小山 総市朗

Introduction Upper limb motor function and activities of daily living (ADL) are related in chronic stroke patients. This study investigated this relationship after removal of the influence of motor function of the affected lower limb, which until now has remained unclear. Methods This retrospective cross-sectional study included 53 patients with chronic stroke. Upper and lower limb motor function and ADL were assessed using the Fugl-Meyer assessment of the upper (FMA-UL) and lower limbs (FMA-LL) and functional independence measure motor score (FIM-M). To clarify the relationship between FMA-UL and total FIM-M before and after removal of the influence of FMA-LL, Spearman’s rank correlation coefficient and partial correlation analysis were used. The relationship between FMA-UL and each item of FIM-M after removal of the influence of FMA-LL was assessed using partial correlation analysis. Results Before the influence of FMA-LL was removed, FMA-UL was moderately to well correlated with total FIM-M. This became weak after the influence was removed. Regarding each item of FIM-M, FMA-UL was correlated with dressing (upper body), toileting, and walking or wheelchair after removal of the influence. Conclusion The relationship between upper limb motor function and ADL is strongly influenced by lower limb motor function.

介護福祉分野のロボット活用は，高い期待が寄せられている．特に，核家族化と高齢者世帯数増加に伴うマンパワー不足の補填として，介護福祉ロボット開発が盛んである．理学療法士は，要介護者・介護者・医療福祉従事者といった多面的な視点から対象者の生活を支援している．この専門性は，介護福祉ロボットの効果的な使用，開発や普及にも貢献できる．本稿では，私が理学療法士として関わった経験から，在宅支援に役立つロボットと理学療法士の立場について概説する．一般住宅で活用される介護ロボットは，住空間に適応する機器の大きさが共存の必要条件である．また，在宅でのロボットの使用者は，要介護者や介護者，その他の支援者と多様である．ロボットは，誰でも誤りなく安全に使用できるように，多機能ではなく，用途が明確で操作理解が容易であることが，普及の条件である．介護ロボットの使用環境が一般住宅である場合，開発初期から一般的な居住空間で使用者である高齢者のユーザー実証試験が欠かせない．介護福祉ロボット分野への理学療法士の参入は，実用的な支援機器の開発・活用・運用・普及に必要である．

BACKGROUND AND PURPOSE: There are no reports regarding the effect of Lee Silverman Voice Treatment® BIG (LSVT® BIG) on standing balance ability evaluated using quantitative assessment. This case report aimed to describe and evaluate the influence of LSVT® BIG on the center of pressure (COP) trajectory in a patient with Parkinson's disease (PD). METHODS: Although this paper focused on one case, quantitative assessment on the effect of LSVT® BIG on standing balance ability was performed. A 67-year-old woman patient diagnosed with PD at age 59, with a Hoehn and Yahr stage 3 disability severity, underwent a 4-weeks supervised LSVT® BIG program. The total distances of the COP trajectory (two-dimensional [2D] horizontal plane, anterior-posterior [AP] direction, and medial-lateral [ML] direction), and the mean COP velocity for each direction, postural stability, and posture subsections of the Unified Parkinson's Disease Rating Scale (UPDRS) Part 3 were assessed at pre- and post-intervention. RESULTS: The total distances of the COP trajectory, mean COP velocities, and scores of postural stability and posture subsections of the UPDRS Part 3 improved after intervention (from 124.6 to 76.6 cm [2D], 89.4 to 57.7 cm [AP], 77.4 to 38.5 cm [ML]; 4.0 to 2.6 cm/s [2D], 3.0 to 1.9 cm/s [AP], 2.6 to 1.3 cm/s [ML]; and 3 to 0, and 3 to 2, respectively). DISCUSSION: LSVT® BIG may be effective in improving the total distance of the COP trajectory, mean COP velocity, and both postural stability and posture subsections of the UPDRS Part 3 in the presented PD case.

BACKGROUND: There are no reports regarding the long-term retention of effects of Lee Silverman Voice Treatment® BIG (LSVT® BIG) on improvements in quality of life (QOL) among patients with Parkinson's disease (PD). OBJECTIVE: This study aimed to evaluate the short-term effect of LSVT® BIG on QOL improvement and its retention in a patient with PD. Motor symptoms, walking ability, and walking speed were evaluated as factors associated with QOL. METHODS: A 63-year-old woman who was diagnosed with PD received a 4-week LSVT® BIG program under the supervision of certified LSVT® BIG physical therapists. The participant's disease severity was classified as Hoehn and Yahr stage 2. The Parkinson's Disease Questionnaire-39 (PDQ-39), Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part 3, timed up-and-go test (TUG), and 10 m walk test (10 MWT) were evaluated before, after, and 1-year after the intervention. RESULTS: The results indicated short-term improvements in the PDQ-39, MDS-UPDRS part 3, TUG, and 10 MWT which were retained for up to 1 year. CONCLUSIONS: This case report suggests the possibility of 1-year retention of improvements in QOL, motor symptoms, walking ability, and walking speed resulting from LSVT® BIG intervention in a patient with mild PD.

Introduction: Lee Silverman Voice Treatment® BIG (LSVT® BIG) is widely used to improve motor symptoms in patients with mild-to-moderate Parkinson's disease (PD).Objective: To describe the effect of LSVT® BIG on the motor symptoms of a patient with severe PD.Case Description: A 77-year-old woman who was diagnosed with PD received a 4-week LSVT® BIG program under the supervision of certified LSVT® BIG physical therapists. Her disease severity was classified as Hoehn and Yahr stage 4. The unified Parkinson's disease rating scale (UPDRS) part 3, 10-m walk test (10MWT), timed up-and-go test (TUG), Berg balance scale (BBS), and 30-s chair stand test (30-s CST) were used for assessment before and after intervention.Outcomes: The UPDRS part 3, 10MWT, TUG, BBS, and 30-s CST improved after intervention (33 to 26, 0.51 to 0.69 m/s, 38.1 to 23.2 seconds, 11 to 34, and 3 to 9 times, respectively). All improvements exceeded the Minimal Clinically Important Difference or Minimal Detectable Change values (2.5, 0.16 m/s, 3.5 seconds, 5, and 3 times, respectively).Conclusions: These results indicated that LSVT® BIG appears to have improved motor symptoms in a patient with severe PD. Further studies, ideally randomized controlled trials, are needed to confirm these findings.

Background: The rate of force development (RFD) is an indicator of muscle strength. A previous study reported that the RFD of hip abductor muscles was increased by neuromuscular electrical stimulation (NMES) to gluteus medius (GM) during gait in healthy adults. However, the effects for patients following femoral head replacement for hip fracture are unclear. Purpose: The aim of this case report was to investigate the effects of gait training with sub-motor threshold NMES on RFD of hip abductor muscles in two patients following femoral head replacement for hip fracture compared to gait training without NMES. Case description: Two elderly patients following femoral head replacement for hip fracture received both interventions of gait training with sub-motor threshold NMES to GM and without NMES. Intervention phases involved 14 sessions each, for 28 sessions total. Outcomes: The RFD of hip abductor muscles, maximum walking speed, six-minute walk distance (6MWD), Berg Balance Scale, one-leg standing time (OLST), functional independence measure, and Numeric Pain Rating Scale (NPRS) were used as outcome measures. In both patients, RFD, 6MWD, OLST, and NPRS were improved by gait training with NMES compared to without NMES. Conclusion: Our results suggest the potential of NMES as a treatment methodology for these two patients undergoing femoral head replacement for hip fracture.

高齢者の安心、安全、快適かつ活動的な生活を支援する、ロボティックスマートホーム(robotic smart home;RSH)の開発を進めている。これまで2段階で開発を行っており、第1段階では移動/移乗支援、操作支援、情報支援のシステム開発を行った。移動/移乗支援では昇降型、横移乗型、懸架型のロボットを、操作支援では生活支援ロボットと環境制御システムの統合を、情報支援では遠隔地との通信を活用するシステムを、それぞれ検討した。進行中の第2段階では、過剰な生活支援によって日常生活活動の能動性を低下させることなく、活動的な生活を促す住まいづくりを目指し、生活リズム支援、自発機能支援、運動支援の観点から開発を行っている。生活リズム支援ではIoTやセンサの活用による睡眠、排泄、活動などのリズムづくりを、自発機能支援では在宅環境での仮想コンシェルジュ構築を、運動支援では移動/移乗支援ロボットのIoT対応による活動検出などを、それぞれ検討している。(著者抄録)

理学療法・作業療法専攻学生の教育における診療参加型臨床実習(Clinical Clerkship(CC))の効果を、臨床実習中のストレス、睡眠状態、技能習得の点で検証した。従来の臨床トレーニングを行った学生48名(従来群)とCCを行った学生48名(CC群)を対象に、職業性ストレス簡易調査票(BJSQ)、アテネ不眠尺度(AIS)、技能習得評価の成績を比較した。その結果、CC群は従来群と比較してBJSQの量的負担および質的負担の項目の点数が有意に高く、課題のコントロール度、イライラ感、疲労感、抑うつ感、身体愁訴の項目の点数は有意に低かった。またCC群では活気および指導者のサポート項目に関する点数が高かった。AISスコア中央値はCC群で有意に低かった。臨床実習成績の基本的姿勢、治療技術の項目の点数において、従来群よりもCC群で有意に高かった。以上から、当該学生のストレス、睡眠状態、ある種の技能習得に対するCCの効果が示された。

Purpose/aim of the study: An increase of hip abductor muscle strength contributes to the increase in gait speed. It is known that the rate of force development (RFD), an indicator of muscle strength, is increased by the combined use of low-intensity neuromuscular electrical stimulation (NMES) to the glutaeus medius (GM) and low-load resistance training (RT). However, it is unclear whether low-intensity neuromuscular electrical stimulation of the glutaeus medius during walking also increases the rate of force development. The aim of this study was to clarify whether NMES to the GM during gait modulates the RFD of the hip abductor muscles in healthy adults.Materials and methods: Twenty-two healthy adults randomly received both gait with sub-motor threshold NMES and gait with sham NMES conditions. The RFD was assessed at pre- and post-intervention. A two-way repeated measures analysis of variance was used to analyse the effects of time and intervention.Results: Gait with sub-motor threshold NMES condition significantly increased the RFD in shorter time interval (0-50 and 0-100 ms) compared to gait with sham NMES condition.Conclusions: These findings suggest that the adding low-intensity NMES of the GM to gait is effective in increasing the RFD of the hip abductor muscles.

<p>Objectives: The ability to transfer between surfaces is essential for wheelchair users' independence. We hypothesized that transfer of hemiparetic stroke patients would be improved by using surfaces at the same height with no gap or obstacle between them.</p><p>Methods: A cross-sectional study was conducted to compare the difficulty of two transfer methods as a pilot study. Thirteen hemiparetic stroke patients were transferred from a platform table to a chair (wheelchair or flat chair) and from the chair to the table using the regular and lateral transfer methods. Functional Independence Measure (FIM) transfer score in both transfer methods and Stroke Impairment Assessment Set (SIAS) score were measured.</p><p>Results: The FIM transfer score significantly increased in the lateral transfer condition compared with the regular transfer condition, indicating that the former method reduced the transfer difficulty, regardless of the SIAS scores.</p><p>Conclusions: The transfer difficulty of patients with hemiparetic stroke decreases when using the lateral transfer method. The lateral transfer method is easy, potentially helping prevent care-related injuries among caregivers.</p>

INTRODUCTION: Falling is a leading cause of injury-related death. Previous studies reported that an impairment of standing balance is one of the causative factors associated with falling. The combined use of static and dynamic stretching has been reported as a treatment method for improving standing balance. As one of the combined methods, stretching based on Mézières' concept, which has an efficacy on the improvement of body flexibility, has been used. However, it is not fully clear whether stretching based on Mézières' concept can improve standing balance. This study aimed to examine the effects of combined method of static and dynamic stretching of anti-gravitational muscles based on Mézières' concept on body flexibility and standing balance. METHODS: This study employed a quasi-randomized controlled trial design. Thirteen subjects were assigned randomly to one of two groups: stretching or control. A sit and reach test (SRT), functional reach test (FRT), and total trajectory length of center of pressure (COP) during static standing were assessed at pre- and post-intervention. An independent t-test was used to compare the rate of improvement between both groups at each assessment. RESULTS: The stretching group demonstrated a significantly larger rate of improvement in the total trajectory length of COP compared to the control group. In the SRT and FRT, the stretching group showed a trend toward improvement compared to the control group, but did not achieve statistical significance. CONCLUSIONS: The combined use of static and dynamic stretching of anti-gravitational muscles might have the potential to improve the standing balance.

尿失禁と頻尿によって外出不安を呈した通所介護利用者の80代女性に対して、排尿日誌に基づく生活指導と骨盤底筋体操を行った。評価は排尿機能とQOL、活動範囲、身体・認知機能について初回、5ヵ月後、10ヵ月後に実施した。初期評価の排尿日誌から夜間頻尿と夜間多尿を認めた。しかし5ヵ月後以降は、問題を認めなかった。排尿機能とQOLはICIQ-SFが初回5点から5ヵ月後0点に改善を認めた。10ヵ月後のLife-Space Assessmentは41.5点から64.5点に改善した。身体機能は変化を認めなかった。外出事例として、介入から2ヵ月後に県内の催事に1人で行くことができた。排尿日誌に基づいて生活習慣を変え骨盤底筋体操を継続することで、排尿状態に関する不安が軽減されQOLの改善と外出が可能になったと考えられる。(著者抄録)