{"@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/1390282680550119296.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.14900/cjpt.2010.0.dcof1088.0"}},{"identifier":{"@type":"NAID","@value":"130005017538"}},{"identifier":{"@type":"URI","@value":"https://search.jamas.or.jp/link/ui/2011200541"}}],"dc:title":[{"@language":"ja","@value":"胸郭可動域練習の生理学的意義は何か？"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"ja","@value":"【目的】呼吸理学療法では，胸郭柔軟性の改善を目的に，胸郭伸張法，肋骨の捻転，胸郭の捻転，シルベスター法などの徒手的な胸郭可動域練習を実施している。これらの治療対象は呼吸器疾患のみならず，神経筋疾患や脳血管障害患者など幅広く，呼吸理学療法におけるコンディショニングの一つとしてプログラムに組み込まれることが多い。<BR>ところで，これらの胸郭可動域練習によって期待できる治療効果としては，胸郭柔軟性の改善だけでなく，換気量の増大，胸郭周囲筋の筋緊張抑制，リラクセーションなどが挙げられているが，これらの効果を裏付ける根拠となるデータは殆どないのが現状である。そこで本研究では，徒手的な胸郭可動域練習の効果を明らかにする目的で，治療前後における肺・胸郭のコンプライアンスや呼吸運動出力などを分析し，胸郭可動域練習の生理学的意義について検討した。      <BR>【方法】対象は健常な成人男性13名とした。年齢は22.1±2.8歳，身長は176.1±5.4cm，体重は66.5±9.7kgであった。各対象者に対し，初めにスパイロメーター（ミナト医科学社製AS-407）を用いて肺活量（VC）を測定した。測定は3回行い最大値を採用した。次に背臥位となり安静時の一回換気量，呼吸数などの換気パラメーターおよび，呼吸運動出力の指標として気道閉塞圧（P0.1）を測定した。方法は気道閉塞装置(Inflatable Balloon-Type&#8482; Inspiratory Occlusion)に流量計とマスクを直列に接続し，対象者の口から息が漏れないよう，測定担当者が固定した。さらに最大吸気位からゆっくり力を抜いて段階的に息を吐かせ，各肺気量位における肺容量と気道内圧の関係から圧量曲線を求め，肺・胸郭のコンプライアンスを測定した。これらの測定を以下に示す胸郭可動域練習の治療前後で同様の手順で実施した。  治療として実施した胸郭可動域練習は，全て背臥位における徒手胸郭伸張法，肋骨の捻転，胸郭の捻転の3種類とした。手技方法は，「呼吸理学療法標準手技（2008）」に掲載されている方法に準じて両側の胸郭に対し実施した。治療時間は実際の臨床を想定し，各手技の実施時間を約2分間，合計約6分間とした。統計解析は，治療前後における各測定項目について，対応のあるt検定を実施し，有意水準は5%未満とした。<BR>【説明と同意】全ての被験者には，本研究の主旨を口頭および書面で説明し，同意を得た上で測定を実施した。<BR>【結果】肺活量は治療前後でそれぞれ，4.98±0.57L，5.01±0.61Lと有意な増加は認められず，また圧量曲線から求めた肺・胸郭のコンプライアンスは治療前後でそれぞれ，5.22±1.59L/cmH2O，5.65±1.86 L/cmH2Oと有意な改善は認められなかった。一方，安静時のおける一回換気量も治療前後で変化が認められなかったにも関わらず，呼吸運動出力を示すP0.1（1.81±0.45cmH2O，1.18±0.45cmH2O）や呼吸数（14.21±4.33回/分，12.76±3.59回/分），吸気時間（1.96±0.54秒，2.64±0.84秒），呼気時間（2.32±0.55秒，2.84±0.78秒），吸気呼気時間比（0.85±0.11，0.93±0.13）には治療前後で有意な改善が認められた。<BR>【考察】本研究では，呼吸理学療法におけるコンディショニングとして実施されている胸郭可動域練習の生理学的意義について，呼吸機能や肺のコンプライアンス，呼吸運動出力の面から検討した。その結果，肺活量や肺のコンプライアンスには治療前後における改善は認められなかったが，P0.1や吸気時間，呼気時間などにおいて有意な改善が認められた。P0.1は中枢からの呼吸運動出力を反映すると考えられ，横隔神経活動との相関があることから，呼吸努力を間接的に捉えることができるため，呼吸困難に関する研究の指標として使われている。したがって，従来は胸郭可動性を改善することで胸郭柔軟性（胸郭コンプライアンス）や肺活量（肺のコンプライアンス）の改善などが得られると考えられてきたが，本研究の結果から，胸郭可動域練習の生理学的意義は呼吸運動出力の低下，すなわち呼吸困難の軽減やリラクセーション効果であることが示唆された。<BR>【理学療法学研究としての意義】<BR>  本研究の結果は，これまで実施されてきた胸郭可動域練習の効果に関する生理学的意義を明らかにするものであり，今後の呼吸理学療法のエビデンス作りに寄与するものである。<BR>"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1420845751153756544","@type":"Researcher","personIdentifier":[{"@type":"KAKEN_RESEARCHERS","@value":"70269851"},{"@type":"NRID","@value":"1000070269851"},{"@type":"CINII_AUTHOR_ID","@value":"DA16895421"},{"@type":"URI","@value":"https://ci.nii.ac.jp/author/DA16895421#entity"},{"@type":"URI","@value":"https://viaf.org/viaf/NII%7CDA16895421"},{"@type":"NRID","@value":"9000003209470"},{"@type":"NRID","@value":"9000391685698"},{"@type":"NRID","@value":"9000391686436"},{"@type":"NRID","@value":"9000327101576"},{"@type":"NRID","@value":"9000403150967"},{"@type":"NRID","@value":"9000392016545"},{"@type":"NRID","@value":"9000006428079"},{"@type":"NRID","@value":"9000007507767"},{"@type":"NRID","@value":"9000287358088"},{"@type":"NRID","@value":"9000345273995"},{"@type":"NRID","@value":"9000345240879"},{"@type":"NRID","@value":"9000392018159"},{"@type":"NRID","@value":"9000258363408"},{"@type":"NRID","@value":"9000258347209"},{"@type":"NRID","@value":"9000258339001"},{"@type":"NRID","@value":"9000258360244"},{"@type":"NRID","@value":"9000263465479"},{"@type":"NRID","@value":"9000010650025"},{"@type":"NRID","@value":"9000256606981"},{"@type":"NRID","@value":"9000283765758"},{"@type":"NRID","@value":"9000350550320"},{"@type":"NRID","@value":"9000313614857"},{"@type":"NRID","@value":"9000345272176"},{"@type":"NRID","@value":"9000345236726"},{"@type":"NRID","@value":"9000310333848"},{"@type":"NRID","@value":"9000258376338"},{"@type":"NRID","@value":"9000258350207"},{"@type":"NRID","@value":"9000024193260"},{"@type":"NRID","@value":"9000401894916"},{"@type":"NRID","@value":"9000392015052"},{"@type":"NRID","@value":"9000397685805"},{"@type":"NRID","@value":"9000258353812"},{"@type":"NRID","@value":"9000258379735"},{"@type":"NRID","@value":"9000258382314"},{"@type":"NRID","@value":"9000257761072"},{"@type":"NRID","@value":"9000003260310"},{"@type":"NRID","@value":"9000266745519"},{"@type":"NRID","@value":"9000391686565"},{"@type":"NRID","@value":"9000345238055"},{"@type":"NRID","@value":"9000345414208"},{"@type":"NRID","@value":"9000314384370"},{"@type":"NRID","@value":"9000403151028"},{"@type":"NRID","@value":"9000258373740"},{"@type":"NRID","@value":"9000258337227"},{"@type":"NRID","@value":"9000258095836"},{"@type":"NRID","@value":"9000263469113"},{"@type":"NRID","@value":"9000263464533"},{"@type":"NRID","@value":"9000024269476"},{"@type":"NRID","@value":"9000312254012"},{"@type":"NRID","@value":"9000345239411"},{"@type":"NRID","@value":"9000253259998"},{"@type":"NRID","@value":"9000392015167"},{"@type":"NRID","@value":"9000258353945"},{"@type":"NRID","@value":"9000258353905"},{"@type":"NRID","@value":"9000258341202"},{"@type":"NRID","@value":"9000258334592"},{"@type":"NRID","@value":"9000265256188"},{"@type":"NRID","@value":"9000263464515"},{"@type":"NRID","@value":"9000263468815"},{"@type":"NRID","@value":"9000391685805"},{"@type":"NRID","@value":"9000391811199"},{"@type":"NRID","@value":"9000321627590"},{"@type":"NRID","@value":"9000350553059"},{"@type":"NRID","@value":"9000345240865"},{"@type":"NRID","@value":"9000345246312"},{"@type":"NRID","@value":"9000258353596"},{"@type":"NRID","@value":"9000258381442"},{"@type":"NRID","@value":"9000018319259"},{"@type":"NRID","@value":"9000006051962"},{"@type":"NRID","@value":"9000283760889"},{"@type":"NRID","@value":"9000345231430"},{"@type":"NRID","@value":"9000283749138"},{"@type":"NRID","@value":"9000254135700"},{"@type":"NRID","@value":"9000257761439"},{"@type":"NRID","@value":"9000024952118"},{"@type":"NRID","@value":"9000002574855"},{"@type":"NRID","@value":"9000045647963"},{"@type":"NRID","@value":"9000003220386"},{"@type":"NRID","@value":"9000283756967"},{"@type":"NRID","@value":"9000006809313"},{"@type":"NRID","@value":"9000370283768"},{"@type":"NRID","@value":"9000317564725"},{"@type":"NRID","@value":"9000350553032"},{"@type":"NRID","@value":"9000345231404"},{"@type":"NRID","@value":"9000345414272"},{"@type":"NRID","@value":"9000392017450"},{"@type":"NRID","@value":"9000398283432"},{"@type":"NRID","@value":"9000398798197"},{"@type":"NRID","@value":"9000258337226"},{"@type":"NRID","@value":"9000258340849"},{"@type":"NRID","@value":"9000257755732"},{"@type":"NRID","@value":"9000005618489"},{"@type":"NRID","@value":"9000350556758"},{"@type":"NRID","@value":"9000283774069"},{"@type":"NRID","@value":"9000345414644"},{"@type":"NRID","@value":"9000392149811"},{"@type":"NRID","@value":"9000392016771"},{"@type":"NRID","@value":"9000283117717"},{"@type":"NRID","@value":"9000403433532"},{"@type":"NRID","@value":"9000018823934"},{"@type":"NRID","@value":"9000321627358"},{"@type":"NRID","@value":"9000345233892"},{"@type":"NRID","@value":"9000345234409"},{"@type":"NRID","@value":"9000283752004"},{"@type":"NRID","@value":"9000283756826"},{"@type":"NRID","@value":"9000253259848"},{"@type":"NRID","@value":"9000414821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彰"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"兵庫医療大学  リハビリテーション学部"}]},{"@id":"https://cir.nii.ac.jp/crid/1410282680550119297","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000283774784"}],"foaf:name":[{"@language":"ja","@value":"大島 洋平"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"京都大学医学部附属病院  リハビリテーション部"}]},{"@id":"https://cir.nii.ac.jp/crid/1420845751140767488","@type":"Researcher","personIdentifier":[{"@type":"KAKEN_RESEARCHERS","@value":"50449435"},{"@type":"NRID","@value":"1000050449435"},{"@type":"NRID","@value":"9000002304560"},{"@type":"NRID","@value":"9000412280476"},{"@type":"NRID","@value":"9000405634115"},{"@type":"NRID","@value":"9000398794573"},{"@type":"NRID","@value":"9000414821270"},{"@type":"NRID","@value":"9000412280398"},{"@type":"NRID","@value":"9000412574241"},{"@type":"RESEARCHMAP","@value":"https://researchmap.jp/kera"}],"foaf:name":[{"@language":"ja","@value":"解良 武士"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"日本医療科学大学  保健医療学部"}]}],"publication":{"prism:publicationName":[{"@language":"en","@value":"Congress of the Japanese Physical Therapy Association"},{"@language":"ja","@value":"理学療法学Supplement"}],"dc:publisher":[{"@language":"en","@value":"Japanese Physical Therapy Association(Renamed Japanese Society of Physical Therapy)"},{"@language":"ja","@value":"日本理学療法士協会（現 一般社団法人日本理学療法学会連合）"}],"prism:publicationDate":"2011","prism:volume":"2010","prism:number":"0","prism:startingPage":"DcOF1088","prism:endingPage":"DcOF1088"},"url":[{"@id":"https://search.jamas.or.jp/link/ui/2011200541"}],"availableAt":"2011","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=%E5%91%BC%E5%90%B8%E7%90%86%E5%AD%A6%E7%99%82%E6%B3%95","dc:title":"呼吸理学療法"},{"@id":"https://cir.nii.ac.jp/all?q=%E8%83%B8%E9%83%AD%E5%8F%AF%E5%8B%95%E5%9F%9F%E7%B7%B4%E7%BF%92","dc:title":"胸郭可動域練習"},{"@id":"https://cir.nii.ac.jp/all?q=%E5%91%BC%E5%90%B8%E9%81%8B%E5%8B%95%E5%87%BA%E5%8A%9B","dc:title":"呼吸運動出力"}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:1003389079"},{"@type":"CIA","@value":"130005017538"}]}