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要約 目的:重度脳性麻痺患者のoptokinetic nystagmus(OKN)をアイトラッカーで測定し,誘発されたOKNを能動的に追従したときに誘発されるlook OKN(LOKN)と受動的に見ているときに誘発されるstare OKN(SOKN)に分類する。
対象と方法:対象は痙直型の重度脳性麻痺患者4例。眼球運動の測定にはアイトラッカーを使用した。視覚刺激は0.3cycles/degreeの矩形波チャートを水平方向へ5秒間ずつ10degree/sec(dps)で移動させた。刺激の間にはインターバルを設け,刺激提示時と比較した(マン・ホイットニーのU検定)。視線位置からOKNの緩徐相速度を算出し,3.0dps以上をLOKN,3.0dps未満をSOKNに分類した。
結果:全例で視覚刺激提示時とインターバルの眼球運動速度の間に有意差があり(p<0.0001),OKNが誘発された。4例の緩徐相速度はそれぞれ3.4,4.0,4.6,1.8dpsで,3例がLOKN,1例がSOKNに分類された。
結論:本法により重度脳性麻痺患者4例のOKNをLOKNとSOKNに分類でき,LOKNに分類された3例については能動的に視覚を活用できることが示された。本法は重度脳性麻痺患者の客観的視機能評価法の1つとして期待される。
Abstract Purpose:Optokinetic nystagmus(OKN)was assessed in four patients with severe cerebral palsy(CP)using eye tracker. Elicited OKN was classified as either look OKN(LOKN), which involves active tracking;or stare OKN(SOKN), which involves passive viewing.
Subjects and Method:The subjects were four patients with severe spastic CP. Eye movement was recorded using eye tracker. For the visual stimulus, a 0.3 cycles/degree square wave chart was moved horizontally at a speed of 10 degree/s(dps)for 5 seconds. Intervals were placed between successive stimuli. The eye movement velocity during visual stimulus presentation was compared with the eye movement velocity during the intervals. The slow-phase velocity of OKN was calculated based on gaze position. A velocity of ≧3.0 dps was classified as LOKN, while a velocity of <3.0 dps was classified as SOKN.
Result:All patients showed a significant difference between eye movement velocity during visual stimulus presentation and during the intervals. The slow-phase velocities for the four patients were 3.4, 4.0, 4.6, and 1.8 dps;thus, three patients' OKN was classified as LOKN, while one patient's OKN was classified as SOKN.
Conclusion:The method described in the present study was used to classify the OKN of four patients with severe CP as LOKN or SOKN;the three patients whose OKN was classified as LOKN were observed to be capable of using active vision. The method in the present study promises as an objective method for assessing visual function in patients with severe CP.
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