免荷式歩行器を用いた歩行練習が回復期脳卒中片麻痺者の歩行速度に与える即時的変化

【目的】免荷式歩行器を用いた歩行練習が、脳卒中片麻痺者の歩行速度に与える即時的効果について検討した。【方法】回復期脳卒中片麻痺者25名を対象とした。通常の歩行練習条件（以下、通常歩行）、非免荷歩行練習条件（以下、非免荷歩行）、免荷歩行練習条件（以下、免荷歩行）を各1日ランダムに10分間ずつ実施した。歩行評価は各歩行練習前後で実施した。評価項目は快適歩行速度、歩幅、Stride長、歩行率、両脚・単脚支持期割合、歩行対称性とした。各評価項目を介入前後と条件間で比較した。【結果】快適歩行速度、非麻痺側歩幅、Stride長に交互作用を認め、免荷歩行後に有意に増加した。また麻痺側立脚後期における両脚支持...

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Published in支援工学理学療法学会誌 Vol. 2; no. 1; pp. 5 - 13
Main Authors 藤田, 峰子, 島津, 尚子, 吉川, 大志, 隆島, 研吾
Format Journal Article
LanguageJapanese
Published 日本支援工学理学療法学会 30.09.2022
Subjects
免荷式歩行器
歩行速度
脳卒中
Online AccessGet full text
ISSN2436-6951
DOI10.57302/jatpt.2.1_5

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Abstract 【目的】免荷式歩行器を用いた歩行練習が、脳卒中片麻痺者の歩行速度に与える即時的効果について検討した。【方法】回復期脳卒中片麻痺者25名を対象とした。通常の歩行練習条件（以下、通常歩行）、非免荷歩行練習条件（以下、非免荷歩行）、免荷歩行練習条件（以下、免荷歩行）を各1日ランダムに10分間ずつ実施した。歩行評価は各歩行練習前後で実施した。評価項目は快適歩行速度、歩幅、Stride長、歩行率、両脚・単脚支持期割合、歩行対称性とした。各評価項目を介入前後と条件間で比較した。【結果】快適歩行速度、非麻痺側歩幅、Stride長に交互作用を認め、免荷歩行後に有意に増加した。また麻痺側立脚後期における両脚支持期割合、両脚支持時間対称性にも交互作用を認め、通常歩行と非免荷歩行後に有意に増加した。【結論】脳卒中片麻痺者に対する免荷式歩行器を用いた介入が、対象者の歩行速度およびその関連指標を即時的に改善させることが示唆された。
AbstractList 【目的】免荷式歩行器を用いた歩行練習が、脳卒中片麻痺者の歩行速度に与える即時的効果について検討した。【方法】回復期脳卒中片麻痺者25名を対象とした。通常の歩行練習条件（以下、通常歩行）、非免荷歩行練習条件（以下、非免荷歩行）、免荷歩行練習条件（以下、免荷歩行）を各1日ランダムに10分間ずつ実施した。歩行評価は各歩行練習前後で実施した。評価項目は快適歩行速度、歩幅、Stride長、歩行率、両脚・単脚支持期割合、歩行対称性とした。各評価項目を介入前後と条件間で比較した。【結果】快適歩行速度、非麻痺側歩幅、Stride長に交互作用を認め、免荷歩行後に有意に増加した。また麻痺側立脚後期における両脚支持期割合、両脚支持時間対称性にも交互作用を認め、通常歩行と非免荷歩行後に有意に増加した。【結論】脳卒中片麻痺者に対する免荷式歩行器を用いた介入が、対象者の歩行速度およびその関連指標を即時的に改善させることが示唆された。
Author 隆島, 研吾
吉川, 大志
島津, 尚子
藤田, 峰子
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  fullname: 島津, 尚子
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  fullname: 吉川, 大志
  organization: 神奈川県立保健福祉大学大学院　保健福祉学研究科
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  fullname: 隆島, 研吾
  organization: （元）神奈川県立保健福祉大学大学院　保健福祉学研究科
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References 32) Sousa CO, Barela JA, Prado-Medeiros CL, et al.: The use of body weight support on ground level: an alternative strategy for gait training of individuals with stroke. J Neuroengineering Rehabil, 6: 43, 2009.
29) Tilson JK, Sullivan KJ, Cen SY, et al.: Meaningful gait speed improvement during the first 60 days poststroke: Minimal clinically important difference. Phys Ther, 90: 196-208, 2010.
12) Barela AMF, Gama GL, et al.: Gait alterations during walking with partial body weight supported on a treadmill and over the ground. Sci Rep, 9: 8139, 2019.
23) Aaslund MK, Helbostad JL, Moe-Nilssen R: Familiarisation to body weight supported treadmill training for patients post-stroke. Gait Posture, 34: 467-472, 2011.
22) Hurt CP, Burgess JK, Brown DA: Limb contribution to increased self-selected walking speeds during body weight support in individuals poststroke. Gait Posture, 41: 857-859, 2015.
26) Mehrholz J, Wagner K, Rutte K, et al.: Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil, 88: 1314-1319, 2007.
14) Gama GL, Celestino ML, Barela JA, et al.: Effects of Gait Training With Body Weight Support on a Treadmill Versus Overground in Individuals With Stroke. Arch Phys Med Rehabil, 98: 738-745, 2017.
30) Perera S, Mody SH, Woodman RC, et al.: Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc, 54: 743-749, 2006.
2) Schmid A, Duncan PW, Studenski S, et al.: Improvements in speed-based gait classifications are meaningful. Stroke, 38: 2096-2100, 2007.
3) Perry J, Garrett M, Gronley JK, et al.: Classification of walking handicap in the stroke population. Stroke, 26: 982-989, 1995.
19) Senthilvelkumar T, Magimairaj H, Fletcher J, et al.: Comparison of body weight-supported treadmill training versus body weight-supported overground training in people with incomplete tetraplegia: a pilot randomized trial. Clin Rehabil, 29: 42-49, 2015.
20) 武井圭一, 金子誠喜, 國澤洋介, 他: 回復過程の脳卒中片麻痺者への部分免荷トレッドミル歩行練習の特徴—異なる歩行練習間の歩行速度変化, 歩行距離, 歩容の比較—. 理学療法学, 37: 139-145, 2010.
28) Faul F, Erdfelder E, Lang AG, et al.: G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods, 39: 175-191, 2007.
9) Dickstein R: Rehabilitation of gait speed after stroke: a critical review of intervention approaches. Neurorehabil Neural Repair, 22: 649-660, 2008.
10) Mehrholz J, Thomas S, Elsner B: Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev, 8: CD002840, 2017.
6) Bowden MG, Balasubramanian CK, Neptune RR, et al.: Anterior-posterior ground reaction forces as a measure of paretic leg contribution in hemiparetic walking. Stroke, 37: 872-876, 2006.
8) Goldie PA, Matyas TA, Evans OM: Gait after stroke: initial deficit and changes in temporal patterns for each gait phase. Arch Phys Med Rehabil, 82: 1057-1065, 2001.
24) Nakazono T, Takahashi K, Suzuki Y, et al.: Reliability and validity of Japanese version of Fugl-Meyer assessment for the lower extremities. Top Stroke Rehabil, 29: 125-132, 2022.
35) Chen G, Patten C: Joint moment work during the stance-to-swing transition in hemiparetic subjects. J Biomech, 41: 877-883, 2008.
13) Sousa CO, Barela JA, Russo-Junior DV, et al.: Gait training with partial body weight support during overground walking for individuals with chronic stroke: a pilot study. J Neuroengineering Rehabil, 8: 48, 2011.
15) Koshisaki H, Nagai S: Effect of the use of a body weight-supported walker on gait parameters in hemiplegic stroke patients. J Phys Ther Sci, 33: 434-438, 2021.
27) Patterson KK, Gage WH, Brooks D, et al.: Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture, 31: 241-246, 2010.
36) Danielsson A, Sunnerhagen KS: Oxygen consumption during treadmill walking with and without body weight support in patients with hemiparesis after stroke and in healthy subjects. Arch Phys Med Rehabil, 81: 953-957, 2000.
25) Holden MK, Gill KM, Magliozzi MR, et al.: Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther, 64: 35-40, 1984.
5) Olney SJ, Griffin MP, McBride ID: Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. Phys Ther, 74: 872-885, 1994.
7) Balasubramanian CK, Bowden MG, Neptune RR, et al.: Relationship between step length asymmetry and walking performance in subjects with chronic hemiparesis. Arch Phys Med Rehabil, 88: 43-49, 2007.
33) Altenburger PA, Dierks TA, Miller KK, et al.: Examination of sustained gait speed during extended walking in individuals with chronic stroke. Arch Phys Med Rehabil, 94: 2471-2477, 2013.
1) Jørgensen HS, Nakayama H, Raaschou HO, et al.: Stroke. Neurologic and functional recovery the Copenhagen Stroke Study. Phys Med Rehabil Clin N Am, 10: 887-906, 1999.
21) 佐藤瑞騎, 倉田昌一, 岩倉正浩, 他: 回復期脳卒中片麻痺患者に対する部分免荷型トレッドミル歩行練習の即時効果—非免荷型トレッドミル歩行練習との比較—. 理学療法学, 45: 197-202, 2018.
34) Sibley KM, Tang A, Patterson KK, et al.: Changes in spatiotemporal gait variables over time during a test of functional capacity after stroke. J Neuroengineering Rehabil, 6: 27, 2009.
17) Kim SB, Lee KW, Lee JH, et al.: Effect of Caregiver Driven Robot-Assisted In-Ward Training in Subacute Stroke Patients: A Case Series. Ann Rehabil Med, 42: 195-203, 2018.
4) Brandstater ME, de Bruin H, Gowland C, et al.: Hemiplegic gait: analysis of temporal variables. Arch Phys Med Rehabil, 64: 583-587, 1983.
11) Bayat R, Barbeau H, Lamontagne A: Speed and temporal-distance adaptations during treadmill and overground walking following stroke. Neurorehabil Neural Repair, 19: 115-124, 2005.
31) 山本澄子: 脳血管障害の歩行分析. 理学療法科学, 17: 3-10, 2002.
16) Miller EW, Quinn ME, Seddon PG: Body weight support treadmill and overground ambulation training for two patients with chronic disability secondary to stroke. Phys Ther, 82: 53-61, 2002.
18) 渡邊慎吾, 大瀧亮二, 小野修, 他: 亜急性期脳卒中者に対するBody Weight Supported Overground Trainingの効果—ABAシングルケースデザインによる検討—. 理学療法学, 49: 43-48, 2022.
References_xml – reference: 3) Perry J, Garrett M, Gronley JK, et al.: Classification of walking handicap in the stroke population. Stroke, 26: 982-989, 1995.
– reference: 1) Jørgensen HS, Nakayama H, Raaschou HO, et al.: Stroke. Neurologic and functional recovery the Copenhagen Stroke Study. Phys Med Rehabil Clin N Am, 10: 887-906, 1999.
– reference: 35) Chen G, Patten C: Joint moment work during the stance-to-swing transition in hemiparetic subjects. J Biomech, 41: 877-883, 2008.
– reference: 5) Olney SJ, Griffin MP, McBride ID: Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. Phys Ther, 74: 872-885, 1994.
– reference: 16) Miller EW, Quinn ME, Seddon PG: Body weight support treadmill and overground ambulation training for two patients with chronic disability secondary to stroke. Phys Ther, 82: 53-61, 2002.
– reference: 12) Barela AMF, Gama GL, et al.: Gait alterations during walking with partial body weight supported on a treadmill and over the ground. Sci Rep, 9: 8139, 2019.
– reference: 28) Faul F, Erdfelder E, Lang AG, et al.: G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods, 39: 175-191, 2007.
– reference: 30) Perera S, Mody SH, Woodman RC, et al.: Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc, 54: 743-749, 2006.
– reference: 7) Balasubramanian CK, Bowden MG, Neptune RR, et al.: Relationship between step length asymmetry and walking performance in subjects with chronic hemiparesis. Arch Phys Med Rehabil, 88: 43-49, 2007.
– reference: 10) Mehrholz J, Thomas S, Elsner B: Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev, 8: CD002840, 2017.
– reference: 4) Brandstater ME, de Bruin H, Gowland C, et al.: Hemiplegic gait: analysis of temporal variables. Arch Phys Med Rehabil, 64: 583-587, 1983.
– reference: 8) Goldie PA, Matyas TA, Evans OM: Gait after stroke: initial deficit and changes in temporal patterns for each gait phase. Arch Phys Med Rehabil, 82: 1057-1065, 2001.
– reference: 34) Sibley KM, Tang A, Patterson KK, et al.: Changes in spatiotemporal gait variables over time during a test of functional capacity after stroke. J Neuroengineering Rehabil, 6: 27, 2009.
– reference: 27) Patterson KK, Gage WH, Brooks D, et al.: Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture, 31: 241-246, 2010.
– reference: 31) 山本澄子: 脳血管障害の歩行分析. 理学療法科学, 17: 3-10, 2002.
– reference: 13) Sousa CO, Barela JA, Russo-Junior DV, et al.: Gait training with partial body weight support during overground walking for individuals with chronic stroke: a pilot study. J Neuroengineering Rehabil, 8: 48, 2011.
– reference: 19) Senthilvelkumar T, Magimairaj H, Fletcher J, et al.: Comparison of body weight-supported treadmill training versus body weight-supported overground training in people with incomplete tetraplegia: a pilot randomized trial. Clin Rehabil, 29: 42-49, 2015.
– reference: 14) Gama GL, Celestino ML, Barela JA, et al.: Effects of Gait Training With Body Weight Support on a Treadmill Versus Overground in Individuals With Stroke. Arch Phys Med Rehabil, 98: 738-745, 2017.
– reference: 17) Kim SB, Lee KW, Lee JH, et al.: Effect of Caregiver Driven Robot-Assisted In-Ward Training in Subacute Stroke Patients: A Case Series. Ann Rehabil Med, 42: 195-203, 2018.
– reference: 36) Danielsson A, Sunnerhagen KS: Oxygen consumption during treadmill walking with and without body weight support in patients with hemiparesis after stroke and in healthy subjects. Arch Phys Med Rehabil, 81: 953-957, 2000.
– reference: 15) Koshisaki H, Nagai S: Effect of the use of a body weight-supported walker on gait parameters in hemiplegic stroke patients. J Phys Ther Sci, 33: 434-438, 2021.
– reference: 18) 渡邊慎吾, 大瀧亮二, 小野修, 他: 亜急性期脳卒中者に対するBody Weight Supported Overground Trainingの効果—ABAシングルケースデザインによる検討—. 理学療法学, 49: 43-48, 2022.
– reference: 32) Sousa CO, Barela JA, Prado-Medeiros CL, et al.: The use of body weight support on ground level: an alternative strategy for gait training of individuals with stroke. J Neuroengineering Rehabil, 6: 43, 2009.
– reference: 2) Schmid A, Duncan PW, Studenski S, et al.: Improvements in speed-based gait classifications are meaningful. Stroke, 38: 2096-2100, 2007.
– reference: 25) Holden MK, Gill KM, Magliozzi MR, et al.: Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther, 64: 35-40, 1984.
– reference: 23) Aaslund MK, Helbostad JL, Moe-Nilssen R: Familiarisation to body weight supported treadmill training for patients post-stroke. Gait Posture, 34: 467-472, 2011.
– reference: 9) Dickstein R: Rehabilitation of gait speed after stroke: a critical review of intervention approaches. Neurorehabil Neural Repair, 22: 649-660, 2008.
– reference: 33) Altenburger PA, Dierks TA, Miller KK, et al.: Examination of sustained gait speed during extended walking in individuals with chronic stroke. Arch Phys Med Rehabil, 94: 2471-2477, 2013.
– reference: 6) Bowden MG, Balasubramanian CK, Neptune RR, et al.: Anterior-posterior ground reaction forces as a measure of paretic leg contribution in hemiparetic walking. Stroke, 37: 872-876, 2006.
– reference: 29) Tilson JK, Sullivan KJ, Cen SY, et al.: Meaningful gait speed improvement during the first 60 days poststroke: Minimal clinically important difference. Phys Ther, 90: 196-208, 2010.
– reference: 20) 武井圭一, 金子誠喜, 國澤洋介, 他: 回復過程の脳卒中片麻痺者への部分免荷トレッドミル歩行練習の特徴—異なる歩行練習間の歩行速度変化, 歩行距離, 歩容の比較—. 理学療法学, 37: 139-145, 2010.
– reference: 21) 佐藤瑞騎, 倉田昌一, 岩倉正浩, 他: 回復期脳卒中片麻痺患者に対する部分免荷型トレッドミル歩行練習の即時効果—非免荷型トレッドミル歩行練習との比較—. 理学療法学, 45: 197-202, 2018.
– reference: 11) Bayat R, Barbeau H, Lamontagne A: Speed and temporal-distance adaptations during treadmill and overground walking following stroke. Neurorehabil Neural Repair, 19: 115-124, 2005.
– reference: 22) Hurt CP, Burgess JK, Brown DA: Limb contribution to increased self-selected walking speeds during body weight support in individuals poststroke. Gait Posture, 41: 857-859, 2015.
– reference: 26) Mehrholz J, Wagner K, Rutte K, et al.: Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil, 88: 1314-1319, 2007.
– reference: 24) Nakazono T, Takahashi K, Suzuki Y, et al.: Reliability and validity of Japanese version of Fugl-Meyer assessment for the lower extremities. Top Stroke Rehabil, 29: 125-132, 2022.
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SubjectTerms 免荷式歩行器
歩行速度
脳卒中
Title 免荷式歩行器を用いた歩行練習が回復期脳卒中片麻痺者の歩行速度に与える即時的変化
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ispartofPNX 支援工学理学療法学会誌, 2022/09/30, Vol.2(1), pp.5-13
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