治療的電気刺激による痙性麻痺者の歩容改善

抄録

Damage of central nervous system caused by a stroke or spinal cord injury usually brings about motor paralysis and increase of muscle tone, spasticity. Excessive spasticity disturbs smooth and coordinated voluntary movement. In this study, we investigated the change of motion parameters during walking in the spastic paraplegic patients and hemiparetic stroke patients before and after application of therapeutic electrical stimulation (ES) . Five spastic paraplegics and seven spastic hemiparetics participated in this study. Eight were male and mean age was 46.3 ± 13.8 (16∼61) years. With regard to the stroke patients, all had left hemiparesis. Stimulation parameters were pulse width of 0.3 msec and frequency of 20 Hz. For the spastic paraplegic patients, stimulation was given to right and left leg alternately during 15 min with 10 s on and 5 s off interval. For the spastic hemiparetic patients, stimulation was only given to the side of paralysis with same duration and interval as the paraplegics. The data of more-spastic side of paraplegics and paralyzed side of hemiparetics were treated as one group (severe side). As for severe side, mean motion range of knee joint was significantly increased after ES (p < 0.05) . Mean motion range of hip joint showed a tendency to increase after stimulation (p < 0.1). Physiological and kinesiological mechanism on the effect of ES providing the change of some motion parameters is complicated. Usually, therapeutic ES for a muscle brings about spasticity inhibition of the antagonist muscle and facilitation of the target muscle. In the present study, ES for rectus muscle possibly suppressed the tone of hamstrings and elicited voluntary action of rectus. Hamstrings have actions as a knee flexor and a hip extensor. Consequently, the motion range of knee and hip joint may have been easily expanded during walking. The results in the present study suggest ES during 15 min can improve gait performance.