Physical Therapy for Cerebellar Ataxia

Ataxia, the incoordination and balance dysfunction in movements without muscle weakness, causes gait and postural disturbance in patients with stroke, multiple sclerosis, and degeneration in the cerebellum. The aim of this article was to provide a narrative review of the previous reports on physical therapy for mainly cerebellar ataxia offering various opinions. Some systematic reviews and randomized control trial studies, which were searched in the electronic databases using terms “ataxia” and “physical therapy,” enable a strategy for physical therapy for cerebellar ataxia. Intensive physical therapy more than 1 hour per day for at least 4 weeks, focused on balance, gait, and strength training in hospital and home for patients with degenerative cerebellar ataxia can improve ataxia, gait ability, and activity of daily living. Furthermore, the weighting on the torso, using treadmill, noninvasive brain stimulation over the cerebellum for neuromodulation to facilitate motor learning, and neurophysiological assessment have a potential to improve the effect of physical therapy on cerebellar ataxia. Previous findings indicated that physical therapy is time restricted; therefore, its long-term effect and the effect of new optional neurophysiological methods should be studied

Rehabilitation for Spinocerebellar Ataxia

Rehabilitation is an important treatment for spinocerebellar ataxia (SCA). The lack of improvement in ataxia, deficit of motor learning, and unstable balance causes disability for activities of daily living and restricts participation in social activities, further resulting in a disturbance of the restoration of quality of life. This narrative review describes physical rehabilitation, including measurement of movement disorder, associated with ataxia and possible interventions. Several lines of evidence suggest that high-intensity individualized physical rehabilitation programs, especially for gait and balance training, improve motor function. Continuous exercise at home contributes to the maintenance of the gait and balance function. Moreover, videography and mechanical technology contribute to the evaluation of ataxia and motor learning ability, and assistive robotic systems may improve gait stability. Neuromodulation montages, such as repetitive transcranial magnetic stimulation and transcranial electrical stimulation, can enhance the effect of physical rehabilitation. Further research aimed at developing a more-effective physical rehabilitation for these patients is expected

脳卒中患者における二重課題下での移乗動作能力低下は転倒と関連がある

入院中の脳卒中(テント上脳梗塞・脳出血)患者14例を対象に、移乗動作のみと、移乗動作に思考課題(数字の逆唱課題)を負荷した時との移乗動作を、脳卒中発症後に転倒歴のある7例とない7例で比較した. 移乗動作のperformanceは12項目で評価し、点数化した. 移乗動作のみの時には、転倒歴の有無と移乗動作のperformanceには関係はなかったが、数字逆唱課題負荷時には転倒歴のある群の移乗動作のperformanceは、負荷しない時より有意に不良であり、特にブレーキ・フットレスト管理での評価点数が低かった. この結果は、二重課題下での運動課題のperformanceが低下する脳卒中患者は、低下しない者より転倒リスクが高いことを示唆する. 以上より、移乗動作に思考課題を負荷すると移乗動作自立度判定の精度が向上することが示唆された.Performance of transfer of bed to wheel chair and wheel chair to bed was compared between under single task and dual task which were transfer and repeat the number in reverse sequence in hospitalized 14 stroke patients. The patients were separated to two groups that involved 7 patients had fall history(FALL) and other patients had not it(NON-FALL). The transfer performance was evaluated with 12 items. The performance was not significant difference between FALL and NON-FALL in single-task that was transfer. But the performance of transfer in FALL was significantly lower than that in NON-FALL in dual-task. The point of dual-task was significantly lower than that of single-task in management of brakes and the foot rest. These findings indicate that the performance of transfer is decreased by second cognitive task in stroke patient. The dual-task setting may be effective of assessment of performance of transfer in stroke patients

松葉杖歩行における身体局所的疲労と潜在的適応学習

松葉杖歩行による下肢の疲労部位と程度、歩行パターンについて検討した。対象は松葉杖歩行未経験の大学2年生24名とし、200mを非利き足を完全免荷で松葉杖歩行させ、歩数と時間を計測・解析した。また荷重足とした利き足の大腿・下腿部の前後面、足背・足底部の歩行後の疲労感をNumerical Rating Scale（NRS）を用いて計測し、全ての部位のスコアを加算したものを総疲労スコアとした。その結果、下腿部と足底部に高い疲労感を認めた。また、総疲労スコアと歩数、総疲労スコアと総時間に弱い正の相関、歩行速度と総歩数、歩行距離と5m毎の歩数に中等度の負の相関を認めた。以上から、片側下肢の完全免荷松葉杖歩行の初回歩行では、荷重足の底背屈筋、足趾屈伸筋に疲労が出現しやすい可能性、歩幅が大きいと疲労しにくい可能性、また外的教示なしでも歩幅を大きくする適応的学習が生じる可能性が示唆された。We investigated the position and degree of fatigue in the supporting leg and a pattern of gait alterations at the first time of walking with crutches. Twenty-four college students participated in this study. The subjects walked with crutches with load to dominant leg for 200 m. The number of steps and time were measured. After walking, the degree of fatigue in the upper and lower leg and foot was measured by Numerical Rating Scale. All the scores were summed and the total fatigue score（TFS） was calculated. Fatigue was observed in the lower leg and sole. There was a low positive correlation between TFS and total steps and between TFS and total time. There was a moderate negative correlation between walking speed and steps and between steps per 5 m and walking distance. These results indicate that fatigue in the lower leg and sole is caused by gait alterations during first time of walking with crutches. Moreover, as a stride becomes large, it is harder for the leg and foot to fatigue. Finally, implicit adaptation, a gradually increasing stride without instruction, is caused during the first time of walking with crutches

脳卒中患者に対する低頻度反復経頭蓋磁気刺激と運動療法の併用が損傷側手指ピンチ動作の筋活動に与える影響 シングルケースにおける検討

近年、反復経頭蓋磁気刺激（repetitive transcranial magnetic stimulation； rTMS）は脳卒中患者上肢に対するアプローチとして有効性が示唆されている。その中で非損傷運動野への1Hz でのrTMS と手指運動を併用することによって損傷側手指の課題成績の増大等が報告されている。しかしながら筋活動に及ぼす影響は一貫した結果が報告されていない。そこで非損傷運動野への1Hz でのrTMS が筋活動に与える影響を検証した。今回、脳卒中患者1 例に対して非損傷側運動野への疑似刺激（sham-TMS）、1Hz-rTMS（real-TMS）の2 群の介入を実施し、1Hz-rTMS が損傷側手指の筋活動に与える影響を検証した。介入はsham-TMS、real-TMS 後にそれぞれ手指運動を15 分実施した。対象者には両側の第一背側骨間筋（first dorsal interosseous； FDI）に電極を設置し、筋活動を記録した。評価はrTMS 前（pre）、後（post1）、手指運動後（post2）に単純ピンチ反応課題をさせ、EMG-onset からpeak までのEMG 振幅を記録した。またpre、post₁ に非損傷側FDI より記録される運動誘発電位（Motor Evoked Potential； MEP）の振幅を記録した。結果はFDI においてreal-TMS におけるpost1 のMEP 振幅はpre と比較して有意に減少した。real-TMS におけるEMG 振幅はpost1、post2 において有意に増加し、群間比較はpost1、2においてsham と比較し、有意に増加した。これらより本症例において手指運動前に非損傷側運動野に1Hz-rTMS を行うことにより非損傷側運動野の興奮性が抑制され、手指運動による筋活動は手指運動のみより増加することが示された。This study was designed to examine the effect of repetitive transcranial magnetic stimulation（rTMS） on motor deficits of affect hand in a patient with stroke. The patient was a woman with left hemiplegia persisting month after stroke. The conditions received 1 Hz rTMS over the unaffected hemisphere before motor training of pinch function, or sham rTMS before motor training of pinch function. We evaluated the electromyography（EMG） amplitude of the affected first dorsal interosseous（FDI） and the motor evoked potential（MEP） of the affected motor cortex by TMS. The MEP amplitude after 1 Hz rTMS significantly decreased than the MEP amplitude before 1 Hz rTMS. The EMG amplitude after 1 Hz rTMS and after motor training pinch function significantly increased than the EMG amplitude before 1 Hz rTMS and sham rTMS condition. These findings indicate that 1 Hz rTMS improved EMG activity and hand function

高校吹奏楽部所属学生における身体症状と身体機能に関する研究

高校吹奏楽部所属学生を対象に、演奏楽器別に整形外科的症状の出現時期や出現部位について明確にすること、ならびに身体機能評価から整形外科的症状との関係について言及することを目的とした. 方法として身体症状はアンケート調査、身体機能評価は協力できる部員に筋力や関節柔軟性を測定した. 整形外科的症状が出現していた部員の多くはユーフォニウム、チューバ担当であり、比較的、大型の重量楽器を演奏する部員に多かった. また、サックス、パーカッション、カラーガード担当も複数の関節に症状が出現していた. 関節の柔軟性については低下している部員が多く、長座体前屈距離や下肢伸展挙上で全国平均値を下回っていた. また、体幹筋力を評価する上体起こしや背筋力は全国平均値を下回っていた.We intended that the students belonging to the brass band in high school to clarify for site of origin and time of appearance of symptoms orthopedic by musical instruments, to mention the relationship between symptoms and orthopedic from the assessment body functions and. Physical symptoms questionnaire, physical function evaluation was to measure the strength and joint flexibility to staff as a way to cooperate. Euphonium, many of the staff orthopedic symptoms had appeared tuba is in charge, there were many in the staff that a relatively large weight to playing an instrument. In addition, the symptoms have appeared in multiple joints sax, percussion, and color guard personnel. For many staff the joint flexibility is declining, was below the national average in distance and elevation on sit-and-reach distance and straight leg raising. In addition, the trunk body to evaluate back strength and sit up was below the national average

運動方向の違いが到達把持運動時の指先距離に与える影響

本研究は、運動方向の違いが到達把持運動時の指先距離に与える影響を検討する事を目的とした。対象は、健常成人12名である。大球・中球・小球の3種類の物品を、正面(以下;F)、右45°(以下;R)、左45°(以下;L)に設置し、各物品に対する"F"・"R"・"L"の運動方向へ到達把持運動を実施し、動作解析法を用いて、動作開始から物品接触までの指先距離を抽出し,3群間で比較検討した。結果、大球の比較では、60～90%の時点において、"F"が、"L"より、指間距離は有意に広く、さらに"L"が"R"においても指先距離は有意に広かった。中球比較では、70～90%の時点で、"F"が"L"より、有意に指先距離が広く、さらに"R"が"L"より有意に広かった。小球では、60～95%の時点で、"L"が"F"より有意に指先距離が広く、さらに"L"が"R"より有意に広かった。これらのことから、"L"への到達把持運動では"F"・"L"と異なったパターンを示し、これらの要因として、肩関節・手関節における関節の自由度に対する方向調整と適応調整による動作パターンの違いが考えられ、運動方向の違いでの手指の形成パターンは異なることが明らかとなった。This study was intended to examine whether the difference in the movement direction affects the distance of the fingertip at the time of reaching the gripping movement. The subject is a healthy adult 12 people. Target is the large ball, medium ball and small ball, which is the three types. Placed of the target is a Front("F") and Right45°("R"), left 45 °("L") . Between three groups by extracting the distance of the fingertip with reach and grasping motion is compared motion analysis to each target. Result, In the comparison of large ball, "L" is significantly wider distance of the fingertip at time of 65-90% than the "F". "L" was more significantly wider than "R". In the comparison of medium ball, "F" is significantly wider distance of the fingertip at the time of 20-40% than the "L", "L" was significantly wider than "R". In the comparison of small ball, "L" is significantly wider distance of the fingertip at the time of 60-95% than the "F". "L" was significantly wider than "R". From these things, this study showed that the difference in the movement direction affects the fingers forming the pattern

臨床実習における理学療法実践体験量と理学療法技術水準の関係

理学療法臨床実習における見学、検査測定体験、治療体験の量が、実習終了時の自覚的な検査測定技術、治療技術の水準に及ぼす影響を検証するために、臨床実習を終了した本学理学療法学専攻4年次学生36名を対象にアンケートを行った. 質問内容は、一日あたりに見学した患者数とその時間、検査測定した患者数とその時間、指導を受けたセラピスト数とした. 理学療法技術水準は、実習終了時の自己の検査測定技術、治療技術水準が考えうる最高の水準であれば100点、最低の水準であれば0点として自己採点させた. 検査測定技術点、治療技術点は治療時間と有意な正の相関関係、見学人数と有意な負の相関関係にあった. 以上より、実習中の治療体験量の増大は、実習終了時の自覚的な理学療法技術水準を増大させるが、見学では増大しない可能性が示唆された.Purpose of this study was to investigate the effect of the volume of observation of physical therapy,experiment of measurement and therapy on skill of measurement and therapy by self-evaluation. The thirty six student of physical therapy after clinical internship of physical therapy were asked about the internship by questionnaire distributed after the internship. The items in the questionnaire were the number of patient and time in observation per day, the number of the patient and time in evaluation and therapy, and number of therapist who teach the student of physiotherapy per day. The ability of evaluation and therapy were scored by self-estimation after the internship. There were significantly positive correlation between the score of ability of evaluation and therapy and the time of therapy. In the other, there was significantly negative correlation between the score and number of patient in observation. These finding indicate that increasing of the volume of experiment of physical therapy can increase the ability of evaluation and therapy but increasing of observation cannot increase the ability

短期間の理学療法評価臨床実習の実態調査

理学療法士を養成する大学で実施される短期間の理学療法評価臨床実習の実態を明らかにすることを目的に、3年次大学生を対象にアンケート調査を実施した. 実習で学生が担当した症例の約80%が典型的な運動器疾患であり、約87%の学生が実習開始3日目以内に理学療法評価を開始していた. 1日の検査測定実施時間は約40分、治療実施時間は約17分、見学の時間は約340分であった. 帰宅後、デイリーノートや課題に費やす時間は約4時間、睡眠時間は約3時間であった. 以上より、実習期間が短いことと、初めての臨床実習であることを考慮し、計画的に実習が進行されていたと考えられた. その一方、見学や課題レポート作成の時間に比べて、評価・治療実施時間が極めて短いことがわかったが、現行の診療報酬制度下による病院運営の観点から、実習生に評価・治療体験のための時間を増加することは困難であると推測される. 効果的な理学療法実習を実現するための臨床実習体制の提案が必要である.The aim of this study was to investigate the actual situation of the clinical internship of physical therapy evaluation in 3 weeks. The inventory survey was conducted for the third grader student belonging to the university which trains a physical therapist. Approximately 80% of disease of the case of what student was in charge were the patients after a typical fracture. Approximately 87% of students started a physical therapy evaluation within third day. The time of evaluation was approximately 40 minutes, the time of therapy was approximately 17 minutes and the time of study by observation was 340 minutes per one day. Approximately 4 hours were spent for homework and the time of sleep was approximately 3 hours per day. Thus, in consideration of very short period of the clinical internship of physical therapy evaluation, the internship could be premeditatedly conducted by supervisor. On the other hand, it was found that the time of evaluation and therapy was extremely shorter than the time of study by observation and homework. From the viewpoint of hospital management under current fee-for-service system, it could be difficult to make a time to evaluation and therapy by student. The new proposal of the clinical internship of physical therapy system for effective training is necessary

Cerebellar TMS Induces Motor Responses Mediating Modulation of Spinal Excitability: A Literature Review

Since individuals with cerebellar lesions often exhibit hypotonia, the cerebellum may contribute to the regulation of muscle tone and spinal motoneuron pool excitability. Neurophysiological methods using transcranial magnetic stimulation (TMS) of the cerebellum have been recently proposed for testing the role of the cerebellum in spinal excitability. Under specific conditions, single-pulse TMS administered to the cerebellar hemisphere or vermis elicits a long-latency motor response in the upper or lower limb muscles and facilitates the H-reflex of the soleus muscle, indicating increased excitability of the spinal motoneuron pool. This literature review examined the methods and mechanisms by which cerebellar TMS modulates spinal excitability