母指に限局した運動麻痺に対して持続的神経筋電気刺激下の促通反復療法を実施した脳卒中急性期の一例

Repetitive facilitative exercise under continuous neuromuscular electrical stimulation for isolated thumb palsy after acute stroke: A case study

要旨：症例は70歳代男性の脳梗塞急性期例で，左母指に限局した運動麻痺に対して，持続的神経筋電気刺激下の促通反復療法（以下，RFE under cNMES）を行った．第6病日からRFE under cNMESを実施し，母指の対立は短母指屈筋，掌側外転は短母指外転筋，橈側外転は長母指伸筋を電気刺激の標的筋とした．1週間の訓練で，物品操作能力（Action Research Arm Testの改善量：9点，Nine Hole Peg Testの改善量：175.62秒）の評価項目で改善を得た．RFE under cNMESを母指に選択的に実施することで，母指運動麻痺の回復を促進する可能性が示唆された．

　A man in his 70s with isolated thumb palsy was treated with repetitive facilitative exercise under continuous neuromuscular electrical stimulation (RFE under cNMES). The RFE under cNMES was performed on the 6th day from the onset of stroke. The RFE under cNMES patterns for this program was thumb opposition/palmar abduction/radial abduction. The surface electrodes were placed on the flexor pollicis brevis muscle, abductor pollicis brevis muscle, and extensor pollicis longus muscle. The 1-week intervention improved the ability to manipulate objects (9 points by the Action Research Arm Test, 175.62 seconds by the Nine Hole Peg Test), suggesting that selective RFE under cNMES on the thumb may promote recovery from isolated thumb palsy.