2010 年 10 巻 p. 77-84
Exercise therapy was ordered for a patient with Guillain-Barré syndrome who had difficulty typing on a computer keyboard with the left little finger. No abduction or flexion of the left little finger was observed during typing, while marked compensatory supination of the forearm was observed. Occupational therapy and electromyography findings suggested that weakness of the left ulnar carpal flexor and extensor muscles reduced the stability of the attachment sites of these muscles, which are the pisiform, hamate, and 5th metacarpal bones. The reduced stability of these bones inhibited efficient muscle activity of the abductor and flexor muscles in the little finger. In exercise therapy, the left ulnar carpal flexor and extensor muscles were simultaneously strengthened to increase the stability of the pisiform, hamate, and 5th metacarpal bones, with the goal of increasing the muscle activity of not only the left little finger abductor and flexor muscles but also those of the muscles around this finger. The patient was able to type by abduction and flexion of the left little finger 2 months after initiation of the exercise therapy, and this improvement was also observed on electromyography. It is important to perform an occupational therapeutic evaluation with exercise therapy, focusing not only on the activity of the muscles around the left little finger but also on the carpal and metacarpal stability due to activity of the left ulnar flexor muscles.