만성 뇌졸중 환자들의 체간 조절이 상지 기능에 미치는 영향
The Effect of Trunk Control on Upper Extremity Function in People with Chronic Stroke
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본 연구는 만성 뇌졸중 환자들의 체간 조절이 상지 기능에 어떠한 영향을 미치는지 알아보고자 하였다. 87명의 만성 뇌졸중 환자를 대상으로 체간 조절 평가는 체간 조절 검사(Trunk Control Test, TCT), 뇌졸중 자세 평가 척도-체간 조절(Postural Assessment Scale for Stroke-Trunk Control, PASS-TC), 수정된 체간 장애 척도(modified Trunk Impairment Scale, mTIS)를 상지 기능 평가는 Wolf 운동 기능 검사(Wolf Motor Function Test, WMFT), 퓨글 마이어 상지 검사(Fugl Meyer Assessment-Upper/Extremity, FM-U/E)를 이용하였다. 체간 조절이 상지 기능 수행에 미치는 요인 분석과 상지 기능 구분( FM-U/E: 만점 66점, 51∼65점: 경미한 장애/ FM-U/E=0∼50점: 중증 또는 경증 장애)을 위한 체간 조절 평가의 변별력은 수용자 작업 특성곡선을 이용하여 선별 기준값과 우도비를 구하였다. 연구 결과 체간조절이 상지 기능에 미치는 요인 분석에서 mTIS-동적 항목(체간 외측 굴곡)과 협응(체간 회전)이 (설명력 37%) WMFT에 영향을 주었고, mTIS-동적 항목(42%)이 FM-U/E에 영향을 주는 것으로 나타났다. 상지 기능 수행 예측을 위한 최적의 선별 기준값은 mTIS-협응 >2.5점, mTIS-총점은 >7.5점이었다. mTIS-총점이 상지 기능 수행(FM-U/E: 51∼65점)을 예측할 수 있는 변수로 mTIS 총점이 >7.5점인 경우 ≤7.5점인 환자들에 비해 0.161배 높은 것으로 나타났다. 뇌졸중 환자들은 여전히 체간 조절 결핍과 상지 기능에 장애가 보인다. 따라서 체간 조절은 상지 기능 회복과 유의한 관련이 있으므로 체간 조절의 외측 굴곡과 회전 훈련은 강조되어야 한다.
Abstract
The purpose of this study is to investigate the effect of trunk control on upper extremity function in stroke patients. The evaluation of trunk control in 87 stroke patients was conducted using trunk control test(TCT), postural assessment scale for stroke-trunk control(PASS-TC), modified trunk impairment scale(mTIS), and the evaluation of upper extremity function was conducted using Wolf Motor Function Test(WMFT) and Fugl-Meyer Upper Extremity(FM-U/E). This study calculated the selection criteria value and the likelihood ratio using the receiver operating characteristic(ROC) curve, to analyze the factors by which trunk control affects the performance of upper extremity function and identify the discriminant power of trunk control evaluation for upper extremity functional classification [FM-U/E (66 points in full scale) = 51-65 points (minor disability) / FM-U/E = 0-50 points (severe or mild disability)]. According to the result of analyzing the factors by which trunk control affects upper extremity function, it turned out that mTIS-dynamic items (lateral trunk bending) and coordination (trunk rotation) affected the WMFT (explanatory power of 37%) and that mTIS-dynamic items (42%) affected FM-U/E.The optimal selection criteria value for the prediction of upper extremity functional performance were mTIS - coordination > 2.5 points and mTIS - total score > 7.5 points. t turned out that the patients with mTIS total score > 7.5 points was 0.161 times higher than the patients with ≤7.5 points in mTIS - total score, which is a predictor of upper extremity functional performance (FM-U/E: 51-65 points). Stroke patients are still deficient in trunk control and they have an impaired upper extremity function. In conclusion, trunk control is significantly associated with upper extremity function recovery, and thus, lateral trunk bending and rotation training should be emphasized.
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