宮坂 裕之

Practicing walking in a safety suspension device allows patients to move freely and without excessive reliance on a therapist, which requires correcting errors and may facilitate motor learning. This opens the possibility that patients with subacute stroke may improve their walking ability more rapidly. Therefore, we tested the hypothesis that overground gait training in a safety suspension device will result in achieving faster supervision-level walking than gait training without the suspension device. Twenty-seven patients with stroke admitted to the rehabilitation ward with functional ambulation categories (FAC) score of 2 at admission were randomly allocated to safety suspension-device group (SS group) or conventional assisted-gait training group (control group). In addition to regular physical therapy, each group underwent additional gait training for 60 min a day, 5 days a week for 4 weeks. We counted the days until reaching a FAC score of 3 and assessed the probability using Cox regression models. The median days required to reach a FAC score of 3 were 7 days for the SS group and 17.5 days for the control group, which was significantly different between the groups (P < 0.05). The SS group had a higher probability of reaching a FAC score of 3 after adjusting for age and admission motor impairment (hazard ratio = 3.61, 95% confidence interval = 1.40-9.33, P < 0.01). The gait training with a safety suspension device accelerates reaching the supervision-level walking during inpatient rehabilitation. We speculate that a safety suspension device facilitated learning by allowing errors to be experienced and correct in a safe environment.

Neuromuscular electrical stimulation (NMES), specifically functional electrical stimulation (FES) that compensates for voluntary motion, and therapeutic electrical stimulation (TES) aimed at muscle strengthening and recovery from paralysis are widely used in stroke rehabilitation. The electrical stimulation of muscle contraction should be synchronized with intended motion to restore paralysis. Therefore, NMES devices, which monitor electromyogram (EMG) or electroencephalogram (EEG) changes with motor intention and use them as a trigger, have been developed. Devices that modify the current intensity of NMES, based on EMG or EEG, have also been proposed. Given the diversity in devices and stimulation methods of NMES, the aim of the current review was to introduce some commercial FES and TES devices and application methods, which depend on the condition of the patient with stroke, including the degree of paralysis.

要旨：脳卒中患者の麻痺側上肢訓練の一つとして電気刺激療法があり，運動麻痺改善や痙縮抑制効果などが報告されている．われわれは電気刺激療法の一種である随意運動介助型電気刺激(IVES)を回復期脳卒中患者の麻痺側上肢に行い，治療同日の持続効果について検討した．IVESによる訓練は1週間継続し，開始時と1週間後の治療前，治療直後，治療後から30分毎に120分後までの手関節背屈自動運動角度の経時変化を評価した．手関節背屈自動運動角度は，開始時に比べ，有意な改善がみられた．SIAS，MASは開始時と比べ，改善を認めたが有意差はみられなかった．また，治療直後の角度が有意に低下するのが開始時は治療後60分，1週間後は治療後90分であり，継続した使用により効果が持続されやすいと考えられた．

省スペースの定常環境下にて多数歩採取が容易となるトレッドミルを用いて三次元動作解析を行い,歩行中の足部内外反運動の計測を試み,その計測方法と分析結果について検討した.整形および中枢疾患の既往歴のない健常成人男性5例を対象とした.平均歩数は,12.2歩であった.歩行周期の内外反運動は,踵接地では内反位を呈し,立脚中期に正中および軽度外反位,立脚中期から遊脚期にかけて内反になる運動パターンの傾向を示し,5例ともほぼ同じ傾向であった.トレッドミル歩行分析では,多数歩にて正規化後加算平均処理が容易となるため,歩行周期の足部内外反運動を明確に示すことが可能になった.また,標準偏差,変動係数といった統計学的検討も可能となるため,臨床の歩行分析において非常に有用な指標になると思われた