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1 Journal of the Korea Academia-Industrial cooperation Society Vol. 13, No. 12 pp , 뇌졸중환자에서주관절각도변화에따른상완이두근의근구조및탄성변화에관한연구 배세현 1, 정찬주 2, 김경윤 3* 1 광주희망병원물리치료실, 2 청암대학교물리치료과, 3 동신대학교물리치료학과 A Study on Muscle Architectural and Tissue Compliance of Biceps Brachii in Stroke Patient Based on Elbow Joint Angle Sea-Hyun Bae 1, Chan-Joo Jeong 2 and Kyung-Yoon Kim 3* 1 Dept. of Physical Therapy, Gwangju Heemang Hospital 2 Dept. of Physical Therapy, Cheongam College 3 Dept. of Physical Therapy, Dongshin University 요약본연구의목적은뇌졸중환자에서주관절각도변화에따른상완이두근 (biceps brachii) 의근구조및탄성변화에관하여알아보고자하였다. 연구대상은주관절수동 ROM범위가 가능하며 MAS(modified Ashworth scale) 1 3등급인뇌졸중환자 12명을대상으로하였다. 이완 (resting) 상태의건측과환측상완이두근의우모각, 근섬유속길이, 근탄성의측정은초음파영상촬영장치와근긴장도측정기 (myotonometer) 를이용하여주관절을 로변화시키면서측정하였다. 본연구결과, 환측상완이두근을건측과비교시우모각은신전위치 (<40 ) 에서큰값을나타냈으며 (p<.05), 근섬유속길이는굴곡위치 (>20 ) 에서짧은길이를나타냈으며 (p<.05), 근긴장은신전위치 (<50 ) 에서전위값이낮게나타나근긴장이높아짐을나타냈다 (p<.05). 이렇듯이완시상완이두근의근구조및탄성은주관절각도에의해영향을받는다는것을알수있었다. 본결과를뇌졸중환자의근구조변화및임상치료의연구자료로사용할수있을것으로생각된다. Abstract The aim of this study was to find on muscle architectural and tissue compliance of biceps brachii in stroke patient based on elbow joint angle. The subjects of this study were twelve hemiplegic adults after stroke with passive range of motion in the elbow from 10 to 90 and Modified Ashworth Scale score 1 to 3 were recruited. Ultrasonography and Myotonometer was used to measure biceps brachii muscle pennation angle, fascicle length, and tissue compliance at the rest condition and pennation angle, fascicle length, and tissue compliance of the biceps brachii muscle were measured in the affected and unaffected sides of people after stroke at 9 different elbow angles ranging from 10 to 90 at the rest condition. The results of this study, comparisons found that the pennation angles of the affected biceps brachii muscle were significantly larger(p<.05) than the unaffected muscle in the most extended positions(<40 ), whereas the affected fascicle lengths were significantly shorter(p<.05) than the unaffected muscle in most flexed positions(>20 ), and the affected tissue compliance were significantly lower(p<.05) than the unaffected muscle in most extended positions(<50 ) Therefore, pennation angles, fascicle lengths, and tissue compliance were found to be joint-angle-dependent in both the affected and unaffected sides at the rest condition. Suggest that, the results data can be used as a muscle architectural changes and clinical treatment research in stroke patients. Key Words : Stroke, Biceps brachii, Ultrasonographic, Myotonometer, Muscle architectural, Tissue compliance * Corresponding Author : Kyung-Yoon Kim (Dongshin University) Tel: redbead7@daum.net Received September 7, 2012 Revised (1st October 17, 2012, 2nd October 22, 2012) Accepted December 6,

2 한국산학기술학회논문지제 13 권제 12 호, 서론 뇌졸중환자들의신경학적손상은운동기능장애의중요한원인이다. 이러한운동기능장애는환측근육의구조적인변화를동반하며근육의기능에영향을미친다 [1]. 선행연구들은뇌졸중환자의환측근육양 (muscle volume) 의감소, 근섬유 (muscle fiber) 의단축, 운동단위 (motor units) 의감소가나타난다하였다 [2,3]. 이러한근육의변형은근약화, 경직, 구축과큰관련이있다 [3]. 그중경직은뇌졸중환자들에게서빈번히, 과도하게나타나운동기능을방해하며, 기능적활동을악화시키는원인이된다 [4]. 그러므로뇌졸중환자에서근육의구조적인변화를평가하는것은임상적진단과치료에있어서매우중요하다. 일반적으로임상에서는뇌졸중환자의경직정도평가를대부분 MAS(Modified Ashworth Scale) 를사용하는데, 이러한평가는근육의구조적인변화를판단할수없으며, 평가자의주관적인개입이결과에영향을미칠수있다 [4]. 이러한단점을최소화하고근육구조의객관성을높인비침습적 (non-invasive) 측정방법인초음파영상분석이그대안이될수있다. 초음파영상분석은생체내에서비침습적으로근육과건의특성을연구하는데사용되며, CT 및 MRI 등과같은다른진단영상검사와비교시비용이저렴하고, 공간에서관절의움직임을측정하는것이가능하며, 검사시방사선의위험이없이간편하게시행할수있는장점들이있다 [5]. 그리고초음파영상분석을통해우모각 (pennation angle), 근섬유속길이 (fascicle length) 등의근육구조의객관적특성을측정하여분석할수있다 [6]. 임상에서초음파영상을통한근육구조의비교및분석은치료의기전해석및중재내용에상당한영향을미칠수있어그중요성이강조된다 [7,8]. 한편, 환자의근육에대한특성을정확히파악하는것은여러면에서중요하다. 초음파영상을통한근육의구조적형태분석외에 Myotonometer의개발로근육조직의탄성 ( 근긴장도 ) 을객관적및정량적으로측정할수있게되었다. 이장비는근육을비침습적 (non-invasive) 으로압박하는 probe로구성되며, 이 probe에의해근육에적용되는힘당조직이전위 (displacement) 되는정도를전산화시켜조직의탄성의정도를알수있게하는장비이다 [9]. 측정시간의소요가적고, 데이터를다른측정장비에비해더빠르게구할수있으며, 분석과정에대한많은훈련기간이필요치않고, 측정자간, 측정자내신뢰도가매우높다 [9,10]. 따라서이들장비의사용으로인해환자의근특성을보다객관화및정량화시켜근육의상태를파악하는데도움을받을수있게되었다. 지금까지골격근 (skeletal muscle) 에대한연구결과들에서횡단면적 (cross-sectional area), 모멘트팔 (moment arm), 길이-장력 (length-tension) 에의해관절에서생성되는힘은근육의구조적요소들과큰관련이있음을밝히고있다.[11] 또한, 이러한근육구조는관절의위치에따라변한다고하였다 [12]. 따라서, 본연구에서는관절각도변화에따라근육의변화를알아보고자하였다. 뇌졸중환자는상위운동신경원의 2차적현상으로이완시주관절이굴곡되는경향을나타내며, 골격근은바뀐관절위치에순응하게되는데 [12,13], 이러한굴곡된자세의부동및경직이주관절내의근절수를감소시켜근섬유속길이와우모각의변화를동반해수의적수축을어렵게한다 [14]. Kim 등 [13] 은뇌졸중환자상지근육의과항진 (hyperactivity) 은이완시주관절의불수의적인굴곡위치를만들어근절의감소를가져와근수축능력을감소시킨다하였다. 따라서, 뇌졸중환자의이완시근구조의특징을분석하는것은수의적근수축능력을이해하는기초자료가될수있을것으로생각된다. 그러나, 지금까지뇌졸중발병후이완시에서관절각도를변화시켜상지근육의구조적특징을초음파로평가한연구는전무하다. 따라서관절의움직임을배제한근육구조의측정보다관절각도변화에따른이완시근육구조의측정은재활치료후근육기능의향상을평가하고뇌졸중환자의근육구조의메커니즘을이해하는데있어서많은도움을줄수있을것으로생각된다. 이에본연구에서는경직을가지는뇌졸중환자의이완 (rest) 시의건측과환측을다양한주관절각도변화에따른근육구조의변화와근육조직탄성의변화를정량적으로평가및비교함으로서뇌졸중환자의근육변화의이해와임상적치료접근법에대한기초자료를제공하고자하였다. 2. 연구방법 2.1 연구대상 연구대상의자료수집은 2011년 10월부터 2012년 4 월까지다음의선정조건을만족하는뇌졸중환자 18명을선정하였다. 선정조건은다음과같다 : 발병후신경학적회복이어느정도일어나고불용기간을거친 6개월이상 18개월이하인자 ; 주관절 MAS(Modified Ashworth Scale) 등급은수동운동이어려운 4등급을제외한 1에서 3인자 ; 주관절의수동굴곡운동이 가능한자 ( 주관절완전신전이 0 ); 주관절에근골격계의병적소견이없는자 ; 실험자의지시를이해하고수행할수있는자 ; 5868

3 뇌졸중환자에서주관절각도변화에따른상완이두근의근구조및탄성변화에관한연구 보톨리눔톡신이나페놀또는알코올주사의치료력이없는자 ; 대상자는연구에대해실험자로부터설명을들었으며, 자발적으로동의하였다. 2.2 실험방법 초음파측정영상수집은 GE LOGIQ-3 EXPERT(GE Medical systems co., 2003, Korea) 를사용하여상완이두근 (biceps brachii) 을측정하였다. 초음파영상측정에사용된초음파변환기는 12 MHz선형탐촉자 (linear transducer) 이며, 민감도 (gain: G72) 와동적범위 (dynamic range: C4) 는고정된값으로모든검사에동일하게적용하였다. 측정이일정하도록변환기는피부와직각이되도록하였다 근긴장도측정상완이두근의근긴장도를측정하기위해 Myotonometer (Neurogenic Technologies, Inc., Missoula, 2000, USA) 를사용하였다. 이장비는근이완또는근수축시근육의긴장상태를측정할수있도록고안된장비로, 측정된조직들의긴장상태는전산화하여수치로표현되도록되어있다. 측정기부분은내측실린더와외측실린더로구성된다. 조직의저항에따라두실린더간에거리가변하게되어조직의저항치가힘으로환산된다. 실린더가받는힘은 8단계 (0.25, 0.75, 1.00, 1.25, 1.5, 1.75, 2.00 kg ) 로구분되어각해당되는지점에서전위 (displacement) 되는정도 ( mm ) 를측정한다 평가과정대상환자의환측상완이두근의경직평가는임상경력 5년이넘는 5명의물리치료사가 MAS를이용하여평가하여 18명의대상자중측정자간동일한등급이나온 12 명의환자를다시선발하였다 [Table 1]. 대상자의측정자세는의자에앉은상태에서상체를바로세우고견관절은해부학적위치를유지하였으며주관절은어깨높이와같게한후 Digital angle gauge(wr300 Wixey,, 2010, USA) 를사용하여 10 굴곡부터 90 굴곡까지 10 씩증가시키면서주관절각도를조정하였다. 초음파측정은영상의학과의도움을얻어측정자한명이주관절근위 1cm전면부위에서우모각과근섬유속길이를측정하였으며, 초음파측정기 (probe) 와피부의전도도를향상시키기위하여겔 (gel) 을사용하였다. 근긴장도측정자세는초음파측정과동일하며, 근긴장도측정기 (probe) 에의해 1초간격으로증가되는 8단계의힘에서각각의전위값을물리치료사한명이획득하 였다. 8단계의측정값을합산하여평균값을산출하여통계에사용하였다. 측정순서는초음파측정을먼저시행하고하루의휴식시간을가진후근긴장도측정을시행하였다. 각측정은약 15분정도소요되었다. 또한, 각각도사이에측정시 1분간의휴식시간을두어환자의피로감을최소한으로줄였다. 2.3 통계방법 SPSS 18.0 ver. for windows 을사용하여평균및표준편차를산출하였으며, 이완상태의건측과환측주관절각도에따른우모각, 근섬유속길이와근긴장도의차이를알아보기위해 two-way ANOVA를실시하였으며사후검정으로 Bonferroni를실시하였다. ANOVA 분석에서유의성이나타나면주관절각도에따른건측과환측의우모각, 근섬유속길이와근긴장도를각각비교하기위해 paired t-test로분석하였다. 통계학적유의수준은 α=0.05 로하였다. 3. 결과 3.1 연구대상자의의학적특성 연구대상자 12명중남자는 6명, 여자는 6명이었다. 마비의형태는오른쪽 5명, 왼쪽 7명이었으며, 진단별분포는뇌경색환자가 7명, 뇌출혈환자가 5명이었다. MAS 등급은 1+ 등급 6명, 2등급 4명, 3등급 2명이었다. 연령분포는 42세에서 64세까지였으며, 유병기간은평균 개월이었다 [Table 1]. [Table 1] Characteristics of subjects 대상자 (n=12) 연령 ( 세 ) 54.83±5.90 # 성별 ( 남 / 여 ) 6/6 유병기간 ( 개월 ) 15.75±2.38 # 마비유형 ( 오른쪽 / 왼쪽 ) 5/7 MAS 등급 (1+/2/3) 6/4/2 원인 ( 뇌경색 / 뇌출혈 ) 7/5 # Mean±SD 3.2 각도에따른근구조의변화대상자의 ANOVA 분석결과, 건측과환측모두주관 절각도변화에따라우모각과근섬유속길이에영향을미쳤으며주관절각도가 10 에서 90 로증가시환측이 5869

4 한국산학기술학회논문지제 13 권제 12 호, 2012 건측보다유의하게우모각이증가함을나타내었고, 근섬유속길이는유의하게감소함을나타내었다 (p<.001). 우모각은주관절굴곡각도가 10 에서 90 로증가시건측은 ±1.47 에서 ±2.08 로유의하게증가하였고 (p<.001), 환측은 ±0.88 에서 ±0.94 로유의하게증가하였다 (p<.001). 근섬유속길이는주관절굴곡각도가 10 에서 90 로증가시건측은 ±1.77 에서 8.88 ±1.31 로유의하게감소하였고 (p<.001), 환측은 ±1.53 에서 7.92 ±0.42 로유의하게감소하였다 (p<.001). 각도에따른건측과환측의근구조의변화차이를알아보기위해 paired-t test결과우모각은주관절굴곡근육이신장되는각도인 10, 20, 30, 40 에서유의한차이를나타냈으며, 근섬유속길이는 30, 40, 50, 60, 70, 80, 90 주관절각도에서유의한차이를나타냈다 (p<.05)[table 2], [Table 3] 3.3 각도에따른근긴장도의변화대상자의 ANOVA 분석결과, 건측과환측모두주관절각도변화에따라근긴장도에영향을미쳤으며주관절각도가 10 에서 90 로증가시환측이건측보다유의하게낮은전위값을나타냈었다 (p<0.001). 근긴장도는주관절굴곡각도가 10 에서 90 로증가시건측은 6.97 mm ±1.03 mm에서 8.64 mm ±1.24 mm로유의하게전위값이증가하였고 (p<.001), 환측은 5.80 mm ±1.07 mm에서 7.88 mm ±1.06 mm로유의하게전위값이증가하였다 (p<.001). 각도에따른건측과환측의전위의변화차이를알아보기위해 paired-t test결과 10, 20, 30, 40, 50 에서유의한차이를나타냈다 (p<.05)[table 4]. [Table 2] According to the angle to change of pennation angle ( 단위 : ) 각도 건측 # 10.46± ± ± ± ± ± ± ± ±2.08 환측 # 12.13± ± ± ± ± ± ± ± ±0.94 p.011 *.014 *.021 *.011 * Tested by two-way ANOVA(#; p<.001), and Tested by paired t-test(*; p<.05) [Table 3] According to the angle to change of fascicle length ( 단위 : cm ) 각도 건측 # 13.88± ± ± ± ± ± ± ± ±1.31 환측 # 11.83± ± ± ± ± ± ± ± ±0.42 p *.012 *.012 *.022 *.006 *.002 *.038 * Tested by two-way ANOVA(#; p<.001), and Tested by paired t-test(*; p<.05) [Table 4] According to the angle to change of muscle tone ( 단위 : mm ) 각도 건측 # 6.97± ± ± ± ± ± ± ± ±1.24 환측 # 5.80± ± ± ± ± ± ± ± ±1.06 p.008 *.001 *.025 *.038 *.002 * Tested by two-way ANOVA(#; p<.001), and Tested by paired t-test(*; p<.05) 5870

5 뇌졸중환자에서주관절각도변화에따른상완이두근의근구조및탄성변화에관한연구 4. 논의 골격근 (skeletal muscle) 은인간의활동능력을결정짓는중요한요인으로, 근수축을통해기계적힘을발생시켜신체의움직임을나타낸다. 그러나뇌졸중환자는자발적근수축능력감소와부적절한근활성및경직으로인하여굴곡된주관절위치를불수의적으로만들게되어근육의생체역학적특성이변하게된다 [13]. 또한, 골격근은관절의위치에따라변한다고하였다 [12]. 따라서뇌졸중환자에게수의적으로근수축을시켜근구조를파악하는것도필요하지만, 이완시관절위치에따른우모각, 근섬유의길이나두께같은섬유형태를파악하여비교하는연구의필요성도증가되고있다 [7]. 이에본연구에서는뇌졸중환자의이완시주관절각도변화에따른건측과환측의상완이두근을비침습적방법인초음파영상과근긴장도측정기 (myotonometer) 를이용하여뇌졸중환자의골격근구조변화를분석하였다. 본연구의건측상완이두근의결과는정상근육의우모각과근섬유속길이를분석한선행연구와유사하였다 [15-18]. 이러한연구들은모두다른영상기법을사용하였고, 이완상태에서관절각도변화가근육구조에영향을미치는것으로나타났다. 그러나환측근육의결과는 Shortland 등 [19] 의선행연구와다른부분이있었다. Shortland는소아뇌성마비환자의경직비복근 (gastrocnemius) 의근섬유각과근섬유속길이가관절각도에따라유의하게변경되지않는다고보고하였다. 이러한차이는상완이두근과비복근이서로다른길이-장력 (length-tension) 의관계를가지고있어서발생된것으로생각된다. 근육구조에관한연구에따르면, 큰우모각을가지는골격근육은작은우모각을가지는근육보다길이-장력이좁은관계를나타내는것으로보고되었다 [20]. Shortland 등 [19] 은내측비복근의우모각이 22.3 로보고하였으며, 본연구의상완이두근의우모각의평균값은 15.9 이었다. 이러한우모각의차이가연구의불일치의원인으로생각된다. 선행연구에서근육의과항진 (hyperactivity) 또는경직 (spasticity) 은근섬유의근절 (sarcomeres) 들의수가감소하여영구적인단축을초래할수있다고하였다 [21,22]. Halar 등 [21] 은방사선 (radiographs) 을사용하여뇌졸중환자의건측과환측비복근의근복 (muscle belly) 길이를비교하였는데환측비복근의근복이건측보다더짧아졌음을보고하였다. Harlaar 등 [22] 은발목저측굴곡근 (plantarflexors) 의경직이있는환자를대상으로 EMG를통해근활동과토크를측정하여근육경직으로인하여단축근섬유가증가하는것을발견하였다. 하지만 Shortland 등 [19] 은초음파를사용하여소아뇌성마비환자의경직형비복근의근섬유속길이가정상소아와비교하여유의한차이가없다고하였다. Lieber와 Friden[23] 은심한손목굴곡경직을가지는환자의척측수근굴근 (flexor carpi ulnaris) 의근절길이를측정한후, 정상적인신경지배를받은환자와비교하여근섬유속길이가변하지않는것을확인하였다. 그러나 Tardieu 등 [24] 은사람의생검결과를근거하여정상인에비해뇌성마비가있는환자의근섬유속길이가줄어든다고보고하였다. 이러한연구결과의차이는임상의병인학적 (etiologies) 원이의차이와서로다른근육의연구로인한것으로생각되어진다. 본연구에서는뇌졸중환자의환측상완이두근의근섬유속길이는건측근섬유속길이와비교시더짧은경향을나타냈다. 이러한이유는환측주관절이경직으로인하여굴곡된자세를만들기때문으로생각된다. 즉굴곡된자세에서는근섬유속길이가짧아지는것을알수있었다. 이렇듯환측상완이두근의근섬유속길이의감소는강직 (stiffness) 과경직 (spasticity) 의증가와주관절굴곡근 (flexor muscle) 이짧아지는자세에서의고정화때문으로생각되어진다. 또한, 환측주관절각도를 20 이상으로굴곡시킬시근섬유속길이가짧아지는경향을나타내었다. 이러한결과는환측주관절이큰각도로굴곡된자세를장기간지속하면근섬유는구축을발생시키며순응 (adaptation) 을유발하여근절 (sarcomere) 의수를감소하게만들어근섬유속은짧아진다는선행연구를통해부분적설명이가능할것이다 [14]. 관절각도를변화시키면서발생되는근긴장도를측정하였는데 50 이하신전위치에서는 50 이상굴곡위치보다전위값이낮게나타나근긴장이증가되는것을알수있었다. 특히, 환측 30 이하관절각도에서근긴장도가높았는데, Murray 등 [25] 과 Koo등 [26] 은 20 주관절굴곡범위에서길이-장력곡선이상승하는이상적인각도라하였다. 이상적인각도를넘어서스트레칭이될때근섬유속에서는수동적인장력이발생되기시작한다고하였다 [27]. 이러한영향으로인하여 30 이하관절범위에서근긴장이증가되는것으로생각되며, 환측근긴장이더증가한이유는주관절굴곡경직으로인하여굴곡보다신전에서더큰수동장력이발생하여근긴장이증가된것으로생각된다. 본연구에서이완시주관절각도를변화시킬때상완이두근의우모각, 근섬유속길이, 근긴장도변화는각도가증가될수록우모각은증가하며근섬유속길이는감소하였다. 이러한변화로인하여근긴장도는감소되는경향을나타내었다. 환측은건측과비교시더큰우모각을 5871

6 한국산학기술학회논문지제 13 권제 12 호, 2012 가지고있었다. 특히 50 이하에서차이점이분명하게나타났다. 이러한우모각의증가는뇌졸중환자들은과항진된경직으로인하여주관절을굴곡시키는자세를만들려는경향으로인해부동 (immobilization) 이증가되어더짧은근섬유속길이를만들게되어결국더큰우모각의증가를가져오는것으로생각된다. 이렇듯, 본연구의결과들은상완이두근의기능적인특징을이해하는것과뇌졸중발병후근육구조가변화하는기전을이해하는데도움을줄수있을것으로생각된다. 본연구에서는몇가지제한점이있었다. 먼저대상자의수가작았으며, 선별과정에서성별과연령, 우세손의차이에따른근구조적특성을감안하지못하였다. 그러므로본연구의결과를일반화시키는데에는제한이있을것이다. 앞으로연구에서는관절각도에따른이완시와수축시근구조와탄성력변화차이를검증하는연구가진행되어야될것으로생각된다. 5. 결론 본연구에서는뇌졸중환자를대상으로이완시주관절의각도를변화시켜상완이두근의근구조와근긴장을측정하였다. 그결과환측상완이두근을건측과비교시우모각은신전위치에서큰값을나타냈으며, 근섬유속길이는굴곡위치에서짧은길이를나타냈다. 근긴장은 50 이하신전위치에서전위값이낮게나타나근긴장이높아짐을나타냈다. 이렇듯이완시상완이두근의근구조및탄성은주관절각도에의해영향을받는다는것을알수있었다. 본결과를뇌졸중환자의근구조변화및임상치료의연구기초자료로사용될수있을것으로생각된다. References [1] L. Li, K. Y. Tong, X. Hu. The effect of poststroke impairments on brachialis muscle architecture as measured by ultrasound, Arch Phys Med Rehabil, Vol.88, No.2, pp , 2007, [2] N. Metoki, Y. Sato, K. Satoh, K. Okumura, J. Iwamoto. Muscular atrophy in the hemiplegic thigh in patients after stroke, Am J Phys Med Rehabil, Vol.82, No.11, pp , 2003, [3] C. Patten, J. Lexell, H. E. Brown. Weakness and strength training in persons with poststroke hemiplegia: rationale, method, and efficacy, J Rehabil Res Dev, Vol.41, pp , 2004, [4] S. J. Lee, T. R. Han. A quantitative assessment of spasticity in hemiplegic patients using isokinetic dynamometer, J Korean Acad Rehab Med, Vol.22, No.4, pp , [5] G. Chi-Fishman, J. E. Hicks, H. M. Cintas, B. C. Sonies, L. H. Gerber. Ultrasound imaging distinguishes between normal And weak muscle, Arch Phys Med Rehabil, Vol.85, No.6, pp , 2004, [6] N. M. Maurits, E. A. Beenakker, D. E. van Schair, J. M. Fock, J. H. van der Hoeven. Muscle ultrasound in children: normal values and application to neuromuscular disorders, Ultrasound Med Biol, Vol.30, No.8, pp , 2004, [7] R. L. Lieber, J. Fridén. "Functional and clinical significance of skeletal muscle architecture", Muscle Nerve, Vol. 23(11), pp , 2000, [8] L. Li, K. Y. Tong, X. Hu. The effect of poststroke impairments on brachialis muscle architecture as measured by ultrasound, Arch Phys Med Rehabil, Vol.88, No.2, pp , 2007, [9] C. T. Leonard, J. S. Brown, T. R. Price, S. A. Queen, E. L. Mikhailenok. Comparison of surface electromyography and myotonometer measurements during voluntary isometric contractions, J Electromyogr Kinesiol, Vol.14, No.6, pp , 2004, [10] C. T. Leonard, W. P. Deshner, J. W. Romo, E. S. Suoja, S. C. Fehrer, E. L. Mikhailenok. Myotonometer intra-and interrater reliabilities, Arch Phys Med Rehabil, Vol.84, No.6, pp , 2003, [11] M. V. Marici. Human skeletal muscle architecture studied in vivo by non-invasive imaging techniques: functional significance and applications, J Electromyogr Kinesiol Vol.9, No.2, pp , 1999, [12] M. R. Gossman, S. A. Sahrmann, S. J. Rose. Review of length-associated changes in muscle. Experimental evidence and clinical implications, Phys Ther, Vol.62, No.12, pp , [13] B. O. Kim, T. M. K, J. M. Chae, K. H. Cho. Kinetic characteristics during initiation of gait in stroke patients, J Korean Acad Rehab Med, Vol.25, No.2, pp ,

7 뇌졸중환자에서주관절각도변화에따른상완이두근의근구조및탄성변화에관한연구 [14] C. Tardieu, J. C. Tabary, C. Tardieu. Adaptation of sarcomere numbers to the length imposed on muscle In: F. Guba, G. Marechal, O. Takacs, editors. Mechanism of muscle adaptation to functional requirements, Elmsford: Pergamon Pr; pp , [15] M. V. Narici, T. Binzoni, E. Hiltbrand, J. Fasel, F. Terrier, P. Cerretelli. In vivo human gastrocnemius architecture with changing joint angle at rest and during graded isometric contraction, J Physiol, Vol.496, pp , [16] G. S. Chleboun, A. R. France, M. T. Crill, H. K. Braddock, J. N. Howell. In vivo measurement of fascicle length and pennation angle of the human biceps femoris muscle, Cells Tissues Organs, Vol.169, No.4, pp , 2001, [17] T. Fukunaga, Y. Kawakami, S. Kuno, K. Funato, S. Fukashiro. Muscle architecture and function in humans, J Biomech. Vol.30, No.5, pp , 1997, [18] Y. Kawakami, Y. Ichinose, T. Fukunaga. Architectural and functional features of human triceps surae muscles during contraction, J Appl Physiol, Vol.85, No.2, pp , [19] A. P. Shortland, C. A. Harris, M. Gough, R. O. Robinson. Architecture of the medial gastrocnemius in children with spastic diplegia, Dev Med Child Neurol, Vol.44, No.3, pp , 2002, [20] R. D. Woittiez, P. A. Huijing, H. B. Boom, R. H. Rozendal. A three-dimensional muscle model: a quantified relation between form and function of skeletal muscles, J Morphol, Vol.182, No.1, pp , 1984, [21] E. M. Halar, W. C. Stolov, B. Venkatesh, F. V. Brozovich, J. D. Harley. Gastrocnemius muscle belly and tendon length in stroke patients and able-bodied persons, Arch Phys Med Rehabil, Vol.59, No.10, pp , [22] J. Harlaar, J. G. Becher, C. J. Snijders, G. J. Lankhorst. Passive stiffness characteristics of ankle plantar flexors in hemiplegia, Clin Biomech (Bristol, Avon), Vol.15, No.4, pp , 2000, [23] R. L. Lieber, J. Fridén. Spasticity causes a fundamental rearrangement of muscle-joint interaction, Muscle Nerve, Vol.25, No.2, pp , 2002, [24] C. Tardieu, E. Huet de la Tour, M. D. Bret, G. Tardieu. Muscle hypoextensibility in children with cerebral palsy: I. Clinical and experimental observations, Arch Phys Med Rehabil, Vol.63, No.3, pp , [25] W. M. Murray, T. S. Buchanan, S. L. Delp. The isometric functional capacity of muscles that cross the elbow, J Biomech, Vol.33, No.8, pp , 2000, [26] T. K. Koo, A. F. Mak, L. K. Hung. In vivo determination of subject-specific musculotendon parameters: applications to the prime elbow flexors in normal and hemiparetic subjects, Clin Biomech (Bristol, Avon), Vol.17, No.5, pp , 2002, [27] F. E. Zajac. Muscle and tendon: properties, models, scaling, and application to biomechanics and motor control, Crit Rev Biomed Eng, Vol.17, No.4, pp , 배세현 (Sea-Hyun Bae) [ 정회원 ] < 관심분야 > 신경계물리치료학, 임상전기생리학 2011 년 2 월 : 동신대학교물리치료학과 ( 이학석사 ) 2011 년 3 월 : 동신대학교물리치료학과박사과정 2007 년 3 월 ~ 현재 : 광주희망병원물리치료실근무 정찬주 (Chan-Joo Jeong) [ 정회원 ] < 관심분야 > 스포츠물리치료학, 정형운동치료 1996 년 2 월 : 조선대학교컴퓨터공학과 ( 공학석사 ) 2003 년 2 월 : 조선대학교컴퓨터공학과 ( 공학박사 ) 2005 년 2 월 : 동신대학교물리치료학과 ( 이학석사 ) 1997 년 3 월 ~ 현재 : 청암대학교물리치료과교수 5873

8 한국산학기술학회논문지제 13 권제 12 호, 2012 김경윤 (Kyung-Yoon Kim) [ 정회원 ] 2004 년 2 월 : 동신대학교물리치료학과 ( 물리치료학석사 ) 2007 년 2 월 : 동신대학교물리치료학과 ( 이학박사 ) 2006 년 3 월 ~ 현재 : 동신대학교물리치료학과교수 < 관심분야 > 운동치료학, 신경과학 5874

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