뇌졸중 환자의 재활을 위한 경두개 직류전기자극의 활용 = Application of Transcranial Direct Current Stimulation (tDCS) - As A Rehabilitation Tool to Patient After Stroke

국문 초록 (Abstract)

뇌졸중은 만성적 운동장애를 유발하게 하는 가장 큰 원인중 하나로 알려져 있다. 뇌졸중을 겪은 사람들은 뇌졸중 이후 대부분 경도에서 중도에 이르기까지 장애를 안고 살아간다. 특히 상지 및 하지의 운동결핍(motor deficit)은 일상생활을 영위하는데 부정적인 영향을 준다. 최근 전통적 관점의 재활 패러다임과 더불어 운동수행의 발현 및 운동학습에 관여하는 뇌영역을 자극하여 뇌졸중의 재활을 촉진시키는 비칩습 뇌자극 기법을 통한 뇌졸중 환자의 재활 효과를 규명하고자 하는 시도가 이루어지고 있다. 그 중 경두개 전기자극(transcranial direct current stimulation: tDCS)은 다른 비침습 자극 장치와 비교했을 때 처치가 간편하고 장비의 가격이 비교적 저렴하여 뇌줄중 환자의 재활에 도움을 줄 수 있는 새로운 방법으로 적용되고 있다. 본 연구에서는 tDCS를 만성 뇌졸중 환자의 재활에 적용하였을 때 밝혀진 연구결과들을 제시 및 요약하고, 향후 재활 훈련프로그램에서 고려하여야 할 사항들에 대한 지침을 제공하고자 하였다. 연구 결과 tDCS는 만성 뇌졸중 환자의 운동기능 회복에 효과가 있는 것으로 나타났고, 뇌졸중 환자의 운동기능 회복 차원의 재활에 효과를 줄 수 있는 새로운 방법으로 자리매김을 하고 있는 것으로 나타났다. 하지만 자극시간, 자극 강도, 자극 형태 및 자극 위치 선정 등은 후속 연구를 통해 정확한 지침을 정립할 필요성이 요구되고, 또한 뇌졸중 환자의 발병 시간에 따른 연구를 추가함으로써 tDCS의 효과성을 구체화할 필요가 있을 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

Stroke is one of the leading cause of chronic motor disabilities. The patients after stroke suffer from mild to severe disabilities. Especially, motor deficits on upper and lower limb by stroke cause negative effects on their daily life. Non-invasive stimulation involves modulation of the central nerve system by electrically activating neurons in the brain has been arising to as a new approach to explore the effects on the neurorehabilitation. Transcranial Direct Current Stimulation (tDCS) which is portable, economical and easily accessible, is becoming a popular treatment protocol. This study provides a comprehensive overview of the results of recent papers applied tDCS protocol to chronic stroke patients and applicable guidelines for the successful rehabilitation program in the future. As we reviewed, tDCS can be a new technique to enhance motor function recovery and to organize re-learning systems for the chronic stroke patients. But further considerations to apply the precise tDCS stimulations of duration, intensity, type, and location will be required. Also, additional researches recruiting other types of stroke (e. g. acute or subacute patients) will be needed to specify effects of tDCS.

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