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과제지향훈련 및 부가적인 TENS 중재가 만성 뇌졸중 환자의 상지 근활성, 운동기능 및 경직에 미치는 효과

The Effects of Task-Related Training Combined with Transcutaneous Electrical Nerve Stimulation (TENS) on Muscle Activation, Motor Function and Spasticity in Patients with Stroke

정진화|정경심|인태성|조휘영
특수교육재활과학연구소 (The Research Institute for Special Education & Rehabilitation Science)|2016.09|특수교육재활과학연구|제55권 제3호|pp. 435-450|DOI http://dx.doi.org/10.15870/jsers.2016.09.55.3.435

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키워드

경직TENSspasticity상지 운동 기능과제지향훈련transcutaneous electrical nerve stimulation(TENS)arm motor functionTask–related training
주제분류기타사회과학

초록

본 연구는 만성뇌졸중 환자에게 과제지향훈련 및 부가적인 TENS(transcutaneous electrical nerve stimulation) 중재가 상지의 근활성, 운동기능 그리고 경직에 미치는 효과를 규명하기 위하여 실시되었다. 단일맹검 및 사전 무작위 임상시험으로 진행되었으며, 24명의 만성 뇌줄중 환자는 무작위로 실험군(n=12)과 대조군(n=12)로 배정되었다. 실험군은 과제지향훈련을 4주간 주 5회, 총 20회 시행하였고, 과제수행 전 30분간 TENS자극을 마비측 팔에 적용받았다. 대조군은 동일한 과제지향훈련을 수행하였고, 속임 TENS자극을 받았다. 근활성은 표면 근전도를 이용하였고, 상지의 운동기능을 측정하기 위하여 Fugl-Meyer 상지 검사를 이용하였다. 또한 경직을 측정하기 위하여 Modified Ashworth Scale(MAS)를 사용하였다. 중재 후 실험군과 대조군 모두에서 근활성이 유의하게 증가하였고, 상지의 운동기능이 유의하게 향상되었다. 또한 경직도 유의한 개선을 보였다. 실험군은 대조군에 비하여 긴노쪽손목폄근과 운동기능 그리고 팔꿉 굽힘근의 경직을 유의하게 개선하였다. 본 연구는 과제지향훈련은 만성 뇌졸중 환자의 근활성 증가, 운동기능개선 그리고 경직 중재에 효과적이며, 부가적인 TENS 중재는 이를 더욱 효과적으로 향상시킴을 증명하였다.

Abstract

This study investigated the efficacy of task-related training (TRT) combined with Transcutaneous Electrical Nerve Stimulation (TENS) on the improvement of upper limb muscle activation, motor function and spasticity of upper extremity in chronic stroke patients. This study designed as a pilot randomized clinical trial study. 24 inpatients with chronic stroke were recruited and randomly assigned into two group: the experimental group (n=12) and the control group (n=12). Subjects in the experimental group received high-frequency TENS for 30 minutes on wrist and elbow extensors, while the control group received placebo-TENS stimulation that was not real electrical stimulation. All participants in both groups conducted task-relate training for 30 minutes after TENS application five days a week for four weeks (20 sessions). The primary outcomes of upper limb muscle activation were measured by surface electromyography (EMG), and Fugl-Meyer upper extremity scale (FMUE) was used to assess motor function of upper extremity. Modified ashworth scale (MAS) was used to identify spasticity. The measurements were performed before and after the 4 weeks intervention period. Both groups showed significant improvements in muscle activation, motor function, and spasticity after intervention. Especially, the experimental group shows a significant differences in muscle activation of extensor carpi radialis longus, FMUE, and spasticity on elbow flexor compared to the control group. Our findings indicate that TRT is effective to improve muscle activity, motor function and spasticity in paretic upper limb of chronic stroke patients, and additional TENS application makes this more efficient.

참고문헌 (34)

  1. 정상모, "Balance trainer 훈련이 만성 뇌졸중 환자의 발목 근력과 균형 능력에 미치는 효과", 특수교육재활과학연구, 52(4), pp.377~390 (2013), 특수교육재활과학연구소
  2. Abdollahi, I., "The relationship between isokinetic muscle strength and spasticity in the lower limbs of stroke patients", J Bodyw Mov Ther, 19(2), pp.284~290 (2015)
  3. Ansari, N. N., "The interrater and intrarater reliability of the Modified Ashworth Scale in the assessment of muscle spasticity : limb and muscle group effect", NeuroRehabilitation, 23(3), pp.231~237 (2008)
  4. Beas, B. S., "Effects of acute administration of the GABA(B)receptor agonist baclofen on behavioral flexibility in rats", Psychopharmacology(Berl), 233(14), pp.2787~2797 (2016)
  5. Blouin, J. S., "High-frequency submaximal stimulation over muscle evokes centrally generated forces in human upper limb skeletal muscles", J Appl Physiol, 106(2), pp.370~377 (2009)
  6. Carr, J. H., "Neurological Rehabilitation : Optimizing Motor Performance" (1998), Butterworth-Heinemann
  7. Celnik, P., "Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke", Arch Phys Med Rehabil, 88, pp.1369~1376 (2007)
  8. Conforto, A. B., "Effects of Somatosensory Stimulation on Motor Function After Subacute Stroke", Neurorehabil Neural Repair, 24(3), pp.263~272 (2010)
  9. Day, B. L., "Changes in the response to magnetic and electrical stimulation of the motor cortex after muscle stretch in man", J Physiol, 433, pp.41~57 (1991)
  10. Dean, C., "Task-related circuit training improves performance of locomotor tasks in chronic stroke : A randomized, controlled pilot trial", Arch Phys Med Rehabil, 81(4), pp.409~417 (2000)
  11. Duncan, P. W., "Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident", Phys Ther, 63(10), pp.1606~1610 (1983)
  12. Hamdy, S., "Long-term reorganisation of human motor cortex driven by short-term sensory stimulation", Nature Neurosci, 1, pp.64~68 (1998)
  13. Ikuno, K., "Effects of peripheral sensory nerve stimulation plus task-oriented training on upper extremity function in patients with subacute stroke : a pilot randomized crossover trial", Clin Rehabil, 26(11), pp.999~1009 (2012)
  14. Kafri, M., "EMG activity of finger flexor muscles and grip force following low-dose transcutaneous electrical nerve stimulation in healthy adult subjects", Somatosens Mot Res, 32(1), pp.1~7 (2015)
  15. Kara, M., "Quantification of the effects of transcutaneous electrical nerve stimulation with functional magnetic resonance imaging : a double-blind randomized placebo-controlled study", Arch Phys Med Rehabil, 91(8), pp.1160~1165 (2010)
  16. Kim, T. H., "Task-related training combined with transcutaneous electrical nerve stimulation promotes upper limb functions in patients with chronic stroke", Tohoku J Exp Med, 231(2), pp.93~100 (2013)
  17. Koesler, I. B., "Electrical somatosensory stimulation improves movement kinematics of the affected hand following stroke", J Neurol Neurosurg Psychiatry, 255, pp.1567~1573 (2009)
  18. Krakauer, J. W., "Arm Function after Stroke : From Physiology to Recovery", Semin Neurol, 25(4), pp.384~295 (2005)
  19. Pradeep Kumar, "Prediction of Upper Limb Motor Recovery after Subacute Ischemic Stroke Using Diffusion Tensor Imaging: A Systematic Review and Meta-Analysis", 대한뇌졸중학회지, 18(1), pp.50~59 (2016), 대한뇌졸중학회
  20. Laddha, D., "Effect of Transcutaneous Electrical Nerve Stimulation on Plantar Flexor Muscle Spasticity and Walking Speed in Stroke Patients", Physiother Res Int (2015)
  21. Maeda, Y., "Release of GABA and activation of GABA(A)in the spinal cord mediates the effects of TENS in rats", Brain Res, 1136(1), pp.43~50 (2007)
  22. Martins, F. L., "Immediate effects of TENS and cryotherapy in the reflex excitability and voluntary activity in hemiparetic subjects : a randomized crossover trial", Rev Bras Fisioter, 16(4), pp.337~344 (2012)
  23. McDonnell, M. N., "Influence of combined afferent stimulation and task-specific training following stroke : a pilot randomized controlled trial", Neurorehabil Neural Repair, 21, pp.435~443 (2007)
  24. Mills, P. B., "Transcutaneous Electrical Nerve Stimulation for Management of Limb Spasticity : A Systematic Review", Am J Phys Med Rehabil, 95(4), pp.309~318 (2016)
  25. Ng, S. S., "Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke", Stroke, 38, pp.2953~2959 (2007)
  26. Rakel B, "A new transient sham TENS device allows for investigator blinding while delivering a true placebo treatment", J Pain, 11(3), pp.230~238 (2010)
  27. Renner, CIe., "Group therapy task training versus individual task training during inpatient stroke rehabilitation : a randomised controlled trial", Clin Rehabil, 30(7), pp.637~648 (2016)
  28. Ross, S. A., "Relation between spasticity and strength in individuals with spastic diplegic cerebral palsy", Dev Med Child Neurol, 44(3), pp.148~157 (2002)
  29. Sawaki L, "Effects of somatosensory stimulation on usedependent plasticity in chronic stroke", Stroke, 37, pp.246~247 (2006)
  30. Shaygannejad, V., "Comparison of the effect of baclofen and transcutaneous electrical nerve stimulation for the treatment of spasticity in multiple sclerosis", Neurol Res, 35(6), pp.636~641 (2013)
  31. Thielman, G. T., "Rehabilitation of reaching after stroke : Task-related training versus progressive resistive exercise", Arch Phys Med Rehabil, 85(10), pp.1613~1618 (2004)
  32. Tinazzi, M., "Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation(TENS)of forearm muscles : evidence of reciprocal inhibition and facilitation", Exp Brain Res, 161, pp.457~464 (2005)
  33. Tyson, S. F., "The effects of transcutaneous electrical nerve stimulation on strength, proprioception, balance and mobility in people with stroke : a randomized controlled cross-over trial", Clin Rehabil, 27(9), pp.785~791 (2013)

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