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뇌졸중 환자의 작업기반 양측성 상지훈련 효과: 예비연구

Effects of Occupation-Based Bilateral Upper Extremity Training for Chronic Stroke: Pilot Study

박지혁|김선호
대한신경계작업치료학회 (Korean Society for Neurological Occupational Therapy)|2017.08|재활치료과학 (Therapeutic Science for Rehabilitation)|제6권 제2호|pp. 47-58

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키워드

뇌졸중Stroke작업기반양측성 상지 훈련Bilateral upper extremity activityOccupation-Based

초록

목적: 뇌졸중 환자에게 의미 있는 작업을 기반으로 한 양측성 상지 훈련의 효과를 알아보기 위한 예비연구로 실시되었다. 연구방법: 뇌졸중으로 인한 편마비를 가진 환자 4명을 대상으로 실험군(2명)과 대조군(2명)으로 나누어 진행되었다. 2016년 5월부터 8월까지 진행하였으며, 대상자 당 총 5주간, 주 3회, 회기 당 60분의 작업기반 양측성상지훈련 중재와 전통적 양측성 상지 훈련을 각 각 실시하였다. 중재 전 후로 EMG, 가속도계, ARAT, Y-BAT, SIS, COPM를 실시하여 각 군간 비교 하였다. 결과: 실험군은 대조군 보다 노쪽 손목폄근과 앞 어깨 세모근의 근 활성도, SIS에서 손 기능(Hand function), 기억력(Memory)항목을 제외한 모든 항목에서 중재 전·후 큰 변화량을 나타냈으며, 양손의 사용량을 측정한 가속도계와 COPM, Y-BIT, ARAT평가의 잡기(grasp), 집기(pinch), 대동작 (gross movement)항목에서 실험군은 대조군 보다 중재 전·후 큰 변화량을 나타냈다. 결론: 본 연구를 통해 작업기반 양측성 상지 훈련이 신경학적 변화를 통한 상지기능 회복 및 사회참여등에 효과적임을 알 수 있었다. 추후 연구에서는 작업기반 양측성 상지 훈련 프로토콜의 내용에 대해높은 내용 타당도를 확보하기 위한 개발 연구가 필요할 것이며, 이를 토대로 많은 뇌졸중 환자를 대상으로 한 무작위대조군 실험 연구를 통한 효과 검증과 효과지속성에 대한 검증이 필요할 것이다.

Abstract

Objective : The purpose of this study is to observe effects of Occupation-Based bilateral UE training for chronic stroke. Methods : 4 patients with hemiplegic stroke were divided into two groups: experimental group and control group. From May to August 2016, we conducted a occupation - based bilateral UE training and a traditional bilateral UE training for 5 weeks, 3 times a week, and 60 minutes per session for each subject. EMG, accelerometer, ARAT, Y-BAT, SIS, and COPM were performed before and after the intervention. Results : The experimental group showed a large changes before and after intervention in ECR, DA and all items except for hand function and memory of SIS, compared with the control group. Also, the experimental group showed a large change before and after the intervention compared to the control group in the accelerometer measuring the amount used of bilateral hand and grasp, pinch, and gross movement items of ARAT and COPM, Y-BIT. Conclusions : Occupation-based bilateral upper extremity training was effective in the recovery of upper limb function and social participation through neurological changes. Future research will be required development studies to ensure a high content validity of the Occupation-based bilateral upper extremity training protocol.

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