관절가동기법이 양 하지 뇌성마비 아동의 대 운동기능 및 비복근 활동에 미치는 영향

• 영문명: The effect of joint mobilization for Gross Motor Functional Measurement and Electromyography of lower limbs in diplegic children with cerebral palsy
• 발행기관: 한국지체.중복.건강장애교육학회
• 저자명: 오태영(Oh, Tae-Young) 박래준(Park, Rae-Jun)
• 간행물 정보: 『지체.중복.건강장애연구』제52권 제1호, 175~194쪽, 전체 20쪽
• 주제분류: 사회과학 > 교육학
• 파일형태: PDF
• 발행일자: 2009.01.30

국문 초록

본 연구의 목적은 경직형 양하지 뇌성마비 아동의 하지 기능을 개선시키기 위해서 하지 다관절 근군과 관절에 관절가동기법을 적용함으로서 그 치료적 효과를 증명하고자 하는 것이며, 또한 하지 기능 개선을 위해서 정형외과 수술 병력을 가진 아동과 국소약물주사 병력을 가진 아동, 그리고 이러한 병력 없이 관절가동기법을 적용한 아동들의 하지 기능 개선의 차이를 확인하고자 하는 것이다. 본 연구에 참여한 대상자는 정형외과 수술 병력을 가진 10명의 아동(수술적용군), 국소약물주사 병력을 가진 아동 10명(약물주사군), 수술이나 약물주사 병력을 전혀 가지지 않은 아동 10명(가동기법군)을 대상으로 실시하였으며, 모두 경직형 양하지 뇌성마비 아동으로 의학적 진단을 받았으며, 14세 이하의 독립보행이 가능한 아동으로 선정하였다. 대상자 모두에게 1주당 2회 신경학적 치료를 실시하였으며, 가동기법군에는 관절가동기법을 병행하여 실시하였으며, 모두 4주간의 실험기간을 거쳤다. 하지 기능을 알아보기 위해서 대 운동 기능 평가(GMFM), MP 150 근전도 기기를 이용한 비복근의 근육활동 등을 평가하였으며, 그 결과 관절가동기법을 적용한 실험군에서 대 운동 기능 평가, 근육활동 등이 일관성있는 통계학적 유의한 차이를 나타냄으로서 관절가동기법의 적용이 양하지 뇌성마비 아동들의 하지 기능을 개선시키는데 매우 중요한 역할을 하는 것을 알 수 있었다. 수술이나 약물주사 병력을 가진 아동들도 하지 기능 개선을 나타내었지만, 유의한 차이는 없었으며, 각 군내에서 편차가 아주 많았던 것을 알 수 있었다. 결론적으로 경직의 감소나 근육의 역학적 변화가 운동의 질을 개선시키는데 한계가 있다는 것을 알 수 있었으며, 양하지 뇌성마비 아동들의 하지 기능을 질적으로 향상시키기 위해서는 근육의 정상 활동을 통한 관절 운동 기전을 회복시키는 것이 무엇보다도 중요한 요소가 된다는 것을 확인할 수 있었다.

영문 초록

The problem of skeletomuscular in diplegic children with cerebral palsy have variety physical problem and decrease quality grade of movement in A.D.L. The purpose of this study was to estimate the effect of joint mobilization on multi joint muscle and lower limbs joint for improvement of lower limbs function in diplegic children with cerebral palsy without history of orthopaedic surgery and local injection, compare to the differences of improvement among diplegic children with cerebral palsy with orthopaedic surgery and local injection and without any medical history. Function of lower limbs measured were through Gross motor functional measurement Scale, muscle activation of both gastrocnemius using E.M.G. Thirty subjects with diplegic cerebral palsy who were able to walk independently participated were divided into three groups ; operation group(n=10) had a history with orthopaedic surgery, injection group(n=10) had a history with local injection, mobilization group(n=10) had manual mobilization approach. Only neurological approach was applied operation and injection groups, but neurological approach with joint mobilization technique were applied to mobilization group for twice per week by experimental period of 4 weeks The result of this study were as follow ; 1. In mobilization group, there were significant difference between pre and post experiment in GMFM total scores. 2. In mobilization group, GMFM item D scores related on standing , and GMFM item E scores related on walking . 3. There were correlational coefficient among total scores, item D scores, item E scores in GMFM of three groups. 4. Result of E.M.G in mobilization groups show that right gastrocnemius activation was increased In conclusion, we could confirm that decrease of spastic and mechanical change of muscle were limited for improve of movement quality, and that is very important to improve the normal arthrokinetic mechanism by normal muscle activation for the function of lower limbs in diplegic children with cerebral palsy. The problem of skeletomuscular in diplegic children with cerebral palsy have variety physical problem and decrease quality grade of movement in A.D.L. The purpose of this study was to estimate the effect of joint mobilization on multi joint muscle and lower limbs joint for improvement of lower limbs function in diplegic children with cerebral palsy without history of orthopaedic surgery and local injection, compare to the differences of improvement among diplegic children with cerebral palsy with orthopaedic surgery and local injection and without any medical history. Function of lower limbs measured were through Gross motor functional measurement Scale, muscle activation of both gastrocnemius using E.M.G. Thirty subjects with diplegic cerebral palsy who were able to walk independently participated were divided into three groups ; operation group(n=10) had a history with orthopaedic surgery, injection group(n=10) had a history with local injection, mobilization group(n=10) had manual mobilization approach. Only neurological approach was applied operation and injection groups, but neurological approach with joint mobilization technique were applied to mobilization group for twice per week by experimental period of 4 weeks The result of this study were as follow ; 1. In mobilization group, there were significant difference between pre and post experiment in GMFM total scores. 2. In mobilization group, GMFM item D scores related on standing , and GMFM item E scores related on walking . 3. There were correlational coefficient among total scores, item D scores, item E scores in GMFM of three groups.

목차

Ⅰ. 서 론

Ⅱ. 연구 방법

Ⅲ. 연구 결과

Ⅳ. 고 찰

Ⅴ. 결론 및 제언

키워드

관절가동기법 양하지 뇌성마비 대운동기능평가 비복근활성도 joint mobilization diplegic children G.M.F.M Adtivation of Gastrocnemius