ABDOLRAHMANI ABBAS

称号及び氏名博士（保健学）

学位授与の日付

平成３０年３月３１日

論文

名Immediate effects of quick trunk exercises performed in a seatedposition on sit-to-stand movement in children with spastic
cerebral palsy
座位での速い体幹運動が脳性麻痺児の立ち上がり動作に及ぼす即時効果について

論文審査委員

主 査

岩田晃

副 査

淵岡聡

副 査

平岡 浩一

副 査

米津亮

論文要旨
The sit-to-stand (STS) movement is a common skill of daily living and an important measureof physical function that requires adequate postural control to transfer the center of mass overthe feet and maintain alignment of the upper and lower body segments. However, children withcerebral palsy (CP) have difficulty in performing STS movement effectively, as they often
show deficits in movement and postural control. Therefore, improvement of STS performanceplays a crucial role in the improvement of social participation in these children. Previous
studies demonstrated beneficial effects of some intervention in STS of children with CP.
However, the main focus of these interventions was on lower limb impairment with lessconsideration of the key role of trunk control during STS movement and its deficit in children
with CP. From these points of view, we are interested in understanding whether quick trunk
movements could improve trunk control in children with CP and therefore allow them toperform STS more efficiently. Thus, this research study aimed to assess the immediate effects
of a quick-seated trunk movement exercise (QSTE) on STS movement in children with CP.
In research I, the study participants included five children with spastic CP, aged 6–17

years. All participants received five sessions of natural STE (NSTE) at a self-selected speed asa control intervention. Following a 50-min rest period, five sessions of the QSTE wereconducted as an experimental intervention for each child. Assessments were performed before
and after each intervention in a single day. To assess STS movements, a motion analysis
system with four cameras that were synchronized with a pressure-sensitive trigger device wasused. The sagittal and angular movements of the trunk, hip, knee, and ankle were calculated.
Then, the total STS task duration and the maximum trunk forward tilt and ankle dorsiflexion
angle were calculated.
The results of research I showed a significant difference in the total duration of the STSmovement before and after NSTE (2.40 ± 0.67 s vs. 2.24 ± 0.44 s) and QSTE (2.41 ± 0.54 s vs.
2.06 ± 0.45 s). However, there was no significant difference in the kinematic parameters after
both interventions.
Despite the same STS performance before natural and quick STE, possibility of learning
effects due to the single day measurement may limit the generalization of the results inresearch I.
Thus, to decline this limitation, multiple day measurement was chosen in research II. A
total of seven children with spastic diplegia CP, aged 4–13 years, participated in this study. Allsubjects participated in both experimental and control intervention. First, participants wereassessed before the experimental intervention (pre-test). Then, after 3–5 days of washout
period, they were reassessed (post-test) immediately after receiving five sessions of QSTE forexperimental intervention. Second, after 2-4 weeks of interval, all participants were assessed
before the control intervention (pre-test). Following 3–5 days of washout period, they werereassessed immediately after control intervention (post-test). The participants sat for 10
minutes on a stool for the control intervention. A conventional video recording camera wasused to record STS movements. The sagittal and angular movements of the trunk, hip, knee,and ankle were calculated for each lower limbs using Image-J. Then, the total STS task
duration was calculated.
The results of research II showed that the start position and STS duration of pre-test data
were not significantly different for experimental and control intervention. A significant
difference was observed in the total duration of the STS movement before and after QSTE
(2.67 ± 0.34 s vs. 1.69 ± 0.11 s). However, no significant change was found between the total
duration of the STS movement before and after control intervention (2.49 ± 0.25 s vs. 2.41 ±0.18 s).
The total duration of the STS movement significantly decreased after QSTE in bothresearches. Although QSTE did not change the abnormal kinematic pattern of the STS
movement, QSTE may improve trunk control, which in turn would help children with CP toperform STS movement faster. These improvements would facilitate their social participationand lead to better performance during daily activities.
Keys Words: Fast trunk exercise, Sit-to-stand, Cerebral palsy

審査結果の要旨
本研究は、脳性麻痺児（CP 児）の日常生活に不可欠な立ち上がり動作に対して、座位で体幹を素早く動かすエクササイズ（quick-seated trunk movement exercise: QSTE）を実施し、立ち上がり動作に対してどのような即時効果が認められるかについて検証を行った研究である。
Research 1 では、5 名の CP 児に対して、 QSTE と通常速度で座位での体幹を動かすエクササイズを実施し、間接角度などの運動学的指標に変化は認められないものの、立ち上がり動作に要する時間が短縮することを明らかにした。しかし、この研究では、対象として片麻痺と両麻痺が混在していることや、1 日で実施したため学習効果や持ち越し効果を考慮出来ていないこと、通常速度の規定が不十分であることなど、幾つかの研究限界があった。
そこで、Research 2 では、これらの研究限界に対して、対象者を両麻痺に限定すること、測定の間隔を十分に空けること、さらにコントロールとして安静座位を採用することで対応し、QSTE の効果を検証した。その結果、QSTE によって、立ち上がりに要する時間が有意に短縮することが示された。
CP 児は個別性が高いため、介入方法の効果を数値で表し、検証することは容易ではない。
本研究では、QSTE によって立ち上がり動作に要する時間が有意に短縮するという新しい知見を明確に示しており、その点において博士学位論文としての水準を満たしていると判定できる。さらに、Research 1 は日本で、Research 2 はイランで実施しており、人種や環境の異なる両国において、同様の結果が得られたことから、普遍的な介入方法であることを示した点においてもその意義は大きいと考えられる。