著者

安部 厚志 若旅 正弘 石橋 清成 岡本 善敬 内田 武正 山本 哲

出版者

脳機能とリハビリテーション研究会

雑誌

Journal of Rehabilitation Neurosciences (ISSN:24342629)

巻号頁・発行日

vol.22, no.JPN, pp.222402, 2022 (Released:2022-12-30)

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This study reports a case of a paraplegic stroke patient who had difficulty walking with an ankle–foot orthosis, but was able to walk independently with a short knee–ankle–foot orthosis (semi-KAFO). A 34-year-old man presented with right hemiplegia due to left putaminal hemorrhage. At 143 days after the stroke onset, he could not obtain sufficient support for the paralyzed leg and required assistance during his walk with an ankle–foot orthosis because the knee joint of the paralyzed side was always flexed due to knee flexor hypertonia. Conversely, he was able to walk with a semi-KAFO under observation. He practiced putting on and taking off the semi-KAFO, standing, sitting, walking, and toileting with a semi-KAFO for three weeks. At 164 days after stroke onset, he was able to walk and toilet independently with a semi-KAFO. This study’s results indicate that a semi-KAFO is useful as a daily living orthosis for hemiplegic stroke patients who have difficulty walking with an ankle–foot orthosis due to increased knee joint flexor muscle tone.

著者

飯川 雄 石橋 清成 野﨑 貴裕 武次 幸治 高杉 潤

出版者

脳機能とリハビリテーション研究会

雑誌

Journal of Rehabilitation Neurosciences (ISSN:24342629)

巻号頁・発行日

vol.22, no.JPN, pp.222601, 2022 (Released:2022-12-30)

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The function of the insular cortex (IC) in humans is poorly understood because brain injuries with a focal lesion in this area are extremely rare. Here, we compare the clinical presentation of two patients with cerebral infarction with major lesions in the left anterior and right posterior IC, respectively, and discuss the functions of these areas. Patient 1 (man in his 70s; cerebral infarctions in the left anterior IC, left inferior frontal gyrus, and dorsolateral left frontal lobe) did not show any motor or sensory function deficit. He presented with transient aphasia and global attention dysfunction that persisted for 3 months after onset, but he was able to return to work and resume driving. Patient 2 (woman in her 60s; cerebral infarctions in the right posterior IC, right supramarginal gyrus, and right parieto-occipital subcortical) presented with transient motor paralysis of the left side of the face and left upper limb and hypoalgesia of the left upper and lower limb. She showed decreased stereognostic sense in the left hand and disturbances in taste, olfaction, and interoception. The different clinical presentations of these two patients suggest that the anterior and posterior areas of the IC have different functions: the anterior area is mainly involved in cognitive functions, whereas the posterior area is mainly involved in sensorimotor functions. Our patients did not have focal lesion of the IC, and more cases need to be evaluated to reveal the IC’s function in humans.

著者

安部 厚志 若旅 正弘 石橋 清成 岡本 善敬 内田 武正 山本 哲

出版者

脳機能とリハビリテーション研究会

雑誌

Journal of Rehabilitation Neurosciences (ISSN:24342629)

巻号頁・発行日

pp.222402, (Released:2022-12-28)

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This study reports a case of a paraplegic stroke patient who had difficulty walking with an ankle–foot orthosis, but was able to walk independently with a short knee–ankle–foot orthosis (semi-KAFO). A 34-year-old man presented with right hemiplegia due to left putaminal hemorrhage. At 143 days after the stroke onset, he could not obtain sufficient support for the paralyzed leg and required assistance during his walk with an ankle–foot orthosis because the knee joint of the paralyzed side was always flexed due to knee flexor hypertonia. Conversely, he was able to walk with a semi-KAFO under observation. He practiced putting on and taking off the semi-KAFO, standing, sitting, walking, and toileting with a semi-KAFO for three weeks. At 164 days after stroke onset, he was able to walk and toilet independently with a semi-KAFO. This study’s results indicate that a semi-KAFO is useful as a daily living orthosis for hemiplegic stroke patients who have difficulty walking with an ankle–foot orthosis due to increased knee joint flexor muscle tone.

著者

岡本 善敬 山本 哲 梅原 裕樹 石橋 清成 沼田 憲治

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.0882, 2015 (Released:2015-04-30)

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【目的】脳卒中後の後遺症の一つに運動麻痺があり,その多くが錐体路損傷による痙性麻痺を呈する。錐体路の損傷では四肢遠位部の手指や足部の分離した運動がより重度に障害されることが多いが,今回遠位部と比較し近位部の機能障害が重度であった症例を経験し,その病態メカニズムについてMRI画像を元に考察したため報告する。【症例提示】70歳代,女性。めまいを自覚し近医受診され左橋梗塞の診断を受け同日入院。保存的加療にて第25病日にリハビリテーション目的に転院となった。第31病日のMRI画像では,T2強調画像にて左橋背側部からやや腹側方向へ広がる高信号変化を認めた。身体機能面では,意識状態はJCS1桁であったが会話および従命可能。明らかな疼痛や感覚低下はなし。企図振戦,眼振など小脳失調症状は認められなかった。右上下肢で軽度腱反射亢進。Brunnstrom stageは右上肢V,右手指V,右下肢V。筋力はMedical Research Council scaleにて右上下肢は肩関節外転3,肘関節屈曲4-,手指伸展4,手指屈曲4,股関節屈曲3,右膝関節伸展4-,右足関節背屈4+と近位筋優位に筋力低下を認めた。左上下肢は4~5。Berg Balance Scaleは30/56点であり立位での検査項目で減点がみられた。起居動作は自立,立位保持はふらつきあり上肢の支持を要した。歩行では膝折れがみられ歩行器の使用が必要かつ介助を要した。箸の使用,ボタン閉めはともに可能であった。【経過と考察】退院時においても近位筋優位の筋力低下は残存し移動には歩行器の使用が必要であった。姿勢の保持に関与する近位筋の運動制御には橋背内側部を通る皮質網様帯路および網様帯脊髄路や外側前庭脊髄路など内側運動制御系が関与する。本症例の臨床所見は近位筋優位に筋力低下を認め立位姿勢維持に障害をきたしていた。画像所見では,巧緻性動作に関与する錐体路が通る腹側部より背側に病巣が認められることから内側運動制御系の損傷による影響が示唆された。