園田 茂

<p>ヒトでは運動失調の歩行異常に重心動揺が見られる。B6-wob/tマウス（Wob/t）は小脳プルキンエ細胞の変性と脱落により歩行失調が見られことから、重心動揺の測定を試みた。評価するパラメータとして、単位時間あたりの水平方向の軌跡長（trajectory length, TL）と鉛直方向の体重変動（weight variance, WV）を用い、wild typeであるC57BL/6J（B6）マウスと比較した。まず歩行失調を示す四肢の協調運動を見るためにrotarod試験を行ったところ、B6に対しWob/tの回転棒上での歩行持続時間は短く（p<0.001）運動失調であることが示された。さらにオープンフィルド内で、休止状態（standstill state）時のTLとWVを測定したところ、いずれもWob/tの重心動揺はB6に対し有意に強い振幅が見られた（p<0.001）。さらにWob/tに強制歩行訓練（Ex）を行い、体幹振戦に与える影響をWob/t非運動（NEx）群と比較した。その結果、Ex群は、NEx群に対し、TL、WVともに振幅が有意に（p<0.05）弱くなった。またEx群とB6群のTLは有意差（p<0.05）があるものの、WVでは有意差が無くなった。一方、休息時（resting state）はTL、WVともに3群間に差が認められなかった。以上の結果から、B6に対しWob/tは、TLとWVの重心動揺の振幅が大きいことが示された。しかし強制運動歩行訓練を行ったEx群はNEx群よりも重心動揺の振戦が弱められた。以上の結果はWob/tの歩行失調の原因は、小脳プルキンエ細胞脱落による体幹の振戦の影響を受けていること、強制歩行運動により振戦が弱まることが示された。また、resting stateにおいて、B6群、Wob/tのNEx群、Ex群、のTLとWVの重心動揺に有為差が認められなかったのは、休息時が傾眠状態にあり、Wob/tの小脳性振戦はヒトと同様、運動時に現れる姿勢振戦で同じと考えられる。</p>

[Purpose] The motor paralysis-improving effect on the hemiplegic lower limb was compared among mirror therapy, integrated volitional-control electrical stimulation, therapeutic electrical stimulation, repetitive facilitative exercises, and the standard training method in post-stroke hemiplegia patients. [Subjects and Methods] Eighty one stroke patients admitted to a convalescent rehabilitation ward were randomly allocated to the above 5 treatment groups. Each patient performed functional training of the paralytic lower limb for 20 minutes a day for 4 weeks, and changes in the lower limb function were investigated using the Stroke Impairment Assessment Set. [Results] The hip and knee joint functions did not significantly improve in the standard training control group, but significant improvements were observed after 4 weeks in the other intervention groups. Significant improvement was noted in the ankle joint function in all groups. [Conclusion] Although the results were influenced by spontaneous recovery and the standard training in the control group, the hip and knee joints were more markedly improved by the interventions in the other 4 groups of patients with moderate paralysis, compared to the control group.

Background: We investigated differences in factors affecting judgments regarding the creation of new adjustable posterior strut knee-ankle-foot orthoses (APS-KAFO) and knee-ankle-foot orthoses with metal struts (traditional KAFO) for hemiplegic stroke patients for whom KAFO were created in rehabilitation wards. Methods: Subjects were 50 patients with hemiplegia due to new-onset stroke (cerebral infarction: n = 25, cerebral hemorrhage: n = 25) who were prescribed KAFO. Patient ages ranged from 36 to 90 years, and the mean duration from stroke onset to hospitalization was 28.8 +/- 13.8 days. Neurologic symptoms, cognitive function, activities of daily living, duration from hospitalization to orthosis creation, hospitalization duration, walking ability at discharge, outcome after discharge, and so forth were compared. Results: Fourteen patients were prescribed APS-KAFO, and 36 were prescribed traditional KAFO. Those prescribed APS-KAFO had somewhat milder neurologic symptoms and cognitive dysfunction and a shorter hospitalization duration than those prescribed traditional KAFO. Patients prescribed APS-KAFO also had a higher score and efficiency on functional independence measure at admission and discharge. Walking independence at discharge was seen in 8 of the 14 patients for whom APS-KAFO were created and 8 of the 36 patients for whom traditional KAFO were created. Conclusions: APS-KAFO was chosen for patients with a high level of activity in the ward and with a higher likelihood of acquiring walking ability using APS-AFO at discharge, whereas traditional KAFO tended to be chosen for patients with relatively severe symptoms who were not expected to acquire practical walking ability.

[Purpose] To develop a device for measuring the torque of an ankle joint during walking in order to quantify the characteristics of spasticity of the ankle and to verify the functionality of the device by testing it on the gait of an able-bodied individual and an equinovarus patient. [Subjects and Methods] An adjustable posterior strut (APS) ankle-foot orthosis (AFO) was used in which two torque sensors were mounted on the aluminum strut for measuring the anterior-posterior (AP) and medial-lateral (ML) directions. Two switches were also mounted at the heel and toe in order to detect the gait phase. An able-bodied individual and a left hemiplegic patient with equinovarus participated. They wore the device and walked on a treadmill to investigate the device's functionality. [Results] Linear relationships between the torques and the corresponding output of the torque sensors were observed. Upon the analyses of gait of an able-body subject and a hemiplegic patient, we observed toque matrices in both AP and ML directions during the gait of the both subjects. [Conclusion] We developed a device capable of measuring the torque in the AP and ML directions of ankle joints during gait.

[Purpose] The purpose of this study was to find whether a fast treadmill gait training speed is effective for the gait training of stroke patients in the early rehabilitation stage. [Subjects and Methods] Thirty-nine stroke patients were the subjects of our investigation. They walked on a treadmill with handrail supports at a fast speed (130% of their comfortable gait speed in the 2nd week). The treadmill gaits of the patients were recorded using a 3-dimensional analysis system at two and six weeks after their admissions. Intraclass Correlation Coefficients (ICC) of the temporal and spatial parameters of the two periods were statistically analyzed. [Results] For all of the patients, the ICCs of the measured parameters were greater than 0.58. In the case of patients whose gait speeds of the two periods were close, the ICC units were greater than 0.7. [Conclusion] The fast gait speed training allowed us to expose the patients to a gait speed that they were expected to acquire at a later stage of their rehabilitation. This training method was found to be beneficial for the mildly paralyzed patients.

要旨：【目的】回復期リハビリテーションを実施した脳卒中患者において，言語性・非言語性知能がADL 改善に及ぼす影響を検討した．【方法】回復期リハビリを施行した脳卒中患者146 名に対し，RCPM（Raven's Colored Progressive Matrices）とMMSE（Mini-Mental State Examination）を施行し，ADL 改善に与える影響について検討した．【結果】MMSE のみの低下（M 群）は，左半球損傷で言語障害例に多く，RCPM のみ低下（R 群）では右半球損傷で視空間認知障害例に多かった．M 群は両者で低下のないもの（N 群）とADL 改善に差はなかった．R 群はN 群より在院日数が長く，退院時ADL が低かった．両者共に低下したもの（MR 群）は他の群に比べ，退院時ADL が低く，ADL 改善効率が低かった．また，MR 群はN 群より在院日数が長かった．【結論】MMSE は言語性，RCPM は非言語性知能を反映しており，両者の成績は退院時ADL やADL の改善に影響を与えることが示唆された．

【目的】三次元動作解析装置を用いた片麻痺運動障害の定量的評価法Quantified Paralysis Performance Assessment(QPPA)を開発し,臨床場面で使用する前段階として,再現性と,最小可検変化量を検証することである.【方法】初発脳卒中患者66名(男性39名,女性27名,年齢60±12歳(平均±標準偏差))を対象として,QPPAでの計測を2回1セットで行った.計測は上肢機能(腕=QPPA-UE),下肢機能(股関節=QPPAHip,膝関節=QPPA-Knee,足関節=QPPA-Ankle)の4種類を行い,各指標マーカの挙上距離と最大速度を代表値とした.1セットの計測の各代表値から,級内相関係数(Intraclass correlation coefficient;ICC),および,最小可検変化量(minimal detectable change)の95%信頼区間(以下,MDC95)を算出した.【結果】急性期の同一症例から2週間以上の間隔を空けて,2セットの計測値が得られた場合は,別のデータとして分析を行い,総計91セットの計測値からQPPA指標におけるICC0.956〜0.989およびMDC95 4.56〜6.79%を得た.【結論】QPPAの代表値は高い再現性を示した.また,最小可検変化量は小さく,順序尺度の評価法より臨床的変化を鋭敏に捉えられると推測された.(著者抄録)

Aloe vera gel exhibits protective effects against insulin resistance as well as lipid-lowering and anti-diabetic effects. The anti-diabetic compounds in this gel were identified as Aloe-sterols. Aloe vera gel extract (AVGE) containing Aloe-sterols has recently been produced using a new procedure. We previously reported that AVGE reduced large-sized intestinal polyps in Apc-deficient Min mice fed a high fat diet (HFD), suggesting that Aloe vera gel may protect against colorectal cancer. In the present study, we examined the effects of Aloe vera gel powder (AVGP) and AVGE on azoxymethane-induced colorectal preneoplastic aberrant crypt foci (ACF) in mice fed a HFD. Male C57BL/6J mice were given a normal diet (ND), HFD, HFD containing 0.5% carboxymethyl cellulose solution, which was used as a solvent for AVGE (HFDC), HFD containing 3% or 1% AVGP, and HFDC containing 0.0125% (H-) or 0.00375% (L-) AVGE. The number of ACF was significantly lower in mice given 3% AVGP and H-AVGE than in those given HFD or HFDC alone. Moreover, 3% AVGP, H-AVGE and L-AVGE significantly decreased the mean Ki-67 labeling index, assessed as a measure of cell proliferation in the colonic mucosa. In addition, hepatic phase II enzyme glutathione S-transferase mRNA levels were higher in the H-AVGE group than in the HFDC group. These results suggest that both AVGP and AVGE may have chemopreventive effects on colorectal carcinogenesis under the HFD condition. Furthermore, the concentration of Aloe-sterols was similar between 3% AVGP and H-AVGE, suggesting that Aloe-sterols were the main active ingredients in this experiment.

Obesity markedly increases the risk of colorectal cancer. Recently, the preventive effects of edible mushrooms on triglyceride elevation and visceral fat accumulation have been reported. Here, the effects of Pleurotus eryngii (Eringi) and Hypsizygus marmoreus (Bunashimeji) on azoxymethane (AOM)-induced aberrant crypt foci (ACF precancerous lesions) in the colorectums of mice fed a high-fat diet were examined. Eringi (ER) and Bunashimeji (BU) mushroom powder samples were used. Six-week-old male C57BL/6J mice received an intraperitoneal injection of AOM (10 mg/kg) once a week for two weeks, and were sacrificed and dissected at 6 weeks after the start of the experiment. After the initiation of the experiment, they received a normal diet (ND), high-fat diet (HFD), HFD + ER (1 or 5% of diet), or HFD + BU (1 or 5% of diet). As a result, body and fat weights were significantly lower in the 5% ER and BU groups than in the HFD group. Liver triglyceride levels were also significantly lower in the 5% ER and BU groups. Total liver cholesterol levels were significantly lower in the 5% ER group. The numbers of ACF (especially large ACF) showed strong inhibitory effects in both ER and BU groups. Measurement of the cell proliferation marker Ki-67 labeling index in the colonic mucosa demonstrated more significant suppression in both ER and BU groups than in the HFD group. These results suggest that the simultaneous intake of ER and BU may inhibit colorectal tumorigenesis in HFD-fed mice.

Patients with pontine hemorrhage usually experience severe disturbances of consciousness, pupillary abnormalities, quadriparesis, and respiratory failure. However, little is known regarding cognitive dysfunction in patients with pontine hemorrhage. We report the case of a rehabilitation patient presenting with hemiplegia, ataxia, and cognitive dysfunction caused by a pontine hemorrhage. A 55-year-old, right-handed male suffered sudden onset of vertigo, dysarthria, and hemiplegia on the right side. He was diagnosed with brain stem hemorrhage, and conservative treatment was administered. The vertigo improved, but dysarthria, ataxia, hemiplegia, and gait disorder persisted. He was disoriented with respect to time and place and showed a poor attention span, impaired executive function, and reduced volition. A computed tomography revealed hematomas across the pons on both sides, but no lesions were obvious in the cerebellum and cerebrum. Single-photon emission tomography showed decreased perfusion in the brain stem, bilateral basal ganglia, and frontal and parietal lobes in the left hemisphere. The patient received exercise therapy and cognitive rehabilitation, and home modifications were performed to allow him to continue living at home under the supervision of his family. His symptoms improved, along with enhanced regional cerebral blood flow to the frontal and temporal lobes. These findings suggest that the pontine hemorrhage caused diaschisis resulting in secondary reduction of activity in the cerebral hemisphere and the occurrence of cortical symptoms. Therefore, rehabilitation is necessary, along with active instructions for the family members of patients with severe neurological deficits. This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

[Purpose] The aim of this study was to investigate the recovery process of standing postural control in hemiplegia after stroke. [Subjects and Methods] Thirty-four inpatients with hemiparesis after first-onset stroke were included in this study. We measured the center of pressure fluctuations during quiet standing using a force platform at 2, 4, and 6 weeks after admission. We assessed weight-bearing asymmetry, and velocity and amplitude of body sway. [Results] Weight-bearing asymmetry diminished in the first 2 weeks of observation. Velocity of body sway also decreased significantly in the first 2 weeks, though its amplitude only decreased significantly after 4 weeks of observation. [Conclusion] Amplitude of body sway requires a longer time for significant improvement than weight-bearing asymmetry and velocity of body sway. Although the loading function of the paretic lower limb improved at an early stage, attainment of optimum postural control, including management of the affected paretic lower limb, requires much time.

Predicting recovery from hemiparesis after stroke is important for rehabilitation. A few recent studies reported that the levels of some growth factors shortly after stroke were positively correlated with the clinical outcomes during the chronic phase. The aim of this study was to examine the relationships between the serum levels of growth factors (vascular endothelial growth factor [VEGF], insulin-like growth factor-I [IGF-I], and hepatocyte growth factor [HGF]) and improvement in hemiparesis in stroke patients who received rehabilitation in a postacute rehabilitation hospital. Subjects were 32 stroke patients (cerebral infarction: 21 and intracerebral hemorrhage [ICH]: 11). We measured serum levels of VEGF, IGF-I, and HGF and 5 items of the Stroke Impairment Assessment Set (SIAS) for hemiparesis on admission and at discharge. Age-matched healthy subjects (n 5 15) served as controls. Serum levels of VEGF and HGF in cerebral infarct patients on admission were higher than those in control subjects, and the serum levels of IGF-I in stroke patients were lower than those in controls. The level of HGF in ICH patients on admission was negatively correlated with gains in SIAS, and higher outliers in HGF concentration were correlated with lower gains in SIAS. Focusing on the extremely high levels of these factors may be a predictor of the low recovery from hemiparesis after stroke.

Purpose: The purpose of this study was to identify major risk factors of the falls of the patients with stroke whom live at home by analyzing patients' information and functional evaluation tools data such as FIM (Functional Independence Measure) instrument and SIAS (Stroke Impairment Assessment Set). Methods: Sixty-four stroke outpatients who had earlier discharged from Fujita Health University Nanakuri Sanatorium were participated in our study. We evaluated the following baseline characteristics for all patients: age, sex, stroke type, affected side of the body, number of stroke suffered, maximum walking speed, use of ankle foot orthosis, use of cane, use of medicine that may increase the risk of falling, and frequency of the falls of the patient during their rehabilitation period in the hospital, FIM, SIAS, and Mini-Mental State Examination scoring were also done before their discharge from the hospital. We first carried out bivariate analysis to determine which variables differed significantly between the non-fallers and fallers. Those variables of significant statistical values were then included in a multivariate logistic regression analysis. The model was simplified in a Forward Selection Method (Likelihood Ratio) by removing variables. Results: Those patients with a falling experience comprised 25 patients out of the total 64 patients (39.1% ). The logistic model was refined until it excluded all the predictors except two. These two predictors were maximum walking speed, and use of ankle foot orthosis. Conclusions: Those patients with a slow speed of walking and/or the patients who required the use of ankle foot orthosis were at a higher risk of falling.

【目的】脳卒中患者の退院直前の各種医療情報を多変量解析することで転倒予測に関わる要因を検討することを目的とした。【方法】対象は,当院を退院した脳卒中患者64名である。退院時の年齢,性別などのプロフィールの他,Functional Independence Measure, Stroke Impairment Assessment Set,最大歩行速度,下肢装具,杖,転倒に関わる薬剤の使用,Mini-Mentai State Examination,入院中の転倒などを測定・調査し,変数増加法(尤度比)ロジスティック回帰分析から転倒予測要因を抽出した。【結果】退院6ヵ月後の転倒率は39.1%であった。転倒が予測されたのは最大歩行速度が時速2.5km以下の患者と,下肢装具を使用している患者であった。【結論】脳卒中患者の歩行速度には運動麻痺が大きく影響し,下肢装具は運動機能の補助として使用されることを考慮すると,下肢運動麻痺と深く関連する因子が転倒予測因子として抽出されたと考えられた。

We examined the effects of high temperature- and pressure-treated garlic (HITPG), which has enhanced anti-oxidative activity, on 1, 2-dimethylhydrazine (DMH)-induced mucin-depleted foci (MDF), as premalignant lesions, in the rat colorectum at the post-initiation stage. Male F344 rats (5 weeks old) were injected s.c. with DMH (40 mg/kg, once weekly for 2 weeks). Rats were fed basal diet or experimental diets containing 1% or 3% HTPG for 6 weeks, starting 1 week after the last injection of DMH. At sacrifice, the number of MDF in the 3% HTPG diet group was significantly lower than that in the basal diet group. In addition, we also studied the influence of 3% HTPG diet ingestion. Rats were fed basal diet or 3% HTPG diet under the above conditions without DMH treatment. The 3% HTPG diet did not affect most hematological and plasma biochemical parameters. These results, combined with our previous work (APJCP, 2009), suggest that HTPG may be useful as a health supplement.