if concentrated physical therapy was applied starting 4 days after the injury till 16 days, which is the period of the most active recovery.