静的・動的平衡機能の変化からみた一卵性双生児の水頭症児に対する作業療法の効果

Effects of occupational therapy on identical twin children with hydrocephalus based on variations in static and dynamic equilibrium reaction

要旨：不安定な直立姿勢と歩行を呈する一卵性双生児の水頭症例への作業療法経過を，静的および動的平衡反応の変化から分析した．対象児の主訴は「歩行中転ぶことが多くまっすぐ歩けない」と共通していた．重心動揺検査では両児とも動揺面積，軌跡長は健常成人と比べ大きい値を示したが，A児では閉眼で動揺が大きくなり，B児では開・閉眼に差がなかった．治療は，A児は感覚統合遊具を用いた筋協調運動の改善，B児は筋緊張の調節と分離運動の促通に焦点を当て実施した．ABABデザインで治療効果の確認を行い，両児とも線上歩行での歩様，重心動揺検査ではA児は外周面積，B児は外周面積と総軌跡長の改善が得られ，効果が確認された．

　We analyzed an effect of occupational therapy on identical twin children with hydrocephalus based on variations in static and dynamic equilibrium reactions. The subjects developed poor standing posture and unstable ambulation, and their chief complaint was "fell down during a walk" and "not able to walk straight".

　In order to acquire an index of static equilibrium reaction, both twins were examined using a stabilometer indicating an increase in both the circumference area, and total length of sway path. Alternatively, case A was affected by opening and closing the eyes, but case B was not. The following therapy is recommended:

　Case A has been targeted to better improve muscle coordination using a sensory integrated plaything.

　Case B has been targeted to better regulate muscle tone and separation of movement.

　We adopted an ABAB design to confirm the effect of the therapy. The results imply an improvement of gait in both children. This was measured using an index of dynamic equilibrium reaction, and walking in a line. Furthermore, the circumference area of case A was improved, while both the circumference area and total length of sway path of case B was improved. In conclusion, therapy based on characteristics of static equilibrium reaction affected static and dynamic equilibrium reaction of the subjects.