Intervention based on Biomechanical Frame of Reference for Balance and Manual Function: a Single Subject Research

생체역학 모델을 통한 균형능력과 상지기능의 중재: 단일대상연구

  • 김태훈 (가야대학교 작업치료학과)
  • Published : 2009.11.28


The purpose of this study was to investigate changes in balance and upper extremity (UE) function associated with reaching training for children with quadriplegic cerebral palsy based on Biomechanical Frame of Reference. The baseline (phase A) lasted one week. The therapeutic protocol consisted of three reaching training (Phase B) for 40 minutes three times a week. Intervention phases lasted 4 weeks. The CMS-70P (Zebris Medizintechnik Gmbh, Germany) was used to evaluate the qualitative changes in UE function and Pediathc Berg Balance Scale was used to test the balance. The observed performance changes seem to be associated with the presence of intervention and suggest that biomechanical training can be a useful intervention to improve not only manual function but also balance.


Balance;Manual Function;Biomechanics;Motion Analysis;Quadriplegia


  1. P. Kramer and J. Hinojosa, Frames of reference for pediatric occupational therapy, 3rd ed. Baltimore, Md.: Lippincott Williams & Wilkins, 2009.
  2. A Shumway-Cook, S. Hutchinson, D. Kartin, R. Price, and M. Woollacott, "Effect of balance training on recovery of stability in children with cerebral palsy," Dev Med Child Neurol, Vol.45, pp.591-602, 2003(9).
  3. F. B. Horak and L. M. Nashner, "Central programming of postural movements: adaptation to altered support-surface configurations," J Neurophysiol, Vol.55, pp.1369-81, 1986(6).
  4. L. M. Nashner, "Analysis of movement control in man using the movable platform," Adv Neurol, Vol.39, pp.607-19, 1983.
  5. L. Oddsson and A. Thorstensson, "Fast Voluntary trunk flexion movements in standing: motor patterns," Acta Physiol Scand, Vol.129, pp.93-106, 1987(1).
  6. A. Pedotti, P. Crenna, A. Deat, C. Frigo, and J. Massion, "Postural synergies in axial movements: short and long-term adaptation," Exp Brain Res, Vol.74, pp.3-10, 1989.
  7. J. Noronha, A. Bundy, and J. Groll, "The effect of positioning on the hand function of boys with cerebral palsy," Am J Occup Ther, Vol.43, pp.507-12, 1989(8).
  8. J. H. Carr and R. B. Shepherd, A motor relearning programme for stroke, 2nd ed. Oxford Rockville, Md: Heinemann Medical Books ; Aspen Publishers, 1987.
  9. P. M. Davies, Steps to follow : a guide to the treatment of adult hemiplegia : based on the concept of K. and B. Bobath. Berlin ; New York: Springer-Verlag, 1985.
  10. R. W. Bohannon, "Recovery and correlates of trunk muscle strength after stroke," Int J Rehabil Res, Vol.18, pp.162-167, 1995(6).
  11. J. Mohr, "Management of the trunk in adult hemiplegia: the Bobath concept," Topics in neurology. Alexandria: American Physical Therapy Association, 1990.
  12. L. Bly, The components of normal movement during the first year of life and abnormal motor development: Neuro-Developmental Treatment Association; Pittengen and Associates, 1983.
  13. C. Dean, R. Shepherd, and R. Adams, "Sitting balance I: trunk-arm coordination and the contribution of the lower limbs during self-paced reaching in sitting," Gait Posture, Vol.10, pp.135-46, 1999(10).
  14. G. Gillen and A. Burkhardt, Stroke rehabilitation : a function-based approach, 2nd ed. St. Louis, Mo.: Mosby, 2004.
  15. C. M. Dean, E. F. Channon, and J. M. Hall, "Sitting training early after stroke improves sitting ability and quality and carries over to standing up but not to walking: a randomised trial," Aust J Physiother, Vol.53, pp.97-102, 2007.
  16. C. M. Dean and R. B. Shepherd, "Task-related training improves performance of seated reaching tasks after stroke. A randomized controlled trial," Stroke, Vol.28, pp.722-728, 1997(4).
  17. J. H. Carr and R. B. Shepherd, Stroke rehabilitation : guidelines for exercise and training to optimize motor skill, 1st ed. Edinburgh; New York: Butterworth-Heinemmn, 2003.
  18. J. Case-Smith, A. Allen, and P. Pratt, Occupational therapy for children: Mosby Inc, 2005.
  19. A. Shumway-Cook and M. H. Woollacott, Motor control : translating research into clinical practice, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2007.
  20. P. A. Burtner, C. Qualls, and M. H. Woollacott, "Muscle activation characteristics of stance balance control in children with spastic cerebral palsy," Gait Posture, Vol.8, pp.163-174, Dec 1 1998.
  21. L. M. Nashner, A. Shumway-Cook, and O. Marin, "Stance posture control in select groups of children with cerebral palsy: deficits in sensory organization and muscular coordination," Exp Brain Res, Vol.49, pp.393-409, 1983.
  23. M. Rice, A. J. Alaimo, and J. A. Cook, ''Movement dynamics and occupational embeddedness in a grasping and placing task," Occupational Therapy International, Vol.6, pp.298-307, 1999.
  24. M. R. Franjoine, J. S. Gunther, and M. J. Taylor, "Pediatric balance scale: a modified version of the berg balance scale for the school-age child with mild to moderate motor impairment," Pediatr Phys Ther, Vol.15, pp.114-28, Summer 2003.
  25. J. Gottman and S. Leiblum, How to do psychotherapy and how to evaluate it: A manual for beginners: Harcourt School, 1974.
  26. P. Kramer and J. Hinojosa, Frames of reference for pediatric occupational therapy, 2nd ed. Philadelphia: Williams & Wilkins, 1999.
  27. R. W. Bohannon, "Lateral trunk flexion strength: impairment, measurement reliability and implications following unilateral brain lesion," Int J Rehabil Res, Vol.15, pp.249-51, 1992.
  28. C. Winstein, A. M. Wing, and J. Whitalr, "Motor control and learning principles for rehabilitation of upper limb movements after brain injury," Plasticity and Rehabilitation., 2003.
  29. T. L. Gasser-Wieland and M. S. Rice, "Occupational embeddedness during a reaching and placing task with survivors of cerebral vascular accident," Occupational Therapy Journal of Research: Occupation, Participation, and Health, Vol.22, pp.153-160, 2002.
  30. H. I. Ma, C. A. Trombly, and C. Robinson-Podolski, "The effect of context on skill acquisition and transfer," Am J Occup Ther, Vol.53, pp.138-44, Mar-Apr 1999.
  31. C. Wu, C. A. Trombly, K. Lin, and L. Tickle-Degnen, "A kinematic study of contextual effects on reaching performance in persons with and without stroke: influences of object availability," Arch Phys Med Rehabil, Vol.81, pp.95-101, 2000(1).
  32. E. Blair, J. Balluntyne, S. Housman, and P. Chauvel, "A study of a dynamic proximal stability splint in the management of children with cerebral palsy," Developmental Medicine & Child Neurology,Vol.37, pp.544-554, 1995.
  33. U. Myhr, L. Wendt, S. Norrlin, and U. Radell, "Five-year follow-up of functional sitting position in children with cerebral palsy," Developmental Medicine & Child Neurology, Vol.37, pp.587-596, 1995.
  34. A. Colbert, K. Doyle, and W. Webb, "DESEMO seats for young children with cerebral palsy," Archives of physical medicine and rehabilitation, Vol.67, pp484, 1986.
  35. E. Brogren, M. Hadders-Algra, and H. Forssherg, ''Postural control in children with spastic diplegia: muscle activity during perturbations in sitting," Developmental Medicine & Child Neurology, Vol.38, pp.379-388, 1996.
  36. B. Fisher, "Effect of trunk control and alignment on limb function," J Head Trauma Rehabil, Vol.2, pp.72, 1987.
  37. A. E. Kazdin, Single-case research designs : methods for clinical and applied settings. New York: Oxford University Press, 1982.
  38. M. Rice, A. J. Alaimo, and J. A. Cook, "Movement dynamics and occupational embeddedness in a grasping and placing task," Occupational Therapy International, Vol.6, pp.298-307, 1999.
  39. S. Richards, Single subject research : applications in educational and clinical settings. San Diego: Singular Pub. Group, 1999.
  40. K. Ottenbacher, Evaluating clinical change: Strategies for occupational and physical therapists: Lippincott Williams and Wilkins, 1986