전정재활운동이 파킨슨병 환자들의 자세조절 및 감각구성에 미치는 영향 = Effects of Vestibular Rehabilitation on Postural Control and Sensory Organization in Patients with Parkinson's Disease

다국어 초록 (Multilingual Abstract)

[INTRODUCTION] Postural instability in patients with Parkinson's disease(PD) is most incapacitating symptom which can put patients at increased risk for falls and death. Although there were many reports about various physical interventions that can be performed on PD patients, few study groups have paid attention to the effects of vestibular rehabilitation as a treatment. The aim of this study is to assess effectiveness of vestibular rehabilitation in improving postural instability in patients with PD. [METHOD] Thirty patients diagnosed with idiopathic PD at a high risk of falls were enrolled based on their scores on the timed up and go test. General rehabilitation therapy was performed on PD patients using Hamid's exercise in the period of 12 weeks. They were asked to complete questionnaires including verbal analogue scale (VAS), activities specific balancing confidence scale (ABC) for the functional aspect before and after the treatment. Quantification of improvement was conducted utilizing static posturography and Sensory Organization Test (SOT) of Computerized Dynamic Posturography (CDP). Statistical significance was tested in between the patients before and after treatment by t-test. [RESULT] There was a statistically significant improvement in body sway, scores of VAS and ABC. The spectral frequency analysis of body sway showed a significant decrease in spectral power at low frequencies which means a significant improvement of proprioception after the treatment. The patients showed a significant improvement in the follow-up CDP (p<.05). [CONCLUSION] The results showed that vestibular rehabilitation is effective in improving postural control in individuals of PD, and further the activities of daily life, as well as in reducing the risk of falls.

국문 초록 (Abstract)

[서론] 파킨슨병의 주요증상의 하나인 자세불안정은 환자들의 삶의 질에 나쁜 영향을 끼칠 수 있는 주요 증상으로서 이의 치료를 위한 전정재활요법에 관심이 증대하고 있다. 파킨슨병 환자들에게 운동요법이 주가 된 재활치료의 효과에 대해서는 선행연구가 많이 있으나 전정재활치료로 특화된 요법을 시행하였을 때에도 좋은 효과를 기대할 수 있는지에 대한 연구는 드문 실정이다. 이 연구의 목적은 파킨슨병 환자들에게 전정재활치료를 시행한 후에 자세조절능력의 변화 정도를 자세측정기검사를 통해 정량화함으로써 치료의 효과를 밝히고자 하였다. [방법] 넘어질 위험이 많은 파킨슨병 환자 30명에게 Hamid 전정적응강화운동을 수행시켰다. 치료 효과의 평가를 위해서 환자들에게 재활치료 시작 전과 약 3개월 후에 설문 조사(Verbal analogue scale,VAS; Activities specific balancing confidence scale, ABC)로 주관적인 자세불안정의 척도를 구했고, 정적 및 동적자세측정기 검사(Computerized dynamic posturography, CDP)로 정량화된 평가를 받게 하였다. 치료 전후에 따른 변인간 비교 분석을 위해 대응 t-test를 실시하였다. [결과] 환자들이 느끼는 주관적인 척도로서의 VAS와 ABC는 모두 치료 전보다 치료 후에 유의하게 개선되었다. 정적 자세측정기검사는 치료 받은 후에 동요거리 및 동요면적과 속도가 치료 전보다 유의하게 줄어들고 1 Hz 이하의 동요주파수영역의 파워가 치료 후에 유의하게 줄어들었다. CDP검사에서는 감각구성검사에서 조건 4,5와 6 및 종합평형점수가 치료 후에 유의한 향상이 있었다. 감각분석에서 시각비, 전정비, 체성감각비 및 시각우선 항목의 점수가 향상이 있었다. [결론] 전정재활치료 후에 환자들의 주관적인 느낌의 개선과 객관적인 검사에서 얻어진 자세조절 지표의 호전의 결과는 병행되었다. 이로 보아 전정재활치료는 PD 환자들의 자세조절능력을 향상시키고 삶의 질을 더 나아지게 하는 데에 유용한 것으로 사료된다.

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