융합적 자세교정치료가 뇌성경직양측마비 아동의 선택된 근육 활성도와 강직도에 미치는 영향: 사례연구 Effects of Combined Postural Correction Exercises on Selected Muscle Activity and Stiffness in Children With Cerebral Spastic Diplegia: Case Study원문보기
본 연구에서는 뇌성경직양측마비 아동을 대상으로 융합적인 자세교정치료가 근강직도(muscle stiffness) 및 근활성도(muscle activity)에 미치는 단기적인 영향을 알아보고자 하였다. 연구 대상자는 4세부터 7세의 뇌성경직양측마비 아동 3명(남자2, 여자1)을 대상으로 하였다. 측정부위는 위등세모근, 배곧은근, 큰볼기근이며, 근강직도 측정기(Myoton)와 표면 근전도(EMG)를 이용하여 근강직도와 근활성도를 측정하였으며, 양측 대칭성에 대해서도 알아보았다. 연구결과, 보상작용이 심했던 아동들이 융합적 자세교정 치료 중재 후 전반적으로 위등세모근과 배곧은근에서 근강직도와 근활성도가 감소하였고, 큰볼기근에서는 증가하는 경향을 보였다. 특히 해당 근육에서 왼쪽과 오른쪽의 대칭성이 줄어드는 특성을 보였다. 본 연구에서는 몇 가지 제한점에도 불구하고 융합적인 자세교정치료가 뇌성경직양측마비 아동의 자세교정 측면에서 긍정적인 효과가 있음을 보여 주었다.
본 연구에서는 뇌성경직양측마비 아동을 대상으로 융합적인 자세교정치료가 근강직도(muscle stiffness) 및 근활성도(muscle activity)에 미치는 단기적인 영향을 알아보고자 하였다. 연구 대상자는 4세부터 7세의 뇌성경직양측마비 아동 3명(남자2, 여자1)을 대상으로 하였다. 측정부위는 위등세모근, 배곧은근, 큰볼기근이며, 근강직도 측정기(Myoton)와 표면 근전도(EMG)를 이용하여 근강직도와 근활성도를 측정하였으며, 양측 대칭성에 대해서도 알아보았다. 연구결과, 보상작용이 심했던 아동들이 융합적 자세교정 치료 중재 후 전반적으로 위등세모근과 배곧은근에서 근강직도와 근활성도가 감소하였고, 큰볼기근에서는 증가하는 경향을 보였다. 특히 해당 근육에서 왼쪽과 오른쪽의 대칭성이 줄어드는 특성을 보였다. 본 연구에서는 몇 가지 제한점에도 불구하고 융합적인 자세교정치료가 뇌성경직양측마비 아동의 자세교정 측면에서 긍정적인 효과가 있음을 보여 주었다.
The aim of this study was to investigate the short-term effects of combined postural correction exercises (CPCE) on muscle stiffness and muscle activity in children with cerebral spastic diplegia(CSD). The subjects were 3 children (2 male and 1 female) with CSD from 4 to 7 years old. The measurement...
The aim of this study was to investigate the short-term effects of combined postural correction exercises (CPCE) on muscle stiffness and muscle activity in children with cerebral spastic diplegia(CSD). The subjects were 3 children (2 male and 1 female) with CSD from 4 to 7 years old. The measurement sites were upper trapezius muscle(UT), rectus abdominis muscle(RA), and gluteus maximus muscle(Gmax), muscle stiffness and muscle activity were measured using Myoton and surface EMG, and the symmetry of both sides was also examined. As a result, children with severe compensatory action showed decreased muscle stiffness and muscle activity in UT and RA and increase in Gmax after CPCE intervention. Especially, the left and right symmetry of the muscles was decreased. In this study, despite some limitations, CPCE have shown a positive effect in posture correction of children with CSD.
The aim of this study was to investigate the short-term effects of combined postural correction exercises (CPCE) on muscle stiffness and muscle activity in children with cerebral spastic diplegia(CSD). The subjects were 3 children (2 male and 1 female) with CSD from 4 to 7 years old. The measurement sites were upper trapezius muscle(UT), rectus abdominis muscle(RA), and gluteus maximus muscle(Gmax), muscle stiffness and muscle activity were measured using Myoton and surface EMG, and the symmetry of both sides was also examined. As a result, children with severe compensatory action showed decreased muscle stiffness and muscle activity in UT and RA and increase in Gmax after CPCE intervention. Especially, the left and right symmetry of the muscles was decreased. In this study, despite some limitations, CPCE have shown a positive effect in posture correction of children with CSD.
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문제 정의
However, most studies have been conducted on the effects of one intervention method, and few studies have verified the effects of convergence of various intervention methods. Therefore, in this study, in children with cerebral palsy with characteristic cerebral spastic diplegia with difficulty in controlling the trunk muscle, the effect of combined postural correction exercises based on neurodevelopmental therapy on rectus abdominis muscle, gluteus maximus muscle and upper trapezius muscle using muscle stiffness meter and surface electromyography device was investigated, and through this the aim of this study was to identify the short-term effects of combined postural correction exercises as well as present clinically significant treatment methods.
Therefore, it is possible to sit and stand, but there is a significant difference in symmetrical and harmonic muscle contraction in the joints and muscles of the balance and lower extremity, and the lack of weight shifting due to the muscle weakness of the lower extremity muscles makes it difficult for the children to walk[8]. Therefore, the goal of treatment is to reduce the asymmetry and compensatory action of children with cerebral palsy through coordination of muscle tone and harmonic contraction of the lower limb muscles including trunk. This requires posture control to maintain a stable posture against gravity in the pelvis, hip and lower extremities, and maintain normal body alignment state[9].
Training for posture control must be included as a component of the intervention program, and a comprehensive therapeutic approach including posture control in the treatment of children with cerebral palsy is a very important aspect. This study therefore aimed to investigate the short-term effects of combined postural correction exercises on muscle stiffness and muscle activity. For this purpose, in children with cerebral palsy, the muscle stiffness meter and surface electromyography were used to compare values before and after intervention in upper trapezius muscle, rectus abdominis muscle, and gluteus maximus muscle.
제안 방법
Muscle activity measurements were taken for 15 seconds in a relaxed posture facing forward. Data were collected for 9 seconds excluding the first and last 3 seconds, raw data were obtained, filtered to reduce confusion, and mean values of maximal voluntary isometric contraction were normalized and was used for analysis in this study[8].
In this regard, in this study, it was found that the postural correction intervention method was effective in improving gait improvement and functional aspects, as the muscle activity of both sides decreased and symmetry increased during walking in specific children after the intervention. However, the limitations of this study were the lack of number of subjects and the short intervention period of the combined postural correction exercises that only demonstrated short-term effects. In later studies, if more than one month of intervention is performed on more samples, it is considered that it will be of great help in establishing a clinically effective customized intervention program.
Subjects participated in a treatment program (3 times a week) to correct posture. The intervention was conducted directly by a skilled specialist in a child rehabilitation hospital in Gyeonggi-do, and the intervention method consisted of a combination of posture correction intervention based on neurodevelopmental approach and balance training using ankle-foot orthosis in standing posture[14]. The contents of the combined postural correction exercises are as follows(Table 3).
The study examined short-term effects of combined postural correction exercises on muscle stiffness and muscle activity and bilateral symmetry in children with cerebral spastic diplegia. As a result, in children with severe compensatory action, muscle stiffness and muscle activity decreased overall in the upper trapezius muscle and rectus abdominis muscle after the combined postural correction exercises intervention, and there was a trend of increase in the gluteus maximus muscle.
This study was performed to evaluate the muscle stiffness and muscle activity of children with cerebral palsy before and after combined postural correction exercises based on neurodevelopmental therapy, and the results are as follows.
To evaluate the muscle stiffness of upper trapezius muscle, rectus abdominis muscle, and gluteus maximus muscle before and after combined postural correction exercises for children with cerebral palsy, a muscle stiffness meter (Myoton AS, ESTONIA) [Fig. 1] was used. For the measurement posture, the upper trapezius muscle and the rectus abdominis muscle were measured in the supine position and the gluteus maximus muscle was measured in the prone position.
To measure the muscle activity of the upper trapezius muscle, the rectus abdominis muscle, and the gluteus maximus muscle in standng and walking before and after the combined postural correction exercises of children with cerebral palsy, surface electromyography(EMG)(Trigno, Delsys Inc, USA) equipment was used. EMGworks 3.
대상 데이터
The subjects of this study were children with cerebral spastic diplegia (2 male and 1 female). The selection criteria of the subjects were, 1) Children diagnosed with cerebral palsy, 2) Children who can understand and perform the instructions given by the researcher, and 3) Children without vision and hearing impairment.
성능/효과
Various studies have shown that the trunk strengthening exercise applied to children with cerebral palsy improves the stability by reducing the compensatory action significantly, and also positively affects gait and balance as well as functional activities[23][24]. Also in this study, it was confirmed that in the upper trapezius muscle with increased muscle activity due to lack of trunk stability, the muscle activity was reduced after combined postural correction exercises intervention. These results can be considered similar to that of the trends of preceding studies.
Especially, in the specific muscle, the left and right symmetry of the muscle was decreased. Despite some limitations, this study showed that combined postural correction exercises had a positive effect on the posture correction of children with cerebral spastic diplegia. In future studies, it is considered that the number of subjects should be increased and various treatment programs should be applied over a long period of time in accordance with the characteristics of related children for the development of effective therapeutic intervention methods.
In the study results, in case A, after combined postural correction exercises, the left and right upper trapezius muscle(muscle stiffness) decreased by –12.09 N/m and –22.15 N/m, respectively, and rectus abdominis muscle(muscle stiffness) decreased by –124.34 N/m and –16.33 N/m, respectively.
In addition, walking may be the final goal of the motor function of children with cerebral palsy, and it is an important activity to represent the gross motor function as a whole. In this regard, in this study, it was found that the postural correction intervention method was effective in improving gait improvement and functional aspects, as the muscle activity of both sides decreased and symmetry increased during walking in specific children after the intervention. However, the limitations of this study were the lack of number of subjects and the short intervention period of the combined postural correction exercises that only demonstrated short-term effects.
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