脳卒中非麻痺側上肢機能への注意機能障害の影響

The effect of stroke-induced attentional dysfunction on unaffected upper limb function

要旨：右片麻痺群53例，左片麻痺群48例，対照群32例のManual Function Test（以下，MFT），Trail Making Test，改訂長谷川式簡易知能評価スケール，Barthel Indexを測定し，脳卒中片麻痺者に生じる注意機能障害の非麻痺側上肢機能に及ぼす影響を分析した．左右片麻痺者の非麻痺側MFTの得点は対照群の同名上肢よりも低下した．重回帰分析の結果では，右片麻痺左上肢のMFTの得点には注意機能が関係したが，左片麻痺者では関係がみられなかった．同じ課題遂行でも，左上肢の方が右上肢より課題遂行能力が低かった．脳卒中者の非麻痺側上肢機能低下は，注意障害の程度と課題難易度の影響を受けることを明らかにした．

　The Manual Function Test (MFT), the Trail Making Test (TMT), the Revised Hasegawa Dementia Scale (HDS-R) and the Barthel Index (BI) were examined in 101 stroke patients who fulfilled the inclusion criteria, and 32 age-matched healthy control subjects in order to evaluate the effect of stroke-induced attentional dysfunction on unaffected upper limb function. The total score of the MFT was lower in the unaffected limbs of the patients with left and right hemispheric lesions than that of the ipsilateral of the control group. In addition, the pegboard score of the MFT was lower in the unaffected limbs of the patients with left hemispheric lesions than that of ipsilateral of the control group. The ⊿TMT scores were poor in patients with both left and right hemispheric lesions. Multiple regression analysis showed that total and pegboard scores of MFT were highly correlated with the ⊿TMT scores in the patients with left hemispheric lesions, but were not in those with right hemispheric lesions. The pegboard task was more difficult for the upper left limbs, which was the non-dominant hand, than for the right. These results demonstrate that attentional dysfunction decreased the performance of the unaffected limbs of the stroke patients. It is plausible that performance level in the stroke patients were influenced by the task difficulty and their available attentional capacity.