[논문]고유 수용성 신경근 촉진법과 시각 되먹임 기반 관절재현 훈련이 발목관절의 고유 수용성 감각 수준과 한 발 서기 균형 능력에 미치는 영향

이재선; 김종호; 강민주; 황지선; 황선홍

doi:10.9718/jber.2022.43.2.81

고유 수용성 신경근 촉진법과 시각 되먹임 기반 관절재현 훈련이 발목관절의 고유 수용성 감각 수준과 한 발 서기 균형 능력에 미치는 영향
Effects of Proprioceptive Neuromuscular Facilitation and Visual-Feedback based Joint Position Reproduction Training on the Level of Ankle Proprioception and One-leg Standing Balance Ability 원문보기

Journal of biomedical engineering research : the official journal of the Korean Society of Medical & Biological Engineering, v.43 no.2, 2022년, pp.81 - 93

이재선 (호서대학교 일반대학원 물리치료학과) , 김종호 (호서대학교 생명보건대학 물리치료학과) , 강민주 (호서대학교 생명보건대학 물리치료학과) , 황지선 (호서대학교 일반대학원 물리치료학과) , 황선홍 (호서대학교 생명보건대학 물리치료학과)

Abstract ▼ AI-Helper

Proprioception training has been considered a secondary method to facilitate postural control ability. This study investigated the effects of two different proprioception training methods - the proprioceptive neuromuscular facilitation (PNF) and visual feedback-based joint position and force reproduction (VF) - on postural control advancements. Sixteen healthy people volunteered for this study, and they randomly grouped two. Each group participated in the PNF and VF training for three weeks. We evaluated each subject's proprioception levels and balance ability before and after the training. We used a clinometer and electromyogram (EMG) for VF training. The joint position reproduction test was also used to evaluate the position and force aspects of the proprioception level. We analyzed the trajectory of the center of pressure (COP) while subjects were standing on the firm floor and balance board with one leg using a pressure mat. The improvement of the position aspect of the proprioception level of the VF group (4.93±4.74°) was larger than that of the PNF group (-0.43±2.08°) significantly (p=0.012). The improvement of the anterior-posterior COP velocity of the PNF group (0.01±0.01 cm/s) was larger than that of VF group(0.002±0.01 cm/s) significantly (p=0.046). Changes of position error in the PNF group (rho=0.762, p=0.028) and tibialis anterior force reproduction error in the VF group showed a significantly strong relationship with balance ability variables. These results showed that different PNF and VF have different effects on improving two aspects of proprioception and their relationship with the balance ability. Therefore, these results might be useful for selecting proprioception or balance rehabilitation considering the clinical and patients' situation.

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표/그림 (13)

그림 그림 1. 측정 장비; (a) 근전도 센서, (b) 경사계 어플리케이션, (c) 압력매트센서, (d) 밸런스보드 Fig. 1. Measurement equipment (a) electromyogram sensor, (b) clinometer aplication, (c) pressure mat sensor, (d) balance board
표 표 1. 대상자 인체계측학 정보 Table 1. Demographic characteristics of subjects
그림 그림 2. 앞정강근과 외측 장딴지근의 고유 수용성 힘 감각 재현 능력 평가를 위한 근전도 전극 부착 모습 Fig. 2. Positions of electromyogram electrodes for the tests of reproducibility of force aspect of the proprioception on the tibialis anterior and gastrocnemius lateral muscles.
그림 그림 3. 고유 수용성 위치 감각 재현 능력 평가 Fig. 3. Reproducibility test for the position aspect of the proprioception
그림 그림 4. 딱딱한 바닥(좌측)과 불안정한 바닥(밸런스보드 위에서, 우측) 한 발 서기 균형 능력 평가 Fig. 4. Assessment of balance ability using one-leg standing on the firm floor (left) and unstable floor (balance board, right)
그림 그림 5. 고유 수용성 신경근 촉진법 중 율동적 안정화 기법 Fig. 5. Rhythmic stabilization (RS) exercise of proprioceptive neuromuscular facilitation method
그림 그림 6. 앞정강근과 외측 장딴지 근에 대한 시각 되먹임 기반 근력 재현 훈련 기법 Fig. 6. Visual feedback based joint position & muscle force reproduction training on tibialis anterior (left) and gastrocnemius lateral muscle (right)
그림 그림 7. 발목관절에 대한 시각 되먹임 기반 관절 재현 훈련 기법 Fig. 7. Visual feedback based joint position & muscle force reproduction training on position reproduction training
표 표 2. 훈련 전, 후에 측정된 고유 수용성 감각 수준 평가 변인들의 평균에 대한 집단 내 및 집단 간 비교 Table 2. Inter and intra group comparison among mean values of proprioception evaluation variables in the two groups measured from pre- and post-training.
그림 그림 8. 각 집단별 훈련 전, 후 고유 수용성 감각 수준 변화(TA_e: 앞 정강근 힘 재현 오차, GCL_e: 외측 장딴지근 힘 재현 오차, Position_e: 발목관절 위치(각도) 재현 오차, *: p<0.05) Fig. 8. Changes of force and position aspects of proprioception levels between pre- and post-training for each group (TA_e: tibialis anterior force reproduction errors, GCL_e: gastrocnemius lateral force reproduction errors, Position_e: ankle sagittal angle reproduction errors, *: p<0.05)
표 표 3. 훈련 전, 후에 측정된 균형 능력 평가 변인들의 평균에 대한 집단 내 및 집단 간 비교 Table 3. Inter and intra group comparison among mean values of balance variables in the two groups measured from preand post-training
그림 그림 9. 고유 수용성 신경근 촉진 훈련 집단과 시각 되먹임 훈련 집단의 훈련 전, 후 한 발 서기 시 압력중심궤적 변인들의 변화(PNF : 고유 수용성 신경근 촉진훈련 집단, VF : 시각 되먹임 훈련 집단, Flr_L : 딱딱한 바닥에서 COP 이동거리, Flr_Vm_ap : 딱딱한 바닥에서 전후 방향 COP 이동속도, Flr_A : 딱딱한 바닥에서 COP 이동면적, Board_L : 밸런스보드 위에서 COP 이동거리, Board_Vm_ap : 밸런스보 드 위에서 전후방향 COP 이동속도, Board_A : 밸런스보드 위에서 COP 이동면적, *: p<0.05) Fig. 9. Changes of COP variables from the two groups before and after the training (PNF : proprioceptive neuromuscular facilitation training group, VF : visual feedback training group, Flr_L : length of COP trajectory on the firm floor, Flr_Vm_ap : anterior-posterior velocity of COP trajectory on the firm floor, Flr_A : area of COP trajectory on the firm floor, Board_L : length of COP trajectory on the balance board, Board_Vm_ap : anterior-posterior velocity of COP trajectory on the balance board, Board_A : area of COP trajectory on the balance board, *: p<0.05)
표 표 4. 훈련 전, 후 고유 수용성 감각 수준과 한 발 서기 균형 능력 변화량 사이 상관관계 Table 4. Correlation coefficients about changes between the proprioception level and one leg standing balance ability

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