脳卒中片麻痺の運動機能に関する研究(第1報)
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In order to clarify the specificity and to standardize the method for evaluating grade of the impairment, the motor function in hemiplegia following cerebrovascular accident was examined by means of the ADL (activities of daily living) test and the motor functional test.Part 1 ADL test Twenty items of ADL were tested, the score of 0-3 points being given to each activity. Forty-six patients were tested over 136 times, and the scores were analyzed in relation to motor function of each extremity and that of the trunk. The conclusions are as follows : 1) Such activities that can be compensated by the non-affected side mark high scroes even before treatment.2) The activity of proximal joints improves during treatment more remarkably than that of distal ones. Compensation by the non-affected side is made more skillfull by treatment.3) The activities of the upper extremity reach the maximum level sooner than those of lower extremity.Part 2 Motor functional test The ADL test is insufficient for clarifing motor function of the diseased extremity itself. The manual muscle testing method is useful for flaccid paralysis but not for spastic paralysis because of poly-articular synergy. In this study, therefore, seven patterns of mono- or poly-articular movements were difined, and each of them was scored 0-5 points according to the magnitude of independent voluntary motion capable in that pattern. Conclusions obtained from 341 patients are as follows : 1) Hemiplegic patients are classified into the following three types according to the course and plateau of motor restoration of the upper extremity after stroke. A) The flaccid type in which the upper extremity remains flaccid and the finger function is quite poor and does not show even flexor synergy.B) The spastic type associated with spasticity of various degree. In this type the motor function shows only flexor synergy, and facilitation of flexor movements is restored in the order of elbow, fingers and writst. C) The flaccid or weak spastic type characterized by relatively good finger function even immediately after stroke. In this type motor disturbance is mainly due to weakness of proximal muscles. In the majority of patients of this type the motor function is over the stage of extensor synergy.2) For a patient to be categoriezed "independent" in the sense of ADL, he must be able to (a) to raise the diseased leg in supine position, (b) to raise the diseased arm beyond the level of the head and (c) to oppose the thumb to the middle finger or farther ones.
- 1970-01-18
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