{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1390282680547754368.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.14900/cjpt.2011.0.bb1190.0"}},{"identifier":{"@type":"NAID","@value":"130004692773"}}],"dc:title":[{"@language":"ja","@value":"在宅脳卒中片麻痺患者の排泄動作自立者における下衣操作能力の検討"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"ja","@value":"【はじめに、目的】　脳卒中片麻痺患者にとって排泄動作の内,ズボンの上げ下げ（以下,下衣操作）は操作能力や立位バランス能力を必要とするために,特に難易度の高い動作である.そこで今回,片手でズボンの下衣操作が自立している在宅脳卒中片麻痺患者の下衣操作能力を麻痺の重症度別に分類し,バランス能力,筋力との関連性について検討した.【方法】　対象の選択基準は,平成20年4月から平成22年4月の間に当法人の通所リハビリテーションを利用している初発脳卒中片麻痺患者68名のうち，排泄動作が自立しており,片手のみで下衣操作を行っている28名（男性17名,女性11名,72.0±7.6歳）とした．下肢Brunnstrom stage（以下,下肢stage）はIII:10名,IV:12名,V:6名であった.方法は,下衣操作能力の評価として下衣操作遂行時間と持ち替え回数の２種類を測定した.下衣操作は，ヤコビー線を指標とし, ヤコビー線から膝蓋骨上縁まで下げるように指示したズボンを，再びヤコビー線まで上げる動作を１動作として、遂行時間とその回数をストップウォッチにて計測した.立位バランス能力は, ツイングラビコーダー（アニマ社製G-620）を使用して，静止立位（総軌跡長,健側・患側下肢荷重率）と下衣操作時（健側・患側下肢荷重率）の２場面を評価した.患側機能評価は，安定した10秒間患側最大荷重率を測定した．健側膝関節伸展筋力（以下,健側膝伸展筋力）は，ハンドヘルドダイナモメーター（以下,HHD）を使用して測定し，握力はデジタル式握力計T.K.K5401(竹井機器)を用いて測定した．いずれも２回施行し,大きい値を採用した.統計処理は統計ソフトIBM SPSS Statics18.0を用いて,下衣操作能力（動作遂行時間,持ち替え回数）と各評価項目との関係をSpearmanの順位相関係数にて分析を行った.３群間の比較には多重比較検定（Tukey-Kramer法）を行った.統計的有意水準は5%未満とした.【倫理的配慮、説明と同意】　本研究は,当院の倫理委員会の承認を得て行われており,対象者には,口頭にて十分な説明を実施し,文章にて同意を得た.【結果】　静止立位,下衣操作時における健側荷重率の比較では,ツイングラビコーダー解析から，静止立位時は,28名中26名は健側荷重率が50%以上であった.また麻痺が重度なほど,その値は増大傾向にあり,健側荷重優位の非対称性の立位姿勢を呈していた.下衣操作時は,28名中27名が健側荷重優位となった.多重比較検定では，静止立位の健側荷重率において，StageIIIとstageIV（p＝0.047）,stageIIIとstageV（p＝0.001）,下衣操作中の健側荷重率において，StageIIIとstageIV（p＝0.026）,stageIIIとstageV（p＝0.046）に有意差を認めた.患側最大荷重率と下衣操作能力の比較では,患側最大荷重率と下衣操作遂行時間及び持ち替え回数との関係は,いずれも有意な相関は認められなかった.健側筋力と下衣操作能力の比較では,健側膝伸展筋力と下衣操作遂行時間及び持ち替え回数との関係は，stageIIIでは中等度以上の相関を認めたが,stageIV,Vにおいては有意な相関を認めなかった.握力と下衣操作遂行時間及び持ち替え回数との関係は,stageIIIでは中等度以上の負の相関を認めたが,stageIV,Vにおいては有意な相関を認めなかった.【考察】　今回，対象者28名の脳卒中片麻痺患者における麻痺重症度分類による排泄動作能力を検討した結果，荷重率は下肢運動機能が重度なほど健側荷重優位であった．しかも患側最大荷重率と下衣操作能力との間には有意な相関は認められなかったことから，患側への荷重能力が必ずしも下衣操作能力の向上にはつながらないことが示唆された.下肢stageIIIでは筋力（健側膝伸展筋力,握力）と下衣操作能力（下衣操作遂行時間,持ち替え回数）との間に中等度以上の相関を認められたことは,患側の運動機能が低下していても,健側上下肢筋力の代償作用によって下衣操作は円滑に行えることが推察された.【理学療法学研究としての意義】　今日，医療制度改革の進む中,在院日数の短縮やクリティカルパスの導入など医療効率の向上が求められている.理学療法場面においても排泄動作の自立に向けた積極的な治療介入が重要かつ，早急の課題となっており,今回の結果は,下衣操作能力の効率的な運動指導の一助になる可能性があるのではないかと考える."}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410001205572361858","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000018781855"},{"@type":"NRID","@value":"9000392011245"},{"@type":"NRID","@value":"9000258379079"},{"@type":"NRID","@value":"9000347098026"},{"@type":"NRID","@value":"9000258378938"},{"@type":"NRID","@value":"9000347098683"},{"@type":"NRID","@value":"9000258378925"},{"@type":"NRID","@value":"9000347098819"},{"@type":"NRID","@value":"9000263468049"},{"@type":"NRID","@value":"9000392012329"},{"@type":"NRID","@value":"9000283771486"},{"@type":"NRID","@value":"9000347098774"},{"@type":"NRID","@value":"9000283770399"},{"@type":"NRID","@value":"9000266898755"},{"@type":"NRID","@value":"9000257757096"},{"@type":"RESEARCHMAP","@value":"https://researchmap.jp/kenji7"}],"foaf:name":[{"@language":"ja","@value":"岩田 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