낙상공포와 인지적 과제 수행이 고령자의 장애물 보행에 미치는 영향
Effects of Fear of Falling and Cognitive Task on the Obstacle Gait in Older Adults
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[목적] 본 연구의 목적은 낙상공포를 느끼는 노인들과 느끼지 않는 노인들을 대상으로 청각을 통해 제시한 인지과제를 동시에 수행하는 장애물 보행과 일반 장애물 보행 간 움직임 특성의 차이를 비교·분석하는데 있다. [방법] 낙상공포를 느끼는 노인 6명(연령: 74.3±5.9세, 키: 150±10cm, 체중: 57.7±9.8kg)과 낙상공포를 느끼지 않는 노인 9명(연령: 72.4±3.7세, 키: 150±10cm, 체중: 52.0±4.7kg)이 참여하였다. 장애물 보행 시 인체의 움직임을 분석하기 위해 카메라 10대, 마커, Visual 3D 프로그램이 사용되었고, 장애물을 건너며 지면을 내딛는 하지의 힘과 압력중심의 변화를 살펴보기 위해 지면반력기가 사용되었으며, 인지과제로 1-back 과제가 사용되었다. 낙상공포 집단과 비낙상공포 집단의 단일과제(장애물 보행)와 이중과제(인지과제+장애물 보행)의 특성을 비교 분석하기 위해 반복측정 이원분산분석이 사용되었다. [결과] 낙상공포는 엉덩이, 무릎과 발목의 굴곡력, 발의 수직거리, 장애물을 먼저 건넌 후 지면을 딛는 발의 최대수직지면반력에 유의한 영향을 주었으며, 인지과제는 분석된 변인에 통계적으로 유의한 영향을 미치지 않았다. [결론] 낙상공포를 느끼는 노인들은 장애물 보행 시 엉덩이, 무릎과 발목을 적게 굴곡하여 걸었으며, 장애물의 중심을 지날 때 발의 가장 낮은 부분과 장애물의 가장 윗부분 사이의 최소 수직 거리가 짧게 나타났고, 장애물을 건넌 후 조심스럽게 지면을 딛는 것으로 나타났다. 향후 이중과제 연구 시 본 연구에 사용된 1-back 과제 외에 일상생활에서 자주 사용되는 실질적인 인지과제의 적용이 필요하다.
Abstract
[PURPOSE] The purpose of this study was to investigate characteristics of the concurrent performance of a secondary cognitive task influences on obstacle gait in older adults with Fear Of Falling(FOF). [METHODS] Six elders with FOF(Age: 74.3±5.9yr, Height: 150±10cm, Weight: 57.7±9.8kg)and nine elders with Non FOF(Age: 72.4±3.7yr, Height: 150±10cm, Weight: 52.0±4.7kg)participated in the study. Ten cameras, marker sets, Visual 3D program, and two force platforms were used to analyze the performance of an obstacle gait. In the dual task, each subject stepped over an obstacle in accordance with performing a cognitive task(1-back task). Two way ANOVA was used to compare kinematic and obstacle gait parameters. [RESULTS] FOF significantly affected the flexion of the hip, knee, and ankle joint, foot clearance, and maximum vertical ground reaction force of the leading foot. Variables which we investigated were not affected by the addition of a secondary cognitive task. [CONCLUSIONS] Elders with FOF showed the stiff walking with less flexion of the lower extremity and stepping over the obstacle with conservative strategy. The relative importance of the secondary task to the subjects in real life may apply to the future study.
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