高位脊髄(頸髄)損傷四肢麻痺患者のリハビリテーションにおけるUpper Extremity OrthoticsおよびExternally Powered Deviceの臨床的応用比較

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The upper extremity orthoses and externally powered flexor hinge splints available today for rehabilitation of quadriplegic patients due to high cervical cord injury with specific reference to the increase in their mobility and independence are comparatively discussed.In order to use wrist driven flexor hinge splint effectively, patients with spinal cord injury at C_6 functional level (including the C_5 level patients who had muscle transplant of brachioradialis to wrist extensors) must have power to lift at least 1.4 kg of weight voluntarily and be able to hold it at 45 degrees of wrist extension. Since the muscles lose about grade in case of transplant, brachioradialis should be at least GOOD to NORMAL in standard muscle testing for determining the surgical indication.In application of 4 different external power devices the following points are discussed.1) Electrophysiological splint has disadvantages of inconsistent performance due to the extreme fatigability of the paralyzed muscle although the strength of 2-3 kg pinch is thought to be ideal.2) Flexor hinge aplint with McKibben muslcle has advantages of mechanical dependability and short period required for training, but has disadvantages of frequent filling of CO_2 gas and the pinch can be too strong for anesthetic fingers.3) Flexor hinge splint with electric electric torque motor has an advantage of stopping the motor automatically according to the size of objects picked and simplicity of charging the battery overnight although the disadvantages include frequent mechanical repair and the switch control being affected by unstable postures as in the cases of McKibben muscle control.4) Flexor hinge splint with myoelectric control has a great advantage in increasing the mobility of C_4 patients who are otherwise completely dependent and also the fact myoelectric control is not affected by unstable postures is considered as an advantage while the disadvantages include the problem in patients with excessive perspiration due to the usage of surface electrodes and the fairly long period required for training.At present stage, combined application of flexor hinge splint with myoelectric control and balanced forearm orthoses (BFO) is far superior to an electric arm with tongue control or multiple channel control using available muscles.
社団法人日本リハビリテーション医学会の論文
1970-01-18

高位脊髄(頸髄)損傷四肢麻痺患者のリハビリテーションにおけるUpper Extremity OrthoticsおよびExternally Powered Deviceの臨床的応用比較

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