Muscle afferent block (MAB) は0.5%リドカインと無水エタノールを10 : 1の割合で筋肉内に注射する方法であり, 筋の異常活動を正常化し痙縮改善効果が期待できる. 脳卒中後の上肢の痙縮を有する2例に対してMABを用いて治療を試みた. 痙縮の評価は対象関節のModified Ashworth ScaleとPassive Range of Motionを用いて行った. 治療の結果, 2例とも早期に痙縮改善効果を認め, 痙縮が原因のリハビリテーション的問題点の改善も得られた. この結果はA型ボツリヌス毒素の筋肉内注射と比較して, 効果発現は早いが効果持続期間は短いとされる文献上のMABの特徴に合致するものであった. MABは痙縮に対するA型ボツリヌス毒素の筋肉内注射や神経破壊剤を使用した神経ブロック法の代替手段としての可能性を有すると考えられた.

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We experienced a case of a 66-year-old man who had lumbar plexus paralysis caused by a retroperitoneal hemorrhage complicated by anticoagulation treatment administered for f cerebral infarction. He was hospitalized for cerebral infarction with right hemiplegia and aphasia, and underwent anticoagulation treatment. After a few days, both the hemiplegia and the aphasia were improved by the treatment. However, disturbance of consciousness and serious anemia developed suddenly, and his condition was diagnosed as retroperitoneal hemorrhage. It was treated conservatively, and the disturbance of consciousness was improved one month later, but then, he noticed motor paralysis of the right lower extremity. Objectively, muscles of the iliopsoas, quadriceps femoris, and hip adductors showed serious paralysis, and this was diagnosed as lumbar plexus paralysis by physical examination and electromyography. For the neuroparalysis, rehabilitation such as therapeutic electrical stimulation and biofeedback, were administered, but the paralysis still remained six months later. A knee brace and a T cane were necessary for him to walk. As a complication of anticoagulation treatment, retroperitoneal hemorrhage is known, but there are a few reports about coincidence with hemiplegia. It is necessary to consider this complication from the early phase such as bedside rehabilitation because an early diagnosis can lead to the developmental prevention of serious dysfunction.

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It has been generally considered that physical fitness is represented by exercise performance under aerobic conditions. However, we are often required to exert highly powerful movements momentarily or within a few seconds in daily life. Therefore, when we evaluate physical fitness, it appears important to evaluate physical fitness not only under aerobic conditions, but also under anaerobic conditions, with the latter being represented by maximal muscle power. In the daily living of people with physical disabilities, whether or not they can achieve a specific activity (for example, standing up, getting up from the floor and sitting down, etc.) is considered to depend on their performance under anaerobic conditions rather than under aerobic conditions. The Wingate anaerobic test (WAnT) has been developed as one of the most precise tests to evaluate anaerobic exercise performance. The WAnT, established at the Wingate Institute in Israel in 1970s, is a test incorporating bicycle riding with a maximal effort for 30 seconds. An ergometer with equipment to load an examinee with a constant resistance from a suspended weight is used in this test. The WAnT is measured as the changes in mechanical power that are yielded by multiplying the resistance produced from a suspended weight by the rotation speed of pedaling during a period of 30 seconds. The WAnT has not been usually applied so far to disabled people due to some technical problems. However, we have been improving the test to overcome those problems so that we can adopt the WAnT in the field of rehabilitation. We expect that this modified WAnT would contribute to a comprehensive evaluation of physical fitness in people with disabilities.

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QOLをみすえた周術期リハビリテーション…小山　照幸　839

悪性腫瘍（がん）の周術期呼吸リハビリテーション…辻　　哲也　844

周術期呼吸リハビリテーションとそのシステム…菅　　俊光，沖井　　明　852

急性期治療での呼吸リハビリテーション—当院での工夫と課題—…高橋　紳一　859

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第31回日本リハビリテーション医学会関東地方会…888

第18回日本リハビリテーション医学会九州地方会…891

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