抄録
We performed physical therapy for a patient with left hemiplegia after right putaminal hemorrhage who had a tendency to fall backwards toward the paralyzed left side while standing up. In the standing-up motion of this patient, hip joint flexion on the paralyzed left side was poor in the flexion phase, and flexion, abduction, and internal rotation of the hip joint on the non-paralyzed right side caused slight pelvic anteversion from retroversion, and pelvic depression and forward inclination of the trunk on the right side. In addition, the hip joint on the paralyzed side was externally rotated, and the ankle joint was in the plantar flexion position and lifted the medial sole from the floor, increasing weight-bearing on the lower limb on the non-paralyzed side when the gluteal region was lifted from the seat. Consequently, weight-bearing on the paralyzed left side was insufficient, and the gluteal region was lifted from the seat by extension of the hip and knee joints on the non-paralyzed right side. This movement of the right lower limb induced hip joint flexion and adduction, knee joint extension, ankle joint plantar flexion, and an associated contralateral reaction: inversion of the left foot, which lifted the sole on the paralyzed side, leading to a tendency to fall backwards toward this side with hip joint extension and adduction, knee joint extension, and ankle joint plantar flexion on the right side in the subsequent extension phase. Thus, physical therapy was performed to improve the problem with the standing-up motion after the gluteal region had been lifted from the seat, focusing on a symmetric seated posture, symmetric movement in the flexion phase of standing up, and the application of tactile and pressure sensations to the sole on the paralyzed left side. In addition, the patient was instructed to load weight carefully on the lower limb on the paralyzed side while visually confirming sufficient contact of the sole on that side with the floor by half standing, followed by slowly increasing the seat height and weight-bearing on the left lower limb. Through this procedure, the patient became aware of weight-bearing on the paralyzed side and was able to support lifting of the gluteal region and the extension phase of the standing-up motion with both lower limbs, thereby achieving a standing position. Through this case, we confirmed the necessity of considering the environment and limb positions in physical therapy, and the awareness of weight-bearing on the paralyzed lower limb by patients with severe tactile disorder of the sole and difficulty in weight-bearing on the paralyzed side. In addition, we learned that support by the paralyzed lower limb can be acquired and an abnormal pattern of standing-up movement can be improved by repeated practice of the normal motion, with emphasis on the application of tactile and pressure sensations to the sole on the paralyzed side.
