大塚 圭

Ankle-foot orthosis (AFO) is known to correct abnormal gait patterns and improve walking stability and speed in patients with hemiparesis. To quantify these benefits in post-stroke gait, a three-dimensional motion analysis of gait pattern was conducted. Forty patients with hemiparesis were enrolled. A three-dimensional motion analysis system was used to analyze patients' treadmill walking with/without an AFO. Outcome measures were 12 abnormal gait indices (forefoot contact, knee extensor thrust, retropulsion of the hip, flexed-knee gait, medial whip in the stance phase, circumduction gait, hip hiking, insufficient knee flexion during the swing phase, excessive lateral shifting of the trunk, contralateral vaulting, excessive hip external rotation, and posterior pelvic tilt), calculated using kinematic data and spatiotemporal indices, and the symmetry index of double-stance and single-stance time and step length. Forefoot contact (without AFO vs. with AFO: 71.0 vs. 65.8, P < 0.001), circumduction gait (65.0 vs. 57.9, P < 0.001), and contralateral vaulting (78.2 vs. 72.2, P = 0.003) were significantly reduced, whereas excessive hip external rotation (53.7 vs. 62.8, P = 0.003) significantly increased during walking with an AFO. Hip hiking (77.1 vs. 71.7) showed marginal reduction with the use of AFO ( P = 0.096). The absolute symmetry index of double-stance time (21.9 vs. 16.1, P = 0.014) significantly decreased during walking with an AFO. AFO effectively mitigates abnormal gait patterns typical of hemiparetic gait. A 3D motion analysis system with clinically oriented indices can help assess intervention efficacy for gait abnormalities.

OBJECTIVES: The purpose of this study was to capture the lifestyle characteristics of traumatic brain injury (TBI) patients by administering the Frenchay Activities Index (FAI), a self-assessment questionnaire used for assessing life-related activities, among TBI patients. METHODS: This study was conducted using the revised FAI Self-Assessment Form, administering an interview-based questionnaire survey to TBI patients and healthy participants. The target group comprised 60 traumatic brain injury patients who had progressed from at least 1 year since the injury, with a comparison group of 788 healthy participants. RESULTS: A comparison of FAI scores between TBI patients and healthy participants by questionnaire revealed that TBI patients exhibited significantly higher FAI scores than healthy participants for outdoor walking and transportation use (Mann-Whitney U test, P<0.01). A comparison by occupation revealed that TBI patients were significantly less among the unemployed and other categories (Mann-Whitney U test, P<0.01). For office workers, government employees, high school students, and college students, scores were higher among TBI patients compared with healthy participants, although the differences were not significant. CONCLUSIONS: Although TBI patients were less active than healthy participants in life-related activities, their scores for cleaning up after meals and cleaning and putting things in order were close to those of healthy participants, indicating that TBI patients cannot be considered to be inactive. The findings also revealed differences in TBI patients' engagement in life-related activities and frequency of activities depending on their social position.

OBJECTIVES: This study investigates how online frame-of-reference (FOR) training of raters of the objective structured clinical examination (OSCE) for physical therapy students affects assessment accuracy. METHODS: The research was conducted in a 1-month-long randomized controlled trial. PARTICIPANTS: The participants were 36 physical therapists without experience assessing clinical skills using the OSCE. The training group completed the FOR training online, which was conducted once a week in two 90-minute sessions. The control group self-studied the rubric rating chart used in the assessment. As a measure of accuracy, weighted kappa coefficients were used to check the agreement between correct score and those assessment by the participant in the OSCE. RESULTS: The scores of the training group were higher than those of the control group in both post- and follow-up assessments, showing significant differences. No significant difference was found based on the assessment time and group for the high-agreement groups. Furthermore, scores of the low-accuracy training group were higher in the post- and follow-up assessments than those in the pre-assessment, showing significant differences. CONCLUSIONS: Online FOR training of the raters of the OSCE for physical therapists improved the assessment accuracy of the raters who had low accuracy in the pre-assessment; this improvement was maintained.

目的:本研究の目的は,理学療法士・作業療法士教育における臨床教育者の指導経験が診療参加型臨床実習に及ぼす影響について検証することである。方法:対象は藤田医科大学の教育病院において臨床実習を経験した理学および作業療法専攻の学生とし,臨床教育者の診療参加型臨床実習指導経験が無い群(CE未経験群)48名と有る群(CE経験群)49名の2群に分け,臨床実習中の学生のストレス状態,基本的姿勢,睡眠状態を比較した。結果:CE経験群では,CE未経験群と比較し,臨床実習中の対人関係,適性度,イライラ感のストレスが減少し,実習の満足度が増加していた。また,基本的姿勢の評価の点数は高かった。一方で,睡眠状態は,CE未経験群に比較してCE経験群では「不眠症なし」と判定された割合は減少し,「軽度不眠症」と判定された割合は増加していた。結論:指導経験ある臨床教育者による実習では,学生のストレスは軽減し,基本的姿勢の評価は向上するものの,睡眠状態に関しては,一定数の睡眠障害のある学生は残存し,心理面のサポートとともに,自宅での学習状況や睡眠時間を留意しながら指導する必要性が示唆された。(著者抄録)

OBJECTIVES: In stroke patients, the assessment of gait ability over time is important. For quantitative gait assessment using measuring devices, the walking speed condition for measurement is generally based on the patient's preferred walking speed or the maximum walking speed at the time of measurement. However, because walking speed often increases during the convalescent stage, understanding the effects of change in walking speed on gait when comparing the course of recovery is necessary. Although several previous studies have reported the effects of change in walking speed on gait in stroke patients, the time-distance parameters described in these reports may not be generalizable because of the small case numbers. Therefore, we measured treadmill gait at the preferred walking speed (PWS) and 1.3 times the PWS (130% PWS) in 43 post-stroke hemiplegic patients and analyzed the effects of change in walking speed on time-distance parameters. METHODS: Forty-three patients with hemiplegia after a first stroke, who were able to walk on a treadmill under supervision, were recruited as subjects. Using a three-dimensional motion analysis system, treadmill gait was assessed under two conditions: PWS and 130% PWS. The primary outcome measures were the time-distance parameters, which were compared between the PWS and 130% PWS conditions. RESULTS: Cadence, stride length, and step length of the affected and unaffected lower limbs increased significantly at 130% PWS compared with at PWS. In terms of actual time, single stance time and initial and terminal double stance time in both affected and unaffected limbs decreased significantly at 130% PWS. In terms of relative time (% of the gait cycle), compared with PWS, relative single stance time increased significantly, whereas relative initial and terminal double stance times decreased significantly at 130% PWS in both the affected and unaffected limbs. CONCLUSIONS: This study on treadmill gait in patients with hemiplegia after a first stroke confirmed the effects of change in walking speed on time-distance parameters. Our results will help in the interpretation of time-distance parameters measured under different walking speed conditions.

Background: Despite recent developments in the methodology for measuring spasticity, the discriminative capacity of clinically diagnosed spasticity has not been well established. This study aimed to develop a simple device for measuring velocity-dependent spasticity with improved discriminative capacity based on an analysis of clinical maneuver and to examine its reliability and validity. Methods: This study consisted of three experiments. First, to determine the appropriate motion of a mechanical device for the measurement of velocity-dependent spasticity, the movement pattern and the angular velocity used by clinicians to evaluate velocity-dependent spasticity were investigated. Analysis of the procedures performed by six physical therapists to evaluate spasticity were conducted using an electrogoniometer. Second, a device for measuring the resistance force against ankle dorsiflexion was developed based on the results of the first experiment. Additionally, preliminary testing of validity, as compared to that of the Modified Ashworth Scale (MAS), was conducted on 17 healthy participants and 10 patients who had stroke with spasticity. Third, the reliability of the measurement and the concurrent validity of mechanical measurement in the best ankle velocity setting were further tested in a larger sample comprising 24 healthy participants and 32 patients with stroke. Results: The average angular velocity used by physical therapists to assess spasticity was 268 ± 77°/s. A device that enabled the measurement of resistance force at velocities of 300°/s, 150°/s, 100°/s, and 5°/s was developed. In the measurement, an angular velocity of 300°/s was found to best distinguish patients with spasticity (MAS of 1+ and 2) from healthy individuals. A measurement of 300°/s in the larger sample differentiated the control group from the MAS 1, 1+, and 2 subgroups (p &amp;lt; 0.01), as well as the MAS 1 and 2 subgroups (p &amp;lt; 0.05). No fixed or proportional bias was observed in repeated measurements. Conclusion: A simple mechanical measurement methodology was developed based on the analysis of the clinical maneuver for measuring spasticity and was shown to be valid in differentiating the existence and extent of spasticity. This study suggest possible requirements to improve the quality of the mechanical measurement of spasticity.

Objectives: To evaluate the safety and acceptability of a newly developed tele-rehabilitation exercise system using computer-generated animation. Methods: The participants comprised a convenience sample of 38 diverse individuals in Experiment 1 (15 healthy young people, 16 healthy older people, 5 patients with stroke, and 2 patients with respiratory disease) and 18 healthy older individuals in Experiment 2. Experiment 1 assessed safety in terms of cardiopulmonary vascular aspects and risk of fall, and Experiment 2 assessed treatment acceptability via a subjective evaluation. All participants completed the same exercise program. The safety assessment was conducted using heart rate (HR) and saturation of percutaneous oxygen (SpO2), measured before and after exercise. In addition, the occurrence of falls was assessed. For the acceptability assessment, the participants answered five questions (three-point Likert scale) after the exercise program. Results: The safety assessment indicated that HR and SpO2 changed from 70.5±10.2 beats per minute and 97.8±1.3% before exercise to 87.6±13.6 beats per minute and 98.2±0.9% after exercise, respectively. In addition, all participants completed the exercises without experiencing any falls. In the acceptability assessment, the score reflecting continuation desire was the highest of the five items examined (2.71±0.46). In contrast, the adequacy of exercise intensity had the lowest score (1.29±0.57). Conclusions: The present system was confirmed to be safe, and the participants were motivated to continue the exercises. Future developments should incorporate a function to enable participants and medical staff to adjust exercise intensity according to individual physical function.

BACKGROUND: Ankle-foot orthoses are used to improve gait stability in patients with post-stroke gait; however, there is not enough evidence to support their beneficial impact on gait stability. AIM: To investigate the effects of ankle-foot orthoses on post-stroke gait stability. DESIGN: An experimental study with repeated measurements of gait parameters with and without orthosis. SETTING: Inpatients and outpatients in the Fujita Health University Hospital. POPULATION: Thirty-two patients (22 males; mean age 48.3±20.0 years) with poststroke hemiparesis participated in the study. METHODS: Three-dimensional treadmill gait analysis was performed with and without ankle-foot orthosis for each participant. Spatiotemporal parameters, their coefficient of variation, and margin of stability were evaluated. Toe clearance, another major target of orthosis, was also examined. The effect of orthosis in the patients with severe (not able to move within the full range of motion, defying gravity) and mild ankle impairment (able to move within the full range but have problem with speed and/or smoothness of the ankle movement) was compared. RESULTS: In the total group comparison, the decrease in the coefficient of variation of step width (P=0.012), and margin of stability on the paretic side (P=0.023) were observed. In the severe ankle impairment groups, the decreased in the coefficient of variation of the non-paretic step length (P=0.007), stride length (P=0.037), and step width (P=0.033) and margin of stability on the paretic side (P=0.006) were observed. No significant effects were observed in the mild ankle impairment group; rather, the coefficient of variation of non-paretic step length increased with the use of orthosis in this group (P=0.043); however, toe clearance increased with the use of ankle-foot orthosis (P=0.041). CONCLUSIONS: Ankle-foot orthoses improved gait stability indices; however, the effect was either not significant or showed possible worsening in the patients with mild ankle impairment, while the effect on toe clearance was significant. These results suggest that the effects of using orthoses in patients with mild impairment should be carefully evaluated. CLINICAL REHABILITATION IMPACT: Understanding the effects of ankle-foot orthoses on the stability of post-stroke gait and their relationship with ankle impairment severity may support clinical decision-making while prescribing orthosis for post-stroke hemiparesis.

BACKGROUND: Assessing abnormal gait patterns could indicate compensatory movements, which could be an index for recovery and a process of motor learning. To quantify the degree of posterior pelvic tilt, contralateral vaulting is necessary. OBJECTIVES: This study aimed to develop and evaluate the validity of quantitative indices for posterior pelvic tilt and contralateral vaulting in hemiplegic patients. METHODS: Forty-six healthy control subjects and 112 hemiplegic patients participated in this study. Of the 112 patients, 50 were selected into each abnormal gait pattern group, with some overlap. Three experienced physical therapists observed their walking and graded the severity of the two abnormalities in five levels. An index to quantify each of the two abnormal gait patterns was calculated from the three-dimensional treadmill gait analysis. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment done by three physical therapists with expertise in gait analysis. RESULTS: The index values were significantly higher in hemiplegic patients than in healthy subjects (28.0% and 44.7% for the posterior pelvic tilt in healthy subjects and patients, respectively and 0.9 and 4.7 for the contralateral vaulting, respectively). A strong correlation was observed between the index value and the median observational rating for two abnormal gait patterns (r = -0.68 and -0.72). CONCLUSIONS: The proposed indices for posterior pelvic tilt and contralateral vaulting are useful for clinical gait analysis, and thus encouraging a more detailed analysis of hemiplegic gait using a motion analysis system.

Introduction: Gait exercise assist robot (GEAR), a gait rehabilitation robot developed for poststroke gait disorder, has been shown to improve walking speed and to improve the poststroke gait pattern. However, the persistence of its beneficial effect has not been clarified. In this matched case-control study, we assessed the durability of the effectiveness of GEAR training in patients with subacute stroke on the basis of clinical evaluation and three-dimensional (3D) gait analysis. Methods: Gait data of 10 patients who underwent GEAR intervention program and 10 patients matched for age, height, sex, affected side, type of stroke, and initial gait ability who underwent conventional therapy were extracted from database. The outcome measures were walk score of Functional Independence Measure (FIM-walk), Stroke Impairment Assessment Set total lower limb motor function score (SIAS-L/E), and 3D gait analysis data (spatiotemporal factors and abnormal gait patter indices) at three time points: baseline, at the end of intervention, and within 1 week before discharge. Results: In the GEAR group, the FIM-walk score, SIAS-L/E score, cadence, and single stance time of paretic side at discharge were significantly higher than those at post-training (p < 0.05), whereas the stance time and double support time of the unaffected side, knee extensor thrust, insufficient knee flexion, and external rotated hip of the affected side were significantly lower (p < 005). However, no significant differences in these respects were observed in the control group between the corresponding evaluation time points. Conclusion: The results indicated significant improvement in the GEAR group after the training period, with respect to both clinical parameters and the gait pattern indices. This improvement was not evident in the control group after the training period. The results possibly support the effectiveness of GEAR training in conferring persistently efficient gait patterns in patients with poststroke gait disorder. Further studies should investigate the long-term effects of GEAR training in a larger sample.

OBJECTIVES: This study aimed to determine the effects of clinical clerkship in physical and occupational therapy students' education on their stress, sleep, and technical skill acquisition. METHODS: We compared responses to the Brief Job Stress Questionnaire and the Athens Insomnia Scale, and students' clinical training grades between a traditional clinical training group (n=48) and a clinical clerkship group (n=48). RESULTS: Compared with the traditional group, the clinical clerkship group showed significantly higher scores on the Brief Job Stress Questionnaire for quantitative and qualitative burden, and significantly lower scores for the extent of control over tasks, irritability, fatigue, depression, and physical ailment. Scores for vitality and supervisor support were also significantly higher in the clinical clerkship group than the traditional group. The median Athens Insomnia Scale score was significantly lower in the clinical clerkship group. Clinical training grades for fundamental attitude and treatment techniques were significantly higher in the clinical clerkship group than in the traditional group. CONCLUSIONS: Students that experienced clinical clerkship perceived quantitative and qualitative burdens, which may be attributable to the level of interaction with patients during training. Their perception of low control over tasks may be because their supervisors described tasks specifically. However, the clinical clerkship group showed lower mental and physical stress than the traditional group. These students perceived they had supervisor support, which may be attributable to increased communication with their supervisor. Clinical clerkship was also linked to better sleep status than traditional training. Continuing clinical clerkship is necessary to develop students' technical clinical skills.

Hemiparesis resulting from stroke presents characteristic spatiotemporal gait patterns. This study aimed to clarify the spatiotemporal gait characteristics of hemiparetic patients by comparing them with height-, speed-, and age-matched controls while walking at various speeds. The data on spatiotemporal gait parameters of stroke patients and that of matched controls were extracted from a hospital gait analysis database. In total, 130 pairs of data were selected for analysis. Patients and controls were compared for spatiotemporal gait parameters and the raw value (RSI) and absolute value (ASI) of symmetry index and coefficient of variation (CV) of these parameters. Stroke patients presented with prolonged nonparetic stance (patients vs. controls: 1.01 ± 0.41 vs. 0.83 ± 0.25) and paretic swing time (0.45 ± 0.12 vs. 0.39 ± 0.07), shortened nonparetic swing phase (0.35 ± 0.07 vs. 0.39 ± 0.07), and prolonged paretic and nonparetic double stance phases [0.27 ± 0.13 (paretic)/0.27 ± 0.17 (nonparetic) vs. 0.22 ± 0.10]. These changes are especially seen in low-gait speed groups (<3.4 km/h). High RSIs of stance and swing times were also observed (-9.62 ± 10.32 vs. -0.79 ± 2.93, 24.24 ± 25.75 vs. 1.76 ± 6.43, respectively). High ASIs and CVs were more generally observed, including the groups with gait speed of ≥3.5 km/h. ASI increase of the swing phase (25.79 ± 22.69 vs. 4.83 ± 4.88) and CV of the step length [7.7 ± 4.9 (paretic)/7.6 ± 5.0 (nonparetic) vs. 5.3 ± 3.0] were observed in all gait speed groups. Our data suggest that abnormalities in the spatiotemporal parameters of hemiparetic gait should be interpreted in relation to gait speed. ASIs and CVs could be highly sensitive indices for detecting gait abnormalities.

© 2018 The Author(s). Background: Ankle-foot orthoses (AFOs) are frequently used to improve gait stability, toe clearance, and gait efficiency in individuals with hemiparesis. During the swing phase, AFOs enhance lower limb advancement by facilitating the improvement of toe clearance and the reduction of compensatory movements. Clinical monitoring via kinematic analysis would further clarify the changes in biomechanical factors that lead to the beneficial effects of AFOs. The purpose of this study was to investigate the actual impact of AFOs on toe clearance, and determine the best strategy to achieve toe clearance (including compensatory movements) during the swing phase. Methods: This study included 24 patients with hemiparesis due to stroke. The gait performance of these patients with and without AFOs was compared using three-dimensional treadmill gait analysis. A kinematic analysis of the paretic limb was performed to quantify the contribution of the extent of lower limb shortening and compensatory movements (such as hip elevation and circumduction) to toe clearance. The impact of each movement related to toe clearance was assessed by analyzing the change in the vertical direction. Results: Using AFOs significantly increased toe clearance (p = 0.038). The quantified limb shortening and pelvic obliquity significantly differed between gaits performed with versus without AFOs. Among the movement indices related to toe clearance, limb shortening was increased by the use of AFOs (p &lt; 0.0001), while hip elevation due to pelvic obliquity (representing compensatory strategies) was diminished by the use of AFOs (p = 0.003). The toe clearance strategy was not significantly affected by the stage of the hemiparetic condition (acute versus chronic) or the type of AFO (thermoplastic AFOs versus adjustable posterior strut AFOs). Conclusions: Simplified three-dimensional gait analysis was successfully used to quantify and visualize the impact of AFOs on the toe clearance strategy of hemiparetic patients. AFO use increased the extent of toe clearance and limb shortening during the swing phase, while reducing compensatory movements. This approach to visualization of the gait strategy possibly contributes to clinical decision-making in the real clinical settings. Trial registration: UMIN000028946. Registered 31 August 2017 (retrospectively registered).

© 2018 Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. Three-dimensional gait analysis (3DGA) is shown to be a useful clinical tool for the evaluation of gait abnormality due to movement disorders. However, the use of 3DGA in actual clinics remains uncommon. Possible reasons could include the time-consuming measurement process and difficulties in understanding measurement results, which are often presented using a large number of graphs. Here we present a clinician-friendly 3DGA method developed to facilitate the clinical use of 3DGA. This method consists of simplified preparation and measurement processes that can be performed in a short time period in clinical settings and intuitive results presentation to facilitate clinicians&#039; understanding of results. The quick, simplified measurement procedure is achieved by the use of minimum markers and measurement of patients on a treadmill. To facilitate clinician understanding, results are presented in figures based on the clinicians&#039; perspective. A Lissajous overview picture (LOP), which shows the trajectories of all markers from a holistic viewpoint, is used to facilitate intuitive understanding of gait patterns. Abnormal gait pattern indices, which are based on clinicians&#039; perspectives in gait evaluation and standardized using the data of healthy subjects, are used to evaluate the extent of typical abnormal gait patterns in stroke patients. A graph depicting the analysis of the toe clearance strategy, which depicts how patients rely on normal and compensatory strategies to achieve toe clearance, is also presented. These methods could facilitate implementation of 3DGA in clinical settings and further encourage development of measurement strategies from the clinician&#039;s point of view.

1.中枢神経疾患患者の歩行障害では、歩行速度低下、バランス機能低下、再現性低下などの特徴を認めるとともに、典型的な異常歩行を呈することが多い。2.時間距離因子の分析は、歩行速度の低下を探る第一歩となるとともに、運動学習の指標や対称性の指標になり得る。3.中枢神経疾患患者の歩行障害で高い頻度で認められる足部の過度な内反は、三次元動作分析装置によるトレッドミル歩行分析で評価でき、ボツリヌス療法の治療効果の判定にも有用となる。4.異常歩行の同定は、歩行障害の原因となる病態理解、重症度の判定、介入方針の決定、歩行練習の効果判定の手段としても有用であり、定量的に分析されることが望ましい。5.機能障害を有する中枢神経疾患患者の歩行再建において代償運動の活用は不可欠である一方、過度な代償運動は安定性や耐久性を低下させる要因にもなり得るため、機能障害と代償運動の関係を的確に評価する必要がある。(著者抄録)

<p>【はじめに，目的】</p><p></p><p>歩行練習アシスト（Gait Exercise Assist Robot；以下，GEAR）は，脳卒中片麻痺者の歩行練習支援を目的に開発されたロボットであり，立脚中の麻痺側下肢の支持性や遊脚中の膝屈曲などの様々なパラメータ変更による難易度調整が可能である。発症後早期から適切な難易度で多数歩練習を繰り返すことで，効率の良い歩行自立度の改善が期待される。</p><p></p><p>今回，GEARを用いて歩行練習をした患者（以下，GEAR群）の退院時の異常歩行の重症度を，GEARを用いずに従来通りの歩行練習をした患者（以下，従来群）と比較した。</p><p></p><p></p><p>【方法】</p><p></p><p>対象は，GEAR群は藤田保健衛生大学病院で発症後早期からGEARを用いて歩行練習した5症例とし，退院時に歩行計測を実施した。従来群は，初発脳卒中片麻痺患者の歩行データの中から，GEAR群1例に対して，GEAR群の退院時の発症後日数（以下，TAO）と麻痺の重症度（SIAS-mの下肢合計，以下SIAS-LT）が同程度の1症例を選出し，両群の異常歩行の重症度を比較した。GEAR群の内訳は，年齢：66.0±6.3歳，TAO：129.0±47.8日，SIAS-LT：7.6±1.1，トレッドミル歩行速度：1.7±1.1，GEAR練習日数：29.2±16.3日，従来群の内訳は，年齢：53.4±8.8歳，TAO：154.6±104.7日，SIAS-LT：7.6±1.1，トレッドミル歩行速度：1.5±0.6であった。</p><p></p><p>歩行計測は，対象の平地快適歩行速度でのトレッドミル歩行（手すり，短下肢装具使用）を，三次元動作分析システムKinemaTracer^Ⓡ（キッセイコムテック社製）を用いて，サンプリング周波数60Hzで20秒間記録した。得られたデータから，脳卒中片麻痺患者に特徴的な12種類の異常歩行の重症度の指標値を算出，比較した。統計学的処理は対応のあるt検定を用い，有意水準は5%とした。</p><p></p><p></p><p>【結果】</p><p></p><p>両群の年齢と歩行速度に有意差はなかった。従来群において，遊脚期の膝屈曲不全，分回し歩行，骨盤挙上の値が健常範囲を超えて異常を示し，GEAR群ではこれらの指標値が有意に小さかった（遊脚期の膝屈曲不全：GEAR群40.1±14.0，従来群68.5±18.0，分回し歩行：GEAR群7.5±4.1，従来群11.7±2.0，骨盤挙上：GEAR群4.2±1.7，従来群7.7±2.3）。</p><p></p><p></p><p>【結論】</p><p></p><p>遊脚期の膝屈曲不全は機能障害を示し，分回し歩行と骨盤挙上は麻痺側下肢を振り出すための代償動作である。発症後早期から麻痺側の膝を屈曲させて麻痺側下肢の振り出しをアシストすることにより，麻痺側下肢の振り出しにおける機能障害の改善と過剰な代償の抑制につながったと考えた。</p>

Although a posturography is commonly used for objective evaluation of static balance function, dynamic balance function is usually evaluated only with clinical scales. Simplified objective measurement systems for the evaluation of dynamic balance function need to be developed. In this preliminary study, we attempted to develop an index for the objective measurement of dynamic balance function from COP-COG data. The subjects comprised nine hemiparetic post-stroke patients and five healthy subjects. The simultaneous measurements of COG and COP were performed using a three-dimensional motion analysis system (Kinematracer, KisseiComtec, Japan) combined with force plate analysis. As indices for evaluating dynamic balance function, the latency of COP passing COG after heel contact (LCP) and the averaged |COP| -|COG| subtraction value during stance phase (ASV) were calculated. For evaluating validity of the measurement, the Berg Balance Scale, a frequently used clinical balance scale, was used. The results showed significant differences (0.13 +/- 0.02 vs. 0.29 +/- 0.23 s) between the healthy subjects and patients in LCP, and large, yet insignificant, differences (4.3 +/- 0.5 vs. 2.7 +/- 2.0 cm) in ASV. The ASV was strongly correlated with BBS. A strong correlation was observed between COG acceleration and ASV, except in one patient, who had a severe balance disorder. These results may encourage further investigation into the feasibility of COP-COG measurements for balance measurement.

Background: The toe clearance of a paretic limb in the swing phase of gait is related to tripping, which is considered a major cause of falls. The biomechanical factors for obtaining toe clearance are more complicated in hemiparetic gait than that in normal gait because of the compensatory movements during swing phase. Understanding the biomechanical factors should help in targeting the point for rehabilitative interventions. Objective: To clarify the biomechanical factors behind toe clearance during swing phase in hemiparetic gait. Methods: Fifty patients with hemiparesis after a stroke participated in this study. Three-dimensional motion analysis was used for the kinematic analysis of the hemiparetic gait. The correlation coefficients between limb shortening and angle changes and between limb shortening and hip elevation and foot lateral shift were calculated. Limb shortening was defined as the shortening of the hip-toe distance. The significant factors that determine toe clearance were examined by multiple regression analysis. Independent variables were limb shortening, hip elevation, and foot lateral shift. Results: Limb shortening was negatively correlated with hip elevation (r = -0.75) and foot lateral shift (r = -0.41). Multiple regression analysis showed a significant contribution of limb shortening and hip elevation to toe clearance. The coefficient of determination was 0.95. Conclusions: Toe clearance was mainly determined by limb shortening and hip elevation, which were found to be in a trade-off relationship. These results warrant further investigation into the use of three-dimensional motion analysis in the rehabilitation clinic to facilitate targeted rehabilitative training to restore gait ability.

Objective: The purpose of this study was to analyze the extent to which lower limb shortening and compensatory movements contribute to toe clearance during swing, and to identify the different strategies employed by healthy individuals and hemiplegic stroke patients to achieve toe clearance.<br /> <br /> Methods: The subjects comprised 18 hemiplegic stroke patients and 18 healthy individuals matched for age, gender, and walking speed. We calculated toe clearance and its components for comparison between the two groups. We also calculated the correlations between the components.<br /> <br /> Results: The foot-to-floor distance during mid-swing was smaller in hemiplegic stroke patients than in healthy individuals. Regarding the components, shortening of hip-toe length (SHTL) was smaller in stroke patients, whereas upward movement of the hip due to pelvic obliquity, upward movement of the foot due to abduction, and upward movement of the contralateral hip were all greater. Among hemiplegic stroke patients, there were significant negative correlations between SHTL and the other components.<br /> <br /> Conclusions: Hemiplegic stroke patients achieved smaller upward movement by lower limb shortening compared with healthy individuals. The contribution of hip hiking and other compensatory movements that correlated to SHTL appeared to be important in achieving toe clearance.<br /> <br />