어깨뼈 근육의 등척성 훈련이 뇌졸중 환자의 몸통근 활성과 몸통조절 및 균형에 미치는 효과 = Effects of isometric muscles on trunk muscle activation, trunk control and balance in patients with stroke

국문 초록 (Abstract)

본 연구는 어깨뼈 근육의 등척성 훈련이 뇌졸중 환자의 몸통근 활성과 몸통조절 및 균형에 미치는 효과에 대해서 알아보고자 실시하였다.
연구목적 달성을 위해 뇌졸중 환자 30명을 대상으로 하였으며, 블록 무작위 배정으로 연구군 15명, 대조군 15명으로 분류하여 8주간 주 3회, 회당 30분 동안 치료를 실시하였고, 측정도구로는 표면 근전도, 몸통손상척도, 버그균형척도, 기능적 팔 뻗기를 사용하였으며 결과는 다음과 같다.
1. 어깨뼈 근육의 등척성 훈련과 보존적 물리치료군의 치료 전·후 몸통근 활성도 변화는 다음과 같다.
1) 척추세움근의 등뼈부분 근활성도는 마비쪽에서 어깨뼈 근육의 등척성 훈련군에 유의한 변화를 보였으며(p<.01) 보존적 물리치료군에서 유의한 변화는 없었다(p>.05). 비마비쪽에서는 어깨뼈 근육의 등척성훈련군과 보존적 물리치료군의 변화량에서 유의한 변화는 없었다(p>.05).
2) 척추세움근의 허리뼈부분 근활성도는 마비쪽에서 어깨뼈 근육의 등척성 훈련군에 유의한 변화를 보였으며(p<.01) 보존적 물리치료군에서 유의한 변화는 없었다(p>.05). 비마비쪽에서는 어깨뼈 근육의 등척성훈련군과 보존적 물리치료군의 변화량에서 유의한 변화는 없었다(p>.05).
3) 배속빗근의 근활성도는 마비쪽에서 어깨뼈 근육의 등척성 훈련군과 보존적 물리치료군의 변화량에서 유의한 변화는 없었다(p>.05). 비마비쪽에서는 어깨뼈 근육의 등척성 훈련군에 유의한 변화를 보였으며(p<.05) 보존적 물리치료군의 변화량에서 유의한 변화는 없었다(p>.05).
4) 배바깥빗근의 근활성도는 마비쪽에서 어깨뼈 근육의 등척성 훈련군과 보존적 물리치료군의 변화량에서 유의한 변화는 없었다(p>.05). 비마비쪽에서는 어깨뼈 근육의 등척성 훈련군에 유의한 변화를 보였으며(p<.05) 보존적 물리치료군의 변화량에서 유의한 변화는 없었다(p>.05). 집단 간 차이에서 통계적으로 비마비쪽 배바깥빗근에서만 유의한 차이를 보였다(p<.05).
2. 어깨뼈 근육의 등척성 훈련과 보존적 물리치료군의 치료 전·후 몸통근 활성을 활용한 대칭성 점수 변화는 다음과 같다.
1) 척추세움근의 등뼈부분 근활성도의 대칭성 검사에서 어깨뼈 근육의 등척성 훈련군의 변화량에서 유의한 변화를 보였으며(p<.01) 보존적 물리치료군의 변화량에서 유의한 변화는 없었다(p>.05). 집단 간 차이에서 어깨뼈 근육의 등척성 훈련군과 보존적 물리치료군 간에 통계적으로 유의한 차이를 보였다(p<.05).
2) 척추세움근의 허리뼈부분 근활성도의 대칭성 검사에서 어깨뼈 근육의 등척성 훈련군의 변화량에서 유의한 변화를 보였으며(p<.05) 보존적 물리치료군의 변화량에서 유의한 변화는 없었다(p>.05).
3) 배속빗근의 근활성도의 대칭성 검사에서 어깨뼈 근육의 등척성 훈련군과 보존적 물리치료군의 변화량에서 유의한 변화를 보였다(p<.05).
4) 배바깥빗근의 근활성도의 대칭성 검사에서 어깨뼈 근육의 등척성훈련군의 변화량에서 유의한 변화를 보였으며(p<.05) 보존적 물리치료군의 변화량에서 유의한 변화는 없었다(p>.05).
3. 어깨뼈 근육의 등척성 훈련과 보존적 물리치료군의 치료 전·후 몸통조절능력 점수 변화는 다음과 같다.
1) 몸통손상척도의 어깨뼈 근육의 등척성 훈련군과 보존적 물리치료군의 변화량에서 유의한 변화를 보였다(p<.001). 집단 간 차이에서 어깨뼈 근육의 등척성 훈련군과 보존적 물리치료군 간에 통계적으로 유의한 차이를 보였다(p<.05).
4. 어깨뼈 근육의 등척성 훈련과 보존적 물리치료군의 치료 전·후 균형능력 점수 변화는 다음과 같다.
1) 버그균형척도의 어깨뼈 근육의 등척성 훈련군과 보존적 물리치료군의 변화량에서 유의한 변화를 보였다(p<.001). 집단 간 차이에서 어깨뼈 근육의 등척성 훈련군과 보존적 물리치료군 간에 통계적으로 유의한 차이를 보였다(p<.05).
2) 기능적 팔 뻗기 검사의 어깨뼈 근육의 등척성 훈련군과 보존적 물리치료군의 변화량에서 유의한 변화를 보였다(p<.001). 집단 간 차이에서 어깨뼈 근육의 등척성 훈련군과 보존적 물리치료군 간에 통계적으로 유의한 차이를 보였다(p<.05).
위의 결과로 보아, 8주간의 어깨뼈 근육의 등척성 훈련이 뇌졸중 환자의 몸통근 활성도의 대칭성과 몸통조절 및 균형 향상을 위한 훈련법으로 적용될 수 있다. 또한 어깨뼈 근육의 등척성 훈련이 보존적 물리치료에 비해 배바깥빗근의 근활성도, 몸통근 활성도로 분석한 척추세움근의 등뼈부분의 대칭성, 몸통조절, 균형에 더 효과적이라는 것을 알 수 있다.

다국어 초록 (Multilingual Abstract)

This study was to identify the effects of isometric training of the scapular muscles on trunk muscle activity, control, and balance in patients with stroke. A total of 30 patients with histories of stroke were included in the study. Subjects were assigned as block randomization to either the experimental group, which carried out isometric training of the scapular muscles (15 patients), or the control (conservative physical therapy) group (15 patients). Each treatment session, in both groups, lasted for 30 minutes, with three sessions per week for eight weeks. Surface Electromyography, the Trunk Impairment Scale, the Berg Balance Scale, and the Functional Reach Test were utilized. The results of the study showed the following:
1. There were changes in trunk muscle activity scores before and after isometric training and conservative physical therapy. These changes included:
1) Erector spinae muscle activity on the paretic side showed significant changes in patients who underwent isometric training of the scapular muscle (p<0.01), while there were no significant changes observed in the conservative physical therapy group (p>0.05). Neither the isometric training nor conservative physical therapy groups experienced significant changes in activity scores on the nonparetic side (p>0.05).
2) On the paretic side, erector spinae muscle activity was significantly changed in the isometric training group (p<0.01). No significant changes were observed in the conservative physical therapy group (p>0.05). On the nonparetic side, there were no significant changes in the lumbar muscle activity scores for either the isometric training or the conservative physical therapy groups(p>0.05).
3) On the paretic side, internal oblique muscle activity was not significantly changed either the isometric training or the conservative physical therapy groups (p>0.05). On the nonparetic side, internal oblique muscle activity scores were significantly altered for the isometric training group (p<0.05), while no changes were observed in the conservative physical therapy group (p>0.05).
4) There were no significant changes in external oblique muscle activity for either the isometric training or the conservative physical therapy groups (p>0.05). However, the isometric training group exhibited significant changes in the muscle activity on the non-paretic side (p<0.05). There were no significant changes in the external oblique muscle activity scores on the nonparetic side in the conservative physical therapy group (p>0.05). For the external oblique, we only observed statistically significant changes in muscle activity between the two treatment groups on the nonparetic side(p<0.05).
2. These are the changes we observed in trunk muscle symmetry scores before and after isometric training of the scapular muscle and conservative physical therapy:
1) Patients who received isometric training of the scapular muscle experienced significant changes in their spinal muscle activity symmetry scores for the erector spinae (p<0.01). In contrast, no significant changes we observed for symmetry scores in the conservative physical therapy group (p>0.05). There were statistically significant between-group differences in the symmetry scores for the two treatment groups.
2) There were significant changes in erector spinae symmetry test scores for the isometric training group (p<0.05), and no significant changes were observed in the conservative physical therapy group (p>0.05).
3) Both the isometric training and the conservative physical therapy groups showed significant changes in their internal oblique muscle activity symmetry scores (p<0.05)
4) For the isometric training group, external oblique muscle activity symmetry scores showed significant changes pre- to post-training (p<0.05); however, such changes were not observed for the conservative physical therapy group (p>0.05).
3. Pre- to post-training changes in trunk muscle control before for the isometric training and conservative physical therapy groups were as follows:
1) Both the isometric training and the conservative physical therapy groups showed significant changes in their Torso Injury Scale scores pre- to post-training (p<0.001). There were also statistically significant between-group differences (p<0.05).
4. Changes in balance ability pre- to post-treatment for the isometric training and conservative physical therapy groups were as follows:
1) Both groups demonstrated significant changes in their Berg Balance Scale scores (p<0.001). Additionally, there were significant between-group differences (p<0.05).
2) Both the isometric training and the conservative physical therapy groups showed significant changes in their Functional Reach Test scores pre- to post-treatment (p<0.001). Additionally, there were significant inter-group differences in the scores of the functional reach test (p<0.05). The above findings demonstrate that eight weeks of isometric training of the scapular muscle can improve trunk muscle activity symmetry, trunk muscle control, and balance in patients who with histories of stroke. Furthermore, isometric training of the scapular muscle was a more efficient means of improving the erector spinae symmetry, trunk control, and balance than conservative physical therapy, as determined by analysis of external oblique and torso muscle activity.

목차 (Table of Contents)

• Ⅰ. 서 론 ·····································································································1
• 1. 연구의 필요성 ·························································································1
• 2. 이론적 배경·····························································································5
• 3. 연구의 목적·····························································································7
• 4. 연구의 가설·····························································································8
• 5. 연구의 기대효과 ·····················································································9
• 6. 연구의 제한점 ·························································································9
• Ⅱ. 연구 방법 ·································································································10
• 1. 연구대상 및 기간·················································································10
• 2. 연구설계 ·································································································11
• 3. 측정도구 및 평가·················································································13
• 4. 연구중재 ·································································································17
• 5. 자료분석 ·································································································21
• Ⅲ. 연구결과··································································································22
• 1. 대상자의 일반적 특성·········································································22
• 2. 어깨뼈 근육의 등척성 훈련이 몸통근 활성도에 미치는 영향 ···24
• 3. 어깨뼈 근육의 등척성 훈련이 비마비쪽과 마비쪽의 몸통근 활성도의 대칭성에 미치는 영향 ······························································36
• 4. 어깨뼈 근육의 등척성 훈련이 몸통조절에 미치는 영향 ·············44
• 5. 어깨뼈 근육의 등척성 훈련이 균형에 미치는 영향·····················46
• Ⅳ. 고 찰 ···································································································50
• Ⅴ. 결 론 ···································································································55
• Ⅵ. 참고문헌··································································································58
• ABSTRACT ··································································································65
• 부 록·········································································································70