記述言語：英語   掲載種別：研究論文（学術雑誌）  

[Purpose] Humans keep their trunks vertical while walking. This defining characteristic is known as upright bipedalism. Research on the neural control of locomotion indicates that not only subcortical structures, but also the cerebral cortex, especially the supplementary motor area (SMA), is involved in locomotion. A previous study suggested that SMA may contribute to truncal upright posture-control during walking. Trunk Solution® (TS) is a trunk orthosis designed to support the trunk in decreasing the low back load. We hypothesized that the trunk orthosis might reduce the burden of truncal control on the SMA. The objective of this study was, therefore, to determine the effect of trunk orthosis on the SMA during walking. [Participants and Methods] Thirteen healthy participants were enrolled in the study. We measured the hemodynamics of the SMA during walking with functional near-infrared spectroscopy (fNIRS). The participants performed two gait tasks on a treadmill: (A) independent gait (usual gait) and (B) supported gait while wearing the TS. [Results] During (A) independent gait, the hemodynamics of the SMA exhibited no significant changes. During (B) gait with truncal support, the SMA hemodynamics decreased significantly. [Conclusion] TS may reduce the burden of truncal control on the SMA during walking.

DOI： 10.1589/jpts.35.502

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

[Purpose] Fall risk is immanent in humans because they are bipedal. Bipedalism has transited from quadrupedalism in both evolutional and developmental contexts. Past studies have measured the peak vertical ground force of forelimbs and hindlimbs in quadrupedalism; and revealed that load dominancy shifted from forelimbs to hindlimbs during evolution. The dominance of hindlimb peak vertical ground force allows forelimb freedom and is considered important for locomotor evolution toward bipedalism. With this consideration, we hypothesize that hindlimb peak vertical ground force is dominant in human adults when they designedly crawl in a quadrupedal manner. [Participants and Methods] Six healthy human adults crawled on their hands and knees over a pressure platform. We calculated the peak vertical ground force of their hands and knees by integrating the pressure of the contact area of each limb. [Results] The mean knee peak vertical ground force at 0.694 (per body weight) was significantly higher than that of the hand at 0.372 (per body weight). The mean hand/knee peak vertical ground force ratio was 0.536; therefore, it was -0.624 on the natural logarithmic scale. [Conclusions] Our findings on human adults are compatible with existing considerations on locomotor evolution toward bipedalism. Our findings contribute to the comprehensive understanding of human locomotion.

DOI： 10.1589/jpts.35.306

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Patients with Parkinson's disease (PD) exhibit distinct abnormal postures, including neck-down, stooped postures, and Pisa syndrome, collectively termed "abnormal posture" henceforth. In the previous study, when assuming an upright stance, patients with PD exhibit heightened instability in contrast to healthy individuals with disturbance, implying that abnormal postures serve as compensatory mechanisms to mitigate sway during static standing. However, limited studies have explored the relationship between abnormal posture and sway in the context of static standing. Increased muscle tone (i.e., constant muscle activity against the gravity) has been proposed as an underlying reason for abnormal postures. Therefore, this study aimed to investigate the following hypothesis: abnormal posture with increased muscle tone leads to a smaller sway compared with that in other postures, including normal upright standing, under the sway minimization criterion. To investigate the hypothesis, we assessed the sway in multiple postures, which is determined by joint angles, including cases with bended hip joints. Our approach involved conducting forward dynamics simulations using a computational model comprising a musculoskeletal model and a neural controller model. The neural controller model proposed integrates two types of control mechanisms: feedforward control (representing muscle tone as a vector) and feedback control using proprioceptive and vestibular sensory information. An optimization was performed to determine the posture of the musculoskeletal model and the accompanied parameters of the neural controller model for each of the given muscle tone vector to minimize sway. The optimized postures to minimize sway for the optimal muscle tone vector of patients with PD were compared to the actual postures observed in these patients. The results revealed that on average, the joint-angle differences between these postures was <4°, which was less than one-tenth of the typical joint range of motion. These results suggest that patients with PD exhibit less sway in the abnormal posture than in other postures. Thus, adopting an abnormal posture with increased muscle tone can potentially serve as a valid strategy for minimizing sway in patients with PD.

DOI： 10.3389/fncom.2023.1218707

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Voluntary sway is the periodic movement of one's body back and forth. The study aimed to clarify the effects of sway frequency on center of pressure and joint angle during voluntary sway. We measured 10 unrestricted voluntary sway conditions with different frequencies and natural pace conditions. The frequencies ranged from 0.1 to 1 Hz in 0.1-Hz increments. The joint angles and centers of pressure during voluntary sway were compared between the conditions. The joint angle amplitude of the trunk and knee were greater in the slow frequency condition than in the fast frequency condition. The trunk and knee joint angles during voluntary sway were considered to change according to the sway frequency.

DOI： 10.1080/00222895.2023.2211540

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記述言語：日本語   出版者・発行元：(株)シービーアール  

小児に対するリハビリテーションにおいて,患児が抱えている痛みに対する問題を正確に理解することは非常に難しい.患児は成人と違い問題を正確に表出することが難く,さらにはオノマトペ(擬声語)が成人のそれとは異なることもしばしばある.しかし,セラピストはあらゆる手段を駆使し,患児の表現から正確に状態を見極めて援助に取り組まねばならない.身体だけに着目し治療を進めることは,痛みの増加や恐怖体験を引き起こす可能性もある.また,「痛み」から逃れるために間違った行動様式が刷り込まれ,日常動作を変容させ心身の成長にも影響を及ぼす危険がある.本稿では患児の理解と日常生活動作の改善について説明する.(著者抄録)

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記述言語：日本語   出版者・発行元：日本ヒューマンケア・ネットワーク学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J07469&link_issn=&doc_id=20221129430015&doc_link_id=%2Fdz8shuma%2F2022%2F002001%2F018%2F0103-0106%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdz8shuma%2F2022%2F002001%2F018%2F0103-0106%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本靴医学会  

本研究の目的は,足部形態の評価指標として国際的に用いられるArch height index(AHI)と,本邦で用いられる足高率の関連性,および,AHI・足高率と,足部可動性の評価指標であるFootmobility magnitude(FMM)の関連性を明らかにすることとした.健常成人男性52名104足の,AHIおよび足高率とFMMを計測し,各評価指標間の関連性を検討した.AHIと足高率の間に有意な正の相関関係が認められ,AHI・足高率とFMMの間には有意な弱い負の相関関係が認められた.本研究の結果から,足高率が足部機能を評価するうえで有用な評価指標である可能性が示唆された.一方で,形態と可動性との関連性が弱いことから,臨床現場においては形態と可動性の二つの観点から足部機能を評価する必要がある.(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The Fugl-Meyer Assessment is widely used to test motor function in stroke survivors. In the Fugl-Meyer Assessment, stroke survivors perform several movement tasks and clinicians subjectively rate the performance of each task item. The individual task items in the Fugl-Meyer Assessment are selected on the basis of clinical experience, and their physiological relevance has not yet been evaluated. In the present study, we aimed to objectively rate the performance of task items by measuring the muscle activity of 41 muscles from the upper body while stroke survivors and healthy participants performed 37 Fugl-Meyer Assessment upper extremity task items. We used muscle synergy analysis to compare muscle activity between subjects and found that 13 muscle synergies in the healthy participants (which we defined as standard synergies) were able to reconstruct all of the muscle activity in the Fugl-Meyer Assessment. Among the standard synergies, synergies involving the upper arms, forearms and fingers were activated to varying degrees during different task items. In contrast, synergies involving posterior trunk muscles were activated during all tasks, which suggests the importance of posterior trunk muscle synergies throughout all sequences. Furthermore, we noted the inactivation of posterior trunk muscle synergies in stroke survivors with severe but not mild impairments, suggesting that lower trunk stability and the underlying activity of posterior trunk muscle synergies may have a strong influence on stroke severity and recovery. By comparing the synergies of stroke survivors with standard synergies, we also revealed that some synergies in stroke survivors corresponded to merged standard synergies; the merging rate increased with the impairment of stroke survivors. Moreover, the degrees of severity-dependent changes in the merging rate (the merging rate-severity relationship) were different among different task items. This relationship was significant for 26 task items only and not for the other 11 task items. Because muscle synergy analysis evaluates coordinated muscle activities, this different dependency suggests that these 26 task items are appropriate for evaluating muscle coordination and the extent of its impairment in stroke survivors. Overall, we conclude that the Fugl-Meyer Assessment reflects physiological function and muscle coordination impairment and suggest that it could be performed using a subset of the 37 task items.

DOI： 10.1093/braincomms/fcac200

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Infants acquire the ability to roll over from the supine to the prone position, which requires body coordination of multiple degrees of freedom under dynamic interactions with the ground. Although previous studies on infant rolling observed kinematic characteristics, little is known about the kinetic characteristics of body segments in contact with the surface. We measured the ground contact pressure under the arms, legs, head, and proximal body segments using a pressure mat and their displacements using a three-dimensional motion capture system. The data obtained from 17 infants aged 9-10 months indicated that most of them showed 2-4 of 6 highly observed movement patterns, including 1 axial rolling, 2 spinal flexion, and 3 shoulder girdle leading patterns. The arms and legs had small contributions to the ground contact pressure in the axial rolling and spinal flexion patterns. The ipsilateral leg in relation to the rolling direction was involved in supporting the body weight in only 1 shoulder girdle leading pattern. The contralateral leg showed large peak pressure to push on the floor before rolling in 3 shoulder girdle leading patterns. The results indicate that infants can produce multiple rolling-over patterns with different strategies to coordinate their body segments and interact with the floor. The results of the analysis of the movement patterns further suggest that few patterns correspond to those reported in adults. This implies that infants generate unique motor patterns by taking into account their own biomechanical constraints.

DOI： 10.1007/s00221-021-06174-w

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Korean Academy of Kinesiology  

OBJECTIVES Medial heel wedges are commonly prescribed to manage the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones. Previous studies have reported that a medial heel wedge is effective in the management of musculoskeletal injuries. However, it remains unclear the effect of a medial heel wedge on the weight-bearing responses of footarch bones in vivo. To clarify the effects of a medial heel wedge on the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones is necessary to understand how best to treat musculoskeletal injuries clinically. The purpose of our study was to clarify the effects of a medial heel wedge on the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones.METHODS Twenty-five healthy males were analyzed. We obtained MRI scanning of the right foot under non-loading (NL) and full weight-bearing (FW) conditions. Participants wore two insole types, a flat insole and a medial heel wedge. To evaluate the weight-bearing response in hindfoot valgus, the hindfoot alignment view (HAV) was measured. We also measured navicular and talus bone positions and calculated the total positional changes of the navicular and talus bones (ΔTPCN, ΔTPCT) from the vertical and medial displacements using the Pythagorean theorem.RESULTS Significant interactions were observed with the HAV. Under both NL and FW conditions, the HAV was smaller on the medial heel wedge than on the flat insole. In addition, the ΔTPCN was significantly smaller on the medial heel wedge than on the flat insole. However, no significant differences were observed for ΔTPCT.CONCLUSIONS Our results suggest that use of a medial heel wedge decreases hindfoot valgus values under both NL and FW conditions and stabilizes the total weight-bearing response of the navicular bone.

DOI： 10.15758/ajk.2021.23.3.46

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その他リンク： http://ajkinesiol.org/journal/view.php?doi=10.15758/ajk.2021.23.3.46

掲載種別：研究論文（学術雑誌）   出版者・発行元：Informa UK Limited  

DOI： 10.1080/01691864.2021.1948353

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In individuals with a musculoskeletal disorder, goal-directed reaching movements of the hand are distorted. Here, we investigated a pain-related fear-conditioning effect on motor control. Twenty healthy participants (11 women and 9 men, 21.7 ± 2.7 years) performed a hand-reaching movement task. In the acquisition phase, a painful electrocutaneous stimulus was applied on the reaching hand simultaneous with the completion of reaching. In the subsequent extinction phase, the task context was the same but the painful stimulus was omitted. We divided the kinematic data of the hand-reaching movements into acceleration and deceleration periods based on the movement-velocity characteristics, and the duration of each period indicated the degree of impairment in the feedforward and feedback motor controls. We assessed the wavelet coherence between electromyograms of the triceps and biceps brachii muscles. In the acquisition phase, the durations of painful movements were significantly longer in both the acceleration and deceleration periods. In the extinction phase, painful movements were longer only in the acceleration period and higher pain expectation and fear were maintained. Similarly, the wavelet coherence of muscles in both periods were decreased in both the acquisition and extinction phases. These results indicate that negative emotional modulations might explain the altered motor functions observed in pain patients.

DOI： 10.1038/s41598-021-90518-7

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掲載種別：研究論文（学術雑誌）   出版者・発行元：The Japanese Society of Physical Fitness and Sports Medicine  

DOI： 10.7600/jpfsm.10.75

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Unilateral spatial neglect is a disorder of higher brain function that occurs after a brain injury, such as stroke, traumatic brain injury, brain tumor, and surgical procedures etc., and leads to failure to attend or respond to stimuli presented to the side contralateral to the lesioned cerebral hemisphere. Because patients with this condition often have other symptoms due to the presence of several brain lesions, it is difficult to evaluate the recovery mechanisms and effect of training on unilateral spatial neglect. In this study, a mouse model of unilateral spatial neglect was created to investigate whether the size of the lesion is related to the severity of ipsilesional spatial bias and the recovery process. Focal infarction was induced in the right medial agranular cortex (AGm) of mice via photothrombosis. After induction of cerebral infarction, ipsilesional spatial bias was evaluated for 9 consecutive days. The major findings were as follows: (1) unilateral local infarction of the AGm resulted in ipsilateral bias during internally guided decision-making; (2) the lesion size was correlated with the degree of impairment rather than slight differences in the lesion site; and (3) mice with anterior AGm lesions experienced lower recovery rates. These findings suggest that recovery from ipsilesional spatial bias requires neural plasticity within the anterior AGm. This conditional mouse model of ipsilesional spatial bias may be used to develop effective treatments for unilateral spatial neglect in humans.

DOI： 10.1016/j.bbr.2020.113097

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We explore the effects of body weight-supported (BWS) treadmill training, including the change of cortical activation, on a patient with post-stroke hemidystonia. PATIENT: The patient was a 71-year-old man with left thalamus hemorrhage. His motor symptoms indicated slight impairment. There was no overactive muscle contraction in the supine, sitting, or standing positions. During his gait, the right initial contact was the forefoot, and his right knee showed an extension thrust pattern. These symptoms suggested that he had post-stroke hemidystonia. METHODS: The patient performed BWS treadmill training 14 times over 3 weeks. The effects of the BWS training were assessed by a step-length analysis, electromyography and functional magnetic resonance imaging (fMRI). RESULTS: The patient's nonparetic step length was extended significantly in the Inter-BWS (p<0.001) and Post-BWS (p=0.025) periods compared to the Pre-BWS session. The excessive muscle activity of the right gastrocnemius medialis in the swing phase was decreased at the Inter-BWS, Post-BWS, and follow-up compared to the Pre-BWS session. The peak timing difference of the bilateral tibialis anterior muscle became significant (p<0.05) on the first day of the intervention. The fMRI revealed that the cortical areas activated by the motor task converged through the intervention (p<0.05, family-wise error corrected). CONCLUSION: These results suggest that there was improvement of the patient's symptoms of post-stroke hemidystonia due to changes in the brain activity during voluntary movement after BWS intervention. Body weight-supported treadmill training may thus be an effective treatment for patients with poststroke hemidystonia.

DOI： 10.1298/ptr.E10032

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Neural plasticity compensates for the loss of motor function after stroke. However, whether neural plasticity occurs in the somatosensory pathways after stroke is unknown. We investigated the left-right somatosensory interaction in two hemorrhagic patients using a paired somatosensory evoked potentials (p-SEPs) recorded at CP3 and CP4, which was defined as an amplitude difference between the SEPs of paired median nerve stimulations to both sides and that of single stimulation to the affected side. Patient 1 (61-year-old, left thalamic hemorrhage) has a moderate motor impairment, severe sensory deficit, and complained of pain in the affected right upper limb. Patient 2 (72-year-old, right thalamic hemorrhage) had slight motor and sensory impairments with no complaints of pain. Single SEPs (s-SEPs) were obtained by stimulation of the right and left median nerves, respectively. For paired stimulations, 1 ms after the first stimulation to the non-affected side, followed by a second stimulation to the affected side. In patient 1, a s-SEP with stimulation to the non-affected side and a p-SEP were observed in CP4. However, a s-SEP was not observed in either hemisphere with stimulation to the affected side. On the other hand, in patient 2, a s-SEP in CP3 with stimulation to the non-affected side and in CP4 with stimulation to the affected side were observed; however, a p-SEP was not observed. In addition, to investigate the mechanism by which ipsilateral median nerve stimulation enhances contralateral p-SEP in patient 1, we compared the SEP averaged over the first 250 epochs with the SEP averaged over the second 250 epochs (total number of epochs recorded: 500). The results showed that in the patient 1, when the bilateral median nerve was stimulated continuously, the habituation did not occur and the response was larger than that of the s-SEP with unilateral median nerve stimulation. In the current case report, the damage to the thalamus may cause neuroplasticity in terms of the left-right interaction (e.g., left and right S1). The somatosensory input from the affected side may interfere with the habituation of the contralateral somatosensory system and conversely increase the response.

DOI： 10.3389/fnhum.2021.761186

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hyper-adaptability, the ability to adapt to changes in the internal environment caused by neurological disorders, is necessary to recover from various disabilities, such as motor paralysis and sensory impairment. In the recovery from motor paralysis, the pre-existing neural pathway of the ipsilateral descending pathway, which is normally suppressed and preserved in the course of development, is activated to contribute to the motor control of the paretic limb. Conversely, in sensory pathways, it remains unclear whether there are compensatory pathways which are beneficial for the recovery of sensory impairment due to damaged unilateral somatosensory pathways, such as thalamic hemorrhage. Here, we investigated the interaction between the left and right somatosensory pathways in healthy humans using paired median nerve somatosensory evoked potentials (SEPs). Paired median nerve SEPs were recorded at CP3 and CP4 with a reference of Fz in the International 10-20 System. The paired median nerve stimulation with different interstimulus intervals (ISIs; 1, 2, 3, 5, 10, 20, 40, 60, and 100 ms) was performed to test the influence of the first stimulus (to the right median nerve) on the P14, P14/N20, and N20/P25 components induced by the second stimulus (left side). Results showed that the first stimulation had no effect on SEP amplitudes (P14, P14/N20, and N20/P25) evoked by the second stimulation in all ISI conditions, suggesting that there might not be a neural connectivity formed by a small number of synapses in the left-right interaction of the somatosensory pathway. Additionally, the somatosensory pathway may be less diverse in healthy participants.

DOI： 10.3389/fnsys.2021.698758

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Motor learning is the process of updating motor commands in response to a trajectory error induced by a perturbation to the body or vision. The brain has a great capability to accelerate learning by increasing the sensitivity of the memory update to the perceived trajectory errors. Conventional theory suggests that the statistics of perturbations or the statistics of the experienced errors induced by the external perturbations determine the learning speeds. However, the potential effect of another type of error perception, a self-generated error as a result of motor command updates (i.e., an aftereffect), on the learning speeds has not been examined yet. In this study, we dissociated the two kinds of errors by controlling the perception of the aftereffect using a channel-force environment. One group experienced errors due to the aftereffect of the learning process, while the other did not. We found that the participants who perceived the aftereffect of the memory updates exhibited a significant decrease in error-sensitivity, whereas the participants who did not perceive the aftereffect did not show an increase or decrease in error-sensitivity. This suggests that the perception of the aftereffect of learning attenuated updating the motor commands from the perceived errors. Thus, both self-generated and externally induced errors may modulate learning speeds.

DOI： 10.3389/fnhum.2021.602405

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記述言語：英語   出版者・発行元：Japan Society of Kansei Engineering  

For patients who have suffered a stroke and are undergoing rehabilitation, the motivation for recovery and achievement of independence is a major factor that must be considered for effective treatment. A patient’s sense of agency affects their motivation for activities, such as rehabilitation. This study was conducted to investigate the motivation and sense of agency of patients with cerebrovascular disease who were undergoing rehabilitation and to examine the influence of nursing involvement on improving patient independence. This study of inpatients in a rehabilitation hospital ward was conducted using questionnaires. Our results suggest that sense of agency may affect patient motivation during hospitalization and was influenced by nursing support for independence. Interventions targeted to improve the patient’s sense of agency were shown to be a potentially effective method for improving the patient’s rehabilitative motivation. Nursing support for independence provides a promising effective strategy for improving the patient’s sense of agency.

DOI： 10.5057/ijae.ijae-d-20-00029

DOI： 10.5057/ijae.ijae-d-23-00050_references_DOI_Dq0SzPr62QqfSMaJWGplAuyXvDb

CiNii Research

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その他リンク： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-18K11504/

記述言語：日本語   出版者・発行元：日本運動障害研究会  

左右の対称性が損なわれた歩容を呈していたパーキンソン病(PD)患者に対して、Honda歩行アシスト(HWA)を用いた歩行訓練を行った。本症例では、単回のHWA歩行訓練後に、即時的に歩行の左右対称性の改善が認められた。また、歩行の安定性の指標である変動係数は訓練前後で変化なく、訓練中の転倒などの有害事象を認めなかった。HWAは左右のサポート量を任意に変えることのできる歩行訓練機器であり、HWAを用いた歩行訓練は、本症例のように左右の対称性が損なわれている歩容を呈しているPDに対する新たな歩行訓練として有効である可能性が示唆された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J02794&link_issn=&doc_id=20210308030004&doc_link_id=%2Fcb8undou%2F2020%2F003001%2F004%2F0023-0030%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcb8undou%2F2020%2F003001%2F004%2F0023-0030%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：茨城県立医療大学付属病院  

【目的】当院では、作業療法の一環として集団形式での音楽活動を取り入れており、現在はボランティア活動として実施している。これまで、対象者の音楽活動中の変化に着目して効果を検討してきたが、各担当作業療法士がどのような過程を経て音楽活動を導入し、それが対象者のその後の日常生活へどのように影響を及ぼしているか、報告は見当たらない。本研究では、音楽活動を患者に導入した担当作業療法士にインタビューを行い、作業療法士が音楽活動にどのような意味を感じているのかを理解する。【方法】入院生活を通して音楽活動に参加したA氏の退院後、担当作業療法士へ音楽活動に関するインタビュー調査を行い、質的に検討した。【結果】担当作業療法士は、A氏の自宅生活復帰を目指したリハビリテーションにおいて、個別介入の限界を感じていた。そこで、司会業実践の場として音楽活動を導入することで、成功体験を積み重ねることに成功し、それが復職の一助になったと意味を感じていた。【考察】当院音楽活動が、通常の療法では実現困難であった、対象者の復職支援という「参加」への介入として、機能した可能性が示唆された。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

•We determined the relationship between long hours of care and the assistance in each activity of daily living (ADL) element.•The assistance in wiping of the body, dressing and toileting were significantly associated with longer hours of care .•To support caregivers effectively, it is important to consider the kinds of ADL elements of the care recipients.

DOI： 10.1016/j.ssmph.2020.100565

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Objectives: Patients with Down syndrome have many orthopedic problems including flat foot. Insertion of an insole for a flat foot provides support to the medial longitudinal arch; thus, insole therapy is often used to treat a flat foot. However, the influence of an insole insertion on the knee joint kinematics for a patient with Down syndrome is unknown. This study aimed to elucidate the influence of an insole for a flat foot on the knee kinematics during gait for a patient with Down syndrome. Materials and Methods: The subject was a 22-year-old male with Down syndrome who had a flat foot. The knee joint angle during the gait was measured using a 3D motion capture system that consisted of eight infrared cameras. Results: The gait analysis demonstrated a reduction in the knee flexion angle during double knee action. The knee valgus and tibial internal rotation angles also decreased during the loading response phase while wearing shoes that contained the insole. Conclusions: As the angle of the knee joint decreased during the gait, it was considered that the stability of the knee joint improved by inserting the insole. In particular, there was a large difference in the tibial internal rotation angle when the insole was inserted. It is thus hypothesized that the insole contributes to the rotational stability of the knee joint. This study suggests that knee stability may improve and that gait becomes more stable when a Down syndrome patient with a flat foot wears an insole.

DOI： 10.3390/medicina56050219

PubMed

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記述言語：日本語   出版者・発行元：(公社)全国自治体病院協議会  

当院で実施している神経・筋疾患患者を対象としたHybrid Assistive Limb医療用下肢タイプ(HAL)を用いた歩行運動処置を含む入院リハビリテーション(HALプログラム)の効果を検証するとともに、得られた効果がHALプログラム実施前のどのような身体機能と関連があるか検討した。HALプログラムを実施した15例(男性11例、女性4例、平均58.9±16.0歳)を対象とした。2分間歩行距離(2MD)は実施前75.8±35.1mが実施後84.9±34.5mと増加し、左右膝関節屈曲・伸展トルクの合算値(M-power)は実施前2.0±1.6Nm/kgが実施後2.4±1.8Nm/kgに増加した。2MDとM-powerの増加は統計的に有意な変化であった。一方、Timed up and go test(TUG)は実施前19.1±10.4秒が実施後16.7±8.1秒と短縮していたものの統計的に有意な変化ではなかった。また、Δ2MDは実施前TUGとのみ正の相関を示し、実施前2MD、実施前M-powerとは有意な相関を認めなかった。ΔM-powerは実施前2MD、実施前TUG、実施前M-powerのいずれとも相関を示さなかった。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

[Purpose] Flatfoot often presents in patients with Down syndrome, and it can be diagnosed using a simple radiograph. Consequently, due to radiograph limitations, alternative non-invasive testing must be determined. Conventionally, arch height ratio can be used for evaluation of the medial longitudinal arch, where the foot is evaluated by detecting the navicular bone on the foot surface. However, detection of the navicular tuberosity is difficult and even though the detection is relatively straightforward for patients without intellectual disability, measuring navicular bone is more difficult in patients with intellectual disability, such as those who have Down syndrome and are uncooperative with a tester. Therefore, we evaluated arch height ratio using the malleoli instead of the navicular bone to determine whether malleoli testing was appropriate for patients with Down syndrome that have an intellectual disability. [Participants and Methods] We conducted a retrospective study of 16 pairs of feet in 16 patients with Down syndrome, diagnosed with flatfoot. The height to the centre of the talo-navicular joint and that of the malleoli from the sole were measured on radiographs using weight-bearing conditions. [Results] The age range was 5.2 to 25.3 years. There was a correlation between the height of the navicular bone and that of the medial and lateral malleoli. [Conclusion] We conclude that the medial and lateral malleoli can substitute navicular bone as a landmark diagnosis test for flatfoot. Considering the close physical distance between the medial malleolus and navicular bone, and the association between the tibia and medial longitudinal arch, the medial malleolus may provide a better landmark in patients with Down syndrome with it being potentially less invasive for uncooperative patients.

DOI： 10.1589/jpts.32.315

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To investigate the relationship between changes in nutritional status and the functional outcome of adult post-stroke patients hospitalized for rehabilitation. DESIGN: A cross-sectional study. SUBJECTS: Post-stroke patients (n = 134) who were admitted to a convalescent rehabilitation ward. METHODS: On admission and discharge, the nutritional status of each subject was assessed using the "controlling nutritional status" system. Activities of daily living were assessed using the Functional Independence Measure (FIM). Patients were divided into 2 categories: (i) those whose nutritional status improved or remained normal during the rehabilitation; and (ii) all others. RESULTS: The median age of patients was 65.5 years. Although there were no significant differences between the 2 categories in most characteristics, the FIM efficiency was significantly higher (0.230 in the improved category and 0.133 in the other; p < 0.001). Multiple linear regression analysis showed that the improved category as a variable was independently associated with greater FIM efficiency (p < 0.001). CONCLUSION: Improvement or maintenance of nutritional status was associated with better functional recovery in post-stroke rehabilitation in adult patients of all ages.

DOI： 10.2340/16501977-2655

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Transcranial direct current stimulation (tDCS) has been reported to modulate cortical excitability. Most studies on this topic addressed the modulation effects of tDCS on the upper extremities. Foot-sole tactile sensation is essential to gait, but little is known about the effect of tDCS on sensory function in the foot area. Here we administered tDCS to 10 healthy adults, and we observed that the modulation effects of cathodal tDCS on the left motor area led to a decrease in the tactile threshold of the left center of the distal pulp of the hallux. This effect was not observed in the sham condition. In addition, the subjects' vigilance levels were not changed between before and after the tDCS. These results suggest that sensation on the sole of the left foot could be modulated by cathodal tDCS on the left motor area.

DOI： 10.1016/j.neulet.2018.10.032

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

[Purpose] Recent studies have reported the effectiveness of robotic rehabilitation of paralyzed upper limbs in stroke patients. For example, the Single-Joint Hybrid Assistive Limb has been shown to improve upper limb impairments. However, limited data are available on the effectiveness of robotic rehabilitation of the upper limb with regards to daily living. In this case study, an accelerometer was adopted to examine whether rehabilitation using the Single-Joint Hybrid Assistive Limb improved upper limb activity during daily living in a stroke patient. [Participant and Methods] The participant was a 69-year-old male diagnosed with stroke and left hemiparesis. The Single-Joint Hybrid Assistive Limb was applied to the participant's elbow on the paralyzed side. The participant wore an accelerometer on each wrist to measure the activities of the upper limbs. Clinical tests of the paralyzed upper limb were also performed. [Results] The activity of the paralytic limb was significantly higher after Single-Joint Hybrid Assistive Limb intervention than before the intervention. On the other hand, none of the results of the clinical tests changed beyond a clinically important difference. [Conclusion] The Single-Joint Hybrid Assistive Limb could be useful for promoting active use of a paralyzed upper limb in daily living. In addition, an accelerometer could be especially useful for evaluating the effects of robotic rehabilitation.

DOI： 10.1589/jpts.32.192

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Virtual reality (VR) systems have been integrated into rehabilitation techniques for phantom limb pain (PLP). In this case report, we used electroencephalography (EEG) to analyze corticocortical coherence between the bilateral sensorimotor cortices during vibrotactile stimulation in conjunction with VR rehabilitation in two PLP patients. As a result, we observed PLP alleviation and increased alpha wave coherence during VR rehabilitation when stimulation was delivered to the cheek and shoulder (referred sensation areas) of the affected side. Vibrotactile stimulation with VR rehabilitation may enhance the awareness and movement of the phantom hand.

DOI： 10.1080/13554794.2019.1696368

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Independent walking is important for individuals who have undergone lower limb amputation. Recently, robot-assisted gait training has been widely used for individuals with abnormal gait. However, no study has evaluated the effect of the Honda Walking Assist Device® (HWA) on the gait of patients who have undergone transfemoral (TF) amputation. OBJECTIVE: This study aimed to investigate the safety, feasibility, and effect of gait training using the HWA for individuals who underwent lower limb amputation. METHODS: This study included two elderly patients who underwent TF amputation due to a nontraumatic reason. Gait training interventions using the HWA were performed for a week (5 training sessions). Self-selected walking speed (SWS), step length, cadence, hip kinematic parameters, and symmetricity of single support time ratios during SWS were measured before and after the HWA interventions. RESULTS: SWS, step length, cadence, and hip angle range improved after the HWA interventions in both patients. Symmetricity of single support time ratios and maximum hip extension angle improved in patient 1, but not in patient 2. There were no adverse events in either patient. CONCLUSIONS: Gait training using the HWA was safe and effective for improving the gait of two TF amputees.

DOI： 10.3233/BMR-191726

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: We aimed to report the clinical evaluation results of gait training with the Honda Walking Assist Device® (HWAT) in a patient with spinal cord injury (SCI). PATIENTS AND METHODS: A 63-year-old male with SCI (grade D on the American Spinal Injury Association Impairment Scale) underwent 20 HWAT sessions over 4 weeks. The self-selected walking speed (SWS), mean step length, cadence, 6-minute walking test (6MWT), Walking Index for SCI score, SCI Functional Ambulation Inventory gait score, American Spinal Injury Association Impairment Scale grade, neurological level, upper and lower extremity motor scores, modified Ashworth Scale, Penn Spasm Frequency Scale, and Spinal Cord Independence Measure version III were measured on admission, at the start of HWAT, at 2 and 4 weeks post-HWAT, and at discharge. Three-dimensional kinematic gait analysis and electromyographic assessments were performed before and after HWAT. RESULTS: The patient safely completed 20 HWAT sessions. We found improvements above the clinically meaningful difference in SWS and 6MWT as well as increased hip extension, ankle plantar- and dorsi-flexion range of motion and increased hip extensor, abductor, adductor, and ankle plantar flexor muscle activity. DISCUSSION: The SWS improved more markedly during the HWAT intervention, exceeding the minimal clinically important difference (0.10 to 0.15 m/s) in walking speed for people with SCI until discharge. Moreover, the 6MWT results at 2 weeks after the start of HWAT exceeded the cutoff value (472.5 m) for community ambulation and remained at a similar value at discharge. CONCLUSION: The walking distance (6MWT) and the walking speed (SWS) both demonstrated clinically important improvements following 20 treatment sessions which included HWAT.

DOI： 10.1177/2151459320956960

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記述言語：日本語   出版者・発行元：茨城県立病院医学雑誌編集委員会  

2016年度の診療報酬改定で回復期リハビリテーション病棟の質の評価である、実績指数が導入された。そこで、実績指数導入前後での患者の特徴や患者動態の傾向について2015年度、2016年度で比較検討を行った。対象は、当院回復期リハビリテーション病棟を2015年4月1日から2017年3月31日までに入棟し退棟した全ての患者265名とし、実際の実績指数の集計では除外した者も解析に含めた。実績指数導入前後で有意差のあった項目は、Functional Independence Measure(FIM)の運動項目利得および実績指数であり、患者動態については著明な変化は認めなかった。診療報酬改定による変化に適切に対応することができ、患者動態には大きな影響を及ぼさず、FIM運動項目利得が低く、入棟期間が長くなるような重症患者の入院が制限されていないことが分かった。また、適切なリハビリテーション医療の提供ができていることが示された。(著者抄録)

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記述言語：日本語   出版者・発行元：茨城県立医療大学付属病院  

【目的】非対称的な症状を呈したPD患者に対して、歩行の対称性に着目してHonda歩行アシスト(HWA)を使用した歩行訓練の効果について報告する。【対象】60歳代男性(Hoehn-Yahr重症度分類StageIII)。8年前に診断され、右優位の筋固縮、動作緩慢、姿勢反射障害を認めた。歩行は自立していたが、在宅生活にて転倒が増えたため、リハビリテーション目的で当院入院となった。【方法】HWAを用いた歩行訓練を、1日1回20分以内を14日間に計10回実施した。介入期間の前後に(1)運動機能:Unified Parkinson's Disease Rating Scale(UPDRS)PartIII、(2)歩行能力:10m最大歩行テスト、2分間歩行テスト、Timed Up and Go(TUG)、Freezing of Gait Questionnaire(FOGQ)、(3)バランス能力:Balance Evaluation Systems Test(BESTest)を計測した。【結果】TUG(右回り/左回り)は11.7秒/12.9秒から、10.2秒/10.5秒へと短縮した。また、FOGQは12点から9点へ改善し、BESTestは75点から81点へ改善を認めた。UPDRS PartIII、10m歩行速度、歩幅、歩行率、2分間歩行距離には大きな変化は認めなかった。【考察】PD患者の歩行障害に対し、HWAによる歩行訓練を実施したところ、FOGQ、TUG、BESTestで改善を認めた。特に、TUGは右、左回り共に計測時間の短縮を認め、非対称性が改善した。PD患者における症状の左右差に着目し、歩行の対称性に着目してHWAを設定したことが、効果的な歩行訓練につながったと考えた。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Limited evidence is available on optimal patient effort and degree of assistance to achieve preferable changes during robot-assisted training (RAT) for spinal cord injury (SCI) patients with spasticity. To investigate the relationship between patient effort and robotic assistance, we performed training using an electromyography-based robotic assistance device (HAL-SJ) in an SCI patient at multiple settings adjusted to patient effort. In this exploratory study, we report immediate change in muscle contraction patterns, patient effort, and spasticity in a 64-year-old man, diagnosed with cervical SCI and with American Spinal Injury Association Impairment Scale C level and C4 neurological level, who underwent RAT using HAL-SJ from post-injury day 403. Three patient effort conditions (comfortable, somewhat hard, and no-effort) by adjusting HAL-SJ's assists were set for each training session. Degree of effort during flexion and extension exercise was assessed by visual analog scale, muscle contraction pattern by electromyography, modified Ashworth scale, and maximum elbow extension and flexion torques, immediately before and after each training session, without HAL-SJ. The amount of effort during training with the HAL-SJ at each session was evaluated. The degree of effort during training can be set to three effort conditions as we intended by adjusting HAL-SJ. In sessions other than the no-effort setting, spasticity improved, and the level of effort was reduced immediately after training. Spasticity did not decrease in the training session using HAL-SJ with the no-effort setting, but co-contraction further increased during extension after training. Extension torque was unchanged in all sessions, and flexion torque decreased in all sessions. When performing upper-limb training with HAL-SJ in this SCI patient, the level of assistance with some effort may reduce spasticity and too strong assistance may increase co-contraction. Sometimes, a patient's effort may be seemingly unmeasurable; hence, the degree of patient effort should be further measured.

DOI： 10.3390/medicina55080404

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND OBJECTIVES: The Honda Walking Assistive device® (HWA) is a light and easywearable robot device for gait training, which assists patients' hip flexion and extension movementsto guide hip joint movements during gait. However, the safety and feasibility of robot-assisted gaittraining after total hip arthroplasty (THA) remains unclear. Thus, we aimed to evaluate the safetyand feasibility of this gait training intervention using HWA in a patient who underwent THA. MATERIALS AND METHODS: The patient was a 76-year-old woman with right hip osteoarthritis. Gaittraining using HWA was implemented for 20 sessions in total, five times per week from 1 week to5 weeks after THA. Self-selected walking speed (SWS), step length (SL), cadence, timed up and go(TUG), range of motion (ROM) of hip extension, and hip abduction and extension torque weremeasured preoperatively, and at 1 (pre-HWA), 2, 3, 4, 5 (post-HWA), and 10 weeks (follow-up) afterTHA. The gait patterns at SWS without HWA were measured by using three-dimensional (3D) gaitanalysis and an integrated electromyogram (iEMG). RESULTS: The patient completed 20 gait trainingsessions with no adverse event. Hip abduction torque at the operative side, hip extension torque,SWS, SL, and cadence were higher at post-HWA than at pre-HWA. In particular, SWS, TUG, andhip torque were remarkably increased 3 weeks after THA and improved to almost the same levelsat follow-up. Maximum hip extension angle and hip ROM during gait were higher at post-HWAthan at pre-HWA. Maximum and minimum anterior pelvic tilt angles were lower at post-HWA thanat pre-HWA. The iEMG of the gluteus maximus and gluteus medius in the stance phase were lowerat post-HWA than preoperatively and at pre-HWA. CONCLUSIONS: In this case, the gait training usingHWA was safe and feasible, and could be effective for the early improvement of gait ability, hipfunction, and gait pattern after THA.

DOI： 10.3390/medicina55030069

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The integration of multiple sensory modalities allows us to adapt to the environment of the outside world. It is widely known that visual stimuli interfere with the processing of auditory information, which is involved in the ability to pay attention. Additionally, visuospatial attention has the characteristic of laterality. It is unclear whether this laterality of visuospatial attention affects the processing of auditory stimuli. The sensorimotor gating system is a neurological process, which filters out unnecessary stimuli from environmental stimuli in the brain. Prepulse inhibition (PPI) is an operational measure of the sensorimotor gating system, which a weaker prestimulus (prepulse), such as a visual stimulus, inhibits the startle reflex elicited by a subsequent robust startling stimulus (pulse) such as a tone. Therefore, we investigated whether the visual stimulus from the left or right visual space affects the sensorimotor gating system in a "rest" task (low attentional condition) and a "selective attention" task (high attentional condition). In the selective attention task, we found that the target prepulse presented in the left and bilateral visual fields suppressed the startle reflex more than that presented in the right visual field. By contrast, there was no laterality of PPI in the no-target prepulse condition, and there was no laterality of PPI in the rest task. These results suggest that the laterality of visuospatial attention affects the sensorimotor gating system depending on the attentional condition. Moreover, the process of visual information processing may differ between the left and right brain.

DOI： 10.3389/fnbeh.2019.00001

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掲載種別：研究論文（学術雑誌）   出版者・発行元：ClinMed International Library  

DOI： 10.23937/ijfa-2017/1710015

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記述言語：日本語   出版者・発行元：茨城県立医療大学付属病院  

歩行障害を呈する患者6例に対してHonda歩行アシストを用いた歩行訓練を実施し、その効果について検討した。介入は最大2週間、計10回、1回あたり約20分とした。介入期間の前後で10m最大歩行テストと歩行アシスト装着準備時間を計測した結果、歩行速度は5例で増加し、うち4例では歩幅、歩行率の両者が増加していた。歩行アシストの装着時間は1回あたり平均2分50分で、理学療法士1人で短時間かつ容易に装着が可能であった。以上より、歩行アシストはリハビリテーションのツールとして臨床応用が期待できる機器であると考えられた。

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記述言語：日本語   出版者・発行元：茨城県立医療大学付属病院  

当院の職員・看護学生84名を対象に体圧分布測定器利用群と非利用群に分け、左側30度側臥位のポジショニングを2回実施し、学習効果を比較検討した。その結果、学生、職員にかかわらず、体圧分布測定器利用の有無は、2回の施行における最高圧値差に影響することが判明した。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

[Purpose] The hybrid assistive limb was developed to improve the kinematics and muscle activity in patients with neurological and orthopedic conditions. The purpose of the present study was to examine the long-term sustained effect of gait training using a hybrid assistive limb on gait stability, kinematics, and muscle activity by preventing knee collapse in a patient with cerebral palsy. [Participant and Methods] A 17 year-old male with cerebral palsy performed gait training with a hybrid assistive limb 12 times in 4 weeks. After completion of 12 sessions of hybrid assistive limb training, monthly follow-up was conducted for 8 months. The improvement was assessed on the basis of joint angle and muscle activity during gait. [Results] The degree of knee collapse observed at baseline was improved at 8-month follow-up. Regarding muscle activity, electromyography revealed increased activation of the vastus lateralis at 8-month follow-up. Moreover, the hip and knee angles were expanded during gait. In particular, the knee extension angle at heel contact was increased at 8 months after follow-up. [Conclusion] Gait training with a hybrid assistive limb provided improvement of gait stability such as kinematics and muscle activity in a patient with cerebral palsy. The improved gait stability through prevention of knee collapse achieved with hybrid assistive limb training sustained for 8 months.

DOI： 10.1589/jpts.30.1206

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記述言語：日本語   出版者・発行元：日本ヒューマンケア・ネットワーク学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J07469&link_issn=&doc_id=20210330190012&doc_link_id=%2Fdz8shuma%2F2018%2F001601%2F013%2F0086-0091%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdz8shuma%2F2018%2F001601%2F013%2F0086-0091%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本ヒューマンケア・ネットワーク学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J07469&link_issn=&doc_id=20210330190005&doc_link_id=%2Fdz8shuma%2F2018%2F001601%2F006%2F0040-0043%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdz8shuma%2F2018%2F001601%2F006%2F0040-0043%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

[Purpose] The Kyoto Scale of Psychological Development is an evaluation scale developed in the field of psychology. The initial aim of this study was to determine whether the quotient of the Postural-Motor area in the scale was correlated with the use of orthosis in patients with Down syndrome. The second aim was to examine a correlation among Postural-Motor, Cognitive-Adaptive, and Language-Social areas in the participants. [Participants and Methods] Patients with Down syndrome who had received a developmental examination, the Kyoto Scale of Psychological Development, were retrospectively investigated. The sample included 78 participants. Data on the participants' calendar ages ranged from 4.1 to 6.0 years, and the mean age was 4.9 at the examination. The investigated parameters were the number of participants who used an orthosis or insole and the mean developmental quotient for the Postural-Motor, Cognitive-Adaptive, and Language-Social areas. [Results] Twenty participants who completed the exam used an orthosis, and 18 of these had an insole as a first orthosis. The mean Postural-Motor quotient was significantly lower in participants who used an orthosis than in those who did not (52.3 ± 14.7). [Conclusion] The mean quotient of the Postural-Motor area was significantly lower in patients with Down syndrome who were prescribed some kind of orthosis than in those who were not. There was a significant correlation among the quotients of the three areas. The use of orthosis was expected to positively influence the Cognitive-Adaptive and Language-Social areas through the future in people with Down syndrome who have some difficulty with posture and movement.

DOI： 10.1589/jpts.30.1019

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記述言語：日本語   出版者・発行元：日本運動障害研究会  

症例は外傷性頸髄損傷により不全四肢麻痺を呈した48歳男性。ピックアップウォーカーを用いて歩行可能であったが、歩隔が狭く、リズムが乱れた歩行で、遊脚期に対側の下肢に接触をする場面が散見された。このため、歩容改善による歩行能力の向上を目的としてHonda歩行アシストを使用した歩行練習を実施した。週5回、計10回の介入を行った結果、歩行速度、歩行率、Spinal Cord Injury Functional Ambulation Inventory、Walking Index for Spinal Cord Injury IIの改善を認めた。ビデオ解析の結果、介入後の立脚期股関節伸展角度、遊脚期膝関節屈曲角度の増加を認め、振り子運動を利用した効率的な歩行を獲得していることが確認された。Honda歩行アシストを用いた歩行練習は、頸髄損傷不全四肢麻痺者の歩行能力の改善に有効である可能性が示唆された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J02794&link_issn=&doc_id=20180806140006&doc_link_id=%2Fcb8undou%2F2018%2F002801%2F006%2F0035-0042%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcb8undou%2F2018%2F002801%2F006%2F0035-0042%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: This study investigated the sequential physical changes after botulinum toxin type A (BTX-A) injected in children with cerebral palsy. METHODS: Nine children with cerebral palsy were included. Measurements were performed before treatment and 4 weeks, 8 weeks, and 12 weeks after treatment. We used video-recorded gait in the sagittal plane. The maximum flexion and extension angles of the hip, knee and ankle joints, step length, gait speed, and observational gait were measured using the Foot Contact Scale (FCS) and the Physician's Rating Scale (PRS). We also measured the lower limb range of motion (ROM), Modified Tardieu Scale (MTS), knee joint extension torque, and Gross Motor Function Measure-66 (GMFM-66). RESULTS: The ankle dorsiflexion ROM, GMFM-66, and the maximum dorsiflexion angle of the ankle during gait were significantly increased at 8 weeks after treatment, and knee joint extension torque was significantly increased at 12 weeks after treatment. CONCLUSION: Maximum effects of BTX-A treatment do not occur during the early stage after treatment. Therefore, long-term intervention with rehabilitation between BTX-A treatment may be more effective than implementing rehabilitation for only a brief period.

DOI： 10.1016/j.braindev.2018.02.003

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

[Purpose] The general approach for flat foot (FF) treatment in people with Down's syndrome (DS) is the use of insoles. However, the appropriate timing of the first insole prescription remains unclear. An aim of this present research was to investigate the status of prevalence of FF and orthosis prescription in the DS population. [Subjects and Methods] Two hundred fifteen subjects with DS who were seen at our hospital were retrospectively investigated. Investigated parameters were: prevalence of FF and other foot diseases, ratio and timing of orthopaedic consultation, ratio and timing of orthoses prescription, and mean age at the time of orthosis prescription. [Results] The prevalence of FF was 27.0% (58 subjects), and 50 subjects (23.3%) consulted an orthopaedic surgeon. An orthosis was prescribed for 54 subjects; 88.9% of these orthoses were insoles. Foot and leg orthoses other than insoles were prescribed significantly more frequently for females than males. The mean ages at the time of the first prescription of all types of orthoses and an insole were 7.3 years and 6.4 years, respectively. [Conclusion] The prevalence of FF was low, and the age at which subjects with DS were prescribed an orthosis was relatively high at our institution compared to previous reports. Since physical therapists see patients who could potentially have FF, those with suspected FF should then be referred to an orthopaedic doctor, which would enable the earlier orthosis prescription.

DOI： 10.1589/jpts.30.520

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

[Purpose] Sufficient sleep is required for maximal performance and good mood. Japan has three national wheelchair basketball teams: Top male, Top female, and Under-23 (U23) male teams. Using these team members as model, this study investigated the difference of sleep status of wheelchair basketball players by age and gender. [Subjects and Methods] There were 44 participants: 14 in the Top male team (29.5 ± 5.2 years), 18 in the Top female team (30.6 ± 9.2 years), and 12 in the U23 team (19.1 ± 2.0 years). Sleep status was assessed with the Pittsburgh Sleep Quality Index (PSQI); higher scores indicate poor sleep quality. [Results] PSQI scores in the Top male and female teams were higher than in the U23 team. The Top teams showed shorter sleep duration and worse sleep efficacy than the U23 team. Time spent in bed and sleep duration in the female team were shorter than in the Top male and U23 teams. More male players reported "feel too hot" as the reason for sleep disturbance than female players. [Conclusion] Players in the Top Japanese national wheelchair basketball teams had poorer sleep status than U23 players. Among female players, the reason for insomnia was less sleep duration. For males, the reason for insomnia was "feel too hot."

DOI： 10.1589/jpts.30.63

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記述言語：日本語   出版者・発行元：日本臨床作業療法学会  

本論文の目的は、事例を通して、身体障害領域における作業バランスと作業の意味を考慮した介入の有用性を示すことである。今回、整形外科疾患による上肢機能障害を呈し、復職を希望するクライエントに、入院中に実際の行為を用いた介入を中心に行い、退院後復職に至った。しかし、作業過剰状態から身体的な負担が大きくなり、身体の不調やうつ傾向により仕事の継続が危ぶまれる状態に陥った。そこで、外来作業療法でクライエントと協働して作業バランスを可視化し、クライエント自身が各作業のする意味と優先順位を意識し、不調となる原因や対策を考えられるように介入した。その結果、クライエントは作業量を調整出来るようになり、うつ傾向が改善され、仕事の継続に至った。本事例より、本人にとって無理のない、かつ納得のいく方法で作業の継続を支援するために、継続を望む作業だけでなく他の作業とのバランスや意味に着目する重要性が改めて示唆された。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The sit-to-stand motion is a common movement in daily life and understanding the mechanism of the sit-to-stand motion is important. Our previous study shows that four muscle synergies can characterize the sit-to-stand motion, and they have specific roles, such as upper body flexion, rising from a chair, body extension, and posture stabilization. The time-varying weight of these synergies are changed to achieve adaptive movement. However, the relationship between sensory input and the activation of the muscle synergies is not completely understood. In this paper, we aim to clarify how vestibular and visual inputs affect the muscle synergy in sit-to-stand motion. To address this, we conducted experiments as follows. Muscle activity, body kinematics, and ground reaction force were measured for the sit-to-stand motion under three different conditions: control, visual-disturbance, and vestibular-disturbance conditions. Under the control condition, the participants stood without any intervention. Under the visual-disturbance condition, the participants wore convex lens glasses and performed the sit-to-stand motion in a dark room. Under the vestibular-disturbance condition, a caloric test was performed. Muscle synergies were calculated for these three conditions using non-negative matrix factorization. We examined whether the same four muscle synergies were employed under each condition, and the changes in the time-varying coefficients were determined. These experiments were conducted on seven healthy, young participants. It was found that four muscle synergies could explain the muscle activity in the sit-to-stand motion under the three conditions. However, there were significant differences in the time-varying weight coefficients. When the visual input was disturbed, a larger amplitude was found for the muscle synergy that activated mostly in the final posture stabilization phase of the sit-to-stand motion. Under vestibular-disturbance condition, a longer activation was observed for the synergies that extended the entire body and led to posture stabilization. The results implied that during human sit-to-stand motion, visual input has less contribution to alter or correct activation of muscle synergies until the last phase. On the other hand, duration of muscle synergies after the buttocks leave are prolonged in order to adapt to the unstable condition in which sense of verticality is decreased under vestibular-disturbance.

DOI： 10.3389/fnins.2018.01042

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The synergistic effects of a trunk orthosis and an ankle-foot orthosis (AFO) in stroke patients with a hemiplegic gait are unclear. We previously developed a trunk orthosis with joints providing resistive force (TORF) to modify malalignment of the trunk and pelvis and confirmed its positive effects in stroke patients during level walking without an AFO. The aim of the present study was to determine if this trunk orthosis and an AFO have synergistic effects during level walking in community-dwelling patients with chronic stroke. METHODS: Twenty-eight community-dwelling stroke patients performed level walking at a self-selected speed with an AFO and again while wearing a TORF (TORF group) or a corset (control group). Spatiotemporal, kinematic, and kinetic data were recorded using a three-dimensional motion analysis system. RESULTS: When compared with the control group, the TORF group showed significant increases in walking speed, number of steps on the paretic leg per minute, and peak ankle plantar flexion moment during the single stance phase. CONCLUSION: The TORF increased the ankle joint plantar flexion moment at the end of the single stance phase during level walking in stroke patients, leading to an increase in their gait speed because of the modified trunk and pelvis alignment.

DOI： 10.2147/CIA.S146881

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND OBJECTIVE: We developed a quantitative method to measure movement representations of a phantom upper limb using a bimanual circle-line coordination task (BCT). We investigated whether short-term neurorehabilitation with a virtual reality (VR) system would restore voluntary movement representations and alleviate phantom limb pain (PLP). METHODS: Eight PLP patients were enrolled. In the BCT, they repeatedly drew vertical lines using the intact hand and intended to draw circles using the phantom limb. Drawing circles mentally using the phantom limb led to the emergence of an oval transfiguration of the vertical lines ('bimanual-coupling' effect). We quantitatively measured the degree of this bimanual-coupling effect as movement representations of the phantom limb before and immediately after short-term VR neurorehabilitation. This was achieved using an 11-point numerical rating scale (NRS) for PLP intensity and the Short-Form McGill Pain Questionnaire (SF-MPQ). During VR neurorehabilitation, patients wore a head-mounted display that showed a mirror-reversed computer graphic image of an intact arm (the virtual phantom limb). By intending to move both limbs simultaneously and similarly, the patients perceived voluntary execution of movement in their phantom limb. RESULTS: Short-term VR neurorehabilitation promptly restored voluntary movement representations in the BCT and alleviated PLP (NRS: p = 0.015; 39.1 ± 28.4% relief, SF-MPQ: p = 0.015; 61.5 ± 48.5% relief). Restoration of phantom limb movement representations and reduced PLP intensity were linearly correlated (p < 0.05). CONCLUSIONS: VR rehabilitation may encourage patient's motivation and multimodal sensorimotor re-integration of a phantom limb and subsequently have a potent analgesic effect. SIGNIFICANCE: There was no objective evidence that restoring movement representation by neurorehabilitation with virtual reality alleviated phantom limb pain. This study revealed quantitatively that restoring movement representation with virtual reality rehabilitation using a bimanual coordination task correlated with alleviation of phantom limb pain.

DOI： 10.1002/ejp.910

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Society of Physical Therapy Science  

DOI： 10.1589/jpts.29.228

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Informa UK Limited  

DOI： 10.1080/01691864.2016.1244489

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記述言語：日本語   出版者・発行元：(株)診断と治療社  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J03252&link_issn=&doc_id=20160909210007&doc_link_id=%2Fae4chilj%2F2016%2F001909%2F009%2F0661-0663%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae4chilj%2F2016%2F001909%2F009%2F0661-0663%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Although pain is unpleasant, it should serve as a reminder for individuals to avoid similar damaging incidents in the future. Hereditary sensory and autonomic neuropathy (HSAN) includes genetic disorders involving various sensory and autonomic dysfunctions. They are classified by the mode of inheritance, clinical features, and related genes. HSAN type 4 (HSAN-4) and type 5 (HSAN-5) are characterized by insensitivity to pain and thermal sensation. Further, HSAN-4 is accompanied by decreased sweating and intellectual disabilities. These characteristics of HSAN-4 and -5 result in many clinical features, such as pediatric, psychiatric, orthopedic, oral, dermatological, and ophthalmological problems. Orthopedic problems include destructive injuries such as multiple fractures and joint dislocation. Studies on gait have shown greater speed and higher heel contact angular velocity in HSAN-4 and -5 patients compared with controls. Studies on grasp-lift-holding tasks have shown higher grasp force and fluctuations in acceleration of the object. We believe that these findings represent outcomes of deficient motor learning. We propose a new rehabilitation method for patients with HSAN-4 and -5, with the aim of decreasing their destructive injuries.

DOI： 10.1016/j.neures.2015.10.011

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記述言語：英語   出版者・発行元：ELSEVIER IRELAND LTD  

Posture control to maintain an upright stance is one of the most important and basic requirements in the daily life of humans. The sensory inputs involved in posture control include visual and vestibular inputs, as well as proprioceptive and tactile somatosensory inputs. These multisensory inputs are integrated to represent the body state (body schema); this is then utilized in the brain to generate the motion. Changes in the multisensory inputs result in postural alterations (fast dynamics), as well as long-term alterations in multisensory integration and posture control itself (slow dynamics). In this review, we discuss the fast and slow dynamics, with a focus on multisensory integration including an introduction of our study to investigate "internal force control" with multisensory integration-evoked posture alteration. We found that the study of the slow dynamics is lagging compared to that of fast dynamics, such that our understanding of long-term alterations is insufficient to reveal the underlying mechanisms and to propose suitable models. Additional studies investigating slow dynamics are required to expand our knowledge of this area, which would support the physical training and rehabilitation of elderly and impaired persons. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.

DOI： 10.1016/j.neures.2015.12.002

Web of Science

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The effects of lumbosacral and spinal orthoses on low back pain and gait are not exactly clear. We previously developed a trunk orthosis with joints providing resistive force on low back load to decrease such load, and confirmed its positive effects during level walking in healthy young adults. Therefore, we aimed to determine the efficacy of this trunk orthosis during level walking in healthy elderly subjects. METHODS: Fifteen community-dwelling elderly subjects performed level walking at a self-selected speed without an orthosis, with our orthosis, and with a lumbosacral orthosis. Kinematic and kinetic data were recorded using a three-dimensional motion analysis system, and erector spinae activity was recorded by electromyography. RESULTS: When comparing the three conditions, our orthosis showed the following effects: it decreased the peak extension moment, increased the peak flexion moment, decreased the lateral bending angle, increased the peak thoracic extension angle, and had significantly lower erector spinae activity and significantly larger peak pelvic forward tilt angles. CONCLUSION: Our orthosis with joints providing resistive force decreased low back load and modified trunk and pelvis alignments during level walking in healthy elderly people.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

To understand cortical mechanisms related to truncal posture control during human locomotion, we investigated hemodynamic responses in the supplementary motor area (SMA) with quadrupedal and bipedal gaits using functional near-infrared spectroscopy in 10 healthy adults. The subjects performed three locomotor tasks where the degree of postural instability varied biomechanically, namely, hand-knee quadrupedal crawling (HKQuad task), upright quadrupedalism using bilateral Lofstrand crutches (UpQuad task), and typical upright bipedalism (UpBi task), on a treadmill. We measured the concentration of oxygenated hemoglobin (oxy-Hb) during the tasks. The oxy-Hb significantly decreased in the SMA during the HKQuad task, whereas it increased during the UpQuad task. No significant responses were observed during the UpBi task. Based on the degree of oxy-Hb responses, we ranked these locomotor tasks as UpQuad > UpBi > HKQuad. The order of the different tasks did not correspond with postural instability of the tasks. However, qualitative inspection of oxy-Hb time courses showed that oxy-Hb waveform patterns differed between upright posture tasks (peak-plateau-trough pattern for the UpQuad and UpBi tasks) and horizontal posture task (downhill pattern for the HKQuad task). Thus, the SMA may contribute to the control of truncal posture accompanying locomotor movements in humans.

DOI： 10.1155/2016/6168245

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Thalamic pain is a central neuropathic pain disorder which occurs after stroke. Its severe chronic pain is often intractable to pharmacotherapies and affects the patients' activities of daily living (ADL) and quality of life (QOL). Recently, spinal cord stimulation (SCS) has been reported to be effective in relieving the pain of thalamic pain; however, the effect of SCS on gait performance in patients is unknown. Therefore, we evaluated the gait performance before and after SCS in a case with thalamic pain. A 73-year-old male with thalamic pain participated in this study. We evaluated the gait of the patient two times: before SCS insertion and after 6 days of SCS. At the second evaluation, we measured the gait in three conditions: stimulation off, comfortable stimulation, and strong stimulation. SCS succeeded in improving the pain from 7 to 2 on an 11-point numerical rating scale. Step frequency and the velocity of gait tended to increase between pre- and poststimulation periods. There were no apparent differences in gait among the three stimulation conditions (off, comfortable, and strong) at the poststimulation period. SCS may be effective on gait in patients with thalamic pain.

DOI： 10.1155/2016/8730984

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The cognitive capacity for number representation is thought to be a functional isomorphism of space representation. Numbers are represented in a left-to-right-oriented mental number line and hemispatial neglect patients consistently demonstrate rightward midline shift of visuospace, the internal space and number representation. However, patients with pathologic pain in one limb showed a negative correlation between midline shift of the visuospace and number representation. The purpose of the present study is to ascertain whether such dissociation in accessing space and number representation is observed in another neuropathic pain condition, and then to propose a theoretical model regarding an intimate relationship between visuospace and internal space representations. Using patients with deafferentation pain caused by a nerve lesion in a limb, we investigated whether number representation is closely linked to space representation by evaluating visual subjective body-midline judgments in dark and light conditions (egocentric- and allocentric-spaces, respectively). We also used a number-interval-bisection task to analyze this question. All of the patients perceived allocentric-space accurately. Respective patients showed perceptual shifts in egocentric-space and number representation, however they did not demonstrate any trend of the shifted-direction. Direct comparison revealed that number representation is negatively correlated with not allocentric-space but egocentric-space: a leftward midline-shift of egocentric-space was linked with a rightward midline-shift of number bisection, and vice-versa. Internally-represented space demonstrated a mirror-reversed image of the visuospatial representation, similar to our previous finding. To explain the inverted representation, we can propose a theoretical model that spacing between mentally-aligned numbers in a left-to-right sequential line is anisometric.

DOI： 10.1016/j.mehy.2015.06.035

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記述言語：日本語   出版者・発行元：医歯薬出版(株)  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

神経病変が原因で自発的に疼痛が起きる神経障害性疼痛には生体の防御系としての意味合いは全くなく、痛み自体が疾患であると認識されなければならない。がん患者における神経障害性疼痛は約10%に観察され、痛みの重症度は高く、QOLの低下が著しい。そのため、神経障害性疼痛は適切に診断し治療する必要がある。神経障害性疼痛の診断は国際疼痛学会の診断ガイドに則って実施するが、その評価が困難な場合には神経障害性疼痛スクリーニング質問票を用いると便利である。また、治療では薬物療法が基本となるが、痛みに伴う身体的要因と心理的要因が悪影響を与え合う"痛みの悪循環"が形成されていることが多いため、一義的に疼痛の緩和を治療目標に設定するのではなく、痛みのために低下したADL/QOLの改善も目標に設定する。神経障害性疼痛患者が抱えるさまざまな問題に対して多面的に対応するため、集学的な診療チームによる治療が望ましい。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)シービーアール  

四肢切断後には、失ったはずの肢(幻肢)が存在するように感じるだけでなく、幻肢や残存肢に痛みを感じることもある。このような痛みを主とする異常な感覚を、四肢切断患者の60～80%が経験すると報告されており、痛みによってADLとQOLが大きく低下することは珍しくない。残存肢の痛みは、幻肢痛や断端痛と呼ばれてきたが、その定義が明確でないため混同されがちであった。本稿では、断端痛は残存肢の局所の痛みと定義し、その原因として筋、骨、末梢神経を取り上げ、慢性的な変化による病態とそれに応じた治療法を概説する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜ポイント＞頸椎は生理的に前彎するが,加齢などにより変形する.頸椎の変形により大後頭神経が障害されると頭痛の原因になりうる.頭蓋骨の腫瘍性病変や変形が,頭痛の原因になることがある.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J01440&link_issn=&doc_id=20150708230026&doc_link_id=10.11477%2Fmf.1402223612&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1402223612&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本トラウマティック・ストレス学会  

「痛み」は"組織の実質的ないしは潜在的な傷害と関連した、あるいはこのような傷害と関連して述べられる不快な感覚的、情動体験"と定義されており、痛みの身体要因と心理要因は常に共存し、身体的な痛みの認知は心理因子によってさまざまに影響を受ける。"疾患は何らかの組織傷害(だけ)に起因して発症する"とする考え方(生物医学還元論)では不十分であり、患者の痛みの訴えに対しては常に生物心理社会的モデルに則って、個々の慢性疼痛患者が抱える問題点を層別化して評価する必要がある。このような痛みにおける心身反応について脳機能画像研究に基づいて考察する。さらに、慢性疼痛に対する治療では"機能障害に対する治療"を中心に据え、"疼痛に特化した治療"と"心理的要因に対する治療"の2つを併用し支援する。治療のゴール設定は、疼痛が充分に緩和することだけでなく、有意義な日常生活を過ごし精神心理的な問題を持たないことに設定する必要がある。このような慢性疼痛に関する一般的な診療の考え方について、ペインクリニックにおける集学的疼痛診療として概説する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J04099&link_issn=&doc_id=20150710230002&doc_link_id=%2Fds7jstss%2F2015%2F001301%2F004%2F0012-0022%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fds7jstss%2F2015%2F001301%2F004%2F0012-0022%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医歯薬出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

STUDY DESIGN: Repeatability and reliability for measuring methods for real-time lumbar range of motion. OBJECTIVE: We established a novel set of marker positions for 3-dimensional motion analysis (VICON system) to determine lumbar spine range of motion (LROM) and lumbar motion precisely; we compared the repeatability and reliability of VICON system with those of an electrogoniometer. SUMMARY OF BACKGROUND DATA: The assessment of the LROM using x-ray is still one of the most precise methods, despite the radiation exposure. To avoid this, alternative methods, such as the VICON system and electrogoniometer, have been widely used. No study has reported the repeatability and reliability of LROM measurements using a VICON system and electrogoniometer. METHODS: The VICON system and electrogoniometer measured LROM and lumbar motion in 7 healthy males during 7 days. Differences between both systems were analyzed using Bland-Altman plots. Repeatability and reliability of the LROM measurements was assessed using coefficients of multiple correlations and intraclass correlation coefficients, respectively. Standard error of measurement was calculated to quantify the systematic error in LROM measurements. RESULTS: The mean maximum LROM values using the VICON system/electrogoniometer were 42°/52° for flexion, 17°/24° for extension, 16°/16° for lateral bending, and 8°/2° for axial rotation, respectively. Between VICON system and the electrogoniometer, Bland-Altman plots revealed no discrepancies in LROM values except for flexion.Coefficients of multiple correlations for LROM showed excellent repeatability. LROM measurements with VICON system showed excellent reliability for flexion and extension and fair-to-good reliability for other motions. LROM measurements with the electrogoniometer showed excellent reliability for flexion and fair-to-good reliability for other motions. Except for axial rotation, maximum intraclass correlation coefficients using VICON system were more reliable than the electrogoniometer for measuring lumbar motion. CONCLUSION: VICON system with our novel marker set allows practical and reliable longitudinal assessment of dynamic LROM. LEVEL OF EVIDENCE: N/A.

DOI： 10.1097/BRS.0b013e3182a0dbc5

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本義肢装具学会  

四肢切断後に現れる幻肢痛をはじめとする神経障害性疼痛の発症には末梢神経系と脊髄での神経系の異常興奮とその可塑性に加え、大脳を中心とした中枢神経系の可塑性が関与していることが最近の脳機能画像研究から確立しつつある。幻肢の随意運動の中枢神経系における制御機構をもとに、われわれが行っている鏡を用いて幻肢の随意運動を獲得させることによる臨床治療(鏡療法)についてその有効性と限界、そして今後の幻肢痛および神経障害性疼痛に対する新規神経リハビリテーション治療の可能性について概説する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J01801&link_issn=&doc_id=20131010450002&doc_link_id=%2Ffq8gishi%2F2013%2F002904%2F003%2F0206-0211%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffq8gishi%2F2013%2F002904%2F003%2F0206-0211%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To clarify the features of gait in patients with congenital insensitivity to pain (CIP) by analyzing the video-recorded gait. METHODS: Eleven patients with the diagnosis of hereditary sensory and autonomic neuropathy (HSAN) type 4 or 5 and 15 healthy participants were enrolled in this study. Gait was analyzed using two-dimensional (2D) digital video and video analysis software. Walking speed, cadence, step length, stance phase duration, and heel contact to foot flat period were compared between patients and healthy participants. RESULTS: The results showed that walking speed and heel contact angular velocity were significantly higher (p < 0.05), and step length was significantly longer (p < 0.05) in CIP patients, especially in the younger age group. CONCLUSION: Young patients with CIP walked faster, with a longer step length and higher heel contact angular velocity than young control participants. These results may explain the frequency of lower extremity injuries in CIP patients.

DOI： 10.3109/17518423.2012.760117

PubMed

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記述言語：日本語   出版者・発行元：医歯薬出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Quadrupedalism is a common mode of locomotion in land animals. The load distribution between the forelimbs (FL) and hindlimbs (HL) in quadrupedalism has been of great interest to researchers, and a database of the vertical peak force (Vpk) for FL and HL has been created for various species. However, Vpk in human infant crawling, a natural form of human quadrupedalism, has not been evaluated. We aimed to study Vpk in human infant crawling. Eight healthy infants who used a typical crawling style (i.e., crawling on the hands and knees) were included. The infants were encouraged to crawl over pressure mats placed on the floor, and Vpk of FL and HL were calculated. FL Vpk was 0.631±0.087 (per BW), and HL Vpk was 0.638±0.089 (per BW). No significant difference was observed between FL and HL Vpk. The mean FL/HL Vpk ratio was -0.011 on a natural logarithmic scale. These data could be added to the current database on Vpk for quadrupedalism.

DOI： 10.1016/j.gaitpost.2012.07.004

PubMed

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記述言語：日本語   出版者・発行元：(株)医学書院  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J02268&link_issn=&doc_id=20120215230007&doc_link_id=10.11477%2Fmf.1551102189&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1551102189&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本ペインクリニック学会  

脊髄刺激療法(spinal cord stimulation:SCS)は難治痛に有用であり、最近はパーキンソン病などの運動変性疾患にも応用されている。今回、脊変性症による両下肢痙性不全麻痺を呈していた61歳男性にSCSを行い、下肢運動機能への影響を、光学式三次元動作分析システムを用いて評価したので報告する。患者は、発症時から動作(特に座位からの立ち上がり動作)時に左腰痛が起こり、痛みは徐々に増強し、数値評価スケール(numerical rating scale:NRS)で8であった。各種の薬物療法に抵抗性であったので、第10胸椎レベルでのSCSを行い、痛みはNRSで5に改善した。座位からの立ち上がり動作の分析で、SCS施行前には5.5±0.5秒を要していたがSCS後には4.0±0.1秒(P<0.05)に短縮した。さらに、SCS使用時は骨盤と体幹のアライメントが10.0±6.8°前傾(P<0.05)し、歩行姿勢が改善した。SCSの効果判定には痛みだけの改善でなく、生活の質全体への影響が求められ、三次元動作分析システムを用いた運動機能評価はその一助となりうる。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J03612&link_issn=&doc_id=20120315370008&doc_link_id=%2Fca0jjspc%2F2012%2F001901%2F008%2F0044-0047%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fca0jjspc%2F2012%2F001901%2F008%2F0044-0047%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)診断と治療社  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J03252&link_issn=&doc_id=20120106310010&doc_link_id=%2Fae4chilj%2F2012%2F001501%2F012%2F0043-0045%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae4chilj%2F2012%2F001501%2F012%2F0043-0045%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

われわれは、三次元動作解析装置を用いた詳細な動作解析を行い、三次元動作解析を診療場面における評価に応用することが出来た。2009年度は、股関節、膝関節、足関節について、左右の下肢で運動機能が異なることを明らかにした。2010年度は、股関節、膝関節、足関節の片脚に着目し、装具療法の有効性を明らかにした。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J00650&link_issn=&doc_id=20111205430004&doc_link_id=%2Fco2socie%2F2011%2F003605%2F004%2F0456-0459%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fco2socie%2F2011%2F003605%2F004%2F0456-0459%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

幻肢痛や腕神経叢引き抜き損傷後疼痛、脊髄損傷後疼痛を代表例とする神経障害性疼痛は重症度が高く、そのQOLの低下は著しい。これまで痛みは疾患の一症状として扱われることが多かったが、神経障害性疼痛は"疾患"として扱われるべき病態である。本稿では神経障害性疼痛とともに診療に難渋することが少なくない複合性局所疼痛症候群(complex regional pain syndrome;CRPS)の臨床的分類と大脳レベルの病態生理を概説し、続いて我々が行っている神経リハビリテーション治療について概説する。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本理学療法学会連合  

歩行中の足部の動態はいまだ定量的に解析されていない。本研究では、足部に変形を有する小児(今回は15歳以下とした)を対象に、足部の変形により歩行中の下肢各関節の動態がどのように変化するかを明らかにするために三次元での動作解析を行った。歩行立脚期の足部角度は、被験者間でのばらつきが大きかったが、いずれの被験者でも立脚期を通じての角度変化は少なかった。前額面では股関節外転モーメント・膝関節外反モーメントが小さく、立脚期の2峰性パターンは確認できなかった。足部の変形により、特に前足部-後足部間の動きが少ないことが確認できた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J01747&link_issn=&doc_id=20110512390018&doc_link_id=%2Fcb3physi%2F2011%2F003802%2F018%2F0142-0143%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcb3physi%2F2011%2F003802%2F018%2F0142-0143%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：神奈川県立こども医療センター  

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記述言語：日本語   出版者・発行元：(株)中外医学社  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Neural blockades are considered an alternative to pharmacotherapy for neuropathic pain although these blockades elicit limited effects. We encountered a patient with postbrachial plexus avulsion injury pain, which was refractory to conventional treatments but disappeared temporarily with the administration of the local anesthetic lidocaine around the left mandibular molar tooth during dental treatments. This analgesic effect on neuropathic pain by oral local anesthesia was reproducible. Under conditions of neuropathic pain, cerebral somatotopic reorganization in the sensorimotor cortices of the brain has been observed. Either expansion or shrinkage of the somatotopic representation of a deafferentated body part correlates with the degree of neuropathic pain. In our case, administration of an oral local anesthetic shrank the somatotopic representation of the mouth, which is next to the upper limb representation and thereby expanded the upper limb representation in a normal manner. Consequently, oral local anesthesia improved the pain in the upper limb. This case suggests that pain alleviation through neural plasticity within the brain is related to neural blockade.

DOI： 10.1155/2011/984281

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present a case of complex regional pain syndrome (CRPS), in which symptoms, including burning pain and severe allodynia, were alleviated by using a regional intravenous nerve blockade (Bier block) combined with physiotherapy, but reappeared following an epileptic seizure. Symptoms disappeared again following control of epileptic discharges, as revealed by single-photon emission computed tomography (SPECT) and electroencephalography (EEG) results. Although systemic toxicity of a local anesthetic applied by Bier block was suspected as a cause of the first seizure, the patient did not present any other toxic symptoms, and seizures repeatedly occurred after Bier block cessation; the patient was then diagnosed as having temporal symptomatic epilepsy. This case suggests that symptoms of CRPS may be sustained by abnormal brain conditions, and our findings contribute to the understanding of how the central nervous system participates in maintaining pain and allodynia associated with CRPS.

DOI： 10.1155/2011/494975

PubMed

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記述言語：日本語   出版者・発行元：克誠堂出版(株)  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J01397&link_issn=&doc_id=20101108110004&doc_link_id=%2Fad3msuie%2F2010%2F005911%2F006%2F1364-1369%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3msuie%2F2010%2F005911%2F006%2F1364-1369%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本ハンドセラピィ学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00540-010-0921-6

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

After amputation, most patients experience a phenomenon known as a phantom limb (PL). A variety of PL experiences appear to be associated with neural plasticity within the CNS. However, due to the subjective nature of PL experiences, there was no definitive way to reliably assess PL experiences other than using patients' direct reports. Here, we were able to obtain patients' indirect responses to PL experiences, for a more objective evaluation. First, we conducted a study with normals and 17 non-PL patients experiencing pathological pain in one hand. We took digital photographs of their affected and unaffected hands, altered the sizes of the images digitally, and then asked each subject to choose the image that most closely matched the actual size of their own hands (from a series of images presented on a video screen). Subjective size perceptions of the hands were homologous, regardless of the pathological condition of one hand (p<0.0001, Spearman R(2)=0.82). Next, we used the same method for total 19 patients with a phantom hand. The intact hand-size perception was linearly correlated with phantom hand-size perception (weighted linear regression analysis: p<0.0001, R(2)=0.75, adjusted R(2)=0.73, F-value=50.1, degree of freedom=18). Thus, without requiring a subjective description about PL, the patients' evaluation of the intact hand-size precisely but indirectly indicated whether the PL was perceived to be telescoped (shrunken), normal or enlarged. This more objective evaluation of PL phenomena could become a key tool for disentangling the neural mechanisms involved.

DOI： 10.1016/j.ejpain.2009.05.003

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

二分脊椎児1例を対象に視診による歩行評価と動作分析装置による歩行評価を比較した。その結果、1)視診では体幹の左右への動揺と左足の内反を2名の検者が独立に報告された。2)動作分析装置による評価では、股関節は立脚中、右が左に比べて屈曲内旋位にあった。膝関節は右より左が伸展し、前額面では立脚中にO脚→X脚と変化していた。一方、足関節は左底背屈が消失し、立脚中に左は外反→内反→外反と変化し、右は内旋→外旋位へ変化していた。また、前足部は回内位であった。3)これらの結果から、動作分析装置を用いることで視診では検出不可能であった詳細な歩行評価を、動的、定量的に行うことが可能であることが確認された。

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J01133&link_issn=&doc_id=20100210080006&doc_link_id=%2Ffj2ortho%2F2010%2F008401%2F008%2F0034-0037%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj2ortho%2F2010%2F008401%2F008%2F0034-0037%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本ペインクリニック学会  

四肢切断後に現れる幻肢痛をはじめとする神経障害性疼痛の発症には末梢神経系と脊髄での神経系の異常興奮とその可塑性に加え、大脳を中心とした中枢神経系の可塑性が関与していることが、最近の脳機能画像研究から確立しつつある。本稿では、幻肢痛を含む病的疼痛全般は脊髄よりも上位の中枢神経系に由来するというわれわれの持論から、まず幻肢の感覚表象について概説し、続いて幻肢の随意運動の中枢神経系における制御機構から「幻肢が中枢神経系にとって健常肢として存在すれば幻肢痛が寛解する」という仮説を提案する。この仮説を、われわれが行っている鏡を用いて幻肢の随意運動を獲得させることによる臨床治療(鏡療法)から検証し、鏡療法の有効性と限界、そして今後の幻肢痛および神経障害性疼痛に対する新規神経リハビリテーション治療の可能性について概説する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J03612&link_issn=&doc_id=20100215480001&doc_link_id=%2Fca0jjspc%2F2010%2F001701%2F001%2F0001-0010%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fca0jjspc%2F2010%2F001701%2F001%2F0001-0010%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Complex regional pain syndrome (CRPS) patients show impaired visuospatial perception in the dark, as compared to normal patients with acute nociceptive pain. The purpose of this study is 2-fold: (i) to ascertain whether this distorted visuospatial perception is related to the chronicity of pain, and (ii) to analyse visuospatial perception of CRPS in comparison with another neuropathic pain condition. MATERIALS AND METHODS: We evaluated visual subjective body-midline (vSM) representation in 27 patients with post-herpetic neuralgia (PHN) and 22 with CRPS under light and dark conditions. A red laser dot was projected onto a screen and moved horizontally towards the sagittal plane of the objective body-midline (OM). Each participant was asked to direct the dot to a position where it crossed their vSM. The distance between the vSM and OM was analysed to determine how and in which direction the vSM deviated. RESULTS: Under light condition, all vSM judgments approximately matched the OM. However, in the dark, CRPS patients, but not PHN patients, showed a shifted vSM towards the affected side. CONCLUSION: We demonstrated that chronic pain does not always impair visuospatial perception. The aetiology of PHN is limited to the peripheral nervous system, whereas the distorted visuospatial perception suggests a supraspinal aetiology of CRPS.

PubMed

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記述言語：日本語   出版者・発行元：(株)メディカルプレス  

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記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

乳児期～15歳以降まで経過観察した開放性脊髄髄膜瘤21名(男8名、女13名、15～25歳・平均18歳)を対象に、長期にわたり経過観察した二分脊椎患者の移動能力や関係する因子について検討した。対象の麻痺レベル、移動能力を検討すると、5名は麻痺レベル別の目標に比べ移動能力が高く、5名は低かった。前者では足部褥瘡が多く、その他の因子には差はなく、原因は麻痺レベルの評価法であると思われた。後者では側彎、股関節脱臼、肥満度が関係すると思われた。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2009&ichushi_jid=J00650&link_issn=&doc_id=20090316360011&doc_link_id=%2Fco2socie%2F2009%2F003401%2F011%2F0049-0051%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fco2socie%2F2009%2F003401%2F011%2F0049-0051%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本小児整形外科学会  

橈側列形成不全症は比較的頻度が高く、重要な疾患である。治療の原則は、装具療法などの保存的治療であるが、多くが外科的治療を必要とする。外科的治療は、centralization法が代表的である。しかし、橈屈変形の再発や尺骨の発達障害による前腕の短縮などのため、完成された術式とはいえない。我々は、橈側列形成不全の1例を経験した。症例は、出生時より診断され、装具療法を開始した。3歳時、7歳時にcentralization法を、14歳時にイリザロフ法による矯正と前腕の延長を行った。17歳の最終経過観察時、経過は概ね良好である。本症例では、3歳時の術中、橈骨の遠位が一部存在していることが明らかになった。7歳時の手術で接合した橈骨の一部は、橈側の支持として重要な役割を果たす一方で、前腕回内外制限の原因ともなった。このため、正確な病態の把握と手術時期や術式の十分な検討が必要であると考えられた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2009&ichushi_jid=J02876&link_issn=&doc_id=20090225050024&doc_link_id=%2Ffn8seike%2F2009%2F001801%2F025%2F0123-0127%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffn8seike%2F2009%2F001801%2F025%2F0123-0127%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(公社)日本リハビリテーション医学会  

二分脊椎患者の移動能力には複数の要素が関与するが、麻痺レベルの関与が最も大きいとされる。また歩行可能な患者でも加齢に伴い移動能力が低下することがあるが、縦断的な調査はほとんどない。本研究では、乳児期から15歳以降まで継続して経過観察した開放性脊髄髄膜瘤患者21名の移動能力やそれに関係する因子について検討した。最終診察時の移動能力を、沖による麻痺レベル別の目標移動能力と比べると、5名は目標移動能力を上回っていた。これらはいずれも第3,4腰髄レベルの麻痺であり、従来麻痺レベルの評価法として利用されることの多いSharrardの方法と、われわれが用いたMenelausの方法との違いも原因の一つと考えた。別の5名は目標移動能力を下回っており、うち2名は経過観察中に移動能力が低下した。これら5名を残りの16名と比較すると、側彎、股関節脱臼、肥満の頻度が高く、低い移動能力に影響している可能性があった。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2008&ichushi_jid=J04897&link_issn=&doc_id=20080624200011&doc_link_id=%2Fch7remed%2F2008%2F004506%2F010%2F0365-0370%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fch7remed%2F2008%2F004506%2F010%2F0365-0370%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

二分脊椎の下肢機能を評価するために、理学所見、超音波画像、表面筋電図を検討した。1歳1ヵ月～15歳11ヵ月の二分脊椎児14名を対象とした。合計84筋(6筋/人)のうち、理学所見(徒手筋力テストor自発運動の観察)は、66筋(79%)で可能であった。超音波検査は、全例、可能であった。表面筋電図検査は、65筋(77%)で可能であった。理学所見、超音波画像、表面筋電図は有意に相関していた。理学所見、表面筋電図で検査できなかったのは、幼少や知的障害で指示に従えず、十分な自動運動を観察できない児であった。超音波画像は患児の協力が得られなくても施行可能で、簡便、非侵襲的な検査方法である。超音波画像を用いることで、より早期から正確に下肢機能の予後を予測できる可能性が示唆された。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2008&ichushi_jid=J00650&link_issn=&doc_id=20080310320010&doc_link_id=%2Fco2socie%2F2008%2F003301%2F010%2F0043-0044%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fco2socie%2F2008%2F003301%2F010%2F0043-0044%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本小児整形外科学会  

先天性脛骨欠損症Jones分類2型においては、一般的に残存した脛骨近位部と腓骨を接合する脛腓骨間骨接合術を選択する。装具を用いた独歩獲得など良好な成績が得られていることが多く、骨癒合不全の報告はほとんどない。今回、当院で同時期に施行した脛腓骨間骨接合術のJones2型の4症例中、術後に癒合不全を呈した3症例を紹介し、術中術後の留意点を検討した。3症例ともKirschnerワイヤー(以下Kワイヤー)1本で髄内固定し、一期的に足関節離断術も施行した。2症例では腓骨近位端の遠位部を部分切除した。術後は2症例で膝上から足までのギプス(AKギプス)を巻き、1症例ではギプス固定をしなかった。全症例脛骨遠位端が前方に押し出される形の偽関節であり、追加手術を要した。治療に当たる際は、骨癒合不全を念頭において内外の固定方法や手術方法を十分に検討し、骨癒合を得るために種々の工夫をこらす必要がある。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本小児整形外科学会  

環軸椎回旋位固定に対して、鎮静下に頭部を回旋制限のある方向に抵抗のない範囲に回旋して撮影したCT(以下矯正位CT)を用いて評価を行った。対象は男児2例、女児2例の計4例(平均5歳10ヵ月)だった。環椎前後軸が軸椎前後軸を越えて反対側に回旋している場合をcross over(+)、していない場合をcross over(-)として評価した。初回の矯正位CTは初診時、もしくはNSAIDs、筋弛緩薬内服、頸椎カラー固定後に行ったが、全例でcross over(-)だった。介達牽引、全身麻酔下徒手整復およびハローベスト固定を症例に応じて行い、各治療後に矯正位CTでcross overの有無を評価した。cross over(+)となった3例は、回旋制限が改善し再発もなかった。環軸椎回旋位固定の治療前後の評価として鎮静下矯正位CTは有効な可能性がある。(著者抄録)

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記述言語：日本語   出版者・発行元：関東整形災害外科学会  

17歳男性。患者は尖足および膝屈曲拘縮による歩行障害を主訴とした。出生直後より左尖足があり、他医にて3歳、6歳、10歳時にアキレス腱延長術を受けたが、その度に再発していた。受診時、下肢はSMDで右85.5cm、左83cmと脚長差がみられ、左膝には約15°の屈曲拘縮を認めた。上肢は左が2cm短く、上腕、前腕の周径差を認め、左手関節に背屈制限、左示指近位指切間関節には可動域制限を認めた。一方、単純X線では、左腓骨に蝋を流したような骨硬化像があり、髄腔は狭小化し、左足部は広範囲に斑状・線状骨硬化が認められた。いずれの骨硬化像も左右非対称であった。以上、これらの所見より、本症例はメロレオストーシスと診断され、膝の屈曲拘縮に対し左大腿骨伸展骨切り術と左ハムストリング延長術、更に尖凹足に対して足根骨の矯正骨切り術が行われた。その結果、術後、病変部でない大腿骨骨切り部の仮骨形成は良好であったが、病変部の足根骨骨切り部は6ヵ月での骨癒合と遷延がみられた。

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記述言語：日本語   出版者・発行元：(一社)日本小児整形外科学会  

脚長不等に対する経皮的膝骨端線閉鎖術の有効性について検討した.対象は脚長不等の治療のため経皮的膝骨端線閉鎖術を行い術後1年以上経過した8例で,脚長不等の原因疾患は先天性片側肥大症3例,先天性大腿骨短縮症,大腿骨骨折後過成長,化膿性股関節炎,化膿性膝関節炎,先天性股関節脱臼ペルテス病様変化,それぞれ1例である.手術時年齢,術後経過観察期間,Menelaus法とmultiplier法それぞれによる最終予想脚長差と両者の比率(M/m比),術前脚長差,最終脚長差(平均値は絶対値の平均),改善値(術前脚長差-最終脚長差),について調査した.それぞれの調査項目の平均値は,手術時年齢12歳9ヵ月,術後経過観察期間3年,最終予想脚長差Menelaus法4.4cm,multiplier法4.0cm,M/m比1.09,術前脚長差3.6cm,最終脚長差1.6cm,改善値2.3cm,であった.経皮的膝骨端線閉鎖術は低侵襲で脚長の補正が可能で,脚長不等の治療法として有効である(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本小児神経学会  

6歳女児の左急性中耳炎の経過中,左耳前部・頬部の疼痛と左外転神経麻痺が出現し,Gradenigo症候群と診断された.頭部MRIで両側中耳,乳突蜂巣,蝶形骨洞,飾骨洞の粘膜肥厚,左錐体尖部のT2高信号と異常増強効果,海面静脈洞と上咽頭の異常増強効果および同レベルでの左内頸動脈の狭小化が認められた.中耳炎以外に副鼻腔炎から波及した可能性も考えられた.抗生物質静注による保存療法により軽快したが,錐体尖部の増強効果は長期間持続した

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2004&ichushi_jid=J01232&link_issn=&doc_id=20040630100010&doc_link_id=1390282679530433792&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282679530433792&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：日本語   出版者・発行元：(株)文光堂  

0歳男児.母親(37歳)が家族性高コレステロール血症であった新生児ヘモクロマト-シス(NH)の1剖検例を経験した.患児の母親がII型家族性高コレステロール血症で,20歳頃から薬剤治療を継続していた.妊娠23週まで鉄欠乏性貧血で鉄剤投与され,26週時にコレステロール値の上昇でコレスチラミンとフェノフィブラートを投与された.在胎23週から子宮内発育遅延を認め,在胎35週3日に胎児仮死で緊急帝王切開にて出生し,NICUに入院した.高度の肝機能不全を呈し,凝固能異常による多臓器出血を併発し,生後7日で死亡した.剖検では,肝に高度の肝細胞脱落と結節状の肝小葉を認め,同じく高度の肝細胞鉄沈着が認められた.さらに,膵臓および漿液腺上皮,内分泌腺上皮,尿細管上皮,胸腺上皮,心筋にも鉄沈着が認められたが,細網内皮系(脾臓,骨髄,リンパ節)には認められなかった.フェノフィブラートはヒト肝細胞ミトコンドリアの形態変化をきたすことから,本例の高度肝障害にフェノフィブラートの関与の可能性が考えられた

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The mouse Zic genes encode zinc-finger (Zf) proteins expressed only in the cerebellum of the adult brain. The genes are the vertebrate homologues of the Drosophila pair-rule gene, odd-paired (opa). We identified a novel gene, Zic4, which belongs to the Zic gene family, through a genomic and cDNA cloning study. Zic4 is highly similar to Zic1, Zic2 and Zic3, especially in its Zf motif. An analysis of the genomic organization of Zic4 showed that the gene shares a common exon-intron boundary with Zic1, Zic2, Zic3 and opa. The chromosomal location of Zic4 was determined to be mouse chromosome 9 in the vicinity of Zic1, using an interspecific backcross panel. An RNase protection study showed that Zic4 is expressed only in the cerebellum during the adult stage, as are the other Zic genes. The temporal profile of mRNA expression in the developing cerebellum is similar to that of Zic3 which has a peak on postnatal day 5. These findings suggest that Zic4 is a gene which works cooperatively with other Zic genes during cerebellar development.

PubMed

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