<30382D D DBCDBC7F6BDC22C20C0B1C5C2BFF82E687770>

J Korean Soc Phys Med, 2016; 11(2): 63-70 http://dx.doi.org/10.13066/kspm.2016.11.2.63 Online ISSN: 2287-7215 Print ISSN: 1975-311X Research Article Open Access 균형과보행능력향상을위한오타고운동프로그램의임상적유용성 : 만성뇌졸중환자를대상으로, 무작위배정실험연구 송현승 윤태원 1 첨단우암병원재활센터, 1 수완재활요양병원재활센터 Clinical Feasibility of Otago Exercise Program to Improve the Balance and Gait Ability: In Chronic Stroke Patient, Randomized Controlled Trial Hyun-Seung Song, PT, PhD Tae-Won Yun, PT, MSc 1 Rehabilitation Center, Chumdan Wooam Hospital 1 Rehabilitation Center, Suwan Medical Center Received: March 11, 2016 / Revised: March 17, 2016 / Accepted: April 21, 2016 c 2016 J Korean Soc Phys Med Abstract 1) PURPOSE: The aim of this study was to conduct an Otago exercise program with stroke patients in a clinical setting and ascertain its effects on balance and walking ability. METHODS: The participating subjects were 45 people who had been diagnosed with stroke. They were assigned to two groups (Otago exercise; OE, n=22; balance exercise; BE, n=23), and the exercises were conducted for three sessions per week for eight weeks. The main balance outcomes were evaluated using the timed up and go test (TUG) and the four step square test (FSST), while walking ability was evaluated using the 10 m walk test (10MWT), direction change ability was measured using the figure 8 of walk test (F8WT), and the decrease of fear was evaluated using the modified falls Corresponding Author : taewonyunkorea@gmail.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. efficacy scale (MFES). RESULTS: In the analysis results, the Otago exercise group showed significant increases in TUG, FSST, 10MWT, and F8WT within the both groups. There were significant differences in all variables between the OE group and the BE group at the post-intervention evaluation, but there was no significant difference between the groups with respect to the 10MWT. This study showed that conducting Otago exercise in stroke patients increased the main outcomes for TUG, FSST, F8WT scores, but not for 10MWT. CONCLUSION: The results of this study demonstrated that Otago exercise would be useful to improve balance and gait for stroke patients who want to improve their abilities and activities of daily living. Key Words: Balance, Gait, Otago exercise, Stroke

64 J Korean Soc Phys Med Vol. 11, No. 2 Ⅰ. 서론뇌졸중환자는운동, 감각, 인지및정서손상에대한복합적인장애가나타난다. 운동감각 (sensorimotor) 손상의결과로자세조절장애가나타난다. 자세조절장애는뇌졸중환자의독립적인일상생활활동의성취와퇴원후지속되는장애를예측하는중요한인자이다 (de Haart 등, 2004). 따라서기능회복과성공적재활을위해균형장애를조기에평가하여적절하게대처하고균형능력을향상시키는치료를제공하는것이필요하다 (Tyson 등, 2006). 뇌졸중환자의균형저하는주로고유수용성감각계의손상에서기인하는것으로알려져있으나, 하지및체간근력의약화도앉은자세및선자세에서균형유지를어렵게한다 (Tyson 등, 2006). 뇌졸중환자에게있어균형유지는전정계, 시각계, 고유수용성감각계근골격계및인지능력의상호작용에의한복합적과정으로자세를유지하고수의적운동을하는동안자세를안정시킴으로써이동하기나걷기등일상생활동작을안전하고독립적으로수행하는데있어필수항목이다 (Karatas 등, 2004). 또한뇌졸중환자에게서나타나는보행의가장큰특징은정상인과비교해서보행속도와보행율 (cadence) 의감소, 보폭의감소, 그리고양하지의비대칭성이다 (Roerdink 등, 2007). 뇌졸중환자의보행시나타나는협응저하로인해다양한환경과과제에적절히반응하는능력이감소된다 (Roerdink 등, 2007). Michael 등 (2005) 은뇌졸중환자의균형과보행장애는근약화, 강직, 비정상적인중추신경계의근조절과관계가있으며이는보행의효율성을크게떨어뜨린다고하였으며, Lee 등 (2012) 은비대칭적인체중지지가보행시비대칭과관련이있다고하였다. Verheyden 등 (2006) 은균형과보행, 그리고기능적능력사이의높은상관관계를보고하고있으며, Patterson 등 (2007) 은독립적인활동과보행에있어보다수월한보행기능을위해서기자세에서의균형능력과자세균형조절이우선시되어야한다고강조하였다. 뇌졸중환자의균형에대한최근연구들은더효과적 인치료방법에대한비교연구 (Lin 등, 2007; Orrell 등, 2006) 등의다양한관점에서다루어지고있다. 그러나치료방법들이고가의장비를이용하거나, 치료사의감독이나지시에따라시행하도록되어있어치료시간을이외의시간에환자스스로할수있는자가운동방법은부족하다. 또한자가운동을하더라도체계화된프로그램으로기능향상에따른운동프로그램제시가필요하다. 오타고운동은근육강화균형훈련과걷기로구성된프로그램으로명확한훈련프로그램을제시하고있으며, 장소나도구에구애받지않고실시할수있는장점이있다 (School OM, 2003). 그러나선행연구들은노인을대상으로균형과낙상효능감, 근력에유의한향상을보고 (Kerse, 등, 2010; Liu-Ambrose 등, 2008) 하고있는실정이다. 편마비환자는균형능력이저하되어낙상의위험이높아자기주도적으로시행할수있는프로그램이필요하다. 따라서본연구의목적은지역사회노인들의균형능력향상및낙상예방운동프로그램으로효과가입증된오타고운동프로그램을이용하여만성편마비환자들을대상으로균형과보행능력향상에효과적인지알아보고이를임상에서자가운동프로그램으로적용가능성을알아보고자한다. Ⅱ. 연구방법 1. 연구대상및연구기간본연구는 G광역시에소재한요양병원에뇌졸중으로진단받고입원중인환자를대상으로하였으며, 다음의선별기준을거쳐선정하였다. 한국형간이정신검사 (Korean version of mini-mental state exam; MMSE-K) 에서 24점이상인자, 연구내용을이해하고수행할수있는자, 시각과청각및전정기관에손상이없는자, 사지결손이없는자, 지팡이를이용하여보행이가능한자, 앉은자세및선자세유지가가능한자로하였다. 모든대상자들에게연구의목적및절차를설명하고동의서를배부하였으며, 이에자발적으로서명한자를대상으로하였다. 발병일이 6개월이상경과하

균형과보행능력향상을위한오타고운동프로그램의임상적유용성 65 고연구에동의한만성뇌졸중환자 49명을모집하였다. MMSE-K 24점이하인자 3명을제외하고, 총 45명이연구대상자로선정하였다. 대상자들은제비뽑기를통해오타고운동군 (otago exercise group; OE group) 22명과균형운동군 (balance exercise group; BE group) 23명으로배정하였고, 중재는 1일 40분, 주 3회, 총 8주간진행하였다. 2. 중재방법 1) 오타고운동프로그램오타고운동군에적용한오타고운동프로그램은대상자의안전을위해 School OM (2003) 에서권고하는수준으로대상자가 3회실시할수있는정도의운동단계로설정하여시행하였으며, 모든동작은지지대나지팡이를가지고있는상태에서이루어졌다. 근력강화는무릎앞강화를하는무릎폄운동, 무릎뒤강화를하는무릎굽힘운동, 엉덩이옆을강화하는엉덩관절벌림운동, 장딴지를올리는발목관절의발바닥굽힘과발가락을올리는발등굽힘으로구성되어있다. 또한균형훈련은무릎굽힘, 뒤로걷기, 8자걷기, 일렬로걷기, 한발로서기, 발꿈치로걷기, 발가락으로걷기, 발꿈치와발가락으로뒤로걷기, 앉은자세에서일어서기, 계단걷기로구성되어있다. 본운동은치료사의감독하에주 3회 40분간단계별로실시하였다. 2) 균형운동프로그램균형운동프로그램은임상에서균형능력향상을위한목적으로시행중인균형운동을대조군에적용하였으며 (Ahn 등, 2008; Song과 Park, 2016), 평평한바닥에놓인 balance pad (airex balance pad, Airex Inc, Swiss) 위에발을올려두고앉은자세에서일어서는동작을수행, 선자세에서눈을감고자세유지하기, 선자세에서다양한방향으로체중이동하는동작, 선자세에서상지를이용해과제수행훈련을하도록하였다. 본운동은치료사의감독하에주 3회 40분간단계별로실시하였다. 3. 측정방법 1) 균형능력 (1) Timed up and go test 대상자의동적균형능력을검사하기위해 timed up and go test (TUG) 를이용하였다 (Ng와 Hui-Chan, 2005). TUG는 46cm높이의팔걸이가있는의자에등을대고팔걸이에팔을올려놓는다. 이검사의측정자내신뢰도 (r=0.99), 측정자간신뢰도 (r=0.98) 가높은검사도구이다 (Podsiadlo과 Richardson, 1991). 시작이라고하면일어나서편안하고안전한속도로 3m 바닥의선을따라걸어간뒤돌아서다시의자로와서앉는다. 전체시간을초시계를이용하여시작이라는말을하는시점에서부터대상자가의자에앉는시간까지를측정하였다. 3회측정하여평균값을사용하였다. (2) Four square step test 노인들의다양한낙상의방향변화와걸음을확인하는동적균형을검사하기위해 Four square step test (FSST) 를이용하였으며, 측정자간신뢰도 (r=0.99) 와측정자내신뢰도 (r=0.98) 를가지고있는도구이다 (Dite와 Temple, 2002). FSST는시선은몸돌림없이전방만을주시하고십자모양으로배치된 4개의사각막대기를전, 후, 좌, 우방향으로건들지않고가능한빠르게넘어제자리로돌아온다. 측정동안대상자가편안하게걷을수있는속도로시간을측정하였으며, 3회측정하여평균값을사용하였다. 2) 보행능력보행능력을평가하기위해 10m walk test (10MWT) 를이용하였다. 10MWT 는대상자에서총 14m의구간을걸어가는동안출발지점과도착지점에서가속과감속을고려해전, 후 2m 의구간을제외한 10m 구간을이동하는데소요된시간을측정한다. 10MWT는측정자간및측정자내신뢰도가 r=0.89로신뢰도가검증되었다 (Steffen 등, 2002). 대상자가편안하게걷을수있는속도로측정하였으며, 3회측정하여평균값을사용하였다 (Dean 등, 2002).

66 J Korean Soc Phys Med Vol. 11, No. 2 3) 방향전환능력검사곡선보행과탐색하는능력을보기위해 Figure 8 of walk test (F8WT) 를이용하였다 (Hess 등, 2010). F8WT 는 1.5m 거리에원뿔을설치하고원뿔사이중앙에원뿔면으로부터바깥쪽으로향해서게하고곡선주행방향을선택한후평상시속도로걷게한다. 그리고 8자모양을그리며걷고시작자리로돌아오는동안의소요시간및걸음수를측정한다. F8WT는속도, 걸음수등을측정할수있으며, 속도의측정자간신뢰도는 r=0.90, 측정간신뢰도는 r=0.84이고걸음수의측정자간신뢰도는 r=0.92, 측정간신뢰도는 r=0.82이다 (Hess 등, 2010). 1회연습후측정하였다. 기술통계를이용해평균과표준편차를구하였고, 그룹내중재전과후의차이비교는대응 t 검정을그룹간효과비교는독립 t 검정을사용하였다. 통계학적유의수준은 α=0.05로정하였다. Ⅲ. 연구결과 1. 대상자일반적특성본연구의 OE 과 BE 군에참여한대상자들의특징은 Table 1과같으며, 동질성검정에서모든항목에서그룹간유의한차이는없었다. 4) 낙상효능감검사특정활동을수행하는동안낙상하지않을확신의정도를알아보기위해 falls efficacy scale-international (FES-I) 을이용하였다 (Danielli 등, 2009; Yardley 등, 2006). 이검사의신뢰도는 Chronbach α=0.921 로보고되었다 (Huh, 2001). FES-I는일상생활에필요한 16가지행동을수행하는데따르는두려움점수가낮을수록두려움이큰것을의미한다. 16가지항목총점을사용한다. 치료사와 1:1 방식으로문항을설명한후점수를표기하도록하였다. 2. 균형능력의변화비교 TUG와 FSST는군내중재전후비교에서 BE군과 OE군모두에서유의한차이가나타났고 (p<0.001), 군간비교에서 OE군과 BE군사이에유의한차이가나타났다 (p<0.05)(table 2). 3. 보행능력변화비교 10MWT에서군내중재전후비교에서 BE군과 OE군모두유의한차이가나타났고 (p<0.001), 군간비교에서는유의한차이가없었다 (Table 2). 4. 자료처리연구를통해수집된자료는윈도우용 SPSS Ver. 17.0 통계프로그램을이용하여대상자들의일반적특성은 4. 방향전환능력변화비교 F8WT에서시간은중재전후비교에서 BE군과 OE군모두유의한차이가나타났고 (p<0.001), 군간비교에서 Table 1. General characteristics of subjects BE group (n=23) OE group (n=22) t Sex (Male/Female) 11/12 9/13 0.39 Age (yrs) 63.81 (12.45) a 63.73 (10.67) 0.79 Height ( cm ) 161.94 (8.43) 159.40 (10.03) 0.99 Weight ( kg ) 64.44 (8.79) 64.33 (8.69) 0.39 Etiology (Hemorrhage/Infarction) 8/15 5/17 0.65 Prevalence (months) 20.56 (11.25) 20.58 (11.25) 0.97 a Means (SD) BE: General exercise+balance exercise OE: General exercise+otago exercise

균형과보행능력향상을위한오타고운동프로그램의임상적유용성 67 Table 2. Comparison of measured balance, gait, redirection and fall efficacy in BE group and OE group BE group (n=23) OE group (n=22) t Pre-test Post-test Pre-test Post-test t t a Balance ability TUG(sec) 33.99 (8.72) b 28.52 (7.95) 5.80 29.62 (7.85) 23.60 (7.99) 6.00 2.07 * FSST(sec) 39.79 (12.74) 34.41 (12.75) 6.92 33.46 (15.39) 28.43 (14.36)) 7.21 1.48 * Gait ability 10MWT(sec) 29.95 (18.02) 25.75 (16.81) 5.35 24.48 (14.09) 18.20 (10.00) 4.21 1.82 Redirection ability F8WTtime 33.98 (12.86) 29.56 (12.51) 6.33 28.48 (10.28) 22.58 (8.95) 7.46 2.14 * F8WTstep 32.70 (5.81) 29.17 (7.62) 2.72 29.13 (8.13) 24.27 (7.95) 8.70 0.89 * FES-I(score) 25.09 (1.95) 29.61 (1.70) -12.36 24.36 (1.47) 30.77 (1.97) -16.09-2.12 * a Between group comparison, b Means (SD), TUG: Timed Up and Go test FSST: Four Square Step Test 10MWT: 10m Walk test F8WT: Figure 8 of walk test FES-I: Modified Falls Efficacy Scale BE: General exercise+balance exercise OE: General exercise+otago exercise p<0.05, p<0.01, p<0.001 OE군과 BE군사이에유의한차이가나타났다 (p<0.05) (Table 2). 스텝도중재전후비교에서 BE군과 OE군모두유의한차이가나타났고 (p<0.01), 군간비교에서 OE군과 BE군사이에서유의한차이가나타났다 (p<0.05)(table 2). 5. 낙상효능감변화비교 FES-I에서중재전후비교에서 BE군과 OE군모두유의한차이가나타났고 (p<0.001), 군간비교에서 OE군과 BE군사이에서유의한차이가나타났다 (p<0.05) (Table 2). Ⅳ. 고찰본연구는노인들의균형능력향상효과가입증된오타고운동프로그램을이용하여뇌졸중환자에게균형능력향상을위한유용성을알아보고자하였다. 오타고운동프로그램을 8주간적용한결과균형능력, 방향전환능력과낙상효능감향상을확인하였다. 뇌졸중환자들에있어체감각, 협응, 근긴장도및균형과근력의손상은균형능력유지에문제를일으키 고, 낙상위험성을높이며, 기능적인이동능력이감소되는문제가제시되어왔기에, 이에대한훈련을강조하였다 (Shea과 Moriello, 2014). 이를바탕으로근력운동 ( 하지근력강화 ), 균형운동 ( 무릎굽힘, 뒤로걷기, 8자걷기, 일렬로걷기, 한발로서기 ), 보행운동 ( 발꿈치로걷기, 발가락으로걷기, 앉은자세에서일어서기, 계단걷기 ) 으로구성된오타고운동프로그램을적용하였다 (School OM, 2003). 본연구에서 TUG와 FSST는그룹간비교에서 OE 그룹에서유의한향상이있었다. 오타고운동과관련된 152편의논문으로메타분석을시행한연구에서는오타고운동이대상자들의낙상위험을효과적으로감소시킨다고하였다 (Thomas 등, 2010). 80세이상정상여성 233명을대상으로 6개월간오타고운동을적용한연구 (Campbell 등, 1997) 와지역사회거주노인 21명을대상으로주 2회, 8주동안오타고운동을적용한연구에서균형능력이향상되었다는연구결과들은본연구결과와동일하였다 (Liston 등, 2014). 또한뇌졸중환자를대상으로체감형훈련을적용한후 TUG를통해균형능력을비교한결과는대조군보다유의한향상이나타났으며 (Ahn 등, 2012) 와닫힌사슬운동을적용한후균형능력을비교한결과에서도대조군보다유의한향상이

68 J Korean Soc Phys Med Vol. 11, No. 2 나타났다 (Moon과 Kim, 2014). 이러한연구결과들역시오타고운동이균형능력을향상시키는데유용한방법이될수있다는면에서본연구결과와유사하게나타났다. 이러한결과들은본연구에서적용한오타고운동프로그램중 8자걷기나일자로걷기운동이포함되어있어유의한결과를보인것으로생각된다. 10MWT는 OE와 BE 그룹모두에서중재전과후에차이는있었으나그룹간차이는없었다. 이결과는 80세이상여성노인 19명을대상으로오타고운동프로그램을적용해보행능력에서유의한효과를보고한결과 (Binns, 2006) 와는대조적이다. 이는 OE 그룹뿐만아니라 BE 그룹대상자도일반적인운동치료시직선보행운동을실시하고있었으며, 자가운동시에도직선보행운동을실시해그룹간유의한차이가나타나지않는것으로생각된다. 일상생활에서보행중방향전환능력은꼭필요한활동으로높은수준의균형능력이요구된다 (Kiriyama 등, 2005). 방향전환능력은직선보행보다양발의안쪽과바깥쪽면에체중을균등하게지지해야하므로균형을유지하는데어렵다 (Kiriyama 등, 2005). 본연구에서직선보행능력뿐만아니라보행중방향전환능력도향상된것을확인할수있었다. 이는오타고운동프로그램의보행에필요한특정근육근력강화와동적인균형능력향상운동을체계적으로시행했던점과운동프로그램에방향전환능력향상을위한운동이포함되어긍정적인영향을준것으로생각된다. 오타고운동결과, 낙상효능감도향상시키는것으로확인되었다. Binns (2006) 는 80세이상여성을대상으로 6개월간오타고운동을실시한결과, 낙상효능감이향상되었다고보고하였다. 다른연구에서는오타고운동을시행하고 2년후추적조사를한결과, 통계적으로유의한긍정적인영향을미치는것으로확인하였다 (Campbell 등, 1997). 본연구에서사용한오타고운동프로그램은노인들의특정근육군의선택적근력강화운동과다양한활동을포함하고있는동적인균형능력향상운동이포함되어있었고, 이러한운동프로그램은뇌졸중환자의균형능력, 보행능력, 방향전환능력, 낙상효능감을향상시 키는데효과적임을확인하였다. 추후연구에서는효과의지속여부를확인하지못한점과중재결과에대해환자스스로느끼는만족도를조사하지못한점을보완해야할것으로생각되며, 또한보행이나균형능력을대상자의기능적수준을고려한후선정하여중재의효과를명확하게밝힐필요가있다고생각한다. Ⅴ. 결론본연구는노인들의균형능력향상효과가입증된오타고운동프로그램을이용하여뇌졸중환자에게균형능력향상을위한유용성을알아보고자실시하였고, 오타고운동프로그램을 8주간적용한결과균형능력 (p<0.05), 방향전환능력 (p<0.05), 낙상효능감 (p<0.05) 향상이있음을확인하였다. 이러한결과를통해오타고운동프로그램이뇌졸중환자의균형과방향전환능력향상을위한운동프로그램으로서임상에서적용이가능함을확인하였다. References Ahn MH, Park KD, You YY. The effect of feedback on somesthetic video game training for improving balance of stroke patients. J Korean Soc Phys Med. 2012;7(4):401-9. Ahn WH, Jeong MK, Kim CK. The Training effect of balance pad in stroke. Journal of Sport and Leisure Studies. 2008;32(2):803-11. Binns, Elizabeth. The otago exercise programme: do strength and balance improve? Diss. Auckland University of Technology. 2006. Campbell AJ, Robertson MC, Gardner MM et al. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ. 1997;315(7115):1065-9. Danielli Coelho de Morais Faria C, Fuscaldi Teixeira-Salmela

균형과보행능력향상을위한오타고운동프로그램의임상적유용성 69 L, Nadeau S. Effects of the direction of turning on the timed up & go test with stroke subjects. Top Stroke Rehabil. 2009;16(3):196-206. de Haart M, Geurts AC, Huidekoper SC et al. Recovery of standing balance in post-acute stroke patients: a rehabilitation cohort study. Arch Phys Med Rehabil. 2004;85(6):886-95. Dean CM, Richards CL, Malouin F. Walking speed over 10 metres overestimates locomotor capacity after stroke. Clin Rehabil. 2001;15(4):415-21. Dite W, Temple VA. A clinical test of stepping and change of direction to identify multiple falling older adults. Arch Phys Med Rehabil. 2002;83(11):1566-71. Hess RJ, Brach JS, Piva SR et al. Walking skill can be assessed in older adults: validity of the Figure-of-8 Walk Test. Phys Ther. 2010;90(1):89-99. Huh JY. The Effects of Fear of falling and sensory integration on balance and Postural Control in health Elderly. Korean Journal of Sport Psychology. 2001;12(2): 57-68. Karatas M, Çetin N, Bayramoglu M et al. Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients. Am J Phys Med Rehabil. 2004;83(2):81-7. Kerse N, Hayman KJ, Moyes SA et al. Home-based activity program for older people with depressive symptoms: DeLLITE a randomized controlled trial. Ann Fam Med. 2010;8(3):214-23. Kiriyama K, Warabi T, Kato M et al. Medial lateral balance during stance phase of straight and circular walking of human subjects. Neurosci Lett. 2005;388(2):91-5. Lee YW, Shin DC, Lee KJ, et al. The Relation between asymmetric weight-supporting and gait symmetry in patients with stroke. J Korean Soc Phys Med. 2012; 7(2):205-12. Lin KC, Wu CY, Chen CL et al. Effects of object use on reaching and postural balance: a comparison of patients with unilateral stroke and healthy controls. Am J Phys Med Rehabil. 2007;86(10):791-9. Liston MB, Alushi L, Bamiou DE et al. Feasibility and effect of supplementing a modified OTAGO intervention with multisensory balance exercises in older people who fall: a pilot randomized controlled trial. Clin Rehabil. 2014;28(8):784-93. Liu-Ambrose T, Donaldson MG, Ahamed Y et al. Otago homebased strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial. J Am Geriatr Soc. 2008;56(10): 1821-30. Michael KM, Allen JK, Macko RF. Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil. 2005;86(8):1552-6. Moon SH, Kim YM. Effects of close kinetic chain resistant exercise of lower extremity on the gait with stroke. J Korean Soc Phys Med. 2014;(9(4):475-83. Ng SS, Hui-Chan CW. The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke Arch Phys Med Rehabil. 2005;86(8):1641-7. Orrell AJ, Eves FF, Masters RS. Motor learning of a dynamic balancing task after stroke: implicit implications for stroke rehabilitation. Phys Ther. 2006;86(3):369-80. Patterson SL, Forrester LW, Rodgers MM et al. Determinants of walking function after stroke: differences by deficit severity. Arch Phys Med Rehabil. 2007;88(1):115-9. Podsiadlo D, Richardson S. The timed up and go: a test of basic functional mobility for frail eldery person. J Am Geriatr Soc. 1991;39:142-8. Roerdink M, Lamoth CJ, Kwakkel G et al. Gait coordination after stroke: benefits of acoustically paced treadmill walking. Phys Ther. 2007;87(8):1009-22. School OM. Otago exercise programme to prevent falls in older adults. Otago: University of Otago. 2003. Shea SMoriello G. Feasibility and outcomes of a classical pilates program on lower extremity strength, posture, balance, gait, and quality of life in someone with

70 J Korean Soc Phys Med Vol. 11, No. 2 impairments due to a stroke. J Bod Mov Ther. 2014; 18(3):332-60. Song GB, Park EC. The effects of balance training on balance pad and sand on gait ability in stroke patients. J Korean Soc Phys Med. 2016;11(1):45-52. Steffen TM, Hacker TA, Mollinger L. Age-and gender-related test performance in community-dwelling elderly people: six-minute walk test, berg balance scale, timed up & go test, and gait speeds. Phys Ther. 2002;82(2): 128-37. Thomas S, Mackintosh S, Halbert J. Does the Otago exercise programme reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing. 2010;102. Tyson SF, Hanley M, Chillala J et al. Balance disability after stroke. Phys Ther. 2006;86(1):30-8. Verheyden G, Vereeck L, Truijen S, et al. Trunk performance after stroke and the relationship with balance, gait and functional ability. Clin Rehabil. 2006;20(5): 451-8. Yardley L, Donovan-Hall M, Francis K, et al. Older peolpe s views of advice about falls prevention: a qualitative study. Health Educ Res. 2006;21:508-17.