26 4 549 553 2011 症例研究 The Immediate Effect of Backward Walking Exercise on the Posture and Postural Control of a Patient with Parkinson s Disease 1) 1) 1) 1) 2) YASUTAKA NIKAIDO, RPT 1), HISATOMO SATO, RPT 1), RYUJI TAKAYAMA, RPT 1), HIROSHI OHNO, RPT 1), RYUICHI SAURA, MD, PhD 2) 1) Department of Rehabilitation, Osaka Medical College Hospital: 2 7 Daigaku-machi, Takatsuki-city, Osaka, 569-8686, Japan. TEL+81 72-683-1221 FAX+81 72-684-6336 E-mail: reh055@poh.osaka-med.ac.jp 2) Department of Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical College Rigakuryoho Kagaku 26(4): 549 553, 2011. Submitted Feb. 7, 2011. Accepted Mar. 24, 2011. ABSTRACT: [Purpose] The stooped posture, which limits various motions and increases the risk of falling, is one of the symptoms accompanying Parkinson s Disease (PD). It was recently reported that backward walking exercise improved the posture and the ability of forward walking of PD patients. However, the detailed mechanisms of these effects still remain unclear. The purpose of this study was to clarify the mechanisms of the immediate effects of backward walking exercise on the posture and postural control of a patient with PD. [Subject] The backward walking exercise and evaluation of the changes in terms of the posture and postural control abilities were conducted for a PD patient (Hoehn & Yahr Stage III) with moderate stooped posture. [Methods] We evaluated the change of the posture, the center of gravity (COG), and the center of pressure (COP) using a force plate and a three-dimensional motion analysis system in 3 kinds of tasks performed by the patient: the static standing posture, the functional reach test (FR) and the cross test (CT). The measurements were performed just before and after a 5-minute backward walking exercise. [Results] In the static standing posture, both COG and COP moved backward and the stooped posture seemed to be moderately improved just after the backward walking exercise. Also, the extent of ankle strategy in postural control in the FR task increased in comparison with the hip strategy, and both COG and COP moved more forward in the CT task after the backward walking exercise. [Conclusion] The results suggest that the backward walking exercise moderately improved the stooped posture and postural control through greater dependence on ankle strategy than on hip strategy, and these effects lead to increased stability in both standing and walking of the patient with PD. Key words: Parkinson s disease, backward walking, postural control 要旨 :Parkinson s Disease: PD PD PD PD Hoehn & Yahr III Functional Reach Test FR Cross Test CT FR CT キーワード : 1) : 2 7 569-8686 TEL 072-683-1221 FAX 072-684-6336 2) 2011 2 7 2011 3 24
550 26 4 I. はじめに 15 m 5 Parkinson Disease PD Hoehn Yahr H-Y III 1,2) PD Center of Gravity: COG 3,4) 5,6) PD 2) 7) 8,9) 8,9) PD 10) PD Functional Reach Test FR Cross Test VICON460 AMTI 10 cm 15 10 5 120Hz 2 m 30 COG Center of foot Pressure: COP COG 10 10 FR 12) 3 cm 60 cm 90 COG COP Cross Test 13) 14) COG 1 4 COG 4 II. 対象と方法 COG 1 32 1 59 PD 2 H-Y III COG COG COP 1 3 pull test 11) 1 III. 結 果 1 COG 18.0 mm COP 13.5 mm 33.7 mm 2 24.3 mm 10 22.6 mm
551 FR 2 COG COP COP 15.2 mm Cross Test 3 COG 87.7 mm 115.9 mm COP 99.9 mm 136.6 mm 79 mm 113.7 mm COG COP 表 1 mm IV. 考 察 COG COP COP 10 : : 67.8 3.1 30.5 3.6 94.4 4.2 85.4 2.8 88.2 3.2 69.6 1.5 52.0 1.5 49.8 2.7 17 3.1 60.7 3.7 61.1 2.8 110.8 3.4 71.6 2.1 54.2 2.3 18.0 13.5 33.7 24.3 22.6 2.0 2.2 5 cm 15) COG 67.8 3.1 mm 49.8 2.7 mm COP 10 2) 3,4) 表 2 FR mm 164.2 3.4 165.8 2.2 1.6 COG mm 77.5 2.3 76.3 2.8 25.5 3.1 79.0 2.5 78.1 2.4 40.7 2.9 1.5 1.8 15.2 N m N m 34.0 0.4 56.1 0.6 27.1 0.6 65.0 0.6 6.9 9.1 表 3 Cross Test COG mm 51.5 3.8 36.2 2.5 53.8 1.9 73.9 2.8 73.9 2.5 42.0 1.8 58.0 2.8 74.9 3.1 22.4 5.8 4.2 1.0 69.6 1.9 33.3 1.7 9.7 2.3 10.2 1.9 101.3 3.1 35.3 1.8 8.8 2.4 10.8 2.2 31.7 2.0 0.9 0.6 29.4 2.7 49.6 2.6 10.4 1.5 11.0 1.8 56.5 3.4 57.2 2.4 10.2 1.8 11.4 1.2 27.1 7.6 0.2 0.4
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