関西理学療法
Online ISSN : 1349-9572
Print ISSN : 1346-9606
ISSN-L : 1346-9606
症例報告
麻痺側上肢での包丁操作において食材の切断が困難であった脳梗塞後右片麻痺患者に対する理学療法
伊藤 陸貝尻 望藤本 将志大沼 俊博渡邊 裕文萩尾 亜弥鈴木 俊明
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2013 年 13 巻 p. 121-128

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In this study, we report the results of physiotherapy for a patient with right hemiplegia after cerebral infarction, who complained of difficulty in using a kitchen knife with his right hand. This was because of the occurrence of pathological synkinesis involving left trunk lateroflexion and right shoulder elevation, shoulder joint flexion, adduction, and internal rotation; elbow joint internal rotation; and forearm pronation. While isolated movements on the right side became possible one month after the onset of cerebral infarction, a decrease in performance due to involuntary movements, causing the knife to move left and forward, was continuously observed. Hypotonia in the bilateral internal and external oblique muscles and hypertonia in the left iliocostalis muscle were suspected as the primary causes of these abnormal movements. Pathological synkinesis in the right upper limb leading to left trunk lateroflexion and simultaneous right shoulder girdle elevation, may have occurred when using a kitchen knife, because of abnormal tone of the trunk muscles. Based on this hypothesis and focusing on the problem with the trunk, physiotherapy was performed to improve the tone of the trunk muscles by practicing lateral weight shifts to the left in the standing position. It became possible for the patient to handle a kitchen knife, while maintaining the trunk in a neutral position without left trunk lateroflexion. This led to the disappearance of pathological synkinesis on the right side when performing cutting activities, improving the patient’s handling of the kitchen knife. These results highlight the importance of maintaining symmetrical postures for the improvement of upper limb functions on the affected side in patients with post-stroke hemiplegia.

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© 2013 関西理学療法学会
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