戸田 芙美

BACKGROUND: Electrical stimulation therapy is effective for patients with dysphagia. However, because of the pain, strong stimulation cannot be applied. Although magnetic stimulation induces less pain, there are no reports on magnetic stimulation being synchronised with a swallowing reflex. OBJECTIVE: This study aimed to determine whether it is possible to induce magnetic stimulation during a voluntary swallowing using electromyography (EMG)-triggered peripheral magnetic stimulation and to evaluate its effect on healthy individuals. METHODS: A total of 20 healthy adults in seated position were instructed to swallow saliva and 10 ml of barium under videofluoroscopy. For concomitant use of magnetic stimulation, a magnetic stimulus for suprahyoid muscles at 30 Hz frequency was applied for 2 s when the EMG level in the sternohyoid muscle exceeded the threshold. During the voluntary swallowing, the movement of the hyoid bone and opening width of the upper oesophageal sphincter (UES) were measured. Furthermore, pressure topography was evaluated in 6 subjects using high-resolution manometry. RESULTS: The magnetic stimulation significantly extended the movement time of the hyoid bone (p < 0.001). During liquid deglutition, significant increases were observed in the anterior maximum movement distance of the hyoid bone (p < 0.05), opening width of the UES (p < 0.001) and anterior movement distance of the hyoid bone at the maximum UES opening (p < 0.01). In the pressure topography, the maximum pressure immediately after UES closure significantly decreased with magnetic stimulation (p < 0.05). CONCLUSION: EMG-triggered peripheral magnetic stimulation made it possible to apply magnetic stimulation during a voluntary swallowing.

Purpose: To identify factors associated with falls in Japanese polio survivors and assess the extent of their impact.Materials and methods: Subjects were 128 polio survivors. Fall history and fear of falling, lower limb muscle strength, gait ability (determined by walking speed and number of steps per day), post-polio syndrome incidence, and orthosis or walking aid use were assessed, and factors associated with falls were identified using logistic regression analysis.Results: The fall rate was 64%. Fallers (subjects with one or more falls in the preceding 12 months) had low lower limb muscle strength, slow walking speed, high total scores on the Fall Efficacy Scale-International, which assesses fear of falling, and a high orthosis use rate. Knee extension muscle strength on the weaker side was identified as a main factor influencing risk of falls (odds ratio: 0.72, 95% confidence interval: 0.56-0.96). Receiver operating characteristic curve analysis gave a cutoff value for knee extension muscle strength on the weaker side of 0.42 N/kg or lower.Conclusion: Low knee extension muscle strength on the weaker side was associated with falls, but predictive ability using a single internal factor might be poor. It appears that a comprehensive examination, including other factors, is required.Implications for rehabilitationAs polio survivors age, their risk of falling increases.To identify polio survivors who are at risk of falls, it is important to determine the factors associated with falls and their influence on fall risk.The results of this study showed that reduced knee extension muscle strength on the weaker side was a risk factor for falls in polio survivors.To precisely predict the risk of falls in polio survivors, a comprehensive evaluation of both internal and external factors is required.

摂食嚥下障害の治療はチームで行われる。多職種が共通のスケールを用いて患者を評価し、治療方針および効果を判断することにより、患者にとって適切な摂食状況の変更を遅滞なく進めることができる。チームメンバーが同じように患者の機能障害を把握し、共通の治療目標に向かって進むためには、常に摂食嚥下障害の重症度とリスクに対する対応を明らかにしておく必要がある。臨床的重症度分類(dysphagia severity scale;DSS)は、摂食嚥下運動の主な障害である口腔期障害、咽頭期障害の2要素を臨床的重要性から1軸にまとめて段階づけたものである。この重症度の段階は臨床所見から診断できるように考えられており、各段階に推奨される対処法と直接訓練の可否が述べられていて、臨床的に用いやすいスケールである。(著者抄録)

ポリオ感染症の新規発症がほとんどない本邦において、一般医療現場では「過去の病」として認識・看過されている。一方、リハビリテーションの現場では、ポリオ罹患後数十年を経てポリオ経験者に生じる新たな筋力低下、疲労感増大などが、ポストポリオ症候群(post-polio syndrome;PPS)として注目されている。PPS発症・進行防止のためには、生活スタイルの改善、装具療法、運動療法が必要である。このうち装具療法では、必要最低限の機能を見極め、装具自体をシンプル・軽量化することで過用防止を目指す「ポストポリオ装具」という概念の導入が必要である。(著者抄録)

近年、ポリオ経験者に生じるポストポリオ症候群(post-polio syndrome;PPS)が問題となっている。PPS診断基準に疼痛が挙げられ、訴えも多い。歩行自立したポリオ経験者70名を対象に、疼痛の実態を調査した。疼痛部位、特に良好側・不良側、下肢装具使用の有無に着目して分析を行った。対象のうち、52名(74.3%)に疼痛を認めた。疼痛発症率は、上下肢で比較すると下肢で、不良側と比較すると良好側で有意に高かった(p<0.05)。良好側では特に膝関節、下腿で有意に高かった(p<0.05)。装具使用者では、不良側(装具使用側)の膝関節、下腿で疼痛発症率が低かった。結論として、疼痛は良好側の膝関節より遠位に多かった。下肢装具使用により不良側遠位で疼痛発症率が低く、装具を含めて包括的に負担の軽減を図る必要性が示唆された。(著者抄録)

<br> <br>機能評価と食事形態の選択…柴田 斉子, 戸田 芙美, 小野木啓子, 稲本 陽子, 太田 喜久夫, 加賀谷 斉, 才藤 栄一 900<br><br>パーキンソン病の摂食嚥下障害－これまでの知見と最近の話題－…野﨑 園子 905<br><br>経頭蓋直流電気刺激を用いた嚥下障害治療〈総説〉…重松 孝, 藤島 一郎, 金沢 英哲 913