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로봇미러링훈련과 로봇거울치료의 아급성기 뇌졸중 환자에 대한 편측무시 개선 효과성 비교: 무작위대조군예비연구

Comparing the Effectiveness of Robot Mirroring Training and Mirror Therapy with Robot on Unilateral Neglect in Patients with Subacute Stroke: A Randomized Controlled Pilot Study

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한국노인작업치료학회 (Korean Society for Geriatric Occupational Therapy)|2024.12|한국노인작업치료학회지 (Korea Journal of Geriatric Occupational Therapy)|제6권 제2호|pp. 65-81

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참고문헌

키워드

뇌졸중Stroke편측무시Randomized controlled trial거울치료Mirror therapyUnilateral neglect로봇중재무작위대조연구Robot intervention

초록

목적 : 본 연구는 로봇을 활용한 중재법인 로봇미러링훈련과 로봇거울치료가 아급성기 뇌졸중 환자의 편측무시 감소와 일상생활활동 수행에 미치는 영향을 알아보고 효과성을 비교하고자 하였다. 연구방법 : 본 연구는 무작위 대조군 예비연구로 충청지역의 D병원에 입원 중인 뇌졸중 환자 16명을 대상으로 로봇미러링훈련 집단과 로봇거울치료 집단으로 각각 8명씩 배정하였다. 각 집단의 중재는 총 15회기로 5주간 주 3회, 1회기 당 30분의 중재를 실시하였다. 중재 전⋅후 편측무시를 평가하기 위해 행동무주의검사-전통적하위검사(Behavioral Inattention Test-Conventiona; BIT-C)와 한국판 캐서린버지고척도(Korean Catherine Bergego Scale: K-CBS)를 사용하였고 일상생활활동 수행을 평가하기 위해 한국판수정바델지수(Korean Modified Bathel Index; K-MBI)를 사용하였다. 결과 : 집단 내 전⋅후 비교 시, 로봇미러링훈련 집단은 BIT-C와 K-CBS, K-MBI에서 통계학적으로 유의미한 변화를 보여(p < .05) 편측무시 감소와 일상생활활동의 향상을 확인하였다. 로봇거울치료 집단은 BIT-C 중 선이등분검사(Line Bisection Test; LBT)와 그림따라그리기(Figure and shape Copying Test; FCT)를 제외한 항목과 BIT-C 총점, K-CBS, K-MBI에서 통계학적으로 유의미한 변화를 보였다(p < .05). 집단 간 변화량 비교에서는 BIT-C 총점과 별지우기검사(Star Cancellation Test; SCT), LBT, FCT에서 유의미한 차이가 있었으나(p < .05) K-CBS와 K-MBI에서는 유의미한 차이가 없었다(p > .05). 결론 : 연구의 결과를 통해, 로봇미러링훈련이 뇌졸중 환자의 편측무시 중재로 활용될 가능성을 확인할 수 있었다. 본 예비연구는 편측무시에 대한 새로운 중재법을 시도하였다는 측면에서 임상적인 의미가 있다.

Abstract

Objective : This study examined the effects of robotic mirroring training (RMTr) and mirror therapy with Robot (MTh-R) on unilateral neglect and activities of daily living (ADL) in patients with subacute stroke, and compared their effectiveness. Methods : A randomized controlled pilot trial was conducted on 16 patients with stroke in D Hospital in the Chungcheong, South Korea. Eight subjects were randomly classified into RMTr and MTh-R groups. Each intervention consisted of 15 sessions 30 min each, three times weekly for 5 weeks. Unilateral neglect was assessed using the Behavioral Inattention Test-Conventional (BIT-C) and Korean Catherine Bergego Scale (K-CBS). ADL performance was evaluated using the Korean Modified Barthel Index (K-MBI). Results : The RMTr group showed significant improvements in BIT-C, K-CBS, and K-MBI scores(p < .05), indicating reduced unilateral neglect and improved ADL performance. The MTh-R group showed significant changes in the BIT-C total score, subtests, K-CBS, and K-MBI, except for the Line Bisection Test (LBT) and Figure and Shape Copy Test (FCT; p < .05). Comparisons between group revealed significant differences in the BIT-C total score, Star Cancellation Test, LBT, and FCT (p < .05); however, no significant differences were observed in the K-CBS and K-MBI (p > .05). Conclusion : RMTr has the potential to be an effective intervention for unilateral neglect in stroke patients, offering new clinical insights for addressing this condition.

참고문헌 (52)

  1. Altschuler, E. L., "Rehabilitation of hemiparesis after stroke with a mirror", The Lancet, 353(9169), pp.2035~2036 (1999)[DOI]
  2. Bazan, R., "Effect of robot-assisted training on unilateral spatial neglect after stroke : Systematic review and meta-analysis of randomized controlled trials", Neurorehabilitation and Neural Repair, 36(8), pp.545~556 (2022)[DOI]
  3. Bergego, C., "Functional consequences of unilateral neglect : validation of an evaluation scale, the CB scale", Annales de Réadaptation et de Médecine Physique, 38, pp.183~189 (1995)[DOI]
  4. Bosma, M. S., "Prevalence, severity and impact of visuospatial neglect in geriatric stroke rehabilitation, a cross-sectional study", Journal of the American Medical Directors Association, 24(11), pp.1798~1805 (2023)[DOI]
  5. Bosma, M. S., "Impact of visuospatial neglect post-stroke on daily activities, participation and informal caregiver burden : A systematic review", Annals of Physical and Rehabilitation Medicine, 63(4), pp.344~358 (2020)[DOI]
  6. Bouska, M. J., "Manual for application of the motor-free visual perception test to the adult population", Moss Rehabilitation Hospital, ~ (1983)
  7. Cermak, S. A., "The behavioral inattention test for unilateral visual neglect : A critical review", Physical & Occupational Therapy In Geriatrics, 7(3), pp.43~53 (1989)[DOI]
  8. Choi, Y. S., "The effect of an upper limb rehabilitation robot on hemispatial neglect in stroke patients", Annals of Rehabilitation Medicine, 40(4), pp.611~619 (2016)[DOI]
  9. Colarusso, R. P., "Motor-free visual perception test" (1972), Academic Therapy Pub
  10. Cox, J. A., "Keeping an eye on visual search patterns in visuospatial neglect : A systematic review", Neuropsychologia, 146, pp.107547~ (2020)[DOI]
  11. Deconinck, F. J., "Reflections on mirror therapy : A systematic review of the effect of mirror visual feedback on the brain", Neurorehabilitation and Neural Repair, 29(4), pp.349~361 (2015)[DOI]
  12. De-Rosende-Celeiro, I., "Independence in daily activities after stroke among occupational therapy patients and its relationship with unilateral neglect", International Journal of Environmental Research and Public Health, 18(14), pp.7537~ (2021)[DOI]
  13. Dohle, C., "Mirror therapy promotes recovery from severe hemiparesis : A randomized controlled trial", Neurorehabilitation and Neural Repair, 23(3), pp.209~217 (2009)[DOI]
  14. Doron, N., "Is unilateral spatial neglect associated with motor recovery of the affected upper extremity poststroke? A systematic review", Neurorehabilitation and Neural Repair, 33(3), pp.179~187 (2019)[DOI]
  15. Embrechts, E., "The association of personal neglect with motor, activities of daily living, and participation outcomes after stroke : A systematic review", Archives of Clinical Neuropsychology, 39(2), pp.249~264 (2024)[DOI]
  16. Folstein, M. F., ""Mini-mental state" : A practical method for grading the cognitive state of patients for the clinician", Journal of Psychiatric Research, 12(3), pp.189~198 (1975)[DOI]
  17. Fruhmann Berger, M., "On the relation between active and passive behaviour in patients with spatial neglect-Insights from acute stroke and the course of recovery", Doctor, pp.2008
  18. Heo, E. Y., "The comparison between CBS and pencil and paper test in patients with unilateral neglect", Therapeutic Science for Rehabilitation, 2(1), pp.48~56 (2013)[DOI]
  19. Hillier, S., "Assessing proprioception : A systematic review of possibilities", Neurorehabilitation and Neural Repair, 29(10), pp.933~949 (2015)[DOI]
  20. Jeong, E. H., "A review of spatial neglect : Types, theories, neuroanatomy, assessments and treatment", Therapeutic Science for Rehabilitation, 6(1), pp.11~23 (2017)[DOI]
  21. Jung, H. Y., "Development of the Korean version of Modified Barthel Index(K-MBI) : Multi-center study for subjects with stroke", Journal of the Korean Academy of Rehabilitation Medicine, 31(3), pp.283~297 (2007)
  22. Kang, Y. W., "A validity Study on the Korean Mini-Mental State Examination(K-MMSE)in dementia patients", Journal of the Korean Neurological Association, 15(2), pp.300~308 (1997)
  23. Kim, J. M., "Comparison of diagnostic validities between MMSE-K and K-MMSE for screening of dementia", Journal of Korean Neuropsychiatric Association, 42(1), pp.124~130 (2003)
  24. Kwakkel, G., "Predicting activities after stroke : What is clinically relevant?", International Journal of Stroke, 8(1), pp.25~32 (2013)[DOI]
  25. Lee, B. E., "Reliability and validity of Korean Catherine Bergego scale for evaluation of unilateral neglect in stroke patients", Korean Journal of Occupational Therapy, 23(2), pp.45~56 (2015)[DOI]
  26. Lee, M. M., "The mirror therapy program enhances upper-limb motor recovery and motor function in acute stroke patients", American Journal of Physical Medicine & Rehabilitation, 91(8), pp.689~700 (2012)[DOI]
  27. Lindell, A. B., "Cl inical assessment of hemispatial neglect : Evaluation of different measures and dimensions", The Clinical Neuropsychologist, 21(3), pp.479~497 (2007)[DOI]
  28. Lo, A. C., "Clinical designs of recent robot rehabilitation trials", American Journal of Physical Medicine & Rehabilitation, 91(11 Suppl 3), pp.S204~S216 (2012)[DOI]
  29. Longley, V., "Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury", Cochrane Database of Systematic Reviews, 7(7), pp.CD003586~ (2021)[DOI]
  30. Luukkainen-Markkula, R., "Rehabilitation of hemispatial neglect : A randomized study using either arm activation or visual scanning training", Restorative Neurology and Neuroscience, 27(6), pp.665~672 (2009)[DOI]
  31. Meyer, S., "Somatosensory impairments in the upper limb poststroke : Distribution and association with motor function and visuospatial neglect", Neurorehabilitation and Neural Repair, 30(8), pp.731~742 (2016)[DOI]
  32. Muñoz-Gómez, E., "Effects of mirror therapy on spasticity and sensory impairment after stroke : Systematic review and meta-analysis", PM&R, 15(11), pp.1478~1492 (2023)[DOI]
  33. Nam, H. S., "Recovery of proprioception in the upper extremity by robotic mirror therapy : A clinical pilot study for proof of concept", Journal of Korean Medical Science, 32(10), pp.1568~1575 (2017)[DOI]
  34. Nijboer, T. C., "The impact of recovery of visuo-spatial neglect on motor recovery of the upper paretic limb after stroke", PLoS One, 9(6), pp.e100584~ (2014)[DOI]
  35. Nijboer, T., "Predicting functional outcome after stroke : The influence of neglect on basic activities in daily living", Frontiers in Human Neuroscience, 7, pp.182~ (2013)[DOI]
  36. Pandian, J. D., "Mirror therapy in unilateral neglect after stroke(MUST trial) : A randomized controlled trial", Neurology, 83(11), pp.1012~1017 (2014)[DOI]
  37. Park, J. H., "The effects of robot-assisted left-hand training on hemispatial neglect in older patients with chronic stroke: A pilot and randomized controlled trial", Medicine, 100(9), pp.e24781~ (2021)[DOI]
  38. Polanowska, K., "Left-hand somatosensory stimulation combined with visual scanning training in rehabilitation for post-stroke hemineglect : A randomised, double-blind study", Neuropsychological Rehabilitation, 19(3), pp.364~382 (2009)[DOI]
  39. Punt, T. D., "Motor neglect : Implications for movement and rehabilitation following stroke", Disability and Rehabilitation, 28(13-14), pp.857~864 (2006)[DOI]
  40. Robertson, I. H., "Spatio-motor cueing in unilateral left neglect : The role of hemispace, hand and motor activation", Neuropsychologia, 30(6), pp.553~563 (1992)[DOI]
  41. Robertson, I. H., "Rehabilitation by limb activation training reduces left-sided motor impairment in unilateral neglect patients : A single-blind randomised control trial", Neuropsychological Rehabilitation, 12(5), pp.439~454 (2002)[DOI]
  42. Rode, G., "Looking while imagining : The influence of visual input on representational neglect", Neurology, 68(6), pp.432~437 (2007)[DOI]
  43. Saevarsson, S., "Designing rehabilitation programs for neglect : Could 2 be more than 1+ 1?", Applied Neuropsychology, 18(2), pp.95~106 (2011)[DOI]
  44. Samuelsson, H., "Visuospatial neglect and an ipsilesional bias during the start of performance in conventional tests of neglect", The Clinical Neuropsychologist, 10(1), pp.15~24 (1996)[DOI]
  45. Schrader, M., "The effect of mirror therapy can be improved by simultaneous robotic assistance", Restorative Neurology and Neuroscience, 40(3), pp.185~194 (2022)[DOI]
  46. Selles, R. W., "Effects of a mirror-induced visual illusion on a reaching task in stroke patients : Implications for mirror therapy training", Neurorehabilitation and Neural Repair, 28(7), pp.652~659 (2014)[DOI]
  47. Shah, S., "Improving the sensitivity of t he B arthel Index f or s troke rehabilitation", Journal of Clinical Epidemiology, 42(8), pp.703~709 (1989)[DOI]
  48. Sim, T. Y., "Comparing the effectiveness of bimanual and unimanual mirror therapy in unilateral neglect after stroke : A pilot study", NeuroRehabilitation, 50(1), pp.133~141 (2022)[DOI]
  49. Umeonwuka, C., "Current trends in the treatment of patients with post-stroke unil ateral spatial negl ect : A s coping r eview", Disability and Rehabilitation, 44(11), pp.2158~2185 (2022)[DOI]
  50. Wee, J. Y., "Comparing consequences of right and left unilateral neglect in a stroke rehabilitation population", American Journal of Physical Medicine & Rehabilitation, 87(11), pp.910~920 (2008)[DOI]
  51. Wilson, B., "Development of a behavioral test of visuospatial neglect", Archives of Physical Medicine and Rehabilitation, 68(2), pp.98~102 (1987)
  52. Zhang, W., "Effect of modified constraint-induced movement therapy on the activities of daily living of patients with acute stroke", Chinese Journal of Contemporary Neurology & Neurosurgery, 15(4), pp.280~ (2015)[DOI]

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