麻痺側足部の機能障害と高次脳機能障害により歩行の実用性が低下した脳梗塞後左片麻痺の一症例

抄録

We report our experience of performing physical therapy on a patient with altered practical gait due to neuropsychological deficit and left foot paralysis associated with left-sided hemiplegia caused by a stroke suffered two years ago. Neuropsychological deficits observed in this patient were left body agnosia, disturbance of attention, and memory disorder. In order to improve the gait, we initiated physical therapy for the paralyzed foot. However, the effects of physical therapy were only temporary. The patient’s practical gait was further altered with changes in the environment and base of support. Because of impaired recognition of the left side of the body, the patient routinely repeated the same movement and found it difficult to diverge from this fixed movement pattern. We then initiated a physical therapy regimen that emphasized relation of movement, perception, and cognitive function to identify new movement. Remarkably, the patient could adapt his gait according to changes in the environment, suggesting the effectiveness of this physical therapy approach.