寺西 利生

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.

OBJECTIVE: To examine the effect of in-bed leg cycling exercise on patients with intensive care unit-acquired weakness (ICU-AW). DESIGN: Single-center retrospective study. SUBJECTS/PATIENTS: Patients admitted to the ICU between January 2019 and March 2023 were enrolled in the ergometer group, and those admitted to the ICU between August 2017 and December 2018 were enrolled in the control group. METHODS: The ergometer group performed in-bed leg cycling exercises 5 times per week for 20 min from the day of ICU-AW diagnosis. Furthermore, the ergometer group received 1 early mobilization session per day according to the early mobilization protocol, whereas the control group received 1 or 2 sessions per day. The number of patients with recovery from ICU-AW at ICU discharge and improvement in physical functions were compared. RESULTS: Significantly more patients in the ergometer group recovered from ICU-AW than in the control group (87.0% vs 60.6%, p = 0.039). Regarding physical function, the ergometer group showed significantly higher improvement efficiency in Medical Research Council sum score (1.0 [0.7-2.1] vs 0.1 [0.0-0.2], p < 0.001). CONCLUSION: In-bed leg cycling exercise, in addition to the early mobilization protocol, reduced the number of patients with ICU-AW at ICU discharge.

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: Wearable robotic exoskeletons (WREs) have been globally developed to achieve gait reconstruction in patients with spinal cord injury (SCI). The present study aimed to enable evidence-based decision-making in selecting the optimal WRE according to residual motor function and to provide a new perspective on further development of appropriate WREs. Methods: The current review was conducted by searching PubMed, Web of Science, and Google Scholar for relevant studies published from April 2015 to February 2020. Selected studies were analysed with a focus on the participants' neurological level of SCI, amount of training (number of training sessions and duration of the total training period), gait speed and endurance achieved, and subgroup exploration of the number of persons for assistance and the walking aid used among patients with cervical level injury. Results: A total of 28 articles (nine using Ekso, three using Indego, ten using ReWalk, one using REX, five using Wearable Power-Assist Locomotor) involving 228 patients were included in the analysis. Across all WREs, T6 was the most frequently reported level of SCI. The amount of training showed a wide distribution (number of training sessions: 2-230 sessions [30-120 min per session]; duration of the total training period: 1-24 weeks [1-5 times per week]). The mean gait speed was 0.31 m/s (standard deviation [SD] 0.14), and the mean distance on the 6-min walking test as a measure of endurance was 108.9 m (SD 46.7). The subgroup exploration aimed at patients with cervical level injury indicated that 59.2% of patients were able to ambulate with no physical assistance and several patients used a walker as a walking aid. Conclusion: The number of cervical level injury increased, as compared to the number previously indicated by a prior similar review. Training procedure was largely different among studies. Further improvement based on gait performance is required for use and dissemination in daily life. The translational potential of this article: The present review reveals the current state of the clinical effectiveness of WREs for gait reconstruction in patients with SCI, contributing to evidence-based device application and further development.

理学療法士は臨床経験が増すにつれ、毎年より多くの転倒などの事故を経験するか、さらに実務の最初の年に事故を経験することが2年目の事故に関連しているか調べた。療法士642名を臨床経験年数(1年、2年、3年、4年、5〜20年)に基づいて5群(それぞれ138名、112名、117名、58名、217名)に分け、8年間で報告された事故を集計した。1〜3年群と5〜20年群の間で有意差が明らかになり、5〜20年群の療法士は他の群よりも事故が少なかった。1年目に事故に遭遇した療法士は、そうでなかった療法士と比較して、2年目に事故が有意に増加した。以上より、1〜3年の臨床経験の療法士は5年を超える臨床経験のある療法士よりも事故に遭遇する可能性が高く、事故を経験した若い療法士は、将来事故を起こしやすいと結論づけられた。

AimWe aimed to clarify whether there are differences in the effect of exercise interventions between prefrail older adults and older adults without frailty. MethodsThe participants were community-dwelling older adults (mean age 75.1 5.1 years). The participants were instructed to use a training method at home to prevent frailty. The effects of the intervention were evaluated at 4 months. Outcome measures were the Timed Up and Go test, grip strength, one leg balance, knee extension strength and the fall risk index. The present study used the criteria for frailty status of the National Center for Geriatrics and Gerontology in Japan. The studied sample included prefrail participants (n = 17) and robust participants (n = 24). We compared the value of outcome measures before and after the intervention in each group using two-way repeated measures analysis of variance. ResultsThere were significant differences for the group effect for one leg balance (P &lt; 0.01), and there were significant differences for the time effect for Timed Up and Go, one leg balance and knee extension strength (P &lt; 0.01). In these outcomes, there were no significant interactions between frailty status and intervention. Four prefrail participants (mean age 78.0 +/- 3.8 years) returned to the robust status after the intervention. No participants became frail. ConclusionsThese results suggest that we can expect similar interventional effects for prefrail older adults and robust older adults. It is important that a frail status be prevented in prefrail older adults by using an exercise intervention. Further studies are required to determine the different effects of exercise intervention on prefrail status compared with frailty status in community-dwelling older adults. Geriatr Gerontol Int 2017; 17: 1265-1269.

Background With the development of computer technology, computerized dynamic posturography provides objective assessments of balance and posture control under static and dynamic conditions. Although a force-instrumented treadmill-based balance assessment is feasible for balance evaluations, currently no data exists. Objective This study was undertaken to assess the reliability and validity of balance evaluations using a force-instrumented treadmill. Methods Ten healthy adults participated in evaluations using both the treadmill and the EquiTest. Four balance evaluations were conducted: Modified Clinical Test of Sensory Interaction on Balance, Unilateral Stance, Weight Bearing Squat, and Motor Control Test. Results All balance evaluations using the force-instrumented treadmill method shared good reliability (intraclass correlation coefficient ≥0.6). The Modified Clinical Test of Sensory Interaction on Balance, Unilateral Stance, and Weight Bearing Squat evaluations had a correlation of r &lt  0.5 with EquiTest, whereas the Motor Control Test balance evaluation had moderate correlations (r &gt  0.5) with the EquiTest. Conclusion The results demonstrated that all balance evaluations using the force-instrumented treadmill were reliable, and that the Motor Control Test evaluation was moderately correlated with the EquiTest. Therefore, the use of a force-instrumented treadmill in balance evaluations might provide a certain level of value to clinical practice.

Objective: To investigate factors affecting the occurrence of falls during the early stage of hospitalization in a Kaifukuki (convalescence) rehabilitation ward.<br /> <br /> Methods: The subjects were 545 hospitalized patients, divided into a fall group (having experienced a fall within 14 days following admission) and a non-fall group. Differences between the two groups in terms of the Standing Test for Imbalance and Disequilibrium (SIDE) level and in the subscales of the Functional Independence Measure (FIM) were investigated. Logistic regression was carried out on items for which there were significant differences between the groups as dependent variables and the occurrence of falls as the objective variable, and the odds ratios were computed.<br /> <br /> Results: The fall group comprised 36 subjects. Significant differences between groups were found in the SIDE level, lower body dressing, bath transfer, stairs, social interaction, problem solving, and memory. Logistic regression only identified problem solving as associated with the occurrence of falls (odds ratio, 0.288; p=0.035). For the SIDE level, complete separation of non-fall subjects was seen at levels of 2b or higher.<br /> <br /> Conclusion: Falls in the early stage following admission do not occur among individuals with good balance, and problem solving according to the FIM is involved in falls.

Objective: We investigated the effect of botulinum toxin type A for upper limb spasticity on activities of daily living using the Disability Assessment Scale (DAS).<br /> Methods: The subjects were 47 patients who received botulinum therapy for upper limb spasticity. They were assessed before administration and 2, 6, and 12 weeks after administration by using the DAS, the Modified Ashworth Scale (MAS), and upper-limb-related parameters from the Fugl-Meyer Assessment (FMA).<br /> Results: DAS scores for hygiene, dressing, and limb position improved significantly 2 and 6 weeks after administration (p &lt; 0.05), but there was no significant change in pain. MAS scores exhibited significant improvement 2, 6, and 12 weeks after administration, and the total scores for FMA upper-limb parameters exhibited significant improvement 2 and 6 weeks after administration (p &lt; 0.05).<br /> Conclusion: Botulinum therapy contributes to improving not only the spasticity itself, but also to improving difficulties in activities of daily living associated with upper limb spasticity.

<p>【はじめに，目的】近年，療法士養成数の増加に伴い，臨床経験の少ない療法士が急速に増加し，実習指導者の経験年数も相対的に低下している。また，現在の臨床実習では，実習指導者間の評価基準の相違が問題点の一つとして指摘されている。実習指導者による評価は，主観的で評価者の経験による影響を受け易く，信頼性に問題があるとも言われている。しかし，信頼性について効果検証を行った報告は少ない。</p><p></p><p>そこで本研究では，実習生の臨床技能を段階づけする際の評価者間信頼性を検討した。</p><p></p><p></p><p>【方法】評価者は療法士10名（経験年数4-12年目）とした。実習生が患者に対し，課題を行ったビデオ画像20施行を評価者に観察させ，臨床技能を5段階に段階づけさせた。課題は肩関節外転の関節可動域測定とした。評価する際のポイントは市販の書籍（PT・OTのための臨床技能とOSCE：コミュニケーションと介助・検査測定論）の採点基準に準じて行わせた。段階づけした結果の評価者間信頼性を検討するため，Cohenの一致係数（κ係数）を用いて，完全一致と，1段階のズレを半分一致として重み付けしたκ係数をそれぞれ45組算出し，平均した。さらに評価者を経験年数にて6年以上群5名と6年未満群5名の2群に分け，各々のκ係数10組の平均を算出した。また，各評価者の評点間の相関および差を比較するために，45組のSpearman順位相関係数，およびWilcoxon符号付き順位検定を行った。</p><p></p><p></p><p>【結果】臨床技能評価の一致率はκ=0.08，重み付きκ=0.15であった。6年以上群の一致率はκ=0.24，重み付きκ=0.31，6年未満群の一致率はκ=0.09，重み付きκ=0.15であった。評点に有意な相関を認めたのは14組（31%）であり，有意差を認めた組み合わせは45組中28組（62%）であった。</p><p></p><p></p><p>【結論】本研究より，全体の一致率はslight～fairにとどまり，実習生の臨床技能を段階づけする際の評価者間信頼性は低いことが明らかとなった。6年目以上群において一致率が高くなる傾向を認めたが，評価者間信頼性としては低いことから，信頼性の低さは臨床実習において広く存在する現象である可能性がある。また，評価者間の評点の相関が低く，かつ中央値に有意差を認めた組み合わせが多かったことから，一致率を低下させた要因は各評価者の評価基準が主観的であるためと考えた。本研究では，臨床使用の頻度が高い1課題を検証したが，その他の臨床技能においても同様の現象が起こる可能性があり，更なる検証が必要であると考える。</p><p></p><p>今後，実習生の臨床技能を段階づけする際の評価者間信頼性を向上させるためには，臨床技能を標準化・細分化し，解釈を統一した上で，明示的な基準を定める必要があると考えられる。</p>

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 />

Recently, health awareness in Japan has been increasing and active exercise is now recommended to prevent lifestyle-related diseases. Cytokine activities have many positive effects in maintaining the health of a number of organs in the body. Myokines are cytokines secreted by skeletal muscles in response to exercise stimulation, and have recently generated much attention. Around 700,000 patients in Japan suffer from rheumatoid arthritis, making it the most prevalent autoimmune disease that requires active prevention and treatment. In the present study, a mouse model of spontaneous arthritis (SKG/Jcl) was subjected to continuous exercise stimulation, starting before the disease onset, to examine the effects of anti-inflammatory and inflammatory cytokine secretion on arthritis. For this stimulation, we developed a device that combines shaking and vibration. The results revealed that exercise stimulation delayed the onset of arthritis and slowed its progression. Thickened articular cartilage and multiple aggregates of chondrocytes were also observed. Further, exercise stimulation increased the expression of IL-6, IL-10, and IL-15, and inhibited TNF-α expression. From these results, we infer that the anti-inflammatory effects of IL-6 and IL-10, which showed increased expression upon exercise stimulation, inhibited the inflammatory activity of TNF-α and possibly delayed the onset of arthritis and slowed its progression. Novel methods for preventing and treating arthritis under clinical settings can be developed on the basis of these findings.

[Purpose] The number of bedridden patients requiring nursing care in Japan has increased sharply in recent years because of its aging population and advances in medical care and has become a major social issue. Because bedridden patients are susceptible to nursing and healthcare-associated pneumonia, it is very important to improve their immunocompetence. Therefore, the effect of exercise therapy on stimulation of cytokine secretion in the saliva of bedridden patients was investigated. [Subjects and Methods] The subjects of this study were bedridden patients admitted to nursing care facilities. They were instructed to perform active assistive movement in the supine and sitting positions, with vital signs used as an index of the exercise load. Thirty-five patients fulfilled the inclusion criteria, which included cerebrovascular disease as the main cause of being bedridden and at least 6 months since onset. Interleukins were measured by enzyme-linked immunosorbent assay as immune mediators. [Results] Vital signs improved significantly after therapeutic exercise intervention, and the IL-6, IL-8, IL-15, and IL-17 levels also increased significantly after the intervention. [Conclusion] The results demonstrated that measurement of saliva samples may offer a safe minimally invasive method of measuring immune response in bedridden patients. This study suggests that exercise therapy may hold promise as an effective means of improving immunity in bedridden patients and may contribute to preventing aspiration pneumonia and promoting spontaneous recovery.

Background: Gait assessment is important to determine the most effective strategy to regain gait function during stroke rehabilitation. To understand the mechanisms that cause abnormal gait patterns, it is useful to objectively identify and quantify the abnormal gait patterns. Objective assessment also helps evaluate the efficacy of treatments and can be used to provide suggestions for treatment. Objective: To evaluate the validity of quantitative indices for retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegic patients. Methods: Forty-six healthy control subjects and 112 hemiplegic patients participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the three abnormal gait patterns was calculated from the three-dimensional coordinate data. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment by three physical therapists with expertise in gait analysis. Results: Strong correlation was observed between the index value and the median observational rating for all three abnormal gait patterns (-0.56 to -0.74). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects. Conclusions: The proposed indices are useful for clinical gait analysis. Our results encourage a more detailed analysis of hemiplegic gait using a motion analysis system.

[Purpose] This study examined the effects of clinical training focusing on level-3 OSCE (analytical and therapeutic skills) items, and compared the achievement levels of physical (PT) and occupational (OT) therapist students. [Subjects] A total of 282 (165 PT and 117 OT) students enrolled at our university between 2008 and 2010 were studied. [Methods] OSCE scores were compared between before and after clinical training focusing on level-3 OSCE items, and between PT and OT students. [Results] Scores for 5 out of the 6 level-3a items were significantly higher after than before clinical training. Increases in scores of 2 or 3 level-3b and -3c items were also observed after clinical training. There were no marked differences between PT and OT students in scores for level-3a, -3b, and -3c items before clinical training. In contrast, after clinical training, OT students' scores for 3a and 3c items related to dressing were higher than those of PT students, and the latter's scores for 3b items related to transfer were higher than those of the former. [Conclusion] The results suggest level-3 OSCE items are effectively taught during clinical training.

[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.

【はじめに】地域在住での比較的自立度の高い高齢者であっても，転倒リスクは経年的に上昇すると報告されており，早期より転倒ハイリスク者を識別し，転倒予防活動を展開する必要がある。われわれは，文部科学省の高齢者向けの新体力テストを用い，屋外歩行が自立している地域在住高齢者の転倒を予測できるのではないかと考えた。本研究の目的は，屋外歩行が自立している地域在住高齢者を対象に，「過去１年間の転倒経験の有無」と「新体力テスト6項目」の結果を比較検討し，転倒に関係する評価を明らかにすることである。【方法】対象は，地区の公民館まで自力で通うことができる60歳以上の地域在住高齢者とした。新体力テストは，握力・上体起こし・長座体前屈・開眼片足立ち・10m障害物歩行・6分間歩行の6項目を実施した。質問紙調査から，対象を過去１年間に転倒経験がある群と転倒経験のない群の2群に分類し，6項目の平均値の差をMann-Whitney U検定にて比較分析した。さらに，有意差（p＜0.05）のあった項目を独立変数，転倒経験の有無を従属変数とした多重ロジスティック回帰分析を行い，転倒発生のOdds比を求めた。また転倒経験の有無を状態変数としてROC曲線を描き，AUC， Cut off値，転倒予測感度，特異度を求めた。【結果】女性高齢者76名（年齢73.6±8.3歳）中，質問紙の結果から，転倒群は12名（年齢73.4±7.6歳），非転倒群は64名（年齢73.0±8.5歳）であり，転倒発生率は15.8%であった。両群における新体力テスト6項目の比較から，開眼片足立ち，10m障害物歩行，6分間歩行で有意差（p＜0.05）を認めた。これら3項目を独立変数，転倒経験の有無を従属変数とした多重ロジスティック回帰分析を行った結果，10m障害物歩行のみ有意差（p＝0.005）を認め，Odds比は1.473（95%信頼区間1.127-1.924）であった。なお，ROC曲線よりAUC＝0.763, Cut off値8.7秒，転倒予測の感度は100%, 特異度は57.8%であった。【考察】新体力テスト6項目中10m障害物歩行は，転倒のOdds比が1.473であり，対象群の転倒に深く関与していることが示唆された。10m障害物歩行は特異度が低いものの感度は100%であった点から，10m障害物歩行は，屋外歩行が自立している地域在住高齢者の一次スクリーニングとして有用であることが示唆された。今後，スクリーニングとしての活用法だけではなく，高齢者自身がバランス保持能力を把握し，合わせて日常生活での転倒予防の留意点などを指導することが望まれる。

[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.