뇌졸중 환자의 실어증 및 상지 기능 회복을 위한 모바일 프로그램의 개발 및 유효성 검증

Abstract

Stroke rehabilitation requires repetitive, intensive, goal-oriented therapy. We designed home-based mobile rehabilitation programs as a way of u-health service for aphasia and upper limb function recovery that increased the hours of repetitive goal-oriented tasks without increasing costly therapy time or requiring expensive equipment. Experiment 1. Mobile program for poststroke aphasia A. A Tele-screening tool to detect aphasia in patients with stroke We developed a valid, reliable Mobile Aphasia Screening Test (MAST) for patients suffering from stroke. To accomplish this, we enrolled patients with (n = 30) and without (n = 30) stroke-induced aphasia after stroke. To validate the MAST, we compared its performance to that of the Korean version of the Western Aphasia Battery (K-WAB) and conventional shortened paper version (K-FAST). There was significant correlation between K-FAST and MAST. MAST also had a high correlation with K-WAB. Inter-rater reliability was very high. The test had high sensitivity and specificity with an accuracy of 0.930. The MAST is a valid and reliable tool for detecting aphasia in patients with stroke. B. A Telerehabilitation Approach for Chronic Aphasia Following Stroke We developed a telerehabilitation program for chronic aphasia following stroke that utilizes a mobile device (iAphasia). Eight patients received 4 weeks of telespeech therapy using iAphasia. After the 4-week treatment, language function as measured by the K-WAB was significantly improved. The improvement was persistent at the 1-month follow-up visit. The degree of improvement was strongly associated with usage time, regardless of participants age and severity of aphasia. Overall, satisfaction with iAphasia was rated high. iAphasia is an effective and feasible treatment method for chronic aphasia. Experiment 2. Mobile program for upper limb dysfunction after stroke We developed a mobile game-based upper extremity virtual reality program using a smartphone and tablet PC for patients with stroke (MoU-Rehab) and evaluated the programs feasibility and effectiveness. This randomized, double-blind, controlled trial included 24 patients with ischemic stroke. The intervention group (n = 12) received 30 min of conventional occupational therapy (OT) plus 30 min of the MoU-Rehab. The control (n = 12) received conventional OT alone for 1 h per day. Rehabilitation consisted of 10 sessions of therapy 5 days per wk for 2 wk. A greater improvement in the FMA-UE, B-stage, and MMT was found after treatment with the MoU-Rehab than with conventional therapy. The amount of improvements in the MBI, EQ-5D, and BDI were not significantly different between the two groups. Patients in the experimental group completed the 2-wk treatment without adverse effects, and they were generally satisfied with the MoU-Rehab. The MoU-Rehab is feasible and effective for promoting upper limb recovery after ischemic stroke. We developed programs for aphasia and upper limb recovery in patients with stroke. We gained scientific evidence for efficacy and feasibility of home-based mobile rehabilitation programs as a way of u-Health service.