• 제목/요약/키워드: Motor recovery

검색결과 59건 처리시간 0.116초

fMRI를 이용한 성인 편마비의 항조절점 운동이 대뇌피질의 활성화에 미치는 효과 (The Effect on Activity of Cerebral Cortex by Key-point Control of The Adult Hemiplegia with fMRI)

  • 이원길
    • The Journal of Korean Physical Therapy
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    • v.15 no.3
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    • pp.295-345
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    • 2003
  • This study investigated activation of cerebral cortex in patients with hemiplegia that was caused by neural damage. Key-point control movement therapy of Bobath was performed for 9 weeks in 3 subjects with hemiplegia and fMRI was used to compare and analyze activated degree of cerebral cortex in these subjects. fMRI was conducted using the blood oxygen level-dependent(BOLD) technique at 3.0T MR scanner with a standard head coil. The motor activation task consisted of finger flexion-extension exercise in six cycles(one half-cycles = 8 scans = $3\;sec{\times}\;8\;=\;24\;sec$). Subjects performed this task according to visual stimulus that sign of right hand or left hand twinkled(500ms on, 500ms off). After mapping activation of cerebral motor cortex on hand motor function, below results were obtained. 1. Activation decreased in primary motor area, whereas it increased in supplementary motor area and visual association area(p<.001). 2. Activation was observed in bilateral medial frontal gyrus, middle frontal gyrus of left cerebrum, inferior frontal gyrus, inter-hemispheric, fusiform gyrus of right cerebrum, superior parietal lobule of parietal lobe and precuneus in subjedt 1, parahippocampal gyrus of limbic lobe and cingulate gyrus in subject 2, and inferior frontal gyrus of right frontal lobe, middle frontal gyrus, and inferior parietal lobule of left cerebrum in subject 3 (p<.001). 3. Activation cluster extended in declive of right cellebellum posterior lobe in subject 1, culmen of anterior lobe and declive of posterior lobe in subject 2, and dentate gyrus of anterior lobe, culmen and tuber of posterior lobe in subject 3 (p<.001). In conclusion, these data showed that Key-point control movement therapy of Bobath after stroke affect cerebral cortex activation by increasing efficiency of cortical networks. Therefore mapping of brain neural network activation is useful for plasticity and reorganization of cerebral cortex and cortico-spinal tract of motor recovery mechanisms after stroke.

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Targeting motor and cognitive networks with multichannel transcranial direct current stimulation along with peripheral stimulation in a subacute stroke survivor: single case study

  • Midha, Divya;Arumugam, Narkeesh
    • Physical Therapy Rehabilitation Science
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    • v.9 no.4
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    • pp.318-323
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    • 2020
  • Objective: Reacquisition of motor functions following stroke depends on interhemispheric neural connections. The intervention highlighted in the present case is an insight for augmenting motor recovery by stimulating the lesioned area and adjacent areas governing the motor behaviour of an individual. The purpose of this study was to determine the changes in the motor and cognitive outcomes through multi target stimulation of cortical areas by application of multichannel transcranial direct current stimulation (M-tDCS) in a stroke survivor. Design: A case report. Methods: The patient was a participant of a trial registered with the clinical trial registry of India (CTRI/2020/01/022998). The patient was intervened with M-tDCS over the left primary motor cortex i.e. C3 point and left dorsolateral prefrontal cortex i.e. F3 point with 0.5-2 mA intensity for the period of 20 minutes. SaeboFlex-assisted task-oriented training, functional electrical stimulation over the lower extremity (LE) to elicit dorsiflexion at the ankle and eversion of the foot, and conventional physiotherapy rehabilitation including a tailored exercise program were performed. Outcome assessment was done using the Fugl-Meyer assessment scale (FMA) for the upper and lower extremity (UE and LE), Montreal Cognitive Assessment (MOCA), Wisconsin Gait Scale (WGS) and the Stroke Specific Quality of Life (SSQOL) measures. Assessment was taken at Day 0, 15 and 30 post intervention. Results: Improvement was observed in all the outcome measures i.e FMA (UE and LE), MOCA, SSQOL and WGS across the span of 4 weeks. Conclusions: M-tDCS induced improvement in motor functions of the UE and LE, gait parameters and cognitive functions of the patient.

Evidence of Cortical Reorganization in a Monoparetic Patient with Cerebral Palsy Detected by Combined Functional MRI and TMS

  • ;장성호
    • Yeungnam University Journal of Medicine
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    • v.22 no.1
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    • pp.96-103
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    • 2005
  • 뇌성마비로 인해 오른 손에서 단부전마비를 호소하는 환자를 대상으로 기능적 자기공명영상 장치와 경두개 자기 자극기를 사용하여 운동신경의 회복기전을 연구하였다. 대상자는 21세 된 남자 환자로 오른손에 경미한 운동 기능의 손상을 보였고, 자기공명영상의 소견에서 좌반구의 precentral knob에서 병변을 보였다. 기능적 자기공명영상 촬영은 한 명의 대상자와 여덟 명의 정상인을 대상으로 표준화된 헤드코일을 사용하여 1.5 T의 장치에서 BOLD 기술을 적용하여 실시하였다. 대상자들의 운동 수행은 1 Hz 주기로 손가락의 굴곡과 신전을 반복하는 과제가 제시되었다. 경두개 자기 자극은 원형 코일을 사용하여 코일의 앞쪽 부분이 대상자의 두피에서 1 cm 정도 떨어진 정접 부위에 적용되었고 양측의 짧은엄지벌림근에서 발생된 운동 유발 전위가 동시에 측정되었다. 자기공명영상의 결과에서 환자의 비손상측(좌측) 손과 정상군의 좌측 손의 운동 수행 시 오른쪽의 일차운동감각영역(SM1)의 precentral knob에서 활성도가 나타났다, 그러나, 환자의 손상측(우측) 손의 운동 수행 시, 좌측 일차운동감각영역의 손상된 precentral knob 내측 부위에서 활성도를 보였다. 또한, 경두개 자기 자극의 결과에서 손상측 짧은엄지벌림근에서 발생된 운동 유발 전위에 해당하는 뇌 부위가 환자의 정상측과 비교하여 1 cm 내측에서 발견되었다. 그러므로 손상측 손의 운동 기능이 손상된 precentral knob의 내측 부분으로 전위되어 신경재구성이 이루어진 것으로 추정되는 결론을 얻었다.

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뇌경색(腦硬塞) 환자(患者)의 운동장애(運動障碍)에 대(對)한 2Hz와 120Hz 전침(電鍼) 치료(治療)의 효과(效果) 비교(比較) : 운동유발전위검사를 통한 비교 (The Effect of 2Hz vs. 120Hz Frequency Electrical Acupoint Stimulation on Motor Recovery after Stroke by Motor Evoked Potential Study)

  • 홍진우;최창민;박영민;신원준;정동원;박성욱;정우상;박정미;문상관;고창남;조기호;배형섭;김영석
    • 대한한방내과학회지
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    • v.27 no.1
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    • pp.265-275
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    • 2006
  • Objectives : Electrical acupoint stimulation(EAS) has been used to treat motor dysfunction of stroke patients with reportedly effective results. The purpose of this study is to evaluate the efficacy of the EAS with different frequencies in treating motor dysfunction of ischemic stroke patients. Methods : The subject of this study were forty-two ischemic stroke patients with motor dysfunction in Kyunghee oriental medicine hospital who were hospitalized for one week to one month from onset. They were treated with 2Hz or 120Hz EAS for two weeks, and motor evoked potentials(MEP) were measured before and after EAS treatment. To compare the effect of 2Hz EAS with 120Hz, the number of patients who showed MEP responses after two weeks among those who had no previous response was checked. Also measured were latency, central motor conduction time(CMCT), amplitude of MEP before and after EAS treatment. Results : After two weeks of treatment, 4 out of 15 patients(27%) in the 2Hz EAS group and lout of 19 patients(5%) in the 120Hz group showed potential responses. Yet there was no significant difference between the two groups. When MEP data of the affected side between the 2Hz group and the 120Hz group was compared, the former showed more significant improvement than the latter in latency, CMCT and amplitude(P=0.040, 0.019,0.021). When the proportion of the affected side and unaffected side in MEP data was examined, the 2Hz group showed improvement on only latency and CMCT with significant differences(P=0.040, 0.014). Conclusions : These results show that EAS with low frequency is more helpful for motor recovery after ischemic stroke than that with high frequency. This suggests that low frequency EAS activates the central motor conduction system better than high frequency EAS.

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양혈장근건보탕(養血壯筋健步湯)과 전침의 병용치료가 손상된 척수신경 및 운동기능에 미치는 영향 (Effects of Yanghyuljanggeungunbo-tang(Yangxuezhuangjinjianbu-tang) and Electrical Acupuncture on the Spinal Nerve Injury and the Motor Function)

  • 설재욱;추민규;김선종;최진봉;신미숙;김수익
    • 한방재활의학과학회지
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    • v.19 no.2
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    • pp.1-25
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    • 2009
  • Objectives : The purpose of this study was to investigate the effects of Yanghyuljanggeungunbo-tang(Yangxuezhuangjinjianbu-tang, YGKT) and electrical acupuncture treatment in spinal cord injury(SCI)-induced rats. Methods : The subjects were divided into 5 groups ; Normal, Control-no treatment after SCI, Experimental I(Exp. I)-taken with YGKT 500 mg/kg $0.5m{\ell}$ daily after SCI. Experimental II(Exp. II)-taken with electrical acupuncture after SCI and Experimental III(Exp. III)-taken with YGKT 500 mg/kg $0.5m{\ell}$ and electrical acupuncture after SCI. After each operation, the present author observed cytological changes, the motor behavior recovery and nerve regeneration by analysis of the motor behavior tests, EMG, hematological(AST, ALT, WBC), histological and immunological changes. Rats were tested by Motor behavior test at 1st, 3rd, 7th, 14th and 21st day. Results : 1. All the experimental groups were improved compared with control group in the motor behavior tests including Tarlov test, Basso-Beattle-Bresnahan locomotor rating scale, modified inclined plane test, open field test, grid walk test and narrow beam test. Especially Exp. III was significantly improved among other groups. 2. In EMG test, H and M wave were significantly increased in Exp. III. 3. All the experimental groups were significantly decreased compared with control group in AST, ALT and WBC. 4. NGF, BDNF and Trk B of spinal cord gray matter in all the experimental groups were increased compared with control group. Especially, Exp. III was more effective. 5. In histological observations, muscle contraction and denaturation of gastrocnemius muscle of all the experimental groups were inhibited. Especially, those of Exp. III was more effective. On the observations of liver and kidney, cell atrophy and apoptosis of all the experimental groups were decreased compared with control group. Especially, those of Exp. III was more effective. Conclusions : It can be suggested that YGKT and electrical acupuncture may improve motor behavior, EMG, hematological, histological and immunological findings in SCI-induced rats. Especially, combination of these two treatments will be somewhat better in spinal nerve recovery and motor function improvement.

양혈장근건보탕(養血壯筋健步湯)과 녹용약침(鹿茸藥鍼)이 척수손상 유발 흰쥐의 운동기능 회복 및 신경재생에 미치는 영향 (Effects of Yanghyuljanggeungunbo-tang(Yangxuezhuangjinjianbu-tang) and Cervi Cornu Parvum Pharmaco-Acupuncture on the Motor Function Recovery and Nerve Regeneration in Rats Induced Spinal Cord Injury)

  • 박지용;설재욱;김선종;최진봉;신미숙
    • 한방재활의학과학회지
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    • v.19 no.2
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    • pp.27-49
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    • 2009
  • Objectives : The purpose of this study was to investigate the effects of Yanghyuljanggeungunbo-tang(Yangxuezhuangjinjianbu-tang) and Cervi Cornu Parvum pharmaco-acupuncture in Spinal Cord Injury(SCI)-induced rats. Methods : The subjects were divided into 5 groups ; Normal, Control no treatment after SCI, Experimental I taken with Yanghyuljanggeungunbo-tang (Yangxuezhuangjinjianbu-tang) 500 mg/kg $0.5m{\ell}$ daily after inducing SCI. Experimental II taken with Cervi Cornu Parvum pharmaco-acupuncture at Taegye(KI3) and $Yangnungch{\acute{o}}n$(GB34) after inducing SCI and Experimental III taken with Yanghyuljanggeungunbo-tang(Yangxuezhuangjinjianbu-tang) 500 mg/kg $0.5m{\ell}$ and Cervi Cornu Parvum pharmaco-acupuncture at KI3 and GB34 to SCI-induced rats. After each operation, the present author observed the motor behavior recovery and nerve regeneration by analysis of the motor behavior tests, EMG, hematological(AST, ALT, WBC), histological and immunological changes. Rats were tested at modified Tarlov test at the 1st, 2nd, 3rd, 4th day, and Motor behavior test at 1st, 3rd, 7th, 14th, 21st day. Results : Results are as follows. 1. All the experimental groups were improved compared with control group in the motor behavior tests including Tarlov test, Basso-Beattle-Bresnahan locomotor rating scale, modified inclined plane test, open field test, grid walk test and narrow beam test. Especially Experimental III was improved significantly among other groups. 2. In EMG test, H wave appeared weak only in Experimental III. And M wave was increased significantly in Experimental III. 3. All the experimental groups were significantly decreased compared with control group in serum AST, serum ALT and serum WBC tests. 4. significantly decreased in Tumor Necrosis Factor-${\alpha}$ test compared with the first day of SCI. 5. Muscle contraction and denaturation of all the experimental groups were inhibited in histological observations of gastrocnemius muscle. Especially, those of experimental III was more effective. 6. NGF and BDNF of spinal cord gray matter in all the experimental groups were increased compared with control group. Especially, those of experimental III was more effective. Conclusions : As above, it can be suggested that Yanghyuljanggeungunbo-tang(Yangxuezhuangjinjianbu-tang) and Cervi Cornu Parvum pharmaco-acupuncture may improve motor behavior, EMG, hematological, histological and immunological findings in Spinal Cord Injury(SCI)-induced rats. Especially, effects will be somewhat better in combination of these two treatments.

척수 종양 제거 술 중 운동유발전위의 호전과 근력 호전의 관계 (Increased Intraoperative Motor Evoked Potentials and Motor Recovery after Spinal Cord Tumor Removal)

  • 표소은;박윤길;박진영;고유정
    • 대한근전도전기진단의학회지
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    • v.20 no.2
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    • pp.98-105
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    • 2018
  • Objective: To evaluate whether the increase of the amplitude of motor evoked potentials (MEPs) during surgery can imply favorable prognosis postoperatively in spinal cord tumor surgery. Method: MEPs were monitored in patients who underwent spinal cord tumor surgery between March 2016 and March 2018. Amplitude changes at the end of monitoring compared to the baselines in limb muscle were analyzed. Minimum and maximum changes were set to $MEP_{min}$ (%) and $MEP_{max}$ (%). Strengths of bilateral 10 key muscles which were documented a day before ($Motor_{pre}$), 48 h ($Motor_{48h}$) and 4 weeks ($Motor_{4wk}$) after the surgery were reviewed. Results: Difference of $Motor_{48h}$ from $Motor_{pre}$ ($Motor_{48h-pre}$) and $Motor_{4wk}$ from $Motor_{pre}$ ($Motor_{4wk-pre}$) positively correlated with $MEP_{min}$, suggesting that smaller the difference of MEPs amplitude, less recovery of muscle strength. There was a negative correlation between the amount of bleeding and $MEP_{min}$, indicating that the greater the amount of bleeding, the smaller the $MEP_{min}$, implying that MEPs amplitude is less likely to improve when the amount of bleeding is large. It also showed significant difference between patients with improved or no change of motor status and patients with motor deterioration after surgery according to anatomical tumor types. Conclusion: Improve of muscle strength was less when the increase of MEPs amplitude was small, and improvement of MEPs amplitude was less when the amount of bleeding was large. Correlation between changes of status of muscle strength after surgery and tumor types was observed. With amplitude increase in MEPs monitoring, restoration of muscle strength can be expected.

가정-중심 가상현실이 만성뇌졸중환자의 팔 운동기능에 미치는 영향 - 실험자 맹검 단일실험연구 (Effects of Home-based Virtual Reality on Upper Extremity Motor Function for Stroke - An Experimenter Blind Case Study)

  • 이정아;황수진;송창순
    • 한국산학기술학회논문지
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    • v.13 no.7
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    • pp.3023-3029
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    • 2012
  • 본 연구의 목적은 만성 편마비 뇌졸중 환자를 대상으로 상지 운동기능 회복을 위하여 적용한 가상현실 가정운동프로그램의 가능성을 알아보기 위함이다. 만성 뇌졸중 환자 2명을 대상으로, 한 명의 참여자는 가상현실운동프로그램을 가정운동프로그램으로 처방하여 실행하였고, 다른 한 명의 참여자는 강제-유도운동치료를 가정운동프로그램으로 처방하여 실행하였다. 치료기간은 4주간으로 1주일에 총, 5회로 1회에 4시간씩 실시하였다. 평가는 뇌졸중 기능회복평가(Fugl-Meyer Assessment; FMA), 운동활동척도검사(Motor Activity Log, MAL), 그리고 울프운동기능검사(Wolf Motor Function Test; WMFT)를 이용하였다. 가상현실 운동프로그램을 가정운동프로그램으로 실시한 대상자가 모든 운동기능평가에서 상당한 기능적 회복을 보여주었다. 특히, FMA 점수는 가상현실프로그램을 사용한 대상자는 17% 향상된 반면, 강제유도운동치료를 가정운동프로그램으로 실시한 대상자는 5% 증가하였다. 또한, MAL 점수의 환측 상지를 이용하는 양(Amount of Use; AOU)와 움직임의 질(Quality of Movement; QOM)점수에서도 가정중심 가상현실 프로그램을 이용한 대상자가 각 40%, 20% 향상된 반면, 강제유도운동치료를 받은 대상자는 각각 0%, 20% 증가하였다. 가상현실 프로그램을 사용한 대상자와 강제유도운동치료를 받은 대상자의 WMFT 점수가 모두 20%증가하였다. 본 연구결과, 만성 편마비 뇌졸중 환자의 상지 운동 기능 향상을 목적으로 가정운동프로그램을 설계할 때 가상현실 운동프로그램이 강제-유도운동치료보다 더욱 효과적인 것으로 사료된다.

국소적 부하와 전신적 부하가 슬관절 위치 감각에 미치는 영향 (The effects of knee joint position sense following local and general load protocols)

  • 황윤태;박래준;최진호
    • The Journal of Korean Physical Therapy
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    • v.17 no.3
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    • pp.429-440
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    • 2005
  • The purpose of this study was to compare the effects of knee joint position sense following local and general load protocols in 25 healthy male subjects. Proprioception of the knee joint was evaluated by measuring absolute angular errors at matching angles before, after and between 2 different types of load protocols. Proprioception tests(on the dominant knee) were performed in which proprioception of the passivepassive reproduced and active-active reproduced knee position was measured. Local load was provided with maximum isokinetic knee extension-flexion on the isokinetic dynamometer(Cybex), and general load was 10 minutes running on a treadmill. Peak torque(knee extension and flexion) and heart rate(beats per minute) was evaluated as an indicator of local and general fatigue during load protocols. The results were as follows: 1. For pasive-pasive reproduced knee position test, significant difference in absolute angular errors after general load protocol was detected compared with that before general load protocol(P<.05), significant difference in absolute angular errors after local load protocol was detected compared with that before local load protocol(P<.05). However, no significant difference in absolute angular errors of general load protocol was detected compared with that of local load protocol (P>.05), no significant difference in absolute angular errors of local load protocol was detected compared with that of general load protocol(P>.05). 2. For active-active reproduced knee position test, significant difference in absolute angular errors after general load protocol was detected compared with that before general load protocol(P<.05), significant difference in absolute angular errors after local load protocol was detected compared with that before local load protocol (P<.05). Also, significant difference in absolute angular errors of general load protocol was detected compared with that of local load protocol(P<.05), significant difference in absolute angular errors of local load protocol was detected compared with that of general load protocol(P<.05). 3. A significant decrease of peak torque of knee extensors and flexors was seen after local load, although heart rate was significantly increased(P<.05). No significant change of peak torque of knee extensors and flexors was seen after general load(P>.05), although heart rate was also significantly increased(P<.05). The previous study revealed that knee proprioception is significantly altered when the muscle mechanoreceptors are dysfunctional due to muscle fatigue, although the joint mechanoreceptors have no significantly effect on knee proprioception when the presence of knee muscle fatigue. However, the results of this study are different from those of the previous study in that muscle weakness of the knee could not be seen after general load. This study shows that general load may diminish motor control by the central nervous system. Proprioceptional decline without muscle weakness of knee after general load suggests a change in the proprioceptional pathway without influence from muscle mechanoreceptors.

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