The Effect of Convergence Intervention of Focal Vibration Stimulation and Bilateral Upper Extremity Training on Recovery of Upper Limb Function in Stroke Patients

국소 진동 자극과 양쪽 팔 훈련의 융합 중재가 뇌졸중 환자의 팔 기능 회복에 미치는 효과

  • Kim, Sun-Ho (Department, Dept. of Occupational Therapy, Won-Ju Young Kwang Hospital)
  • 김선호 (원주 영광 병원 작업치료실)
  • Received : 2020.12.10
  • Accepted : 2021.02.20
  • Published : 2021.02.28


The purpose of this study was to investigate the convergence effect of focal vibration stimulation and bilateral upper limb training on the recovery of upper limb function when applied to stroke patients. For 20 stroke patients, divided into an experimental group that performed convergence intervention with focal vibration stimulation and bilateral upper limb training, and a control group who performed only bilateral upper limb training. It was conducted 20 times for 4 weeks, 30 minutes per session. Vibration stimulation was applied to the affected side of the experimental group for 30 minutes during training. Results were measured for the degree of recovery of the affected upper limb function, amount of use on the affected and unaffected sides, the quality and satisfaction in performance on use of both upper limbs. Comparisons were made within groups using a paired-sample t-test and between groups using covariance analysis. As a result of the study, the experimental group showed a significant difference in dexterity and the amount of use on the affected than the control group. The effect size was more than the small effect size in all evaluation items. Through this study, it is thought that the convergence intervention of focal vibration stimulation and bilateral upper limb trainingcan be used clinically as an effective intervention for the recovery of arm function in stroke patients.

본 연구의 목적은 국소 진동 자극과 양측성 팔 훈련의 융합 중재를 뇌졸중 환자에게 적용했을 때, 팔 기능 개선에 미치는 영향을 알아보는 것이다. 20명의 뇌졸중 환자를 국소 진동 자극과 양측성 팔 훈련의 융합 중재를 실시한 실험군과 양측성 팔 훈련만 실시한 대조군으로 나누어, 회기 당 30분씩 4주간, 총 20회 실시하였다. 진동자극은 실험군의 손상측 팔에 훈련이 이루어지는 30분간 적용되었다. 평가는 손상 측 팔의 회복정도와 양측 팔 의 사용량, 양손 사용의 수행의 질과 만족도를 측정하였으며, 대응표본 t-검정을 사용하여 그룹 내, 공분산 분석을 사용하여 그룹 간 비교를 하였다. 연구 결과, 실험군은 대조군보다 손상 측 팔의 기민성과 손상 측의 사용량에서 유의한 차이의 변화를 보였다. 효과 크기는 모든 항목에서 작은 효과 크기 이상의 차이를 보였다. 본 연구를 통해, 국소 진동 자극과 양측성 팔 훈련의 융합 중재가 뇌졸중 환자의 팔 기능 회복을 위한 효율적 중재로써 임상에서 사용 될 수 있을 것으로 생각된다.



  1. B. Elsner, J. Kugler & J. Mehrhol. (2018). Transcranial direct current stimulation (tDCS) for upper limb rehabilitation after stroke: future directions. Journal of NeuroEngineering and Rehabilitation, 15(106), 1-4. DOI: 10.1186/s12984-018-0459-7
  2. S. J. Page, S. A. Sisto & P. Levine, (2002). Modified constraint-induced therapy in chronic stroke. American Journal of Physical Medicine and Rehabilitation, 81(11), 870-875. DOI:10.1097/00002060-200211000-00013
  3. J. H. Cauraugh, N. Lodha, S. K. Naik & J. J. Summers, (2009). Bilateral movement training and stroke motor recovery progress: A structured review and meta-analysis. Human Movement Science, 29(5), 853-870. DOI:10.1016/j.humov.2009.09.004
  4. J. J. Summers, F. A. Kagerer, M. I. Garry, C. Y. Hiraga, A. Loftus & J. H. Cauraugh. (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. DOI:10.1016/j.jns.2006.10.011
  5. M. K. Fleming, I. O. Sorinola, S. F. Roberts-Lewis, C. D. Wolfe, I. Wellwood & D. J. Newham. (2015). The effect of combined somatosensory stimulation and task-specific training on upper limb function in chronic stroke: A double-blind randomized controlled trial. Neurorehabilitation and Neural Repair, 29(2), 143-152. DOI: 10.1177/1545968314533613
  6. S. H. Kim. (2019). Effects of simultaneous application of focal vibration stimulation and task-oriented training in the improvement of upper extremity motor function after stroke. Journal of The Korean Society of Integrative Medicine, 17(3), 117-125. DOI:10.15268/ksim.2019.7.3.117
  7. M. Roelants, S. Verschueren, C. Delecluse, O. Levin & V. Stijnen, (2006). Whole-body-vibration-induced increase in leg muscle activity during different squat exercises. Journal of Strength and Conditioning Research, 20(1), 124-129. DOI: 10.1519/R-16674.1
  8. R. S. Calabro, A. Naro, M. Russo, D. Milardi, A. Leo, S. Filoni, A. Trinchera & P. Bramanti. (2017). Is two better than one? Muscle vibration plus robotic rehabilitation to improve upper limb spasticity and function: A pilot randomized controlled trial. PloS one, 12(10), e0185936. DOI:10.1371/journal.pone.0185936
  9. C. Costantino, L. Galuppo & D. Romiti, (2017). Short-term effect of local muscle vibration treatment versus sham therapy on upper limb in chronic post-stroke patients: a randomized controlled trial. European Journal of Physical and Rehabilitation Medicine, 53(1), 32-40. DOI:10.23736/S1973-9087.16.04211-8
  10. H. J. Hong, H. Y. Park, J. R. Kim, & J. H. Park. (2020). Effects of bimanual intensive training on upper extremity function in stroke patients. Therapeutic Science for Rehabilitation, 9(2), 119-135. DOI:.10.22683/tsnr.2020.9.2.119
  11. V. Mathiowetz, G. Volland, N. Kashman & K. Weber. (1985). Adult norms for the box and block test of manual dexterity. American Journal of Occupational Therapy, 39(6), 386-391. DOI:10.5014/ajot.39.6.386
  12. S. J. Page, G. D. Fulk & P. Boyne, (2012). Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke. Physical Therapy, 92(6), 791-798. DOI: 10.2522/ptj.20110009
  13. M. Noorkoiv, H. Rodgers & C. I. Price. (2014). Accelerometer measurement of upper extremity movement after stroke: A systematic review of clinical studies. Journal of NeuroEngineering and Rehabilitation, 11(1), 144-154. DOI:10.1186/1743-0003-11-144
  14. J. H. Lee, I. P. Hong, J. H. Park & J. H. Shin. (2020). Validation of yonsei-bilateral activity test (Y-BAT)-bilateral upper extremity inventory using rasch analysis. OTJR: Occupation, Participation and Health, 40(4), 277-286. DOI: 10.1177/1539449220920732
  15. J. H. Cauraugh, S. A. Coombes, N. Lodha, S. K. Naik & J. J. Summers. (2009). Upper extremity improvements in chronic stroke: coupled bilateral load training. Restorative Neurology And Neuroscience, 27(1), 17-25. DOI: 10.3233/RNN-2009-0455
  16. O. Donchin, A. Gribova, O. Steinberg, A. R. Mitz, H. Bergman & E. Vaadia. (2002). Single-unit activity related to bimanual arm movements in the primary and supplementary motor cortices. Journal of Neurophysiology, 88(6), 3498-3517. DOI: 10.1152/jn.00335.2001
  17. C. Y. Wu, Y. W. Hsieh, K. C. Lin, L. L. Chuang, Y. F. Chang, H. L. Liu, C. L. Chen, K. H. Lin & Y. Y. Wai. (2010). Brain reorganization after bilateral arm training and distributed constraint-induced therapy in stroke patients: a preliminary functional magnetic resonance imaging study. Chang Gung Medical Journal, 33(6), 628-638.
  18. M. Christova, S. Golaszewski, A. Ischebeck, A. Kunz, D. Rafolt, R. Nardone & E. Gallasch. (2013). Mechanical flutter stimulation induces a lasting response in the sensorimotor cortex as revealed with BOLD fMRI. Human brain mapping, 34(11), 2767-2774. DOI: 10.1002/hbm.22102
  19. B. Marconi, G. M. Filippi, G. Koch, V. Giacobbe, C. Pecchioli, V. Versace, F. Camerota, V. M. Saraceni, C. Caltagirone & C. Caltagirone. (2011). Long-term effects on cortical excitability and motor recovery induced by repeated muscle vibration in chronic stroke patients. Neurorehabilitation and neural repair, 25(1), 48-60. DOI: 10.1177/1545968310376757
  20. R. Casale, C. Damiani, R. Maestri, C. Fundaro, P. Chimento & C. Foti. (2014). Localized 100 Hz vibration improves function and reduces upper limb spasticity: A double-blind controlled study. European Journal of Physical and Rehabilitation Medicine, 50(5), 495-504.
  21. K. A. DeCelles & M. I. Norton, (2016). Physical and situational inequality on airplanes predicts air rage. Proceedings of National Academy of Science, 113(20), 5588-5591. DOI:10.1073/pnas.1521727113
  22. M. E. Cohen & R. W. Schemm. (2007). Clint-centered occupational therapy for individuals with spinal cord injury. Occupational Therapy in Health Care, 21(3), 1-15. DOI: 10.1300/J003v21n03_01
  23. D. K. Rose & C. J. Winstein. (2004). Bimanual training after stroke: are two hands better than one? Topics in Stroke Rehabilitation, 11(4), 20-30. DOI: 10.1310/NCB1-JWAA-09QE-7TXB