著者

甲田 広明 堤 陽平 森 幸子 北口 遼 船越 大生 前川 和道

出版者

公益社団法人 日本理学療法士協会

雑誌

理学療法学Supplement Vol.42 Suppl. No.2 (第50回日本理学療法学術大会 抄録集)

巻号頁・発行日

pp.1535, 2015 (Released:2015-04-30)

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【はじめに,目的】理学療法を行うにあたってブリッジ運動を利用できる場面は様々である。ブリッジ運動は臥位で行えるため安全で,幅広い患者に用い易い。理学療法中ブリッジ運動を用いると,患者によって殿部の挙上度合いに差があり,歩行自立度の高い患者ほどブリッジ運動時に股関節を伸展出来ているように感じる。そこで今回,ブリッジ運動時の股関節伸展角度と歩行自立度の関係を調べ,歩行自立度低下の予測及び予防をする際の指標とすることを目的とした。【方法】当院外来通院中で,屋外歩行自立度が独歩自立または杖歩行自立の患者を対象とした。対象の年齢選定は,年齢によるバイアスを少なくする目的で,下限を前期高齢者以上とし上限を90歳未満とした。得られた対象者は独歩自立の者が21名(男性8名,女性13名,平均年齢76.4±5.4歳,以下,独歩群),杖歩行自立の者が11名(男性2名,女性9名,平均年齢79.2±7.8歳,以下,杖歩行群)であった。下肢に麻痺のある者,ブリッジ運動時に痛みの出る者,また屋外歩行が独歩であったり杖歩行であったりと歩行自立度が一定しない者は除外した。ブリッジ運動の開始肢位は,背臥位にて両側上肢をベッド上に置き,膝関節を膝蓋骨の鉛直下方に踵部の後端が位置するところまで屈曲した肢位とした。開始肢位からゆっくりと可能な範囲で殿部を挙上させ,挙上が止まった時点での股関節伸展角度をゴニオメーターで計測した。その際上肢の力を用いることは禁止しなかった。股関節伸展角度は,日本整形外科学会及び日本リハビリテーション医学会の定める測定方法を参考にし,体幹と大腿で計測を行った。統計は,独歩群と杖歩行群において得られた股関節伸展角度及び年齢について比較検討した。統計処理にはt検定を用い,有意水準を5%未満とした。また,独歩群と杖歩行群の歩行自立度に関するカットオフ値をROC曲線より決定し,クロス集計表より感度,特異度,陽性的中率,陰性的中率,正答率を算出した。【結果】ブリッジ運動時の股関節伸展角度の平均値は,独歩群1.4±11.1°,杖歩行群-21.8±11.5°で有意差を認めた(p<0.05)。両群間の年齢については有意差を認めなかった(p=0.25)。またブリッジ運動時の股関節伸展角度のROC曲線から,最も有効な統計学的カットオフ値は-15°であると判断できた。この点をカットオフ値としたクロス集計表より,感度86%,特異度82%,陽性的中率75%,陰性的中率90%,正答率84%の値が算出された。【考察】今回の研究から,独歩群は杖歩行群と比較してブリッジ運動時の股関節伸展角度が有意に高値を示し,カットオフ値は-15°であることが分かった。クロス集計表から得られた値は,陽性的中率を除いてすべて80%以上であり,歩行自立度に関する評価指標として有用であると考えられた。陽性的中率は75%であったが,陰性的中率は90%,正答率は84%であり,ブリッジ運動時の股関節伸展角度が-15°以上であれば歩行自立度が独歩となり易いことが示された。以上より,独歩自立の者のブリッジ運動時の股関節伸展角度が-15°のカットオフ値を下回るようであると,今後歩行自立度が低下すると予測された。また,独歩自立の者でブリッジ運動時の股関節伸展角度が-15°以上であれば,それを下回らないように理学療法を行うことで歩行自立度低下を予防できると考えられた。さらに現在の歩行自立度が杖歩行である者に対しては,-15°のカットオフ値を上回るように理学療法を行うことで,歩行自立度を向上させる可能性も示唆された。しかし今回の研究では,何故ブリッジ運動時の股関節伸展角度と歩行能力に関連があるのかについての詳細な検討は出来ておらず今後の研究課題としたい。また,どのような理学療法を行うとブリッジ運動時の股関節伸展角度が向上するかについても合わせて調査をしていきたい。【理学療法学研究としての意義】ブリッジ運動時の股関節伸展角度を計測することで,歩行自立度低下の予測及び予防をする際の指標になる可能性を示すことができ,理学療法学研究としての意義はあったと思われる。

著者

光森 幸子

出版者

広島大学英文学会

雑誌

英語英文學研究 (ISSN:02882876)

巻号頁・発行日

vol.58, pp.11-27, 2014

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Alice Walker focuses on the lives of sharecroppers suffering under Jim Crow laws in the post-Civil War South in her first published novel, The Third Life of Grange Copeland, by realistically delineating the life of Grange Copeland. Facing everyday hardships, Grange's main concern is to survive the crop-lien system, which was de facto slavery by another name, through its rigidly hierarchical structure. It is reasonably assumed that his violence against his wife and his son, Brownfield, is deeply rooted in white supremacy. Therefore, in previous studies, Grange's behavior has been mostly construed as the reactions of an archetypal black male against white male dominance. Even the incident of Central Park in New York has been considered from such dichotomous perspective. Grange shows a remarkable self-development when he happens to see the breakup between a pregnant white woman and a soldier in the park. Feeling deep sympathy for the white people for the first time in his life, regardless of the danger, as an equal human being he tries to cross racial boundaries in order to console the grieving woman. Consequently, her refusal of his approach and her hatred of blacks cause her to slip into a pond and die. Despite the fact that he had got a glimpse of the human bonding beyond race, after she releases his rescuing "black" hand, Grange lets her die in the frozen pond. However, it should not be overlooked that, whereas the white woman's death restores his manhood and rekindles his racial pride, his flash of inspiration "to save and preserve life is an instinct" continues to haunt him, and he accuses himself of this "murder" for the rest of his life. After Grange returns to Georgia, his emotional growth becomes reinforced by understanding the lonely battle of his son's wife, Mem. She is more marginalized than Brownfield, living in a cabin on a white man's plantation. Mem represents any anonymous sharecroppers' wife, who is a victim of racism and sexism in society as well as at home, an archetypal black female who has no chance to develop her inner self. However, through Ruth's eyes, Walker implies Mem's unyielding resistance against falling victim to the Sachiko Mitsumori 27 system. That Mem voluntarily gets shot by Brownfield should be given more consideration. She thought her violent act against her brutal husband as horrifying but necessary for survival, to protect her children from him and also to liberate him from "new slavery." By giving up her life in atonement for her "sin," she tried to put an end to the chain of violence. Grange understands her struggle for finding human bonds in the segregated social milieu and guides Ruth by regarding Mem as her role model. Thus, Walker places Ruth as a witness to Mem's silent resistance, and leaves her the future responsibility to embody collective voices of black people. Through his unconditional love of Ruth, Grange realizes that he was once trapped in the system by creating a white destructive "God" inside him, and that he made himself a slave by abandoning his responsibility for his family. The understanding Grange has obtained in his life can be interpreted as his own "emancipation proclamation." Whereas Grange thus achieves selfrealization by overcoming his own racism, Brownfield becomes an agent of white supremacy-"living dead" who regards a white judge as his God and uses his power to get Ruth back to him. On the surface, Grange's killing of Brownfield is "kin killing" in a racist society. When Grange shoots Brownfield to protect Ruth from him, at the same time, he is determined to give up his life, for he had already learned that his life was not only his own. It was passed on to him through generations and it must continue in the next generation. Hence, in condemning violence, Grange voluntarily takes responsibility for breaking off his human bonds in the same way that Mem did. As a result, Grange's achievement of his full humanity, which is "a state of oneness," is firmly passed on to Ruth.