상지의 운동기능 장애는 뇌졸중 환자에게서 빈번히 보고되는 증상 중의 하나이다. 뇌졸중의 원인인 신경학적 손상의 회복은 발병 초기인 6개월 동안 가장 활발히 일어나며, 이 시기의 회복은 이후 기능회복에 결정적 영향을 미친다. 독립적인 일상생활 수행과 상지 운동기능의 재활을 위하여 다양한 재활치료 접근이 적용되어 왔으나 그 효과성에 있어서 일관성이 결여된 결과가 보고되어 왔다. 따라서 뇌졸중 환자의 신경학적, 기능적 상지 운동 기능의 재활을 촉진할 수 있는 보다 효과적인 치료 방안 마련이 시급하다고 할 수 있다. 재활의학 분야의 연구에서 음악은 운동기능의 향상에 긍정적인 영향을 미치고 있으며, 특히 하지 운동기능 향상에 있어서 리듬 적용의 근거 및 그 효과성이 입증되고 있다. 하지만, 음악연주를 활용한 뇌졸중 환자의 상지 운동기능 재활에 대한 근거는 아직 확립되어 있지 않으며, 적용 대상 또한 만성 뇌졸중 환자에 제한 되어 있는 실정이다. 본 연구에서는 운동기능을 촉진하는 음악의 역할을 근거로, 뇌졸중 환자의 상지 운동기능 재활을 위하여 다양한 음악활동을 사용한 선행 연구를 고찰 및 분석하였다. 이를 바탕으로 아급성 뇌졸중 환자의 상지 운동기능의 재활을 도모하기 위한 악기연주 활용 방안에 대한 근거를 마련하고자 하였다.
상지의 운동기능 장애는 뇌졸중 환자에게서 빈번히 보고되는 증상 중의 하나이다. 뇌졸중의 원인인 신경학적 손상의 회복은 발병 초기인 6개월 동안 가장 활발히 일어나며, 이 시기의 회복은 이후 기능회복에 결정적 영향을 미친다. 독립적인 일상생활 수행과 상지 운동기능의 재활을 위하여 다양한 재활치료 접근이 적용되어 왔으나 그 효과성에 있어서 일관성이 결여된 결과가 보고되어 왔다. 따라서 뇌졸중 환자의 신경학적, 기능적 상지 운동 기능의 재활을 촉진할 수 있는 보다 효과적인 치료 방안 마련이 시급하다고 할 수 있다. 재활의학 분야의 연구에서 음악은 운동기능의 향상에 긍정적인 영향을 미치고 있으며, 특히 하지 운동기능 향상에 있어서 리듬 적용의 근거 및 그 효과성이 입증되고 있다. 하지만, 음악연주를 활용한 뇌졸중 환자의 상지 운동기능 재활에 대한 근거는 아직 확립되어 있지 않으며, 적용 대상 또한 만성 뇌졸중 환자에 제한 되어 있는 실정이다. 본 연구에서는 운동기능을 촉진하는 음악의 역할을 근거로, 뇌졸중 환자의 상지 운동기능 재활을 위하여 다양한 음악활동을 사용한 선행 연구를 고찰 및 분석하였다. 이를 바탕으로 아급성 뇌졸중 환자의 상지 운동기능의 재활을 도모하기 위한 악기연주 활용 방안에 대한 근거를 마련하고자 하였다.
Upper extremity dysfunction is a common consequence following stroke. Spontaneous recovery during the first six months post-stroke is rigorous and considered as a significant indicator of potential long-term progress. Various approaches have been utilized to regain functional upper limb movement nec...
Upper extremity dysfunction is a common consequence following stroke. Spontaneous recovery during the first six months post-stroke is rigorous and considered as a significant indicator of potential long-term progress. Various approaches have been utilized to regain functional upper limb movement necessary for independent living; however, conventional therapy approaches have failed to prove consistency, especially for subacute stroke patients. There is, thus, a need for innovative therapeutic strategies that motivate stroke survivors to facilitate neural and functional recovery during the critical window immediately following stroke. The effect of music on physical enhancement has been frequently reported in the field of medicine as well as neurorehabilitation. The efficacy of rhythm on lower extremity deficits has been well established. Yet, the rationale for using instrumental music making enhancing subacute upper extremities rehabilitation is not clearly described to date. Based on the key mechanism of music as sensori-motor movement facilitator, this paper reviews previous empirical research that utilized music-based interventions for upper extremity rehabilitation for stroke patients, either in the form of receptive or expressive activity. This paper, further, focuses on the current research trends in subacute stroke upper limb rehabilitation and provides applicable rationale of using instrumental music playing.
Upper extremity dysfunction is a common consequence following stroke. Spontaneous recovery during the first six months post-stroke is rigorous and considered as a significant indicator of potential long-term progress. Various approaches have been utilized to regain functional upper limb movement necessary for independent living; however, conventional therapy approaches have failed to prove consistency, especially for subacute stroke patients. There is, thus, a need for innovative therapeutic strategies that motivate stroke survivors to facilitate neural and functional recovery during the critical window immediately following stroke. The effect of music on physical enhancement has been frequently reported in the field of medicine as well as neurorehabilitation. The efficacy of rhythm on lower extremity deficits has been well established. Yet, the rationale for using instrumental music making enhancing subacute upper extremities rehabilitation is not clearly described to date. Based on the key mechanism of music as sensori-motor movement facilitator, this paper reviews previous empirical research that utilized music-based interventions for upper extremity rehabilitation for stroke patients, either in the form of receptive or expressive activity. This paper, further, focuses on the current research trends in subacute stroke upper limb rehabilitation and provides applicable rationale of using instrumental music playing.
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문제 정의
The paper explored the potential of using instrumental music playing for upper extremity rehabilitation in subacute stroke. The basic mechanism in terms of how music perception enhances motor function was briefly described and the efficacy of rhythm-driven lower extremity rehabilitation was introduced.
It is, thus, necessary to establish therapeutic rationale of using music as upper extremity rehabilitation tool for subacute stroke patients and design effective therapeutic strategy beyond the rationale. The purpose of this paper is to review the empirical literature pertaining to music and motor movement and to provide a theoretical rationale for using music as sensory-motor experience facilitating learning and exercising through playing a musical instrument for subacute stroke upper limb rehabilitation.
제안 방법
Researchers utilized rhythm patterns presented in a variety of tempi, including participants’ preferred tempo, and deviated (i.e., either decreased or increased tempo) from their neutral states, while asking participants to perform spontaneous motor-related tasks.
Rossignol and Jones (1976) explored the possibility of using sound for muscle facilitation. The purpose of the study was to investigate immediate activation and habituation of H-reflex responses to auditory stimuli and the synchronization of motor responses to musical stimuli during hopping. Participants first heard metronome beats with a certain pitch at 110dB and the H-reflex from the medial or lateral head of the gastrocnemius muscle was electrically recorded.
성능/효과
In conclusion, with the necessity of early intervention immediately following stroke due to the limited critical period of neural recovery, instrumental music playing, therefore, can be innovative alternatives for upper extremity rehabilitation in subacute stroke. Future research studies will be undertaken in order to obtain empirical evidence that confirms the effect of using instrumental music playing in improving upper limb functions of patients with subacute stroke.
Subacute stroke patients in rehabilitation hospital received either a three week music-supported therapy that aimed to rehabilitate fine as well as gross motor movement or a conventional therapy. Results obtained from electrophysiology (EEG) responses showed significantly decreased power of beta bands in participants who received the music therapy group, particularly with the affected limb, indicating an increased activity of motor regions. Coherence of electronic activation among brain regions was more pronounced in the music therapy group, particularly with drum pads playing, indicating inter-communication among brain regions and, further, neural reorganization post-stroke.
(2007). Results showed that patients trained with music-supported therapy performed finger tapping, hand tapping, supination, and target movement tasks significantly better than those who received conventional therapy and CIT. Also, changes in functional movement of upper extremities as measured by extensive occupational assessment batteries (i.
The latency of the the femoral quadriceps was inverse to increase in sound intensity. The findings indicated prominent influence of sound pattern and intensity on voluntary as well as involuntary muscle movement.
In the second condition, participants were instructed to hop on one leg in synchrony with beat. The results obtained from the EMG responses showed the effectiveness of using patterned auditory rhythm in increasing excitability of gastrocnemius muscle immediately and maintaining the audio-spinal potentiation through the auditory-startle pathway. A decrease in EMG amplitude after repeated exposure to sound over time was observed, indicating habituation of motor movement to sounds.
Music-supported training sessions consisted of instrumental playing (MIDI keyboard or electronic drum pads tuned with a certain pitch) of which task challenged gradually, while conventional therapy sessions included traditional occupational and physical therapy. The results showed that finger tapping performance increased significantly in music-supported training as measured by strength, dexterity, and evenness. The pre-posttest scores obtained from occupational assessment instruments (i.
Two groups of musicians practiced daily the technique with different levels of exposure over two weeks. The results showed that the external beat entrained the first finger movement, leading to greater peak EMG amplitude followed by a gradual decrease in the rest of the other fingers. Changes in movement patterns at the glenohumeral and radioulnar joints were accompanied; however, it was questionable that pronation of the forearm facilitated relieving the stress of the joint of the fingers and, thus, enhanced positioning the first finger in a successive movement.
후속연구
In conclusion, with the necessity of early intervention immediately following stroke due to the limited critical period of neural recovery, instrumental music playing, therefore, can be innovative alternatives for upper extremity rehabilitation in subacute stroke. Future research studies will be undertaken in order to obtain empirical evidence that confirms the effect of using instrumental music playing in improving upper limb functions of patients with subacute stroke.
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