非特異的腰痛患者に対する骨盤リアライメントコンセプトに基づいた運動療法の効果

聖隷クリストファー大学2013年

Effect Of Isometric Exercises Using an Active Therapeutic Movement Device for Patients with Acute Low Back Pain

Background: This study aimed to investigate the effects of isometric exercise using ATM®2 for acute low back pain (LBP) patients as a flexion or extension type. Methods: The subjects were twenty individuals (age 39.7±8.0ys, 12 males / 8 females) with acute LBP of less than four weeks duration who volunteered to participate in the study. The participants were allocated into four groups. First, the participants were classified by the direction of the movement causing pain in flexion and extension types. Secondly, both types were allocated randomly into two groups which were given exercises using the ATM®2 group and the usual care group. Finally, both groups were treated three times weekly for two weeks, totaling six sessions. Results: In terms of the extension type of LBP, the effect of the extension pain in the ATM®2-group significantly decreased pain (p=0.04) immediately. And in both groups significantly decreased (p=0.01, 0.001) for two weeks of intervention. Furthermore, in the flexion type of LBP, the effect of the flexion pain in the ATM®2-group and usual care group significantly decreased (p=0.001, p=0.03) during the two weeks intervention. However, neither group had an immediate effect. Conclusion: Isometric exercise using ATM®2 may have an immediate and short-term effect on acute LBP, which is greater in patients with an extension-type pattern. The ATM®2 exercise may reduce the pain of the acute LBP. Furthermore, it will be a problem in the future to analyze if the influence of pain is reduced in the immediate natural period that gives to chronic LBP

若年女性における外反母趾の有無と内側アーチおよび踵骨傾斜角との関係

研究論文Original Articles　［目的］外反母趾は，中高年においてしばしば問題となる変形である．外反母趾の存在は他部位への運動学的変化を及ぼすことが報告されていることから，若年者から予防的な介入が必要かもしれない．しかし，若年者において外反母趾が他部位に及ぼす影響は明らかではない．本研究では，若年女性を対象に足部アライメントを調査し，外反母趾と内側縦アーチおよび踵骨角度との関係を明らかにすることを目的とした．　［方法］大学生女性81 名162足を対象とし，第一趾側角度，アーチ高率，Leg Heel Alignment を測定した．第一趾側角度とアーチ高率・Leg Heel Alignment それぞれの相関関係と，アーチ高率およびLeg Heel Alignment において外反母趾あり群となし群の比較を行った．　［結果］各項目間に有意な相関関係は認められなかった．群間比較ではアーチ高率で有意差を認め（p<0.01）， 外反母趾あり群が有意に低下していた．　［結論］若年者の外反母趾を有する足部では，内側縦アーチは低下し，踵骨角度には影響しないことが示唆された．　[Objective] Hallux valgus is often a problematic deformation in middle-aged and elderly people. Preventive intervention may be necessary for young people, as the presence of Hallux valgus has been reported to exert kinetic changes to other sites. However, the influence of Hallux valgus on other parts of the body in young people is unclear. In this study, we aimed to investigate foot alignment in young women with Hallux valgus and to clarify the relationship between Hallux valgus and the medial longitudinal arch and calcaneus angle.　[Methods] The study subjects were 81 female college students （162 legs）. The first toe side angle, arch height ratio, and leg-heel alignment were measured for the legs. The correlations of arch height ratio to the first toe side angle and leg-heel alignment were compared between the group with and the group without Hallux valgus.　[Results] No significant correlation was found between the items. A significant difference in arch height ratio （p < 0.01） was observed between the groups, and the group with Hallux valgus had a significantly decreased arch height ratio.　[Conclusion] This study suggests that in feet with Hallux valgus in young persons, the medial longitudinal arch decreases and does not affect the calcaneus angle

初学者によるデジタル画像を用いた角度測定の精度および信頼性

研究論文Original article〔目的〕本研究の目的は，0.5 度刻みで設定した被写体に対し，学生が検査者となった場合，デジタル画像解析による角度測定の精度を検証することである．〔対象と方法〕検査者は大学生10 名とした．デジタルカメラで撮影した被写体は，89.0 度，89.5 度，90.0 度，90.5 度，91.0 度の5 条件を設定したモデルとした．得られたデジタル画像に対し，各条件で3 回の角度測定を行った．〔結果〕すべての検査者において，測定値は，いずれの設定条件でも設定角度の大きい条件は小さい条件より大きかった．また，各条件間で有意な差を認めた．絶対誤差は，平均0.16 ± 0.05 度であった．級内相関係数ICC（1，3）は0.981-0.987 であった．〔結語〕この研究では，デジタル画像解析が，大学生が測定しても，小さな変化を検出できる精度をもっていることが示唆された．[Purpose] The purpose of this study is to verify the accuracy of angle measurement by digital image analysis for subjects set at 0.5-degree increments.[Methods] The examiners were 10 university students. The subjects were photographed with a digital camera, and the model was set to five conditions: 89.0, 89.5, 90.0, 90.5, and 91.0 degrees. The examiner performed angle measurements in each condition using the digital images obtained.[Results] In all examiners, measurements were greater for the larger set angle condition than for the smaller set angle condition for all conditions. In addition, measurements were significantly different between conditions. Absolute errors averaged 0.16 ± 0.05 degrees. The intraclass correlation coefficient ICC (1, 3) was 0.981-0.987.[Conclusion] This study suggests that digital image analysis has the accuracy to detect small changes even when measured by university students

言語指示が着地動作時の股・膝関節キネマティクスにおよぼす影響

研究報告Original Articles　本研究では，口頭による言語指示が，着地動作における股および膝関節の角度に影響をおよぼすか調査した。対象は，高校女子バスケットボール部員7名とし，関節角度は三次元動作解析装置により測定した。課題は，高さ30cmの台から両脚にて，まず任意により自由に着地し，次に「つま先と膝の方向をまっすぐするように着地してください」と指示し，再び着地した。その結果，股関節は，接地時と最大垂直床反力時に指示後が指示前より有意に外転した（p<0.05）。膝関節は，いずれの関節角度とも，言語指示による影響は認められなかった。膝関節の内外反角度を変化させるには1回の単純な言語指示では困難であることが示唆された。The aim of this study is to investigate whether athletes can alter their knee kinematics during a drop landing task by following simple verbal instructions. This study included 7 high school female basketball players. The subjects performed a leg drop landing task using both legs, from a box situated at a height of 30 cm. Five sets of infrared video cameras attached to a 3-D analyzer system were used to capture the hip and knee angles during the landing tasks. First, the subjects landed naturally, with no verbal instructions (natural-landing). They were then instructed to land with their lower extremities in a neutral position in the sagittal plane; after receiving these instructions, they performed the landing task a second time (verbal-landing). At initial contact and at a peak vertical ground reaction force, the hip abduction angle during verbal-landing was significantly greater than that during natural-landing. The knee angles were not significantly different between the 2 types of landing. This study suggested that a single intervention with verbal instructions did not significantly decrease the knee valgus during leg landing using both legs

聖隷クリストファー大学リハビリテーション学部における授業開放週間（オープンウィーク）とピアレビューの試み

実践報告Practical repor

大学生の午前と午後の授業中の眠気は夜間の睡眠状況と関連するか

研究論文Original Articles　本研究の目的は，大学生の授業中の眠気と夜間の睡眠状況の関連性を，午前と午後の授業時間帯別に明らかにすることであった．対象は，本学リハビリテーション学部に所属する学生137 名であった．方法は，自己記入によるアンケート調査であり，午前・午後の授業中の眠気の有無を目的変数，夜間の睡眠状況，性別，授業への興味や関心，服薬中の薬剤，うつ症状を説明変数としてロジスティック回帰分析を行った．結果，午前の授業中の眠気は，就床時間が遅く（p0.05）．授業中に眠気を感じる学生に対して，夜間の睡眠環境の整備を行うよう指導する場合があるが，午後の授業中の眠気の予防には，夜間の睡眠環境の整備のみでは効果が得られない可能性がある．　The purpose of this study was to identify the relationship between sleepiness during taking classes and the nighttime sleep in university students. This study focused on sleepiness in the morning class and the afternoon class. 137 students in Seirei Christopher University, School of Rehabilitation Sciences were participated in this study. The method of this study was a selfadministered questionnaire. The statistical analysis was used as a logistic regression analysis. The objective variables were analyzed sleepiness in the morning and afternoon classes. The explanatory variables were analyzed nighttime sleep situations, sex, interests in the class, medication, and depressive symptoms. The result showed that the students who felt sleepiness in the morning class went bed significantly later (p 0.05). The professors sometimes instruct to the students who feel sleepy in class for improvement their sleep in the night. However, it may not be solved it for their afternoon class

理学療法領域におけるクリニカル・クラークシップ実践例 : 一通所リハビリテーション施設の紹介

調査・報告Investigation / report　本稿では，一通所リハビリテーション施設でのクリニカル・クラークシップの実践例を紹介し，クリニカル・クラークシップの基本原則を踏まえた実践方法を示すとともに，クリニカル・クラークシップを実践する中で生じた今後の課題についても言及した．クリニカル・クラークシップの原則は，1. 実習指導者の助手として診療参加，2. 部分的に技術単位で診療参加，3. 見学・模倣・実施の原則，4. できることから実践する実習，5. 行動目標対象者は利用者である実習環境，6. 学習到達度の形成的評価であり，基本原則を踏まえた指導が重要である．今後の課題は，他職種へのクリニカル・クラークシップの理解をどう促していくか，および実習指導者の臨床推論能力をどのように育成していくかであり，これらの課題を解決するための取り組みが必要であると考えられた．　This study introduces an example of the clinical clerkship for the physical therapy practicum in visiting care facilities. Specifically, we described practices and problems for clinical clerkship in visiting care facilities such as day care. The important points of clinical clerkship for success are student participation, the first method of teaching students as a modeling, next coaching and finally fading, practice from what you can do, priority of patient benefit, and formative assessment. The current problems of clinical clerkship are the lack of understanding for clinical clerkship by other occupations and the lack of clinical reasoning ability in clinical supervisor. We should work on for solutions of these lacks

臨床実習指導者が考えるクリニカル・クラークシップの問題点に関する文献検証

研究論文Original Articles　本研究の目的は，わが国のリハビリテーション専門職の臨床実習において，臨床実習指導者が考えるクリニカル・クラークシップの問題点を文献的に明らかにすることであった．対象論文は，医学中央雑誌とメディカルオンラインに掲載されており，キーワード検索に該当した原著論文であった．検索キーワードは，「クラークシップ」OR 「参加型」AND 「実習」とした．その結果，キーワード検索により 215 論文が抽出され，対象論文は，除外基準に該当した論文を除く5 論文であった．5 論文内の記載で多く認められたクリニカル・クラークシップの問題点は，「学生が患者の全体像を把握しにくい」，「臨床実習指導者が学生の理解度を把握しにくい」，「臨床実習指導者の負担が増加する」であった．臨床実習指導者が，なぜ上記の問題点をクリニカル・クラークシップの問題点と考えやすいのか，養成校の教員は原因を分析し，対策を講じる必要がある．　The purpose of this literature review was to clarify the issue of clinical clerkship on clinical practicum of rehabilitation professionals in Japan. The authors searched Centra Revuo Medicina Web and Medical Online. A literature review was conducted using the search term“Clerkship” OR “"On the Job Training” AND “Clinical Practicum”. In total, 215 studies were identified and 5 studies were selected and analyzed. The issue with the clinical clerkship were "It was difficult for students to understand the patients", "It was difficult for clinical educator to understand the students\u27 level of understanding”, "The burden on clinical educator increased”. The instructors in the training institutions for rehabilitation professionals need to analyze the issue of clinical clerkship and take their action