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KMID : 1034620170070020044
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Korean Journal of Neuromuscular Rehabilitation
2017 Volume.7 No. 2 p.44 ~ p.68
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Novel Approach for Improving Walking Function of Patients With Chronic Stroke : Clinical Application of ‘Neuromuscular Control and Reset’ Concept
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Won Sang-Hee
Oh Duck-Won
Yu Dal-Yeong
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Abstract
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Stroke is characterized by various symptoms such as sensory-motor paralysis, spasticity, reduced muscular strength and endurance, and limited joint mobility on affected side, thereby leading to functional impairments. In stroke rehabilitation, the recovery of walking function is ultimate goal to re-integrate community life and facilitate active participation in daily activities. In general, most clinicians have adopted specific approaches to treat functional impairments caused by stroke in their own decision, which followed theoretical frameworks based on neurophysiological knowledge. However, researches failed to clarify therapeutic evidences on the clinical efficacies of traditional approaches. Taken with motor learning principles, task-oriented approach and functional training is more likely to facilitate functional recovery in patient-centered way following stroke. In most cases, musucloskeletal impairments such as misalignment of joint and muscle imbalance have been in little attention in stroke rehabilitation; however, specific solution for these problems needs to manage a variety of functional impairments and demonstrate improved effects of the training. Concept of ‘Neuromuscular Control and Reset (NCR)’ reflects this issue along with focusing on the benefits of functional training, and this introduces an combination of the advantages of ‘Top-down approach’ and ‘Bottom-up approach’. Algorithm of the NCR concept provides detailed procedure to help decision-making process of physical therapists, which includes four types of a reset: joint malalignment, muscle imbalance, and impaired joint stability and sensory-motor control. This study aimed to illustrate the therapeutic principles of the NCR concept and application method of algorithm offering the specific process of evaluation and treatment to enhance the walking function of patietns with post-stroke hemiparesis.
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KEYWORD
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Neuromuscular control and reset, Stroke, Walking
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