Title Page
Abstract
Contents
1. Introduction 12
1.1. Background and Necessity 12
1.2. Purpose 17
1.3. Hypothesis 17
2. Theoretical background 18
2.1. Anatomical structure of the shoulder joint 18
2.2. Stroke 19
2.3. Shoulder instability of stroke 20
2.4. Proprioceptive Neuromuscular Facilitation(PNF) 22
2.5. K-E concept(Kaltenborn-Evjenth concept) 23
2.6. Functional Electrical Stimulation(FES) 24
3. Methods 25
3.1. Participants 25
3.2. Study procedures 28
3.3. Study method 30
3.3.1. K-E centralization exercises 30
3.3.2. PNF upper pattern 32
3.3.3. Functional electrical stimulation(FES) 35
3.4. Assessments 36
3.4.1. Range of motion 36
3.4.2. Visual analog scale 38
3.4.3. Manual function test 39
3.4.4. Strength 40
3.4.5. Sensory(joint position sense test) 41
3.4.6. Shoulder subluxation 43
3.5. Statistical Analysis 44
4. Result 45
4.1. Comparison of the ROM 45
4.1.1. Comparison of the Shoulder flextion 47
4.1.2. Comparison of the Shoulder Extention 48
4.1.3. Comparison of the Shoulder Abduction 49
4.1.4. Comparison of the Shoulder Adduction 50
4.1.5. Comparison of the Shoulder Internal rotation 51
4.1.6. Comparison of the Shoulder External rotation 52
4.2. Comparison of the Pain 53
4.2.1. Comparison of the Shoulder VAS 54
4.3. Comparison of the Fuction 55
4.3.1. Comparison of the Shoulder MFT 56
4.4. Comparison of the Strength 57
4.4.1. Comparison of the Shoulder HG 58
4.5. Comparison of the Sensory 59
4.5.1. Comparison of the Sensory(30%) 60
4.5.2. Comparison of the Sensory(60%) 61
4.5.3. Comparison of the Sensory(90%) 62
4.6. Comparison of the Subluxation 63
4.6.1. Comparison of the Subluxation 64
5. Discussion 65
5.1. Shoulder Centralization Exercise and ROM 66
5.2. Shoulder Centralization Exercise and VAS 67
5.3. Shoulder Centralization Exercise and Function 68
5.4. Shoulder Centralization Exercise and Strength 69
5.5. Shoulder Centralization Exercise and Sensory 70
5.6. Shoulder Centralization Exercise and Jig 71
6. Conclusion 72
List of references 74
List of abbreviations 89
Appendix 93
〈Appendix 1〉 Visual analogue scale(VAS) 93
〈Appendix 2〉 Upper extremity function test(Manual Function Test) 93
Table 1. Intervention 27
Table 2. Changes in range of motion before and after intervention between three groups 46
Table 3. Changes in pain before and after intervention between three groups 53
Table 4. Changes in function before and after intervention between three groups 55
Table 5. Changes in muscle strength before and after intervention between three groups 57
Table 6. Changes in proprioception before and after intervention between three groups 59
Table 7. Changes in subluxation before and after intervention between three groups 63
Figure 1. Flowchart 29
Figure 2. Centralization(manual) 30
Figure 3. Exercise for Centralization 31
Figure 4. PNF Upper pattern 33
Figure 5. Mat activity for Upper pattern 34
Figure 6. FES(Microstim, Microstim2) 35
Figure 7. Attachment point 35
Figure 8. Goniometer(Jamar,Stainless Steel Goniometers,USA) 37
Figure 9. Manual fuction test(SAKAI med, SOT-5000,Japan) 39
Figure 10. Hand Dynamometer(SAEHAN, Hand Dynamometer,Korea) 40
Figure 11. Proprioception test(joint sesnse) 42
Figure 12. Jig developed 43
Figure 13. Comparison of the Shoulder flexion ROM between the experimental and... 47
Figure 14. Comparison of the Shoulder Extension ROM between the experimental... 48
Figure 15. Comparison of the Shoulder Abduction ROM between the experimental... 49
Figure 16. Comparison of the Shoulder Adduction ROM between the experimental... 50
Figure 17. Comparison of the Shoulder Internal rotation ROM between the... 51
Figure 18. Comparison of the Shoulder External rotation ROM between the... 52
Figure 19. Comparison of the VAS between the experimental and control group 54
Figure 20. Comparison of the MFT between the experimental and control group 56
Figure 21. Comparison of the HG between the experimental and control group 58
Figure 22. Comparison of the Sensory(30%) between the experimental and control group 60
Figure 23. Comparison of the Sensory(60%) between the experimental and control group 61
Figure 24. Comparison of the Sensory(90%) between the experimental and control group 62
Figure 25. Comparison of the JIG between the experimental and control group 64
Figure 26. Visual analog scale 93
Figure 27. Manual Function Test 93