과목명 : 임상생체역학실습 교수명 : 황 성 수 교수님 발표일 : 2007. 6. 7 발표자 : 박 용 신 사례 보고서 과목명 : 임상생체역학실습 교수명 : 황 성 수 교수님 발표일 : 2007. 6. 7 발표자 : 박 용 신

General information 성명 : 김 O O 성별 : M 나이 : 56세 진단명 : Double hemiplegia d/t bilateral ACA area infarction (Rt.>Lt.) 본원에 2007. 2. 28. 입원하여 약 3개월 정도치료 받았음

Subjective information Onset - 2005.12.14 PI - 기도 중 쓰러짐. 서울복지병원에서 진단 받음. Lt. ICA stent 시술(2006.10.) PHx. - HTN, L-HNP, knee OA C/C - 몸통을 가누기가 어렵고 오른다리 힘이 약하다⇒ 일상생활을 어렵게 한다. Pt’s goal - 일상생활 독립적으로 하기(화장실 사용, 이동 등), 걷기(가능하면 혼자서)

Objective information Sensory Rt. Lt. Superficial (light touch, pain, Tem.) Intact Deep (pressure, vibration) Proprioception (Jt. Position) Impaired (nearly intact)

Objective information Muscle tone - MAS Rt. Lt. U/E G 1 G 0 L/E G 1~1+

Objective information Passive ROM - Generally full ROM without Hip flexion & extension Rt. Lt. Hip flexion (with knee flexion) normal Hip flexion (with knee extension) 65⁰ 70⁰ Hip extension (with knee flexion) 0⁰ 10⁰ Hip extension (with knee extension)

Objective information MMT Rt. Lt. Trunk flexor F Trunk extensor Trunk rotator To Lt.: F+, To Rt.: F Quadratus lumborum Hip flexor (with knee flexion) F+ G Hip flexor (with knee extension) P+ Hip extensor (with knee flexion) Hip extensor (with knee extension) P Hip abductor

Objective information Functional ability Assist grade Roll-over Ind. Sit up Min. Sit to stand Mod. ~ Min. Transfer(W/C↔bed) Gait Max. ~ Mod. Balance - functional balance grade sitting Static: Good Dynamic: Fair ~ Good standing Static: Poor ~ Fair Dynamic: Poor ~ Fair

Objective information Sitting posture

Objective information Standing posture

Objective information Transfer Rolling

Objective information Come to sit Sitting balance 1

Objective information Sitting balance 2 Sitting balance 3

Objective information Sit ↔ stand Standing balance 1

Objective information Standing balance 2 Standing balance 3

Assessment – problem list Core stability 부족 ⇒ Trunk stability(esp. lower part) & mobility 감소(esp. rotation) Obesity(esp. abdominal part), Abdominal m. weakness, hip flexor shortening ⇒ pelvic malalignment(lumbar curve ↑) 형성 및 pelvic mobility 감소

Assessment – short term goal 1 Core stability 향상 A: patient B: spinal stabilization, trunk movement.(esp. lower part) C: supine, sitting, standing position active or active-assistive ex. D: 15 Min.

Assessment – short term goal 2 Pelvic realignment A: patient B: pelvic tilting ex., Abdominal m. strengthening, hip flexor lengthening C: hooklying, sitting, standing position active or active-assistive, resistive ex. D: 15 Min.

Assessment – long term goal Dynamic sitting & standing balance 증진을 통해 일상생활 능력 향상 A: patient B: trunk의 movement를 동반한 여러 가지 activity(공 주고받기, 배드민턴 등), 일상생활 동작 연습 C: supine, sitting, standing position active or active-assistive ex. D: 10 Min.

Plan Adm. 1 time(40Min.)/day, 5 times/week 치료실에서 치료사와 함께 운동치료 ward re-education ⇒ pelvic movement, sit to standing 1 month later reassessment

Treatment Spinal stabilization

Treatment Trunk rotation movement re-education

Treatment Balance training 치료 후 모습

Treatment Activity

감사합니다!!