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陳旧性の脳卒中後遺症において機能回復は困難であるとされている．特に脳卒中患者の歩行は安定した単脚支持を実現するために重心線が単脚支持側の足部の支持基底面内に完全に入るゆっくりとした歩行であることが多い．一方で健常者は単脚支持期に重心線が足部の支持基底面の中に入らない歩行であるが，脳卒中患者がこうした歩行を再獲得するためには何らかの慣性力を歩行の中で無意識的に生み出す能力を再獲得する必要がある．ヒトが自然と行う動作は1つ1つの動作を意識して行うのではなく無意識的に行われることが多い．今回，発症後約1年が経過しT字杖と金属支柱付き装具を使用しゆっくりとした歩行（0.58m/sec）の50歳代の男性に対し,週3回，7ヶ月間動作を意識させずに繰り返し運動を行うことで装具をGait solution に変更でき，杖なし歩行も自立し歩行速度（0.63m/sec）・安定性も向上したことを報告する．慢性期の脳卒中片麻痺であっても介入によって改善できる可能性が示唆される．

Rehabilitation training for activities of daily living is important for hemiplegic patients caused by stroke. In this study, a home care type powered suit for upper limb rehabilitation was developed by modifying the previously developed powered suit, which consists of shoulder joint powered suit and elbow joint powered suit with forearm unit. The previous shoulder joint powered suit was improved so as to save the weight and to reduce the slippage, and an effectiveness of the improvement was verified through experiments. While, the forearm unit of the previous elbow joint powered suit was improved to make it easy to put on and take off the suit. By combining the improved shoulder joint powered suit and the improved elbow joint powered suit, usefulness of the developed powered suit for upper limb rehabilitation was examined by simple experiment. In addition, by unifying the control method using a micro computer "Arduino", the powered suit became portable and can be used at home. Finally, 4 kinds of task which is assumed to be used in actual rehabilitation were proposed, and it was confirmed that these tasks can be performed using the developed powered suit.

本研究は脳卒中片麻痺患者のトイレ介助となった時点での立位保持時間から,トイレ介助に必要な立位保持時間を明らかにすること，高次脳機能障害の関連について検討した．対象は23名（男性12名，女性11名，年齢73±10歳，注意障害23名，失語症12名）で注意障害，失語症及びトイレ動作FIM値が3となった時点の垂直棒把持での立位保持時間をカルテ抽出した．注意障害（軽度群，重度群），失語症（なし群，あり群）平均立位保持時間（高値群，低値群）に関連についてχ二乗独立性の検定，Fisherの直接法を使用し，注意障害，失語症の2群間における立位保持時間の差をMann-WhitneyのU検定 にて検討した．結果，立位保持時間は，32.7±2.8秒であった．立位時間高値群と失語症あり群は有意に立位高値群に多く，立位時間高値群と注意障害重度群は有意に立位高値群に多く認めた（p, In this study, we investigated the time required from the toilet support standing time of stroke patients and investigated the relationship with higher brain dysfunction. We examined the standing time of 23 subjects when they were assisted in the toilet, and statistically analyzed them, separating attention deficit, aphasia, and average standing time into two. As a result, the standing time was 32.7 ± 2.8 seconds. There were significant differences between the high time group, the aphasia group, and the severe attention disorder group (p

【目的】脳血管疾患により片麻痺となった後期高齢者の回復期における心理プロセスを明らかにすることである。【方法】脳血疾患で片麻痺となり，回復期リハビリテーション病棟に入院中の後期高齢者を対象に，半構成的面接を行った。入院から現在までの経過を振り返ってもらい，その時々で何を思い療養生活を送っているのかという心理的内容を抽出し，修正版グラウンデッド・セオリーアプローチを用いて分析した。【結果】研究対象者4名のインタビューデータを分析した結果，22概念，7カテゴリーから《壊れた自己像》《自己像を作り直す作業》《未来に向っていく自己像》の3コアカテゴリーが生成された。【結論】脳血管疾患で片麻痺となった後期高齢者は＜捨てられない過去の自分＞と《壊れた自己像》の間で葛藤し，医療者ならびに身内や親しい知人に支えられ《自己像の作り直し作業》をしながら＜希望を描く＞，そして《未来へ向かっていく自己像》を見出すという心理プロセスを歩んでいた。喪失を繰り返し縮小する生活の中で，障害や老いに対し静かに折り合いをつけるという，後期高齢者の特徴的な心理が確認された。

Journal of Rehabilitation and Health Sciences. 15, p.9-16

旅行経験が在宅脳卒中片麻痺者にもたらす心理的要因と行動の変化を明らかにすることを目的に男性3名,女性4名の片麻痺者を対象としたインタビューを実施した.半構造化面接によるインタビュー内容をKJ法に準じてデータ化し,最終的に10個の統合概念が抽出された.旅行前には「障害への負の感情と旅行環境への過重配慮」「介助者に対するジレンマ」「旅行の動機となる他者からの働きかけと環境への安心感」が,旅行中では「家族との絆を再び認識出来た喜び」「成功体験から育まれる自信と心のゆとり」「旅行で向き合う自分らしさ」「心揺さぶる体験から育まれる感受性と好奇心」が,旅行後は「死生観への気づき」「旅行で気づいた自分の現実課題と目標」「自分の旅行経験を他者に伝えたい承認欲求」が抽出された.片麻痺者において,旅行とは単純な内的構造による活動ではなく,複数の気づきや行動変容などを生じさせる複合的な活動であることが示された., The purpose is to clarify the psychological factors and behavioral changes that travel experiences bring to homed stroke hemiplegics. We conducted an interview for hemiplegic people with 3 men and 4 females. We interviewed by semi-structured interview. It was converted into data according to KJ method. Finally, 10 integrated concepts were extracted. Prior to the trip, concepts such as "negative emotions to the disability and excessive attention to the traveling environment", "dilemma for carers", "motivation from others to motivate travel and feeling of security to the environment" were extracted It was. While traveling, the concepts such as "joy of recognizing bonds with family", "self confidence brought up from experience of success" and "relaxation of mind" "self-facing to travel" "susceptibility and curiosity bred from a trembling experience" Has been extracted. After traveling, "awareness of life and death", "my real problems and targets I realized on my trip" and "desire to pass my travel experience to others" were extracted. In stroke hemiplegic persons, travel was not a simple internal structure activity, but it was regarded as a collective term for multiple activities that resulted in multiple awareness and behavioral changes., 首都大学東京, 2018-09-30, 修士（作業療法学）

本研究の目的は、転倒に至る障害たしかめ体験を行った片麻痺患者の思考プロセスを探 ることである。参加者は入院中の回復期片麻痺患者１３名であり、３ヶ月以内に転倒の経験 者である。方法は、半構成的面接を行い、修正版グラウンデッドセオリーアプローチで分 析した。その結果、４つのカテゴリーが抽出された。そのプロセスは【動機】【繰り返す】 【成功】カテゴリーの循環と、【停滞】カテゴリーに分かれた。まず【動機】カテゴリーで は、《発症前の移動状況を思い描くことからくる思い》から、ある動作でのたしかめ体験実 行につながり、結果として転倒に至った。転倒後、２つのカテゴリーに分かれた。【繰り返 す】カテゴリーでは、たしかめ体験が成功するまで挑戦する思考を繰り返した。一方【停 滞】カテゴリーでは、たしかめ体験を行おうとする思考が停滞した。【成功】カテゴリーで は、たしかめ体験の成功を《通過点としての思い》と受け止め、一動作の習得は、《片麻痺 者としての移動動作を再構築していく過程》となり、一つの成功に満足せず、別のたしか め体験実行のため、再び【動機】カテゴリーに戻る循環が見出された。 以上より、患者が思考プロセスのどこにいるかアセスメントし、成功体験を支援するこ との重要性が示唆された。 Objectives： The purpose of this study was to analyze the thought processes of patients with hemiplegia while reviewing the circumstances of events leading to their fall. Methods： The study involved 13 patients during recovery phase of hemiplegia who had fallen within the previous 3 months. Their responses were analyzed using M Modified Grounded Theory Approach（M-GTA）. Results： The four categories identified were 【motif】 【repetition】 【stagnation】 and 【success】. These four categories divided into a circular structure of 【motif】 【repetition】 【success】 and 【stagnation】. 【Motif】 included entertaining “the thought arising from imagining the motility （how one moved） before disease onset》 and this led to the experience of checking for the possibility and this result in fall. The processes after falling could be roughly divided into two categories 【repetition】 and 【stagnation】. 【Retition】 included to attempt until success, but the other 【stagnation】 included to stagnate idea of trying.If they successfully avoided falling, that success was accepted as 《thought at an interim step （a good idea about how to move）》, followed by 《a process of re-designing one s mode of moving to that of an individual with hemiplegia》 and later returning to the 【motif】 category for implementation of another experience that would not lead to injury. Discussion： The findings from this study suggest the importance of : assessing the current thinking process of the given patient, arranging for an environment within which the patient s desire to be active is acknowledged and respected, and supporting the patient to achieve success experiences.

看護学生の片麻痺疑似体験前後の片麻痺患者に対するイメージの変化を明らかにするため，学生が記載したレポートについて質的に内容分析を行い，比較した．対象は３年次看護学生のうち研究協力が得られた６５名であった．片麻痺擬似体験は，片麻痺患者を約２０分間体験した．片麻痺の設定は利き手側の上下肢とし，片麻痺患者役は日常生活動作を実施した． その結果，擬似体験後の片麻痺患者に対するイメージの記述数は増加し，イメージの内容がより具体的となった．体験後は「片麻痺患者は想像しにくい」の記述がなくなり，カテゴリーとして抽出されなかった．カテゴリーやサブカテゴリーは，体験前の否定的なイメージから，麻痺があっても可能なことはあるなど肯定的なイメージが増えた．また，学生は片麻痺患者の体験するストレスを実感することで，心理面に対する共感的イメージをもつことにつながった．さらに，擬似体験は，机上の学習では気づくことができない患者を想像する貴重な機会となっていた．, In order to show the changes in the image that nursing students have regarding hemiplegic patients before and after simulated experiences of hemiplegia, a content analysis of the reports made by the students was qualitatively conducted, and comparisons were performed. The subjects were６５students in Junior year, all participants signed an informed consent. During the implementation of the simulated hemiplegic experiences, the students experienced becoming hemiplegic patients for approximately ２０ minutes. Hemiplegia was set for the upper and lower limbs on the side of the dominant hand, and students who took the part of hemiplegic patients experienced various activities associated with daily living. As a result, the number of descriptions of their image of hemiplegic patients after the simulated experiences increased, and the descriptions of such images were also more specific. After the experience, as their response “it is not easy to imagine what it is like for hemiplegic patients” was no longer observed, and thus it was not included as a category. The details of the image of the categories and the subcategories showed a more positive image, such as things that they can do in spite of their paralysis, compared to negative details before the experience. In addition, the students felt the stress that hemiplegic patients have, which resulted in them having a more empathetic image regarding psychological aspects. Furthermore, the simulated experiences provided a good opportunity todevelop an image of the patients, which cannot be obtained from reading books or articles.

Purpose: To provide safe assistance in transfer for hemiplegic patients after stroke, We kinetically analyzed the transfer movements in hemiplegia. Method: The subjects were 6 hemiplegic patients (the hemiplegic group) and 6 healthy volunteers (the control group). The subjects were asked to transfer themselves from a bed to wheelchair using both a non-affected side approach and an affected side approach. The movements of each subject were measured with a three-dimensional motion analysis system. The following parameters were evaluated: (1) hip-joint angle (2) knee-joint angle. Results: (1) No significant difference was shown between the two groups for the non-affected side approach. (2) The differences between the two groups for the affected side approach were as follows: In the hemiplegic group, the minimal hip-flexion angle of the affected leg was significantly larger than in the control group. In contrast, the minimal knee-joint angle on the affected-side leg in the hemiplegic group was significantly smaller than in the control group. During standing up movement, the maximal knee-joint angle on the affected leg in the hemiplegic group was significantly smaller than in the control group. Conclusion: The features of transfer movement in hemiplegic patients were standing up with their affected leg placed forward, and maintaining their knee joints bent with a bending-forward style during body rotation.

application/pdf, 論文(Article), The purpose of this study is to clarify the difference between patients with cerebrovascular accident hemiplegia (CVA) and healthy volunteers in wiping movement after excretion. The authors analyzed the movement of defecation by observation and questionnaire. The results show that there were six types of wiping movement in healthy volunteers. There was a significant difference in wiping types between healthy volunteers and CVA. Most CVA wiped with paper after excretion, in the sitting position from the front, while there were a variety of types among healthy volunteers. Moreover, there was a gender difference in wiping movement; the male wiped from the back whereas the female had the tendency to wipe from the front. It was infered that this difference was the influence of external genitals. It was suggested that it is necessary to consider the type of wiping before the onset of CVA of each patient when an occupational therapist perform the training operation of defecation for the CVA.

関頭術後,片麻痺が増強した60歳女性患者の看護を経験した。患者は術後ADLが低下し,「セルフケア不足」と診断,看護介入を行ったが,リハビリテーションへの意欲がみられず,自己否定的感情を表出した。自己概念,感情,役割・関係を中心とした再データ収集とアセスメントを行い,「自己尊重の状況的低下」と診断を変更,介入を行ったところ,自己否定的感情の表出が減少し,リハビリテーションへの意欲が改善した。「自己尊重の状況的低下」に対する看護介入として,(1)機能的リハビリテーションを一時中止し,タッチング,マッサージを併用した傾聴,(2)家族のもつ力量をアセスメントした上での,患者が肯定的な自己評価を見いだすための,家族からの働きかけ,(3)患者と家族によるリハビリテーションの目標設定,が有効であった。

目的 : 脳卒中発症後の麻痺側上肢の機能回復過程にみられる障害像をMFS{上肢機能スコア, MFT(脳卒中上肢機能検査)の得点}が反映するかどうかを検討した。方法 : 脳卒中による片麻痺患者81名(右片麻痺39名, 左片麻痺42名)の回復過程に収集した250件のデータを分析に用いた。MFTの8つの下位得点の組み合わせ(パターン)が上肢の障害像を反映していると仮定して, 回復過程で収集した下位得点の構造を調べた。下位得点のパターンの類似度によってデータを分類し, 各群のMFSの分布を調べた。結果 : MFT下位テスト間で連関の低かった上肢の運動課題とペグボード課題(手指の巧緻性評価)の得点の小計をみると, 少数例ではあるが小計が同点でも障害像の異なるケースがあった。下位得点のパターンの類似度で分類した場合, 各群に属する50%のデータではMFSが群ごとによく分離していた。結論 : MFSは麻痺側上肢の障害像をある程度反映していた。, Object : The purpose of this study was to determine if an MFS (Manual Function Score) describes the actual state of the paretic upper extremities seen post-stroke. Methods : 250 MFT (Manual Function Test) results of 81 stroke survivors (39 Rt. hemiplegia, 42 Lt. hemiplegia) collected during the paretic recovery process were analyzed. Assuming that a combination pattern of 8 MFT subscores shows the state of the paretic upper extremities, the relationship among the subscores was investigated. The 250 data were classified into 6 groups by the pattern of their subscores. The distribution of the MFS of each group was checked. Results : There was a low association between the arm function and the finger dexterity measured by the peg board test. Occasionally, even when the subtotal of both subscores was same, figures of subscore components were different. The comparison between each group of MFS showed that difference in patterns of subscores is reflected in a difference in total MFS in 50% of the cases studied. Conclusion : The total MFS generally corresponded to the actual state of the paretic upper extremities seen post-stroke., 国立情報学研究所で電子化

目的 : 脳卒中発症後の麻痺側上肢の機能回復過程にみられる障害像をMFS{上肢機能スコア, MFT(脳卒中上肢機能検査)の得点}が反映するかどうかを検討した。方法 : 脳卒中による片麻痺患者81名(右片麻痺39名, 左片麻痺42名)の回復過程に収集した250件のデータを分析に用いた。MFTの8つの下位得点の組み合わせ(パターン)が上肢の障害像を反映していると仮定して, 回復過程で収集した下位得点の構造を調べた。下位得点のパターンの類似度によってデータを分類し, 各群のMFSの分布を調べた。結果 : MFT下位テスト間で連関の低かった上肢の運動課題とペグボード課題(手指の巧緻性評価)の得点の小計をみると, 少数例ではあるが小計が同点でも障害像の異なるケースがあった。下位得点のパターンの類似度で分類した場合, 各群に属する50%のデータではMFSが群ごとによく分離していた。結論 : MFSは麻痺側上肢の障害像をある程度反映していた。|Object : The purpose of this study was to determine if an MFS (Manual Function Score) describes the actual state of the paretic upper extremities seen post-stroke. Methods : 250 MFT (Manual Function Test) results of 81 stroke survivors (39 Rt. hemiplegia, 42 Lt. hemiplegia) collected during the paretic recovery process were analyzed. Assuming that a combination pattern of 8 MFT subscores shows the state of the paretic upper extremities, the relationship among the subscores was investigated. The 250 data were classified into 6 groups by the pattern of their subscores. The distribution of the MFS of each group was checked. Results : There was a low association between the arm function and the finger dexterity measured by the peg board test. Occasionally, even when the subtotal of both subscores was same, figures of subscore components were different. The comparison between each group of MFS showed that difference in patterns of subscores is reflected in a difference in total MFS in 50% of the cases studied. Conclusion : The total MFS generally corresponded to the actual state of the paretic upper extremities seen post-stroke., 国立情報学研究所で電子化

今回、心原性脳梗塞により右片麻痺を併発したダウン症児に対し、急性期からのリハビリテーションを行う機会を得た。早期から抗重力位での身体活動や装具の使用を積極的に行い、運動機能の回復に努めた結果、歩行を含めた基本動作が獲得された。We report a rehabilitation process of a patient with Down's syndrome complicated with right hemiplegia caused cardiogenic brain infarction. Physical therapy program, targetting for an antigravity activities to maintain sitting or standing position was performed from early stage. An ambulatory ability and activity of daily living of the patient was improved.

脳血管障害片麻痺患者の無酸素性代謝閾値(AT)を測定し,亜最大運動時のVO_2 peakおよび予測最大酸素摂取量との関係について検討し,以下の結果を得た.1)AT出現時の酸素摂取量と亜最大負荷時のVO_2 peakとの間にはr=0.92(p, The study aimed to asertain whether the VO_2 peak and Pred. VO_2 max might prove usuful or not evaluation aerobic working capacity of twenty-nine hemiplegic patients. The result were as follow: 1) A positive significant correlation was observed between the AT and the VO_2 peak, in both in the hemiplegics (r=0.96

Gait speed and trunk flexion and grasp power in eleven male chronic hemiplegia was reported for four years. The result appeared that gait speed in hemiplegia was half to three quarters the speed of normal subjects. Trunk flexion and grasp power in hemiplegia showed no difference from the normal. The normal declining due to ageing during the for four years was no difference in the hemiplegia patient these patients attended a welfare center independently one to three times a week. They spent time more one hour a day in center. They always exercised and frequently perticipated in group activities. We thought that thier activicy effected the maintenance of motor function. Many Peopole reported that gait ability is an important factor in all of human functions. In this study, these whose gait speed became slow appeared to decline in other functions.

我々の研究グループでは片麻痺患者に対してリズム聴覚刺激を用いた支援方法で改善効果を示してきた。一方で、神経経路の再構築という観点から、固有感覚刺激利用し歩行動作を直接変化させる方法が有効である可能性がある。我々は、安全性や四肢の協調関係を考慮して上肢にリズムを伝える方法を提案する。疑似片麻痺患者で実験を行い、肘を駆動させることで左右への動きが少なくなり、非対称性の緩和が見られた。, We have reported that gait rehabilitation using auditory stimulation was effective on hemiplegic gait. However, not only auditory stimulation but also proprioception is important for walking. We therefore consider a gait rehabilitation method using device changing gait movement by directly inputting rhythmic proprioception stimulation to the upper limbs. In this study, we measured the trunk trajectory and swing time of pseudo hemiplegic patients with moving elbows under two condition, arm rhythmic movement condition with arm fixed condition. We confirmed that the horizontal amplitude of trunk movement and left-right asymmetry of swing time were decreased in former condition. Consequently, we found that rhythmic upper limb movement during locomotion has a potential to improve the gait pattern.

Article, 信州医学雑誌 31(5): 389-401(1983)