무선연습을 적용한 도형그리기 과제가 운동실행장애가 있는 뇌졸중 환자의 글씨쓰기 명료도, 속도, 및 문장쓰기에 미치는 영향: 단일사례연구
Effects of copying figure tasks with random practice on handwriting skills in a stroke patient with motor praxis dysfunction : Single subject design
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본 연구는 운동실행장애가 있는 뇌졸중 환자에게 무선연습방법을 적용하여 글씨쓰기의 학습효과를 확인하였다. 연구방법은 단일사례연구(single subject design)로 AB design과 후속검사를 사용하였다. 연구 대상자는 출혈성 뇌손상을 진단받은 우측편마비 환자 1인이었으며, 중재기간은 3주간 총 13회기였다. 중재는 원, 세모, 네모 3가지의 도형 따라 그리기 과제를 제공하였으며 3가지 도형은 무작위 순으로 제시되었다. 중재의 효과를 확인하기 위하여 한글자모쓰기검사의 명료도와 속도를 측정하였고, 젭슨손기능검사의 짧은 문장 쓰기를사용하였다. 연구결과 한글자모쓰기검사에서 명료도가 향상되었고, 후속검사에서도 학습효과가 유지됨을 확인할 수 있었다. 반면 한글자모쓰기검사에서 속도는 늦어진 상태로 유지되는것을 확인할 수 있었다. 젭슨손기능검사의 짧은 문장 쓰기에서는 중재효과가 나타나지 않았다. 본 연구는 무선연습방법을 적용한 도형 그리기 연습을 통해 뇌졸중 환자의 글씨쓰기 명료도를 향상시킬 수 있음을 시사한다.
Abstract
The purpose of this study is to investigate the effects of random practice on handwriting skill learning in a stroke patient with paralysis of the dominant hand and motor praxis dysfunction. A single-subject study (AB-design) and follow-up tests were conducted with one patient. Total of 13 intervention sessions were provided for 3 weeks. During the intervention, the task was to copy 3 figures (circle, triangle, square), which were presented in random order.Handwriting skills, speed, and legibility were measured with Korean Letter Copying Test and writing test from Jebsen Hand Function Test. Visual analysis indicated stable legibility in the baseline phase, increased legibility in the intervention phase, and maintained legibility in the follow-up phase. However, the speed of letter copying test was slower in intervention phase than in baseline phase. In writing test from Jebsen Hand Function Test, there was no significant difference between baseline and intervention, and between baseline and follow-up. This study suggests that handwriting practice with random practice will improve the legibility of handwriting in a stroke patient with motor praxis dysfunction.
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