著者
綿森 淑子
出版者
社団法人 日本リハビリテーション医学会
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.32, no.5, pp.290-293, 1995-05-18 (Released:2009-10-28)
参考文献数
13
被引用文献数
2 2
著者
大島 博 水野 康 川島 紫乃
出版者
社団法人 日本リハビリテーション医学会
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.43, no.3, pp.186-194, 2006 (Released:2006-05-01)
参考文献数
19
被引用文献数
2

Bone loss and muscle weakness are important medical concerns observed in astronauts after space flight. Even after a short-duration space flight, muscle atrophy and muscle weakness were observed in back, quadriceps and soleus-gastrocnemius muscles. The primary preventive measure against muscle weakness on the ISS has been exercise. The ISS houses a treadmill, a cycle ergometer, and a resistive exercise device. Individualized preflight exercise programs are planned for crew members based on fitness assessments, mission-specific tasks, and the maintenance of optimal health. A preflight exercise program is scheduled for a minimum of two hours a day, three days a week. Inflight exercise prescription will take into consideration available inflight exercise equipment and the specific needs of the individual crew member. Each inflight exercise program shall include components of cardiovascular, resistive and flexibility exercise. A program is scheduled for a minimum of 2.5 hours a day, six days a week. Postflight rehabilitation activities begin when a crew member returns from space flight. The goal of the rehabilitation program is to provide a planned program of recovery that will prevent additional injury, provide progressive improvement in fitness, and enable a full return to the preflight baseline level. A postflight rehabilitation program may include scheduled rest, assisted walking, swimming pool exercise and traditional exercise. Therapeutic massage, whirlpool, heat/ice and passive stretching also may be incorporated.
著者
辻 哲也 園田 茂 千野 直一
出版者
社団法人日本リハビリテーション医学会
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.33, no.5, pp.301-309, 1996-05-18
参考文献数
13
被引用文献数
26 51

機能的自立度評価法(FIM)を用いて, 脳血管障害患者190例の入院・退院時のADL評価を行った.項目別自立度により運動, 認知項目の難易度パターンを調べ, Rasch分析により運動, 認知項目の合計点別に各項目の点数分布を分析した.運動項目では, 難易度パターンは入院・退院時とも同様であり, 損傷病巣側, 年齢による差もなかった.認知項目では損傷病巣側により差がみられた.痴呆は難易度パターンに影響を与えていた.また, Rasch分析により, 運動項目は合計点別に50点未満の介助群から80点台後半の応用歩行自立群までの5つのグループに分けられた.一方, 認知項目では症例の一元性に問題があり, Rasch分析以外の解析手法を検討すべきであると思われた.
著者
小口 和代 才藤 栄一 水野 雅康 馬場 尊 奥井 美枝 鈴木 美保
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.37, no.6, pp.375-382, 2000-06-18 (Released:2009-10-28)
参考文献数
19
被引用文献数
67 68

機能的嚥下障害スクリーニング法として,「反復唾液嚥下テスト」(the Repetitive Saliva Swallowing Test: RSST)を考案した.30秒間の平均空嚥下回数は若年者(N=30)で7.4回,高齢者(N=30)で5.9回,30秒間の平均人工唾液嚥下回数は若年者で7.7回,高齢者で6.2回であった.空嚥下,人工唾液嚥下ともに高齢者は若年者より有意に嚥下回数が少なかった.一方,若年者,高齢者それぞれの空嚥下と人工唾液嚥下の嚥下回数には有意差を認めなかった.嚥下運動の確認は喉頭挙上の触診で可能であった.高齢者の積算嚥下時間(検査開始から嚥下完了時点までの時間)上限より,RSST 2回/30秒間以下が嚥下障害のスクリーニング値として設定できた.
著者
大高 洋平 里宇 明元 宇沢 充圭 千野 直一
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.40, no.6, pp.374-388, 2003-06-18 (Released:2009-10-28)
参考文献数
72
被引用文献数
9 8

Fall prevention is one of the major issues in health care in our aging society. The aim of this review is to provide useful information for researchers and practitioners who plan to start fall prevention programs for elderly persons with various risk levels and in different settings. Fifty-three randomized controlled trials (RCTs) and several meta-analyses retrieved with extensive literature search formed the basis for this review. Available evidence suggests that several preventive strategies have been proven beneficial in fall prevention. For the community-dwelling elderly, two RCTs and one meta-analysis demonstrated that an individually tailored home exercise program provided by nurses or physical therapists could reduce the rate of falls and injuries. One RCT suggested that Tai Chi Chuan might have a high potential to reduce falls. Two large RCTs indicated that programs including group exercise classes could also reduce the number of fallers. For people with known risk factors living in the community, three RCTs showed that home visits to address multiple risk factor modification were an effective way to reduce falls. One RCT with a relatively small sample showed that psychotropic withdrawal reduced falls in elderly persons taking psychotropic medication. A subgroup analysis of one RCT showed that home hazard reduction at hospital discharge reduced subsequent falls in patients with a past history of falls. However, more evidence is needed to prove its effectiveness, because this effect was also observed outside of homes. Dual chamber pacemaker for elderly persons with hypersensitive carotid sinus, who were detected when investigated for undiagnosed falls, markedly reduced subsequent falls with or without syncope. In institutional settings, two RCTs showed that comprehensive risk assessment and modification reduced the rate of falls and fractures or the number of recurrent fallers. Three RCTs performed in hospital settings failed to show any effectiveness. However, a meta-analysis of 3 controlled trials and 7 cohort studies with a historical control suggested that fall prevention program in hospitals could be promising. There are some methodological problems in fall prevention research such as the definition, measures, and monitoring method of falls, inadequate sample size and a short follow-up period. In the future, we need research based on strong and comprehensive methodological designs.
著者
三石 敬之 三石 京子 中西 亮二 山永 裕明
出版者
社団法人 日本リハビリテーション医学会
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.42, no.6, pp.412-417, 2005 (Released:2006-09-22)
参考文献数
11
被引用文献数
4 2

嚥下障害を呈したWallenberg症候群において, 食塊の輪状咽頭部優位通過側とその経時的変化を検討した. 対象は, Wallenberg症候群29例. 嚥下造影の正面像を観察し, 優位通過側を決定した. 9例に患側が優位通過側である時期がみられた. 5例は患側優位の通過が見られた後, 健側優位の通過へ移行した. 1例は両側不通過, 患側優位, 健側優位の順に変化した. 3例は患側優位の通過のみみられた. 20例は患側優位の時期が確認できなかった. Wallenberg症候群における食塊の輪状咽頭部優位通過側は患側の場合があり, また, 経時的に変化する症例が存在することが確認された. 直接的嚥下訓練における代償法として一側嚥下や頸部回旋を行う際には, 優位通過側の経時的確認が重要であると考えられた. Wallenberg症候群における嚥下障害の病態理解に際して, 患側輪状咽頭筋の弛緩状態を加味する必要があると考えられた.
著者
寺岡 史人 西 眞歩 吉澤 忠博 百瀬 瑞穂 平島 靖江 市川 孝子
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.41, no.6, pp.421-428, 2004-06-18 (Released:2009-10-28)
参考文献数
38
被引用文献数
8 1

嚥下造影検査(以下VF)を行った急性期脳卒中220例について,退院時に経口摂取が可能となったか,一部でも経管栄養を要したかを帰結としてロジスティック回帰分析による予後予測を行った.対象の年齢75±10歳,脳梗塞154例,脳出血66例,平均入院期間106±62日であった.173例(79%)が経口摂取可能となり,47例(21%)では胃瘻等が必要であった.VF上の誤嚥,重度の片麻痺,画像上の両側病変が有意な予測因子として抽出された.得られた予測式で,2項目以上が良好な値であれば,経口摂取可能となる確率は90%以上と予測された.しかし,3変数とも不利な値でも,49%の患者が経口摂取可能となっていた.
著者
小口 和代 才藤 栄一 馬場 尊 楠戸 正子 田中 ともみ 小野木 啓子
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.37, no.6, pp.383-388, 2000-06-18 (Released:2009-10-28)
参考文献数
10
被引用文献数
55 80

131名の機能的嚥下障害患者の「反復唾液嚥下テスト」(the Repetitive Saliva Swallowing Test: RSST)と嚥下ビデオレントゲン造影(videofluorography:VF)所見を比較し,RSSTの妥当性を検討した.RSSTはVF所見と相関が高く,カットオフ値として3回/30秒間が妥当であると思われた.誤嚥の有無の判別に関する感度と特異度は,0.98,0.66と,感度が非常に高かった.摂食・嚥下障害の診断・評価としては,まずRSSTでスクリーニングを行い,3回/30秒間未満の場合はさらに詳細な病歴,身体所見をとり,必要と判断されればVFを行い,治療方針を決定するのが適当である.
著者
宮野 佐年
出版者
社団法人 日本リハビリテーション医学会
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.32, no.5, pp.301-306, 1995-05-18 (Released:2009-10-28)
参考文献数
14
被引用文献数
1 1
著者
大高 洋平 里宇 明元 宇沢 充圭 千野 直一
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.40, no.6, pp.389-397, 2003-06-18 (Released:2009-10-28)
参考文献数
41
被引用文献数
2 3

The second part of the review discusses some important issues associated with fall prevention and future perspectives on fall related research. Currently, many kinds of interventions are available for the treatment of patients suffering from osteoporosis, i. e. nutritional supports, medications acting on bone metabolism and exercise. However, a series of meta-analyses showed that only alendronate and risedronate have been proven to prevent non-vertebral fractures in persons with osteoporosis. Anaerobic and weight bearing exercises are known to have a positive effect on the bone mineral density of the spine. There is, however, no reliable data for fracture prevention with exercise alone. Also, the synergistic effect of a combination of these interventions has not been clearly proven. Although there is evidence that the use of hip protectors in institutional settings reduces the rate of hip fractures, this approach faces the problem of patient acceptance and compliance. Psychosocial problems related to falls such as fear of falling, post-fall syndrome and cost-effectiveness of the prevention programs are becoming increasingly important in elderly health care, but little evidence of such has been reported in the literature. In future perspectives on fall relared research, a theory-based approach for fall prevention needs to be included to explore more effective interventions. We must also consider the double-edged effects of interventions that may increase certain fall risk factors while reducing another. Especially, the relation between activities and incidence of falls is important to consider, because increased activity itself may increase the chance of falls. When applying exercise or rehabilitative approaches, the interaction between falls, activity levels, frailty, and injury must be studied much more carefully. In addition, one has to always think about what is the true aim of a program, because the aim of fall prevention goes beyond preventing falls. Although some research has so far been conducted in Europe and the U. S. A. by researchers and practitioners in various fields, the quantity and quality of fall prevention research are still lacking and the available data is therefore insufficient to suggest appropriate decision-making in clinical practice. Especially in Japan, there have been only a few RCTs to determine the effectiveness of fall prevention programs. Because there are many differences in the characteristics of our native population and health care systems vs those of Europe and the U. S. A., it is a critical issue for us to establish fall prevention programs suited to Japanese population and health care system.
著者
村岡 慶裕 正門 由久 富田 豊 藤原 俊之
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.37, no.7, pp.453-458, 2000-07-18 (Released:2009-10-28)
参考文献数
11
被引用文献数
6 4

治療的電気刺激(TES)の作用機序を解明する目的で,脳卒中患者15名の前脛骨筋にTESを行い,その前後で,ヒラメ筋H波と前脛骨筋H波を指標とし,前脛骨筋とヒラメ筋間の2シナプス性Ia相反抑制を観測した.前脛骨筋Ia線維からヒラメ筋へのIa相反抑制は15名中6名が有意に増加し,一方,ヒラメ筋Iaから前脛骨筋へのIa相反抑制は,前脛骨筋にH波の誘発可能であった3名全ての患者が有意に減少した.TESは,電気刺激した筋肉の抑制介在ニューロンからその拮抗筋の運動ニューロンと抑制介在ニューロンへのシナプスの伝達効率を増強させ,それが,主動筋の随意性の向上,拮抗筋の痙縮の抑制に関与している可能性が示唆された.
著者
原 行弘
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.37, no.1, pp.43-52, 2000-01-18 (Released:2009-10-28)
参考文献数
48
被引用文献数
1

Several authors have reported that disuse might not be a major factor of muscle wasting in hemiplegic patients with stroke. A number of published investigations have shown that pathological spontaneous activity can occur in electromyographic studies in upper motor neuron lesions. There have been some reports that the decrease of hemiplegic side M-potential reflects the drop of motor unit numbers. Most of them have estimated that pathological spontaneous activity in hemiplegic muscles might due to transsynaptic degeneration. The submaximal stimuli can evoke a sample of motor unit action potentials of S-MUAPs in the F-response entirely representative of the relative numbers of surface detected S-MUAPs of different sizes. The motor unit number estimation (MUNE) was investigated among the bilateral abductor pollicis brevis (APB) muscles in seven healthy normal controls and fifteen stroke patients with moderate-to-severe hemiplegia. The needle EMG was examined in hemiplegic side APB. The average S-MUAP on each APB muscle was calculated from a selected population of F-wave responses. The MUNE was calculated by dividing the negative peak amplitude measured from the average S-MUAP waveform into corresponding values measured from a maximum M-potential. There was no statistically difference between the both sides motor units number among normal subjects and this MUNE method also revealed the good reproducibility in them. The needle EMG revealed the spontaneous activity in hemiplegic APB muscles at 3-4 months after the onset. The motor unit number on the hemiplegic side was significantly lower than on the unaffected side (p<0.05, Mann-Whitney test) among stroke patients. About one year later, most stroke patients revealed no spontaneous activity by needle EMG but the motor unit decrement in hemiplegic side was also recognized by the MUNE method among them. The motor unit could decrease in the moderate-to-severe hemiplegic muscle due to the trans-synaptic degeneration secondary to the upper motor neuron lesion. Some investigations, however, reported that there was no significant difference in morphometrical anterior horn cell number between the affected and unaffected sides in strokes. The transsectional areas of anterior horn cells associated with the hemispheric lesional side were reported to be significantly decreased compared with those of the unaffected sides in patients and normal subjects. The motor units may remain morphometrically unchanged in their number but the functional motor units number in the hemiplegic side might decrease because the loss of trophic effect from the upper motor neurons could alter the functional state of anterior horn cell in the affected side. The investigation and therapy for the muscle wasting should be proceeded more for the rehabilitation in upper motor neuron lesions.
著者
佐直 信彦 中村 隆一 細川 徹
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.28, no.7, pp.541-548, 1991-07-18 (Released:2009-10-28)
参考文献数
16
被引用文献数
21 7

退院後1年以上経った歩行可能な在宅脳卒中患者54例を対象として,10m最大歩行速度(MWS)と75項目の日常生活活動遂行の関係を検討した.性別,年齢,麻痺側,罹病期間,家庭内地位,MWSを説明変数とし,各項目の遂行頻度を目的変数として,数量化I類を用いて分析した.MWSが第一義の決定因として選出された活動は27項目であった.身辺処理や新聞を読むなどの静的活動はMWSの速度とは無関係であった.20m/分以上で掃除,買物などの家事,趣味や旅行などの余暇活動,40m/分以上で政治,文化講演会参加,80m/分以上では老人などの世話を行っていた.MWSは在宅脳卒中患者の日常生活活動の予知に有用である.