2005 年 5 巻 p. 109-118
We report the case of a cerebral vascular accident patient whose gait was affected by dysfunction of the trunk accompanying a poor mobility of the upper trunk. This patient was a 65-year-old male. He had suffered cerebral infarction in 1972, and was afflicted with paralysis of the left side. He said that his left leg stumbled in walking, and he wanted to walk without stumbling. His posture was retraction of scapula girdle, thorax flat, refloat of the inferior edge of ribs, and thoracic kyphosis, and motions of thorax and thoracic spine were not seen. We thought that the motion of his chief complaint was prevented by dysfunction of abdominal muscles due to poor mobility of the thorax and thoracic spine. We carried out evaluation of surface electromyography to certify trunk muscle activation of the left swing phase in the patient's gait. He carried out step motion of the left leg with a similar motion to the left swing phase. Although a healthy person shows an increase of muscle activation of the abdominal muscles and decrease of muscle activation of the low back muscles, our case had an inadequate muscle activity pattern compared with the healthy person. We perform therapy to increase mobility of the upper trunk to facilitate normalization of abdominal muscles activity. As a result, the mobility of his upper trunk increased, and his motion improved in gait. A similar muscle activity compared to healthy subjects was also shown with surface electromyography. It is suggested that in order to increase the mobility of the upper trunk, it is important to improve the function of trunk muscles, and the mobility of the upper trunk by maintaining normal muscle tone of the abdominal muscles.