スピンターンを用いた左側への方向転換をおこなう際にスピード・安定性低下を認めた小脳出血の一症例

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  • Improvement of speed and stability in left side spin turns by a patient with cerebellar hemorrhage: case report
  • 症例報告 第17回関西理学療法学会症例研究学術大会 大会長賞論文 スピンターンを用いた左側への方向転換をおこなう際にスピード・安定性低下を認めた小脳出血の一症例
  • ショウレイ ホウコク ダイ17カイ カンサイ リガク リョウホウ ガッカイ ショウレイ ケンキュウ ガクジュツ タイカイ タイカイチョウショウ ロンブン スピンターン オ モチイタ ヒダリガワ エ ノ ホウコウ テンカン オ オコナウ サイ ニ スピード ・ アンテイセイ テイカ オ ミトメタ ショウノウシュッケツ ノ イチ ショウレイ

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<p>A patient with cerebellar hemorrhage underwent physical therapy because of a decline in the ability to turn to the left using a spin turn. When the left leg was used as the pivot leg, the main complaint was difficulty in performing an effective and quick turn, which was necessary for returning to work. The ability to turn on the left using a spin turn was essential. In the initial evaluation, when performing a spin turn, outward inclination of the lower left leg was difficult due to left foot pronation and left ankle joint dorsiflexion, and anterior weight shift to the left leg was insufficient. Subsequent lower left leg anteversion, because of ankle dorisflexion, and left side pelvic rotation, because of internal rotation of the hip joint, were insufficient, leading to insufficient travel of the right foot, which grounded without passing the left foot. As a result, a turn in two phases was needed, resulting in a speed decline. Moreover, left lower leg supination was excessive, while left forefoot pronation was poor, causing the left toe to leave the floor, thereby reducing stability. Measurements based on the problems identified by movement observation indicated hypotonia of the left peroneus longus muscle, left tibialis posterior muscle, and left triceps surae muscle, and moderate impairment of left foot position sense. Physical therapy involving pronation and supination movements of the foot allowed elevation of the heel in the standing position. In the final evaluation, outward inclination of the front of the leg with the left foot in pronation and left ankle joint in dorsiflexion had become possible, and anterior weight shift to the left side had increased. As a result, the swing of the right leg to the left side increased allowing a spin turn in one phase, and the speed of the turn improved. In addition, the left leg was now supported by the whole foot grounded on the floor, improving the stability of the left stance phase.</p>

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