지팡이를 이용한 청각적 피드백이 뇌졸중 환자의 보행시 하지 근육의 근 활성도 및 골반 안정성에 미치는 영향
The Effects of Auditory Feedback with a Cane on Muscle Activation and Pelvic Stability in Paients with Stroke
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본 연구는 뇌졸중 환자를 대상으로 지팡이를 지지하여 보행하였을 때, 역치의 유ㆍ무 및 역치 강도에 따른 환측 근활성도와 골반안정성에 미치는 영향을 알아보고자 시행하였다. 13명(남 8, 여 5)의 만성 뇌졸중 환자가 연구에 참여하였으며, 대상자들은 세 가지 다른 조건에서 평가하였다. 첫째 역치 없이 지팡이를 지지하여 보행을 하였으며, 둘째 지팡이에 대한 최대 수직력의 2/3 이하로 지팡이를 지지하여 보행을 하였으며, 셋째 지팡이에 대한 최대수직력의 1/2 이하로 지팡이를 지지하여 각각 3번씩 무작위로 보행 하도록 하였다. 그 결과, 역치의 유ㆍ무 및 역치 강도에 따라 환측 근활성도에 유의한 차이가 있는 것으로 나타났다. 지팡이에 대한 최대 수직력의 1/2 이하로 지팡이를 지지하여 보행하였을 때 환측 척추기립근과 중둔근, 내측광근의 근활성도는 각각 57.88±23.10(%MVIC), 40.90±21.75(%MVIC), 35.56±13.79(%MVIC)로 세 방법 중 가장 큰 것으로 나타났다(p<.05). 또한 역치없이 걸었을 때보다 역치를 적용하여 걸었을 때가 환측 입각기시 골반의 내, 외측 가속도가 큰 것으로 나타났으며, 역치가 작을 때가 클 때보다 내, 외측 가속도가 유의하게 증가하는 것으로 나타났다(p<.05). 앞으로의 연구에서는 청각적 피드백을 이용한 보행 훈련을 하였을 때 환측 근활성도 및 균형, 보행패턴에 미치는 효과에 대해 연구할 필요가 있겠다.
Abstract
The purpose of this study was to examine the effect of a auditory feedback provided through a cane on muscle activation and pelvic stability during walking in subjects post stroke. Thirteen subjects (8 males, 5 female) with stroke enrolled in the study. All patients walked at a relatively slow speed, ranging from 0.10 to 0.47m/s. The applied vertical peak force on the cane were 10.90±3.97% body weight. Data collection over three gait cylces as subjects walkied at self-selected speed during: in randomized order with (1) not applied thereshold (2) applied thereshold as 2/3 of the vertical peak force (3) applied thereshold as 1/2 of the vertical peak force. Higher activations of ES, GM, and VMO muscles on the paretic leg were found during the gait cycle when is provided thereshold through a instrumented cane. Also, results showed that the significant differences in ML pelvic stability during paretic stance phase between three methods. In conclusion, The paretic muscle activation were significantly greater during the walking with a smaller thereshold. Further studies, walking pattern should be measured at during walking applied different thereshold in lhemiparetic subjects, as its use may mask underlying gait impairment.
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