테이핑을이용한건측억제유도운동이만성뇌졸중환자의상지기능에미치는영향

Transcription

1 1) 테이핑을이용한건측억제유도운동이만성뇌졸중환자의상지기능에미치는영향, 1, 2 The Effect of Modified CIMT Combined with Kinesio-Taping on Upper Limb Function in Hemiplegic Patients Myung-kwon Kim, PT, MS, Sang-ku Ji, PT, MS, Hye-jin Jun, PT, MS, Chang-ryeol Lee, PT, MS, 1 Moon-hwan Lee, PT, PhD 2 Department of Physical Therapy, Eulji medical Center 1 Department of Physical Therapy, Youngdong University 2 Department of Physical Therapy, International University of Korea <Abstract> Purpose This study was conducted to investigate whether modified CIMT with Kinesio-Taping on paretic upper limb effects upper limb function in stroke patients in comparison to those receiving only modified CIMT. Methods 20 out-patients with hemiplegia were randomly assigned to either an experimental or a control group. Both groups received modified CIMT during a 10-week period. Additionally, an experimental group received modified CIMT with Kinesio-Taping on paretic upper limb and trunk. Results In Manual function test, Grip strength, Jebsen-Taylor hand function test, MAL(Motor Activity Log) and Functional independence measure (FIM) were significantly different at all intervals of the study period(0, 3, 6, 10-week) in the experimental and control groups(p<.05). Exceptionally there was no significant difference in Jebsen-Taylor hand function test between the experimental and control groups. Conclusion These results suggest that modified CIMT with Kinesio-taping improve the upper limb function. And also increase usage of affected upper limb and assist in daily living activity more than only modified CIMT. Key Words Stroke, Modified CIMT, Taping, Grip strength, Jebsen-Taylor, serhan0520@daum.net / /

2 Ⅰ., (, 2003).,,,,, (, 1997), (, 2000)., (Granger, 1979). PNF(proprioceptive neuromuscular fascilitation), NDT(neurodevelopmental treatment), Brunnstrom technique, (slot machines),, (contraint-induced movement therapy, CIMT), (EMG biofeedback), (Feys, 1998). (Duncan, 1997). (Taub, 1999). 90% 6~7 (Bonifer Anderson, 2003).,,, (Page, 2002). 5, ~2 (modified CIMT) (, 2003; Page, 2002; Sun, 2006)., Page (2002) 5 5, , Sun (2006) Botox A 5 5 4, (2003).,,, (Jaraczewaka Long, 2006). Kim (2002)

3 ,, (ADL), Kilbreath (2006) (gluteal taping) (step length).,.. Ⅱ. 1. S 4 20,. 10.., CT MRI,, MMSE-K 25,, 21 80,, 20, 2 MCP 10,,,, (, 1989).,,. 2. 1) ,,,,,,..,. 3 (, 2005). 2) , (Kinesio Tex, Kinesio, Japan) (erector spinae), (supraspinatus), (deltoid), (serratus anterior), (trapezius) (Jaraczewska Long, 2006) (1)

4 5cm Y, (supraspinatus fossa). (2) 5cm Y. 1) (1) (Manual Function Test) 4, 2, 2, (, 1994). (2) (Grip strength) (JAMAR hand dynamometer, Sammons preston, Canada). (3) 5cm.. (4) 5cm C6~T3 T4~12. (5) 5cm. 3., 3, 6 10,. (3) Jebsen-Taylor Jebsen-Taylor 1969 Jebson,.,,,,,, ( ),. Jebsen-Taylor hand function test (Sammons Preston, USA). 2) (1) MAL(Motor Activity Log) 30 0~5, ) (1) (Functional independence measure, FIM) FIM 1983 Granger (1990).,,,,, 6, 18

5 Table 1. General characteristics of the subjects (N=20) Exp. Group Cont. Group p Gender Male 7 6 Female Age(yr) 43.00± ± Height(cm) ± ± Weight(kg) 66.10± ± Type of stroke Infarction 5 6 Hemorrhage Paretic side Left 3 6 Right Time since stroke(months) 12.40± ± Note. Values are mean±sd, ( ) 1~7., t- (independent t-test) SPSS 12.0K for Windows,, 3, (One way-repeated measure ANOVA) Ⅲ. 1. (Table 1), t- Table 2. The comparison of variables in experimental & control groups. Parameters Group Before 3Wks 6Wks 10Wks F p MFT(score) ± ±8.94 a 47.19±8.77 b 55.63±8.69 c ** ± ±12.35 a 50.62±14.11 b 54.38±13.60 c ** Grip Strength(lbs) ± ±7.61 a 22.30±7.05 b 25.60±6.57 c ** ± ±8.03 a 19.80±7.62 b 22.00±8.53 c ** Jebsen-Taylor(sec) ± ±17.06 a 50.13±16.52 b 45.05±15.54 c ** ± ±14.69 a 51.79±13.45 b 48.63±12.26 c ** MAL1(score) ± ±18.68 a 54.70±12.68 b 64.20±14.68 c ** ± ±24.58 a 42.00±22.96 b 48.80±21.62 c ** MAL2(score) ± ±18.07 a 47.90±17.95 b 57.40±18.83 c ** ± ±24.37 a 43.40±22.76 b 50.50±19.81 c ** FIM(score) ± ±8.92 a 74.60±9.24 b 83.00±9.94 c ** ± ±16.96 a 70.80±16.80 b 76.60±16.68 c ** MFT: manual function test; MAL: motor activity log; FIM: functional independence measure **p<0.01 Note. Values are mean±sd a was represented significant difference between before and 3 weeks following treatment b was represented significant difference between 3 weeks and 6 weeks following treatment c was represented significant difference between 6 weeks and 10 weeks following treatment 1 was represented experimental group 2 was represented control group

6 Table 3. A difference between experimental & control groups according to treatment period. Parameters Exp. Group Cont. Group t p MFT(score) Before-3Wks 7.5± ± * 3Wks-6Wks 5.94± ± * 6Wks-10Wks 8.44± ± * Grip Strength(lbs) Before-3Wks 2.1± ± * 3Wks-6Wks 2.0± ± Wks-10Wks 3.3± ± Jebsen-Taylor(sec) Before-3Wks 4.51± ± Wks-6Wks 4.94± ± Wks-10Wks 4.57± ± MAL1(score) Before-3Wks 10.80± ± * 3Wks-6Wks 19.60± ± ** 6Wks-10Wks 9.50± ± MAL2(score) Before-3Wks 11.50± ± ** 3Wks-6Wks 11.00± ± * 6Wks-10Wks 9.50± ± FIM(score) Before-3Wks 8.6± ± Wks-6Wks 8.6± ± * 6Wks-10Wks 8.4± ± Note. Values are mean±sd *p<0.05 **p<0.01 (p>0.05). 2. (Table 2). (Table 2) (p<0.05), 3 (p<0.05). 3, (p<0.05)(table 3). 3. (Table 2). (Table 2) (p<0.05), 3 (p<0.05). 3 (p<0.05) (p>0.05) (Table 3). 4. Jebsen-Taylor (Table 2). (Table 2) (p<0.05), 3

7 (p<0.05). (p>0.05)(table 3). 5. MAL (Table 2). (Table 2) (p<0.05), 3 (p<0.05) (p<0.05) (p>0.05)(table 3). 6. MAL (Table 2). (Table 2) (p<0.05), 3 (p<0.05) (p<0.05) (p>0.05) (Table 3). 7. (Table 2). (Table 2) (p<0.05), 3 (p<0.05). 3 6 (p<0.05) (p>0.05)(table 3). Ⅳ. (, 2003), Basmajian(1979),,. Culham (1993). Depalma (2003) (rotator cuff),.,,,,.,, Jebsen-Taylor, (2007)

8 2 14 Jebsen-Taylor,. (2003) 2 MFT Jebsen-Taylor ± ±8.94, ±8.77, ±8.69.,. Kim (2002) 5 1, (2003) ±7.97lbs ±7.61lbs, ±7.05lbs, ±6.57lbs,.. Jebsen-Taylor, Jebsen-Taylor 59.58± ±17.06, ±16.52, ±15.54,.... MAL 24.30± ±18.68, ±12.68, ± MAL 25.40± ±18.07, ±17.95, ±18.83,.. 2 (2003) Botox A Sun (2006). Kopp (1999),,.,

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