脳卒中後患者における異常歩行と下肢筋活動の変化
脳卒中後患者は多様な後遺症が生じることから，歩行速度の低下や非対称的な歩行，歩行中の下肢筋活動の変化など異 常歩行として多くの特徴が報告されている.その中でも下肢筋活動の変化は臨床的に直接評価することが難しく，研究領域に おいても定量的な報告が十分とは言い難い.特に，特徴的な筋活動パターンの 1 つとして報告されている筋の同時活動(同時 収縮)は，臨床的には中枢神経系の障害による異常筋活動として解釈されることが多いが，研究報告では姿勢の不安定性に対 する代償的な姿勢制御戦略としての作用が示唆されている.本稿では我々が行ってきた研究成果を中心に，脳卒中後患者にお ける歩行中の筋の同時活動が果たし...
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| Published in | バイオメカニズム学会誌 Vol. 46; no. 4; pp. 228 - 234 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
バイオメカニズム学会
2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-0885 |
| DOI | 10.3951/sobim.46.4_228 |
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| Abstract | 脳卒中後患者は多様な後遺症が生じることから，歩行速度の低下や非対称的な歩行，歩行中の下肢筋活動の変化など異 常歩行として多くの特徴が報告されている.その中でも下肢筋活動の変化は臨床的に直接評価することが難しく，研究領域に おいても定量的な報告が十分とは言い難い.特に，特徴的な筋活動パターンの 1 つとして報告されている筋の同時活動(同時 収縮)は，臨床的には中枢神経系の障害による異常筋活動として解釈されることが多いが，研究報告では姿勢の不安定性に対 する代償的な姿勢制御戦略としての作用が示唆されている.本稿では我々が行ってきた研究成果を中心に，脳卒中後患者にお ける歩行中の筋の同時活動が果たしている役割について解説する. |
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| AbstractList | 脳卒中後患者は多様な後遺症が生じることから，歩行速度の低下や非対称的な歩行，歩行中の下肢筋活動の変化など異 常歩行として多くの特徴が報告されている.その中でも下肢筋活動の変化は臨床的に直接評価することが難しく，研究領域に おいても定量的な報告が十分とは言い難い.特に，特徴的な筋活動パターンの 1 つとして報告されている筋の同時活動(同時 収縮)は，臨床的には中枢神経系の障害による異常筋活動として解釈されることが多いが，研究報告では姿勢の不安定性に対 する代償的な姿勢制御戦略としての作用が示唆されている.本稿では我々が行ってきた研究成果を中心に，脳卒中後患者にお ける歩行中の筋の同時活動が果たしている役割について解説する. |
| Author | 北谷, 亮輔 |
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| Copyright | 2022 バイオメカニズム学会 |
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| References | 10) Rosa, M. C., Marques, A., Demain, S., Metcalf, C. D. and Rodrigues, J.: Methodologies to assess muscle co- contraction during gait in people with neurological impairment - a systematic literature review, Journal of Electromyography and Kinesiology, 24(2), 179-191, (2014). DOI: 10.1016/j.jelekin.2013.11.003 25) Chow, J. W., Yablon, S. A. and Stokic, D. S.: Coactivation of ankle muscles during stance phase of gait in patients with lower limb hypertonia after acquired brain injury, Clinical Neurophysiology, 123(8), 1599-1605, (2012). DOI: 10.1016/j.clinph.2012.01.006 5) Knutsson, E. and Richards, C.: Different types of disturbed motor control in gait of hemiparetic patients, Brain, 102(2), 405-430, (1979). DOI:10.1093/brain/102.2.405 28) Norton, J. A. and Gorassini, M. A.: Changes in cortically related intermuscular coherence accompanying improvements in locomotor skills in incomplete spinal cord injury, Journal of Neurophysiology, 95(4), 2580-2589, (2006).DOI: 10.1152/jn.01289.2005 40) Levin, M. F., Kleim, J. A. and Wolf, S. L.: What do motor " recovery " and " compensation " mean in patients following stroke Neurorehabilitation and Neural Repair, 23(4), 313-319, (2009). DOI: 10.1177/1545968308328727 8) Nadeau, S., Arsenault, A. B., Gravel, D. and Bourbonnais, D.: Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke, American Journal of Physical Medicine and Rehabilitation, 78(2), 123-130, (1999). DOI: 10.1097/00002060-199903000- 00007 35) Hansen, N. L., Conway, B. A., Halliday, D. M., Hansen, S., Pyndt, H. S., Biering-Sørensen, F. and Nielsen, J. B.: Reduction of common synaptic drive to ankle dorsiflexor motoneurons during walking in patients with spinal cord lesion, Journal of Neurophysiology, 94(2), 934-942, (2005). DOI: 10.1152/jn.00082.2005 41) Van Criekinge, T., Vermeulen, J., Wagemans, K., Schröder, J., Embrechts, E., Truijen. S., Hallemans. A. and Saeys, W.: Lower limb muscle synergies during walking after stroke: a systematic review, Disability and Rehabilitation, 42(20), 2836-2845, (2020). DOI: 10.1080/09638288.2019.1578421 2) Grau-Pellicer, M., Chamarro-Lusar, A., Medina-Casanovas, J. and Serda Ferrer, B. C.: Walking speed as a predictor of community mobility and quality of life after stroke, Topics in Stroke Rehabilitation, 26(5), 349-358, (2019).DOI: 10.1080/10749357.2019.1605751 38) Cho, J. E., Lee, W. H., Shin, J. H. and Kim, H.: Effects of bi-axial ankle strengthening on muscle co-contraction during gait in chronic stroke patients: A randomized controlled pilot study, Gait & Posture, 87, 177-183, (2021). DOI: 10.1016/j.gaitpost.2021.04.011 3) Brandstater, M. E., de Bruin, H., Gowland, C. and Clark, B. M.: Hemiplegic gait: analysis of temporal variables, Archives of Physical Medicine and Rehabilitation, 64(12), 583-587, (1983). 4) De Quervain, I. A., Simon, S. R., Leurgans, S., Pease, W. S. and McAllister, D.: Gait pattern in the early recovery period after stroke, Journal of Bone & Joint Surgery, 78(10), 1506-1514, (1996). DOI: 10.2106/00004623- 199610000-00008 18) Den Otter, A. R., Geurts, A. C., Mulder, T. and Duysens, J.: Gait recovery is not associated with changes in the temporal patterning of muscle activity during treadmill walking in patients with post-stroke hemiparesis, Clinical Neurophysiology, 117(1), 4-15, (2006). DOI: 10.1016/ j.clinph.2005.08.014 27) Halliday, D. M., Conway, B. A., Christensen, L. O., Hansen, N. L., Petersen, N. P. and Nielsen, J. B.: Functional coupling of motor units is modulated during walking in human subjects, Journal of Neurophysiology, 89(2), 960-968, (2003). DOI: 10.1152/jn.00844.2002 15) Arene, N. and Hidler, J.: Understanding motor impairment in the paretic lower limb after a stroke: a review of the literature, Topics in Stroke Rehabilitation, 16(5), 346-356, (2009). DOI: 10.1310/tsr1605-346 34) Kitatani, R., Koganemaru, S., Maeda, A., Mikami, Y., Matsuhashi, M., Mima, T. and Yamada, S.: Gait-combined transcranial alternating current stimulation modulates cortical control of muscle activities during gait, European Journal of Neuroscience, 52(12), 4791-4802, (2020). DOI: 10.1111/ejn.14919 32) Grosse, P., Cassidy, M. J. and Brown, P.: EEG-EMG, MEG-EMG and EMG-EMG frequency analysis: physiological principles and clinical applications, Clinical Neurophysiology, 113(10), 1523-1531, (2002). DOI: 10.1016/s1388-2457(02)00223-7 12) Falconer, K. and Winter, D. A.: Quantitative assessment of co-contraction at the ankle joint in walking, Electromyography and Clinical Neurophysiology, 25(2-3),135-149, (1985). 30) Halliday, D. M., Rosenberg, J. R., Amjad, A. M., Breeze, P., Conway, B. A. and Farmer, S. F.: A framework for the analysis of mixed time series/point process data--theory and application to the study of physiological tremor, single motor unit discharges and electromyograms, Progress in Biophysics & Molecular Biology, 64(2-3), 237-278, (1995). DOI: 10.1016/s0079-6107(96)00009-0 37) Hansen, S., Hansen, N. L., Christensen, L. O., Petersen, N. T. and Nielsen, J. B.: Coupling of antagonistic ankle muscles during co-contraction in humans, Experimental Brain Research, 146(3), 282-292, (2002). DOI: 10.1007/ s00221-002-1152-3 36) Nielsen, J. B., Brittain, J. S., Halliday, D. M., Marchand- Pauvert, V., Mazevet, D. and Conway, B. A.: Reduction of common motoneuronal drive on the affected side during walking in hemiplegic stroke patients, Clinical Neurophysiology, 119(12), 2813-2818, (2008). DOI: 10.1016/j.clinph.2008.07.283 29) Kitatani, R., Ohata, K., Aga, Y., Mashima, Y., Hashiguchi, Y., Wakida, M., Maeda, A. and Yamada. S.: Descending neural drives to ankle muscles during gait and their relationships with clinical functions in patients after stroke, Clinical Neurophysiology, 127(2), 1512-1520, (2016). DOI: 10.1016/j.clinph.2015.10.043 33) Power, H. A., Norton, J. A., Porter, C. L., Doyle, Z., Hui, I. and Chan, K. M.: Transcranial direct current stimulation of the primary motor cortex affects cortical drive to human musculature as assessed by intermuscular coherence, Journal of Physiology, 577(Pt3), 795-803, (2006). DOI: 10.1113/jphysiol.2006.116939 6) Shiavi, R., Bugle, H. J. and Limbird, T.: Electromyographic gait assessment, Part 2: Preliminary assessment of hemiparetic synergy patterns, Journal of Rehabilitation Research and Development, 24(2), 24-30, (1987). 14) Levin, M. F. and Hui-Chan, C.: Ankle spasticity is inversely correlated with antagonist voluntary contraction in hemiparetic subjects, Electromyography and Clinical Neurophysiology, 34(7), 415-425, (1994). 16) Lamontagne, A., Richards, C. L. and Malouin, F.: Coactivation during gait as an adaptive behavior after stroke, Journal of Electromyography and Kinesiology, 10(6), 407-415, (2000). DOI: 10.1016/s1050- 6411(00)00028-6 13) Nagai, K., Yamada, M., Uemura, K., Yamada, Y., Ichihashi, N. and Tsuboyama, T.: Differences in muscle coactivation during postural control between healthy older and young adults, Archives of Gerontology and Geriatrics, 53(3), 338- 343, (2011). DOI: 10.1016/j.archger.2011.01.003 23) Kitatani, R., Ohata, K., Sakuma, K., Aga, Y., Yamakami, N., Hashiguchi, Y. and Yamada, S.: Ankle muscle coactivation during gait is decreased immediately after anterior weight shift practice in adults after stroke, Gait & Posture, 45, 35-40, (2016). DOI: 10.1016/ j.gaitpost.2016.01.006 11) Milner, T. E., Cloutier, C., Leger, A. B. and Franklin, D. W.: Inability to activate muscles maximally during cocontraction and the effect on joint stiffness, Experimental Brain Research, 107(2), 293-305, (1995). DOI: 10.1007/ BF00230049 24) Burke, D., Wissel, J. and Donnan, G. A.: Pathophysiology of spasticity in stroke, Neurology, 80(3 Suppl 2), S20-26, (2013). DOI: 10.1212/WNL.0b013e31827624a7 1) Perry, J., Garrett, M., Gronley, J. K. and Mulroy, S. J.: Classification of walking handicap in the stroke population, Stroke, 26(6), 982-989, (1995).DOI: 10.1161/01.str.26.6.982 21) Nagai, K., Yamada, M., Tanaka, B., Uemura, K., Mori, S., Aoyama, T., Ichihashi, N. and Tsuboyama, T.: Effects of balance training on muscle coactivation during postural control in older adults: a randomized controlled trial, Journals of gerontology. Series A, Biological Sciences and Medical Sciences, 67(8), 882-889, (2012). DOI:10.1093/ gerona/glr252 22) Freyler, K., Weltin, E., Gollhofer, A. and Ritzmann, R.: Improved postural control in response to a 4-week balance training with partially unloaded bodyweight, Gait & Posture, 40(2), 291-296, (2014). DOI: 10.1016/ j.gaitpost.2014.04.186 9) Gracies, J. M.: Pathophysiology of spastic paresis. II: Emergence of muscle overactivity, Muscle & Nerve, 31(5), 552-571, (2005). DOI: 10.1002/mus.20285 31) Farmer, S. F., Bremner, F. D., Halliday, D. M., Rosenberg, J. R. and Stephens, J. A.: The frequency content of common synaptic inputs to motoneurones studied during voluntary isometric contraction in man, Journal of Physiology, 470, 127-155, (1993). DOI: 10.1113/jphysiol.1993.sp019851 39) Allen, J. L., Ting, L. H. and Kesar, T. M.: Gait rehabilitation using functional electrical stimulation induces changes in ankle muscle coordination in stroke survivors: A preliminary study, Frontiers in Neurology, 9, 1127, (2018). DOI: 10.3389/fneur.2018.01127 26) Fujita, K., Miaki, H., Hori, H., Kobayashi, Y. and Nakagawa, T.: How effective is physical therapy for gait muscle activity in hemiparetic patients who receive botulinum toxin injections? European Journal of Physical and Rehabilitation Medicine, 55(1), 8-18, (2019). DOI: 10.23736/S1973-9087.18.05168-7 17) Rosa, M. C., Marques, A., Demain, S. and Metcalf, C. D.: Lower limb co-contraction during walking in subjects with stroke: A systematic review, Journal of Electromyography and Kinesiology, 24(1), 1-10, (2014).DOI: 10.1016/ j.jelekin.2013.10.016 7) Detrembleur, C., Dierick, F., Stoquart, G., Chantraine, F. and Lejeune, T.: Energy cost, mechanical work, and efficiency of hemiparetic walking, Gait & Posture, 18(2), 47-55, (2003). DOI: 10.1016/s096 |
| References_xml | – reference: 2) Grau-Pellicer, M., Chamarro-Lusar, A., Medina-Casanovas, J. and Serda Ferrer, B. C.: Walking speed as a predictor of community mobility and quality of life after stroke, Topics in Stroke Rehabilitation, 26(5), 349-358, (2019).DOI: 10.1080/10749357.2019.1605751 – reference: 28) Norton, J. A. and Gorassini, M. A.: Changes in cortically related intermuscular coherence accompanying improvements in locomotor skills in incomplete spinal cord injury, Journal of Neurophysiology, 95(4), 2580-2589, (2006).DOI: 10.1152/jn.01289.2005 – reference: 38) Cho, J. E., Lee, W. H., Shin, J. H. and Kim, H.: Effects of bi-axial ankle strengthening on muscle co-contraction during gait in chronic stroke patients: A randomized controlled pilot study, Gait & Posture, 87, 177-183, (2021). DOI: 10.1016/j.gaitpost.2021.04.011 – reference: 31) Farmer, S. F., Bremner, F. D., Halliday, D. M., Rosenberg, J. R. and Stephens, J. A.: The frequency content of common synaptic inputs to motoneurones studied during voluntary isometric contraction in man, Journal of Physiology, 470, 127-155, (1993). DOI: 10.1113/jphysiol.1993.sp019851 – reference: 36) Nielsen, J. B., Brittain, J. S., Halliday, D. M., Marchand- Pauvert, V., Mazevet, D. and Conway, B. A.: Reduction of common motoneuronal drive on the affected side during walking in hemiplegic stroke patients, Clinical Neurophysiology, 119(12), 2813-2818, (2008). DOI: 10.1016/j.clinph.2008.07.283 – reference: 35) Hansen, N. L., Conway, B. A., Halliday, D. M., Hansen, S., Pyndt, H. S., Biering-Sørensen, F. and Nielsen, J. B.: Reduction of common synaptic drive to ankle dorsiflexor motoneurons during walking in patients with spinal cord lesion, Journal of Neurophysiology, 94(2), 934-942, (2005). DOI: 10.1152/jn.00082.2005 – reference: 10) Rosa, M. C., Marques, A., Demain, S., Metcalf, C. D. and Rodrigues, J.: Methodologies to assess muscle co- contraction during gait in people with neurological impairment - a systematic literature review, Journal of Electromyography and Kinesiology, 24(2), 179-191, (2014). DOI: 10.1016/j.jelekin.2013.11.003 – reference: 37) Hansen, S., Hansen, N. L., Christensen, L. O., Petersen, N. T. and Nielsen, J. B.: Coupling of antagonistic ankle muscles during co-contraction in humans, Experimental Brain Research, 146(3), 282-292, (2002). DOI: 10.1007/ s00221-002-1152-3 – reference: 7) Detrembleur, C., Dierick, F., Stoquart, G., Chantraine, F. and Lejeune, T.: Energy cost, mechanical work, and efficiency of hemiparetic walking, Gait & Posture, 18(2), 47-55, (2003). DOI: 10.1016/s0966-6362(02)00193-5 – reference: 39) Allen, J. L., Ting, L. H. and Kesar, T. M.: Gait rehabilitation using functional electrical stimulation induces changes in ankle muscle coordination in stroke survivors: A preliminary study, Frontiers in Neurology, 9, 1127, (2018). DOI: 10.3389/fneur.2018.01127 – reference: 32) Grosse, P., Cassidy, M. J. and Brown, P.: EEG-EMG, MEG-EMG and EMG-EMG frequency analysis: physiological principles and clinical applications, Clinical Neurophysiology, 113(10), 1523-1531, (2002). DOI: 10.1016/s1388-2457(02)00223-7 – reference: 4) De Quervain, I. A., Simon, S. R., Leurgans, S., Pease, W. S. and McAllister, D.: Gait pattern in the early recovery period after stroke, Journal of Bone & Joint Surgery, 78(10), 1506-1514, (1996). DOI: 10.2106/00004623- 199610000-00008 – reference: 14) Levin, M. F. and Hui-Chan, C.: Ankle spasticity is inversely correlated with antagonist voluntary contraction in hemiparetic subjects, Electromyography and Clinical Neurophysiology, 34(7), 415-425, (1994). – reference: 15) Arene, N. and Hidler, J.: Understanding motor impairment in the paretic lower limb after a stroke: a review of the literature, Topics in Stroke Rehabilitation, 16(5), 346-356, (2009). DOI: 10.1310/tsr1605-346 – reference: 18) Den Otter, A. R., Geurts, A. C., Mulder, T. and Duysens, J.: Gait recovery is not associated with changes in the temporal patterning of muscle activity during treadmill walking in patients with post-stroke hemiparesis, Clinical Neurophysiology, 117(1), 4-15, (2006). DOI: 10.1016/ j.clinph.2005.08.014 – reference: 8) Nadeau, S., Arsenault, A. B., Gravel, D. and Bourbonnais, D.: Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke, American Journal of Physical Medicine and Rehabilitation, 78(2), 123-130, (1999). DOI: 10.1097/00002060-199903000- 00007 – reference: 12) Falconer, K. and Winter, D. A.: Quantitative assessment of co-contraction at the ankle joint in walking, Electromyography and Clinical Neurophysiology, 25(2-3),135-149, (1985). – reference: 30) Halliday, D. M., Rosenberg, J. R., Amjad, A. M., Breeze, P., Conway, B. A. and Farmer, S. F.: A framework for the analysis of mixed time series/point process data--theory and application to the study of physiological tremor, single motor unit discharges and electromyograms, Progress in Biophysics & Molecular Biology, 64(2-3), 237-278, (1995). DOI: 10.1016/s0079-6107(96)00009-0 – reference: 16) Lamontagne, A., Richards, C. L. and Malouin, F.: Coactivation during gait as an adaptive behavior after stroke, Journal of Electromyography and Kinesiology, 10(6), 407-415, (2000). DOI: 10.1016/s1050- 6411(00)00028-6 – reference: 5) Knutsson, E. and Richards, C.: Different types of disturbed motor control in gait of hemiparetic patients, Brain, 102(2), 405-430, (1979). DOI:10.1093/brain/102.2.405 – reference: 13) Nagai, K., Yamada, M., Uemura, K., Yamada, Y., Ichihashi, N. and Tsuboyama, T.: Differences in muscle coactivation during postural control between healthy older and young adults, Archives of Gerontology and Geriatrics, 53(3), 338- 343, (2011). DOI: 10.1016/j.archger.2011.01.003 – reference: 23) Kitatani, R., Ohata, K., Sakuma, K., Aga, Y., Yamakami, N., Hashiguchi, Y. and Yamada, S.: Ankle muscle coactivation during gait is decreased immediately after anterior weight shift practice in adults after stroke, Gait & Posture, 45, 35-40, (2016). DOI: 10.1016/ j.gaitpost.2016.01.006 – reference: 41) Van Criekinge, T., Vermeulen, J., Wagemans, K., Schröder, J., Embrechts, E., Truijen. S., Hallemans. A. and Saeys, W.: Lower limb muscle synergies during walking after stroke: a systematic review, Disability and Rehabilitation, 42(20), 2836-2845, (2020). DOI: 10.1080/09638288.2019.1578421 – reference: 27) Halliday, D. M., Conway, B. A., Christensen, L. O., Hansen, N. L., Petersen, N. P. and Nielsen, J. B.: Functional coupling of motor units is modulated during walking in human subjects, Journal of Neurophysiology, 89(2), 960-968, (2003). DOI: 10.1152/jn.00844.2002 – reference: 3) Brandstater, M. E., de Bruin, H., Gowland, C. and Clark, B. M.: Hemiplegic gait: analysis of temporal variables, Archives of Physical Medicine and Rehabilitation, 64(12), 583-587, (1983). – reference: 34) Kitatani, R., Koganemaru, S., Maeda, A., Mikami, Y., Matsuhashi, M., Mima, T. and Yamada, S.: Gait-combined transcranial alternating current stimulation modulates cortical control of muscle activities during gait, European Journal of Neuroscience, 52(12), 4791-4802, (2020). DOI: 10.1111/ejn.14919 – reference: 26) Fujita, K., Miaki, H., Hori, H., Kobayashi, Y. and Nakagawa, T.: How effective is physical therapy for gait muscle activity in hemiparetic patients who receive botulinum toxin injections? European Journal of Physical and Rehabilitation Medicine, 55(1), 8-18, (2019). DOI: 10.23736/S1973-9087.18.05168-7 – reference: 17) Rosa, M. C., Marques, A., Demain, S. and Metcalf, C. D.: Lower limb co-contraction during walking in subjects with stroke: A systematic review, Journal of Electromyography and Kinesiology, 24(1), 1-10, (2014).DOI: 10.1016/ j.jelekin.2013.10.016 – reference: 25) Chow, J. W., Yablon, S. A. and Stokic, D. S.: Coactivation of ankle muscles during stance phase of gait in patients with lower limb hypertonia after acquired brain injury, Clinical Neurophysiology, 123(8), 1599-1605, (2012). DOI: 10.1016/j.clinph.2012.01.006 – reference: 1) Perry, J., Garrett, M., Gronley, J. K. and Mulroy, S. J.: Classification of walking handicap in the stroke population, Stroke, 26(6), 982-989, (1995).DOI: 10.1161/01.str.26.6.982 – reference: 24) Burke, D., Wissel, J. and Donnan, G. A.: Pathophysiology of spasticity in stroke, Neurology, 80(3 Suppl 2), S20-26, (2013). DOI: 10.1212/WNL.0b013e31827624a7 – reference: 9) Gracies, J. M.: Pathophysiology of spastic paresis. II: Emergence of muscle overactivity, Muscle & Nerve, 31(5), 552-571, (2005). 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| Snippet | 脳卒中後患者は多様な後遺症が生じることから，歩行速度の低下や非対称的な歩行，歩行中の下肢筋活動の変化など異 常歩行として多くの特徴が報告されている.その中でも下... |
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| SubjectTerms | コヒーレンス 同時収縮 歩行 筋電図 脳卒中 |
| Title | 脳卒中後患者における異常歩行と下肢筋活動の変化 |
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