足圧中心解析による脳卒中片麻痺者が片手でズボンを上げる工程の立位姿勢安定性—自立群と監視群の比較

Postural stability while standing among clients with hemiparesis during pulling up trousers: A comparison between independent and surveillance groups

要旨：我々は，脳卒中患者の排泄動作のうち，ズボンを上げる工程の練習方法を考案したいと考えた．脳卒中片麻痺者を対象に，その工程の自立群15名と，監視群7名のズボンを上げる工程中の足圧中心動揺を測定した．足圧中心動揺の速度や範囲を，自立群と監視群で比較したところ，監視群の左右方向への動揺範囲が，自立群の動揺範囲より有意に大きかった．監視群では，左右方向に大きい動揺が生じる結果，転倒の可能性があると推測された．それにより，生活場面の排泄動作に監視を要していると考えられた．この結果をもとに，本研究が提案する練習方法には，左右方向への重心動揺を制御する支援があげられた．

　This study aimed at establishing practice methods for pulling up trousers during toileting among patients with hemiparesis, as pulling up trousers has been reported to be the most difficult process in toileting, requiring the patients to perform simultaneous tasks such as maintaining standing postural stability and pulling up trousers. This study measured center-of-pressure (COP) of this process and compared the independent group and the surveillance group. There were a total of 15 patients (11 men and 4 women) in the independent group, and the mean age was 59 years old. There were 7 patients (5 men and 2 women) in the surveillance group, and the mean age was 65 years old. COP indexes were locus length per unit time (total, Antero-posterior, Medial-lateral), root mean square area, and root mean square (Antero-posterior, Medial-lateral). This study identified significant differences between the groups in Medial-lateral root mean square, indicating a larger value in the surveillance group. The results may indicate that the patients in the surveillance group barely maintained their stability, especially in the Medial-lateral direction. Obtaining ability to maintain postural control in this direction was considered to be necessary for the surveillance group. In conclusion, this study proposes balanced exercise to control the center of gravity in the Medial-lateral direction during pulling up trousers and standing simultaneously in the surveillance group.