重要な情報：半身不随患者の下肢の重さ積み荷に関する研究結果
- 脳卒中の後の半身不随患者において、腰とひざの筋肉活動が足取りとバランスを強化するために必要であることが示唆されました。
- 下肢の重さ積み荷は、半身不随患者のゲートとバランスの向上において重要です。
- 脳卒中の後の半身不随患者において、適切な角度で腰とひざの筋肉活動が必要であることが明らかになりました。
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This suggests that in patients with hemiplegia after stroke, muscle activities of the hip and the knee, maintained at appropriate angles, are necessary for weight loading on the lower extremities in order to enhance their gait and balance これは、脳卒中の後の半身不随患者において、腰とひざ（適切な角度に維持される）の筋肉活動が彼らの足取りとバランスを強化するために下肢の上で重さ積載のために必要なことを示唆します 翻訳機にかけるとこんなかんじです… 医学論文の一部なのですが、お願いします。
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これは、脳卒中後の半身不随患者において、適切な角度での腰と膝の筋肉活動が、患者の歩行姿勢と平衡を保つために、下肢に重みをかけるにあたって必要である事を示唆している。 とも
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In the gait cycle, lack of coordination in muscle activities between the hip and the knee during weight loading on the lower extremity in the stance phase results in reduced vertical ground reaction force in hemiplegia patients with lower extremity dysfunction on the affected side． 歩行周期では、低い下肢不全麻痺側片麻痺患者における削減垂直床反力の体重の上下肢立脚相の読み込み中に筋活動股関節と膝の間の調整の欠如の結果します。 うまく訳せません… お願いします
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Testing procedures All study participants completed manual muscle and Tinetti mobility testing , isokinetic strength testing of the quadriceps and hamstring muscle groups , exercise stress testing and gait and balance testing bath at the beginning and gait and balance testing bath at the beginning and end of the 12-wk study period. These measurements were made by blinded examiners at baseline and 7 to 10 days after completion of either the exercise or control protocols. Positioning of the subjects for manual muscle testing of the various lower extremity muscle groups and the zero to five muscle strength grading system were based on the positions and grades established by Kendall and MCreary.27 Modifications in muscle testing were made as necessary following the procedures recommended by Daniels and Worthingham.28 Leg length discrepancies and significant joint motion limitations were recorded at this time. Clinical gait and balance were measured with a modified version of Tinetti’s instrument.29 This mobility test involves a series of simple tasks including sitting, standing up from and sitting down in a cair, standing and tandem standing both with eyes open and closed , turning in a circle, turning head from side to side , standing on one leg , reaching and bending to pick up an object, withstanding a nudge on the sternum while standing and walking short distances with or without the aid of an assistive device. Observations of gait were made for gait intiation, step length and height, step symmetry, step continuity and gait path. Each task was scored on a zero to one or zero to two scale . Isokinetic muscle strength testing was performed at 60°per second to obtain concentric isokinetic strength measurements for knee flexion and extension, measurements for knee flexion and extension, utilizing the Cybex II isokinetic dynamometer (Lumex, Inc. Bayshore, NY) and single-channel chart recorder. Adjustments for age were determined by estimating a 1% decline in strength per year after age 40.30 Measurements of endurance were recorded by tabulating the number of repetitions completed at 180°per second before strength declined to <50% of peak torque. Testing procedures All study participants completed manual muscle and Tinetti mobility testing , isokinetic strength testing of the quadriceps and hamstring muscle groups , exercise stress testing and gait and balance testing bath at the beginning and gait and balance testing bath at the beginning and end of the 12-wk study period. These measurements were made by blinded examiners at baseline and 7 to 10 days after completion of either the exercise or control protocols. Positioning of the subjects for manual muscle testing of the various lower extremity muscle groups and the zero to five muscle strength grading system were based on the positions and grades established by Kendall and MCreary.27 Modifications in muscle testing were made as necessary following the procedures recommended by Daniels and Worthingham.28 Leg length discrepancies and significant joint motion limitations were recorded at this time. Clinical gait and balance were measured with a modified version of Tinetti’s instrument.29 This mobility test involves a series of simple tasks including sitting, standing up from and sitting down in a cair, standing and tandem standing both with eyes open and closed , turning in a circle, turning head from side to side , standing on one leg , reaching and bending to pick up an object, withstanding a nudge on the sternum while standing and walking short distances with or without the aid of an assistive device. Observations of gait were made for gait intiation, step length and height, step symmetry, step continuity and gait path. Each task was scored on a zero to one or zero to two scale . よろしくお願いします
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This study emphasized hemiplegia patients’ lower extremity function on the paretic side during the stance phase in their rehabilitation exercise and conducted a one-leg standing weight-bearing balance exercise 本研究は片麻痺患者の低い上肢機能麻痺側立脚相のリハビリテーション運動中に強調し、片足立ち荷重バランス演習を実施しました。 こんな感じの翻訳であってるでしょうか…
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Loss of the ability to walk safely is often a primary reason for nursing home placement . the most common causes of such gait and balance disturbances are organic brain syndromes and musculoskeletal disorders . but even in the absence of specific diseases, disturbances in gait and balances may produce disability in up to 13%of older individuals . furthermore, nonspecific changes in gait and balance affect nearly all older individuals and are attributed to the normal aging process .reported changes have included increased postural sway accompanied by decreases in ambulatory velocity , step and stride length , step cadence and swingtime ratio . Impairments in gait and balance lead ton such undesirable consequences as heat of falling, galls with fractures , loss of confidence , loss of independence and lowered quality of life. Within long term care institutions , between 40 and 50% of residents will fall during any given year . musculoskeletal weakness , poor balance and number of prescribed medications have been associated with falling among institutionalized subjects . additionally, isokinetic testing of institutionalized fallers has demonstrated both knee and ankle weakness compared with controls . postural sway has also been found to be higher among those who fall . gait comparison of subjects hospitalized after falls versus controls has demonstrated slow walking speed , short step length , narrow stride width , a wide range of stepping frequency , large variability of step length and increasing variability with increasing step frequency . 毎度です(笑) 翻訳出来る方よろしくお願いします。
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In gait, kinesiological asymmetry of the left and right lower extremity joints in the sagittal plane increases knee flexion of the paretic side during the stance phase, resulting in excessive hip flexion during the swing phase. 足取りでは、矢状面の左右の下肢関節の運動学的な非対称はスタンス段階の間、麻痺側のひざ屈曲を増やします。そして、揺れ段階の間、過度の腰屈曲に終わります 翻訳機にかけるとこんなかんじです… 医学論文の一部なのですが、お願いします。
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A clinical trial of strengthening and aerobic exercise to improve gait and balance in elderly male nursing home residents. The purpose of this study was to determine whether a moderate to high intensity strengthening and aerobic exercise program can improve the strength, exercise capacity, gait and balance of deconditioned male nursing home residents. Ambulatory subjects who scored 30 or less on the modified Tinetti gait and balance assessment scale, who demonstrated less than 80% of age-matched lower extremity strength on isokinetic muscle testing and who gave informed consent were enrolled. Subjects were randomized to either an exercise (n = 8) or a control (n = 6) group. All participants underwent an exercise test to determine maximal oxygen uptake (Vo2max) and received quantitative gait and balance measurements. The subjects assigned to the exercise group then completed a 12-wk program of weight training for the lower extremities and stationary cycling. Both the exercise and control groups were then retested. Ten outcome variables were assessed: Tinetti mobility scores, Vo2max, isokinetic-tested lower extremity strength and endurance, stride length, gait velocity, stance time, gait duration, cadence and balance. The exercise group, after completion of the program, demonstrated significant improvements in Tinetti mobility scores (P < 0.05), combined right and left quadricep muscle strength (P < 0.01), right and left lower extremity muscular endurance (P < 0.01), left stride length and gait velocity (P < 0.05), although other outcome variables changed insignificantly. The control group revealed no changes of significance with the exception of improvement of the combined right and left hamstring muscle strength (P < 0.05). Nevertheless, for those outcome variables that had improved significantly in the exercise group, the changes amounted to only a 5 to 10% increase over the baseline measurements. These findings showed that an appropriately designed high intensity exercise program can result in significant although limited improvements for clinical mobility scores, strength, muscular endurance and certain gait parameters. 高齢者男性老人ホームの入居者での歩行とバランスの改善のための臨床試験の強化と有酸素運動 本研究の目的は、中等度から高強度の強化と有酸素運動プログラムが男性老人ホームの入居者運動能力、歩行の評価とバランスを向上させることができるかどうかを決定することであった。等速筋力テストに年齢をマッチさせた下肢強度の80％未満を示したインフォームドコンセントを与えた人修正、歩行評価とバランス評価スケールで30以下を記録した外来被験者が在籍していた。被験者は運動（N = 8）またはコントロール（N = 6）グループのいずれかに無作為に割り付けられた。すべての参加者は、最大酸素摂取量（VO2max）を決定するために運動負荷試験を施行し、定量的歩行とバランスの測定を受けた。運動群に割り当てられた被験者は、その後、下肢と固定サイクリングにウェイトトレーニングの12週のプログラムを完了した。運動と対照群の両方は、次いで再試験した。テン結果変数を評価した：Tinettiモビリティスコア、最大酸素摂取量、等速にテストされた下肢の強さと持久力、歩幅、歩行速度、スタンス時間、歩行時間、リズムとバランスを。運動群は、番組の終了後、左、右と左の大腿四頭筋強度（P <0.01）、左右の下肢筋持久力（P <0.01）を組み合わせTinetti移動度のスコア（P <0.05）において有意な改善を、実証歩幅、歩行速度（P <0.05）、他の結果変数がわずかに変化しない。対照群は、結合された左右のハムストリング筋強度（P <0.05）の改善を除いて、有意の変化を全く示さなかった。それにもかかわらず、運動群で有意に改善したそれらの結果変数のため、変更はベースライン測定上のみ5から10パーセント増となりました。これらの知見は、適切に設計された高強度の運動プログラムは、臨床モビリティのスコア、強さ、筋肉の持久力と一定の歩行パラメータの限定されたものの、大幅な改善につながることを示した。 翻訳機にかけたらこう出て来ました…がよくわかりません。 もっと分かりやすく訳せる方いましたらお願いします。
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The gains in muscle strength, stride length and gait velocity were greater in the left leg than in the right leg. All study participants were right side dominant. The most plausible explanation for the consistently greater nondominant side improvements is that the left lower extremity may have been subject to greater disuse atrophy than the right lower extremity. The finding of asymmetrical left lower extremity strength improvement in conjunction with left stride length and velocity improvement supports the work of Bassey et al 20. Correlating muscle strength to customary gait velocity. The percentage improvements in strength, tinetti mobility score, stride length and stride velocity were only 6,10,5 and 3% of the baseline values, respectively. These changes appeared to be small in relationship to the baseline deficiencies of 62% for strength, 71% for tinetti score, 56% for stride length and60% for gait velocity. Such changes are likely not trivial, however, because increases in gait speed of the magnitude produced by the present exercise program have proven to be predictors of eventual independent mobility in poorly mobile subjects 39. It is also possible that the type of exercise utilized in this particular study, but with greater intensity or longer duration, could magnify the gains. Finally, it needs to be emphasized that the inclusion/exclusion criteria for the study, in addition to the complexity of the protocol, resulted in an extremely small sample size. The small group of subjects may not have been representative of the entire ZVAMC NHCU population. These considerations limit the general izability of the study’s conclusions. 最後です。;; すみませんお願い致します…
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The intervention was found to be acceptable and safe for the selected were missed because of exercise-in-duced musculoskeletal complaints, nor did any subjects drop out because of dissatisfaction with the program. Medical illness requiring hospitalization did cause two participants to withdraw, illustrating the role of intercurrent illness as a cause of deconditioning and progressive debilitation 34. The conclusion that the intervention was only partially effective is based on the evaluation of five types of outcome variables. Strength, endurance and gait improved significantly, but left the treated patients still considerably below age-matched healthy individuals in these respects. Aerobic work capacity and balance were not improved by the 12wk of exercise. The participants in the exercise program did increase their lower extremity muscle strength. The isotonic strength measurements increased symmetrically, whereas the isokinetic strength measure ments revealed left-side gains to be greater than those on the right. In addition to strength, both right and left lower extremity muscular endurance improved significantly. At the end of the exercise program, however, the average scores for strength and endurance were still only about 65% of age-matched normal values. すみません… お願いします
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The Vo2 max did not rise significantly despite increases in leg strength and muscular endurance. Potential reasons for this lack improvement are the complex interaction of multiple disease processes, inadequate duration or intensity of training or the diminished end organ response to exercise training in the frail elderly. The exercise subjects did on average maintain an adequate heart rate response during aerobic training, achieving 82% of their exercise-tested maximal heart rate 35. The duration of 20 min three times weekly may have been suboptimal, with some authors recommending 30 min of aerobic training three times weekly for elderly individuals 36 37. Twenty minutes is considered to be the minimal time necessary to obtain an aerobic response 38. These results are consistent with the conclusion of vase et al 34. That it is difficult to improve aerobic capacity in mild to moderately impaired and deconditioned nursing home residents. In addition, it must be noted that attainment of an accurate Vo2 max depends heavily on subjective factors such as muscle fatigue, perceived exhaustion, level of motivation and the examiner’s willingness to allow subjects to reach exhaustion. A true Vo2 max may therefore be difficult to obtain in the frail elderly. The leg muscle frequently reach exhaustion before the cardiopulmonary system attains its maximal capacity and a valid Vo2 max is never achieved 36. Clinical mobility scores, as measured by the modified tinetti assessment scale, did improve significantly. Whether the improved Tinetti scores would be associated with improved activities of daily living or a decreased incidence of falls in the treated men remains to be learned. One participant in the exercise program who initially required the assistance of his arms to stand from a chair was able to the program. The two subjects who routinely used a cane or walker for added stability during ambulation continued to do so after completion of the exercise program. Although quantitative gait measurements demonstrated significant improvements in left-sided stride length and velocity with lesser increases in right-side stride length and velocity, other gait characteristics, namely stance time, gait duration and cadence, did not change significantly. Furthermore, balance measurements of total excursion revealed no significant changes with the eyes open or closed. These observations suggest that neurologic impairment may have been a more important cause than muscle weakness in causing the ambulatory difficulty of the subjects studied. On the other hand, exercise of greater intensity or longer duration requires testing before a coutributory role of weakness can be excluded. The finding of insignificant balance changes is consistent with results obtained in prior studies すみません… お願いします。
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Experience of the Exercise Group Compliance The eight exercise group subjects completed all 36 sessions. However, before completing all exercise sessions, total of 16 sessions were missed accounting for an overall compliance rate of ～95%. The average heart rate of 103 beats /min, achieved during stationary crying, equaled 82%of the exercise stress-tested maximal heart rate and 70% of the age-predicted maximal heart rate. The exercise participants used the Air-Dyne model cycle ergometers 85% of the time and the Ergo-Metric models the remaining 15%. Because of the added upper extremity exercise provided by the reciprocal arm movements, the subjects achieved higher average heart rates and were encouraged to use the Air-Dyne model cycle ergometers. Safety and intercurrent Illness The exercise program was safe with no apparent adverse side effects and no session were missed because of musculoskeletal complications. None of the subjects dropped out because of dissatisfaction with the program. Twp participants, both in the exercise group, were forced to withdraw from the study because of intercurrent illnesses. Results of testing at the end of the exercise program Compasidon of the first to the last exercise sessions showed that each of the men participating in the exercise program increased the amount of weight lifted in the 10 repetition maximum. Baseline weight lifted averaged 7.6 lbs for the hip muscle groups, 28 lbs for the knee extensors and 46 lbs for the ankle plantar flexors. The increase in weight lifted over the course of the study averaged 7.3 lbs (99%) for the hip muscle groups, 21lbs(81%) for the knee extensors and 37 lbs (80%) for the ankle plantar flexors. Although one repetition maximum values were measured before the first exercise session, they were not repeated at the end of the exercise program. The control subjects did not undergo baseline weight measurement determinations. Table 3 provides information regarding each of the before and after variables measured in the exercise group. The mean increase in tinetti mobility scores of+3.37 was significant (P<0.05), with each subject scoring higher after completion of the exercise program. The tinetti scale was divided into three parts, consisting of strength items (12 points), items combining strength and balance (6 points) and items that were primarily related to balance (16 points). Increases in items primarily related to strength were significant (P<0.01), while increases in balance-related item approached significance (P<0.06). Table2&3 Isokinetic strength measurements that increased significantly included overall strength combining the individual muscle group measurements (P<0.01), combined right and left quadriceps strength (P<0.05) and right- and left- handed muscular endurance (P<0.05). left quadriceps strength improvements approached, but did not achieve significance (P<0.07). post-strengthening measurements of gait and balance revealed significant improvements in left-sided stride length (P<0.005), left gait velocity (P<0.01) and average stride length (P<0.005) and velocity (P<0.05). no significant changes occurred for the other measured parameters including V02 max and balance. Experience of the control group The results for the control group can be found in Table 4. All control subjects completed the testing protocol without complications. No outcome variable improved significantly at the end of the 12-wk control period with the exception of the combined hamstring strength (P<0.05). Between group comparisons Table 5 compares the magnitude of change between the before and after test measurements in the exercise U the control group. Differences of significance included the tinetti mobility scores (P<0.005), left stride length (P<0.05), left velocity (P<0.05), average stride length (P<0.05) and average velocity (P<0.05). よろしくお願いします。 http://www.ncbi.nlm.nih.gov/pubmed/1466871
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