Korean Journal of Occupational Therapy (대한작업치료학회지)

Korean Society of Occupational Therapy (대한작업치료학회)
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The Effects of Modified Constraint-Induced Movement Therapy on Unilateral Neglect and Activities of Daily Living in Stroke Patients

수정된 강제유도 운동치료가 뇌졸중 환자의 편측무시와 일상생활활동에 미치는 영향

Kim, Jeong-Hui;Chang, Moon-Young
김정희;장문영

  • Published : 2009.10.30

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Abstract

Objective : The purpose of this study is to investigate the effects of modified Constraint-Induced Movement Therapy (mCIMT) on the unilateral neglect and Activities of Daily Living (ADL) of stroke patients. Methods : A case study was utilized for four stoke patients with unilateral neglect. Unilateral neglect was measured using a Motor-free Visual Perception Test (MVPT), Line Bisection Test, Star Cancellation, and Catherine Bergego Scale. ADL was also measured using a Canadian Occupational Performance Measure (COPM) and Motor Activity Log (MAL). Results : The MVPT pre-mCIMT raw score was 22, and the left response behavior score was 14, increasing to 26 and 17 post-mCIMT, respectively. For the Line Bisection Test, the mean length of the error distance was improved from 35.2mm pre-mCIMT, and 18.5mm post-mCIMT. The Star Cancellation and Catherine Bergego Scale showed decreased mean error scores of post-mCIMT. For the patients in mCIMT, improvements of mean Amount Of Use (AOU) and Quality Of Movement (QOM) of MAL were 123% and 44%, and improvements of mean COPM satisfaction and performance scores were 3.90 and 3.05, respectively. However, the results showed no statistically significant improvement between pre- and post-mCIMT (p>.05). Conclusion : As the results of this study, while mCIMT showed a positive effect on the reduction of unilateral neglect, and also improved ADL for stroke patients, it failed to show a statistically significant improvement. It will be very useful to do a clinical intervention if mCIMT is proven as an effective application throughout more case-control studies with greater sample sizes.

목적 : 본 연구를 통하여 뇌졸중 환자에게 적용된 수정된 강제유도 운동치료가 편측무시 및 일상생활활동에 미치는 효과를 알아보고자 하였다. 연구방법 : 편측무시가 있는 네 명의 뇌졸중 환자에 대한 사례연구이다. 편측무시 현상은 Motor-free Visual Perception Test (MVPT), 선 나누기 검사, 별 지우기 검사와 Catherine Bergego Scale (CBS)을 사용하여, 일상 생활활동은 Motor Activity Log (MAL)와 Canadian Occupational Performance Measure (COPM)를 사용하여 측정하였다. 수정된 강제유도 운동치료 전 후의 변인의 차이를 검증하기 위하여 윌콕슨 부호순위검정을 실시하였다. 결과 : MVPT 수행 결과 치료 전 평균 원점수가 22점에서 치료 후 26점으로, 치료 전 좌측반응점수가 14점에서 치료 후 17점으로 각각 증가하였다. 선 나누기 검사 수행의 평균오차가 35.2mm에서 18.5mm로 감소되었고, 별 지우기와 CBS의 오류점수도 감소하였다. MAL 수행시 평균 좌측 손사용 횟수와 좌측 손 움직임의 질이 각각 123%, 44% 증가하였다. COPM 수행 시 평균 수행도와 만족도가 각각 2.95점, 3.90점 증가하였다. 그러나 p값이 .06이므로 통계적으로 유의한 차이는 없었다(p>.05). 결론 : 본 연구의 결과 수정된 강제유도 운동치료의 적용이 뇌졸중 환자에게 편측무시 증상의 감소와 일상생활활동 향상의 긍정적인 영향을 미치나, 통계적으로 유의한 차이는 없었다. 향후 수정된 강제유도 운동치료를 보다 많은 대상자에게 적용하여 그 효과가 검증된다면 임상에서 유용하게 활용할 수 있을 것이다.

Keywords

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