著者

保坂 幸毅 松橋 絵里 伊藤 清香 久米 愛 金城 正治

出版者

秋田大学大学院医学系研究科保健学専攻

雑誌

秋田大学大学院医学系研究科保健学専攻紀要 (ISSN:18840167)

巻号頁・発行日

vol.18, no.2, pp.110-119, 2010

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脳卒中片麻痺患者の片手片足での車いす駆動は、体幹前傾での駆動が望ましいとされている。しかし、体幹の傾きが片足駆動における駆動特性にどのような影響を与えるかは明らかにされていない。そこで、体幹の傾きを変化させた時の片足駆動を運動学的・運動力学的に解析し、駆動特性を明らかにするために、体幹の傾きを前傾位・中間位・後傾位に設定し、車いすの片足駆動を行った。その時の初回駆動のビデオ撮影、下肢・体幹の表面筋電図と足圧の計測と10mの直進・スラロームの駆動時間の測定、駆動後のVisual Analog Scale(以下、VAS)に主観的評価も加え、体幹の傾きによる片足駆動の違いを比較検討した。 対象者は、高次脳機能障害や認知症が動作遂行能力を妨げておらず、FIMの歩行・車いすの項目で自立となっている脳卒中片麻痺者8名とした。 初回駆動時間は中間位に比べ、前傾位で有意に短かった。%EMGでは腹直筋は前傾位、脊柱起立筋は後傾位で有意に大きかった。また、下肢の筋は後傾位で大きい傾向にあった。単位時間・体重あたりの足圧は後傾位で有意に値が小さかった。10mの直進駆動では後傾位に比較し、中間位で有意に速かった。スラローム駆動では後傾位に比較し、前傾位・中間位で有意に速かった。VASでは後傾位で駆動しにくい傾向にあり、前傾位では怖さを感じていた。 この結果から前傾位・中間位で効率がよく、対象者の心理面を考慮すると中間位での駆動が最も安定することが示唆された。This study kinematically and kinetically analyzed propulsion with one foot while changing the inclination of the trunk. The study had subjects propel a wheelchair with one foot while adopting either a forward-leaning posture, an upright posture, or a backward- leaning posture in order to reveal propulsion characteristics. During this activity, initial propulsion was captured on video, surface electromyography of the leg and trunk was performed, foot pressure was measured, propulsion time on a 10-m long straight course and slalom was measured, and propulsion was subjectively assessed afterwards using the Visual Analogue Scale(VAS). These indices were used to compare and study differences as a result of trunk inclination. The subjects were eight individuals with hemiplegia due to stroke.Initial propulsion took significantly less time with a forward-leaning posture than with an upright posture. The %EMG activity of the rectus abdominis was significantly greater with a forward-leaning posture while that of the erector spinae muscles was significantly greater with a backward-leaning posture. In addition, the %EMG activity of the leg muscles tended to be greater with a backward-leaning posture. Foot pressure per unit time and body weight was significantly lower a backward-leaning posture. Propulsion on the straight course was significantly faster with an upright posture than with a backward-leaning posture. Propulsion on the slalom course was significantly faster with a forward-leaning posture or an upright posture than with a backward-leaning posture. VAS scores indicated that propulsion was more difficult with a backward-leaning posture, and subjects mentioned fear of falling when in a forward-leaning posture.The current results suggest that propulsion is more efficient in a forward-leaning posture or an upright posture and that propulsion is most consistent when the subject is in an upright posture given the subject's mental state.