{"@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/1390282680552968960.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.14900/cjpt.2013.0937"}},{"identifier":{"@type":"NAID","@value":"130005246928"}},{"identifier":{"@type":"URI","@value":"https://search.jamas.or.jp/link/ui/2014332700"}}],"dc:title":[{"@language":"ja","@value":"膝関節運動制限による股関節および足関節運動への影響"}],"dcterms:alternative":[{"@language":"ja","@value":"―支持面の前後傾斜刺激における立位保持戦略の検討―"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"ja","@value":"【はじめに，目的】膝関節の可動域制限は運動能力低下や日常生活範囲の狭小だけでなく，姿勢制御能力の低下も引き起こす（Masui et al., 2006）。姿勢制御能力の低下は転倒の危険性を増加させるため，その予防として立位保持における膝関節運動と股関節および足関節運動との関係を理解することが重要である。床面（支持面）が前後傾斜するときの立位バランスを調べた研究によると，立位保持のためには股関節や足関節の運動と協調した膝関節運動が必要であると報告されている（Gage et al., 2007）。しかしながら，膝関節運動が制限された場合に股関節や足関節がどのように影響を受けるかはほとんど言及されていない。今回，我々は立位保持における下肢関節運動の役割を検討するために，膝関節運動を制限したときの股関節運動と足関節運動の変化を調べた。【方法】下肢関節に神経学的，および整形外科学的既往のない14名の健常成人（22±2歳）を対象とした。被験者は支持面が身体に対して前後方向に傾斜する台（Nambu mechatro社製）の上で立位を保持した。傾斜刺激を任意のタイミングで正弦波状に与え，20周期繰り返した。傾斜刺激の振幅を15°，周波数を0.25Hzと0.75Hzに設定した。被験者は立位を保持する間，膝関節運動を制限できる装具（ダイヤルロック式膝継手装具）を両膝に装着した。膝関節運動の条件として，膝屈曲20°以上伸展できないように制限する条件と膝装具を装着するだけで関節運動を制限しない条件の2種類を設定した。傾斜刺激の周波数や膝関節運動の条件はランダムに与えられた。身体各部位と傾斜台に反射マーカーを取りつけ，三次元動作解析装置（Motion analysis社製）により身体位置の動揺距離，関節運動の変化量，および傾斜台の傾きを求めた。各条件における股関節運動や足関節運動の変化を比較することで，それらの関節への膝関節伸展制限の影響を検討した。統計検定には反復測定二元配置分散分析，post-hoc testを用いた。危険率は5％とした。【倫理的配慮，説明と同意】この研究は，ヘルシンキ宣言に基づき対象者には必ず事前に研究趣旨を文書および口頭で十分に説明し，書面にて同意を得て行った。また本研究は本学研究院倫理委員会の承認を得て実施された。【結果】頭部の前後動揺距離において膝関節の伸展制限による有意な変化はなかった（制限なし3.2±0.9cm，制限あり3.6±1.0cm，p=0.32）。0.25Hzで傾斜刺激を行ったとき，足関節背屈運動は膝関節伸展制限により有意に増加した（制限なし16.1±2.3°，制限あり21.3±3.9°，p＜0.05）。一方，足関節底屈運動は伸展制限により有意に減少した（制限なし15.6±2.4°，制限あり8.2±2.8°，p＜0.01）。しかしながら，0.75Hzで傾斜刺激を行うと足関節背屈および底屈運動は膝関節伸展制限による影響を受けなかった（背屈p=0.67，底屈p=0.35）。股関節屈曲運動は膝関節伸展制限により0.25Hz（制限なし3.4±1.6°，制限あり7.2±1.8°，p＜0.01）と0.75Hz（制限なし5.5±1.6°，制限あり11.7±2.3°，p＜0.01）の両方において有意に増加した。【考察】傾斜刺激により身体は動揺するが，頭部の動揺距離は膝関節運動の伸展制限による影響を受けなかった。このことは，膝関節の運動を制限した場合でも健常者においては股関節や足関節が適切に調節され，身体動揺が補償される可能性を示唆している。膝関節伸展を制限し，低い周波数の傾斜刺激を与えると足関節背屈運動と底屈運動は有意に変化した。また，股関節屈曲は傾斜刺激の周波数の高低に関わらず膝関節伸展制限の影響を強く受けた。このことから，低い周波数の傾斜刺激の場合，足関節戦略と股関節戦略の両方の変化により姿勢を制御し，高い周波数の傾斜刺激では主に股関節戦略の変化により制御すると考えられる。本研究の結果は，立位バランスの保持において膝関節の役割が重要であること，および，状況に合わせて膝関節の役割を足関節や股関節が補償するであろうことを示唆している。【理学療法学研究としての意義】ある関節に機能低下がある場合，他の関節で代償が起こることをしばしば観察する。本研究は，膝関節における軽度の伸展制限が他の関節運動に大きな影響を及ぼすことを示した。立位保持における各下肢関節の関係を理解することはリハビリテーションにとって重要な課題であろう。理学療法士が適切な治療を提供するための一助となるはずである。"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1420282801199258240","@type":"Researcher","personIdentifier":[{"@type":"KAKEN_RESEARCHERS","@value":"60301917"},{"@type":"NRID","@value":"1000060301917"},{"@type":"NRID","@value":"9000391811334"},{"@type":"NRID","@value":"9000345270308"},{"@type":"NRID","@value":"9000345412311"},{"@type":"NRID","@value":"9000266898769"},{"@type":"NRID","@value":"9000257756275"},{"@type":"NRID","@value":"9000003850384"},{"@type":"NRID","@value":"9000275816544"},{"@type":"NRID","@value":"9000351083124"},{"@type":"NRID","@value":"9000345242729"},{"@type":"NRID","@value":"9000345239270"},{"@type":"NRID","@value":"9000345233035"},{"@type":"NRID","@value":"9000258335223"},{"@type":"NRID","@value":"9000341093184"},{"@type":"NRID","@value":"9000350548628"},{"@type":"NRID","@value":"9000258367317"},{"@type":"NRID","@value":"9000257756489"},{"@type":"NRID","@value":"9000345234596"},{"@type":"NRID","@value":"9000258373749"},{"@type":"NRID","@value":"9000258343793"},{"@type":"NRID","@value":"9000283413438"},{"@type":"NRID","@value":"9000283413338"},{"@type":"NRID","@value":"9000283760336"},{"@type":"NRID","@value":"9000345239021"},{"@type":"NRID","@value":"9000257757181"},{"@type":"NRID","@value":"9000292183150"},{"@type":"NRID","@value":"9000345245295"},{"@type":"NRID","@value":"9000018828465"},{"@type":"NRID","@value":"9000345235556"},{"@type":"NRID","@value":"9000283745848"},{"@type":"NRID","@value":"9000016894520"},{"@type":"NRID","@value":"9000345235178"},{"@type":"NRID","@value":"9000345232783"},{"@type":"NRID","@value":"9000258378467"},{"@type":"NRID","@value":"9000263469895"},{"@type":"NRID","@value":"9000399008827"},{"@type":"NRID","@value":"9000322103081"},{"@type":"NRID","@value":"9000350549950"},{"@type":"NRID","@value":"9000283769584"},{"@type":"NRID","@value":"9000258336704"},{"@type":"NRID","@value":"9000350550914"},{"@type":"NRID","@value":"9000350551163"},{"@type":"NRID","@value":"9000345237957"},{"@type":"NRID","@value":"9000283753359"},{"@type":"NRID","@value":"9000283768583"},{"@type":"NRID","@value":"9000345406672"},{"@type":"NRID","@value":"9000258381038"},{"@type":"NRID","@value":"9000391811308"},{"@type":"NRID","@value":"9000350557316"},{"@type":"NRID","@value":"9000345236700"},{"@type":"NRID","@value":"9000345417070"},{"@type":"NRID","@value":"9000258359186"},{"@type":"NRID","@value":"9000379074434"},{"@type":"NRID","@value":"9000345236686"},{"@type":"NRID","@value":"9000408922055"},{"@type":"NRID","@value":"9000292183194"},{"@type":"NRID","@value":"9000283744919"},{"@type":"NRID","@value":"9000345416850"},{"@type":"NRID","@value":"9000396145133"},{"@type":"NRID","@value":"9000258350086"},{"@type":"NRID","@value":"9000272962280"},{"@type":"NRID","@value":"9000283772254"},{"@type":"NRID","@value":"9000345416956"},{"@type":"NRID","@value":"9000258347744"},{"@type":"RESEARCHMAP","@value":"https://researchmap.jp/Hiroshi_Saito"}],"foaf:name":[{"@language":"ja","@value":"齊藤 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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":"2014","prism:volume":"2013","prism:number":"0","prism:startingPage":"0937"},"url":[{"@id":"https://search.jamas.or.jp/link/ui/2014332700"}],"availableAt":"2014","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=%E5%A7%BF%E5%8B%A2%E5%88%B6%E5%BE%A1","dc:title":"姿勢制御"},{"@id":"https://cir.nii.ac.jp/all?q=%E9%96%A2%E7%AF%80%E9%81%8B%E5%8B%95","dc:title":"関節運動"},{"@id":"https://cir.nii.ac.jp/all?q=%E5%A4%96%E4%B9%B1%E5%88%BA%E6%BF%80","dc:title":"外乱刺激"}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:2001306798"},{"@type":"CIA","@value":"130005246928"}]}