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1 Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology Vol.7, No.4, April (2017), pp 뇌졸중대상자의편측마비상지에적용한 테이핑요법의효과 박선일 윤숙영 요약 뇌졸중대상자의기본적인일생생활증진과지속적인재활참여를위하여마비측상지의기능수행의증진과통증을해결해주는것은중요한사항이다이연구는테이핑요법을제공하여상지통증기능및체열에미치는효과를검증하기위하여실시하였다연구대상자는총명으로시의대학병원에로입원한실험군명대조군명으로구성되었으며비동등성대조군전후유사실험연구방법론으로연구를실시하였다테이핑요법은총주주회실시하며회는연구자가직접부착시켜주며회는대상자가직접수행하거나가족의지지하에수행하도록하였다부착부위는마비측어깨의삼각근극상근극하근에부착하였다연구도구는시각적상사척도상지기능평가도구를사용하여실험전과후에각각측정하였다실험결과테이핑요법을제공한실험군은테이핑요법을제공하지않은대조군보다상지통증이감소되었으며적외선체열온도에영향을주었다이에테이핑요법을뇌졸중대상자를위한중재요법으로적용해볼것을제안한다핵심어뇌졸중상지통증기능체열 Abstract In this paper, stroke rehabilitation an important issue in order to participate actively paralyzed side upper limb and resolve to pain in stroke. This study aimed to verify the effects of taping therapy on paralyzed side upper limb pain, upper limb function and digital infrared thermal imaging. This study applied a quasi-experimental pre-test and post-test control group design with 14 patients(7experimental group, 7control group) of G city university hospital in hospitalized with a CVA. Taping therapy applied total 8 weeks (1-3 times a week). The researcher directly performed taping therapy. The attachment site was attached to paralyzed side deltoid muscle, supraspinous muscle, and infraspinatus muscle of the paralyzed shoulder. The Received (February 15, 2017), Review Result (March 2, 2017) Accepted (March 9, 2017), Published (April 30, 2017) cdu.ac.kr ISSN: AJMAHS Copyright 2017 HSST 849

2 research tools are visual superiority scale, upper limb function evaluation tool and Digital Infrared Thermal Imaging(DITI). The experimental group showed tapping therapy reduces pain in paralyzed side upper limb and digital Infrared thermal imaging to improve influenced of stroke. Therefore, To apply taping therapy as an intervention for stroke subjects. Keywords : Stroke, upper limb, pain, function, digital infrared thermal imaging(diti) 서론 연구개요 뇌졸중대상자는후유증으로편마비가발생하게되는데특히마비측상지의통증으로인하여대부분의뇌졸중대상자들은통증으로부터팔을보호하기위하여움직이지않으려고하며상지를환측에붙이고상지운동동작을하지않고있어이러한상황은상지근육을더경직시켜통증이증가하여관절의운동장애를일으키고구축이초래되어재활에적극적으로참여하는것을지체시키므로나아가일상생활에서도독립적인생활을하기위한기본동작까지불가능하게만든다상지관절운동을증가시키고통증을해결해주는것은뇌졸중대상자의재활에있어중요한문제중하나인데이러한문제를해결하는데약물요법수술물리치료와같은요법들이사용되어왔는데이러한방법들은어느정도의자기부담을동반하고있어평생장애를가지고살아야하는뇌졸중대상자에게스스로통증을관리하기위한방법을알려주어이를지속적으로실행할수있어야한다고본다뇌졸중대상자의통증을관리하는데이용되고있는보완요법중키네시오테이핑요법은뇌졸중대상자의마비에대한치료법으로테이핑을이용하여그효과를검증한연구에서마비측운동기능생활기능운동범위의변화통증감소면에서의변화의결과를측정하여유의한결과를보였다테이핑요법의기전은근육의신장에반응하여근육이늘어나파괴되지않도록작용하고근육의긴장성이일정하게유지되도록하여신경계와순환기계를활성화시키는데이러한기전에의하여긍정적인효과를나타내는것으로보인다테이핑요법을통하여상지통증과기능상태에미치는효과를주관적인표현과연구자에의해서다양한측면을검사지를통하여측정하고자하는데검사시발생하는대상자의불편함과주관적판단을요구하게되지만적외선체열검사는피부에방출되는적외선이온도차이에따라다른색으로표시되어혈관이나근육말초신경등의감각이상통증및기능장애를가시적이며객관적으로설명할수있는수단으로활용할수있다적외선체열촬영은인체표면에서발산하는적은량의적외선을컴퓨터를이용한감지기가천연의색을가진영상으로나타내주어신체표면의온도변화를객관적으로관찰할수있어치료전과후의효과를비교하기위하여사용되고있다따라서적외선체열촬영은구강이나식도등에서측정되는심부온도와는다르게부위에따라특징적인분포양상을나타내기때문에임상적인활용가치가있다고본다 850 Copyright 2017 HSST

3 Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology Vol.7, No.4, April (2017) 따라서본연구에서시도하고자하는테이핑요법이뇌졸중대상자의상지통증기능상태에긍정적인효과가있음을검증하기위하여적외선체열을측정하여이를객관적인지표로사용하고중재후의변화를예측할수있을것이다이에뇌졸중대상자의편측마비상지에테이핑요법을실시하여뇌졸중대상자의상지통증기능및체열에미치는효과를검증하고자한다 연구방법 본론 연구설계및가설본연구는뇌졸중대상자에게테이핑요법을실시하여상지통증기능및체열에미치는효과를검증하고자실시한비동등성대조군전후실험설계이며연구의가설은다음과같다제가설테이핑요법을실시한실험군과실시하지않은대조군의통증정도에차이가있을것이다제가설테이핑요법을실시한실험군과실시하지않은대조군의상지기능정도에차이가있을것이다제가설테이핑요법을실시한실험군과실시하지않은대조군의적외선체열온도에차이가있을것이다 연구대상자본연구의대상자는시의대학병원에뇌졸중으로입원한실험군명대조군명으로총명이다뇌졸중진단받은지개월이경과하며편마비가있고인지장애없이의사소통이가능한자로연구의목적을이해하며연구에참여하기로동의한대상으로하였다 연구도구본연구의연구도구는다음과같다 상지통증측정도구연구대상자의상지통증을측정하기위해 의수평선의가장왼쪽에 가장오른쪽에 이라고적은시각적상사척도 이하 를사용하였다점은전혀안아 프다에서 점매우아프다의범위로주관적으로표현하도록하였으며점수가높을수록통증이높 음을의미한다 ISSN: AJMAHS Copyright 2017 HSST 851

4 상지기능측정도구연구대상자의상지기능을측정하기위해상지기능평가도구이하를사용하였다의하부영역으로상지의운동항목상지앞으로올리기옆으로올리기손바닥을뒷머리로가져가기손바닥등에가져가기파악항목쥐기잡기손가락조작항목입방체옮기기페그보드으로구성된다각하위검사가가능하면점불가능하면점으로측정하고점에서점의범위를나타낸다 적외선체열진단이하연구대상자의체열을촬영하기위하여메디코아제조원적외선체열진단기모델명을사용하였다상체의앞면옆면뒷면을촬영하였고촬영실은도내외습도를유지한장소이며촬영시간은오전시로몸에로션이나오일등을바르지않도록하였다에서정상범위로신체오른쪽과왼쪽의온도차이는대칭적으로나타나야하나비정상의경우이상차이를나타낸다 연구기간및윤리적고려테이핑요법은년월부터월까지총주주회실시하며회는연구자가직접부착시켜주며회는대상자가직접수행하거나가족의지지하에수행하도록하고부착부위는편측마비어깨의삼각근극상근극하근에붙여주었다는실험첫날과마지막날에실시하였다윤리적고려를위하여연구대상자에게연구동의와일정및통계적처리방법을승낙을받고실시하였으며실험종료후대조군에게도회의테이핑요법을실시하여윤리적고려를실시하였다 연구결과 결론 테이핑요법실시후집단내전후비교를실시한결과는다음과같다표 테이핑요법을실시한실험군과실시하지않은대조군의상지통증테이핑요법을실시한실험군과대조군의상지통증정도차이에서통계적으로유의한결과가나타나제가설인테이핑요법을실시한실험군은실시하지않은대조군보다통증정도에차이가있을것이다는지지되었다표 테이핑요법을실시한실험군과실시하지않은대조군의상지기능테이핑요법을실시한실험군과실시하지않은대조군의상지기능정도차이에서통계적으로 852 Copyright 2017 HSST

5 Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology Vol.7, No.4, April (2017) 유의하지않아제가설인테이핑요법을실시한실험군은실시하지않은대조군의상지기능정도에차이가있을것이다는기각되었다표 테이핑요법을실시한실험군과실시하지않은대조군의적외선체열온도테이핑요법을실시한실험군과실시하지않은대조군의적외선체열온도차이에서통계적으로유의한결과가나타나제가설인테이핑요법을실시한실험군은실시하지않은대조군의적외선체열온도에차이가있을것이다는지지되었다표 표 테이핑요법을실시한실험군과실시하지않은대조군의실험결과 전 후 그림 실험군의적외선체열 좌시험전우실험후 ISSN: AJMAHS Copyright 2017 HSST 853

6 전 후 그림 실험군의적외선체열좌시험전우실험후 논의및결론 뇌졸중대상자는편마비로인한견관절통증을호소하는환자는경직성편마비를보이는경우라고하였으며이러한통증을해결하기위해운동치료물리치료요법과수술적치료등을사용하고있는데테이핑요법이근골격계통증과기능에우수한치료효과를보이고편마비통증과기능의호전을위하여적용되고있다테이핑요법은주로관절의가동범위를넓혀주며혈관운동반사근긴장의이완관절내압력의감소등에주요기전을두고정확히필요한근육에테이핑을부착하여관절주변의근육긴장을감소시켜주변근육과조직의순환이원활해져통증의감소로동작부위가증가하여연부조직의콜라겐의재배열로근육의긴장이정상화된다이를통하여움직임이자연스럽게증가하고혈액순환이개선됨에따라가동력이좋아져관절까지회복되는결과를이끌어낼수있다본연구에서제시한제가설인테이핑요법을실시한실험군과대조군의상지통증정도차이의결과에서통계적으로유의한결과가나타났는데선행연구에서도테이핑요법은부작용이적고비침습적요법이며사용하는데어려움이없고자극적이지않아안전한치료방법으로근육의긴장과구축을완화시키며활동성을증가시키는것이라고하여테이핑요법을근골격의통증완화에효과적인중재방법으로사용될수있을것으로보인다두번째가설인테이핑요법을실시한실험군과대조군의상지기능정도차이의결과는유의한결과가나타나지않았다상지기능관련변수에대한선행연구에서상지기능에미치는요소에대한영향력을비교한결과상지근력이가장큰영향력을나타내었다는결과를나타내었는데본연구의대상자들은급성기를지나재활단계에있어건측을환측에비하여더자주사용하고있기때문으로보인다뇌졸중초기에근력운동이병행되어야통증의감소근력과관절가동력 854 Copyright 2017 HSST

7 Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology Vol.7, No.4, April (2017) 을증진시켜건측상지기능을더사용하는것보다일상생활동작시마비측상지기능도사용하사용하도록할수있으므로테이핑요법을급성기부터실시하여이를적용하고효과를검증한추후연구가진행되어야할것으로보인다정상적인체온분포는대칭적으로분포되는데왼쪽과오른쪽의온도차이는평균이내로되어있으며양쪽체온의비대칭양상은임상적으로도주요한요소로판단하고있다는통증과운동범위제한정도를반영하는검사방법이라하였는데이검사방법의기반이되는원리는역사적으로고대이집트에서열병은피부를손으로만져보는것으로알아내었고년히포크라테스는진흙을피부에얇게도포하고병이존재하는부위별로진흙이마르는속도에따라다르다는것을알고질병을진단하였다를위한주요대상질환은뼈관절근육신경등의중심이되며중추신경의경우편마비까지포함한다시보여지는온도차이를구명한국내외연구에서는이상이상의차이를보이는경우비정상으로인정하고있다뇌졸중대상자에게를실시한선행연구에서도신체오른쪽과왼쪽이이상의차이를보이며운동장애가있는환자의대부분이비대칭적인차이가있다고하였는데본연구의결과에서도표로제시하지않았지만를실시한결과신체오른쪽과왼쪽의온도가의차이가나타나편마비를가진대상자의좌우온도의차이가분명히있음을확인하였다테이핑요법을실시한실험군의실험전과실험후온도의차이가이상나타났으며대조군에서는변화가없었다테이핑요법후체열을측정한선행연구결과가없어본연구결과를비교하기어려웠으나안면마비환자명을대상으로침과약물치료후체열의변화에대한선행연구에서치료를실시한환측이건측보다높게나와본연구의실험전과실험후에서실험후로나타났으며안면신경마비의환자의연구에서안면뿐만아니라상지도같이측정하여질환의예후를예측하였는데본연구에서는체열검사를상반신과앞뒤와환측의옆면을촬영하여테이핑부착부위이외의부분까지확인할수있어비슷한결과를보였다따라서뇌졸중대상자의편측마비상지에제공한테이핑요법은상지통증정도와적외선체열온도에영향을주는것으로보여뇌졸중대상자를위한간호중재의한부분으로적용해보아야할것으로보이며나아가다른질환에도적용하고이를적외선체열진단을통하여확인하여객관적자료의근거로하는것을의미가있을것으로판단된다 References [1] Kim Keum Soon, Seo, Hyun Mi, Lee Hae Derk. Effect of taping method on ADL, range of motion, hand function & quality of life in post - stroke Patients for 5 weeks, Korean Journal of Rehabilitation Nursing, (2002) Vol. 5(1) pp [2] Myung Hwan Song, Beom Su Jeon, Chang Ok Cho, Jee Hun Jang, Effect of Kinesio Taping Application on Balance and Gait Ability in Hemiplegic Disables after Cerebral Stroke, Journal of Adapted Physical ISSN: AJMAHS Copyright 2017 HSST 855

8 Activity & exercise, (2008) Vol. 16(2), pp [3] Dekker j.h.m., Wagnaar R.D., Lankhost G.J. de Jong B.A. The painful hemeplegic shoulder. AM Journal of Physical Med Rehabilitation, (1994) Vol. 18(2) pp [4] Chironna RL, Hechet JS, Subscapularis motor point block for the painful hemiplegic shoulder. Arch Physical Med Rehabilitation, (1990) Vol. 71(6) pp [5] Leandri M, Parodi CI, Corrieri N, Rigardo S. Comparison of TENS treatment in hemiplegic shoulder pain. Scand Journal of Rehabilitation Med, (1996) Vol. 22(2) pp [6] Baek, Yong-Hyeon, Seo, Jung-Chul, Lee, Jae-Dong. The Effect of Taping Therapy on the Activity of Daily Living of Poststroke-Hemiplegic Patients: A Clinical Study. Journal of Korean Acupuncture & Moxibustion Society, (2001) Vol. 18(2) pp [7] Sang-Ho Lee, Seok-Hee Chung, Jong-Soo Lee, Sung-Soo Kim, Hyun-Dae Shin. The Effect of Scapular Girdle Taping on Hemiplegic Shoulder Pain; A Clinical Study, Journals under the Korean Oriental Medical Society, (1999) Vol. 20(3), pp [8] Van Ouwenaller, C., Laplace, P.M., & Chantrain, A. Painful Shoulder in Hemiplegia, Arch Phys Med Rehabilitation, (1986) Vol. 67 pp [9] Jocelyn, E. H., Janice, J. E. (2007). Paretic upper limb strength best explains arm activity in people with stroke. Physical Therapy, 87(1), pp [10] Fischer A.A. Documentation of myopayscial trigger point. Arch Physical Med Rehabilitation, (1988) Vol. 96 pp [11] Eun-Tan Pailk, Yun Hyung koog, Jae-Young Min, Sang-Deog Oh, Seung-Man Lim, Su-Yoen Ra. A Study of Digital Infrared Thermal Imaging(DITI) about Symptoms of 55 Stroke Patients' Hemiparesis, Korean Journal of Oriental Internal Medicine, (2000) Vol. 21(5), pp [12] Van Ouwenaller C, Laplace PM, Chantraine A. Painful shoulder in hemiplegia. Arch Phys Med Rehabilitationl, (1986) Vol. 67, pp [13] Aeo Kang, Dr. Aeo's balance taping therapy, green-care, Seoul (2001). [14] Yoo-Soon Bang, Hee-Young Kim,Moon-Kyu Lee, Factors Affecting the Upper Limb Function in Stroke Patients, Journal of the Korea Contents Association (2009) Vol.9(7), pp [15] Lawson R., Implication of Surface temperatures in the diagnosis of brest cabcer. Cand MAJ (1956). [16] Uematsu S, Edwin DH, Jankel WR, Kozikowski J, Trattner M.. Quantification of thermal asymmetry. Part 1: Normal values and reproducibility, Journal of Neurosurgery (1988) Vol. 69(4) pp.552~557. [17] Hyun Jung Keun, Park Jin Young. Usefulness of thermographic diagnosis in Patients With Shoulder Impingement Syndrome. 12th Annual Congress of K.S.E.S. March 26, (2004). [18] Introduction to Diagnostic Thermology, The Korean Society Thermology. Seoul (2003). [19] Han Seung-hea, Kim Yong-ho, Seo Ho-seok, Hwang Gyu-dong, Jeong Byeong-ju, Kim Jin-won, Son Ji-hyung. A clinical study on the relation between facial paralysis and acupoints on the face and the upper limbs by the use of DITI diagnosis. Korean Journal of Oriental Internal Medicine, (2004) Vol. 25(4) pp Copyright 2017 HSST

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar