論文掲載 ～2017年まで

• Koshino Y, Yamanaka M, Ezawa Y, Okunuki T, Ishida T, Samukawa M, Tohyama H.
  Coupling motion between rearfoot and hip and knee joints during walking and single-leg landing.
  J Electromyogr Kinesiol. 2017 Dec;37:75-83. doi: 10.1016/j.jelekin.2017.09.004. Epub 2017 Sep 22.

  The objective of the current study was to investigate the kinematic relationships between the rearfoot and hip/knee joint during walking and single-leg landing. Kinematics of the rearfoot relative to the shank, knee and hip joints during walking and single-leg landing were analyzed in 22 healthy university students. Kinematic relationships between two types of angular data were assessed by zero-lag cross-correlation coefficients and coupling angles, and were compared between joints and between tasks. During walking, rearfoot eversion/inversion and external/internal rotation were strongly correlated with hip adduction/abduction (R=0.69 and R=0.84), whereas correlations with knee kinematics were not strong (R≤0.51) and varied between subjects. The correlations with hip adduction/abduction were stronger than those with knee kinematics (P<0.001). Most coefficients during single-leg landing were strong (R≥0.70), and greater than those during walking (P<0.001). Coupling angles indicated that hip motion relative to rearfoot motion was greater than knee motion relative to rearfoot motion during both tasks (P<0.001). Interventions to control rearfoot kinematics may affect hip kinematics during dynamic tasks. The coupling motion between the rearfoot and hip/knee joints, especially in the knee, should be considered individually.

• Ueno R, Ishida T, Yamanaka M, Taniguchi S, Ikuta R, Samukawa M, Saito H, Tohyama H.
  Quadriceps force and anterior tibial force occur obviously later than vertical ground reaction force: a simulation study.
  BMC Musculoskelet Disord. 2017 Nov 18;18(1):467. doi: 10.1186/s12891-017-1832-6.

  BACKGROUND:
  Although it is well known that quadriceps force generates anterior tibial force, it has been unclear whether quadriceps force causes great anterior tibial force during the early phase of a landing task. The purpose of the present study was to examine whether the quadriceps force induced great anterior tibial force during the early phase of a landing task.
  METHODS:
  Fourteen young, healthy, female subjects performed a single-leg landing task. Muscle force and anterior tibial force were estimated from motion capture data and synchronized force data from the force plate. One-way repeated measures analysis of variance and the post hoc Bonferroni test were conducted to compare the peak time of the vertical ground reaction force, quadriceps force and anterior tibial force during the single-leg landing. In addition, we examined the contribution of vertical and posterior ground reaction force, knee flexion angle and moment to peak quadriceps force using multiple linear regression.
  RESULTS:
  The peak times of the estimated quadriceps force (96.0 ± 23.0 ms) and anterior tibial force (111.9 ± 18.9 ms) were significantly later than that of the vertical ground reaction force (63.5 ± 6.8 ms) during the single-leg landing. The peak quadriceps force was positively correlated with the peak anterior tibial force (R = 0.953, P < 0.001). Multiple linear regression analysis showed that the peak knee flexion moment contributed significantly to the peak quadriceps force (R 2 = 0.778, P < 0.001).
  CONCLUSION:
  The peak times of the quadriceps force and the anterior tibial force were obviously later than that of the vertical ground reaction force for the female athletes during successful single-leg landings. Studies have reported that the peak time of the vertical ground reaction force was close to the time of anterior cruciate ligament (ACL) disruption in ACL injury cases. It is possible that early contraction of the quadriceps during landing might induce ACL disruption as a result of excessive anterior tibial force in unanticipated situations in ACL injury cases.

• Koshino Y, Ishida T, Yamanaka M, Samukawa M, Kobayashi T, Tohyama H.
  Toe-in Landing Increases the Ankle Inversion Angle and Moment During Single-Leg Landing: Implications in the Prevention of Lateral Ankle Sprains.
  J Sport Rehabil. 2017 Nov;26(6):530-535. doi: 10.1123/jsr.2016-0004. Epub 2016 Dec 19.

  CONTEXT:
  Identifying the foot positions that are vulnerable to lateral ankle sprains is important for injury prevention. The effects of foot position in the transverse plane on ankle biomechanics during landing are unknown.
  OBJECTIVE:
  To examine the effects of toe-in or toe-out positioning on ankle inversion motion and moment during single-leg landing.
  DESIGN:
  Repeated measures.
  SETTING:
  Motion analysis laboratory.
  PARTICIPANTS:
  18 healthy participants (9 men and 9 women).
  INTERVENTIONS:
  Participants performed single-leg landing trials from a 30-cm high box under 3 conditions: natural landing, foot internally rotated (toe-in), and foot externally rotated (toe-out).
  MAIN OUTCOME MEASURES:
  4 toe-in or toe-out angles were calculated against 4 reference coordinates (laboratory, pelvis, thigh, and shank) in the transverse plane. Ankle inversion angle, angular velocity, and external moment in the 200 ms after initial foot-to-ground contact were compared between the 3 landing conditions. RESULTS:
  All toe-in or toe-out angles other than those calculated against the shank were significantly different between each of the 3 landing conditions (P < .001). Ankle inversion angle, angular velocity, and moment were highest during toe-in landings (P < .01), while eversion angle and moment were highest during toe-out landings (P < .001). The effect sizes of these differences were large. Vertical ground reaction forces were not different between the 3 landing conditions (P = .290). CONCLUSIONS:
  Toe-in or toe-out positioning during single-leg landings impacts on ankle inversion and eversion motion and moment. Athletes could train not to land with the toe-in positioning to prevent lateral ankle sprains.

• 上泉 理, 江端 純治, 高橋 友哉, 荒谷 隆, 山越 霞, 若杉 大, 田仲 愛, 新明 史江, 神垣 光徳, 伊東 直史, 久保田 卓, 山内 孝, 長谷川 幸生, 白井 真也
  【PADに対する心臓リハビリテーションの最前線】 PADの血行再建術前後における身体機能と体組成の変化
  心臓リハビリテーション 23巻1号 Page6-12(2017.06)
• Koganemaru S, Goto F, Arai M, Toshikuni K, Hosoya M, Wakabayashi T, Yamamoto N, Minami S, Ikeda S, Ikoma K, Mima T.
  Effects of vestibular rehabilitation combined with transcranial cerebellar direct current stimulation in patients with chronic dizziness: An exploratory study.
  Brain Stimul. 2017 May – Jun;10(3):576-578. doi: 10.1016/j.brs.2017.02.005. Epub 2017 Feb 24.

  BACKGROUND:
  Vestibular rehabilitation is useful to alleviate chronic dizziness in patients with vestibular dysfunction. It aims to induce neuronal plasticity in the central nervous system (especially in the cerebellum) to promote vestibular compensation. Transcranial cerebellar direct current stimulation (tcDCS) reportedly enhances cerebellar function.
  OBJECTIVE/HYPOTHESIS:
  We investigated whether vestibular rehabilitation partially combined with tcDCS is superior to the use of rehabilitation alone for the alleviation of dizziness.
  METHODS:
  Patients with chronic dizziness due to vestibular dysfunction received rehabilitation concurrently with either 20-min tcDCS or sham stimulation for 5 days. Pre- and post-intervention (at 1 month) dizziness handicap inventory (DHI) scores and psychometric and motor parameters were compared.
  RESULTS:
  Sixteen patients completed the study. DHI scores in the tcDCS group showed significant improvement over those in the sham group (Mann-Whitney U test, p = 0.033).
  CONCLUSION:
  Vestibular rehabilitation partially combined with tcDCS appears to be a promising approach.

• 五島 史行, 荒井 美希, 利國 桂太郎, 若林 毅, 細谷 誠, 山本 修子, 南 修司郎, 松永 達雄, 角田 晃一, 美馬 達哉, 小金丸 聡子
  tcDCS(経頭蓋小脳直流電気刺激)を用い前庭リハビリテーションの効果増強を試みた2症例
  耳鼻咽喉科・頭頸部外科 (0914-3491)89巻6号 Page471-475(2017.05)

  難治性の代償不全となった2症例に対して経頭蓋小脳直流電気刺激(tcDCS)を用いて前庭リハビリテーション治療を行った。症例は前庭神経炎代償不全の55歳女性(症例1)と眩暈を伴う突発性難聴後遺症の53歳男性(症例2)で、聴力は4分法で症例1は右33.8dB、左21.3dB、症例2は右左とも13.8dBで、発症後6ヵ月以上にわたる慢性の眩暈が遷延していた。前庭リハビリテーション治療の結果、有害事象は認めず、自覚的眩暈症状、不安、抑うつ状態は改善した。また、重心動揺計は、症例1では治療後の閉眼面積以外のパラメーター、TUG、TMTが改善した。

• 奥貫 拓実, 越野 裕太, 山中 正紀, 江沢 侑也, 寒川 美奈, 遠山 晴一
  足部multi-segment modelを用いた歩行時の足部内側縦アーチの動的変化と足部kinematicsの相関性の検討
  日本臨床スポーツ医学会誌 (1346-4159)25巻2号 Page232-238(2017.04)

  歩行時の足部内側縦アーチの動的低下と後・中・前足部kinematicsの相関性を検討することを目的に健常20名の裸足歩行における足部の各セグメントの相対的kinematicsと内側縦アーチ角を算出した。その結果、内側縦アーチ角最大値は後足部外返し(R=0.77)・外旋(R=0.60)および中足部外転(R=0.45)・背屈(R=0.59)における角度最大値との間に有意の正の相関を認め、前足部外返し(R=-0.46)および内返し(R=-0.82)における角度最大値との間に有意の負の相関を認めた。本研究は歩行時の内側縦アーチの動的低下は後・中・前足部kinematicsと相関することを明らかにした。(著者抄録)

• 牧野 均, 生駒 一憲
  利き足と非利き足の運動イメージ生成に関する脳活動の相違に関して　被験者自身と第三者の右足趾及び左足趾の一人称イメージを用いたf-MRI研究
  北海道文教大学研究紀要 (1349-3841)41号 Page13-29(2017.03)

  神経学的既往のない健常人37名(男性19名、女性18名、平均21.4±0.62歳)を対象とした。一人称イメージ:右下肢課題群、一人称イメージ:左下肢課題群に分けた。統計処理として多重比較補正によるfamily wise error(FWB)を用いた場合、右下肢課題群、左下肢課題群共に運動イメージ課題では、運動関連領野に有意に賦活する部位を認めなかったが、右下肢課題群、左下肢課題群共に運動実行課題では、運動関連領野が賦活した。統計処理として多重比較補正を行い仮説検定であるuncorrectedを用いた場合、右下肢課題群の運動実行課題は、左下肢課題群の運動実行課題と比較して、左右のBA40と右BA10及び左BA21の活動が有意に高かった。uncorrectedを用いた場合、右下肢課題群と左下肢課題群の比較で、第三者の動く足趾映像を見ながら運動実行課題を行った場合も、被験者自身の動く足趾映像を見ながら運動実行課題を行った場合も、賦活する共通部位があった。一人称イメージを運動イメージに結びつけて想起した場合、運動実行課題では左頭頂間溝前方部、イメージ課題では左腹側運動前野が賦活傾向にあった。

• 本谷 卓朗, 河村 太介, 小川 圭太, 吉田 一生, 稲垣 侑士, 角井 由佳, 吉田 奈美, 生駒 一憲, 松井 雄一郎, 岩崎 倫政
  腱移行術後のスイッチング障害に対し筋電バイオフィードバックが有用であった症例
  国立大学リハビリテーション療法士学術大会誌 (2188-3416)38回 Page49-51(2017.03)

  50代女性。右肘部管症候群に対して尺骨神経皮下前方移所術とBruner法(短母指伸筋を第一背側骨間筋へ移行)による示指外転機能再建術を施行され、術後3日目から作業療法を開始した。示指外転動作は初期から可能であったが、母指橈側外転と示指外転の分離動作が不十分であった。その要因として、母指橈側外転動作時に移行筋(短母指伸筋)の弛緩が困難なことが考えられた。そこで、短母指伸筋の弛緩を促すために筋電バイオフィードバック療法を行い、良好な結果が得られた。

• 辻澤 陽平, 中山 剛志, 大澤 恵留美, 堤 昌恵, 大槻 美佳, 佐々木 秀直, 生駒 一憲
  多系統萎縮症(MSA-C)に対するコミュニケーション訓練　指圧法変法による発声訓練
  国立大学リハビリテーション療法士学術大会誌 (2188-3416)38回 Page9-15(2017.03)

  MSA患者に対して言語聴覚士(ST)は患者個々に適したコミュニケーション手段を選択することが重要である。今回、STによるリハ開始時すでに発話明瞭度が低下し、音声言語でのコミュニケーションに支障をきたしていた重度MSA-C患者の訓練を経験した。先行研究で音声障害に対する訓練方法として報告されている指圧法に類似する方法(顎下部の筋を両側から軽く圧迫し、上前方に挙上させるようにしながら発声を促す方法)を実施したところ、即時的に発話明瞭度が向上し、音声言語でのコミュニケーションが可能となった。その機序について文献的考察を加え報告した。

• Nojima I, Koganemaru S, Mima T.
  Combination of Static Magnetic Fields and Peripheral Nerve Stimulation Can Alter Focal Cortical Excitability.
  Front Hum Neurosci. 2016 Nov 25;10:598. eCollection 2016.

  Abstract For clinical application of transcranial static magnetic stimulation (tSMS), it is important to achieve a focal target cortical stimulation. Previous study suggested that the associative stimulation combining non-invasive stimulation of the motor cortex (M1) and the peripheral nerve stimulation (PNS) may be useful to produce cortical excitability change. To test this hypothesis, we measured the M1 excitability and intracortical circuits by using transcranial magnetic stimulation (TMS) before and after the tSMS of short duration (5 min) combined with PNS. Thirty-three normal volunteers were participated; tSMS+PNS (n = 11), sham+PNS (n = 11), and tSMS alone (n = 11). We found the transient suppression of the motor-evoked potential (MEP) of the right abductor pollicis brevis (APB) muscle, but not of the abductor digiti minimi (ADM) muscle, when combining tSMS with PNS over median nerve at the wrist. The lack of suppressive effect on APB in tSMS alone with short duration is in accord with the previous observation. In addition, the tendency of transient enhancement of the short-latency intracortical inhibition was observed immediately after intervention in the tSMS±PNS group. These findings show that the combination of tSMS and PNS can induce the cortical excitability change in target cortical motor area and potentiate the suppression effect.

• 憲 克彦, 金子 明義, 細川 吉博, 池田 聡, 遠山 晴一, 生駒 一憲
  回復期リハビリテーション病棟に入院し、退院後外来フォローが可能であった骨粗鬆症性椎体骨折連鎖の検討
  Journal of Clinical Rehabilitation (0918-5259)25巻11号 Page1125-1128(2016.11)

  回復期リハビリテーション病棟に入院し、退院後外来フォローが可能であった骨粗鬆症性椎体骨折連鎖の影響因子について検討した。その結果、原発性骨粗鬆症女性110名のうち、椎体骨折連鎖なし22例、椎体骨折連鎖あり88例であった。椎体骨折連鎖を認める群ではアルブミン値や骨密度も低値であったが、ロジスティック回帰分析では独立した影響因子は認められなかった。

• Chiba T, Yamanaka M, Samukawa M, Saito H, Sabashi K, Tohyama H.
  The relationship between the load on the knee joint during walking and the biomechanical characteristics of single-leg standing.
  J Phys Ther Sci. 2016 Aug;28(8):2199-203. doi: 10.1589/jpts.28.2199. Epub 2016 Aug 31.

  [Purpose]
  The purpose of the present study was to investigate the relationship between the external knee adduction moment (KAM) during walking and the biomechanical characteristics of single-leg standing in healthy subjects.
  [Subjects and Methods]
  Twenty-eight healthy subjects were recruited for this study. Data were collected while the subjects performed walking and single-leg standing using a motion analysis system with six digital video cameras and two force plates. Pearson’s correlation coefficient was used to quantify the relationship between peak KAM during walking and single-leg standing. To determine whether the kinematic behavior of the pelvis and trunk during single-leg standing are associated with peak KAM during walking, Pearson’s correlation coefficients were calculated and stepwise linear regression was performed.
  [Results]
  The peak KAM during single-leg standing was significantly correlated with that during walking. The peak KAM during walking was significantly correlated with the peak lateral lean of the trunk and the peak lateral tilt of the pelvis during single-leg standing. The results of stepwise linear regression analysis show the peak KAM during walking was partially explained by the peak lateral lean of the trunk during single-leg standing.
  [Conclusion]
  Our findings suggest that single-leg standing might be a useful method for predicting the peak KAM during walking.

• 安彦 かがり, タ・キンキン , 生駒 一憲
  研究と報告 高次脳機能障害が後遺したびまん性軸索損傷に拡散テンソル画像のvoxel-based analysisを施行した5例
  総合リハビリテーション (0386-9822)44巻8号 Page703-710(2016.08)

  【目的】
  通常の核磁気共鳴画像法(magnetic resonance imaging;MRI)では所見が不明瞭であるにもかかわらず,高次脳機能障害を後遺する頭部外傷(traumatic brain injury;TBI)患者の病変を明らかにするため,拡散テンソル画像(diffusion tensor imaging;DTI)のvoxel-based analysisの有用性について検討する.
  【対象・方法】
  慢性期のMRI所見が軽微なびまん性軸索損傷(diffuse axonal injury;DAI)による高次脳機能障害患者5例に対して,通常のMRIに加えてDTIを撮影し,fractional anisotropy(FA)値について,健常成人データベースとの間でstatistical parametric mapping(SPM)およびeasy z-score imaging system(eZIS)を使って解析し,Z-score 2以上のvoxelが表示されるFA変化マップを作成した.
  【結果】
  3例では急性期に通常のMRIを施行されており,そのうち2例において慢性期のMRIで所見が消失した急性期fluid attenuated IR(FLAIR)高信号領域に一致してFA値低下がみられた.4例で脳梁にFA値低下領域を認めた.4例で微小出血周囲にFA値低下領域を認めた.
  【結語】
  DTI voxel-based analysisは慢性期TBIにおいて所見が不明瞭となる軸索損傷の描出に有用である.(著者抄録)

• Koshino Y, Ishida T, Yamanaka M, Ezawa Y, Okunuki T, Kobayashi T, Samukawa M, Saito H, Tohyama H.
  Kinematics and muscle activities of the lower limb during a side-cutting task in subjects with chronic ankle instability.
  Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1071-80. doi: 10.1007/s00167-015-3745-y. Epub 2015 Aug 9.

  PURPOSE:
  The purpose of the present study was to evaluate lower limb kinematics and muscular activities during walking, side-turning while walking, and side-cutting movement in athletes with chronic ankle instability and compare the results to those of athletes without chronic ankle instability.
  METHODS:
  Lower limb kinematics and muscular activities were evaluated in 10 athletes with chronic ankle instability and 10 healthy control athletes using a three-dimensional motion analysis system and surface electromyography during the 200-ms pre-initial contact (IC) and stance phases while walking, side-turning while walking, and side-cutting.
  RESULTS:
  During walking or side-turning while walking, there were no significant differences in kinematics or muscle activities between the subjects with and without chronic ankle instability. For the side-cutting task, however, ankle inversion angles during the 200-ms pre-IC and late stance phases [effect sizes (ESs) = 0.95-1.43], the hip flexion angle (ESs = 0.94-0.96) and muscular activities of the gastrocnemius medialis (ESs = 1.04-1.73) during the early stance phase were significantly greater in the athletes with chronic ankle instability than in the healthy control athletes.
  CONCLUSIONS:
  Alterations of kinematics in athletes with chronic ankle instability were found not only at the ankle but also at hip joints during the side-cutting movement. These alterations were not detected during walking or side-turning while walking. The findings of the present study indicate that clinicians should take into account the motion of the hip joint during the side-cutting movement in persons with chronic ankle instability.
  LEVEL OF EVIDENCE:
  III.

• Tadano S, Takeda R, Sasaki K, Fujisawa T, Tohyama H.
  Gait characterization for osteoarthritis patients using wearable gait sensors (H-Gait systems).
  J Biomech. 2016 Mar 21;49(5):684-690. doi: 10.1016/j.jbiomech.2016.01.017. Epub 2016 Feb 14.

  The objective of this work was to investigate the possibilities of using the wearable sensors-based H-Gait system in an actual clinical trial and proposes new gait parameters for characterizing OA gait. Seven H-Gait sensors, consisting of tri-axial inertial sensors, were attached to seven lower limb body segments (pelvis, both thighs, both shanks and both feet). The acceleration and angular velocity data measured were used to estimate three-dimensional kinematic parameters of patients during level walking. Three new parameters were proposed to assess the severity of OA based on the characteristics of these joint center trajectories in addition to conventional gait spatio-temporal parameters. The experiment was conducted on ten subjects with knee OA. The kinematic results obtained (hip, knee and ankle joint angles, joint trajectory in the horizontal and sagittal planes) were compared with those from a reference healthy (control) group. As a result, the angle between the right and left knee trajectories along with that of the ankle joint trajectories were almost twice as large (21.3° vs. 11.6° and 14.9° vs. 7.8°) compared to those of the healthy subjects. In conclusion, it was found that the ankle joints during stance abduct less to avoid adduction at the knee as the severity of OA increases and lead to more acute angles (less parallel) between the right and left knee/ankle joints in the horizontal plane. This method was capable to provide quantitative information about the gait of OA patients and has the advantage to allow for out-of-laboratory monitoring.

• 牧野 均, 生駒 一憲
  一人称イメージと三人称イメージでの運動イメージ課題を用いた場合の脳活動の比較研究　運動イメージ課題をリハビリテーションに用いる場合の効果的方法についての検討
  北海道文教大学研究紀要 (1349-3841)40号 Page55-68(2016.03)

  神経学的既往のない健常な成人男女36名(男性18名、女性18名、平均年齢21.6歳)を対象に、一人称イメージと三人称イメージの運動イメージ想起の方法の違いに着目し、機能的磁気共鳴画像法(f-MRI)を用いて脳活動部位の比較を行った。一人称イメージ課題群19名、三人称イメージ課題群17名とした。三人称イメージとして被験者自身の動く足趾映像を見ながら運動イメージ課題を行った場合、一人称イメージとしての第三者の動く足趾映像を見ながら運動イメージ課題を行った場合を比較すると、左右の舌状回と右前帯状皮質(ACC)の活動が増加した。一人称イメージ運動をイメージ課題として用いる場合には、被験者自身の足趾を見つめさせつつセラピストが他動的に足趾を動かすこと、三人称イメージ課題を用いる場合には、向かいに座ったセラピストの足の動作を模倣しつつ同時にセラピストが他動的に足趾を動かすことが、自己を認識しつつ効果的にリハビリテーションとなる可能性が示唆された。

• Simis M, Di Lazzaro V, Kirton A, Pennisi G, Bella R, Kim YH, Takeuchi N, Khedr EM, Rogers LM, Harvey R, Koganemaru S, Turman B, Tarlacı S, Gagliardi RJ, Fregni F.
  Neurophysiological measurements of affected and unaffected motor cortex from a cross-sectional, multi-center individual stroke patient data analysis study.
  Neurophysiol Clin. 2016 Feb;46(1):53-61. doi: 10.1016/j.neucli.2016.01.003. Epub 2016 Mar 9.

  Abstract
  OBJECTIVES:
  Transcranial magnetic stimulation (TMS) has been used to measure cortical excitability as a functional measurement of corticomotor pathways. Given its potential application as an assessment tool in stroke, we aimed to analyze the correlation of TMS parameters with clinical features in stroke using data from 10 different centers.
  METHODS:
  Data of 341 patients with a clinical diagnosis of stroke were collected from studies assessing cortical excitability using TMS. We used a multivariate regression model in which the baseline cortical excitability parameter “resting Motor Threshold (rMT)” was the main outcome and the demographic, anatomic and clinical characteristics were included as independent variables.
  RESULTS:
  The variable “severity of motor deficit” consistently remained significant in predicting rMT in the affected hemisphere, with a positive β coefficient, in the multivariate models after sensitive analyses and adjusting for important confounders such as site center. Additionally, we found that the correlations between “age” or “time since stroke” and the rMT in the affected hemisphere were significant, as well as the interaction between “time since stroke” and “severity of motor deficit”.
  CONCLUSIONS:
  We have shown that severity of motor deficit is an important predictor for rMT in the affected hemisphere. Additionally, time since stroke seems to be an effect modifier for the correlation between motor deficit and rMT. In the unaffected motor cortex, these correlations were not significant. We discuss these findings in the context of stroke rehabilitation.

• 生田 亮平, 石田 知也, 山中 正紀, 谷口 翔平, 上野 亮, 越野 裕太, 寒川 美奈, 遠山 晴一
  Drop vertical jumpにおけるハムストリングスの着地前筋活動と着地中の膝関節外反角度および外反モーメントとの関係
  日本臨床スポーツ医学会誌 (1346-4159)24巻1号 Page71-77(2016.01)

  女性のdrop vertical jumpにおける膝関節周囲筋の着地前筋活動と膝関節外反角度および外反モーメントとの関係を調査することを目的とした。健常女性18名を対象に、drop vertical jumpを行わせ、表面筋電計と三次元動作解析により膝関節周囲筋の着地前活動と膝関節外反角度および外反モーメントを算出した。結果、大腿二頭筋の着地前筋活動および半腱様筋/大腿二頭筋の着地前筋活動比率と接地後50ms時および最大の膝関節外反角度との間に有意な相関を認めた。本研究結果より、ハムストリングスの着地前筋活動パターンは、着地動作中の膝関節外反運動と関連すると考えられる。(著者抄録)

• Nojima I, Koganemaru S, Fukuyama H, Mima T.
  Static magnetic field can transiently alter the human intracortical inhibitory system.
  Clin Neurophysiol. 2015 Dec;126(12):2314-9. doi: 10.1016/j.clinph.2015.01.030. Epub 2015 Feb 19.

  OBJECTIVE:
  Although recent studies have shown the suppressive effects of static magnetic fields (SMFs) on the human primary motor cortex (M1) possibly due to the deformed neural membrane channels, the effect of the clinical MRI scanner bore has not been studied in the same way.
  METHODS:
  We tested whether the MRI scanner itself and compact magnet can alter the M1 function using single- and paired-pulse transcranial magnetic stimulation (TMS).
  RESULTS:
  We found the transient suppression of the corticospinal pathway in both interventions. In addition, the transient enhancement of the short-latency intracortical inhibition (SICI) was observed immediately after compact magnet stimulation.
  CONCLUSIONS:
  The present results suggest that not only the inhomogeneous SMFs induced by a compact magnet but also the homogeneous SMF produced by the MRI scanner bore itself can produce the transient cortical functional change.
  SIGNIFICANCE:
  Static magnetic stimulation can modulate the intracortical inhibitory circuit of M1, which might be useful for clinical purposes.
  Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

• 憲 克彦, 西向 弘樹, 金子 明義, 細川 吉博, 池田 聡, 遠山 晴一, 生駒 一憲
  機能訓練強化型通所介護を利用した障害高齢者において生活空間評価(LSA)に影響を及ぼす因子の検討　身体機能関連評価とアンケート調査から
  Journal of Clinical Rehabilitation (0918-5259)24巻12号 Page1278-1283(2015.12)

  機能訓練強化型通所介護を1年以上利用した32名(男17名、女15名、平均年齢72.7±7.9歳)を対象とした。運動機能・運動関連能力と生活空間評価(LSA)に加え、アンケートにより生活状態や社会的因子および環境因子を調査した。LSA高値およびLSA低値をその中央値で2群に分け、ロジスティック回帰分析で分析・検討した。LSA高値に対する多変量解析において、LSA総合点では有意な因子は抽出されなかったが、各LSAレベル別分析では町内レベルで「10m歩行速度」が、町外レベルでは「社会的交流」が独立の影響因子として抽出された。

• Koganemaru S, Fukuyama H, Mima T.
  Two is More Than One: How to Combine Brain Stimulation Rehabilitative Training for Functional Recovery?
  Front Syst Neurosci. 2015 Nov 10;9:154. doi: 10.3389/fnsys.2015.00154. eCollection 2015.

  Abstract A number of studies have shown that non-invasive brain stimulation has an additional effect in combination with rehabilitative therapy to enhance functional recovery than either therapy alone. The combination enhances use-dependent plasticity induced by repetitive training. The neurophysiological mechanism of the effects of this combination is based on associative plasticity. However, these effects were not reported in all cases. We propose a list of possible strategies to achieve an effective association between rehabilitative training with brain stimulation for plasticity: (1) control of temporal aspect between stimulation and task execution; (2) the use of a shaped task for the combination; (3) the appropriate stimulation of neuronal circuits where use-dependent plastic changes occur; and (4) phase synchronization between rhythmically patterned brain stimulation and task-related patterned activities of neurons. To better utilize brain stimulation in neuro-rehabilitation, it is important to develop more effective techniques to combine them.

• 高橋 友哉, 上泉 理, 江端 純治, 荒谷 隆, 新明 史江
  中枢神経系疾患患者における基礎代謝量の推定方法による差異
  KKR札幌医療センター医学雑誌 (1881-6207)12巻1号 Page28-32(2015.11)

  【はじめに】
  本研究では生体インピーダンス法と3つの推定式で得られる基礎代謝量(BMR)の推定方法による違いを調査した。
  【方法】
  当院でリハビリテーションを受けている入院・外来中枢神経系疾患患者を後方視的に調査した。調査項目は年齢、性別、身長、体重、BMI、体組成とした。生体インピーダンス法(BIA群)、Harris-Benedictの式(HB群)、日本人の食事摂取基準2010年版(MHLW群)、国立健康・栄養研究所の式(Ganpule群)でBMRを推定し比較した。
  【結果】
  各群のBMR平均はBIA群男性1433.8±72.3kcal、女性1098.7±94.4kcal、HB群男性1369.1±85.1kcal、女性1056.2±119.0kcal、MHLW群男性1480.4±217.9kcal、女性1007.3±168.2kcal、Ganpule群男性1380.9±75.8kcal、女性921.2±140.6kcalであった。男女間、女性のBIA群とGanpule群間に差を認める傾向があった。
  【考察】
  推定方法により差がある可能性があり、必要栄養量よりも提供栄養量が低く算出された場合には、リハビリテーションの実施によりサルコペニアを助長する可能性がある。(著者抄録)

• 堀 弘明, 堀 享一, 由利 真, 生駒 一憲
  ITB療法後に体重免荷歩行訓練を行った痙性対麻痺の一例
  北海道リハビリテーション学会雑誌 (0304-2081)40巻 Page39-43(2015.09)

  痙縮による歩行障害に対して髄腔内バクロフェン療法とともに空圧式体重免荷トレッドミルを使用し歩行能力の改善が認められた症例を経験したので報告した。50歳代男性、2009年歩行障害を自覚し近医受診、2013年当院神経内科を受診し痙性対麻痺と診断され、同年9月バクロフェン髄注の効果を認めたため髄腔内バクロフェン療法のポンプ埋め込み術目的に当院に入院した。バクロフェン(25μg/day)の髄腔内持続注入を行い、下肢の痙縮は改善したが支持性低下が生じ歩行困難となったため、空圧式体重免荷トレッドミルを使用した歩行訓練を実施した。歩行速度は1.0km/hから退院時には1.6km/hと改善した。バクロフェンの髄腔内持続注入により、痙縮の軽減と同時に下肢での体重支持が困難となる可能性は高く、このような場合は、免荷量が調節可能な本装置を用いた歩行訓練が有用であったと考えられる。(著者抄録)

• Nojima I, Koganemaru S, Kawamata T, Fukuyama H, Mima T.
  Action observation with kinesthetic illusion can produce human motor plasticity.
  Eur J Neurosci. 2015 Jun;41(12):1614-23. doi: 10.1111/ejn.12921. Epub 2015 May 23

  After watching sports, people often feel as if their sports skills might have been improved, even without any actual training. On some occasions, this motor skill learning through observation actually occurs. This phenomenon may be due to the fact that both action and action observation (AO) can activate shared cortical areas. However, the neural basis of performance gain through AO has not yet been fully clarified. In the present study, we used transcranial magnetic stimulation to investigate whether primary motor cortex (M1) plasticity is a physiological substrate of AO-induced performance gain and whether AO itself is sufficient to change motor performance. The excitability of M1, especially that of its intracortical excitatory circuit, was enhanced after and during AO with kinesthetic illusion but not in interventions without this illusion. Moreover, behavioral improvement occurred only after AO with kinesthetic illusion, and a significant correlation existed between the performance gain and the degree of illusion. Our findings indicated that kinesthetic illusion is an essential component of the motor learning and M1 plasticity induced by AO, and this insight may be useful for the strategic rehabilitation of stroke patients.

• Ino T, Ohkoshi Y, Maeda T, Kawakami K, Suzuki S, Tohyama H.
  Side-to-side differences of three-dimensional knee kinematics during walking by normal subjects.
  J Phys Ther Sci. 2015 Jun;27(6):1803-7. doi: 10.1589/jpts.27.1803. Epub 2015 Jun 30.

  [Purpose]
  The purpose of this study was to determine the normal range of the side-to-side difference in three dimensional knee kinematics measured by the point cluster technique (PCT).
  [Subjects]
  The subjects were twenty-one healthy normal volunteers without knee pain or an episode of injury to the legs.
  [Methods]
  The subjects were tested bilaterally at a self-selected normal walking speed and six degrees of freedom knee kinematics were measured using the PCT, and the 95% confidence intervals of the average side-to-side differences in flexion-extension (FE), adduction-abduction (AA), internal-external (IE) rotation, and anterior-posterior (AP), medial-lateral (ML), superior-inferior (SI) translation in each stage of the gait cycle were determined.
  [Results]
  The average side-to-side differences and their 95% confidence intervals in rotation/translation in each stage of the gait cycle were determined. The side-to-side differences in AA rotation and AP translation of the tibia were significantly larger in the swing phase than in the stance phase.
  [Conclusion]
  The side-to-side differences in AA rotation and AP translation were highly dependent on the stage of the gait cycle. Therefore, the normal ranges of the side-to-side differences in knee kinematics in each stage of the gait cycle, in particular AA rotation and AP translation of the tibia, is useful information for evaluating knee kinematics during walking.

• 河内 綾乃, 千葉 健, 由利 真, 堀 享一, 松尾 雄一郎, 安彦 かがり, 大森 紅己子, 井口 大暢, 生駒 一憲
  慢性期脳卒中片麻痺患者の歩行障害に対し理学療法とウォークエイドを併用した症例
  国立大学リハビリテーション療法士学術大会誌 (2188-3416)36回 Page23-25(2015.04)

  70歳代男。18年前に左被殻出血により右片麻痺を発症したが、職場復帰を果たした。8年前、右脳梗塞を発症し、構音障害が残存し徐々に活動機会が減少した。下垂足のため歩行時の疲労感が強く、神経筋電気刺激装置ウォークエイド(WA)の使用を開始した。初期評価においてWAの使用のみでは歩容の改善は不十分のため、新たな介入として立脚時の歩容改善を目的に歩行練習を実施した。WAを併用した歩行練習を約1年間実施し、10m歩行では裸足・WA装着時ともに歩数・歩行速度・歩行率で改善が得られた。歩容に関しては、初期評価、中間評価時と比較してback kneeの軽減が得られた。

• 小川 圭太, 稲垣 侑士, 角井 由佳, 吉田 奈美, 堀 享一, 生駒 一憲, 澤村 大輔
  高次脳機能障害患者における就労能力判断基準の検討
  国立大学リハビリテーション療法士学術大会誌 (2188-3416)36回 Page17-19(2015.04)

  高次脳機能障害患者における就労能力判断基準について検討した。行政的診断基準によって高次脳機能障害と診断した372例を対象とした。原因疾患は外傷性脳損傷239例、脳卒中77例、低酸素脳症24例、脳腫瘍17例、脳炎等その他15例であった。退院後3ヵ月時点の就労状況は、就労群67例、非就労群305例であった。群間比較では患者属性における項目間で有意差を認めなかったが、神経心理学的所見において全ての項目で有意差を認めた。群間比較において有意差を認めた項目を独立変数、退院3ヵ月時点の就労状況を従属変数とするロジスティック回帰分析で、RBMTが有意な変数として採択された。就労を状況変数としてRBMTのROC曲線を作成して求めたAUCは有意な値を認め、就労と非就労を判別するRBMTのカットオフ値は16.5点、感度95.5%、特異度62.8%であった。

• 牧野 均, 生駒 一憲
  右利きと左利きにおける後出し負けじゃんけんでの脳活動の比較研究
  北海道文教大学研究紀要 (1349-3841)39号 Page73-85(2015.03)

  健常な成人男女18名(右利き9名、左利き9名)を対象に後出し負けじゃんけん課題を行い、課題中の脳活動について比較し、運動関連領野と認知的活動における左右の脳活動の分業についてfMRI測定を行った。MRI装置の中から背臥位姿勢からプリズムメガネにてスクリーン上に投影された手指動作と足趾動作のじゃんけん映像をみて、指示された課題に従うよう、被験者に指示した。多くの部位では共通して機能していることが分かった。足趾を用いた後出し負けじゃんけんの場合、利き足趾では動作を行う運動野と同側の腹側運動前野が賦活したが、手での右利き右手指を用いた後出し負けじゃんけんでは、動作を行う運動野とは対側の右脳の腹側運動前野が賦活した。右利き群は自己と他者の判断を左右の頭頂葉-腹側運動野で分業するが、左利き群は頭頂葉-腹側運動野を両側使用していることが推察された。また、背外側運動前野と前頭極は、課題の相違により分業し活動していることが示唆された。

• Koganemaru S, Sawamoto N, Aso T, Sagara A, Ikkaku T, Shimada K, Kanematsu M, Takahashi R, Domen K, Fukuyama H, Mima T.
  Task-specific brain reorganization in motor recovery induced by a hybrid-rehabilitation combining training with brain stimulation after stroke.
  Neurosci Res. 2015 Mar;92:29-38. doi: 10.1016/j.neures.2014.10.004. Epub 2014 Oct 18.

  Recently, we have developed a new hybrid-rehabilitation combining 5Hz repetitive transcranial magnetic stimulation and extensor motor training of the paretic upper-limb for stroke patients with flexor hypertonia. We previously showed that the extensor-specific plastic change in M1 was associated with beneficial effects of our protocol (Koganemaru et al., 2010). Here, we investigated whether extensor-specific multiregional brain reorganization occurred after the hybrid-rehabilitation using functional magnetic resonance imaging. Eleven chronic stroke patients were scanned while performing upper-limb extensor movements. Untrained flexor movements were used as a control condition. The scanning and clinical assessments were done before, immediately and 2 weeks after the hybrid-rehabilitation. As a result, during the trained extensor movements, the imaging analysis showed a significant reduction of brain activity in the ipsilesional sensorimotor cortex, the contralesional cingulate motor cortex and the contralesional premotor cortex in association with functional improvements of the paretic hands. The activation change was not found for the control condition. Our results suggested that use-dependent plasticity induced by repetitive motor training with brain stimulation might be related to task-specific multi-regional brain reorganization. It provides a key to understand why repetitive training of the target action is one of the most powerful rehabilitation strategies to help patients.

• Ishigaki T, Ishida T, Samukawa M, Saito H, Hirokawa M, Ezawa Y, Sugawara M, Tohyama H, Yamanaka M.
  Comparing trapezius muscle activity in the different planes of shoulder elevation.
  J Phys Ther Sci. 2015 May;27(5):1495-7. doi: 10.1589/jpts.27.1495. Epub 2015 May 26.

  [Purpose]
  The purpose of this study was to compare the upper, middle, and lower trapezius muscles’ activity in the different planes of shoulder elevation.
  [Subjects]
  Twenty male subjects volunteered for this study.
  [Methods]
  Surface electromyographic (EMG) activity for each of the three regions of the trapezius muscles in the three different planes of elevation were collected while the participants maintained 30, 60, and 90 degrees of elevation in each plane. The EMG data were normalized with maximum voluntary isometric contraction (%MVIC), and compared among the planes at each angle of elevation.
  [Results]
  There were significantly different muscle activities among the elevation planes at each angle.
  [Conclusion]
  This study found that the three regions of the trapezius muscles changed their activity depending on the planes of shoulder elevation. These changes in the trapezius muscles could induce appropriate scapular motion to face the glenoid cavity in the correct directions in different planes of shoulder elevation.

• Ishigaki T, Ishida T, Samukawa M, Saito H, Ezawa Y, Hirokawa M, Kato T, Sugawara M, Tohyama H, Yamanaka M.
  Does restriction of glenohumeral horizontal adduction reflect posterior capsule thickening of the throwing shoulder?
  J Phys Ther Sci. 2015 May;27(5):1299-302. doi: 10.1589/jpts.27.1299. Epub 2015 May 26.

  [Purpose] Glenohumeral posterior capsule tightness possibly relates to posterior capsule thickness (PCT). The purpose of the current study was to analyze the relationships between PCT and glenohumeral range of motion (ROM) in horizontal adduction (HAdd) and internal rotation (IR). [Subjects and Methods] This study recruited 39 healthy collegiate baseball players. We measured PCT by using ultrasonography and ROM of the glenohumeral joint of the throwing shoulder by using a digital inclinometer. Pearson’s correlation coefficients were calculated between PCT and HAdd or IR ROM. [Results] There was no correlation between PCT and HAdd ROM, but PCT was significantly correlated with IR ROM. [Conclusion] This result indicates that posterior shoulder capsule tightness only relates to IR ROM, and that restricted HAdd ROM might reflect tightness of other tissue, such as the posterior deltoid.

• Ishigaki T, Yamanaka M, Hirokawa M, Tai K, Ezawa Y, Samukawa M, Tohyama H, Sugawara M.
  Rehabilitation Exercises to Induce Balanced Scapular Muscle Activity in an Anti-gravity Posture.
  J Phys Ther Sci. 2014 Dec;26(12):1871-4. doi: 10.1589/jpts.26.1871. Epub 2014 Dec 25.

  [Purpose]
  The purpose of this study was to compare the intramuscular balance ratios of the upper trapezius muscle (UT) and the lower trapezius muscle (LT), and the intermuscular balance ratios of the UT and the serratus anterior muscle (SA) among prone extension (ProExt), prone horizontal abduction with external rotation (ProHAbd), forward flexion in the side-lying position (SideFlex), side-lying external rotation (SideEr), shoulder flexion with glenohumeral horizontal abduction load (FlexBand), and shoulder flexion with glenohumeral horizontal adduction load (FlexBall) in the standing posture.
  [Methods]
  The electromyographic (EMG) activities of the UT, LT and SA were measured during the tasks. The percentage of maximum voluntary isometric contraction (%MVIC) was calculated for each muscle, and the UT/LT ratios and the UT/SA ratios were compared among the tasks.
  [Results]
  The UT/LT ratio with the FlexBand was not significantly different from those of the four exercises in the side-lying and prone postures. The UT/SA ratio with the FlexBall demonstrated appropriate balanced activity.
  [Conclusion]
  In an anti-gravity posture, we recommend the FlexBand and the FlexBall for inducing balanced UT/LT and UT/SA ratios, respectively.

• Takeda R, Lisco G, Fujisawa T, Gastaldi L, Tohyama H, Tadano S.
  Drift removal for improving the accuracy of gait parameters using wearable sensor systems.
  Sensors (Basel). 2014 Dec 5;14(12):23230-47. doi: 10.3390/s141223230.

  Accumulated signal noise will cause the integrated values to drift from the true value when measuring orientation angles of wearable sensors. This work proposes a novel method to reduce the effect of this drift to accurately measure human gait using wearable sensors. Firstly, an infinite impulse response (IIR) digital 4th order Butterworth filter was implemented to remove the noise from the raw gyro sensor data. Secondly, the mode value of the static state gyro sensor data was subtracted from the measured data to remove offset values. Thirdly, a robust double derivative and integration method was introduced to remove any remaining drift error from the data. Lastly, sensor attachment errors were minimized by establishing the gravitational acceleration vector from the acceleration data at standing upright and sitting posture. These improvements proposed allowed for removing the drift effect, and showed an average of 2.1°, 33.3°, 15.6° difference for the hip knee and ankle joint flexion/extension angle, when compared to without implementation. Kinematic and spatio-temporal gait parameters were also calculated from the heel-contact and toe-off timing of the foot. The data provided in this work showed potential of using wearable sensors in clinical evaluation of patients with gait-related diseases.

• Miura T, Yamanaka M, Ukishiro K, Tohyama H, Saito H, Samukawa M, Kobayashi T, Ino T, Takeda N.
  Individuals with chronic low back pain do not modulate the level of transversus abdominis muscle contraction across different postures.
  Man Ther. 2014 Dec;19(6):534-40. doi: 10.1016/j.math.2014.05.010. Epub 2014 Jun 20.

  The aim of this study was to evaluate the thickness of the transversus abdominis (TrA) muscle in three basic postures in subjects with and without chronic low back pain. Subjects were classified into a chronic low back pain group (n = 27) and a healthy control group (n = 23). The thickness of the TrA muscle was measured at rest and during the abdominal drawing-in manoeuvre (ADIM) in supine, sitting and standing postures using B-mode ultrasound imaging. Contraction ratio (TrA thickness during the ADIM/TrA thickness at rest) was calculated for each posture. At rest, the TrA thickness in the sitting and standing postures was significantly greater than in the supine posture (p < 0.017) in the control group, but similar in all three postures in the low back pain group. TrA thickness was similar in the low back pain and control group in all three postures. During the ADIM, TrA thickness was significantly greater in the control group than in the chronic low back pain group in all three postures. The contraction ratio was also significantly higher in the control group than in the chronic low back pain group in all three postures. These results indicate that the automatic postural contraction of the TrA observed in the control subjects in the sitting and standing postures was not demonstrated in subjects with chronic low back pain. The present study revealed the one aspect of different response of the TrA muscle to changing posture between two groups.

• 黄 于庭, 遠山 晴一
  ビデオプログラムによる運動療法の変形性膝関節症に対する長期的効果の検討
  運動器リハビリテーション (2187-8420)25巻3号 Page272-278(2014.10)

  DVDプログラムによるホームエクササイズの変形性膝関節症に対する長期的効果を検討するため、経過観察期間2年のSLR訓練との無作為割付比較試験を変形性膝関節症症例107例に行った。その結果、本ビデオを用いた運動療法はSLR訓練に比し、6ヵ月まで有意に高い訓練遵守を認め、膝痛および身体機能を2年まで有意に改善させた。一方、本運動療法介入は膝内反変形のX線学的進行を抑止することができないことが明らかになった。(著者抄録)

• Inagaki Y, Kitamura N, Kurokawa T, Tanaka Y, Gong JP, Yasuda K, Tohyama H.
  Effects of culture on PAMPS/PDMAAm double-network gel on chondrogenic differentiation of mouse C3H10T1/2 cells: in vitro experimental study.
  BMC Musculoskelet Disord. 2014 Sep 27;15:320. doi: 10.1186/1471-2474-15-320.

  BACKGROUND: Recently, several animal studies have found that spontaneous hyaline cartilage regeneration can be induced in vivo within a large osteochondral defect by implanting a synthetic double-network (DN) hydrogel, which is composed of poly-(2-acrylamido-2-methylpropanesulfonic acid) (PAMPS) and poly-(N,N’-dimethyl acrylamide) (PDMAAm), at the bottom of the defect. However, the effect of hydrogel on hyaline cartilage regeneration remains unexplained. The purpose of this study was to investigate the chondrogenic differentiation of C3H10T1/2 cells on PAMPS/PDMAAm DN gel.
  METHODS:
  C3H10T1/2 cells of 1.0 × 105 were cultured on PAMPS/PDMAAm DN gel in polystyrene tissue culture dishes or directly on polystyrene tissue culture dishes. We compared cultured cells on PAMPS/PDMAAm DN gel with those on polystyrene dishes by morphology using phase-contrast microscopy, mRNA expression of aggrecan, type I collagen, type II collagen, Sox 9 and osteocalcin using real-time RT-PCR, and local expression of type II collagen using immunocytochemistry.
  RESULTS:
  C3H10T1/2 cells cultured on the PAMPS/PDMAAm DN gels formed focal adhesions, aggregated rapidly and developed into large nodules within 7 days, while the cells cultured on the polystyrene surface did not. The mRNA levels of aggrecan, type I collagen, type II collagen, Sox 9 and osteocalcin were significantly greater in cells cultured on the PAMPS/PDMAAm DN gel than in those cultured on polystyrene dishes. In addition, C3H10T1/2 cells cultured on PAMPS/PDMAAm DN gel expressed more type II collagen at the protein level when compared with cells cultured on polystyrene dishes.
  CONCLUSIONS:
  The present study showed that PAMPS/PDMAAm DN gel enhanced chondrogenesis of C3H10T1/2 cells, which are functionally similar to mesenchymal stem cells. This suggests that mesenchymal stem cells from the bone marrow contribute to spontaneous hyaline cartilage regeneration in vivo in large osteochondral defects after implantation of PAMPS/PDMAAm DN gels.

• 憲 克彦, 西向 弘樹, 和田 永年, 細川 吉博, 生駒 一憲
  リハビリ特化型デイサービスの有効性と生活空間(Life space assessment:LSA)への効果
  北海道リハビリテーション学会雑誌 (0304-2081)39巻 Page49-53(2014.05)

  我々は今回リハビリ特化型デイサービスを利用している高齢者で、運動機能・身体能力などの有効性と生活空間評価(Life space assessment:LSA)の効果を調査するため、30名の利用者に対しトレーニング前及びトレーニング1年後の各種筋群、握力、10m歩行速度、TUG、FES、LSA変化、さらにはトレーニング1年後のLSAに対する独立の影響因子を、前記各因子を用いて多変量解析を用いて検討した。その結果、1年後の前記各因子では、握力を除く全項目で優位な改善が認められた。しかし一方、1年後のLSA全体に対する独立の影響因子は認められなかった。居室から町内までの各レベルに分けてのLSAにおいても、その影響因子は抽出されなかった。したがって、他の何らかの因子が、よりLSAを規定する可能性がある。(著者抄録)

• 三浦 拓也, 山中 正紀, 遠山 晴一, 斎藤 展士, 寒川 美奈, 小林 巧, 武田 直樹
  体幹の回旋運動に対する腹横筋の寄与　健常者と慢性腰痛症例の比較
  理学療法科学 (1341-1667)29巻2号 Page207-212(2014.04)

  [目的]
  超音波画像診断装置を使用して体幹回旋運動時における腹部深層筋の動態を究明すること。
  [対象]
  下肢・体幹に障害のない健常者10名、および慢性腰痛症例6名とした。
  [方法]
  座位にて下部体幹を回旋させることが可能な装置による他動的な回旋と、随意的な回旋を実施した。課題中における腹横筋の筋厚の変化を健常者と慢性腰痛症例との間で比較した。
  [結果]
  体幹回旋運動に対する腹横筋の一側性の筋厚増加が健常者では認められ、慢性腰痛症例においては認められなかった。
  [結語]
  観察された健常者と慢性腰痛症例の腹横筋活動の違いは、体幹回旋に対する腹横筋の関与と、健常者と慢性腰痛症例における腹横筋の機能性の違いの一端を示唆する。(著者抄録)

• 小川 圭太, 澤村 大輔, 角井 由佳, 大澤 恵留美, 堀 享一, 生駒 一憲
  高次脳機能障害患者の外来集団訓練
  国立大学リハビリテーション療法士学術大会誌 (2188-3416)35回 Page38-42(2014.04)

  平成24年11月～平成25年5月に外来集団訓練に参加した高次脳機能障害患者6名を対象に検討した。外来集団訓練プログラムとして、グループディスカッション、個人発表、机上認知課題、グループゲーム、家族教室を行い、6ヵ月間の集団訓練実施前後で注意機能評価を行った。その結果、集団訓練実施前の障害認識について、対象者の自己評価が家族による客観的評価よりも高く、障害に対する認識に差異が認められた。そして集団訓練実施後では、対象者本人とご家族の障害に対する認識の差が縮小する結果となり、集団訓練実施前後で対象者本人の自己評価には差を認めなかったが、ご家族による客観的評価で点数向上が認められた。また、集団訓練実施後の評価でご家族の介護負担感の軽減が認められた。

• 松尾 雄一郎
  【リハ効果の限界を超える-驚きの改善を認めた症例を通じて】 末梢神経障害はここまでよくなる
  Journal of Clinical Rehabilitation (0918-5259)23巻4号 Page341-348(2014.04)

  症例は60歳代女性で、3歳時にポリオに罹患し、ポリオ後症候群状態であった。布団上で転倒して左肩を強打し、翌日に当院を受診した。左肩脱臼骨折の診断で整復したが、左上肢の徒手筋力検査は全般的に1レベルと重度麻痺を認め、左肩～上腕外側、前腕橈側以外で痛覚が脱失していた。ウルトラスリング装着でフォローしたが、左手指～前腕にかけての疼痛と痺れ、左上肢全般の筋力低下が増強した。4週目からCodman体操を開始し、手指の他動的可動域訓練、肘関節周囲の筋力増強訓練を追加した。運動後に左第2～4指に自発痛と痺れを認め、受傷後よりの薬物療法で効果は得られず、腕神経叢損傷後の神経障害性疼痛の増悪と判断し、温熱療法と有痛性ポリニューロパチーの第一選択のプレガバリンで疼痛は70%程度に軽減したが、1ヵ月後には効果が薄れて第二選択に変更した。疼痛軽減で自主訓練、手指巧緻動作訓練を継続し、最終的には受傷後2年で表在感覚がほぼ正常となった。

• 牧野 均(北海道文教大学 人間科学部理学療法学科), 生駒 一憲
  3人称イメージを用いた「一定リズム」と「一定でないリズム」の足趾の模倣運動を行った場合の脳活動部位の相違に関して　fMRIを用いた研究
  北海道文教大学研究紀要 (1349-3841)38号 Page55-61(2014.03)
• Votinov M1, Aso T, Koganemaru S, Fukuyama H, Mima T.
  Transcranial direct current stimulation changes human endowment effect.
  Neurosci Res. 2013 Aug;76(4):251-6. doi: 10.1016/j.neures.2013.05.007. Epub 2013 Jun 7.

  To test whether the right inferior frontal gyrus (IFG) plays role in the endowment effect, we investigated the effects of transcranial direct current stimulation (tDCS) of the right IFG on the willingness to accept/willingness to pay (WTA/WTP) discrepancy. Twelve healthy subjects underwent anodal, cathodal and sham tDCS on separate days. Stimulation was applied over the right IFG for 20min at 2mA. Subjects participated in the pricing task where they evaluated the presented items under WTA and WTP framings during tDCS intervention. The results showed that the WTA/WTP ratio after anodal tDCS was significantly higher than that after cathodal one. In addition, we found that the reaction time during the cathodal tDCS condition was significantly longer compared to those during anodal or sham tDCS conditions. Our findings suggest the functional relevance of the right IFG for producing endowment effect.

• Kitamura N, Ogawa M, Kondo E, Kitayama S, Tohyama H, Yasuda K.
  A novel medial collateral ligament reconstruction procedure using semitendinosus tendon autograft in patients with multiligamentous knee injuries: clinical outcomes.
  Am J Sports Med. 2013 Jun;41(6):1274-81. doi: 10.1177/0363546513485716. Epub 2013 Apr 26.

  BACKGROUND: Several new procedures for medial collateral ligament (MCL) reconstruction using a hamstring tendon graft have been reported in the 2000s. However, the midterm and long-term clinical outcomes of these procedures have not been reported.
  HYPOTHESIS:
  Postoperative medial stability of the knee that underwent our MCL reconstruction may not be significantly different from that of the noninjured knee. STUDY DESIGN:
  Case series; Level of evidence, 4.
  METHODS:
  A total of 37 patients who sustained multiligamentous knee injuries underwent combined MCL and cruciate ligament reconstruction at our institution between 1994 and 2007. Thirty of the 37 patients were clinically evaluated at least 2 years after surgery. Sixteen had combined MCL and anterior cruciate ligament (ACL) reconstruction, 5 had combined MCL and posterior cruciate ligament (PCL) reconstruction, and 9 had combined MCL, ACL, and PCL reconstruction. The International Knee Documentation Committee (IKDC) evaluation form and Lysholm score were used to evaluate postoperative knee function. Anteroposterior knee laxity was examined with a KT-2000 arthrometer. To assess objective medial instability, we performed a stress radiograph examination under valgus stress with the knee at 20° of flexion.
  RESULTS:
  At the final follow-up, 1 patient showed a loss of knee extension of more than 3°. Five patients revealed a loss of knee flexion of 6° to 15° and 2 patients of 16° to 25°. Lysholm scores averaged 94.8 points. In the IKDC evaluation, 9 patients were graded as A, 17 were graded as B, 3 were graded as C, and 1 was graded as D. In the stress radiograph examination, the mean medial joint opening was 8.5 ± 1.6 mm in the reconstructed knee and 8.0 ± 1.2 mm in the healthy opposite knee. There was no significant difference in the medial joint opening between reconstructed and intact knees.
  CONCLUSION:
  Medial collateral ligament reconstruction for chronic combined knee instabilities can be safely performed using hamstring tendon autografts, and the clinical outcome with a minimum 2-year follow-up was favorable with satisfactory stability.

• 憲 克彦, 西向 弘樹, 和田 永年, 細川 吉博, 生駒 一憲
  要支援・要介護高齢者に対するトレーニングマシーンとスリングを併用したリハビリ特化型デイサービスの有効性について
  北海道リハビリテーション学会雑誌 (0304-2081)38巻 Page31-35(2013.03)

  我々のリハビリ特化型デイサービスにおいて、要支援・要介護15人(平均年齢72.5歳:男性7人、女性8人)の利用者を対象に、筋力トレーニングマシーン及び集団スリングエクササイズを併用した運動訓練プログラムを週1回-3回まで連続して3ヵ月間施行した。施行前後の評価は握力、10m歩行速度、Time Up & Go Test、Falls Efficacy Scale、筋力テストを用いた。その結果、TUG、FES、レッグプレス(筋力)で有意な改善を示した。高齢者でも筋力、動的平衡機能を両方ともに改善する、利にかなった方法である。(著者抄録)

• 牧野 均, 生駒 一憲
  一人称イメージと二パターンの三人称イメージによる足趾運動の脳活動について
  北海道文教大学研究紀要 (1349-3841)37号 Page63-72(2013.03)