寺西 利生

[Purpose] The aim of this study was to examine the applicability of the Objective Structured Clinical Examination (OSCE) to postgraduate education systems for novice and mid-career therapists in workplaces. [Subjects] Physical and occupational therapists with 1 to 5 years of clinical experience took the OSCE to assess their learning, with a physical or occupational therapy faculty member and a clinical supervisor as examiners. Another clinical supervisor acted as a simulated patient. [Methods] A Wilcoxon signed-rank test was performed to compare skills between before and after OSCE-based learning, and a Mann-Whitney U test was used to compare them between therapists with 1 to 2 years (novice) and 3 to 5 years (mid-career) of clinical experience. [Results] While no experience-related differences were observed in behavioral aspects, mid-career therapists exhibited markedly higher scores compared with novices in technical aspects, such as skills to guide patients for standing up, transfer, and dressing. [Conclusion] The OSCE may be sufficiently applicable to postgraduate education systems in workplaces.

[Purpose] To examine agreement rates between faculty members and clinical supervisors as OSCE examiners. [Subjects] The study subjects were involved physical and occupational therapists working in clinical environments for 1 to 5 years after graduating from training schools as OSCE examinees, and a physical or occupational therapy faculty member and a clinical supervisor as examiners. Another clinical supervisor acted as a simulated patient. [Methods] The agreement rate between the examiners for each OSCE item was calculated based on Cohen's kappa coefficient to confirm inter-rater reliability. [Results] The agreement rates for the behavioral aspects of the items were higher in the second than in the first examination. Similar increases were also observed in the agreement rates for the technical aspects until the initiation of each activity; however, the rates decreased during the middle to terminal stages of continuous movements. [Conclusion] The results may reflect the recent implementation of measures for the integration of therapist education in training schools and clinical training facilities.

Osteoporosis is leaving bones more fragile and susceptible to fracture. It has a massive impact, both physically and mentally, markedly diminishing quality of life. A new form of therapeutic exercise or physical therapy that mitigates the abrupt decrease in bone density in postmenopausal women must quickly be developed to avoid those problems. In this study, ovariectomy (OVX) mice were used as models to simulate the decrease in bone density observed in postmenopausal women. Physical therapy via a shaking stimulus, in the form of moving a platform that rotates in a roughly circular motion in the horizontal plane, was studied as a way to prevent the decrease in bone density of the lumbar vertebrae by analysis of bone histomorphometry, a feat that the stimulus from conventional therapeutic exercise and physical therapy have failed to achieve. Comparison of the stimulus/ovariectomized (+/+) group with the -/+ group indicated significant increases in ES (P &lt 0.01), N. Mu. Oc (P &lt 0.05), OV (P &lt 0.05), O. Th (P &lt 0.01), and L. Th (P &lt 0.01) in the +/+ group. If this finding is used clinically, we believe that it could lead to therapy that would prevent compression fractures of the lumbar vertebrae.

歩行時模擬スリップ刺激に対する姿勢制御反応について手提げ運搬の有無により比較検討した。健康成人男性20例を対象とした。荷物を持たない定常歩行中と荷物運搬(左手提げかばん、右手提げかばん)歩行中の右踵接地時に模擬スリップ刺激を与え、刺激に対する姿勢制御反応を三次元動作解析装置で分析した。姿勢制御反応は、「刺激側下肢のみで支持し、非刺激側下肢を離地してステップする反応」(S反応)、「非刺激側下肢は離地せずに両下肢にて支持する反応」(DS反応)とした。S反応はDS反応に比べて仮想重心後方移動と体幹軸後傾が大きく、DS反応はS反応に比べて仮想重心右方移動と体幹軸右側屈が大きかった。右手提げはDS反応の出現数が定常に比べて有意に多く、S反応における非刺激側下肢のステッピング開始時間が他の条件に比べて遅くなる傾向があった。

【目的】簡便で判別的なバランス評価であるSIDE(standing test for imbalance and disequilibrium)を転倒危険度評価に臨床応用する前段階として,転倒事例を動作管理方法から分析し求められる転倒危険度評価を検討することである.【対象と方法】対象は1年間に回復期リハビリテーション病棟を退棟した患者513名であった.方法は入院期間中の転倒発生の有無,転倒があった場合は,入棟後期間および動作管理方法による決定木分類を用いて分析を行った.転倒発生時期は15日刻みで検討した.【結果】入棟中の転倒者数は120名,転倒発生件数は163件であった.転倒発生率は4.65(‰)で,複数回転倒症例は30例であった.また.発生時期は,入棟後15日以内が有意に多かった.動作管理方法による決定木分類では,抑制やセンサーをすり抜けての発生(62件)や,抑制やセンサーを使用していない患者の予想外の行動で発生(55件),許可された動作で発生(26件)が多かった.【結論】入棟時に行えるadherenceとバランスを組み合わせた簡便なスクリーニング検査を考案し,有意に多い入棟早期の転倒に備える必要がある.(著者抄録)

Background and aims Elderly individuals who suffer a fracture develop a gait disturbance and require prolonged bedrest. A fracture has a massive impact both physically and mentally and markedly diminishes quality of life. A new form of therapeutic exercise that mitigates the abrupt decrease in bone density in postmenopausal women must soon be developed so that those problems can be avoided. Methods The current study used a model of the decrease in bone density in ovariectomized mice to simulate postmenopausal women. The stimulus was provided by a shaking horizontal platform rotating in a circular motion. Results Comparison of the +/+ (ovariectomized/stimulated) group and +/- group indicated a significant decrease in BV/TV (p < 0.01), Tb.Th (p < 0.01), and Tb.N (p < 0.05) in the +/+ group and a significant increase in OV/BV (p < 0.01), OV/ OS (p < 0.01), BFR/BV (p < 0.01), dLS/BS (p < 0.05), MS/BS (p < 0.05), BRs.R (p < 0.01), and Tb.Sp (p < 0.01) in the +/+ group. Physical therapy to prevent a decrease in bone density was studied via stimulus in the form of rotation of a platform. Analysis of bone histomorphometry revealed lessening of the decrease in bone density of the lumbar vertebrae, a feat that the stimulus from conventional physical therapy had failed to achieve. Conclusion The current study delivered a shaking stimulus to mice in a model of postmenopause. Analysis of bone histomorphometry of the lumbar vertebrae suggested lessening of the abrupt decrease in bone density of trabecular bone. If this finding is used clinically, it could lead to physical therapy exercise that would be able to prevent compression fractures of the lumbar vertebrae.

[Purpose] A major issue in physical/occupational therapist education is the improvement of students' clinical techniques. In this study, we introduced an education system using an Objective Structured Clinical Examination (OSCE), and made an attempt at standardization of its evaluation. [Subjects] The subjects were 227 students in the classes of 2008 to 2010 who enrolled at our university between 2004 and 2006, before the introduction of the education system using OSCE, and 221 students in the classes of 2011 to 2013 who enrolled between 2007 and 2009, after the introduction. [Methods] Performances in attitude and skills (performance in clinical training and OSCE) were compared between before and after the introduction of OSCE. OSCE results were compared between before and after clinical trainings at each OSCE Level; and the correlation of between performances in clinical training and OSCE was examined. [Results] Performances in OSCE and clinical training (attitude, skills) were improved by the introduction of the education system using OSCE, but no significant correlation was observed in the relationship between performances in OSCE and clinical training. [Conclusion] Further studies should be conducted aiming at the standardization of clinical skill evaluation in postgraduate education to establish an education system using OSCE.

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.

[Purpose] This study investigated the progress of standardization of "clinical competencies evaluation with definition" in the education of physical therapists and occupational therapists by searching for relevancies between performance in Objective Structured Clinical Examination (OSCE), university and practical training. [Subjects and Methods] Subjects were 227 students who graduated between 2007 and 2009, and 174 students who graduated between 2010 and 2011. For data analyses, comparisons among different timings of practical training as well as between before and after reform of the OSCE compliant education system were performed. In addition, relationships among different timings of practical training with performance were also examined. [Results] Because of reform of OSCE compliant education system, performance in practical training (attitude, skills, knowledge) generally improved. Moreover, relationships between the performances in OSCEs and practical training became higher each year. [Conclusion] We would like to promote standardization of the clinical techniques for postgraduate education aiming to further extend the OSCE compliant education system.

Abstract. [Purpose] The purpose of this study was to examine the locus of the center of pressure (COP) of standing postures with different feet positions. [Subjects] Sixty healthy young adults participated in the experiments as subjects. [Methods] The COP was measured using a force plate. Subjects stabilized themselves on the force plate, and the change of the COP trajectory was measured for 30 s. The COP was measured in three standing postures: wide-base, tandem, and one-foot standing. The relative center of anterior-posterior sway was examined as a proportion of the base of support length. [Results] Using one foot length, l, measured from the heel to the toe of the foot as a standard, the mean of the center of anterior-posterior sway was 44.5 ± 5.5% of l in the wide-base stance, 50.2 ± 4.4% of l in the one-foot dominant stance, and 50.4 ± 4.3% of l in the one-foot non-dominant stance. Since the length of the feet is 2l in the tandem posture, the mean of the center of anterior-posterior sway was 41.0 ± 7.0% of 2l with the dominant foot in front and 41.5 ± 6.0% of 2l with the non-dominant foot in front. [Conclusion] The mean of the center of anterior-posterior sway was inclined toward the anterior position in single leg standing compared to the wide base standing. In tandem standing, the COP was located on the rear foot. The results of this study might be useful in considering the mechanism of postural control of patients with hemiplegia.

【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。

[Purpose] The objective of this study was to clarify the relationship between the results of the Objective Structured Clinical Examination (OSCE) and academic and clinical training achievements, which may be significant in terms of the establishment of standards for the evaluation of therapists' clinical performance. [Subjects] The study surveyed 46 physical and 43 occupational therapists who enrolled at our university in April 2007 and graduated from it in March 2011. [Methods] The OSCE results and academic and clinical training achievements were scored to examine the relationship between them by calculating Spearman's rank correlation coefficients. [Results] A significant correlation was observed between academic achievements and between clinical training achievements, while the correlation between the OSCE results was shown to be high or low. The correlation between the OSCE results and academic achievements was significant until the third grade (OSCE Level 2) and non-significant in the fourth grade (OSCE Level 3) requiring application. The correlation between the OSCE results and clinical training achievements showed a tendency to be low. [Conclusion] These results suggest the necessity of reconsidering the adoption of an OSCE system focusing on consistency between the contents of clinical training and academic education.

【目的】脳卒中後の麻痺側上肢の機能的スキルの評価尺度であるFunctional Skills Measure After Paralysis(FSMAP)の内容的妥当性を検討し,臨床での使用に耐えられるようにその内容を整備すること.【方法】作業療法士8名が参加し,質問紙法による調査を行った.内容的妥当性の検討方法としてNominal Group Discussion(NGT)を用いた.NGTは事前に同意基準の定義づけを行い,8割未満の同意しか得られず,内容的妥当性が低いと判定された項目に対しては改変を行なった.改変されたFSMAPに質問紙法による調査を繰り返した.【結果】1回目の調査では,小項目,解説とも15項目中8項目で「同意できない」という結果であった.この結果を元にして内容の修正を行った.2回目は,小項目の15項目中1項目で「同意できない」という結果であり,この項目の改変により内容的妥当性が十分に高まったものと判断し,検討作業を終了した.【考察】内容的妥当性の検討とその結果を元にした改変により,FSMAPは臨床応用に耐えられるレベルまで整備されたと考えられる.(著者抄録)

The standing test for imbalance and disequilibrium (SIDE) is a discriminative measure developed for the purpose of identifying balance deficits that may cause falls. The purpose of the present study was to determine the validity of the sequence of postures used in SIDE. Subjects comprised 30 men with a mean (+/- standard deviation) age of 21.9 +/- 3.11 years (range 19-32 years) and 30 women with a mean age of 20.7 +/- 1.24 years (range 19-23 years). Center of pressure (COP) was measured using a stabilometer recording for 30 s with a 20-Hz sampling frequency. The measurement postures that were similar to postures adopted in the SIDE were: standing with feet 20 cm apart: standing with legs close and the insides of both feet touching; two tandem standing positions (with the dominant foot forward and with the non-dominant foot forward); and two single-leg standing positions (on the dominant foot and on the non-dominant foot). We calculated total path length and envelopment area of sway from the COP data. Statistical differences in means were determined using the Tukey-Kramer multiple comparison test. Results indicate that the orders of total path length and envelopment areas of sway in each posture were consistent with the item order of SIDE. Significant differences existed between the means of total path length and envelopment areas of sway in each posture (p <0.05), with the exception of both tandem standing positions and both one-leg standing positions. The item order of SIDE appears to show concurrent validity in terms of the amount of body sway in the adopted postures. (C) 2011 Elsevier B.V. All rights reserved.

Miyasaka H, Kondo I, Kato H, Takahashi C, Uematsu H, Yasui C, Tani A, Miyata M, Wada N, Teranishi T, Wada Y, Sonoda S. Assessment of the content validity of Functional Skills Measure after Paralysis with nominal group discussion and revision of its content. Jpn J Compr Rehabil Sci 2011; 2: 24-30<br>Purpose: The purposes of this study were to assess the content validity of Functional Skills Measure after Paralysis (FSMAP) and to revise its content to make it appropriate for use in the clinical setting.<br>Methods: Eight occupational therapists (OTs) participated in the questionnaire study. Nominal Group Technique (NGT) was used to measure the content validity. Before using the NGT, we set an 80% agreement as the criterion for consent. If the agreement for an item did not reach this level and the item’s content validity was not high enough, we revised its content. We repeated the same assessment for the revised FSMAP by using a questionnaire.<br>Results: In the first assessment, 8 out of 15 items (including the subitems and descriptions) did not reach the predetermined agreement level. In the second assessment, 1 out of 15 items did not reach the agreement level. We finished the assessment process because we judged that the content validity of FSMAP reached a satisfactory level after the revision of this item.<br>Discussion: We think that FSMAP should be revised to make it appropriate for use in the clinical setting after assessing its content validity.

Wada Y, Kondo I, Sonoda S, Yamada K, Narukawa A, Kawakami K, Nonoyama S, Miyasaka H, Teranishi T, Nagai S, Takeshima N: Mirror therapy for severely affected ankle joints of stroke patients. Jpn J Compr Rehabil Sci 2011; 2: 71-76.<br>Objective: This study investigated the improvement in dorsiflexion of severely affected ankle joints of first-stroke patients after mirror therapy.<br>Methods: Nine first-stroke patients participated in this study. A mirror was placed to reflect the non-paralyzed lower limb. A set of 50 dorsiflexion movements of the ankle joint was performed 4 times a day for 7 days. Foot functions of the Stroke Impairment Assessment Set (SIAS-F) and the foot-floor angle at active dorsiflexion were measured every 7 days starting from 14 days before initiation of the mirror therapy training to 7 days after, for a total of 5 times.<br>Results: SIAS-F did not differ among the cases before mirror therapy training. After the mirror therapy training, 5 of the 9 patients showed SIAS-F improvement. Significant differences were found between the scores at the beginning and at the end of the mirror therapy training, and between the scores at the beginning and 7 days after training. The mean foot-floor angle changed from 0 degrees at the beginning of training to 3.0 degrees at the end of training and 1.2 degrees 7 days after the training; however, these values did not differ significantly.<br>Conclusion: Significant improvement in dorsiflexion of the ankle joint, as measured by SIAS-F, was achieved with mirror therapy.

【目的】立位バランスの判別的尺度であるStanding Test for Imbalance and Disequilibrium(SIDE)を臨床で転倒予防に使用する前段階として,信頼性と妥当性および簡便性を検証することである.【方法】回復期リハビリテーション病棟入院患者30名(男性18名,女性12名),年齢57.4±16.97歳(平均±標準偏差)(範囲:25-85歳)に,2名の理学療法士が別個にSIDE評価を行い,同時にBerg Balance Scale(BBS)も評価した.信頼性の検討は,複数検者によって別個に得られた2回のSIDE level間のCohen&#039;s Kappa統計量を,妥当性の検討は,SIDE levelとBBS score間のSpearmanの順位相関係数を用いて分析した.【結果】Kappa統計量は0.76,Spearmanの順位相関係数は,0.93(p&lt;0.01)であった.【結論】SIDEは,高い信頼性があり,BBSと比較した時,より簡便で十分な同時妥当性があると考えられた.(著者抄録)

The purpose of this study was to determine whether high-speed treadmill training improved the gait velocity of patients whose maximum walking speed was assumed to have reached a plateau level. The subjects included seven patients with hemiplegia after stroke. The high-speed treadmill training was performed as the maximum gait velocity of each patient was presumed to have reached a plateau level. The patients walked 20% faster than their maximum gait velocity of the day for 5 days (phase I). Then they walked 20% slower than maximum gait velocity of the day for 5 days, and they repeated the fast treadmill walking for further 5 days (phase II). Before phase I, mean maximum gait velocity of the day was 0.84 m/sec before phase I, 1.08 m/sec after phase I, and 1.24 m/sec after phase II. These results demonstrated that training at a speed 20% faster than the maximum gait velocity of the day on the treadmill for 5 days could further increase a patient&apos;s gait velocity.

【目的】診療報酬改定による訓練量の増加と運動麻痺改善との関係を検証した．【方法】当院回復期リハビリ病棟に入退院した脳卒中患者で，1日の訓練単位数上限が6単位(2時間)であった時期に5～6単位の訓練を行った122名(6単位群)と，訓練単位数上限が9単位であった時期に7～9単位の訓練を行った41名(9単位群)を対象に入退院時のStroke Impairment Assessment Set(SIAS)の麻痺側運動機能5項目を比較した．入院時運動麻痺の重症度別に3群に層別化した分析も行った．【結果】入退院時のSIAS得点は9単位群で有意に高かったが，SIAS利得には有意差を認めなかった．入院時下肢中等度麻痺群と上肢軽度麻痺群において退院時SIASとSIAS利得が9単位群で有意に高かった．【結論】麻痺程度を層別化して検討することで1日6単位から9単位への訓練量増加により運動麻痺改善が認められた．

【目的】脳卒中患者における回復期リハビリテーション内容の違いが退院後のADLに与える影響を明らかにすることである．【方法】FIT programを受けた脳卒中患者81名(FIT群)と従来型の訓練を受けた脳卒中患者49名(Pre-FIT群)を対象に退院18カ月後のADLを調査した．当院入院時と退院時にFIMを記録し退院18カ月後はFIM質問紙(Flow-FIM)を用いて郵送調査した．【結果】FIM運動項目合計点(FIM-M)はPre-FIT群が入院時50.5点，退院時68.7点，退院18カ月後64.0点でFIT群が入院時52.8点，退院時75.6点，退院18カ月後71.8点であり退院時と退院18カ月後はFIT群が有意に高かった(p‹0.05)．退院18カ月後のFIM-M各項目における6点と7点の全体人数に占める割合は，13項目全てでFIT群がPre-FIT群よりも高い割合を示した．【結論】FIT programの効果は退院18カ月後まで残存していたため，退院時のADLを高くすることは，維持期のADLに寄与する．

Teranishi T, Kondo I, Sonoda S, Kagaya H, Wada Y, Miyasaka H, Tanino G, Narita W, Sakurai H, Okada M, Saitoh E. A discriminative measure for static postural control ability to prevent in-hospital falls: Reliability and validity of the Standing Test for Imbalance and Disequilibrium (SIDE). Jpn J Compr Rehabil Sci 2010; 1: 11-16<br>Purposes: To determine the reliability, validity, and clinical significance of the Standing Test for Imbalance and Disequilibrium (SIDE), a discriminative measure of standing balance, before using it to prevent falls in clinical settings.<br>Methods: In all, 30 patients (18 men and 12 women) with a mean (standard deviation) age of 57.4 (16.97) years (range, 25-85 years) who were admitted to the &ldquo;Kaifukuki&rdquo; rehabilitation ward voluntarily participated in this study. In the reliability study, 2 physiotherapists independently classified the level of static postural control ability by using SIDE. Functional balance control ability was simultaneously evaluated using the Berg Balance Scale (BBS). Cohen's &kappa; statistic was used to determine the inter-rater reliability, and the Spearman rank-correlation coefficient between the BBS score and SIDE level was used to determine the criterion-related validity.<br> Results: Inter-rater reliability of SIDE showed excellent reproducibility (Cohen's &kappa; statistic = 0.76). Criterion-related validity was very high between SIDE levels and BBS scores (Spearman rank-correlation coefficient = 0.93; p < 0.01).<br>Conclusion: SIDE can be used to efficiently and accurately classify balance control ability across individuals and has remarkable concurrent validity in balance evaluation compared to BBS.

トレッドミルでの使用を主たる用途とする3次元歩行分析システム(KinemaTracer)について,臨床使用の前提条件となる精度の検討を行った.方法は,臨床歩行分析懇談会主催のシステム検討会で用いられた方法に準じて,平地およびトレッドミル条件で,計測空間内を剛体のオブジェクトを持って移動し,距離(真値898mm)および角度(真値90度)を測定した.結果は,トレッドミル条件の距離計測で上下方向907.8±1.8mm,進行方向902.7±1.9mm,左右方向896.9±3.4mmで,角度計測では90.7±0.7度であった.KinemaTracerは高額なリアルタイム計測機器に比べ計測精度は劣るものの,トレッドミル歩行分析に使用する場合,原則的に多数歩データの平均値を用いる計測であり,数学的な収束によって実質的な精度の向上が期待できる.このため臨床使用には十分耐えられると考えられた.(著者抄録)

日本語版GMFCSの信頼性の検討とDelphi調査を使った臨床使用における専門家の意見を明らかにする目的でこの検討を行った．信頼性の検討は334 名の脳性麻痺児（男児191 名，女児143 名），8 カ月から12 歳（平均5 歳7 カ月，標準偏差3 歳1 カ月）を対象として行った．181 名の評価者がこの研究に参加し，2 名一組でそれぞれ独立にGMFCSによる重症度の判定を行った. Delphi調査には質問紙を使い，各施設でこの研究を主導した協力者20 名から回答を得た．信頼性の検討から，レベルIIIおよびIVの4～6 歳の年齢帯のKappaが0.40を下回っていた．Delphi調査の結果でも，レベルIIIに対してだけは支持的な回答の比率が80％を超えなかった．GMFCSの信頼性はレベルIIIの4～6 歳の年齢帯における記載が実際の発達より低めに設定されていることによって部分的に低下している可能性が示唆された．

日本語版GMFCSの信頼性の検討とDelphi調査を使った臨床使用における専門家の意見を明らかにする目的でこの検討を行った。信頼性の検討は334名の脳性麻痺児(男児191名、女児143名)、8ヵ月から12歳(平均5歳7ヵ月、標準偏差3歳1ヵ月)を対象として行った。181名の評価者がこの研究に参加し、2名一組でそれぞれ独立にGMFCSによる重症度の判定を行った。Delphi調査には質問紙を使い、各施設でこの研究を主導した協力者20名から回答を得た。信頼性の検討から、レベルIIIおよびIVの4〜6歳の年齢帯のKappaが0.40を下回っていた。Delphi調査の結果でも、レベルIIIに対してだけは支持的な回答の比率が80%を超えなかった。GMFCSの信頼性はレベルIIIの4〜6歳の年齢帯における記載が実際の発達より低めに設定されていることによって部分的に低下している可能性が示唆された。(著者抄録)

麻痺側足関節背屈が重度に障害された初発脳卒中患者に対して,下肢背屈を目的とするミラーセラピーを行った.鏡を非麻痺側下肢が映るように設置し,背屈運動50回を1セットとし,1日4セット,7日間行わせた.ミラーセラピーの対象者は初発脳卒中患者12名で,対照群は当院の過去のデータベースよりStroke Impairment Assessment Setの足関節の運動機能(SIAS-F)のデータを抽出した325名とした.ミラーセラピー群は対照群と比較して,SIAS-Fに有意に大きな改善が認められた.ミラーセラピーによる改善例と非改善例の基本情報には有意差は認められなかった.今回のミラーセラピーの効果要因としては,鏡による錯覚の効果と頻回に背屈運動を促したことによる筋再教育の効果の2つの可能性が考えられた.ミラーセラピーの効果を制限する因子には注意障害の有無と筋緊張の亢進が考えられた.(著者抄録)

近年、脳卒中患者に対してトレッドミル歩行訓練が積極的に行われるようになってきたが、個々の歩行能力や回復過程を考慮にいれた訓練介入方法は確立されていないのが現状である。今回、個々に応じた介入方法立案の手がかりとすべく、脳卒中片麻痺患者19名にトレッドミル歩行を行ってもらい、歩行周期に占める両側の単脚支持時間と両脚支持時間の割合を算出し、歩行速度、歩行自立度、歩行形態との関連について検討した。結果、手すりを用いた監視下トレッドミル歩行の適応となるのは歩行自立度(歩行FIM)4点以上の症例であり、歩行周期パターンからみた適応のポイントは「回復初期(入院後2週程度)」で平地快適歩行速度が「1.0km/h以下」かつ歩行形態が「3動作歩行」の患者であると考えられた。

Study design: Retrospective study of the degree of gait independence achieved by persons with spinal cord injury (SCI) using knee - ankle - foot orthosis with a medial single hip joint (MSH-KAFO). Objective: To examine the effects of the neurological level, degree of paresis, age, and inhibitory physical/other factors on the gait with a MSH-KAFO in patients with SCIs. Setting: Three university hospitals and two rehabilitation hospitals in Japan. Methods: The 45 patients (36 men, nine women) examined included 10 with injuries in the cervical cord between C6 and C8 (group C), 20 with injuries in the upper-middle thoracic cord between T4 and T10 (group UT), and 15 with injuries in the lower thoracic-lumbar cord between T12 and L1 (group TL). Mean age was 34.0 years (range 16 - 68 years). Of these patients, 13 used the Walkabout, four used the gear joint, and 28 used the Primewalk as the medial hip joint. Recursive partitioning, which predicted the final status of gait from the level, degree of paresis, age, and inhibitory factors, was performed, and a decision tree for gait was constructed. Inhibitory factors were spasticity, involuntary spasms or muscle contractions, pain, contracture, weakness of the upper extremities, and decreased motivation to perform gait exercise. The degree of gait independence was rated on the following. five-point scale: outdoor independent gait (5 points), indoor independent gait (4 points), indoor supervised gait (3 points), indoor assisted gait (2 points), and gait within parallel bars (1 point). New branches were added to the decision tree for gait based on the clinical experience, thereby constructing a new decision tree. Results: The coincident ratio between the value predicted on the basis of the decision tree of gait and the value actually observed was 53.3%. The coincident ratio between the value predicted on the basis of the modified decision tree of gait and the actually observed value was 68.9%. Conclusion: The results provide valuable information to medical teams that may assist prescription of gait orthoses.