본문 바로가기
KERD
논문KCI 등재

작업기반 지역사회 재활이 뇌졸중 재가 장애인의 일상생활과 작업수행 기술에 미치는 효과

The Effects of Occupation-Based Community Rehabilitation for Improving Occupational Performance Skills and Activity Daily Living of Stroke Home Disabled People: A Single Subject Design

박혜연|김종배|문광태
대한신경계작업치료학회 (Korean Society for Neurological Occupational Therapy)|2020.05|재활치료과학 (Therapeutic Science for Rehabilitation)|제9권 제2호|pp. 99-117|DOI https://doi.org/10.22683/tsnr.2020.9.2.099

0

조회

0

다운로드

11

인용

0

참고문헌

키워드

지역사회뇌졸중Stroke작업기반방문작업치료작업수행기술지역사회중심재활Community based occupationHome disabledOccupation basedOccupational performance skills

초록

목적 : 지역사회에서 생활하는 뇌졸중 장애인을 대상으로 작업기반 지역사회 재활이 뇌졸중 장애인의작업수행기술에 미치는 영향을 연구하고, 작업 수행의 질과 만족도 변화에 대해 알아보고자 하였다. 연구방법 : 단일대상연구(Single subject research) 중 ABA 설계를 사용하였고, 뇌졸중 진단을 받은 심한장애인 1명을 선정하였다. 연구 과정은 2019년 5월 21일부터 2019년 9월 7일까지 17주간 총 25회기(기초선 A 5회기, 중재 기간 B 14회기, 기초선 기간 A’ 5회기, 추적 기간 1회기)로 진행하였다. 중재는 연구자가대상자의 집으로 방문하여 진행되었다. 작업치료중재과정모델에 따라 중재 모델 선정 및 적용하였으며, 중재에는 과제 제공 및 피드백, 관련 정보 교육, 가정환경 수정, 지역자원 연계가 포함되었다. 작업기반지역사회 재활 프로그램을 적용한 이후 일상생활에서 작업수행기술의 빈도 변화, 작업수행 만족도, 일상생활활동과 삶의 질의 변화를 알아보았으며, 추적 관찰하였다. 결과는 선형그래프와 막대그래프를 이용하여 시각적으로 분석하였다. 결과 : 작업기반 지역사회 재활 프로그램을 적용했을 때, 손 닿는 곳의 상의 입기, 침대에서 양말과 실내화신기, 의자에 앉아 신발 신기 기술과 일상생활활동이 향상되었다. 작업수행기술 평가 결과 대상자의작업수행 기술의 질이 향상되었음을 확인하였으며, 작업수행 만족도 또한 향상되었다. 결론 : 본 연구를 통해 작업기반 지역사회 재활 프로그램이 지역사회에 거주하는 뇌졸중 장애인의 작업수행기술을 향상할 수 있으며, 일상생활활동과 삶의 질, 작업수행 만족도에 긍정적인 영향을 미쳤다. 마지막으로 뇌졸중 대상자 뿐만 아니라 지역사회에 거주하는 장애 유형별로 작업기반 지역사회 재활 프로그램이보편화 되기를 기대해 본다.

Abstract

Objective : The purpose of this study was to study the effects of occupation-based community rehabilitation on occupational performance skills and activities of daily living in stroke disabled persons living in the community, and to investigate the changes in occupation quality and satisfaction. Methods : In this single-subject ABA design study with follow-up evaluation, one severely disabled person diagnosed with stroke who lived in the community was recruited. The procedure consisted of a total of 25 sessions for 17 weeks. Intervention was according to occupation-based community rehabilitation, and the researcher visited the subject’s home. Individualized intervention was applied according to the OTIPM. The intervention was composed of task assignment and feedback, home environment modification, information-related caregiver education, and community resource network. The evaluation of each session included the changes in the frequency of occupational performance skills, the quality of occupational performance in daily life, and the changes in occupational satisfaction, activities of daily living, quality of life, and maintenance of in the occupational performance skills during follow-up. The results were visually analyzed using a bar graph and a linear graph. Results : The results showed that the occupation-based community rehabilitation improved activities of daily living such as putting on socks, shoes slip-on, and upper body dressing garment within reach. Within the framework of the AMPS, it was confirmed that the quality of occupational performance was improved in all the subjects, and the degree of satisfaction also improved. Conclusion : This study showed that occupation-based rehabilitation can improve the occupational performance skills of stroke home disabled people positively affect the quality of occupational performance in daily life. Therefore, I think it is meaningful that useful for them.

참고문헌 (51)

  1. Allen, L., "Community stroke rehabilitation teams : Providing home-based stroke rehabilitation in Ontario, Canada", Canadian Journal of Neurological Sciences, 41(6), pp.697~703 (2014)[DOI]
  2. American Occupational Therapy Association(AOTA), "Occupational therapy practice framework : Domain and process", American Journal of Occupational Therapy, 68(1), pp.1~48 (2014)[DOI]
  3. 안태규, "가정작업치료 필요성 및 부양부담: 부산, 경남지방을 중심으로", 인문사회 21, 7(4), pp.117~132 (2016), 인문사회 21[DOI]
  4. Askim, T., "Effects of a community-based intensive motor training program combined with early supported discharge after treatment in a comprehensive stroke unit : A randomized, controlled trial", Stroke, 41(8), pp.1697~1703 (2010)[DOI]
  5. 방요순, "과제 지향적 활동이 성인 뇌졸중 환자의 인지기능과 일상생활동작에 미치는 영향", 대한작업치료학회지, 15(3), pp.49~62 (2007), 대한작업치료학회
  6. Benvenuti, F., "Community-based exercise for upper limb paresis : A controlled trial with telerehabilitation", Neurorehabilitation and Neural Repair, 28(7), pp.611~620 (2014)[DOI]
  7. Bury, T., "Developmental articles primary health care and community based rehabilitation : Implications for physical therapy", Asia Pacific Disability Rehabilitation Journal, 16(2), pp.29~61 (2005)
  8. Carpenter, L., "The use of the canadian occupational performance measure as an outcome of a pain management program", Canadian Journal of Occupational Therapy, 68(1), pp.16~22 (2001)
  9. Carr, J. H., "Stroke rehabilitation newton" (2003), Butterworth Helenemann
  10. Coninck, L., "Home-and community-based occupational therapy improves functioning in frail older people : A systematic review", Journal of the American Geriatrics Society, 65(8), pp.1863~1869 (2017)[DOI]
  11. Enderby, P., "Community rehabilitation in the United Kingdom", Clinical Rehabilitation, 15(6), pp.577~581 (2001)
  12. Eskandar, M. E., "Ranking the desirability indicators of community-based rehabilitation(CBR)based on analytical hierarchy process", International Journal of Psychology and Behavioral Sciences, 8(1), pp.7~11 (2018)[DOI]
  13. Fisher, A. G., "Occupational therapy intervention process model: A model for planning and implementing top-down, client-centered, and occupation-based intervention" (2009), Three Star Press
  14. Fisher, A. G., "Assessment of motor and process skills Vol. 1: Development. Standardization and administration manual" (2010), Three Star Press
  15. Fisher, A. G., "Assessment of motor and process skills. Vol. 2: User manual" (2014), Three Star Press
  16. Gillen, G., "Stroke rehabilitation:A function-based approach" (2004), Mosby-Year Book
  17. Gitlin, L. N., "Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden : A randomized pilot study", The American Journal of Geriatric Psychiatry, 16(3), pp.229~239 (2008)[DOI]
  18. Graff, M. J., "Community based occupational therapy for patients with dementia and their care givers : Randomised controlled trial", British Medical Journal, 333(7580), pp.1196~ (2006)[DOI]
  19. Hsueh, I. P., "Comparison of the psychometric characteristics of the functional independence measure, 5 item Barthel index, and 10 item Barthel index in patients with stroke", Journal of Neurology, Neurosurgery & Psychiatry, 73(2), pp.188~190 (2002)[DOI]
  20. Kalaria, R. N., "Stroke and cognition", Current Atherosclerosis Reports, 3(4), pp.334~339 (2001)
  21. 강은정, "EQ-5D를 이용한 건강수준의 가치 평가", 보건경제와 정책연구, 12(2), pp.19~43 (2006), 한국보건경제정책학회
  22. Keglovits, M., "In-home occupational performance evaluation for providing assistance(I-HOPE Assist) : An assessment for informal caregivers", American Journal of Occupational Therapy, 69(5), pp.1~9 (2015)[DOI]
  23. Kim, J. H., "Application of occupational therapy intervention process model : A case of child with sensory integration dysfunction", The Journal of Korean Academy of Sensory Integration, 9(2), pp.1~13 (2011)
  24. Kim, M., "The effects of personalized residential environment improvement on occupational performance satisfaction and activities of daily living : Case studies in stroke patients", Journal of The Korean Society of Integrative Medicine, 3(1), pp.41~51 (2015)[DOI]
  25. 김영미, "지역사회중심재활을 기반으로 한 서비스가 뇌졸중 환자의 기능과 삶의 질에 미치는 영향", 재활복지, 17(3), pp.273~289 (2013), 한국장애인재활협회 부설 재활연구소
  26. Kirkley, K. N., "Alternate forms reliability of the assessment of motor and process skills", Journal of Outcome Measurement, 3(1), pp.53~70 (1999)
  27. "Community care policy gathering" (2018)[URL]
  28. Law, M., "The person-environment-occupation model : A transactive approach to occupational performance", Canadian Journal of Occupational Therapy, 63(1), pp.9~23 (1996)
  29. Law, M., "Pilot testing of the canadian occupational performance measure : Clinical and measurement issues", Canadian Journal of Occupational Therapy, 61(4), pp.191~197 (1994)[DOI]
  30. Law, M., "The person-environmentoccupation model : A transactive approach to occupational performance", Canadian Journal of Occupational Therapy, 63(1), pp.9~23 (1996)[DOI]
  31. 이향숙, "지역사회중심 뇌졸중작업치료프로그램을 통한 중재 효과와 참여 학생들의 만족도", 대한작업치료학회지, 15(2), pp.105~115 (2007), 대한작업치료학회
  32. Lee, Y. K., "South Korean time trade-off values for EQ-5D health states : Modeling with observed values for 101 health states", Value in Health, 12(8), pp.1187~1193 (2009)[DOI]
  33. Lightfoot, E., "Community-based rehabilitation : A rapidly growing method for supporting people with disabilities", International Social Work, 47(4), pp.455~468 (2004)[DOI]
  34. Mahoney, F. I., "Functional evaluation : The barthel index : A simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill", Maryland State Medical Journal, 14, pp.61~65 (1965)
  35. Mayo, N. E., "There’s no place like home : An evaluation of early supported discharge for stroke", Stroke, 31(5), pp.1016~1023 (2000)
  36. "2017 Study on the disabled" (2018)[URL]
  37. "Community centered social service provision: Full scale promotion of community care" (2019)[URL]
  38. 노동희, "과제 지향적 활동이 수부손상환자의 손 기능에 미치는 효과", 한국산학기술학회논문지, 16(2), pp.1153~1163 (2015), 한국산학기술학회[DOI]
  39. Olaogun, M. O. B., "Overcoming the barriers for participation by the disabled : An appraisal and global view of community-based rehabilitation in community development", African Journal of Physiotherapy and Rehabilitation Sciences, 1(1), pp.24~29 (2009)[DOI]
  40. Oh, E. Y., "Application of assistive device on activity of daily living for an adult with hemiplegic stroke : A case report", Korean Society of Assistive Technology, 2(1), pp.1~6 (2010)
  41. Polatajko, H. J., "Pilot randomized controlled trial investigating cognitive strategy use to improve goal performance after stroke", American Journal of Occupational Therapy, 66(1), pp.104~109 (2012)[DOI]
  42. Radomski, M. V., "Occupational therapy for physical dysfunction" (2008), Lippincott Williams and Wilkins
  43. Rostami, H. R., "Effect of treatment environment on modified constraintinduced movement therapy results in children with spastic hemiplegic cerebral palsy : A randomized controlled trial", Disability and Rehabilitation, 34(1), pp.40~44 (2012)[DOI]
  44. Shah, S., "Improving the sensitivity of the Barthel index for stroke rehabilitation", Journal of Clinical Epidemiology, 42(8), pp.703~709 (1989)
  45. 송영진, "국내 작업치료 수가체계의 문제점 및 개정 방안", 대한작업치료학회지, 23(1), pp.123~136 (2015), 대한작업치료학회[DOI]
  46. Tatemichi, T. K., "Cognitive impairment after stroke: Frequency, patterns, and relationship to functional abilities", Journal of Neurology, Neurosurgery & Psychiatry, 57(2), pp.202~207 (1994)
  47. 양영애, "방문재활 서비스 도입과 활성화 방안에 관한 연구", 대한고령친화산업학회지, 3(1), pp.59~70 (2011), 대한고령친화산업학회
  48. Yang, Y. R., "Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke", Clinical Rehabilitation, 20(10), pp.860~870 (2006)
  49. 이태임, "Participation in Leisure Activity and Exercise of Chronic Stroke Survivors Using Community-Based Rehabilitation Services in Seongnam City", Annals of Rehabilitation Medicine, 39(2), pp.234~242 (2015), 대한재활의학회
  50. Yoo, E. Y., "The cognitive perceptual performance in relation to activities of daily living in stroke patients", Journal of Korean Society of Occupational Therapy, 5(1), pp.8~19 (1997)
  51. Walker, M. F., "Occupational therapy for stroke patients not admitted to hospital : A randomised controlled trial", The Lancet, 354(9175), pp.278~280 (1999)[DOI]

관련 논문AI추천

국내 뇌졸중 환자를 대상으로 한 일상생활활동 중재 연구 분석: 단일대상연구 설계를 중심으로성지영, 최유임대한신경계작업치료학회 · 재활치료과학2024 · 제13권 제1호지역사회 거주 뇌졸중 환자의 가정방문 작업치료 효과: 사례 연구정은화대한신경계작업치료학회 · 재활치료과학2020 · 제9권 제2호과제지향 중재가 뇌졸중 환자의 독립성 및 일상생활 수행에 미치는 영향: 체계적 고찰이유나, 이지은한국노인작업치료학회 · 한국노인작업치료학회지2025 · 제7권 제1호재가방문재활 프로그램이 만성 뇌졸중 환자의 일상생활활동과 자기효능감 및 삶의 질에 미치는 영향사공 봉, 이하영특수교육재활과학연구소 · 특수교육재활과학연구2015 · 제54권 제3호원격재활 기반 작업치료가 뇌졸중 환자의 실행기능, 일상생활수행, 작업수행에 미치는 영향김희, 김수경, 박성순, 유두한대한신경계작업치료학회 · 재활치료과학2021 · 제10권 제1호지역사회 통합돌봄을 위한 방문 재활 서비스가 재가 장애인의 삶의 질, 균형 능력, 인지 능력, 일상생활 활동, 작업 수행력에 미치는 영향이충휘, 한용구한국지체·중복·건강장애교육학회 · 지체.중복.건강장애연구2023 · 제66권 제3호

이 간행물의 다른 논문 (7건)

이중과제 훈련이 뇌졸중 환자에게 미치는 영향 : 체계적 고찰 및 메타분석박지혁, 박혜연, 원경아, 임승주pp. 7-25무작위 대조군 실험 연구에서 치료의향분석 (Intention-to-treat analysis)에 대한 고찰김정헌pp. 27-38채용공고 분석을 통한 작업치료사 구직 시장에 대한 연구임승주, 박지혁, 양민아, 한대성pp. 39-53국내 작업치료사의 퇴원계획 개입에 대한 실태 조사연구유은영, 황나경pp. 55-71여대생의 인지 및 행동적 회피요인이 우울증상을 매개로 수면의 질에 미치는 영향곽진영, 하은혜pp. 73-86
원문 보기