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

2018 Fiscal Year Final Research Report

• 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
• 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

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.

Free Research Field

小児リハビリテーション

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。