[논문]The Effect of Upper Extremity Training with a Focus on Functional Reaching, on Trunk Control and ADL Performance in Post-Stroke Hemiplegic Patients

Song, Bo-Kyung

The Effect of Upper Extremity Training with a Focus on Functional Reaching, on Trunk Control and ADL Performance in Post-Stroke Hemiplegic Patients 원문보기

대한물리치료학회지 = The journal of Korean Society of Physical Therapy, v.23 no.3, 2011년, pp.71 - 77

Song, Bo-Kyung (Department of Occupational Therapy, Bobath Memorial Hospital)

Abstract ▼ AI-Helper

Purpose: In this study, we tried to determine the effect of upper extremity training such as functional reaching on improved trunk control and ADL performance in post-stroke hemiplegic patients. Methods: We randomly selected 11 stroke patients in the hospital, who had a problem with the upper extremity, trunk and ADL performance. The patients were divided into the conservative training group and the functional reaching training group. We applied general occupational therapy only in the conservative training group whereas we applied upper extremity training with a focus on functional reaching in the functional reaching training group. To compare the two groups we used several assessment tools such as Modified Barthel Index (MBI), total Trunk Impairment Scale (TIS), static TIS, dynamic TIS and coordinative TIS. Results: The results obtained were as follows: (1) In the functional reaching training group, there was a statistically significant difference in the total TIS score, dynamic TIS score, and MBI. (2) We compared the results obtained before training with the changes in the results obtained after training and found that there was a relation between the assessment outcomes. Especially, static TIS score showed a relation in both groups. Conclusion: Functional reaching training influenced both the trunk control and ADL performance. Especially, the functional reaching training group demonstrated better static trunk control ability than the conservative treatment group.

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제안 방법

0. Clinical characteristics of patients were analyzed with descriptive statistics. The effect of the UE training was evaluated by the nonparametric test.
TIS score was measured for evaluating the trunk function. The TIS score increased by 3.
²⁴ to evaluate the static and dynamic ability for trunk control, and coordination in the sitting position. The TIS consists of three subscales, static sitting balance (static TIS), dynamic sitting balance (dynamic TIS), and trunk coordination (coordinative TIS), and each subscale was sorted into 3, 10, and 4 tasks, a total of 17 tasks. The full scores for these tasks are 7, 10, and 6 respectively.
Other interventions were chosen individually based on the decision of the occupational therapist. The experimental group received scapular training for mobile stability and functional reaching training combined with shoulder rotation movement and grasping task in addition to the conservative occupational therapy 5 times a week for 4 weeks (20 times).
Therefore, the present study aimed to investigate the effect of scapular training for mobile stability and functional reaching training combined with rotation movement of the shoulder and grasping task on trunk control and performance of the ADL ability in post-stroke hemiplegic patients.
Treatment protocol in the experimental group was reaching- oriented occupational therapy based on the Eggers's29 therapeutic approach: (1) scapular training for mobile stability, (2) scapula, rotators, and elbow movement, and (3) forward reaching movement of the hand to perform the task.

대상 데이터

There were 9 male and 2 female patients in this study. The average age was 56.

데이터처리

Clinical characteristics of patients were analyzed with descriptive statistics. The effect of the UE training was evaluated by the nonparametric test. Wilcoxon signed-ranked test was used for the trunk function and Mann-Whitney U test for ADL evaluation.
The effect of the UE training was evaluated by the nonparametric test. Wilcoxon signed-ranked test was used for the trunk function and Mann-Whitney U test for ADL evaluation. P<0.

이론/모형

For the evaluation of trunk function and ADL performance, we used the TIS. This scale was developed by Verheyden et al.²⁴ to evaluate the static and dynamic ability for trunk control, and coordination in the sitting position. The TIS consists of three subscales, static sitting balance (static TIS), dynamic sitting balance (dynamic TIS), and trunk coordination (coordinative TIS), and each subscale was sorted into 3, 10, and 4 tasks, a total of 17 tasks.

성능/효과

³⁷ We analyzed the reaching movement in patients in an acute stage after stroke, and they showed excessive recruitment of voluntary muscle activation, change in the muscle firing rate, and delayed onset of muscle contraction during the first several weeks. After a few months, the authors found an improvement in reaching movement, time of onset of muscle contraction, muscle firing rate, and voluntary muscle contraction as compared to that in the acute stage. However, alteration of muscle activity during reaching was still seen, and it is important to understand the change in the muscle activity during recovery after injury.
89). Content validity was determined by the similarity with tasks related to the trunk area in the Stroke Impairment Assessment Set and concurrent validity was measured by correlation with TCT (r=0.91). Predictive validity was measured by regression analysis of prediction factors such as age, duration after stroke, and FIM score during inpatient period influencing the mobility and FIM scores after discharge, and the controlled R2 value was between r=0.
05) (Table 2). Regarding the TIS subscales, the experimental group showed an increase in each subscale: static TIS score increased from 5.83 to 6.17, dynamic TIS score increased from 4.67 to 6.83, and coordinative TIS score increased from 1.83 to 2.67. In the control group, the static TIS score decreased from 6.

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