The relationship between quite sleep and neurobehavioral development in preterm infants

[Background and aims] Recent experimental data suggest sleep plays a role in brain development. Behavioral and physiologic assessments of neonatal sleep might lead to more developmentally appropriate state regulation for infants in intensive care and assist in daily medical care and predicting the neurodevelopmental outcome. Analysis of sleep patterns using amplitude-integrated electroencephalography (aEEG) might predict further neurobehavioral developmental states in premature infants. The study aimed to evaluate the relationship between sleep states, investigated by aEEG, and short-term neurobehavioral developments in preterm infants. [Study design and subjects] 　aEEG and neurobehavioral assessments (Neonatal behavioral assessment scale ; NBAS) were performed at 37-39 weeks of post-conceptional age for 10 infants (median gestational age and birth weight were 35 weeks and 2175g. Quiet sleep (QS) data were collected by aEEG over 12 consecutive night hours. QS as the duration of QS intervals and the variation of QS duration periods were analyzed. NBAS were scored by six cluster scores (Habituation, Orientation, Motor, State Range, State Regulation and Autonomic Stability). Correlations analyses examined the relationship between the QS measurement items and NBAS cluster scores. [Results] There were significant negative correlations between the variation of QS duration periods and state range (ρ=-0.71, p<0.05), and the variation of QS duration periods and state regulation scores (ρ=-0.77, p<0.55). [Conclusions] 　Stable QS periods appear to have some short-term effects on neurobehavioral development in premature infants and therefore protected sleep during premature care is potentially advantageous in improving an infant’s neurobehavioral status

理学療法（士）教育の現状と本学の教育戦略

解説Commentar

Risk Factors for Fracture in Adult Patients with Cerebral Palsy

Most studies on risk factors for fracture in patients with cerebral palsy have been conducted in children. We examined the relationships between age, body mass, gender, osteoporosis, osteomalacia and mobility level with history of a previous fracture in adult patients with cerebral palsy. We studied 124 institutionalized adults (52 men, age: 21-56 years, and 72 women, age: 24-47 years) with cerebral palsy. Antero-posterior radiographs of the pelvis were examined for osteoporosis and graded using the Singh index. Serum calcium, phosphate and alkaline phosphatase were measured. Osteoporosis was defined as grade 1-4 in Singh index. Osteomalacia was defined as calcium 220 U/l. Body mass index (BMI) was calculated from body height and weight. Medical records were examined for history of previous fractures and mobility levels (ambulatory /nonambulatory). A history of previous fracture was noted in 17 patients (6 men and 11 women). The proportion of osteoporosis in non-ambulatory patients was higher than in ambulatory patients. Multiple logistic regression analysis showed that presence of osteoporosis and mobility level (ambulation) were two factors that significantly correlated with a history of fracture. The latter did not correlate with age, BMI, gender and osteomalacia. Our findings suggest that osteoporosis is an important risk factor for fracture in adults with cerebral palsy. Since falling is also a risk factor for certain fractures, fractures seem to be more likely to occur in ambulatory patients through falling despite the low prevalence of osteoporosis

サルコペニアとリハビリテーション

総説Literature Review　骨格筋減少症といわれるサルコペニアは高齢者の虚弱発生の主要な原因であり，老年医学及びリハビリテーションの観点からも重要な課題とされている．近年，国内外問わずサルコペニアに関する知見(判断基準，分類，メカニズム，治療など)が多数報告されている．その中でサルコペニアと栄養との関連性を指摘しているものがある．近年「栄養ケアなくしてリハなし」といわれ，低栄養状態が高齢者の生命予後やActivities of Daily Living（ADL）の悪化につながるとされており，栄養とリハビリテーションの関係が注目されている．本論文では，サルコペニアの概念・メカニズム・治療(栄養介入，運動介入)に関して述べ，さらに今後の課題として，トレーニング介入時の栄養状態に着目することの重要性に関して考察した．Sarcopenia, the loss of muscle mass and strength, is a common phenomenon in aging. It leads to functional limitations and the need for extended rehabilitation services. Malnutrition is also common across varying patient populations, particularly older adults, and sarcopenia prevalence increases with advancing age. Both malnutrition and sarcopenia are present in many patient populations and manifest clinically through a combination of decreased nutrient intake, decreased body weight, along with a decrease in muscle mass, strength, and physical function. Malnutrition and sarcopenia are also associated with increased morbidity, in particular increased infection and complications rates, including falls and disability. Rehabilitation nutrition care management is important to improve their activities of daily living and quality of life. This review article provides the concepts, mechanisms and treatments (nutrition interventions, exercise interventions) of sarcopenia, and discusses their importance, focusing on the nutritional status at the time of intervention

教示条件が異なる荷重課題における運動学習

研究報告Original Articles[目的]本研究の目的は，部分荷重課題に対し，臨床的に汎用されている同時的フィードバックと運動学習理論において学習効果が高いとされている最終的フィードバックの二種類のフィードバックを与えたとき，どちらのフィードバック方法が荷重課題の運動学習に有用かを明らかにすることである。[対象]利き手は右利きの健常成人24名とした。[方法]課題は，端坐位にて骨盤側方に設置した体重計に右手掌で荷重する部分荷重とした。課題荷重量は10kgとした。対象者はフィードバックの種類（最終的・同時的）によって2群に分けられ，それぞれ13回の施行後に保持テストと転移テストを受けた。[結果] 保持テストと転移テストの結果では，同時的フィードバック群に比べて最終的フィードバック群の方が荷重量のばらつきは少なかった。[考察] 本研究の結果から荷重課題において用いるフィードバック方法は，同時的フィードバックに比べて最終的フィードバックの方が学習に効果的であると示唆された。[Purpose] This study compared the effects of practice with either concurrent or postresponse feedback on the learning of partial weight bearing (PWB). [Subject] Twenty four young healthy adults volunteered for the study. [Methods] Subjects practiced bearing 10kg PWB of body weight while supporting the right hand palm on a floor scale. Augmented feedback was provided during each 13 trials for both concurrent and postresponse feedback groups. Subjects were also retested 10 minutes later for a no-feedback retention test. [Results] During practice, variation of the amount of bearing decreased over time in the postresponse feedback group compared to the concurrent feedback group. The postresponse feedback group was also the more accurate than concurrent feedback group during retention. [Conclusion] This study suggested that PWB task with postresponse feedback is beneficial compared with concurrent feedback for the learning of this sensorimotor skill

A comparison of the developmental characteristics of spontaneous upper extremity movements between healthy full-term infants and premature infants with brain injuries

　This study’s aim was to evaluate the characteristics of spontaneous upper extremity movements of premature infants with brain injuries by using dynamical systems analysis. Participants were 4 infants with brain injuries (3 boys and 1 girl, median birth weight and gestational age were 1367.5 g and 30.0 weeks) and 7 healthy full-term newborn infants (3 boys and 4 girls, median birth weight and gestational age were 2990.7 g and 39.0 weeks). We measured limb movement acceleration in 3-dimentional space using a tri-axial accelerometer. Movement acceleration signals were recorded during 200 s from the right wrist when the infant was in an active alert state and lying supine (sampling rate 200 Hz). Data were analyzed nonlinearly. The optimal embedding dimension (OED) values for infants with brain injuries at 3 months were significantly higher than healthy full-term infants, and the OED and MLE values in infants with brain injuries displayed uncorrelated change profiles. Uncorrelated change profiles of the OED and MLE values revealed that incoordination of the number of motor system component and complexity of appeared spontaneous movements. It suggests that infants with brain injuries have difficulties with self-organization processes. Our results suggest that this method makes it possible to detect early developmental disorders such as cerebral palsy

入院高齢者における身体活動習慣がMini Mental State Examination の下位項目因子に与える影響の検討

研究報告Original Articles　［目的］ 入院高齢者の認知機能障害は予後の悪化を招くため，適切な評価や予後予測が重要である．Mini Mental State Examination （MMSE）を，3 つの下位項目因子に分類して検討することで，介入効果判定や予後予測に有用な情報となる可能性がある．また，身体活動習慣が認知機能を維持・改善することが多く報告されているが，MMSE の下位項目因子に対する影響は明らかになっていない．本研究では，入院高齢者においてMMSE の下位項目因子と身体活動習慣との関係を明らかにすることを目的とした．［方法］ 対象は入院高齢者31 名（男性/ 女性 8 名/23 名；年齢 78 ± 11 歳）とした．入院時に身体活動習慣（Baecke physical activity questionnaire；BQ）とMMSE を測定し，MMSE の下位項目を算出した．その後，各項目間の相関関係の解析を実施した．［結果］ MMSE 第2因子とBQ との間（ρ =.46，p<.01），MMSE 第3 因子とBQ との間（ρ =.20，p<.05）にそれぞれ有意な相関関係が認められた．［結論］入院前の身体活動習慣が少ない入院高齢者では，認知機能障害の初期症状である海馬機能やワーキングメモリに関連するMMSE 下位項目因子の得点が低下していることが示唆された．　［Purpose］ The purpose of this study was to verify the relationship between physical activity habits and sub-items of the Mini Mental State Examination (MMSE) in hospitalized elders. ［Method］ Thirty-one hospitalized elders (8 males and 23 females, with a mean age of 78 years and S.D. 11 years) participated in this study. At the time of admission, their physical activity habits and cognitive function were measured using the Baecke physical activity questionnaire (BQ) and the MMSE, respectively. A statistical analysis was performed using the Spearman’s rank correlation coefficient to confirm the relationship between each data set．［Result］ The results of this analysis demonstrated a positive correlation between MMSE sub-item 2 and BQ (ρ= 0.46, p < 0.01) and MMSE sub-item 3 and BQ (ρ= 0.20, p < 0.05)．［ Conclusion］ This study suggested that the scores of the MMSE sub-items were related to hippocampal function, and that working memory was low in the non-active hospitalized elders

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

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

自閉症スペクトラム障害児の症状特性と日中活動，及び夜間睡眠の関係

研究報告Original Articles　［目的］自閉症スペクトラム障害（Autism Spectrum Disorders：ASD）は，社会参加に関する発達障害であるコミュニケーションの障害，パターン化した興味や活動，感覚の偏りという特徴を持っている．本研究の目的は学童期におけるASD 児の症状特性と日中活動，夜間睡眠の関係性を分析し，生活指導時の考慮すべき要因を検討することとした．［方法］ASD と診断された通院中の学童期男児14 例を対象とし，広汎性発達障害の重症度の評価として広汎性発達障害日本自閉症協会評定尺度，感覚過敏性の評価として日本感覚インベントリー，日中活動量，夜間睡眠の評価として3 軸加速度計を用いた身体活動量計測を行った．［結果］対象児に夜間睡眠の質低下が認められ，感覚過敏性と夜間睡眠時の中途覚醒の間に正の相関関係が認められた．また，夜間覚醒時間と日中活動時間の間に負の相関関係が認められた．［結論］ASD 児における感覚過敏性の特性や日中活動時間の短縮が，睡眠の質の低下に影響していることが示唆された．そのため，ASD 児の睡眠の質向上に向けた生活指導時には，各個人の感覚刺激の特性を考慮する必要性が示唆された．　［Background］Autism spectrum disorders (ASD) is characterized by failure of communication is a developmental disorder related to social participation, interests and activities patterned, bias of the senses.　［Purpose］The purpose of this study during the day and symptoms characteristic, the night sleep to analyze the relationship of ASD children in school age activities, it was decided to examine the factors to be taken into account at the time of lifestyle guidance.　［Method］ School-age boys 14 cases (The average 9 year-old and 9 months, IQ 90.3 ± 10.9 points) participated in this study. Intended for school-age boys 14 cases in the diagnosis have been visits to the ASD assessment of pervasive developmental disorder Autism Society Japan rating scale (PARS), Japan sensation inventory (JSI-R), Actigraph.　［Result］The result is a decrease in the quality of sleep, it was recognized positive correlation to feeling irritable and nighttime of wake after sleep onset, negative correlation at night waking time and daytime activity time.　［Conclusion］In other words, the approach according to each individualʼs characteristics due to sensory evaluation of ASD children were contribute to the improvement of nighttime sleep. Therefore, as a factor to be considered at the time of lifestyle guidance, given the approach of the extension and the sensory stimulation of daytime activity time, as they improve the quality of sleep of ASD children become a cranial nerve development