뇌졸중 환자를 대상으로 한 강제유도운동치료와 건측제한의 효과 비교

Comparison of Effect Between Constraint-induced Movement Therapy(CIMT) and Forced Used (FU) Therapy for Hemiplegic Stroke Patients

목적 : 가정환경에서 실시한 강제유도운동치료(Constraint-Induced Movement Therapy: CIMT)와 건측제한(Forced Used: FU)치료법이 편마비 환자의 상지기능과 일상생활활동에 어떠한 영향을 미치는 지를 알아보고자 하였다. 연구방법 : 본 연구는 개별실험 연구방법 중 실험 집단간 다중기초선설계를 사용하였다. 뇌졸중으로 편마비 진단을 받은 6인을 3집단(각 집단 2인)으로 분류하였다. CIMT는 건측제한(5시간)과 함께 환측 집중훈련(3시간)을 실시하였다. FU는 하루 중 활동이 가장 많은 5시간 동안 건측에 장갑을 착용하여 사용을 제한하였다. 기초선과 치료과정 동안에는 상자와 나무토막검사(Box and Block Test: BBT), 치료 전·후에는 울프운동기능검사(Wolf Motor Function Test: WMFT)를 사용하여 상지기능을 측정하였다. 일상생활활동은 치료 전·후에 운동·처리기술평가(Assessment of Motor and Process Skills: AMPS)와 운동활동지표(Motor Activity Log: MAL)를 사용하여 측정하였다. 결과분석은 그래프를 통한 시각적 분석과 치료 전·후 측정값의 변화를 비교하였다.결과 : WMFT와 BBT에서 모든 대상자의 수행능력이 향상 되었다. AMPS 능력치와 MAL의 환측사용빈도와 움직임 질도 모든 대상자에서 향상을 보였다. 특히 각 집단에서 CIMT 대상자들이 모두 FU 대상자보다 많이 향상되었다.

Objective : This study examines how CIMT and FU therapy affect the upper extremity function and activities of daily living of hemiplegic stroke patients under a home environment. Methods : The study adopted a multiple baseline design among experiment groups. Six hemiplegic stroke patients were divided into three groups (two for each group) . CIMT restricted the use of the healthy side of the upper limb (5 hours), while focusing on training of the stroke-affected upper limb (3 hours). In regard to FU, the patients had to wear gloves on the healthy side of the upper limbs to limit their use for five hours during the most active time of day. The function of the upper limbs was measured based on a Box and Block Test (BBT) during the therapy period, and on an Assessment of Motor and Process Skills (AMPS) and Motor Activity Log (MAL) both before and after the therapy. A visual analysis was conducted using a graph, and changes in values were analyzed before and after the therapy to analyze the experimental results. Results : MFT and BBT demonstrated that all patients showed improved functionality. The performance in—dicator of AMPS and frequency of using the stroke-affected limbs and quality of movement in MAL also showed improvement in all patients. In all groups, patients who went through CIMT showed more improvement than those who followed FU therapy. Conclusion : Both CIMT and FU conducted in a home environment had a positive impact on the upper ex—tremity function of hemiplegic stroke patients, and the effect of CIMT was better than FU.