低周波電流刺激による吃音発生抑制作用

われわれのこれまでの研究から、末梢における吃音症状発生の主体は、声帯レベルでの機能異常によるものの可能性が強いことが推測されている。本研究は、吃音発生時の声門レベルの異常に焦点をて、低周波干渉電流が吃音発生の抑制に関与するかを検討することを目的としている。低周波干渉電流刺激療法が、理学療法の分野では末梢神経の伝導抑制作用を示し、その作用を利用して消炎・鎮痛療法があることは広く認められている。また、低周波による神経刺激実験で50Hz以上の電流が鎮痙的作用があることも知られている。3例の成人吃音患者を対象としたが、発話時のBlockと、身体の随伴症状が最も著しかった1例を対象に、上肢に電極を装着して電流刺激をした場合と、咽頭に電極を装着して電流刺激をした場合と、電流を流さない状態とで、文章音読時の吃音症状出現頻度について検討した。電流刺激装置は日本メデックス社の低周波刺激装置を用いた。咽頭への電流刺激方法は、星状神経節ブロック施行時の要領で行い、50-60Hz、5-10mAの電流を流した。また、distraction効果についても検討した。その結果、咽頭への電流刺激が吃音症状軽減に有効であることが示唆された。 干渉低周波刺激電流は、声帯に物理的な刺激を加えるが、声帯の器質的な変化を惹起させることなく、繰り返し利用可能であるので、吃音者が吃音を予測した時に電流をを刺激するすることにより、吃音症状軽減効果が期待できる。This study evaluates the effectiveness of interferential current stimulation to decrease stuttering symptoms. Three patients with chronic stuttering participated in this study. Inferential current stimulation was tried on the most severe patient of the three. The subject received 2 trials of interferential current stimulation on his larynx, and 2 trials of interferential current stimulation to his arm, and two trials of no current stimulation to his larynx. Stuttering symptoms decreased only for inferential current stimulation to his larynx. It is concluded that for chronic stuttering patients inferential current stimulation to their larynxes will decrease severe chronic stuttering.研究課題/領域番号:08671957, 研究期間(年度):1996–1998出典：「低周波電流刺激による吃音発生抑制作用」研究成果報告書　課題番号08671957 (KAKEN：科学研究費助成事業データベース（国立情報学研究所）)　　　本文データは著者版報告書より作

Horizontal visual search in a large field by patients with unilateral spatial neglect

In this study, we investigated the horizontal visual search ability and pattern of horizontal visual search in a large space performed by patients with unilateral spatial neglect (USN). Subjects included nine patients with right hemisphere damage caused by cerebrovascular disease showing left USN, nine patients with right hemisphere damage but no USN, and six healthy individuals with no history of brain damage who were age-matched to the groups with brain right hemisphere damage. The number of visual search tasks accomplished was recorded in the first experiment. Neck rotation angle was continuously measured during the task and quantitative data of the measurements were collected. There was a strong correlation between the number of visual search tasks accomplished and the total Behavioral Inattention Test Conventional Subtest (BITC) score in subjects with right hemisphere damage. In both USN and control groups, the head position during the visual search task showed a balanced bell-shaped distribution from the central point on the field to the left and right sides. Our results indicate that compensatory strategies, including cervical rotation, may improve visual search capability and achieve balance on the neglected side. © 2012 Elsevier Ltd. All rights reserved.Thesis of Ken Nakatani / 中谷 謙 博士論文 金沢大学医薬保健学総合研究科（保健学専攻

要支援高齢者のためのIADL向上プログラムの評価と開発

作業療法では脊髄損傷者や脳卒中後遺症者などの身体障害者にIADLのアプローチの報告はあるが、心身機能障害のない高齢者での文献はない。本研究の目的は、高齢に伴う廃用症候群でIADLが低下した要支援１、２の者を対象に、困難なIADLの共通因子を分析し、IADLの向上を図るプログラムを立案し、実施し、評価した。Ａ県、Ｓ市、Ｋ市で研究協力の得られた訪問介護サービス事業所を対象に、要支援１、２ の６０８名のIADLを訪問介護で主に援助している家事を家事実施チェック表により調査し、因子分析を行った結果、第１因子「協調性・巧緻性」、第２因子「移動・運搬」、第３因子「上肢の動き」、第４因子「握力やつまみ力」の４つの家事困難共通因子が読みとれた。それらの因子に対応したIADLエクササイズと基本的動作からなる基礎的運動プログラムの２つのIADL向上のためのプログラムを立案し、訪問介護利用者９名、通所介護８名を対象に３ヶ月、２０～３０ 分の介入を行った。訪問介護では、身体活動量と各因子に対応した家事実施チェック表によるIADL項目に有意な改善がみられた。通所介護では、階段昇降、屋外移動などの基本的ADLや身体計測値に特に変化がなかったが、IADL評価項目に改善があった。本プログラムの有効性を明らかにするために、対象者を増やし、対照群を設定し、介入を行う必要性があると考えられた。 Ȁ Instrumental Activity of Daily Living (IADL) has been reportedly performed as part of occupational therapy for patients with physical disabilities such as those with spinal cord injuries and stroke sequelae. However, there are still no reports in the literature regarding the application of IADL to the elderly without psychosomatic disorders. This study aimed to (1) analyze common difficult household work factors among elderly people certified as on support level 1 or 2 (the Japanese nursing-care insurance system at a previous stage) whose IADL decreased because of disuse syndrome, (2) prepare a program to improve IADLs, and (3) perform and (4) evaluate such a program. IADLs were studied using a household work checklist in 608 elderly people certified as on support level 1 or 2 who visited home-visit care centers in S city and K city, A prefecture, and then factor analysis was performed. The results demonstrated 4 common factors causing difficulty in household work, namely, “motor coordination/ skill movement”(first factor), “ambulation/ carrying”(second factor), “upper limb movement” (third factor), and “grip strength and pinch strength”(fourth factor). Therefore, two kinds of IADL improvement programs were prepared, including exercise specific for IADLs to address these factors and a basic exercise program containing basic actions. The intervention program was performed for 20 to 30 minutes per session over 3 months in 9 elderly people who visited the home-visit care centers and 8 elderly who had to commute for care. The IADL items in the checklist of household work regarding chairs stand and the above-mentioned factors were significantly improved in those who visited home-visit care centers. On the other hand, the IADL items were improved in those who had to commute for care ; however, there were no significant changes in basic ADLs such as stair climbing and walking outside, or body measurements. More subjects and a control group are needed in future studies to confirm the efficacy of this program

Parkinson\u27s disease showing progressive conduction aphasia

Patients with Parkinson\u27s disease (PD) may develop progressive dementia late in their clinical course. Dementia in PD is mostly related to neuropathological findings of extensive Lewy bodies (LBs), with or without the coexistence of Alzheimer\u27s disease (AD) pathology. Aphasia has been reported in patients with LB diseases with AD pathology; however, there have been no reports of typical PD patients developing progressive aphasia during their clinical course. We describe a female PD patient who later developed progressive conduction aphasia characterized by phonemic paraphasia and disturbance in repetition of short sentences without disturbance in writing or auditory comprehension. No episodes of fluctuations of attention, memory complaints, or planning errors were observed. She experienced episodes of visual hallucination. Her low scores on the Mini-Mental State Examination suggested impairment of orientation and attention, and her scores on Raven\u27s Coloured Progressive Matrices test indicated impaired visuospatial functions. However, her cognitive deficits were not sufficiently severe to impair her daily life. Brain magnetic resonance images revealed atrophy of the left superior temporal gyrus and widening of the left sylvian fissure. [18F]-fluorodeoxyglucose positron emission tomography revealed glucose hypometabolism in the left cerebral hemisphere. These findings may be related to conduction aphasia. During the progression of PD lesions, the brainstem LB is assumed to take an upward course, extend to the limbic system, and then extend to the neocortex. Conduction aphasia observed in our patient may be associated with an unusual progression of the LB pathology from the brainstem to the left temporoparietal lobe. © 2011 Springer-Verlag

アルツハイマー型認知症者を対象にした机上で実施可能なIADL検査の開発と妥当性の検討

The instrumental activities of daily living scale (IADL scale) for Alzheimer’s type of dementia (ATD) does not provide a simple and easy way for evaluators to directly evaluate the targeted individuals. Therefore, we developed an experimental method, which allows a desk evaluation of IADL (on-the-desk evaluation of IADL). The study involved a group of 24 subjects with normal control (MMSE, 28.9 ± 1.4) and a group of 21 subjects with ATD (MMSE, 19.8 ± 4.4). The desk evaluation of IADL involved 9 tasks, which included boiling water with an electric kettle, pulling the plug out of the outlet once the water boils, and making a telephone call. For the test, the subjects were instructed to figure out by themselves the sequence in which they would perform the tasks. The scoring was performed on the basis of the appropriateness or inappropriateness of their behavior in each task and the time it took them to complete each task. The maximum score was set to a total of 59 points. Additionally, in order to examine the validity of the test and the factors which may affect the desk assessment of IADL, various types of neuropsychological tests were performed. The IADL Scale and the Frenchay Activities Index (FAI) were used in the evaluation of IADL. The results showed significant difference in the scores between the 2 groups. The at-the-desk evaluation of IADL revealed a strong correlation between the IADL Scale and the FAI (r＝0.89, r＝0.82, p＜0.001), and a multiple regression analysis of the IADL scores from the desk evaluation showed a high explanation rate (R2＝0.84) by “the Behavioural Assessment of the Dysexecutive Syndrome, “the Wechsler Memory Scale-Revised/digit span backwards test,” the “Rivermead Behavioural Memory Test/appointment”, “Composing task”. The high correlation between the desk evaluation of IADL and the IADL evaluation scale and the results of the multiple regression analysis indicated that the desk evaluation of IADL reflected cognitive functions in ATD and was highly reliable and valid. アルツハイマー型認知症（ATD）用の手段的日常生活活動（IADL）スケールは、評価 者が直接対象者に対して簡便に評価可能なものはない。そこで、我々は机上で実施可能な IADL評価方法（机上IADL検査）の開発を試みた。対象は、健常群２４名（MMSE２８９. ±１４. ） とATD群２１名（MMSE１９８. ±４４. ）とした。机上IADL検査の課題は、電気ポットでお湯を 沸かす、お湯が沸いたらコンセントを抜く、電話をかける、などのIADLの課題を９つ設定 した。また、検査規則として、課題実施順番は自分で考えること、などを伝えた。得点化 は、各課題の適切・不適切行動と検査実施時間、実施順序を対象に行い、合計５９点満点と した。さらに、机上IADL検査に影響する因子と妥当性を検討するために、各神経心理学的 検査を実施し、IADL評価スケールとして、IADL ScaleとFenchay Activities Index（FAI） を実施した。その結果、２群の得点比較では有意差が認められた。また、机上IADL検査 は IADL Scale、FAI ともに強い相関を認め（r =０ ８.９、r =０ ８.２、p＜００.０１）、重回帰分析で は、机上IADL検査得点に対し「遂行機能症候群の行動評価」、「改訂ウェクスラー記憶検 査・逆唱課題」「リバミード行動記憶検査・約束課題」「構成課題」により、高い寄与率 （R２＝０８.４）が示された。机上 IADL 検査は、IADL 評価スケールとの相関が高いこと、重 回帰分析の結果から、ATDの認知機能をよく反映した併存妥当性の高い検査と考えられた

アルツハイマー病者のIADL に影響する高次脳機能障害についての検討 : 机上IADL 検査を用いて

はじめに：アルツハイマー病（AD）の軽度段階では、いくつかの手段的日常生活活動（IADL） の能力が低下し、高次脳機能の低下やうつがIADL に影響していると考えられている。し かし、IADL と高次脳機能、うつとの関連について検討した報告は少ない。そこで、我々 は「机上IADL 検査」を用いて、高次脳機能やうつがIADL にどのように影響しているの かについて検討した。方法：対象は軽度AD 群25 名と健常高齢者群22 名とし、7 種類の IADL 課題で構成され信頼性と妥当性が証明されている、「机上IADL 検査」と神経心理 学的検査、簡易うつ検査（GDS-15）を実施した。結果：軽度AD 群では、「服をしまう」、「ご みの分別」、「本の分別」の課題については、実施割合が高い結果となった。しかし、すべ てのIADL 課題で誤反応が健常高齢者より有意に多い結果となった。7 種類のIADL 課題 と神経心理学的検査とGDS-15、年齢との関連を検討したところ、神経心理学的検査によっ て相関の強さの違いがみられた。また各IADL 課題は、短期記憶との関連が強かった。 考察：軽度AD 者は、誤り行動を含みながらIADL タスクを実施していると考えられた。 また、軽度AD 者へのIADL 支援を行う際は、影響する認知機能の種類に配慮した検査の 選択が必要と考えられた

Physical Health of Mothers of Children with Hearing Loss

Parents, particularly mothers, of children with disabilities often experience mental stress. Various interventions have been used to reduce stress and increase support. As regular physical activity/exercise is beneficial for various health conditions, it could reduce stress in mothers. The purpose of this study was to clarify the physical health status of mothers of children with hearing loss. Participants were 10 mothers of children with hearing loss (mean age: mothers: 36.7 ± 3.3 years). Participants’ muscle strength, muscle endurance, flexibility, agility, and exercise tolerance were tested. Step counts were recorded using a triaxial accelerometer and amount of activity time was measured using metabolic equivalents (METs). Time spent on moderate-to-vigorous physical activity (MVPA) ≥3.0 METs per day was assessed. Standing posture was determined using a photographic lateral view and classified according to Kendall’s posture types. Participants’ performance was compared with the national average for similar-aged women. There was no significant difference in muscle strength, muscle endurance, flexibility, and exercise tolerance. However, participants’ agility (p = 0.013) and number of daily steps (4,913 ± 1,414; p = 0.006) were significantly lower. MVPA time was 49.6 ± 22.8 minutes per day, 44.9 minutes of which were MVPA ≥3.0 METs. Some mothers exhibited a kyphotic posture, and most complained of shoulder stiffness and low back pain. The physical fitness of mothers of children with hearing loss was the same as the national average. Mothers should maintain their physical health by participating in more vigorous daily physical activity and increasing their awareness of posture.アジアヒューマンサービス学会の許可を得て登

金沢方式による聴覚障害幼児の音韻抽出能力の検討

Objectives: To examine predictors of syllable extraction proficiency, a prerequisite forchildren with hearing impairments progressing from spoken to written language by theKanazawa Method.Background: The rates of delayed language acquisition in children with hearingimpairments have remained unchanged despite increased use of cochlear implants. Childrenborn with hearing deficiencies do not receive sufficient auditory inputs, which contributesto delayed acquisition of spoken language. As spoken language is the springboard towritten language, such children are likely to experience delays in acquisition of syllableawareness and written language when taught in the same way as children without hearingimpairments. However, most research on syllable awareness in children with hearingimpairments in Japan is related to studies targeting school-age children and later. Therefore,it remains unclear how to manage syllable awareness problems in pre-school-age children.Methods: This study was conducted on 68 children with hearing impairments, between 4 and6 years of age, diagnosed by the Kanazawa University Hospital with congenital deafness beforethe age of 4 years and receiving outpatient language instruction. To examine the predictors ofsyllable extraction scores, we performed multiple-regression analysis with syllable extraction asthe dependent variable and age, unaided hearing level, and scores for remaining language skills(auditory word comprehension, syllabification, syllable extraction, written language characterrecognition, and written language sentence comprehension) as independent variables.Results: Stepwise regression analysis showed that written language character recognitionscore, age, and auditory word comprehension score contributed to the syllable extraction score.Discussion: The relationship between syllable extraction proficiency and age was consistentwith previous reports. Early intervention targeting character recognition and auditory wordcomprehension assisted the teaching of written language and improved syllable awarenessin children with hearing impairments. The results of this study indicated that early-stageintervention in written language character recognition and auditory word comprehension isan effective method of teaching children with hearing impairments to facilitate acquisitionof written language and the development of syllable awareness. The vocabulary and syllableawareness acquired by exposure to a combination of spoken language, Japanese sign language,and written language can be easily transferred to speechreading. Using the Kanazawa Methodto facilitate understanding of the structure of Japanese language can help children with hearingimpairments to acquire syllable extraction proficiency, regardless of their unaided hearing level