直線偏光近赤外線照射が脳血管障害片麻痺患者の痙縮に与える影響

• Published in: 理学療法学 Vol. 35; no. 1; pp. 13 - 22
• Main Authors: 竹内 伸行, TANAKA Eri, 桑原 岳哉, 臼田 滋
• Format: Journal Article
• Language: Japanese
• Published: 日本理学療法士学会 20.02.2008; Japanese Society of Physical Therapy
• Subjects: 痙縮; 直線偏光筋赤外線; 脳血管障害
• ISSN: 0289-3770; 2189-602X
• DOI: 10.15063/rigaku.kj00004872211

Linear polarized near-infrared ray (LPNR) irradiation is used in deep heating modalities. Because of its properties, we consider it could be used to control spasticity after cerebrovascular disease (CVD). However, little study has been reported about its effects. The purpose of this study was to determine the effects of LPNR irradiation on spasticity after CVD. The subjects were thirty-nine patients after CVD. They were randomly divided into three groups (each group thirteen persons). The N group was given irradiation of the tibial nerve of popliteal space, G group was given irradiation of the gastrocnemius, and C group was not irradiated. R1 and R2 of the Modified Tardieu Scale of ankle dorsiflexion in knee extension and flexion positions were measured four times at before and after irradiation, after irradiation at fifth day and five days after at the last irradiation. R1 mainly reflects the neural components of spasticity. R2 mainly reflects non-neural components. The immediate effects, cumulative effects and carry over effects were analyzed based on each result. In the N group, R1 of knee extension and flexion positions with immediate effects were significantly different from C group. In G group, R1 of knee flexion position with cumulative effects was significantly different from C group. The R2 of knee extension and flexion positions in N and G groups with immediate effects were significantly different from C group. Furthermore, the R2 of knee extension position in N and G groups with cumulative effects were significantly different from C group. We concluded that LPNR irradiation has immediate effects and cumulative effects of control in spasticity after CVD. However, we found that LPNR irradiation has no carry over effects. 脳卒中治療ガイドライン（2004）に示された痙縮治療法の一つに温熱療法がある。直線偏光近赤外線（linear polarized near-infrared ray ; 以下，LPNR）は優れた深部温熱作用を有し痙縮抑制効果が期待できるが，その報告は見当たらない。本研究の目的は，脳血管障害片麻痺患者に対するLPNRの神経照射と筋腹照射の痙縮抑制効果を検討することである。対象は麻痺側下腿三頭筋に痙縮を認める脳血管障害片麻疹患者39人で，この39人を神経照射（N）群13人，筋腹照射（G）群13人，対照（C）群13人に無作為に割り付けた。N群は麻痺側膝窩部脛骨神経上，G群は麻痺側下腿三頭筋筋腹にLPNRを照射した。C群は照射しなかった。照射前，照射直後，照射5日後，照射を止めて（休止）5日後に麻痺側下腿三頭筋におけるModified Tardieu ScaleのR1とR2を膝伸展位と膝屈曲位で測定した。R1は筋を素早く伸張した際に最初にひっかかりが生じる関節角度で，主に痙縮の反射性要素を反映する。R2はゆっくり筋を伸張した際の最大関節角度で，主に非反射性要素を反映する。照射前に対する照射直後の変化量を即時効果，照射5日後の変化量を累積効果，休止5日後の変化量を持ち越し効果と定義した。統計解析は，一元配置分散分析を行い有意差を認めた場合は多重比較検定（Scheffe法）にて群間比較を行った。結果，R1は，即時効果においてN群の膝伸展位と膝屈曲位，累積効果においてG群の膝屈曲位でC群に比して有意な拡大を認めた。R2は，即時効果においてN群とG群の膝伸展位と膝屈曲位，累積効果においてN群とG群の膝伸展位でC群に比して有意な拡大を認めた。痙縮を認める下腿三頭筋の支配神経である脛骨神経またはその筋腹にLPNRを照射した結果，痙縮抑制の即時効果と累積効果を認めたが，持ち越し効果は認めなかった。