본문 바로가기
KERD
논문KCI 등재

만성 뇌졸중 환자에서 거울 치료 시 tDCS의 융합 자극이 다리근력 및 보행능력에 미치는 효과

The Effects of Convergent Stimulation on tDCS during Mirror Therapy to Improve the Muscle Strength and Gait Ability in Chronic Stroke Patients

김경윤|이승태
대한산업경영학회 (Dae Han Society of Industrial Management)|2020.08|산업융합연구 (Journal of Industrial Convergence)|제18권 제4호|pp. 51-59|DOI 10.22678/JIC.2020.18.4.051

1

조회

0

다운로드

2

인용

0

참고문헌

키워드

근력보행능력경두개직류자극거울치료융합자극
주제분류학제간연구

초록

본 연구는 만성 뇌졸중 환자를 대상으로 저항운동이 포함된 거울치료 시 tDCS(transcranial direct current stimulation)의 융합 자극을 통해 마비측 다리의 근력과 보행 능력의 개선을 알아보고자 하였다. 12명의 뇌졸중 환자는 실험군 당 6명씩 무작위로 할당하였다. 실험군Ⅰ(n=6)은 NDT(neurodevelopmental treatment)와 거울치료 시 sham tDCS의 융합자극군, 실험군Ⅱ는 NDT와 거울치료 시 tDCS의 융합자극군으로 나누어 각각 30분씩, 주5회, 총4주 동안 실험을 실시하였다. 모든 평가는 중재 전과 중재 4주 후에 실시하였다. 다리근력은 측정한 모든 근육에서 실험군Ⅰ에 비해 실험군Ⅱ에서 유의한 차이를 나타냈고(p<.05), 변화량을 통한 군 간 비교에서는 quadriceps(p<.01)와 tibialis anterior(p<.01)에서 유의한 차이를 나타냈다. 보행능력은 실험군Ⅰ과 실험군Ⅱ 모두에서 유의한 차이를 나타냈고(p<.05), 변화량을 통한 군 간 비교에서 유의한 차이를 나타냈다(p<.01). 거울치료와 tDCS의 융합자극은 마비측 다리 근력 및 보행능력 향상에 중첩효과를 통한 긍정적인 개선 효과를 주는 것을 알 수 있었다.

Abstract

The purpose of this study was to investigate the improvement of muscle strength and gait ability of paralyzed lower extremity through convergent stimulation of tDCS(transcranial direct current stimulation) during mirror therapy with resistance exercise in chronic stroke patients. 12 patients with stroke were randomly assigned and divided into groupⅠ(n=6) and groupⅡ(n=6). GroupⅠ provided NDT(neurodevelopmental treatment) and mirror therapy with sham tDCS, and groupⅡ provided NDT and mirror therapy with tDCS. Each convergent stimulation was conducted 5 times a week, 30 minutes per session for a total of 4 weeks. All evaluation was conducted before intervention and performed after 4 weeks. Lower extremity strength showed a significant improvement in groupⅡ compared to groupⅠ(p<.05), and in comparison between groups by variance, significant difference in the quadriceps(p<.01) and tibialis anterior(p<.01). Gait ability showed a significant improvement in both groupⅠ(p<.05) and groupⅡ(p<.05), and significant difference in comparison between groups by variance(p<.01). In conclusion, mirror therapy with tDCS convergent stimulation had a positive improvement effect on paralyzed lower extremity to strength and gait ability through the overlapping interaction.

참고문헌 (41)

  1. C. B. Beaman, "Differences in self-selected and fastest-comfortable walking inpost-stroke hemiparetic persons", Gait & Posture, 31(3), pp.311~316 (2010)[DOI]
  2. Simone Dorsch, "Lower Limb Strength Is Significantly Impaired in All Muscle Groups in Ambulatory People With Chronic Stroke: A Cross-Sectional Study", Archives of Physical Medicine and Rehabilitation, 97(4), pp.522~527 (2016), Elsevier BV[DOI]
  3. R. W. Bohannon, "Muscle strength and muscle training after stroke", Journal of Rehabilitation Medicine, 39(1), pp.14~20 (2007)[DOI]
  4. R. W. Bohannon, "Nature, reliability, and predictive value of muscle performance measures in patients with hemiparesis following stroke", Archives of Physical Medicine and Rehabilitation, 73(8), pp.721~725 (1992)[DOI]
  5. M. G. Pandy, "Muscle and joint function in human locomotion", Annual Review of Biomedical Engineering, 15(12), pp.401~433 (2010)[DOI]
  6. Y. Laufer, "Weight-bearing shifts of emiparetic and healthy adults upon stepping on stair of various height", Clinical Rehabilitation, 14(2), pp.125~129 (2000)[DOI]
  7. M. Roerdink, "Gait coordination after stroke: Benefits of acoustically paced treadmill walking", Physical Therapy, 87(8), pp.1009~1022 (2007)[DOI]
  8. F. M. Campbell, "Head and pelvic movements during a dynamic reaching task in sitting: Implications for physical therapists", Archives of Physical Medicine and Rehabilitation, 82(12), pp.1655~1660 (2001)[DOI]
  9. J. M. Gracies, "Pathophysiology of spasitc paralysis. Ⅰ: Paresis and soft tissue changes", Muscle & Nerve, 31(5), pp.535~551 (2005)[DOI]
  10. S. Raine, "Bobath Concept: Theory and Clinical Practice in Neurological Rehabilitation" (2009), Wiley-Blackwell
  11. K. N. Arya, "Task based mirror therapy augmenting motor recovery in poststroke hemiparesis: A randomized controlled trial", Journal of Stroke and Cerebrovascular Disease, 24(8), pp.1738~17480 (2015)[DOI]
  12. S. Blanton, "An application of extremity constraint induced movement therapy in a patient with subacute stroke", Physical Therapy, 79(9), pp.847~853 (1999)
  13. G. Buccino, "The mirror neuron system and action recognition", Brain and Language, 89(2), pp.370~376 (2004)[DOI]
  14. E. H. Choi, "Effect of lower extremity muscle strength exercise using a mirror on gait and balance of patients with chronic stroke", M.S, pp.2017
  15. M. C. D. S. de Moura, "Effects of transcranial direct current stimulation (tDCS) on balance improvement: A systematic review and meta-analysis", Somatosensory & Motor Research, 36(2), pp.122~135 (2019)[DOI]
  16. M. A. Nitsche, "Transcranial direct current stimulation: state of the art 2008", Brain Stimulation, 1(3), pp.206~223 (2008)[DOI]
  17. S. Sütbeyaz, "Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke", Archives of Physical Medicine and Rehabilitation, 88(5), pp.555~559 (2007)[DOI]
  18. D. E. Krebs, "Functional vs. strength training in disable elderly out patients", American Journal of Physical Medicine and Rehabilitation, 86(2), pp.93~103 (2007)[DOI]
  19. D. Podisiadlo, "The timed “UP & GO” : a test basic functional mobility for frail elderly person", Journal of the American Geriatrics Society, 39(2), pp.142~148 (1991)[DOI]
  20. S. G. Kirker, "Changing patterns of postural hip muscle activity during recovery from stroke", Clinical Rehabilitation, 14(6), pp.618~626 (2000)[DOI]
  21. R. W. Bohannon, "Muscle strength and muscle training after stroke", Journal of Rehabilitation Medicine, 39(1), pp.14~20 (2007)[DOI]
  22. L. F. Teixeira-salmela, "Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors", Archives of Physical Medicine and Rehabilitation, 80(10), pp.1211~1218 (1999)[DOI]
  23. C. Pattern, "Weakness and strength training in persons with poststroke hemiplegia: ratinale, method, and efficacy", Journal of Rehabilitation Research and Development, 41(3A), pp.293~312 (2004)[DOI]
  24. A. Bashin, "Neural interface of mirror therapy in chronic stroke patients : A functional magnetic resonance imaging study", Neurology India, 60(6), pp.570~576 (2012)[DOI]
  25. 박승하, "활동관찰, 운동심상, 그리고 거울을 활용한 시각적 착시가 운동피질 활성화에 미치는 영향", 한국스포츠심리학회지, 20(3), pp.211~222 (2009), 한국스포츠심리학회
  26. H. Thieme, "Mirror therapy for improving motor function after stroke", The Cochrane Database of Systematic Review, 7(7), pp.1~66 (2012)[DOI]
  27. E. L. Altchuler, "Rehabilitation of hemiparesis after stroke with a mirror", Lancet, 353(9169), pp.2035~2036 (1999)[DOI]
  28. S. G. Ji, "The effects of the task-oriented mirror visual feedback therapy on the balance and gait of subacute stroke patients", D.S, pp.2013
  29. E. H. Choi, "Effect of lower extremity muscle strength exercise using a mirror on gait and balance of patients with chronic stroke", M.S, pp.2017
  30. D. Liebetanz, "Pharmacological approach to the mechanisms of transcranial DC-stimulation induced after effects of human motor cortex excitability", Brain, 125(Pt10), pp.2238~2247 (2002)[DOI]
  31. Y. H. Kwon, "Primary motor cortex activation by transcranial direct current stimulation in the human brain", Neuroscience Letters, 435(1), pp.56~59 (2008)[DOI]
  32. S. Tanaka, "Single session of transcranial direct cureent stimulation transiently increases knee extensor force in patients with hemiparetic stroke", Neurorehabilitation and Neural Repair, 25(6), pp.565~569 (2011)[DOI]
  33. S. Tanaka, "Enhancement of pinch force in the lower leg by anodal transcranial direct current stimulation", Exp Brain Res, 196(3), pp.459~465 (2009)[DOI]
  34. S. Machado, "Is tDCS an adjunct ergogenic resource for improving muscular strength and endurance performance? A systematic review", Front Psychol, 10(1127), pp.1~14 (2019)[DOI]
  35. E. Lattari, "Acute effects of single dose transcranial direct current stimulation on muscle strength: A systematic review and meta-analysis", Meta-Analysis, 13(12), pp.1~19 (2018)[DOI]
  36. T. M. Steffen, "Age- and Gender-related test performance in community-dwelling elderly people: Six-minute walk test, Berg Balance Scale, Timed Up & Go test, and gait speeds", Physical Therapy, 82(2), pp.128~137 (2002)[DOI]
  37. S. Nadeau, "Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke", American Journal of Physical Medicine Rehabilitation, 78(2), pp.123~130 (1999)[DOI]
  38. C. M. Kim, "Effects of isokinetic strength training on walking in persons with stroke: a double-blind controlled pilot study", Journal of Stroke and Cerebrovascular Disease, 10(6), pp.265~273 (2001)[DOI]
  39. 김신균, "만성 뇌졸중 환자의 하지 근육의 활성도에 트레드밀 경사도 훈련이 미치는 영향", 한국산학기술학회논문지, 13(1), pp.220~226 (2012), 한국산학기술학회
  40. S. S. Kantak, "Rewiring the brain: potential role of the premotor cortex in motor control, learning, and recovery of function follwong brain injury", Neurorehabilitation and Neural Repair, 26(3), pp.282~292 (2012)[DOI]
  41. L. Sawaki, "Effects of somatosensory stimulation on use-dependent plasticity in chronic stroke", Stroke, 37(1), pp.246~247 (2006)[DOI]

관련 논문AI추천

기능적 전기자극을 병행한 거울치료가 만성 뇌졸중 환자의 균형 및 보행능력에 미치는 영향에 관한 융합적 연구김경훈, 김동훈한국융합학회 · 한국융합학회논문지2018 · 제9권 제10호만성 뇌졸중 후 편마비 환자에서 2주간 경두개 전기 자극 후 상지 운동기능 향상김덕용, 박기덕, 박종범, 박창일, 오윤택, 온석훈, 정강재대한재활의학회 · Annals of Rehabilitation Medicine2009 · 제33권 제1호뇌졸중 환자의 상지기능 개선을 위한 과제 지향적 훈련과 진동 자극, 경두개 직류 전류 자극의 융합 효과김선호한국융합학회 · 한국융합학회논문지2020 · 제11권 제9호뇌졸중 환자의 상지기능 향상을 위한 경두개 직류 자극과 강제 유도 운동 치료의 결합 중재 효과에 대한 체계적 고찰김선호대한신경계작업치료학회 · 재활치료과학2019 · 제8권 제4호뇌졸중 환자의 상지기능에 대한 경두개 직류자극술 효과 : 체계적 고찰 및 메타분석박지혁, 박혜연, 양민아, 원경아대한신경계작업치료학회 · 재활치료과학2020 · 제9권 제1호거울치료가 뇌졸중 환자의 운동기능 회복에 미치는 영향: 메타분석이희원, 전혜선한국전문물리치료학회 · 한국전문물리치료학회지2012 · 제19권 제2호

이 간행물의 다른 논문 (13건)

무용공연의 디지털미디어연계 실황중계 사례분석: 창작산실 무용 지원사업을 중심으로이지설pp. 1-8고등학교 교사의 그릿과 직무스트레스 대응행동 간의 관계김진철, 장봉석pp. 9-14원자력발전소 복수기 수실 차단밸브 설치 영향 평가이선기pp. 15-21갱년기 증후군, 회복탄력성이 중년 남성의 은퇴불안에 미치는 융·복합적 영향김순애, 홍은희, 이송현pp. 23-31정신약물을 복용하는 정신질환자의 진정, 섬망, 낙상에 관한 연구박경미pp. 33-40
원문 보기