Therapeutic Science for Rehabilitation (재활치료과학)

Korean Society of Neurological Occupational Therapy (대한신경계작업치료학회)
권호 표지
DOI QR코드

DOI QR Code

The Effect of Symmetrical and Asymmetric Bilateral Training for Chronic Stroke Patients in Upper Extremity Recovery

만성 뇌졸중 환자의 대칭적, 비대칭적 양측성 상지훈련의 상지기능회복 효과

  • 김선호 (원주영광병원 작업치료실) ;
  • 한대성 (상지영성대학교 작업치료과)
  • Received : 2016.11.30
  • Accepted : 2016.12.30
  • Published : 2017.01.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : To identify the effect of symmetrical and asymmetric bilateral training For stroke patients in upper extremity recovery. Methods : 15 patients with stroke, randomized to an in- phase group(n =7) and anti-phase group(n =8). Each groups received symmetrical and asymmetric bilateral training, 30-min sessions per a day for 5 weeks, total 20 session.Accelerometer was used to evaluate the amount used for both groups. Y-BAT was used to evaluate performance status and satisfaction, ARAT was used to evaluate hand function. Results : the amount used of symmetrical movement training showed significant changes in affected and unaffected side. asymmetric bilateral training. there is a significant difference in affected side before and after receiving asymmetric bilateral training. Also, There was a significant difference between the groups on the affected side. Both training, there was no significant difference in performance, satisfaction, and upper limb function between group but, there was significant differences within-groups, Conclusions : Symmetric training showed higher motor performance than asymmetric training, but, To obtain a clearer difference, it would be necessary to use a neuromuscular assessment tool such as fMRI. Also, need a clearer training protocol and the need for follow-up studies on more stroke patients is suggested.

목적 : 양측성 상지 활동의 대칭적, 비대칭적 양측성 상지훈련이 상지기능회복에 미치는 영향을 알아보고자 하였다. 연구방법 : 원주에 소재한 ${\bigcirc}{\bigcirc}$병원의 연구 뇌졸중 환자 15명을 무작위로 대칭적 움직임훈련 그룹과 비대칭적 움직임 훈련 그룹으로 나누었다. 중재는 하루 30분, 주5회, 4주 동안, 총 20회기를 받았다. 결과 : 양측 상지의 실제 사용량은 대칭적 움직임 훈련은 건측, 환측 모두 유의한 변화를 보였으며, 비대칭 움직임 훈련도 환측에서 유의한 변화를 보였다. 또한 환측에서 그룹 간 유의한 변화차이가 있었다. 두 훈련 그룹 모두 수행도와 만족도, 상지기능 변화는 그룹 내 유의미한 변화가 있었지만 그룹 간 차이는 없었다. 결론 : 대칭적 움직임 훈련은 비대칭 움직임 훈련보다 대칭적 움직임은 비대칭적 움직임 보다 운동수행에서의 향상을 보였지만, 보다 명확한 차이를 얻기 위해서는 fMRI와 같은 뇌신경학적 평가도구를 사용하는 것이 필요할 것이라 판단되며, 보다 명확한 훈련 프로토콜이 필요하고, 보다 많은 뇌졸중 환자를 대상으로 한 후속연구의 필요성이 제시된다.

Keywords

References

  1. 권용철, 박종한 (1989) 노인용 한국판 Mini-Mental State Examination (MMSE-K)의 표준화 연구 -제1편:MMSE-K의 개발-. 신경정신의학, 28(1), 125-135.
  2. Cauraugh, J. H., & Kim, S. (2002). Two coupled motor recovery protocols are better than one: electromyogram-triggered neuromuscular stimulation and bilateral movements. Stroke, 33(6), 1589-1594. https://doi.org/10.1161/01.STR.0000016926.77114.A6
  3. Chang, J. J., Tung, W. L., Wu, W. L., & Su, F. C. (2006). Effect of bilateral reaching on affected arm motor control in stroke-with and without loading on unaffected arm. Disability and Rehabilitation, 28(24), 1507-1516. doi:10.1080/09638280600646060
  4. Cirstea, M., Pitto, A., & Levin, M. F. (2003). Arm reaching improvements with short-term practicedepend on the severity of the motor deficit in stroke. Experimental Brain Research, 152(4), 476-488. doi:10.1007/s00221-003-1568-4
  5. Kelso, J. A. S., Southard, D. L., & Goodman, D. (1979). On the nature of human interlimb coordination. Science, 203, 1029-1031. https://doi.org/10.1126/science.424729
  6. Kim, D. Y., Jeon, S. H., Kang, S. Y., & Kim, N. H. (2011). Customized estimating algorithm of physical activities energy expenditure using a tri-axial accelerometer. Journal of Korea Contents Association, 11(12), 103-111. https://doi.org/10.5392/JKCA.2011.11.12.103
  7. Kim, T. H. (2015). Kinematics of Bimanual Complementary Movement in Stroke Patients. Journal of Korea Contents Association, 15(4), 342-349. https://doi.org/10.5392/JKCA.2015.15.04.342
  8. Koh, C. L., Hsueh, I. P., Wang, W. C., Sheu, C. F., Yu, T. Y., Wang, C. H., & Hsieh C. L. (2006). Validation of the action research arm test using item response theory in patients after stroke. Journal of Rehabilitation Medicine. 38(6), 375-380. DOI: 10.1080/16501970600803252
  9. Kwakkel, G., Lollen, G. B., & Wagenaar, R. C. (1999). Therapy impact on functional recovery in stroke rehabilitation: A critical review of the literature. Physiotherapy, 13, 457-470.
  10. Luke, C, Dodd, K. J., & Brock, K. (2004). Outcomes of the Bobath concept on upper limb recovery following stroke. Clinical Rehabilitation, 18(8), 888-898. https://doi.org/10.1191/0269215504cr793oa
  11. Skold, A. (2010). Performing bimanual activities in everyday life- experiences of children with unilateral cerebral palsy. Stockholm, Sweden: Department of Woman and Child Health Karolinska Institutet.
  12. Summers, J. J., Kagerer, F. A., Garry, M. I., Hiraga, C. Y., Loftus, A., & Cauraugh, J. H. (2007). Bilateral and unilateral movement training on upper limb function in chronic stroke patients: A TMS study. Journal of the Neurological Sciences, 252(1), 76-82. https://doi.org/10.1016/j.jns.2006.10.011
  13. Stinear, C. M., Petoe, M. A., Anwar, S., Barber, P. A. & Byblow, W. D. (2014). Bilateral priming accelerates recovery of upper limb function after stroke: A randomized controlled trial. Stroke, 45, 205-210. https://doi.org/10.1161/STROKEAHA.113.003537
  14. Stoykov, M. E., & Corcos, D. M. (2009). A review of bilateral training for upper extremity hemiparesis. Occupational Therapy International, 16(3-4), 190-203. doi: 10.1002/oti.277
  15. Stoykov, M. E., Lewis, G. N., & Corcos, D. M. (2009). Comparison of bilateral and unilateral training for upper extremity hemiparesis in stroke. Neurorehabilitation and Neural Repair, 23(9), 945-953. https://doi.org/10.1177/1545968309338190
  16. Swinnen, S. P. (2002). Intermanual coordination: from behavioural principles to neural-network interactions. Nature Reviews Neuroscience, 3, 350-361.
  17. Volman, M. J. M., Wijnroks, A., & Vermeer, A. (2002). Bimanual circle drawing in children with spastic hemiparesis: effect of coupling modes on the performance of the impaired and unimpaired arms. Acta Psychology, 110, 339-356. https://doi.org/10.1016/S0001-6918(02)00041-0
  18. Whitall, J., McCombe Waller, S., Siler, K. H. C., & Macko, R. F. (2000). Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke, 31, 2390-2395. https://doi.org/10.1161/01.STR.31.10.2390
  19. Wolf, T. J., Chuh, A., Floyd, T., McInnis, K., & Williams, E. (2015). Effectiveness of occupation-based interventions to improve areas of occupation and social participation after stroke: An evidence-based review. American Journal of Occupational Therapy, 69, 6901180060. doi:org/10.5014/ajot.2015.012195