中枢神経疾患患者の起き上がり・立ち上がりの評価と アプローチ

抄録

Central nervous system diseases are diseases that occur when some lesion occurs in the central nervous system, such as the brain or spinal cord, and there is a wide variety of medical conditions. In this lecture, we will discuss the assessment and approach to getting up and standing up in the context of cerebrovascular disease and spinocerebellar degeneration. In the first case, the interpretation and approach to getting up in cerebrovascular disease will be described. In the normal movement of getting up, the thorax is rotated to the same side by flexing the shoulder girdle on the getting up side. However, in the case of the patient with left hemiplegia due to cerebrovascular disease, the flexion of the right shoulder girdle causes insufficient right rotation of the rib cage when the patient rises to the nonparalyzed side. Through this case study, we will explain in what cases the flexion of the shoulder girdle on the rising side becomes inadequate. The approach to be taken in such cases will also be discussed. In the second case, we will discuss the interpretation and approach to standing up movements in spinocerebellar degeneration. In the flexion phase of standing up, the movement begins with trunk flexion, followed by hip flexion. In the extension phase, the trunk, hip, knee, and ankle joints move in tandem. In spinocerebellar degeneration, movements are sometimes interpreted in such a way that “the patient is unable to link movements due to cerebellar ataxia”. However, it is important to analyze movement from a kinematic perspective to clarify and approach the functional impairment. In this lecture, after clarifying the functional disability based on the interpretation of movement, we will explain how to devise an approach based on the characteristics of the case.