森 志乃

OBJECTIVE: Head lift exercise is a widely known form of training in the rehabilitation of patients with dysphagia. This study aimed to compare muscular strength reinforcement training of the suprahyoid muscles using repetitive peripheral magnetic stimulation (rPMS) with head lift exercises in a randomized controlled trial. MATERIALS AND METHODS: Twenty-four healthy adults were randomly assigned to either the magnetic stimulation group (M group) or the head lift exercise group (H group). Both groups underwent training five days a week for two weeks. The primary outcome was the cervical flexor strength, and secondary outcomes were jaw-opening force, tongue pressure, muscle fatigue of the hyoid and laryngeal muscles, displacement of the hyoid bone and opening width of the upper esophageal sphincter (UES) while swallowing 10 mL of liquid, training performance rate, and pain. RESULTS: No dropouts were reported during the two-week intervention period. Cervical flexor strength significantly increased solely in the M group. Tongue pressure significantly improved in both groups. There were no significant differences in the jaw-opening force, median frequency rate of the anterior belly of the digastric muscle, sternohyoid muscle, sternocleidomastoid muscle, anterior and superior hyoid bone displacement, and UES opening width in both groups. CONCLUSIONS: Two-week rPMS of the suprahyoid muscles increased the strength of these muscles compared with the head lift exercise during the same period.

OBJECTIVES: Neuromuscular electrical stimulation has been widely used in patients with dysphagia. However, obtaining sufficient hyoid bone movement through surface electrodes seems difficult. The aim of this study was to evaluate hyoid bone movement at rest through peripheral magnetic stimulation of the suprahyoid muscles in normal individuals. METHODS: Healthy adult men were recruited. A specially designed coil was connected to the peripheral magnetic stimulator. The coil was placed on the submental area of the subjects. Magnetic stimulation was performed at 30 Hz for 2 sec. The intensity level selected induces hyoid bone movement without causing intolerable pain to the subjects. The hyoid bone at rest between on- and off-magnetic stimulations of the suprahyoid muscles were identified using fluoroscopy at 30 frames/sec in lateral projection. Pain during peripheral magnetic stimulation was evaluated using the numerical rating scale (NRS). RESULTS: Eleven subjects aged 32 ± 9 years participated in this study. Magnetic stimulation resulted in 10.9 ± 2.8 mm forward displacement and 8.3 ± 4.1 mm (mean ± SD) upward displacement of the hyoid bone. The median NRS score during magnetic stimulation was 1. CONCLUSIONS: Peripheral magnetic stimulation is noninvasive and easy to perform. It does not require skin preparation, facilitates sufficient hyoid bone movement, and causes minimum level of pain.

【目的】舌骨挙上障害を持つ摂食嚥下障害に対する末梢磁気刺激治療の実現可能性を検討した。【方法】2秒間の磁気刺激を30回で1セットとして1日に2〜3セット、1週間に5日以上の反復末梢磁気刺激治療(repetitive peripheral magnetic stimulation:rPMS)を6週間、舌骨挙上障害を持つ摂食嚥下障害患者2例に対して施行した。【結果】2例ともに、6週間のrPMSを問題なく施行可能であった。82歳の誤嚥性肺炎後の廃用症候群患者ではrPMS後に筋力および舌骨挙上距離の改善を認めた。47歳の皮膚筋炎患者ではrPMS介入後に筋力および筋疲労の改善を認めた。磁気刺激後には頸部のこわばりが軽減し食事中の疲労感が軽減した。【結論】舌骨挙上障害に対するrPMSは新しい治療法となりうる可能性がある。(著者抄録)

失行は日常生活活動(activities of daily living:ADL)に大きな影響を及ぼすが、症候が複雑で行為の誤り方に個別性・多様性が存在するためリハビリテーション手法の確立は困難で、その障害や治療に関する詳細な検討もほとんどない。我々は左頭頂側頭葉のアテローム血栓性脳梗塞で、ごく軽度の右片麻痺と感覚障害に加え、観念失行・観念運動失行・肢節運動失行を呈した82歳女性を経験した。特に食事動作に関し、右手では困難な動作をまず左手で実施し、その後道具を右手に持ち替える方法を取り入れ、誤りなし学習を徹底したところ、動作の自立を果たした。本症例の改善機序として、左上肢の使用により右上肢の体性感覚が補われたことで、誤りの認知や道具使用に関する意味概念への到達が可能となり、正しい運動プログラムの惹起が促進されて、右手の運動学習につながったものと推察された。(著者抄録)