The effect of exercise therapy for peripheral nerve and locomotor function in patients with spastic cerebral palsy

Research Project

Project/Area Number	16K21440
Research Category	Grant-in-Aid for Young Scientists (B)
Allocation Type	Multi-year Fund
Research Field	Rehabilitation science/Welfare engineering Medical engineering assessment
Research Institution	Tokyo University of Technology
Principal Investigator	KUSUMOTO Yasuaki 東京工科大学, 医療保健学部, 講師 (60710465)
Research Collaborator	SUGAWARA Hitoshi
Project Period (FY)	2016-04-01 – 2019-03-31
Project Status	Completed (Fiscal Year 2018)
Budget Amount *help	¥4,030,000 (Direct Cost: ¥3,100,000、Indirect Cost: ¥930,000) Fiscal Year 2017: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000) Fiscal Year 2016: ¥3,380,000 (Direct Cost: ¥2,600,000、Indirect Cost: ¥780,000)
Keywords	痙直型 / 脳性麻痺 / H反射 / ストレッチ / 脊髄前角細胞 / 下肢随意性 / 関節トルク / 神経伝導速度 / 末梢神経 / 神経電動速度 / 筋力 / 脛骨神経 / 粗大運動 / 歩行 / 運動療法
Outline of Final Research Achievements	Within SCP patients classified as levels I and II, based on GMFCS, there were no differences found in tibial nerve conduction velocity between dominant and non-dominant foot. The H-reflex amplitude of standing position was higher than in prone which suggests the decrease in the ability to adjust reflexes in certain postures. In addition, the amplitude of H-reflex showed a significant interaction between the SCP subjects and healthy individuals, both before and after dorsiflexion. The SCP subjects presented diminished ability to regulate H-reflex during isometric ankle dorsiflexion compared to healthy individuals. Finally, we were able to confirm that the H-reflex amplitude improved after the stretching in the standing position in only gross motor level I SCP subjects and healthy individuals.The necessity to alter stretching methods of the gastrocnemius and soleus muscles according to the ability to regulate the amplitude of H-reflexes in SCP patients is suggested.
Academic Significance and Societal Importance of the Research Achievements	ストレッチ後の可動域増大には筋や腱の粘弾性の変化である生理学的要因と脊髄前角細胞の興奮性を含めた神経学的要因が関与する。足関節を上側に動かした際にH波振幅値が上昇する者へのふくらはぎの筋（腓腹筋やヒラメ筋）のストレッチでは相反抑制の効果を組み合わせることはできないため、痙直型脳性麻痺者の足関節ストレッチは、H波振幅値の上昇と低下に合わせて、神経学的な効果を組み合わせるか判断する必要性が示唆された。脳性麻痺患者における運動療法として、より効果的なストレッチ方法の選択が可能となることが示唆された。