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경직성 뇌성마비로 인한 하지 단마비 환아의 일단계 다수준 수술 후 치료적 운동의 효과

Effects of Therapeutic Exercise on Muscle Function following Single-Event Multilevel Surgery in Children with Spastic Lower Limb Monoplegic Cerebral Palsy

이호성|김아람|안근옥
한국운동생리학회|2015.05|운동과학 (Exercise Science)|제24권 제2호|pp. 195-202|DOI 10.15857/ksep.2015.24.2.195

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참고문헌

키워드

경직성 뇌성마비spastic cerebral palsy치료적 운동monoplegia단마비SEMLStherapeutic exercise

초록

[목적] 경직성 하지 단마비성 뇌성마비 환아의 일단계 다수준 수술(Single-event multilevel surgery; SEMLS) 후 근력 및 균형능력 향상을 위한 치료적 운동이 근기능에 미치는 영향을 확인하고, 경직성 뇌성마비 환아의 SEMLS 후 치료적 운동의 기초자료를 제공하는데 목적이 있다. [방법] 본 증례의 대상자는 좌측 원위 슬괵근 연장술, 아킬레스 건 연장술 및 후경골근 부분 이전술의 SEMLS 5개월 후 본 센터에 내원한 7세 여아로 피험자는 뇌성마비로 인한 좌측하지의 까치발 보행이 나타났다. 치료적 운동 프로그램은 발목관절 가동술, 균형운동, 계단 오르기와 내리기, 한 다리로 서서 발뒤꿈치 들기 및 한 다리로 뛰기 운동으로 구성하여 운동간 휴식시간 1분, 1회 40분, 주3회 8주간에 걸쳐 실시하였다. 모든 운동은 근력 및 근지구력의 향상과 운동학습능력을 촉진시키기 위하여 최대반복횟수로 진행하였다. 하퇴둘레, 발목관절 가동범위 및 외발서기 검사는 운동 전(pre) 및 8주 후(post)에 환측 및 건측에서 각각 측정하였다. [결과] 환측 하퇴둘레는 pre의 23.80cm와 비교해서 post에 24.80cm로 증가하였으며, 건측 대비 환측의 비율은 pre의 94.07%와 비교해서 post에 95.75%로 향상되었다. 환측의 무릎관절 굴곡 상태에서 발목관절 배측굴곡 가동범위는 pre의 12.90°와 비교해서 post에 17.30°로 증가하였으며, 건측 대비 환측의 비율은 pre의 75.00%와 비교해서 post에 98.30%로 향상되었다. 환측의 무릎관절 신전 상태에서 발목관절 배측굴곡 가동범위는 pre의 12.00°와 비교해서 post에 17.80°로 증가하였으며, 건측 대비 환측의 비율은 pre의 70.18%와 비교해서 post에 93.19%로 향상되었다. 환측의 눈을 뜬 상태에서 외발서기는 pre의 1.46초와 비교해서 post에 10.66초로 증가하였으며, 건측 대비 환측의 비율은 pre의 7.68%와 비교해서 post에 57.87%로 향상되었다. 환측의 눈을 감은 상태에서 외발서기는 pre의 0.73초와 비교해서 post에 1.60초로 증가하였으며, 건측 대비 환측의 비율은 pre의 8.96%와 비교해서 post에 18.54%로 향상되었다. [결론] 이상의 결과에 의하면, 이 사례연구에서는 경직성 뇌성마비로 인한 하지 단마비 환아의 SEMLS 후 치료적 운동의 적용은 근기능 향상에 효과적이라는 것이 시사되었다.

Abstract

PURPOSE: The purpose of this study was to determine the effect of therapeutic exercise for improving muscle strength and balance ability on muscle function in children with spastic lower limb monoplegic cerebral palsy after single-event multilevel surgery (SEMLS). METHODS: A-seven-year-old child with spastic lower limb monoplegic cerebral palsy(CP) after SEMLS of left distal hamstring lengthening, achiles tendon lengthening, and tibialis posterior transfer, the subject showed crouch gait to the left lower limb due to CP. Therapeutic exercise program consisted of ankle joint mobilization, balance exercise, walking up and down stairs, single leg heel raise, and Single leg jump for 40 min/d, 3d/week for 8 weeks. Exercises were performed intensively to an individualized maximum number of repetitions in order to promote motor learning and improve muscle strength and muscle endurance. Calf circumference, ankle joint range of motion (ROM), and one leg standing test (OLS) were measured before and after 8 weeks of therapeutic exercise each affected side and unaffected side. RESULTS: Calf circumference of the affected side was increased from 23.80 cm to 24.80 cm, and Ratio of affected side to unaffected side was improved from 94.07% to 95.75%. Ankle dorsiflexion ROM with knee flexion of the affected side was increased from 12.90° to 17.30°, and ratio of affected side to unaffected side was improved from 75.00% to 98.30%. Ankle dorsiflexion ROM with knee extension of the affected side was increased from 12.00° to 17.80°, and ratio of affected side to unaffected side was improved from 70.18% to 93.19%. OLS with eye opened of the affected side was increased from 1.46 sec to 10.66 sec, and ratio of affected side to unaffected side was improved from 7.68% to 57.87%. OLS with eye closed of the affected side was increased from 0.73 sec to 1.60 sec, and ratio of affected side to unaffected side was improved from 8.96% to 18.54%. CONCLUSIONS: These results suggest that therapeutic exercise improve muscle function in children with spastic lower limb monoplegic cerebral palsy after SEMLS.

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