FES 강축비 변화에 따른 뇌졸중 환자의 장딴지근과 위팔두갈래근 긴장도에 미치는 즉각적 효과: 앞정강근과 위팔세갈래근 자극을 중심으로
Immediate Effects of Functional Electrical Stimulation On: Off Ratio on Muscle Tone of the Gastrocnemius and Biceps Brachii in Patients with Stroke: Focused on Stimulation of the Tibialis Anterior and Triceps Brachii
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본연구는뇌졸중환자를대상으로기능적전기자극(Functional Electrical Stimulation, FES) 중재시강축비(On:Off ratio) 변화가근긴장도에미치는즉각적인영향을규명하고자하였다. 연구대상은발병6개월이내의뇌졸중환자30명으로, 1:1, 1:3, 1:5의세가지강축비조건에따라 무작위로배정되었다. 하지에서는앞정강근(tibialis anterior), 상지에서는위팔세갈래근(triceps brachii)에 전극을 부착하여 자극하였으며, 장딴지근(gastrocnemius)과 위팔두갈래근(biceps brachii)의 근긴장도를 MyotonPRO 장비를 통해 평가하였다. 근긴장도는 Frequency(Hz)와 Stiffness(N/m)를 주요 지표로 분석하였고, 통계 분석은 대응표본 t-검정 및 일원배치 분산분석(ANOVA)을이용하였다. 연구결과, 하지에서는1:3과1:5 조건모두에서근긴장도가 유의하게감소하였으며(F(2,39) = 6.22, p = .006), 특히1:5 조건은감각자극기반의억제반응을 강화하여 경직 완화에 효과적이었다. 반면, 상지에서는 모든 조건에서 제한적인 변화만이 관찰되었다. 이러한결과는강축비가근피로억제와감각기반억제반응간의균형을조절하는 핵심요인임을시사한다. 본연구는강축비조절이FES 중재의생리학적효율성과임상적안전성을 결정하는주요변수임을실증적으로제시하였으며, 특히하지경직조절에있어1:3~1:5 강축비 설정이유효한근거기반중재전략이될수있음을보여준다. 향후연구에서는반복중재및장기적 변화를포함한분석을통해환자맞춤형FES 프로토콜표준화로발전시킬필요가있다.
Abstract
This study aimed to investigate the immediate effects of changes in the On:Off ratio during functional electrical stimulation (FES) intervention on muscle tone in patients with stroke. Thirty patients within six months post-stroke were randomly assigned to one of three On:Off ratio conditions: 1:1, 1:3, and 1:5. Electrical stimulation was applied to the tibialis anterior for the lower limbs and the triceps brachii for the upper limbs, while the muscle tone of the gastrocnemius and biceps brachii was evaluated using the MyotonPRO device. Muscle tone was analyzed using Frequency (Hz) and Stiffness (N/m) as primary indicators, and statistical analyses were conducted using paired t-tests and one-way analysis of variance (ANOVA). The results showed that, in the lower limbs, muscle tone significantly decreased under both the 1:3 and 1:5 conditions (F(2,39) = 6.22, p = .006), with the 1:5 condition demonstrating greater inhibition based on sensory-driven responses and being particularly effective in alleviating spasticity. In contrast, the upper limbs showed minimal or non-significant changes across all conditions. These findings suggest that the On:Off ratio plays a crucial role in balancing muscle fatigue suppression and sensory-based inhibitory responses. This study demonstrates that adjusting the On:Off ratio is an important factor influencing the physiological response to FES. In particular, setting the ratio between 1:3 and 1:5 may provide an evidence-based therapeutic option for managing lower-limb spasticity. Future studies should include repeated interventions and long-term analyses to develop standardized, patient-specific FES protocols.