Unified Parkinson's disease rating scaleと三次元動作解析を用いたパーキンソン病患者のリハビリテーションの有効性の検討

Efficacy of Rehabilitation in Parkinson's Disease Patients using the Unified Parkinson's Disease Rating Scale (UPDRS) and Three-dimensional Motion Analysis

要旨　【目的】Unified Parkinson's desease rating scale（UPDRS）と三次元動作解析を用いてパーキンソン病のリハ戦略における身体運動機能の重要性を明らかにする．【対象と方法】対象は17名で，体幹・下肢の関節可動域訓練，筋力増強訓練，ストレッチ訓練等のリハを約4週間実施し，リハ前後で比較検討した．【結果】UPDRSを用いた評価では総合点でリハ前37.9±13.2点からリハ後27.3±11.2点に有意に減少し，ADL項目では12.4±6.9点から9.5±6.3点に，運動項目でも22.5±7.5点から15.3±6.5点に改善を認めた．UPDRSの運動項目を用いた評価ではパーキンソン症候では，筋強剛，無動で改善し，身体機能では体幹，上肢，下肢で改善した．三次元動作解析（N＝9）では，歩幅，歩行速度で改善傾向があり，股関節角度変化と骨盤回旋角度変化で増大を認めた．【まとめ】身体運動機能のリハが，パーキンソン症候の改善と下肢・骨盤の関節角度の増大により歩幅と歩行速度の改善をさせた可能性を示唆した．

Abstract　Objective : To demonstrate the importance of physical motor function using the unified Parkinson's disease rating scale (UPDRS) and three-dimensional motion analysis in Parkinson's disease rehabilitation strategies. Participants : Seventeen inpatients with Parkinson's disease. Intervention : Physical training to improve joint mobility, muscle strength and muscle stretch to increase physical capacity was conducted for about four weeks. Results : The mean total scores of UPDRS significantly decreased from 37.9±13.2 (before training) to 27.3±11.2 (after training). The ADL scores of the UPDRS decreased from 12.4±6.9 (before training) to 9.5±6.3 (after training). The motor scores decreased from 22.5±7.5 to 15.3±6.5. Furthermore, muscle rigidity and akinesia, two key Parkinson symptoms, were improved as shown by assessment of the UPDRS motor scores. And physical function of the trunk, and upper and lower extremities was also improved. Finally, the increment of stride length and walking velocity and range of motion (ROM) at the hip and pelvic joints were observed by assessment of three-dimensional motion analysis. Conclusion : This study suggests that improvement of Parkinson symptoms and increment of ROM at the pelvic and lower limbs by physical training may improve stride length and walking velocity.