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아급성기 뇌졸중 환자의 인지 및 운동과제가 10m 보행속도에 미치는 영향과 요인

The effect of cognitive and motor tasks on 10-meter walking speed and associated factors in subacute stroke patients

신병주|최수지|이준민|신준호|안승헌|김경은|양성필|김은주
특수교육재활과학연구소 (The Research Institute for Special Education & Rehabilitation Science)|2024.12|특수교육재활과학연구|제63권 제4호|pp. 229-249|DOI http://dx.doi.org/10.23944/Jsers.2024.12.63.4.11

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인지Cognition뇌졸중걷기운동WalkingStrokeMotor보행 속도Gait speed
주제분류기타사회과학

초록

본 연구의 목적은 아급성기 뇌졸중 환자를 대상으로 보행 중 인지 및 운동 과제를 동반한 이중 과제 수행 시 10m 편안한 보행속도와 빠른 보행속도의 신뢰도를 평가하고, 이중 과제가 보행 속도에 미치는 영향을 비교하고자 하였다. 21명을 대상으로 10m보행검사, 10m보행검사와 인지, 10m보행검사와 운동과제에 등 6가지 조건에서 각각 편안한 보행속도와 빠른 보행속도를 평가하였다. 5∼7일 후 동일한 조건에서 재검사를 실시하였다. 본 연구 결과, 10m보행검사는 편안한 보행속도와 빠른 보행속도에서 높은 신뢰도를 보였으며, ICC는 각각 0.985∼0.986(95% 신뢰구간: 0.951∼0.994)이였다. 또한, 인지 및 운동과제를 동반한 10m보행검사에서 ICC는 각각 0.991∼0.993(95% 신뢰구간: 0.977∼0.997)과 0.989∼0.996(95% 신뢰구간: 0.973∼0.998)로 나타났다. 10m보행검사, 10m보행검사(인지), 10m보행검사(운동)간에 편안한 보행속도와 빠른 보행속도에서 유의미한 차이가 있었으며(p<0.05∼0.001),이중 과제 조건에서도 유의미한 차이가 있었다(χ2 = 25.268, 31.831, p<0.001). BBS는 모든 과제에서 CWS와 FWS에 영향을 주는 요인이었고(설명력 69%∼76%, P<.001), 유병기간은 10mWT-인지의 CWS와 FWS에 영향을 주는 요인이었으며(설명력 14%∼24%, P<.013∼.002), 성별은 10mWT-운동의 CWS와 FWS에 영향을 주는 요인이었다(설명력 4%∼7%, P<.015∼.021). 뇌졸중 환자는 이중 과제 수행 중 보행 속도가 감소하였으며, 균형 능력이 중요한 요인으로 나타났다. 특히, 인지 및 운동 과제를 동시에 수행할 때 보행 속도가 유의미하게 감소하였다. 이러한 결과는 균형 훈련과 인지-운동 통합 이중 과제 훈련을 포함한 재활 전략이 보행 능력과 기능 회복을 개선하는 데 필요함을 강조한다.

Abstract

The purpose of this study was to evaluate the reliability of comfortable walking speed (CWS) and fast walking speed (FWS) during dual-task performance involving cognitive and motor tasks in 10-meter walk tests (10mWT) and to compare dual-task effects on walking speed in subacute stroke patients. Data were collected from 21 subacute stroke patients under six conditions: 10mWT, 10mWT with a cognitive task, and 10mWT with a motor task, each assessed for CWS and FWS. Retests were conducted five to seven days later. The 10mWT showed excellent reliability for CWS and FWS (ICCs: 0.985–0.986), as did dual-task conditions (ICCs: cognitive 0.991–0.993, motor 0.989–0.996). Significant differences were observed in CWS and FWS among tasks (P<0.05–0.001), including dual-task conditions (χ2=25.268, 31.831, P<0.001). The Berg Balance Scale (BBS) was the strongest predictor of CWS and FWS across all tasks, explaining 69%–76% of the variance (P<0.001). Disease duration influenced CWS and FWS during cognitive dual tasks (14%–24%, P<0.013–0.002), while sex affected motor dual-task performance (4%–7%, P<0.015–0.021). Stroke patients showed reduced walking speeds during dual-task performance, with balance ability being a critical factor. Walking speed significantly decreased when cognitive and motor tasks were performed simultaneously. These findings emphasize the need for rehabilitation strategies incorporating intensive balance training and dual-task exercises to improve walking performance and functional recovery.

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