頸椎症性脊髄症に対するしびれ同調経皮的電気神経刺激が生活行為に及ぼす効果—症例報告
要旨：【目的】両手にしびれ感を呈した頸椎症性脊髄症（以下，CSM）術後の60歳代，女性にしびれ同調経皮的電気神経刺激（以下，しびれ同調TENS）を作業療法に併用し実施した．【方法】術後8日から5日間は，通常介入に加え両手を対象とし，しびれ同調TENSを実施した．【結果】両手共にしびれ感が漸減し（右手：Tau＝-0.65，左手：Tau＝-0.69），上肢のパフォーマンスが向上した．それに伴い，食事・入浴・整容動作などが自立し，生活行為への汎化もみられた．【結論】CSMに対するしびれ同調TENSは，術後早期患者に有用であり，しびれ感の改善や上肢のパフォーマンス，生活行為の向上にも寄与する可能性が示...
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| Published in | 作業療法 Vol. 43; no. 4; pp. 532 - 539 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本作業療法士協会
15.08.2024
一般社団法人 日本作業療法士協会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0289-4920 2434-4419 |
| DOI | 10.32178/jotr.43.4_532 |
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| Abstract | 要旨：【目的】両手にしびれ感を呈した頸椎症性脊髄症（以下，CSM）術後の60歳代，女性にしびれ同調経皮的電気神経刺激（以下，しびれ同調TENS）を作業療法に併用し実施した．【方法】術後8日から5日間は，通常介入に加え両手を対象とし，しびれ同調TENSを実施した．【結果】両手共にしびれ感が漸減し（右手：Tau＝-0.65，左手：Tau＝-0.69），上肢のパフォーマンスが向上した．それに伴い，食事・入浴・整容動作などが自立し，生活行為への汎化もみられた．【結論】CSMに対するしびれ同調TENSは，術後早期患者に有用であり，しびれ感の改善や上肢のパフォーマンス，生活行為の向上にも寄与する可能性が示唆された． [Purpose] We implemented dysesthesia-matched transcutaneous electrical nerve stimulation (dysesthesia-matched TENS) in conjunction with occupational therapy in a female patient in her 60s with cervical spondylotic myelopathy (CSM) exhibiting dysesthesia in both hands after surgery. [Methods] Starting from postoperative day 8 and continuing for 5 days, dysesthesia-matched TENS was applied in addition to conventional intervention targeting both hands. [Results] Dysesthesia in both hands gradually decreased (Right hand: Tau=-0.65, Left hand: Tau=-0.69）, and upper limb performance improved. Consequently, independence in activities such as eating, bathing, and grooming was achieved, and generalization to activities of daily living was observed. [Conclusion] Dysesthesia-matched TENS for CSM has shown potential utility in early postoperative patients, and it suggests the potential contribution to the improvement of dysesthesia, upper limb performance, and activities of daily living. |
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| AbstractList | 要旨：【目的】両手にしびれ感を呈した頸椎症性脊髄症（以下，CSM）術後の60歳代，女性にしびれ同調経皮的電気神経刺激（以下，しびれ同調TENS）を作業療法に併用し実施した．【方法】術後8日から5日間は，通常介入に加え両手を対象とし，しびれ同調TENSを実施した．【結果】両手共にしびれ感が漸減し（右手：Tau＝-0.65，左手：Tau＝-0.69），上肢のパフォーマンスが向上した．それに伴い，食事・入浴・整容動作などが自立し，生活行為への汎化もみられた．【結論】CSMに対するしびれ同調TENSは，術後早期患者に有用であり，しびれ感の改善や上肢のパフォーマンス，生活行為の向上にも寄与する可能性が示唆された． [Purpose] We implemented dysesthesia-matched transcutaneous electrical nerve stimulation (dysesthesia-matched TENS) in conjunction with occupational therapy in a female patient in her 60s with cervical spondylotic myelopathy (CSM) exhibiting dysesthesia in both hands after surgery. [Methods] Starting from postoperative day 8 and continuing for 5 days, dysesthesia-matched TENS was applied in addition to conventional intervention targeting both hands. [Results] Dysesthesia in both hands gradually decreased (Right hand: Tau=-0.65, Left hand: Tau=-0.69）, and upper limb performance improved. Consequently, independence in activities such as eating, bathing, and grooming was achieved, and generalization to activities of daily living was observed. [Conclusion] Dysesthesia-matched TENS for CSM has shown potential utility in early postoperative patients, and it suggests the potential contribution to the improvement of dysesthesia, upper limb performance, and activities of daily living. 要旨: 【目的】両手にしびれ感を呈した頸椎症性脊髄症(以下, CSM)術後の60歳代, 女性にしびれ同調経皮的電気神経刺激(以下, しびれ同調TENS)を作業療法に併用し実施した. 【方法】術後8日から5日間は, 通常介入に加え両手を対象とし, しびれ同調TENSを実施した. 【結果】両手共にしびれ感が漸減し(右手: Tau = -0.65, 左手: Tau = -0.69), 上肢のパフォーマンスが向上した. それに伴い, 食事・入浴・整容動作などが自立し, 生活行為への汎化もみられた. 【結論】CSMに対するしびれ同調TENSは, 術後早期患者に有用であり, しびれ感の改善や上肢のパフォーマンス, 生活行為の向上にも寄与する可能性が示唆された. 【目的】両手にしびれ感を呈した頸椎症性脊髄症（以下，CSM）術後の60歳代，女性にしびれ同調経皮的電気神経刺激（以下，しびれ同調TENS）を作業療法に併用し実施した．【方法】術後8日から5日間は，通常介入に加え両手を対象とし，しびれ同調TENSを実施した．【結果】両手共にしびれ感が漸減し（右手：Tau＝−0.65，左手：Tau＝−0.69），上肢のパフォーマンスが向上した．それに伴い，食事・入浴・整容動作などが自立し，生活行為への汎化もみられた．【結論】CSMに対するしびれ同調TENSは，術後早期患者に有用であり，しびれ感の改善や上肢のパフォーマンス，生活行為の向上にも寄与する可能性が示唆された． |
| Author | 衛藤 誠二 北上 守俊 城之下 唯子 下堂薗 恵 豊栄 峻 |
| AuthorAffiliation | 鹿児島大学大学院医歯学総合研究科リハビリテーション医学 鹿児島大学病院リハビリテーション部 |
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| DOI | 10.32178/jotr.43.4_532 |
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| References | 18) Manolov R: Visual aids and Nonoverlap indices. ［Shiny app］. https://manolov.shinyapps.io/Overlap/（accessed 2024-02-04）. 24) Tanaka Y, Sato G, Imai R, Osumi M, Shigetoh H, et al: Effectiveness of patient education focusing on circadian pain rhythms: A case report and review of literature. World J Clin Cases 9（17）: 4441-4452, 2021. 21) Corallo V, Torre M, Ferrara G, Guerra F, Nicosia G, et al: What do spinal cord injury patients think of their improvement? A study of the minimal clinically important difference of the Spinal Cord Independence Measure III. Eur J Phys Rehabil Med 53（4）: 508-515, 2017. 20) Chen HM, Chen CC, Hsueh IP, Huang SL, Hsieh CL: Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke. Neurorehabil Neural Repair 23（5）: 435-440, 2009. 22) Lang CE, Edwards DF, Birkenmeier RL, Dromerick AW: Estimating minimal clinically important differences of upper-extremity measures early after stroke. Arch Phys Med Rehabil 89（9）: 1693-1700, 2008. 3) Inoue T, Soshi S, Kubota M, Marumo K: Efficacy of laminoplasty in improving sensory disturbances in patients with cervical spondylotic myelopathy: A prospective study. World Neurosurg 134: e581-e588, 2020, doi: 10.1016/j.wneu.2019.10.141. 10) Bennett MI, Hughes N, Johnson MI: Methodological quality in randomised controlled trials of transcutaneous electric nerve stimulation for pain: Low fidelity may explain negative findings. Pain 152（6）: 1226-1232, 2011. 16) Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, et al: Development and validation of the Neuropathic Pain Symptom Inventory. Pain 108（3）: 248-257, 2004. 11) 西祐樹，生野公貴，南川勇二，中田佳佑，大住倫弘，他：中枢神経障害によるしびれ感に対するしびれ同調経皮的電気神経刺激の効果検証─シングルケース実験デザイン─．物理療法科学30（1）：67-75，2023 13) Oxford Grice K, Vogel KA, Le V, Mitchell A, Muniz S, et al: Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. Am J Occup Ther 57（5）: 570-573, 2003. 15) Dworkin RH, Turk DC, Revicki DA, Harding G, Coyne KS, et al: Development and initial validation of an expanded and revised version of the Short-Form McGill Pain Questionnaire (SF-MPQ-2）. Pain 144（1-2）: 35-42, 2009. 4) Iwamae M, Suzuki A, Tamai K, Terai H, Hoshino M, et al: Residual numbness of the upper extremity after cervical surgery in patients with cervical spondylotic myelopathy. J Neurosurg Spine 33（6）: 734-741, 2020. 19) Vannest KJ, Ninci J: Evaluating intervention effects in single-case research designs. J Couns Dev 93: 403-411, 2015. 9) Gibson W, Wand BM, O'Connell NE: Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults. Cochrane Database Syst Rev, doi: 10.1002/14651858.CD011976.pub2 ［published online ahead of print September 14, 2017］ 23) Hanley MA, Jensen MP, Ehde DM, Robinson LR, Cardenas DD, et al: Clinically significant change in pain intensity ratings in persons with spinal cord injury or amputation. Clin J Pain 22（1）: 25-31, 2006. 25) Kim T, Lohse KR, Mackinnon SE, Philip BA: Patient outcomes after peripheral nerve injury depend on bimanual dexterity and preserved use of the affected hand. Neurorehabil Neural Repair 38（2）: 134-147, 2024. 14) 玉垣努：感覚・知覚検査．能登真一，山口昇，玉垣努，新宮尚人，加藤寿宏，他・編集，標準作業療法学 専門分野 作業療法評価学 第4版，李範爽・編集協力，医学書院，2024，pp.115-123 17) Jensen MP, Chen C, Brugger AM: Interpretation of visual analog scale ratings and change scores: A reanalysis of two clinical trials of postoperative pain. J Pain 4（7）: 407-414, 2003. 1) Zhang RJ, Shen CL, Zhang JX, Zhang XJ, Dong FL, et al: Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients of different ages: A retrospective study. Spinal Cord 56（1）: 7-13, 2018. 12) Mathiowetz V, Volland G, Kashman N, Weber K: Adult norms for the Box and Block Test of manual dexterity. Am J Occup Ther 39（6）: 386-391, 1985. 5) 日本神経学用語委員会・編：神経学用語集 改訂第3版．文光堂，2008，p.15 8) Nishi Y, Ikuno K, Minamikawa Y, Igawa Y, Osumi M, et al: A novel form of transcutaneous electrical nerve stimulation for the reduction of dysesthesias caused by spinal nerve dysfunction: A case series. Front Hum Neurosci, doi: 10.3389/fnhum.2022.937319 ［published online ahead of print August 24, 2022］ 7) 久保田雅史，前田真弘，松尾英明，成瀬廣亮，嶋田誠一郎，他：頸椎症性脊髄症に伴う感覚障害に対する経頭蓋直流電気刺激の試み─single case design─．理学療法福井18： 122-124，2014 2) Machino M, Yukawa Y, Hida T, Ito K, Nakashima H, et al: The prevalence of pre- and postoperative symptoms in patients with cervical spondylotic myelopathy treated by cervical laminoplasty. Spine（Phila Pa 1976）37（22）: E1383-E1388, 2012, doi: 10.1097/BRS.0b013e3182684c68. 6) Deetz D, Petrie BK: Massage therapy as a complementary treatment for stiffness and numbness post cervical spinal cord injury: A case study. Int J Ther Massage Bodywork 15（4）: 3-8, 2022. |
| References_xml | – reference: 20) Chen HM, Chen CC, Hsueh IP, Huang SL, Hsieh CL: Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke. Neurorehabil Neural Repair 23（5）: 435-440, 2009. – reference: 22) Lang CE, Edwards DF, Birkenmeier RL, Dromerick AW: Estimating minimal clinically important differences of upper-extremity measures early after stroke. Arch Phys Med Rehabil 89（9）: 1693-1700, 2008. – reference: 10) Bennett MI, Hughes N, Johnson MI: Methodological quality in randomised controlled trials of transcutaneous electric nerve stimulation for pain: Low fidelity may explain negative findings. Pain 152（6）: 1226-1232, 2011. – reference: 13) Oxford Grice K, Vogel KA, Le V, Mitchell A, Muniz S, et al: Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. Am J Occup Ther 57（5）: 570-573, 2003. – reference: 15) Dworkin RH, Turk DC, Revicki DA, Harding G, Coyne KS, et al: Development and initial validation of an expanded and revised version of the Short-Form McGill Pain Questionnaire (SF-MPQ-2）. Pain 144（1-2）: 35-42, 2009. – reference: 19) Vannest KJ, Ninci J: Evaluating intervention effects in single-case research designs. J Couns Dev 93: 403-411, 2015. – reference: 9) Gibson W, Wand BM, O'Connell NE: Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults. Cochrane Database Syst Rev, doi: 10.1002/14651858.CD011976.pub2 ［published online ahead of print September 14, 2017］． – reference: 5) 日本神経学用語委員会・編：神経学用語集 改訂第3版．文光堂，2008，p.15． – reference: 12) Mathiowetz V, Volland G, Kashman N, Weber K: Adult norms for the Box and Block Test of manual dexterity. Am J Occup Ther 39（6）: 386-391, 1985. – reference: 23) Hanley MA, Jensen MP, Ehde DM, Robinson LR, Cardenas DD, et al: Clinically significant change in pain intensity ratings in persons with spinal cord injury or amputation. Clin J Pain 22（1）: 25-31, 2006. – reference: 14) 玉垣努：感覚・知覚検査．能登真一，山口昇，玉垣努，新宮尚人，加藤寿宏，他・編集，標準作業療法学 専門分野 作業療法評価学 第4版，李範爽・編集協力，医学書院，2024，pp.115-123． – reference: 24) Tanaka Y, Sato G, Imai R, Osumi M, Shigetoh H, et al: Effectiveness of patient education focusing on circadian pain rhythms: A case report and review of literature. World J Clin Cases 9（17）: 4441-4452, 2021. – reference: 2) Machino M, Yukawa Y, Hida T, Ito K, Nakashima H, et al: The prevalence of pre- and postoperative symptoms in patients with cervical spondylotic myelopathy treated by cervical laminoplasty. Spine（Phila Pa 1976）37（22）: E1383-E1388, 2012, doi: 10.1097/BRS.0b013e3182684c68. – reference: 25) Kim T, Lohse KR, Mackinnon SE, Philip BA: Patient outcomes after peripheral nerve injury depend on bimanual dexterity and preserved use of the affected hand. Neurorehabil Neural Repair 38（2）: 134-147, 2024. – reference: 4) Iwamae M, Suzuki A, Tamai K, Terai H, Hoshino M, et al: Residual numbness of the upper extremity after cervical surgery in patients with cervical spondylotic myelopathy. J Neurosurg Spine 33（6）: 734-741, 2020. – reference: 16) Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, et al: Development and validation of the Neuropathic Pain Symptom Inventory. Pain 108（3）: 248-257, 2004. – reference: 21) Corallo V, Torre M, Ferrara G, Guerra F, Nicosia G, et al: What do spinal cord injury patients think of their improvement? A study of the minimal clinically important difference of the Spinal Cord Independence Measure III. Eur J Phys Rehabil Med 53（4）: 508-515, 2017. – reference: 1) Zhang RJ, Shen CL, Zhang JX, Zhang XJ, Dong FL, et al: Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients of different ages: A retrospective study. Spinal Cord 56（1）: 7-13, 2018. – reference: 3) Inoue T, Soshi S, Kubota M, Marumo K: Efficacy of laminoplasty in improving sensory disturbances in patients with cervical spondylotic myelopathy: A prospective study. World Neurosurg 134: e581-e588, 2020, doi: 10.1016/j.wneu.2019.10.141. – reference: 18) Manolov R: Visual aids and Nonoverlap indices. ［Shiny app］. https://manolov.shinyapps.io/Overlap/（accessed 2024-02-04）. – reference: 7) 久保田雅史，前田真弘，松尾英明，成瀬廣亮，嶋田誠一郎，他：頸椎症性脊髄症に伴う感覚障害に対する経頭蓋直流電気刺激の試み─single case design─．理学療法福井18： 122-124，2014． – reference: 8) Nishi Y, Ikuno K, Minamikawa Y, Igawa Y, Osumi M, et al: A novel form of transcutaneous electrical nerve stimulation for the reduction of dysesthesias caused by spinal nerve dysfunction: A case series. Front Hum Neurosci, doi: 10.3389/fnhum.2022.937319 ［published online ahead of print August 24, 2022］． – reference: 11) 西祐樹，生野公貴，南川勇二，中田佳佑，大住倫弘，他：中枢神経障害によるしびれ感に対するしびれ同調経皮的電気神経刺激の効果検証─シングルケース実験デザイン─．物理療法科学30（1）：67-75，2023． – reference: 17) Jensen MP, Chen C, Brugger AM: Interpretation of visual analog scale ratings and change scores: A reanalysis of two clinical trials of postoperative pain. J Pain 4（7）: 407-414, 2003. – reference: 6) Deetz D, Petrie BK: Massage therapy as a complementary treatment for stiffness and numbness post cervical spinal cord injury: A case study. Int J Ther Massage Bodywork 15（4）: 3-8, 2022. |
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| Snippet | 要旨：【目的】両手にしびれ感を呈した頸椎症性脊髄症（以下，CSM）術後の60歳代，女性にしびれ同調経皮的電気神経刺激（以下，しびれ同調TENS）を作業療法に併用し実... 【目的】両手にしびれ感を呈した頸椎症性脊髄症（以下，CSM）術後の60歳代，女性にしびれ同調経皮的電気神経刺激（以下，しびれ同調TENS）を作業療法に併用し実施した．【方... 要旨: 【目的】両手にしびれ感を呈した頸椎症性脊髄症(以下, CSM)術後の60歳代, 女性にしびれ同調経皮的電気神経刺激(以下, しびれ同調TENS)を作業療法に併用し実施した. 【... |
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| StartPage | 532 |
| SubjectTerms | Activities of daily living Cervical spondylotic myelopathy Dysesthesia-matched transcutaneous electrical nerve stimulation Occupational therapy Sensory disturbance しびれ同調経皮的電気神経刺激 作業療法 感覚障害 生活行為 頸椎症性脊髄症 |
| Title | 頸椎症性脊髄症に対するしびれ同調経皮的電気神経刺激が生活行為に及ぼす効果—症例報告 |
| URI | https://webview.isho.jp/journal/detail/abs/10.11477/mf.6003901478 https://www.jstage.jst.go.jp/article/jotr/43/4/43_532/_article/-char/ja http://mol.medicalonline.jp/en/journal/download?GoodsID=cd6sagyh/2024/004304/009&name=0532-0539j |
| Volume | 43 |
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| ispartofPNX | 作業療法, 2024/08/15, Vol.43(4), pp.532-539 |
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