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만성기 뇌졸중 환자들의 독립 보행 예측 인자

A Predictive factors of Independent gait in People with Chronic Stroke

안승헌|이병권
특수교육재활과학연구소 (The Research Institute for Special Education & Rehabilitation Science)|2013.12|특수교육재활과학연구|제52권 제4호|pp. 177-192

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키워드

뇌졸중Stroke균형Balance하지 근력보행 속도퓨글 마이어 하지 운동 기능Gait velocutyFugl-Meyer lower extremity functionStrength of Lower extremity
주제분류기타사회과학

초록

본 연구는 횡단적 조사 연구(Cros-sectional study)로서 만성기 뇌졸중 환자들의 독립 보행을 예측할 수 있는 변수를 알아보고자 하였다. 뇌졸중 환자 44명을 대상으로 보행 속도는 5m 보행 속도 검사, 인지 기능(Mini Mental State Eaxmination-Korean version, MMSE-K), 마비측 하지 운동 기능(Fugl Meyer-Lower Extremity, FM-L/E), 하지 근력(Sit To Standing test, STS), 동적 균형(Berg Balance Scale, BBS), 체간 장애 척도(Trunk Impairment Scale, TIS)를 이용하였다. 보행 속도의 예측인자는 로지스틱 회귀 분석(Logistic regression analysis, 전진 Wald)과 수용자 작업특성곡선(Receiver operation characteristic curve, ROC curve)을 이용하여 독립된 지역사회 보행예측에 관한 최적의 선별 기준값(cutoff value)을 구하였고, 예측 인자와 보행속도와 관련성을 알아보고자 Χ2검정을 하였다. 연구 결과 뇌졸중 환자들의 보행 장애의 대표적인 특징은 느린 보행 속도이며 그에 따른 하지 근력과 마비측 하지 운동 기능, 균형, 체간 조절 수행 능력에 장애가 있다. 특히 독립된 지역 사회 보행(보행속도 >.8m/s)에서는 하지 근력과 마비측 하지 운동 기능이 가장 영향력을 주는 변수이었고, 균형 능력과는 관련성이 없었으나 STS <11.44초, FM-하지 운동 기능이 >27점인 경우 독립된 지역 사회 보행을 예측하는데 최적의 변수임을 확인할 수 있었다. 따라서 만성 뇌졸중환자들의 보행속도를 증가시키거나 독립된 지역 사회 보행이 가능하기 위해서는 하지 근력과 마비측 하지 운동 기능 증진을 위한 집중적인 치료가 필요하다고 할 수 있다.

Abstract

The purpose of this cross-sectional study was to investigate whether the gait velocity of people with chronic stroke has relevance to Mini Mental State Examination -Korean version(MMSE-K), Fugl Meyer-Lower Extremity(FM-L/E), Sit to Stand (STS), Berg Balance Scale(BBS), and Trunk Impairment Scale(TIS). Forty four patients with chronic stroke were screened with 5M Gait Velocity Test, MMSE- K, FM/LE, STS, BBS, and TIS voluntarily participated in this study. To identify the predictor of gait velocity, logistic regression analysis (Wald test) was used, and receiver operation characteristic curve(ROC curve) was conducted to detect optimal cutoff value to predict independent community ambulation. Chi-square test was used to analyze the relations between the predictor and the gait speed. The findings shows that the typical feature of gait disturbance with chronic stroke patients was delayed gait velocity and the consequential disability in strength and motor function of paretic lower extremity, balance, and trunk control ability. For independent community ambulation with gait velocity of 0.08m/s, especially, FM-L/E and STS were the most influential variables and there was no significant relevance to balance ability, whereas STS under 11.44 seconds and FM-L/E over 27 points was optimal variables identifying to predict of independent community ambulation. Consequently, this study suggests that we should provide intensive strengthening exercise and promote enhancing motor function programs of low extremities for people with chronic stroke to increase gait velocity, and perform independent community ambulation.

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