抄録
We encountered a patient with hemiplegia caused by a cerebrovascular disorder. The chief symptom was gait disturbance due to insufficient lifting of the toe from the ground on the affected side caused by leaning of the trunk forward and toward the affected side when toe on the affected side was lifted from the ground. Hypotonus of the abdominal muscles on the affected side was involved in the leaning of the trunk forward and toward the affected side. Hypertonus of the hamstring muscles on the unaffected side caused by compensation for the instability was observed. In the patient, treatment of hypotonus of the abdominal muscles was performed, but the effects reached a plateau. While re-examining the condition, we noticed shortening of the pectoralis major muscle on the affected side. The shortening of the pectoralis major muscle on the affected side, which had been caused by compensation of the instability induced by long-term hypotonus of the abdominal muscle tonus, limited the mobility of the shoulder girdle and trunk, and further reduced the tonus of the abdominal muscles, creating a vicious circle. We performed stretching exercises of the shortened pectoralis major muscle on the affected side, and examined the effects by EMG. The hypotonus of the abdominal muscles was improved by stretching exercises, and the hypertonus of the hamstring muscles on the unaffected side was also improved. And also the gait disturbance was improved by the combination of treatment of the abdominal muscles and stretching exercises of the shortened pectoralis major muscle on the affected side. Our experience indicated the importance of treatment of the shortened pectoralis major muscle on the affected side caused secondarily in the long term in addition to treatment of hypotonus of the abdominal muscles caused primarily by a cerebrovascular disease.
