I. はじめに II. 対象と方法 Vertebra Body Fracture VBF 11 1) 2 6) 1 ADL 7) 8 10) VBF 1 12) VBF 3,5) 3 5) 4,5,9) ADL 3,6) 3,9,11) ADL ADL 12) VBF VBF AD

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1 症例研究 2 ADL 1 Disuse Syndrome due to Bed Rest after an L2 Vertebral Fracture Delayed Improvement in Activities of Daily Living (ADL): A Case Study 1) 2) 3) 4) 5) 5) 6) TAKEHIRO KATO, RPT 1), YUICHI HIRAMATSU, PhD, RPT 2), SHO TANEMOTO, RPT 3), AKIHO HATTORI, RPT 4), KOSUKE OKU, RPT 5), AKIYOSHI MATSUGI, RPT, PhD 5), DAISUKE KIMURA, RPT, PhD 6) 1) Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 kawahara-cho, Shogoin, Sakyo-ku, Kyoto , Japan TEL kato.takehiro.47n@st.kyoto-u.ac.jp 2) Neurorehabilitation Research Institute, Morinomiya Hospital 3) Iwasaki Orthopedic Clinic 4) Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc. Department of Rehabilitation, Osaka Nakatsu Hospital 5) Faculty of Rehabilitation, Shijonawate Gakuen University 6) Department of Rehabilitation, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare Rigakuryoho Kagaku 32(1): , Submitted Jun. 22, Accepted Aug. 26, ABSTRACT: [Purpose] We report the treatment course of a patient who showed a delay in regaining pre-injury levels of physical function and activities of daily living (ADL) due to disuse syndrome caused by bed rest after a vertebral fracture. [Subjects and Methods] A male in his 70s sustained an L2 vertebral fracture with no clear mechanism of the injury. After bed rest for about 3 weeks, ambulation was permitted; however, due to disuse-associated decreases in muscular endurance and general endurance, he found unassisted walking difficult. Therefore, to improve exercise tolerance, physical therapy consisting of repeated sit-to-stands, bicycle ergometer training, and machine exercise was initiated. [Results] After the physical therapy, the subject showed improvements in general as well as muscular endurance, began to walk unassisted, and regained his pre-injury level of ADL. [Conclusion] Our results suggest that disuse syndrome due to prolonged bed rest is an important prognosticating factor of poor ADL improvement after vertebral fracture. Further studies are necessary to evaluate the effectiveness of therapeutic interventions to improve muscular as well as general endurance during the bed rest period. Key words: vertebral fracture, disuse syndrome, bad prognosis factors 要旨 : ADL ADL ADL キーワード : 1) TEL ) 3) 4) 5) 6)

5) 4,5,9) ADL 3,6) 3,9,11) ADL ADL 12) VBF VBF ADL VBF ADL ADL 1 1 2 70 3 X 2 MRI

2 I. はじめに II. 対象と方法 Vertebra Body Fracture VBF 11 1) 2 6) 1 ADL 7) 8 10) VBF 1 12) VBF 3,5) 3 5) 4,5,9) ADL 3,6) 3,9,11) ADL ADL 12) VBF VBF ADL VBF ADL ADL X 2 MRI 2 T1 T2 1 3 COX 100 mg2 NSAIDs 200 mg FIM Functional Independence Measure Need 図 1MRI T1T

3 L2ADL Range of Motion ROM Manual Muscle Testing MMT Patrick SLR Brunnstrom recovery stage test BRSTModified Ashworth Scale MAS 1 ROM MAS BRST MMT 3 2 Numeric Rating Scale NRS Oswestry Disability Index ODI 1 NRS 5 NRS 1 C 0.41 mg/dl 0.03 mg/dl ODI ODI ODI m 10 m Timed Up & Go Test TUG 6 6MWT30 表 1 ROM 5 5 no data 5 10 MMT no data 2 3 SLR no data no data no data BRST U/E F L/E MAS MMSE 24 no data no data N.P. N.P. N.P. FIM m no data no data TUG no data "7 6 m no data no data no data NRS ODI no data C mg/dl no data NRS: Numeric Rating Scale, ODI: Oswestry Disability Index

4 Chair Stand-30 CS-305 Sit to Stand-5 SS-510 m 13.9 III. 結果 0.72 m/ 26 TUG 18.7 CS SS MWT 210 m m FIM ADL 1ROM BRST MAS MMT NRS 1 ODI 17.1% m m/ 23 TUG 14.7 CS SS MWT 280 m 1 FIM IV. 考察 VBF cm rpm Borg scale ,14) RM 70 15) 20 kg 50 kg ADL FIM ADL ADL VBF 3 12) 3,9) 16) 3 4 VBF

5 L2ADL 図 2 3 SS-5 CS-30 6MD ) ,19) m 20) SS-5 CS-30 21) 22,23) ADL 24) ,26) VBF VBF 27) Type Type 28) 29) Type 1 RM RM ,30,31) VBF ADL VBF ADL 32 34) ADL QOL

6 引用文献 1) Ross PD, Fujiwara S, Huang C, et al.: Vertebral fracture prevalence in women in Hiroshima compared to Caucasians or Japanese in the US Int J Epidemiol, 1995, 24(6): ) Silverman SL: The clinical consequences of vertebral compression fracture. Bone, 1992, 13(Suppl 2): S27 S31. 3) 2010, 59(2): ) Kempinsky WH, Morgan PP, Boniface WH: Osteoporotic kyphosis with paraplegia. Neurology, 1958, 8(3): ) X 2005, 18(5): ) MRI 2005, 18(5): ) 20 ncgg-kenkyu/kadai20.html ) Suzuki N, Ogikubo O, Hansson T: The course of the acute vertebral body fragility fracture: Its effect on pain, disability and quality of life during 12 months. Eur Spine J, 2008, 17(10): ) J Spine Res, 2013, 4(6): ) 2012, 60(6): ) 2002, 37(4): ) 2011, 46(12): ) , pp ) 2006, 23(10): ) DeLorme TL, Watkins AL: Technics of progressive resistance excercize. Arch Phys Med Rehabil, 1948, 29(5): ) 2011, 85(12): ) Mong Y, Teo TW, Ng SS: 5-repetition sit-to-stand test in subjects with chronic stroke: Reliability and validity. Arch Phys Med Rehabil, 2010, 91(3): ) , 19(2): ) 30 CS , 24: ) Pradon D, Roche N, Enette L, et al.: Relationship between lower limb muscle strength and 6-minute walk test performance in stroke patients. J Rehabil Med, 2013, 45(1): ) , 18(1): ) 30 CS PP-A ) COPD 30 CS , PP ) 2008, 25(9): ) 1990, 27(1): ) 2006, 23(10): ) 2000, 3: ) Ohira Y, Jiang B, Roy RR, et al.: Rat soleus muscle fiber response to 14 days of spaceflight and hindlimb suspension. J Appl Physiol (1985), 1992, 73(2 Suppl): 51S 57S. 29) Book House HD ) 2013, 30(11): ) , 47(5): ) 2006, 21(4): ) 2006, 21(3): ) 1996, 33(1):

理学療法検査技術習得に向けた客観的臨床能力試験(OSCE)の試行

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