[논문]파킨슨 환자의 활동 개선을 위한 PNF 개념을 이용한 물리치료 사례보고

신재욱; 김좌준

doi:10.21598/jkpnfa.2016.14.3.219

파킨슨 환자의 활동 개선을 위한 PNF 개념을 이용한 물리치료 사례보고
Case Report of Physical Therapy using Proprioceptive Neuromuscular Facilitation for Activity Improvement in a Patient with Parkinson's Disease 원문보기

PNF and movement, v.14 no.3, 2016년, pp.219 - 229

Abstract ▼ AI-Helper

Purpose: Patients with Parkinson's disease suffer many restrictions in daily life. This case report investigated how intervention with proprioceptive neuromuscular facilitation (PNF)-based physical therapy can affect the activities of Parkinson's patients. Methods: The subject was a 67-year-old female patient diagnosed with Parkinson's disease 3 years ago. Since the last five months, overall activities have become difficult for her, and she finally visited a hospital to take outpatient physical therapy because of the gait difficulties she suffered. The patient's medical history, system review, body structure and function, and activities were evaluated. The patient had difficulties in activities such as lying down, sitting, standing, maintaining a standing position, and walking. The PNF-based intervention was used for treating the impairments and improving the activities. The intervention was performed for 30 min a day, three times a week, for eight weeks. The qualifier of the international classification of functioning, disability, and health was used to measure the result, and the measurement was conducted before and after the intervention for eight weeks. Results: According to the result, the scores for maintaining a standing position, moving around within the home, and going to the toilet improved to "no problem" from "moderate problem." The scores for shifting the body's center of gravity, walking short distances, and washing oneself improved from "moderate problem" to "mild problem." The scores for sitting and standing improved to "no problem" and "mild problem" from "complete problem." The scores for preparing meals and doing housework improved from "severe problems" to "mild problem" or "moderate problem." The scores for walking long distances, moving around outside the home and other buildings, and using transportation did not show significant changes. Conclusion: Intervention with PNF-based physical therapy improved the activity of patients with Parkinson's disease, thus proving its effectiveness. The case report suggested that a therapist can use PNF as a physical therapy intervention for patients with Parkinson's who suffered restrictions in daily activities.

주제어

AI 본문요약
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문제 정의

본 사례보고의 목적은 파킨슨 환자를 대상으로 PNF 개념을 이용한 물리치료 중재를 통하여 활동에 어떠한 영향을 미치는지에 대해 알아보고자 한다.

제안 방법

환자의 활동을 개선시키기 위해 하루 30분, 주 3회, 8주 동안 PNF 개념을 이용한 물리치료 중재를 적용하였다(Table 1).

대상 데이터

환자는 3년 전 파킨슨 진단을 받은 67세 여자 환자이며 키는 159cm, 체중은 51kg으로 마른 체형이다. 매우 활동적인 성향으로 친구들과의 모임, 동호회 모임에 참여하였으나 파킨슨 진단 이후 참여가 어려움을 호소하였다.

이론/모형

환자 평가를 위해 RPS (rehabilitation problem- solving) 양식을 이용하였다(Rauch et al., 2008; Steiner et al., 2002)(Fig. 1). 이러한 양식은 임상추론에 기초한 진단과정을 보여주고 환자의 기능상태에 대한 전체적 개요를 제공한다(Rauch et al.
활동 영역에서의 검진을 위해 국제 기능⋅장애⋅건강 분류(international classification of functioning, disability and health, ICF)의 분류척도를 이용하였다(Rauch et al., 2008). ICF는 임상적으로 환자의 평가, 중재, 재활, 추후 평가를 하기에 유용하며 장애보다 기능적인 문제를 강조하여 활동영역에 초점을 둘 수 있기에 임상에서 활용하기에 적합한 도구이다(Üstün et al.

성능/효과

씻기, 용변 관리하기, 식사 관리하기와 집안 일하기도 개선이 있었으며 이러한 활동들은 선 자세 유지하기, 앉아서 일어서기, 단거리 걷기가 포함된 활동들이므로 개선이 되었던 것으로 생각된다. 그러나 대부분의 중재가 실내 치료실에서 진행되었으며 장거리 걷기, 집과 그 외 건물 밖에서 이동하기, 교통수단 이용하기는 개선되지 않았다.
환자가 목표로 하는 일상생활 동작과 걷기, 검진을 통하여 확인된 활동의 문제점은 8주 동안의 PNF 중재를 통해 대부분 개선되었다.

후속연구

본 사례보고는 한명의 파킨슨 환자를 대상으로 진행하였기 때문에 전체 파킨슨 환자에 일반화하기에는 어려움이 있다. 따라서 향후 연구에서는 더 많은 환자를 대상으로 연구를 진행하여 파킨슨 환자에 대한 PNF 중재의 효과에 대한 검정이 필요할 것으로 사료된다.

질의응답

핵심어	질문	논문에서 추출한 답변
	파킨슨 환자에 필요한 치료방법은?	, 2007). 이러한 개별 훈련 방법들의 효과는 입증되었지만 다양한 신체 문제가 발생되는 파킨슨 질환의 특성상 포괄적으로 접근이 가능한 치료 방법이 필요하다.
	파킨슨 질환이란?	파킨슨 질환은 운동과 비운동 바닥핵 순환에 영향을 주는 진행성의 신경퇴행성 질환이다(Stern et al., 2012).
	파킨슨 환자의 장애는 어떤 요소들에서 발생되는가?	흑색질(substantia nigra)에서 도파민성 뉴런의 퇴행은 운동 완만증, 근육 경직, 휴식시 진전, 그리고 자세 반사 손상과 같은 중요한 운동 특징을 보이는 임상 소견이 나타나게 한다(Bohlhalter & Kaegi, 2011). 일반적인 파킨슨 환자의 장애는 운동과 비운동 계통에서 손상, 기능적 운동성과 일상생활동작 제한, 레크리에이션, 여행, 운동 혹은 다른 신체 활동들의 제약과 같은 여러 요소들에서 발생되며 누적적인 경향으로 나타난다(Alves et al., 2005; Jankovic & Kapadia, 2001; Shulman et al.

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저자의 다른 논문 :

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