Search

麻痺側の前脛骨筋と中殿筋への機能的電気刺激が脳卒中片麻痺者の歩行に与える即時的な運動学的変化を検討することを目的とした。対象は､左片麻痺を呈し脳梗塞発症後101日が経過した70歳代女性、歩行はT 字杖を使用し､自立していた。麻痺側の前脛骨筋のみに対する電気刺激､前脛骨筋に加え中殿筋にも電気刺激を行う２つの刺激条件下で歩行練習を行い､その前後の歩行を比較した。歩行速度､歩行率､ストライド長は２条件ともに改善したが条件間に明らかな差を認めなかった。一方､前脛骨筋のみの刺激に比べ中殿筋への刺激を追加した条件では、麻痺側初期接地時の上部体幹の矢状面における傾斜が正中位に近くなり、股関節の矢状面における運動範囲が増加した。脳卒中の歩行練習では、前脛骨筋に加え中殿筋に電気刺激を行うことで、麻痺側立脚相の体幹と股関節の運動の改善に寄与する可能性が示唆された。PURPOSE: Stroke can cause impairments in gait kinematics, such as drop foot and lateral trunk fluctuation. Although functional electrical stimulation (FES) to the gluteus medius and tibialis anterior is used during gait training to overcome these impairments, its effects on gait kinematics remain unclear. The purpose of this study was to investigate the kinematic effect of FES to the gluteus medius and tibialis anterior during gait in a post-stroke patient. METHODS: The participant was a female patient in her 70s who had experienced a stroke 101 days previously. She was able to walk without the assistance of a cane. The participant had gait training for periods of 20 minutes at a self-selected velocity under two different FES conditions: stimulation to the tibialis anterior during the swing phase (TA) and stimulation to the gluteus medius and tibialis anterior during the swing and early stance phases (TA+GMed). We compared the change in gait velocity, cadence, and stride length, upper trunk angle in the sagittal and frontal plane at initial contact, and the motion range of angle of the affected hip extension-flexion relative to that before training. RESULTS: Gait velocity, cadence, and stride length showed notable increases post-training, although differences between TA and TA+GMed were not as apparent. Upper trunk angle in the sagittal and frontal plane at initial contact showed greater improvement in the TA+GMed condition than in the TA condition. Motion range of angle of the affected hip extension-flexion at post training examination was 40.49 ± 2.12° and 44.14 ± 1.41° in TA and TA+GMed, respectively. CONCLUSION: The results of this study suggest that FES to the gluteus medius and tibialis anterior during gait produces an improvement in hip and trunk kinematics.

麻痺側の前脛骨筋と中殿筋への機能的電気刺激が脳卒中片麻痺者の歩行に与える即時的な運動学的変化を検討することを目的とした。対象は､左片麻痺を呈し脳梗塞発症後101日が経過した70歳代女性、歩行はT 字杖を使用し､自立していた。麻痺側の前脛骨筋のみに対する電気刺激､前脛骨筋に加え中殿筋にも電気刺激を行う２つの刺激条件下で歩行練習を行い､その前後の歩行を比較した。歩行速度､歩行率､ストライド長は２条件ともに改善したが条件間に明らかな差を認めなかった。一方､前脛骨筋のみの刺激に比べ中殿筋への刺激を追加した条件では、麻痺側初期接地時の上部体幹の矢状面における傾斜が正中位に近くなり、股関節の矢状面における運動範囲が増加した。脳卒中の歩行練習では、前脛骨筋に加え中殿筋に電気刺激を行うことで、麻痺側立脚相の体幹と股関節の運動の改善に寄与する可能性が示唆された。PURPOSE: Stroke can cause impairments in gait kinematics, such as drop foot and lateral trunk fluctuation. Although functional electrical stimulation (FES) to the gluteus medius and tibialis anterior is used during gait training to overcome these impairments, its effects on gait kinematics remain unclear. The purpose of this study was to investigate the kinematic effect of FES to the gluteus medius and tibialis anterior during gait in a post-stroke patient. METHODS: The participant was a female patient in her 70s who had experienced a stroke 101 days previously. She was able to walk without the assistance of a cane. The participant had gait training for periods of 20 minutes at a self-selected velocity under two different FES conditions: stimulation to the tibialis anterior during the swing phase (TA) and stimulation to the gluteus medius and tibialis anterior during the swing and early stance phases (TA+GMed). We compared the change in gait velocity, cadence, and stride length, upper trunk angle in the sagittal and frontal plane at initial contact, and the motion range of angle of the affected hip extension-flexion relative to that before training. RESULTS: Gait velocity, cadence, and stride length showed notable increases post-training, although differences between TA and TA+GMed were not as apparent. Upper trunk angle in the sagittal and frontal plane at initial contact showed greater improvement in the TA+GMed condition than in the TA condition. Motion range of angle of the affected hip extension-flexion at post training examination was 40.49 ± 2.12° and 44.14 ± 1.41° in TA and TA+GMed, respectively. CONCLUSION: The results of this study suggest that FES to the gluteus medius and tibialis anterior during gait produces an improvement in hip and trunk kinematics.