TYPE Systematic Review
PUBLISHED 16 August 2022
DOI 10.3389/fnhum.2022.969036

SPECIALTY SECTION

The effects of robot-assisted
gait training combined with
non-invasive brain stimulation
on lower limb function inpatients with stroke and spinal
cord injury: A systematic review
and meta-analysis

This article was submitted toBrain Health and Clinical
Neuroscience,a section of the journal
Frontiers in Human Neuroscience

Wataru Kuwahara1,2 , Shun Sasaki1 , Rieko Yamamoto1,3 ,Michiyuki Kawakami1 and Fuminari Kaneko1,2*

RECEIVED 14 June 2022

1

OPEN ACCESSEDITED BY

Akiyoshi Matsugi,
Shijonawate Gakuen University, Japan
REVIEWED BY

Sofia Rita Cardoso Fernandes,
University of Lisbon, Portugal
Tadamitsu Matsuda,
Juntendo University, Japan*CORRESPONDENCE

Fuminari Kaneko
f-kaneko@tmu.ac.jp

ACCEPTED 19 July 2022
PUBLISHED 16 August 2022
CITATION

Kuwahara W, Sasaki S, Yamamoto R,
Kawakami M and Kaneko F (2022) The
effects of robot-assisted gait training
combined with non-invasive brain
stimulation on lower limb function inpatients with stroke and spinal cord
injury: A systematic review andmeta-analysis.
Front. Hum. Neurosci. 16:969036.
doi: 10.3389/fnhum.2022.969036
COPYRIGHT© 2022 Kuwahara, Sasaki, Yamamoto,Kawakami and Kaneko. This is an
open-access article distributed under
the terms of the Creative Commons
Attribution License (CC BY). The use,
distribution or reproduction in otherforums is permitted, provided theoriginal author(s) and the copyrightowner(s) are credited and that theoriginal publication in this journal iscited, in accordance with accepted
academic practice. No use, distribution
or reproduction is permitted which
does not comply with these terms.

Frontiers in Human Neuroscience

Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan,
Department of Physical Therapy, Graduate School of Health Sciences, Tokyo Metropolitan
University, Tokyo, Japan, 3 Department of Artificial Environment, Safety, Environment and System
Engineering, Graduate School of Environment and Information Sciences, Yokohama National
University, Kanagawa, Japan
2

Objective: This study aimed to investigate the effect of robot-assisted gait
training (RAGT) therapy combined with non-invasive brain stimulation (NIBS)
on lower limb function in patients with stroke and spinal cord injury (SCI).
Data sources: PubMed, Cochrane Central Register of Controlled Trials, Ovid
MEDLINE, and Web of Science were searched.
Study selection: Randomized controlled trials (RCTs) published as of 3 March
2021. RCTs evaluating RAGT combined with NIBS, such as transcranial direct
current stimulation (tDCS) and repetitive transcranial magnetic stimulation(rTMS), for lower limb function (e.g., Fugl-Meyer assessment for patientswith stroke) and activities (i.e., gait velocity) in patients with stroke and SCI
were included.
Data extraction: Two reviewers independently screened the records, extracted
the data, and assessed the risk of bias.
Data synthesis: A meta-analysis of five studies (104 participants) and risk of bias
were conducted. Pooled estimates demonstrated that RAGT combined with
NIBS significantly improved lower limb function [standardized mean difference(SMD) = 0.52; 95% confidence interval (CI) = 0.06–0.99] but not lower limb
activities (SMD = −0.13; 95% CI = −0.63–0.38). Subgroup analyses also failed
to find a greater improvement in lower limb function of RAGT with tDCS
compared to sham stimulation. No significant differences between participantcharacteristics or types of NIBS were observed.

01

frontiersin.org

JRM

Journal of Rehabilitation Medicine

JRM

Journal of Rehabilitation Medicine

JRM

J Rehabil Med 2022; 54: jrm00276

SHORT COMMUNICATIONVISUALLY INDUCED KINAESTHETIC ILLUSION COMBINED WITH THERAPEUTIC
EXERCISE FOR PATIENTS WITH CHRONIC STROKE: A PILOT STUDY
Ryosuke TAKAHASHI, MS1, Motoki KOIWA, MS1, Wataru IDE, MD2, Megumi OKAWADA, MS1,3, Kazuto AKABOSHI, MD, PhD3
and Fuminari KANEKO, PhD3

From the 1Department of Rehabilitation, Hokuto Hospital, Obihiro, Hokkaido, 2Department of Neurosurgery, Hokuto Hospital, Obihiro,
Hokkaido and 3Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan

Objective: Kinaesthetic perceptional illusion byvisual stimulation (KINVIS) combined with neuromuscular electrical stimulation (NMES) and conventional therapeutic exercise (TherEX) has beenshown previously to enhance motor function in
stroke patients with chronic hemiparesis. The aimof this preliminary study is to assess the effects
of a repetitive KINVIS intervention combined with
TherEX, but without NMES, on upper limb motor function of patients with stroke-induced hemiparesis.
Design: A quasi-experimental study, with pretest–
posttest for 1 group
Patients: Ten patients with stroke-induced, chronic,
severe upper limb hemiparesis.
Methods: Patients were evaluated before and aftera 10-day intervention, during which KINVIS and
TherEX were applied for 20 and 60 min, respectively, for 5 days per week (Monday to Friday). Upper
limb motor function was assessed using Fugl-Meyer
Assessment (FMA) and Action Research Arm Test
(ARAT), and resistance to passive movement in flexor
muscles was assessed using the Modified Ashworth
Scale (MAS). In addition, the amount of use and quality of movement of the affected upper limb in daily
life were assessed using Motor Activity Log (MAL).
Results: Clinical assessments with FMA, ARAT, MAS,and MAL significantly improved after the intervention period.
Conclusion: A repetitive KINVIS intervention combinedwith TherEX may improve upper limb motor function inpatients with chronic stroke and severe hemiparesis.
Key words: stroke; upper limb motor function; rehabilitation;
augmented reality; illusion.
Accepted Feb 15, 2022; Epub ahead of print Feb 22, 2022
J Rehabil Med 2022; 54: jrm00276
DOI: 10.2340/jrm.v54.29
Correspondence address: Fuminari Kaneko, Department of
Rehabilitation Medicine, Keio University School of Medicine, 35
Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. E-mail:f-kaneko@keio.jp

Upper limb motor dysfunction is a common problem
in stroke patients. It disrupts the patient’s activities

LAY ABSTRACT
Kinaesthetic perceptional illusion by visual stimulation(KINVIS) combined with neuromuscular electrical stimulation (NMES) and a conventional therapeutic exercise(TherEX) enhance muscle use in stroke patients withchronic paralysis. This preliminary study assessed theeffects of a repetitive KINVIS intervention with added
TherEX, but without NMES, on the use of the arm in Tenpatients with stroke-induced paralysis. Ten patients withstroke-induced chronic paralysis were evaluated before
and after a 10-day intervention, during which KINVIS and
TherEX were applied for 20 and 60 min, respectively, for 5days per week (Monday to Friday). The use of the paralysed arm improved significantly after the intervention. The
repetitive KINVIS intervention combined with TherEX may
improve the use of the arm in patients with chronic paralysis due to stroke.

of daily living (ADL) and reduces their quality of life
(QOL). Kinaesthetic perceptional illusion by visual
stimulation (KINVIS) can be applied as a neurorehabilitation approach, which restores the upper limb motor
function in post-stroke survivors. KINVIS is defined asa psychological phenomenon in which a resting person
feels as if their own body part is moving or feels thedesire to move a body part while watching a video ofthe same body part being moved (1). This is a implicit
motor imagery that is carried as a result of cognitive
substitution of the paralysed real body with a functioning virtual body. We have demonstrated previously thatprimary motor cortex excitability is increased during
KINVIS (1). Moreover, previous studies have shownthat motor-related areas are activated when experiencing
KINVIS more than during simple observation of asimilar movement (2). The psychological experiencesin KINVIS and neurological effects may contribute torecovering post-stroke upper limb motor dysfunction.
KINVIS has been shown to immediately improve motor function in patients with chronic stroke exhibiting
severe hemiparesis (3).
We reported recently that an intervention of combined KINVIS and neuromuscular electrical stimulation

Published by Medical Journals Sweden, on behalf of the Foundation for Rehabilitation Information. This is an Open Access article distributed under the terms of
the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/)

NEUROCASE
2022, VOL. 28, NO. 2, 199–205
https://doi.org/10.1080/13554794.2022.2063747

Effects of kinesthetic illusion induced by visual stimulation (KINVIS) therapy on
patients with stroke in the subacute phase: a visual analysis based on paralysis
severity
Megumi Okawadaa,b, Toru Inadac, Naoki Matsudad, Seiji Motozawac, Masaki Yonetaa, Shun Sasakia, Eriko Shibataeand Fuminari Kanekoa,fDepartment of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjukuku, Tokyo, Japan; bGraduate Course of Health and Social Work, Kanagawa University of Human Services, 1-10-1 Heisei-cho, Yokosuka, Kanagawa,Japan; cDepartment of Rehabilitation, Asahikawa Rehabilitation Hospital, Shindo Medical Corporation, Midorigaoka Higashi 1-1-chome, Asahikawashi, Japan; dDepartment of Rehabilitation, Shinsapporo Neurosurgical Hospital, Medical Corporation, 1-2-1-10 Kaminopporo, Atsubetsu-ku, Sapporoshi, Japan; eDepartment of Physical Therapy, Faculty of Human Science, Hokkaido Bunkyo University, 5-196-1, Koganechuo, Eniwa-shi, Japan;fDepartment of Physical Therapy, Faculty of Health Sciences Graduate School of Health Sciences, Tokyo Metroporitan University, 7-2-10 Higashi-Ogu,
Arakawa-ku, Tokyo, Japana

ABSTRACT

We explored the effect of kinesthetic illusion induced by visual stimulation (KINVIS) therapy on motor
function in patients with stroke during the subacute phase based on paralysis severity. The study was
performed using an ABAB design (A1, B1, A2, B2; for 10 days each). KINVIS therapy was additionallyadministered in periods B1 and B2. Ten patients with stroke were classified according to severity. The
improvement in upper limb motor function was higher after B1 and B2 than after A1 and A2 in themoderate group. The effect of KINVIS therapy increases the degree of improvement in motor function,
especially in the moderate group.

Introduction
Clinically, kinesthetic illusion induced by visual stimulation(KINVIS) therapy with therapeutic exercise in paralyzed patients
after stroke has shown beneficial effects on motor function andspasticity (Aoyama et al., 2020; Kaneko et al., 2016a, 2019;
Maruyama et al., 2020). This vivid kinesthetic perception withoutaccompanying voluntary movement can be induced while placing a virtual body aligned on an actual own body and observing
its movement (Kaneko et al., 2007). This causes the subject tomake a cognitive substitution that the movement of the virtual
body is own. Several studies have indicated that KINVIS has
physiological effects on the central nervous system, which may
clinically affect motor function. KINVIS has shown that corticospinal excitability increases depending on the direction of joint
movement of the observed virtual body (Aoyama et al., 2012;
Kaneko et al., 2016b, 2007). Notably, accumulating evidence
indicates that KINVIS shares a common neural substrate forbrain activity as real movement (Kaneko et al., 2015). As observedin electroencephalography (EEG) studies, event-related desynchronization of the alpha band around the sensorimotor cortex,
which occurred during exercise or motor imagery, also occurred
during KINVIS (Shibata & Kaneko, 2019). A study using EEG in
stroke patients with severe upper limb paralysis also reported
that adaptation of KINVIS therapy caused an immediate improvement in the ability to induce motor imagery (Okawada et al.,2020). Because of the neurophysiological effects of KINVIS, recovery of motor function has been reported in chronic stroke
patients with severe hemiparesis (Kaneko et al., 2016a, 2019).
CONTACT Fuminari Kaneko

f-kaneko@keio.jp© 2022 Informa UK Limited, trading as Taylor & Francis GroupARTICLE HISTORY

Received 25 August 2021
Accepted 4 April 2022
KEYWORDS

Stroke; upper limb motor
function; kinesthetic illusion
induced by visual
stimulation; ABAB study
design; subacute phase

Mirror therapy demonstrates moderate-quality clinical evidence on promoting better improvement of motor function
than other interventions for post-stroke upper limb paralysis
cases (Pollock et al., 2014; Thieme et al., 2018). In mirror therapy, a mirror is placed in the patient’s midsagittal plane toreflect the unaffected side, thereby providing an illusion of
normal movement in the affected limb (Thieme et al., 2018).
The point where the kinesthetic perception is represented in
the brain is common to that in KINVIS. Furthermore, action
observation is a common element to both mirror therapy and
KINVIS therapy as a stimulation. The human experiment indicated action observation involves brain areas of the inferior
frontal gyrus including the ventral premotor cortex, and inferiorparietal lobule with intraparietal sulcus (Cook et al., 2014;
Rizzolatti & Craighero, 2004). As both therapies may sharecommon neural bases involving the mirror neuron system. In
contrast, the kinesthetic perception of the participant during
the mirror therapy is largely triggered by the proprioceptive
input from the contralateral extremity (Chancel et al., 2016).
The major difference between mirror therapy and KINVIS therapy is whether to move the unparalyzed hand while inducing
kinesthetic illusion. During KINVIS therapy, kinesthetic perception is purely induced by comparing between visual information and the proprioceptive state on the involved side. Resting
the unparalyzed hand during KINVIS does not enhance abnormal interhemispheric inhibition associated with non-paretic
hand movements (Murase et al., 2004; Nowak et al., 2009),
which may be beneficial in the treatment of patients with

ORIGINAL RESEARCH
published: 10 January 2022
doi: 10.3389/fnsys.2021.804263

Model-Based Analyses for the Causal
Relationship Between Post-stroke
Impairments and Functional Brain
Connectivity Regarding the Effects ofKinesthetic Illusion Therapy
Combined With Conventional
Exercise
Yu Miyawaki 1,2,3 , Masaki Yoneta 1 , Megumi Okawada 1 , Michiyuki Kawakami 1 , Meigen Liu 1
and Fuminari Kaneko 1 *Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan, 2 Neurorehabilitation ResearchCenter, Kio University, Nara, Japan, 3 Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan1

Aims: Therapy with kinesthetic illusion of segmental body part induced by visual

Edited by:
Jun Izawa,
University of Tsukuba, Japan
Reviewed by:
Soha Saleh,
Kessler Foundation, United States
Rieko Osu,
Waseda University, Japan*Correspondence:
Fuminari Kaneko
f-kaneko@keio.jp
Received: 29 October 2021
Accepted: 15 December 2021
Published: 10 January 2022
Citation:
Miyawaki Y, Yoneta M, Okawada M,
Kawakami M, Liu M and Kaneko F(2022) Model-Based Analyses for the
Causal Relationship Between
Post-stroke Impairments andFunctional Brain Connectivity
Regarding the Effects of Kinesthetic
Illusion Therapy Combined With
Conventional Exercise.
Front. Syst. Neurosci. 15:804263.
doi: 10.3389/fnsys.2021.804263

stimulation (KINVIS) may allow the treatment of severe upper limb motor deficits inpost-stroke patients. Herein, we investigated: (1) whether the effects of KINVIS therapy
with therapeutic exercise (TherEx) on motor functions were induced through improved
spasticity, (2) the relationship between resting-state functional connectivity (rs-FC) andmotor functions before therapy, and (3) the baseline characteristics of rs-FC in patientswith the possibility of improving their motor functions.
Methods: Using data from a previous clinical trial, three path analyses in structural

equation modeling were performed: (1) a mediation model in which the indirect effectsof the KINVIS therapy with TherEx on motor functions through spasticity were drawn,(2) a multiple regression model with pre-test data in which spurious correlations between
rs-FC and motor functions were controlled, and (3) a multiple regression model withmotor function score improvements between pre- and post-test in which the pre-test
rs-FC associated with motor function improvements was explored.
Results: The mediation model illustrated that although KINVIS therapy with TherEx did

not directly improve motor function, it improved spasticity, which led to ameliorated
motor functions. The multiple regression model with pre-test data suggested that rs-FC

Abbreviations: aIPS, Inferior parietal sulcus in the affected hemisphere; ARAT, Action Research Arm Test; ARAT-F,
finger-related ARAT score; ARAT-FD, degree of ARAT-F score improvements from the pre-test to the post-test; ARAT-S,
shoulder-related ARAT score; ARAT-SD, degree of ARAT-S score improvements from the pre-test to the post-test;
aSMG, supramarginal gyrus in the affected hemisphere; FMA, Fugl-Meyer Assessment; FMA-D, degree of FMA score
improvements from the pre-test to the post-test; KINVIS, kinesthetic illusion of segmental body part induced by visual
stimulation; MAS, modified Ashworth Scale; rs-FC, resting-state functional connectivity; TherEx, therapeutic exercise;uIPL, inferior parietal lobule in the unaffected hemisphere; uIPS, inferior parietal sulcus in the unaffected hemisphere;
uPMd, dorsal premotor cortex in the unaffected hemisphere.

Frontiers in Systems Neuroscience | www.frontiersin.org

1

January 2022 | Volume 15 | Article 804263

fnhum-15-674139

June 21, 2021

Time: 12:34#1

ORIGINAL RESEARCH
published: 22 June 2021
doi: 10.3389/fnhum.2021.674139

Influence of Visual
Stimulation-Induced Passive
Reproduction of Motor Images in the
Brain on Motor Paralysis After Stroke
Toshiyuki Aoyama 1 , Atsushi Kanazawa 2 , Yutaka Kohno 3 , Shinya Watanabe 4 ,Kazuhide Tomita 1 and Fuminari Kaneko 5*
Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan, 2 Department of Physical
Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan, 3 Centre for Medical Sciences, Ibaraki
Prefectural University of Health Sciences, Ibaraki, Japan, 4 Department of Occupational Therapy, Ibaraki Prefectural
University of Health Sciences Hospital, Ami, Japan, 5 Department of Rehabilitation Medicine, Keio University Schoolof Medicine, Shinjuku-ku, Japan
1

Edited by:
Ryouhei Ishii,
Osaka Prefecture University, Japan
Reviewed by:
Ardalan Shariat,
Tehran University of Medical
Sciences, IranTakayuki Tabira,Kagoshima University, Japan*Correspondence:
Fuminari Kaneko
f-kaneko@keio.jp
Specialty section:
This article was submitted toBrain Imaging and Stimulation,a section of the journal
Frontiers in Human Neuroscience
Received: 28 February 2021
Accepted: 28 May 2021
Published: 22 June 2021
Citation:
Aoyama T, Kanazawa A, Kohno Y,
Watanabe S, Tomita K and Kaneko F(2021) Influence of Visual
Stimulation-Induced Passive
Reproduction of Motor Images
in the Brain on Motor Paralysis After
Stroke.
Front. Hum. Neurosci. 15:674139.
doi: 10.3389/fnhum.2021.674139

Finger flexor spasticity, which is commonly observed among patients with stroke,disrupts finger extension movement, consequently influencing not only upper limb
function in daily life but also the outcomes of upper limb therapeutic exercise.
Kinesthetic illusion induced by visual stimulation (KINVIS) has been proposed as apotential treatment for spasticity in patients with stroke. However, it remains unclear
whether KINVIS intervention alone could improve finger flexor spasticity and finger
extension movements without other intervention modalities. Therefore, the current study
investigated the effects of a single KINVIS session on finger flexor spasticity, including
its underlying neurophysiological mechanisms, and finger extension movements. To thisend, 14 patients who experienced their first episode of stroke participated in this study.
A computer screen placed over the patient’s forearm displayed a pre-recorded mirror
image video of the patient’s non-paretic hand performing flexion–extension movements
during KINVIS. The position and size of the artificial hand were adjusted appropriately
to create a perception that the artificial hand was the patient’s own. Before and after
the 20-min intervention, Modified Ashworth Scale (MAS) scores and active range offinger extension movements of the paretic hand were determined. Accordingly, MAS
scores and active metacarpophalangeal joint extension range of motion improved
significantly after the intervention. Moreover, additional experimentation was performed
using F-waves on eight patients whose spasticity was reduced by KINVIS to determine
whether the same intervention also decreased spinal excitability. Our results showedno change in F-wave amplitude and persistence after the intervention. These results
demonstrate the potential clinical significance of KINVIS as a novel intervention forimproving finger flexor spasticity and extension movements, one of the most significant
impairments among patients with stroke. The decrease in finger flexor spasticity

Frontiers in Human Neuroscience | www.frontiersin.org

1

June 2021 | Volume 15 | Article 674139

fnhum-15-653713

March 20, 2021

Time: 18:13#1

ORIGINAL RESEARCH
published: 26 March 2021
doi: 10.3389/fnhum.2021.653713

The Effects of Transcranial Direct
Current Stimulation on Dual-Task
Interference Depend on theDual-Task Content
Takehide Kimura 1,2 , Fuminari Kaneko 3,4* and Takashi Nagamine 5
Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan, 2 Department of Physical Therapy,
Faculty of Health Sciences, Tsukuba International University, Tsuchiura, Japan, 3 First Division of Physical Therapy, Schoolof Health Sciences, Sapporo Medical University, Sapporo, Japan, 4 Department of Rehabilitation Medicine, Keio University
School of Medicine, Tokyo, Japan, 5 Department of Systems Neuroscience, School of Medicine, Sapporo Medical University,
Sapporo, Japan
1

Edited by:
Giovanni Di Pino,
Campus Bio-Medico University, Italy
Reviewed by:
Tilo Strobach,Medical School Hamburg, Germany
M. A. Salehienjad,
Ruhr University Bochum, Germany*Correspondence:
Fuminari Kaneko
f-kaneko@keio.jp
Specialty section:
This article was submitted toMotor Neuroscience,a section of the journal
Frontiers in Human Neuroscience
Received: 15 January 2021
Accepted: 04 March 2021
Published: 26 March 2021
Citation:
Kimura T, Kaneko F and
Nagamine T (2021) The Effectsof Transcranial Direct Current
Stimulation on Dual-Task Interference
Depend on the Dual-Task Content.
Front. Hum. Neurosci. 15:653713.
doi: 10.3389/fnhum.2021.653713

Recently, some studies revealed that transcranial direct current stimulation (tDCS)
reduces dual-task interference. Since there are countless combinations of dual-tasks,
it remains unclear whether stable effects by tDCS can be observed on dual-task
interference. An aim of the present study was to investigate whether the effects
of tDCS on dual-task interference change depend on the dual-task content. We
adopted two combinations of dual-tasks, i.e., a word task while performing a tandem
task (word-tandem dual-task) and a classic Stroop task while performing a tandem
task (Stroop-tandem dual-task). We expected that the Stroop task would recruit thedorsolateral prefrontal cortex (DLPFC) and require involvement of executive function to
greater extent than the word task. Subsequently, we hypothesized that anodal tDCS
over the DLPFC would improve executive function and result in more effective reductionof dual-task interference in the Stroop-tandem dual-task than in the word-tandem dualtask. Anodal or cathodal tDCS was applied over the DLPFC or the supplementary motor
area using a constant current of 2.0 mA for 20 min. According to our results, dual-task
interference and the task performances of each task under the single-task condition
were not changed after applying any settings of tDCS. However, anodal tDCS over theleft DLPFC significantly improved the word task performance immediately after tDCS
under the dual-task condition. Our findings suggested that the effect of anodal tDCS
over the left DLPFC varies on the task performance under the dual-task condition waschanged depending on the dual-task content.
Keywords: dual-task, dual-task interference, dual-task content, transcranial direct continuous stimulation,
dorsolateral prefrontal cortex

INTRODUCTION
When an individual performs two tasks simultaneously, the performance of either one or bothtasks may often be impaired. This impairment of performance under a dual-task condition isdefined as dual-task interference (Ebersbach et al., 1995). In our daily life, dual-task interferenceis known to cause various accidents, such as falls or traffic accidents (Lundin-Olsson et al.,
1997; Chaparro et al., 2005). For example, when elderly individuals perform a cognitive task while
walking, a reduction in gait speed and an increment in the cadence and stride duration has been

Frontiers in Human Neuroscience | www.frontiersin.org

1

March 2021 | Volume 15 | Article 653713

455

Restorative Neurology and Neuroscience 38 (2020) 455–465
DOI 10.3233/RNN-201030
IOS Press

Kinesthetic illusion induced by visual
stimulation influences sensorimotor
event-related desynchronization in stroke
patients with severe upper-limb paralysis:
A pilot study
Megumi Okawadaa,b,c , Fuminari Kanekoa,b,∗ , Keiichiro Shindoa,b , Masaki Yonetaa,b,c ,Katsuya Sakaia,b , Kohei Okuyamaa , Kazuto Akaboshia,b,c and Meigen Liuaa Department of Rehabilitation of Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku-ku,

Tokyo, Japanb Department of Rehabilitation, Shonan Keiiku Hospital, Endo, Fujisawa, Kanagawa, Japanc Hokuto Social Medical Corporation, Kisen, Inada-cho, Obihiro, Hokkaido, Japan

Abstract.
Background: Repetition of motor imagery improves the motor function of patients with stroke. However, patients whodevelop severe upper-limb paralysis after chronic stroke often have an impaired ability to induce motor imagery. We havedeveloped a method to passively induce kinesthetic perception using visual stimulation (kinesthetic illusion induced by visual
stimulation [KINVIS]).
Objective: This pilot study further investigated the effectiveness of KINVIS in improving the induction of kinesthetic motor
imagery in patients with severe upper-limb paralysis after stroke.
Methods: Twenty participants (11 with right hemiplegia and 9 with left hemiplegia; mean time from onset [ ± standard
deviation], 67.0 ± 57.2 months) with severe upper-limb paralysis who could not extend their paretic fingers were includedin this study. The ability to induce motor imagery was evaluated using the event-related desynchronization (ERD) recorded
during motor imagery before and after the application of KINVIS for 20 min. The alpha- and beta-band ERDs around thepremotor, primary sensorimotor, and posterior parietal cortices of the affected and unaffected hemispheres were evaluatedduring kinesthetic motor imagery of finger extension and before and after the intervention.
Results: Beta-band ERD recorded from the affected hemisphere around the sensorimotor area showed a significant increase
after the intervention, while the other ERDs remained unchanged.
Conclusions: In patients with chronic stroke who were unable to extend their paretic fingers for a prolonged period of time,
the application of KINVIS, which evokes kinesthetic perception, improved their ability to induce motor imagery. Our findings
suggest that although KINVIS is a passive intervention, its short-term application can induce changes related to the motor
output system.
Keywords: Motor imagery, event-related desynchronization, electroencephalography, stroke, kinesthetic illusion, virtual
reality∗ Corresponding author: Fuminari Kaneko, Department of Rehabilitation of Medicine, Keio University School of Medicine, 35

Shinanomachi, Shinjuku-ku, Tokyo 169-8582, Japan. Tel.: +81 03
5363 3833; E-mail: f-kaneko@keio.jp.

0922-6028/20/$35.00 © 2020 – IOS Press and the authors. All rights reservedNeuroscience Letters 741 (2021) 135483

Contents lists available at ScienceDirect

Neuroscience Lettersjournal homepage: www.elsevier.com/locate/neulet

Research article

Effect of primary motor cortex excitability changes after quadripulse
transcranial magnetic stimulation on kinesthetic sensitivity: A
preliminary study
Megumi Okawada a, b, c, Fuminari Kaneko a, b, *, Eriko Shibata a, daFirst Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, S1 W17 Chuo, Sapporo, Hokkaido, Japan
Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku-ku, Tokyo, Japan
Department of Rehabilitation, Hokuto Hospital, Hokuto Social Medical Corporation, 7-5 Kisen, Inada-cho, Obihiro-shi, Hokkaido, Japand
Department of Physical Therapy, Faculty of Human Science, Hokkaido Bunkyo University, 5-196-1, Koganechuo, Eniwa Shi, Hokkaido, Japanbc

A R T I C L E I N F O

A B S T R A C T

Keywords:
Inesthetic perception
Joint motor detection threshold
Quadripulse
Transcranial
Magnetic stimulation
Primary motor cortex

Muscle spindles provide the greatest contribution to kinesthetic perception. Primary motor cortex (M1) excitability changes in parallel with the intensity of kinesthetic perception inputs from muscle spindles; M1 istherefore involved in kinesthetic perception. However, the causal relationship between changes in kinesthetic
sensitivity and M1 excitability is unclear. The purpose of this study was to test whether artificially and sustainably modulated M1 excitability causes changes in kinesthetic sensitivity in healthy individuals. We evaluatedmotor evoked potentials (MEP) in Experiment 1 and joint motion detection thresholds (JMDT) in Experiment 2
before and after quadripulse transcranial magnetic stimulation (QPS). Nine healthy right-handed male volunteers
were recruited. In each experiment, participants received QPS or sham stimulation (Sham) on separate days. MEP
amplitude and JMDT were recorded before and at 0, 15, 30, 45, and 60 min after QPS and Sham. Our results
showed that M1 excitability and kinesthetic sensitivity increased after QPS, whereas neither changed after Sham.
In the five subjects who participated in both experiments, there was a significant moderate correlation between
M1 excitability and kinesthetic sensitivity. Thus, the long-lasting change in kinesthetic sensitivity may be due tochanges in M1 excitability. In addition, M1 may play a gain adjustment role in the neural pathways of muscle
spindle input.

1. Introduction
Peripheral sensory input plays an important role in motor control[1–5] and motor learning [6]. Kinesthesia encompasses three main
sensations: position and movement of joints; force, effort, and heavinessassociated with muscle contractions; and the perceived timing of muscle
contractions [7]. Subjects whose kinesthesia has been blocked byischemia or anesthesia have shown decreased interjoint coordination or
inability to accurately detect movement direction [1–5]. Therefore,kinesthesia is necessary for coordinated movement. Muscle spindles
provide the greatest contribution to kinesthetic perception [8–13]. Primary motor cortex (M1) excitability has been shown to be associatedwith the intensity of kinesthetic perception in studies using tendon vibration [18]. Furthermore, a previous study showed that subjects
perceived limb movements when repetitive transcranial magnetic
stimulation (rTMS) was applied over M1, dorsal premotor cortex (PMd),or inferior parietal regions, despite the absence of sensory afferents andactual limb movement [19]. M1 is therefore involved in kinesthetic
perception. However, the causal relationship between changes inkinesthetic sensitivity and M1 excitability is unclear.
M1 excitability can be modulated using rTMS, a noninvasive brain
stimulus that induces neural plasticity [20]. Quadripulse TMS (QPS)
modulates M1 excitability; this effect lasts longer and is more pronounced than that of other rTMS techniques [21]. The purpose of thisAbbreviations: QPS, quadripulse transcranial magnetic stimulation; M1, primary motor cortex; rTMS, repetitive transcranial magnetic stimulation; PMd, dorsal
premotor cortex; MEP, motor evoked potential; JMDT, joint motion detection threshold; EMG, electromyography; APB, abductor pollicis brevis; CM, carpometacarpal; TA, tibialis anterior; MVC, maximum voluntary contraction; FDI, first dorsal interosseous; SEP, somatosensory evoked potentials.
* Corresponding author at: Fuminari Kaneko Department of Rehabilitation of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku-ku, Tokyo
160-8582, Japan.
E-mail address: f-kaneko@keio.jp (F. Kaneko).
https://doi.org/10.1016/j.neulet.2020.135483
Received 2 June 2020; Received in revised form 23 October 2020; Accepted 26 October 2020
Available online 5 November 20200304-3940/© 2020 Elsevier B.V. All rights reserved.

症 KINVIS 療法と従来型運動療法による複合療法に例 ADOC H を加えたアプローチによって生活での報 手の使用が促進した 1 症例
告A case study of hand usage facilitation in daily living：The effect of KINVIS therapy and conventional therapeutic exercise
with ADOC H

丸 山

祥＊1

Sho Maruyama

新 藤 恵一郎＊4

Keiichiro Shindo

松 本

仁 美＊2

岡和田 愛 実＊3

赤 星

和 人

金 子

Hitomi Mastumoto＊4

Kazuto Akaboshi

Megumi Okawada

文 成＊3

Fuminari Kaneko

Key words：KINVIS 療法，上肢機能，ADOC H
Abstract：脳卒中後の重度上肢麻痺に対する視覚誘導性自己錯覚（KINVIS）療法と従来型運動療法による複合療法に，Aid for Decision Making in Occupation Choice for Hand（ADOC H）を加えたアプローチによって日常生活での手の使用に変化がみられたので報告する．患者は 50 代男性で，左脳梗塞発症後 3.5 年経過していた．介入（10 日間）は，①視覚誘導性自己錯覚療法，②
従来型運動療法，③ADOC H を用いたアプローチを毎日行った（③のみ 7 日間）．結果，上肢運動機能の改善を認め，日常生活での麻痺手の使用が増加した．本結果は，視覚誘導性自己錯覚療法と従来型運動療法によって運動機能改善が得られ，さらに ADOC H を用いたアプローチによって日常生活での麻痺手の使用が促進することを示唆している．

はじめに

Aid for Decision Making in Occupation Choice

近年，脳卒中後の上肢リハでは，constraint

for Hand（ADOC H）は，CI 療法の主要要素でinduced movement therapy（以下，CI 療法）をある transfer package（TP）を促進するために開代表に，比較的軽度〜中等度の運動麻痺に対する発された iPad アプリケーションである6）．TP は生活での手の使用改善について，その科学的根拠

訓練により獲得した機能を実生活に転移させるたが蓄積されつつある ．しかし，慢性期の重度上めの方略である7）．ADOC H の臨床使用は，「文肢麻痺患者の日常生活での手の使用にまで言及し字や言語だけよりもイメージが湧きやすい」等のたアプローチはほとんどみられない．

肯定的な感想の一方で，CI 療法の適用になるよう

1）

新しい治療方法として視覚誘導性自己運動錯覚な患者には「すでに麻痺手を使っている」といっ（kinesthetic illusion induced by visual stimula-

た感想が挙がっている8）．すなわち，ADOC H は，tion：KINVIS）が利用されている2〜5）．自己運動錯より生活での手の使用のイメージが困難な患者に覚とは，関節運動が生じていないにもかかわら対する適用が有用であると解釈できる．

ず，あたかも自身の四肢が動いているような感覚©MIWA-SHOTEN Ltd, 2020

上記より，KINVIS 療法と従来型運動療法に加．脳卒中片麻痺患

え，ADOC H による TP 実施は，互いの利点を活者の重度の上肢運動機能障害に対して，KINVIS

かす関係にあると考えられる．今回，脳卒中後のにより上肢 Fugl Meyer Assessment Scale（FMA

重度上肢麻痺患者 1 症例に対して，KINVIS 療法

UE）得点の改善や表面筋電図上で筋活動の改善がと従来型運動療法に加え，ADOC H によるアプ認められたと報告されている ．現在，KINVIS

ローチを実施することを経験し，日常生活での手は，神経筋電気刺激（neuromuscular electricalの使用に変化がみられたので報告する．

が引き起こされるものである

2〜5）

3）

stimulation：NMES）との併用による KINVIS 療法としてパッケージ化されている．
＊1

湘南慶育病院，作業療法士 〒252 0816 神奈川県藤沢市遠藤 4360，＊2 同，理学療法士，＊3 慶應義塾大学，理学療法士，＊4
慶應義塾大学，医師（リハビリテーション科）

OT ジャーナル

2

4/

54 ⒀：1437 1442，2020

10 :

8 9

0915 1354/21/紙：￥500/電子：￥1,200/論文/JCOPY

doi: 10.2490/prm.20200025

Progress in Rehabilitation Medicine 2020; Vol. 5, 20200025

CASE REPORT

Feasibility Case Study for Treating a Patient with Sensory
Ataxia Following a Stroke with Kinesthetic Illusion
Induced by Visual Stimulation
Toshiyuki Aoyama, PhD, PT a Atsushi Kanazawa, MSc, PT b Yutaka Kohno, PhD, MD c
Shinya Watanabe, OT d Kazuhide Tomita, PhD, PT a Takehide Kimura, PhD, PT e
Yusuke Endo, MSc, PT f and Fuminari Kaneko, PhD, PT g
Background: Sensory ataxia is a disorder of movement coordination caused by sensory deficits,
especially in kinesthetic perception. Visual stimulus-induced kinesthetic illusion (KINVIS) is amethod used to provide vivid kinesthetic perception without peripheral sensory input by using
a video showing pre-recorded limb movements while the actual limb remains stationary. We
examined the effects of KINVIS intervention in a patient with sensory ataxia. Case: The patient
was a 59-year-old man with a severe proprioceptive deficit caused by left thalamic hemorrhage.
During KINVIS intervention, a computer screen displayed a pre-recorded mirror image video ofthe patient’s unaffected hand performing flexion–extension movements as if it were attached tothe patient’s affected forearm. Kinematics during the flexion–extension movements of the paretic
hand were recorded before and after 20-min interventions. Transcranial magnetic stimulation
was applied to the affected and non-affected hemispheres. The amplitude of the motor-evoked
potential (MEP) at rest was recorded for the muscles of both hands. After the intervention, thetotal trajectory length and the rectangular area bounding the trajectory of the index fingertip
decreased. The MEP amplitude of the paretic hand increased, whereas the MEP amplitude of the
non-paretic hand was unchanged. Discussion: The changes in kinematics after the intervention
suggested that KINVIS therapy may be a useful new intervention for sensory ataxia, a condition
for which few effective treatments are currently available. Studies in larger numbers of patientsare needed to clarify the mechanisms underlying this therapeutic effect.
Key words: body ownership; kinesthetic illusion; sensory ataxia, stroke; transcranial magnetic
stimulation

INTRODUCTION

lowing thalamic stroke.3) Several studies have shown thatrehabilitation can improve some sensory functions, such as
tactile sensation and positional sense,4,5) but a systematic
review by Doyle et al.6) concluded that there is insufficientevidence to support its effectiveness in improving sensory
impairment. Furthermore, there have been very few reports

Sensory ataxia is a disorder of movement coordination
caused by sensory deficits, especially deficits in kinesthetic
perception. Previous studies have shown that sensory ataxia
occurs in patients with peripheral neuropathy1,2) and fol-

Received: July 5, 2020, Accepted: October 13, 2020, Published online: October 28, 2020
a Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japanb Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japanc Centre for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Japand Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japane Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University, Tsuchiura, Japanf Department of Physical Therapy, Health Science University, Fujikawaguchiko, Japang Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
Correspondence: Fuminari Kaneko, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-0016, Japan, Email: f-kaneko@keio.jp
Copyright © 2020 The Japanese Association of Rehabilitation Medicine
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No
Derivatives (CC BY-NC-ND) 4.0 License. http://creativecommons.org/licenses/by-nc-nd/4.0/

1

Human Movement Science 73 (2020) 102683

Contents lists available at ScienceDirect

Human Movement Sciencejournal homepage: www.elsevier.com/locate/humov

Full Length Article

Motor imagery combined with action observation training
optimized for individual motor skills further improves motor skills
close to a plateau

T

Toshiyuki Aoyamaa, , Fuminari Kanekob, Yutaka Kohnoc
⁎

a
b
c

Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-gun, Ibaraki, Japan
Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
Centre for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-gun, Ibaraki, JapanA RTI CL E INFOAB S T RAC T

Keywords:
Motor learning
Plateau
Training
Rehabilitation

The acquisition of high-level motor skills beyond a “plateau” is important in sports training andrehabilitation. We aimed to investigate whether motor skills close to a plateau state can be improved further by performing motor imagery (MI) training while observing movements withdifficulty levels optimized for individual motor skills. The subjects were divided randomly into
four groups (n = 10 per group): the control group and three groups of MI combined with action
observation (MI + AO) training with varying difficulty levels. The task was to rotate the two corkballs 20 times counterclockwise using the left hand. The subjects performed 30 and 10 successful
trials of this task before and after MI + AO training, respectively. In the three training groups, MI
training was performed while observing videos showing ball rotation movements adjusted to thesame level, a moderately higher level, or a remarkably higher level of difficulty than that
achieved by the individual subjects. The improvement rate of the ball rotation time after
MI + AO training was significantly higher in the moderate-difficulty than in the control groupand remarkably higher level of difficulty group. The other two MI + AO training groups did not
differ significantly compared with the control group. The vividness of the MI during MI + AO
training was significantly greater in the moderate-difficulty vs. the remarkably-high-difficultygroup. These results suggest that performing MI training while observing movement at a levelthat is moderately higher than an individual's ability can promote improvements in motor skills(close to a plateau state) in rehabilitation and sports training. The vividness of MI may be an
important index for determining the difficulty level of the movement to be observed during
MI + AO training.

1. Introduction
Humans have the ability to enhance their motor skills by repeatedly practicing certain motor actions. As motor learning progresses, the degree of improvement in motor skills gradually decreases and eventually reaches a nearly steady state, which is called a“plateau” (Adams, 1987). Recently, Gray (2017) defined the limits caused by “the mechanism for the function itself” as asymptotes
and the spurious limits, “which could be surpassed,” as plateaus and distinguished between them. The acquisition of a higher level ofmotor skills beyond the plateau state is a crucial issue in sports training (Smith, 2003) and rehabilitation (Page, Gater, & Bach, 2004).
⁎

Correspondence author.
E-mail addresses: aoyamato@ipu.ac.jp (T. Aoyama), f-kaneko@keio.jp (F. Kaneko), kohno@ipu.ac.jp (Y. Kohno).

https://doi.org/10.1016/j.humov.2020.102683
Received 17 December 2019; Received in revised form 2 September 2020; Accepted 8 September 2020
Available online 16 September 20200167-9457/ © 2020 Elsevier B.V. All rights reserved.

Brain Stimulation 13 (2020) 310e317

Contents lists available at ScienceDirect

Brain Stimulation
journal homepage: http://www.journals.elsevier.com/brain-stimulation

Region-dependent bidirectional plasticity in M1 following quadripulse
transcranial magnetic stimulation in the inferior parietal cortex
Fuminari Kaneko a, b, *, Eriko Shibata a, Megumi Okawada a, b, Takashi Nagamine cabcFirst Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, S1 W17, Chuo, Sapporo, Hokkaido, Japan
Department of Rehabilitation of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku-ku, Tokyo, 160-8582, Japan
Department of Systems Neuroscience, School of Medicine, Sapporo Medical University, S1 W17, Chuo, Sapporo, Hokkaido, Japana r t i c l e i n f o

a b s t r a c t

Article history:
Received 21 May 2019
Received in revised form
28 August 2019
Accepted 19 October 2019
Available online 25 October 2019

Background: The ability to manipulate the excitability of the network between the inferior parietal
lobule (IPL) and primary motor cortex (M1) may have clinical value.
Objective: To investigate the possibility of inducing long-lasting changes in M1 excitability by applying
quadripulse transcranial magnetic stimulation (QPS) to the IPL, and to ascertain stimulus condition- andsite-dependent differences in the effects.
Methods: QPS was applied to M1, the primary somatosensory cortex (S1), the supramarginal gyrus (SMG)
and angular gyrus (AG) IPL areas, with the inter-stimulus interval (ISI) in the train of pulses set to either
5 ms (QPS-5) or 50 ms (QPS-50). QPS was repeated at 0.2 Hz for 30 min, or not presented (sham condition). Excitability changes in the target site were examined by means of single-pulse transcranial
magnetic stimulation (TMS).
Results: QPS-5 and QPS-50 at M1 increased and decreased M1 excitability, respectively. QPS at S1
induced no obvious change in M1 excitability. However, QPS at the SMG induced mainly suppressive
effects in M1 for at least 30 min, regardless of the ISI length. Both QPS ISIs at the AG yielded signiﬁcantly
different MEP compared to those at the SMG. Thus, the direction of the plastic effect of QPS differeddepending on the site, even under the same stimulation conditions.
Conclusions: QPS at the IPL produced long-lasting changes in M1 excitability, which differed dependingon the precise stimulation site within the IPL. These results raise the possibility of noninvasive inductionof functional plasticity in M1 via input from the IPL.
© 2019 Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords:
Angular gyrus
Inferior parietal lobule
Motor cortex plasticity
Quadripulse transcranial magnetic
stimulation
Supramarginal gyrus

Introduction
The parietal lobe is divided into an anterior and a posterior
cortex (PPC). The latter is positioned rostral to the primary andsecondary visual cortex and caudal to the somatosensory cortex [1].
In humans, PPC defects induce misreaching (optic ataxia) andmisgrasping not attributable to a basic sensory or motor deﬁcit

Abbreviations: aMT, active motor threshold; AG, angular gyrus; ECR, extensor
carpi radialis; FCR, ﬂexor carpi radialis; FDI, ﬁrst dorsal interosseous; IPL, inferiorparietal cortex; M1, primary motor cortex; MEP, motor evoked potential; MVC,
maximum voluntary contraction; QPS, quadripulse transcranial magnetic stimulation; PPC, posterior parietal cortex; S1, primary sensory cortex; SMG, supramarginal
gyrus.
* Corresponding author. Department of Rehabilitation of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shjinjuku-ku, Tokyo, 160-8582, Japan.
E-mail address: f-kaneko@keio.jp (F. Kaneko).

[2,3]. Even without direct connections to the spinal cord, the role of
the PPC in movement control is suggested by interconnections withpremotor areas and coactivation with frontal areas during movement execution and planning [4]. The PPC is particularly welldeveloped in primates, where it includes a superior and an inferior parietal lobule (IPL); the latter is particularly involved in visual
spatial processing [4,5].
The IPL is the ventral part of the parietal lobe, located below the
intraparietal sulcus. The supramarginal gyrus (SMG), situated in the
IPL, anterior to the angular gyrus (AG), arching upward at the end of
the lateral ﬁssure, participates in reaching toward both visible andnonvisible targets [4]. The AG arches over the posterior end of thesuperior temporal sulcus in the posterior IPL, and is consistently
activated in various motor tasks [6]. Furthermore, the IPL is
involved in action observation, especially during object-related
action [7]. The SMG is activated during mouth and hand movements, and the AG during foot as well as mouth and hand actions

https://doi.org/10.1016/j.brs.2019.10.016
1935-861X/© 2019 Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

【原著】

中強度・長時間の動的筋収縮による局所疲労が視覚刺激に対する単純反応
時間に与える影響
山田洋（東海大学体育学部） 木塚朝博（筑波大学体育系） 金子文成（慶応大学医学部）
金子公宏（明治大学理工学部） 増田正（福島大学共生システム理工学研究科）

塩崎知美（筑波スポーツ科学研究所） 横井孝志（日本女子大学家政学部）
Effects of local muscle fatigue during moderate prolonged dynamic contraction on
reaction time obtained using visual stimulation
Hiroshi YAMADA, Tomohiro KIZUKA, Fuminari KANEKO, Kimihiro KANEKO, Tadashi MASUDA,
Tomomi SHIOZAKI and Takashi YOKOI

Abstract
The purpose of this study was to investigate the effects of local muscle fatigue during moderate prolonged dynamic
contraction on the delay in reaction time obtained using visual stimulation. Twelve healthy men exerted 40% MVC maximum
voluntary contraction of isotonic knee extension in 60 degree per second using isokinetic machine (Cybex). The fatigue tasks
were set up as 1 min×20 times. Reaction tests to visual stimulation were conducted after each fatigue task. The random
stimulations were delivered five times per 1 min. Subjective degree of fatigue sensation graded five steps was examined during
tasks. The surface EMG signals were recorded from muscles knee extensors. Reaction time (RT), Pre-motor time (PMT) andMotor time (MT) were calculated based on the relationship between EMG signals and stimulation pulse. The subjective fatigue
sensation was increased, and MVC was decreased after knee extension for 20 sets, indicating the fatigue had developed in themuscles. RT was increased significantly, but the standard deviation in RT was not change as fatigue progressed. Significant
increases were seen in PMT, but not seen in MT. These results suggest that the delayed RT due to muscle fatigue after dynamic
contraction was caused from central factors in neuromuscular system.
（Tokai J. Sports Med. Sci. No. 31, 29-37, 2019）

Ⅰ．緒言

視覚刺激に対する単純反応時間に及ぼす影響を検討することは、体育・スポーツ分野における重要な研究課題のひとつである。これらは特に、球技

スポーツ場面における筋疲労は、様々なパフォ
ーマンスの低下を引き起こす 。この疲労による
1）

パフォーマンスの低下のなかでも、脚の筋疲労が系スポーツにおいて極めて重要な意義をもつ。
これらの課題を実験的に検証しようとする場合、反応時間の遅延を誘発する疲労課題を十分に吟味29

CLINICAL TRIAL
published: 17 December 2019
doi: 10.3389/fnsys.2019.00076

A Case Series Clinical Trial of a Novel
Approach Using Augmented Reality
That Inspires Self-body Cognition in
Patients With Stroke: Effects on
Motor Function and Resting-State
Brain Functional Connectivity
Fuminari Kaneko 1,2 *, Keiichiro Shindo 1,2 , Masaki Yoneta 1,2,3 , Megumi Okawada 1,2,3 ,Kazuto Akaboshi 1,2,3 and Meigen Liu 1
Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan, 2 Department of Rehabilitation,
Shonan Keiiku Hospital, Fujisawa, Japan, 3 Hokuto Social Medical Corporation, Obihiro, Japan
1

Edited by:James W. Grau,
Texas A&M University, United States
Reviewed by:
Soha Saleh,
Kessler Foundation, United States
Birgitta Langhammer,
OsloMet—Oslo Metropolitan
University, Norway*Correspondence:
Fuminari Kaneko
f-kaneko@keio.jp
Received: 31 July 2019
Accepted: 27 November 2019
Published: 17 December 2019
Citation:
Kaneko F, Shindo K, Yoneta M,
Okawada M, Akaboshi K and Liu M(2019) A Case Series Clinical Trial of a
Novel Approach Using Augmented
Reality That Inspires Self-body
Cognition in Patients With Stroke:
Effects on Motor Function andResting-State Brain Functional
Connectivity.
Front. Syst. Neurosci. 13:76.
doi: 10.3389/fnsys.2019.00076

Barring a few studies, there are not enough established treatments to improve upper
limb motor function in patients with severe impairments due to chronic stroke. This
study aimed to clarify the effect of the kinesthetic perceptional illusion induced byvisual stimulation (KINVIS) on upper limb motor function and the relationship between
motor function and resting-state brain networks. Eleven patients with severe paralysis
of upper limb motor function in the chronic phase (seven men and four women;age: 54.7 ± 10.8 years; 44.0 ± 29.0 months post-stroke) participated in the study.
Patients underwent an intervention consisting of therapy using KINVIS and conventional
therapeutic exercise (TherEX) for 10 days. Our originally developed KiNvisTM system
was applied to induce KINVIS while watching the movement of the artificial hand.
Clinical outcomes were examined to evaluate motor functions and resting-state brain
functional connectivity (rsFC) by analyzing blood-oxygen-level-dependent (BOLD) signals
measured using functional magnetic resonance imaging (fMRI). The outcomes of motor
function (Fugle-Meyer Assessment, FMA) and spasticity (Modified Ashworth Scale, MAS)significantly improved after the intervention. The improvement in MAS scores for thefingers and the wrist flexors reached a minimum of clinically important differences. Before
the intervention, strong and significant negative correlations between the motor functions
Abbreviations: KINVIS, Kinesthetic perceptional illusion by visual stimulation; TherEX, Therapeutic exercise; rsFC,
Resting-state brain functional connectivity; fMRI, Functional magnetic resonance imaging; CIMT, Constraint-induced
movement therapy; M1, Primary motor; S1, Somatosensory; BOLD, Blood-oxygen-level-dependent; ROIs, Regions ofinterest; TFO, Time from onset; U/L, Upper Limb; SIAS, Stroke impairment assessment set; NMES, Neuromuscularelectrical stimulation; EDC, Extensor digitorum communis; FMA, Fugl-Meyer assessment; MAS, Modified ashworth scale;
ARAT, Action research arm test; BBT, Box and Block Test; MAL, Motor activity log; AOU, Amount of use; QOM,
Quality of movement; MNI, Montreal Neurological Institute; SMG, Supramarginal gyrus; FDR, False discovery-rate; IPL,
Inferior parietal lobule; IPS, Intra parietal sulcus; LOC, Lateral occipital cortex; PMd, Dorsal premotor cortex; SMA,
Supplementary motor area; SFG, Superior frontal gyrus; SPL, Superior parietal lobule.

Frontiers in Systems Neuroscience | www.frontiersin.org

1

December 2019 | Volume 13 | Article 76

Experimental Brain Research (2019) 237:3485–3492
https://doi.org/10.1007/s00221-019-05693-x

RESEARCH ARTICLE

Neural mechanism of selective finger movement independentof synergistic movement
Toshiyuki Aoyama1 · Fuminari Kaneko2 · Yukari Ohashi1 · Yutaka Kohno3
Received: 9 September 2019 / Accepted: 13 November 2019 / Published online: 18 November 2019
© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Abstract
Muscle synergy is important for simplifying functional movement, which constitutes spatiotemporal patterns of activity acrossmuscles. To execute selective finger movements that are independent of synergistic movement patterns, we hypothesizedthat inhibitory neural activity is necessary to suppress enslaved finger movement caused by synergist muscles. To test thishypothesis, we focused on a pair of synergist muscles used in the hand opening movement, namely the index finger abductor
and little finger abductor (abductor digiti minimi; ADM), and examined whether inhibitory neural activity in ADM occurs
during selective index finger abduction/adduction movements and/or its imagery using transcranial magnetic stimulation andF-wave analysis. During the index finger adduction movement, background EMG activity, F-wave persistence, and motor
evoked potential (MEP) amplitude in ADM were elevated. However, during the index finger abduction movement, ADM
MEP amplitude remained unchanged despite increased background EMG activity and F-wave persistence. These results
suggest that increased spinal excitability in ADM is counterbalanced by cortical-mediated inhibition only during selective
index finger abduction movement. This assumption was further supported by the results of motor imagery experiments.
Although F-wave persistence in ADM increased only during motor imagery of index finger abduction, ADM MEP amplitude
during motor imagery of index finger abduction was significantly lower than that during adduction. Overall, our findings
indicate that cortical-mediated inhibition contributes to the execution of selective finger movements that are independent ofsynergistic hand movement patterns.
Keywords Transcranial magnetic stimulation · Hand synergy · F-wave · Selective finger movement · Inhibitory neuralactivity

Introduction
Selective finger movement plays an important role in producing coordinated and dexterous finger movements. Previous studies have demonstrated that inhibitory neural activity,
Communicated by Winston D Byblow.
* Toshiyuki Aoyama
aoyamato@ipu.ac.jp
1

Department of Physical Therapy, Ibaraki Prefectural
University of Health Sciences, 4669-2 Ami, Ami-Machi,
Inashiki-gun, Ibaraki, Japan2

Department of Rehabilitation Medicine, Keio University
School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo,
Japan

3

Center for Medical Sciences, Ibaraki Prefectural University
of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-gun,Ibaraki, Japansuch as surround inhibition (Sohn and Hallett 2004; Becket al. 2008) and short-interval intracortical inhibition (SICI)(Stinear and Byblow 2003, 2004), contribute to the control
of selective finger movement. However, humans cannot perform their intended movements completely independently,
and movements of other body parts not directly related tothat movement may occur. This unintended finger movement is called “enslaving.” A number of previous studies
have investigated the anatomical, biomechanical, and neurophysiological mechanisms of this phenomenon (Schieber
1991; Zatsiorsky et al. 1998; Slobounov et al. 2002; Reilly
and Schieber 2003). In particular, the strength of enslaving depends on which finger is instructed to move as wellas its movement direction (Hager-Ross and Schieber 2000;
Reilly and Hammond 2000; Park and Xu 2017). For example, considering the combination of index and little finger
movement, index finger abduction is often accompanied bylittle finger abduction during hand opening movement in

13

Vol.:(0123456789)

Experimental Brain Research (2019) 237:3233–3240
https://doi.org/10.1007/s00221-019-05665-1

RESEARCH ARTICLE

Event-related desynchronization possibly discriminates
the kinesthetic illusion induced by visual stimulation from movement
observation
Eriko Shibata1 · Fuminari Kaneko2
Received: 6 May 2019 / Accepted: 9 October 2019 / Published online: 19 October 2019
© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Abstract
Visual stimulation of a repetitive self-movement image can evoke kinesthetic illusion when a virtual body part is set over theactual body part (kinesthetic illusion induced by visual stimulation, KINVIS). KINVIS induces activity in cerebral network,
similar to that produced during motor execution, and triggers motor imagery passively. This study sought to identify a biomarker of KINVIS using event-related desynchronization (ERD) to improve the application of KINVIS to brain–machineinterface (BMI) therapy of patients with stroke with hemiparesis. We included healthy adults in whom KINVIS could be
induced. Scalp electroencephalograms were recorded during the KINVIS condition, where KINVIS was induced using aself-movement image. The findings were compared to signals recorded during an observation (OB) condition where only the
self-movement image was viewed. For the signal intensity of the α- and low β-frequency bands, we calculated ERD during
a movie period. The ERD of the α-frequency band in P3 and CP3 during KINVIS was significantly higher than that during
OB. Furthermore, using the ERD of the α-frequency band recorded from FC3 and CP3, we could discriminate illusory perception with a 70% success rate. In this study, KINVIS could be detected using the ERD of the α-frequency band recorded
from the posterior portion of the sensorimotor cortex. Furthermore, adding ERD recorded from FC3 to that recorded from
CP3 may enable the objective discrimination of KINVIS from OB. When applying KINVIS in BMI therapy, the combination ERD of FC3 and CP3 will become a parameter for objectively judging the degree of kinesthetic perception achieved.
Keywords Kinesthetic illusion · Event-related desynchronization · Electroencephalogram · Brain–machine interface ·Embodiment · Body ownership

Introduction
Kinesthetic illusion, the sensation of movement in one’s
own body, is induced by various sensory inputs, even in theabsence of voluntary or passive movement. Kaneko et al.
(2007) reported that visual stimulation using a repetitive
self-movement image evokes a kinesthetic illusion when avirtual body part is set over its actual counterpart; this phenomenon is referred to as kinesthetic illusion induced by* Fuminari Kaneko
f-kaneko@keio.jp
1

First Division of Physical Therapy, Sapporo Medical
University, West 17-South 1, Chuo-ku, Sapporo, Japan2

Department of Rehabilitation Medicine, Keio University
School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo,Japanvisual stimulation (KINVIS). This system can be viewed as a
virtual reality (augmented reality) intervention using embodied-visual feedback, which can induce embodied cognitivechange in self-body and physiological effects on motorassociated areas in the brain (Kaneko et al. 2007; Aoyama
et al. 2012; Kaneko et al. 2015, 2016a, b). In other words,
kinesthetic illusion may represent a cognitive stimulation
to the embodied-brain system for body ownership, sense ofagency, and kinesthetic perception. We have used electrophysiological methods and functional magnetic resonanceimaging (fMRI) to reveal that KINVIS increases activationof cerebral networks, including higher-order motor andsensory processing areas of the superior and inferior parietal lobes, and excitation of the corticospinal tract (Kaneko
et al. 2007; Aoyama et al. 2012; Kaneko et al. 2015); suchenhancement of cerebral network activity resembles thatwhich corresponds to motor execution and occurs when the
self-movement image is viewed. These reports suggest that

13Vol.:(0123456789)

www.nature.com/scientificreports

OPEN

Received: 1 March 2019
Accepted: 21 August 2019
Published: xx xx xxxx

Dissociation between cortical andspinal excitability of the antagonist
muscle during combined motor
imagery and action observation
Toshiyuki Aoyama1, Fuminari Kaneko2, Yukari Ohashi1 & Yutaka Kohno3
Inhibitory neural control of antagonist muscle is one of the fundamental neural mechanism of
coordinated human limb movement. Previous studies have revealed that motor execution (ME) andmotor imagery (MI) share many common neural substrates; however, whether inhibitory neural activity
occurs during MI remains unknown. In addition, recent studies have demonstrated that a combined
MI and action observation (MI + AO) produces strong neurophysiological changes compared with MI
or AO alone. Therefore, we investigated inhibitory changes in cortical and spinal excitability of theantagonist muscle during MI + AO and ME. Single-pulse transcranial magnetic stimulation (TMS)
experiments revealed that corticospinal excitability of the antagonist muscle was decreased during
MI + AO. Conversely, F-wave experiments showed that F-wave persistence of the antagonist muscle
increased. Paired-pulse TMS experiment also demonstrated that short-interval intracortical inhibition(SICI) did not contribute to this inhibition. Therefore, cortical mediated inhibition, except for SICI, may
be related to this inhibition. Conversely, such clear inhibition of the antagonist muscle was not observed
during ME, presumably owing to the effects of muscle contraction to decelerate the movements and/or
sensory input accompanying the joint movements. These findings provide important insights into theneurophysiological differences between MI + AO and ME.
Motor imagery (MI) is defined as the mental simulation of a given movement that is internally reproduced withinbrain without any muscular output1,2. Previous studies using functional imaging have demonstrated that motor
execution (ME) and MI share many common neural substrates, including the primary motor cortex, supplementary motor area, premotor cortex, parietal cortex, and cerebellum3. TMS studies have also revealed that thecorticospinal excitability of the prime mover of the imagined movement increases during MI4–9. However, little is
known regarding the effect of MI on the non-prime mover, such as the antagonist muscle.
Usually, MEP amplitude obtained from the agonist muscle increases before the movement onset10. Since thiscorticospinal excitability change is not accompanied by an increase in agonist EMG activity, as well as during MI,
the neurophysiological changes during MI and before movement onset are similar. On the other hand, a previous
study revealed that the corticospinal excitability of the antagonist muscle is suppressed before movement onset11.
Therefore, considering such neurophysiological similarities occurring during MI and before movement onset in
the agonist muscle, we hypothesized that corticospinal excitability of the antagonist muscles would be suppressed
during MI. However, no study has reported a significant reduction in MEP amplitudes of the antagonist muscle
during MI6,8,12,13.
Recent studies have examined the effect of MI during action observation (AO). At the behavior level, MI
during AO (MI + AO) task has more potential to improve motor function, such as muscle strength or upper limb
function, in stroke patients compared with MI or AO alone14,15. Other studies using fMRI have revealed higher
brain activity in MI + AO than AO or MI alone16–20. In addition, TMS studies have demonstrated that MEP
amplitude increases in MI + AO in agonist muscles of the imagined movement compared with during AO or MI
1

Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashikigun, Ibaraki, 300-0394, Japan. 2Department of Rehabilitation Medicine, Keio University School of Medicine, 35
Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. 3Center for Medical Sciences, Ibaraki Prefectural University of
Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-gun, Ibaraki, 300-0394, Japan. Correspondence and requests formaterials should be addressed to T.A. (email: aoyamato@ipu.ac.jp)
SCIENTIFIC REPORTS |(2019) 9:13120 | https://doi.org/10.1038/s41598-019-49456-8

1

Brain Stimulation 12 (2019) 821e823

Contents lists available at ScienceDirect

Brain Stimulation
journal homepage: http://www.journals.elsevier.com/brain-stimulation

Efﬁcacy and safety of multiple sessions of quadripulse stimulation inpatients with stroke: A report of two cases
Dear Editor
Quadripulse stimulation (QPS) is a new patterned repetitivetranscranial magnetic stimulation (rTMS) protocol. In particular,
QPS induces long-term effects [1], with low inter-individual variabilities, in healthy individuals [2,3]. Recently, various rTMS protocols have been used to improve motor function in patients withstroke [4]. However, there are no reports on the application of
QPS in stroke patients. This study aimed to investigate how multiple sessions of QPS to the lesioned primary motor cortex (M1)combined with other therapies change motor function and electroencephalograms (EEGs) in stroke patients.
Two patients with chronic cerebral infarction were included in
the trial after obtaining written informed consent (Table 1). The
paretic ﬁnger functions as scored with the Stroke Impairment
Assessment Set (SIAS) were 1C (partial individual movements,
shown in the thumb and the index ﬁnger) in Case 1 and 1A (mass
ﬂexion) in Case 2. Both patients could not pick up the marble
used in the Action Research Arm Test. The study was performedin accordance with the Declaration of Helsinki, was approved by
the local Ethics Committee, and was registered to the UMIN Clinical
Trial Registry (UMIN000032286).
The TMS was performed using four monophasic stimulators(Magstim 2002, The Magstim Company, Ltd., Whitland, Carmarthenshire, UK) integrated through a connecting module, andattached to a 70 mm ﬁgure-of-eight coil while subjects were seatedcomfortably. Motor evoked potentials (MEPs) were recorded frombilateral ﬁrst dorsal interosseous muscle via surface electromyogram. Neuronavigation (Brainsight, Rogue Research, Inc., Montreal,
Quebec, Canada) ensured a consistent coil position during all sessions. No MEPs were elicited from the affected hemisphere inboth cases, and the active motor threshold (AMT) of the unaffected
M1 was determined. The QPS protocol of four successive monophasic pulses delivered with an interstimulus interval of 5 milliseconds(QPS-5) was applied to a symmetric position (mirror region) of theunaffected M1 hotspot. One therapeutic session consisted of 360
trains of four pulses (total, 1440 pulses) at the intensity of 90%
AMT and an intertrain interval of 5 seconds. To maximize clinicalbeneﬁts, we used QPS for 30 minutes and kinesthetic illusion
induced by visual stimulation [5] for 20 minutes (40 minutes
including preparation), 5 times a week for 2 weeks. Task-oriented
training for 60 minutes and Hybrid Assistive Neuromuscular Dynamic Stimulation therapy [6] was conducted once every day.
Resting-state EEGs were recorded before and after the intervention with subjects sitting relaxed in an armchair, while keeping
their eyes open without blinking. The EEG data were acquired using
https://doi.org/10.1016/j.brs.2019.02.017
1935-861X/© 2019 Elsevier Inc. All rights reserved.

Geodesic EEG system 400 MR (Electrical Geodesics Inc., Eugene,OR) and Net Station v5.2 recording software, and sampling at
1000 Hz. We used 128-channel high-impedance HydroCel Geodesic
Sensor Nets, with an average of all channels as the reference. Nets
were positioned on each participant by aligning the vertex (Cz)electrode with the vertex of the head. Electrode impedances were
<50 kU, as recommended by the manufacturer. Analysis electrodes,
C3 and C4, were selected according to the international 10e20 system. For ofﬂine analysis, we used a bandpass of 0.5e120 Hz, and anotch of 50 Hz, and removed noisy epochs manually. Data weresegmented into epochs of 2 consecutive seconds (20 points). Powerwas calculated using MATLAB (MATLAB R2018a; The MathWorks
Inc., Natick, MA, USA). Fast Fourier transformation (averaged window, 2 sec) was used to calculate power (mV2) for the following
EEG bands and sub-bands: delta (1e3 Hz), theta (4e7 Hz), alpha(8e13 Hz), and beta (14e30 Hz), low alpha (8e10 Hz), high alpha(11e13 Hz), low beta (14e20 Hz), and high beta (21e30 Hz). Twoway repeated measures ANOVA and Bonferroni post hoc comparison was performed using IBM SPSS Statistics version 25 (IBM Corporation, Armonk, NY, USA) and the level of signiﬁcance was set
at 0.05 (0.003, after Bonferroni adjustments).
After a 20 min rest period following the ﬁrst QPS session, Case 1
could move the middle ﬁnger individually and Case 2 could
perform a mass ﬁnger extension (SIAS 1B) (Table 1). Restorationof paretic ﬁnger functions was accompanied by reduction of spasticity at the ﬁnger ﬂexors (the examiner's subjective impression,
not as measured with Modiﬁed Ashworth Scale), which made it
possible for both patients to pick up and release the marble with
their thumb and index ﬁnger. After the two-week intervention,
the ﬁnger functions were SIAS 2 (able to move each ﬁnger but unable to extend and ﬂex the ﬁngers completely) in Case 1 and 1C(partial individual movements, shown in the thumb and middle
ﬁnger) in Case 2. Both participants showed improved motor function with decreased spasticity of the paretic upper extremity. No
deﬁnite MEPs were recorded in the affected hemisphere. There
was no obvious adverse effect during the trial. Resting-state EEG
analyses showed that time, bands, and the interaction effect between time and bands were signiﬁcant, with signiﬁcantly reduced
powers in the beta band in both hemispheres (lesion side dominant) in Case 2, whereas no signiﬁcant changes were seen in Case 1.
Ten sessions of QPS-5 to the lesioned M1 combined with othertreatments achieved clinical improvements without any adverse effects. To our knowledge, this is the ﬁrst report on multiple sessions
of QPS applied to the stroke patients. In healthy volunteers, theafter-effects of QPS-5 are longer (>75 minutes) [1] than those in
the other rTMS protocols. Although it is unclear how QPS works

Experimental Brain Researchhttps://doi.org/10.1007/s00221-018-5396-y

RESEARCH ARTICLE

Neuromuscular electrical stimulation increases serum brain-derived
neurotrophic factor in humans
Takehide Kimura1,2,3 · Fuminari Kaneko4,5,6 · Erika Iwamoto7 · Shigeyuki Saitoh8,9 · Takashi Yamada4
Received: 11 July 2018 / Accepted: 4 October 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Abstract
Brain-derived neurotrophic factor (BDNF) plays several important roles in nervous system function including neuronal
growth and plasticity. The purpose of the present study was to clarify whether neuromuscular electrical stimulation (NMES)
and voluntary exercise to the same integrated force as by the NMES-induced exercise would enhance serum BDNF. Elevenhealthy male subjects completed three interventions (NMES, voluntary exercise, and resting interventions) for 20 min on
different days. In the NMES intervention, NMES was applied to the quadriceps femoris muscles. The stimulus intensity
of NMES was progressively increased to the highest tolerated intensity during the experiment. In the voluntary exercise
intervention, subjects performed an isometric knee-extension task; in this intervention, the target torque was calculated inaccordance with the integrated force of knee extension obtained during the NMES intervention. In the resting intervention,subjects relaxed in a sitting posture. We measured serum BDNF, blood lactate, heart rate, oxygen uptake, respiratory ratio,
and blood pressure. Serum BDNF was increased in the NMES (p = 0.003) and voluntary exercise interventions (p = 0.004)
after each intervention. At the post-timepoint, serum BDNF in the NMES intervention was highest among all interventions(p = 0.038) and significantly higher than in the voluntary exercise (p = 0.036) and resting (p = 0.037) interventions. Our
results showed that NMES was more effective for enhancing serum BDNF than voluntary exercise at least when employing
the same method and integrated force.
Keywords Brain-derived neurotrophic factor · Voluntary exercise · Blood lactate · Neuromuscular electrical stimulation* Fuminari Kaneko
f-kaneko@keio.jp1

Graduate School of Health Sciences, Sapporo Medical
University, W17-S1 Chuo-ku, Sapporo, Hokkaido 060-8556,
Japan

2

Shinoro Orthopedic Hospital, Shinoro 4-5-3-9, Kita-ku,
Sapporo 002-8024, Hokkaido, Japan3

Department of Physical Therapy, Faculty of Health
Sciences, Tsukuba International University, 6-8-33 Manabe,
Tsuchiura 300-0051, Ibaraki, Japan

4

First Division of Physical Therapy, School of Health
Sciences, Sapporo Medical University, W17-S1 Chuo-ku,
Sapporo, Hokkaido 060-8556, Japan

5

Department of Rehabilitation Medicine, Keio University
School of Medicine, 35 Shinanomachi, Shinjuku-ku,
Tokyo 160-8582, Japan

6

Shonan Keiiku Hospital, 4360 Endo, Fujisawa,
Kanagawa 252-0816, Japan

7

Second Division of Physical Therapy, School of Health
Sciences, Sapporo Medical University, W17-S1 Chuo-ku,
Sapporo, Hokkaido 060-8556, Japan

8

Department of Nursing, School of Health Sciences,
Sapporo Medical University, W17-S1 Chuo-ku, Sapporo,
Hokkaido 060-8556, Japan

9

Department of Cardiovascular, Renal and Metabolic
Medicine, Sapporo Medical University, W17-S1 Chuo-ku,
Sapporo, Hokkaido 060-8556, Japan

13

Vol.:(0123456789)

Human Movement Science 57 (2018) 94–102

Contents lists available at ScienceDirect

Human Movement Sciencejournal homepage: www.elsevier.com/locate/humov

Full Length Article

Motor priming by movement observation with contralateral
concurrent action execution
Yoshihiro Itaguchia,b, Fuminari Kanekoc,d,e,

T

⁎

a

Department of System Design Engineering, Keio University, Yokohama, Japan
Japan Society for the Promotion of Science, Tokyo, Japanc
Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japand
Department of Rehabilitation, Shonan Keiiku Hospital, Kanagawa, JapaneFirst Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japanb

AR TI CLE I NF O

AB S TR A CT

Keywords:
Action observation
Action execution
Congruency eﬀect
Kinesthetic sensation

In the present study, the inﬂuence of simultaneous action execution on motor priming was investigated during movement observation using a simple-reaction task. Although previous studies
have reported various eﬀects of priming on motor performance, it has not yet been clariﬁed how
an additional source conveying kinetic information would modulate the priming eﬀects. In theexperiment, participants were asked to respond to an auditory cue by ﬂexing their wrist whileobserving a line movement, which was slowly swinging like an inverted pendulum. In addition tothe observation of line movement, the participants executed wrist ﬂexion-extension actions
synchronizing with line movement. The hand involved in pre-response wrist action varied withthe priming condition: no movement execution (observation only), contralateral hand, and ipsilateral hand. In the contralateral condition, the stimulus-response congruency of movement
direction was conﬂicted depending on the frame of reference (visual vs. anatomical coordinates).
We found that all three priming conditions produced the compatibility eﬀect, and the eﬀect size
did not diﬀer between them. Importantly, in the contralateral condition, participants responded
faster when the direction of line movement was congruent with the response movement in the
anatomical coordinates. That is, the reaction time was shorter when pre-response action execution was in the ﬂexion phase, even though the direction of observed movement and the response action were incongruent from the participants’ view. These results suggest that kinetic
information has a great contribution to the motor priming system, which can reverse the visionbased compatibility eﬀect.

1. Introduction
In recent years, it has been well established that movement observation signiﬁcantly aﬀects both action execution and actionrelated activation in the brain. This is referred to as motor priming or automatic imitation (Bertenthal, Longo, & Kosobud, 2006;
Boyer, Longo, & Bertenthal, 2012; Brass, Bekkering, & Prinz, 2001; Brass, Bekkering, Wohlschläger, & Prinz, 2000; Edwards,
Humphreys, & Castiello, 2003; Heyes, 2011; Liepelt & Brass, 2010). Motor priming is modulated by stimulus-response compatibility(S-R compatibility), which represents the degree of sharing movement components, including location, direction, and intention (e.g.,⁎
Corresponding author at: Department of Rehabilitation Medicine, Keio University School of Medicine, Keiiku Hospital Branch 4360 Endo, Fujisawa, Kanagawa
252-0816, Japan.
E-mail address: f-kaneko@keio.jp (F. Kaneko).

https://doi.org/10.1016/j.humov.2017.11.007
Received 11 April 2017; Received in revised form 13 November 2017; Accepted 14 November 2017
Available online 29 November 20170167-9457/ © 2017 Elsevier B.V. All rights reserved.

Exp Brain Res
DOI 10.1007/s00221-017-5057-6

RESEARCH ARTICLE

Muscular responses appear to be associated with existenceof kinesthetic perception during combination of tendon
co-vibration and motor imagery
Eriko Shibata1,2 · Fuminari Kaneko1,2 · Masaki Katayose3

Received: 30 December 2016 / Accepted: 3 August 2017
© Springer-Verlag GmbH Germany 2017

Abstract The afferent inputs from peripheral sensory
receptors and efferent signals from the central nervous
system that underlie intentional movement can contributeto kinesthetic perception. Previous studies have revealed
that tendon vibration to wrist muscles elicits an excitatory
response—known as the antagonist vibratory response—inmuscles antagonistic to the vibrated muscles. Therefore, thepresent study aimed to further investigate the effect of tendon
vibration combined with motor imagery on kinesthetic perception and muscular activation. Two vibrators were applied
to the tendons of the left flexor carpi radialis and extensor
carpi radialis. When the vibration frequency was the same
between flexors and extensors, no participant perceived
movement and no muscle activity was induced. When participants imagined flexing their wrists during tendon vibration, the velocity of perceptual flexion movement increased.
Furthermore, muscle activity of the flexor increased only
during motor imagery. These results demonstrate that kinesthetic perception can be induced during the combinationof motor imagery and co-vibration, even with no experienceof kinesthetic perception from an afferent input with covibration at the same frequency. Although motor responses
were observed during combined co-vibration and motor* Fuminari Kaneko
f-kaneko@sapmed.ac.jp
1

Development Research Group for Advanced
Neuroscience-based Rehabilitation, Sapporo Medical
University, West 17- South 1, Chuo-ku, Sapporo, Japan

2

Laboratory of Sensory Motor Science and Sports
Neuroscience, First Division of Physical Therapy, Sapporo
Medical University, West 17- South 1, Chuo-ku, Sapporo,
Japan

3

Second Division of Physical Therapy, Sapporo Medical
University, West 17- South 1, Chuo-ku, Sapporo, Japan

imagery, no such motor responses were recorded during
either co-vibration alone or motor imagery alone, suggesting that muscular responses during the combined condition
are associated with kinesthetic perception. Thus, the present
findings indicate that kinesthetic perception is influenced by
the interaction between afferent input from muscle spindles
and the efferent signals that underlie intentional movement.
We propose that the physiological behavior resulting fromkinesthetic perception affects the process of modifying agonist muscle activity, which will be investigated in a future
study.
Keywords Kinesthetic perception · Motor imagery ·Tendon vibration · Proprioceptive input · Antagonist
vibratory response

Introduction
Kinesthesia is the sense that enables awareness of bodily
position, weight, or movement. Kinesthetic perception is
generated by afferent inputs from muscle spindles and skin,or by the efferent signals from the central nervous systemthat underlie intentional movement. For example, tendon
vibration applied to a biceps brachii in an appropriate pattern can evoke a kinesthetic illusion of elbow extension
without any overt movement (Goodwin et al. 1972). Tendon
vibration mainly activates Ia-type afferents from the muscle
spindle primary endings (Burke et al. 1976; Roll and Vedel
1982; Roll et al. 1989), and consequently, humans can experience vivid kinesthetic illusions of limb movement in the
direction corresponding to the stretch of the vibrated muscle.
Thus, it is hypothesized that proprioceptive inputs from themuscles contribute to generating kinesthetic perception.

13

Vol.:(0123456789)

Journal of Motor Behavior, Vol. 49, No. 4, 2017
Copyright © Taylor & Francis Group, LLCRESEARCH ARTICLE

Working Memory Training Improves Dual-Task Performance on
Motor Tasks
Takehide Kimura1,2, Fuminari Kaneko3,4, Keita Nagahata5, Eriko Shibata3,4, Nobuhiro Aoki6
1

Graduate School of Health Science, Sapporo Medical University, Sapporo, Hokkaido, Japan. 2Department of Rehabilitation,
Shinoro Orthopedic Hospital, Sapporo, Hokkaido, Japan. 3Laboratory of Sensory Motor Science and Sports NeuroScience,First Division of Physical Therapy, Sapporo Medical University, Sapporo, Hokkaido, Japan. 4Development Research Group for
Advanced Neuroscience-based Rehabilitation, Sapporo Medical University, Sapporo, Hokkaido, Japan. 5Japan Community
Health Care Organization Noboribetsu Hospital, Noboribetsu, Hokkaido, Japan. 6Second Division of Physical Therapy,
Sapporo Medical University, Sapporo, Hokkaido, Japan.
ABSTRACT. The authors investigated whether working memory
training improves motor-motor dual-task performance consistedof upper and lower limb tasks. The upper limb task was a simple
reaction task and the lower limb task was an isometric knee extension task. 45 participants (age D 21.8 § 1.6 years) were classified
into a working memory training group (WM-TRG), dual-task
training group, or control group. The training duration was 2
weeks (15 min, 4 times/week). Our results indicated that working
memory capacity increased significantly only in the WM-TRG.
Dual-task performance improved in the WM-TRG and dual-task
training group. Our study provides the novel insight that working
memory training improves dual-task performance without specifictraining on the target motor task.

WM capacity (Jaeggi, Buschkuehl, Jonides, & Perrig, 2008;
Klingberg, 2010; Olesen, Westerberg, & Klingberg, 2004;
Westerberg & Klingberg, 2007) and activates structures in
the frontal-parietal brain region (e.g., the dorsolateral prefrontal cortex [DLPFC] and intraparietal cortex), anterior
cingulate cortex, and striatum (Moore, Cohen, & Ranganath,
2006; Nee et al., 2013; Rottschy et al., 2012). Therefore,
WM training is not only mere cognitive training but also a
training that changes the activation of various brain regions.
Behaviorally, WM training has a broad impact on the performance of various tasks. For example, WM training
improves other cognitive measures, such as reading comprehension (Chein & Morrison, 2010), fluid intelligence (Jaeggi
et al., 2008; Olesen et al., 2004), and attentional control(Chein & Morrison, 2010; Salminen, Strobach, & Schubert,
2012; Westerberg & Klingberg, 2007). Although these previous studies reported the potential of WM training, few studies
have investigated the effect of WM training on dual-task performance (Salminen et al., 2012). In addition, previous studies that investigated the effect of WM training on dual-task
performance adopt dual tasks where both tasks were cognitive to assess the effect of WM training. However, in daily
life, dual-task situations consist of dual motor tasks. When
we drive a car, upper limb controls a steering wheel and lower
limb hits the gas or brake pedal. In other examples, we often
encounter a situation of stepping over an obstacle while holding a glass of water. Therefore, we focused on the motormotor dual-task consisted of upper and lower limb tasks especially. The purpose of the present study was to investigate theeffect of WM training on motor-motor dual-task.
In the present study, we used visuospatial WM training.
Previous studies showed that this visuospatial WM training
was associated with an increase in the hemodynamic
response in the prefrontal and parietal cortex including the
DLPFC (Olesen et al., 2004; Westerberg & Klingberg,2007). Because the DLPFC was activated during

Keywords: dual task, motor performance, working memory,
working memory trainingD

ual task refers to the performance of two or more tasks
simultaneously (Pashler, 1994). Dual-task situations
are common in daily life (e.g., walking while using amobile phone). However, performing a dual task is often
associated with a reduction of performance in each task
(Redelmeier & Tibshirani, 1997; Strayer & Johnston, 2001;
Yogev-Seligmann et al., 2010). This negative aspect istermed named dual-task interference (Marois & Ivanoff,
2005; Watanabe & Funahashi, 2014). Because dual-task
interference might result in falls or accidents (Lundin-Olsson, Nyberg, & Gustafson, 1997), it is important to develop
a method of preventing dual-task interference. One suchmethod is dual-task training (Schwenk, Zieschang, Oster,& Hauer, 2010; Silsupadol et al., 2009; Silsupadol, Siu,
Shumway-Cook, & Woollacott, 2006). However, there is aproblem with dual-task training for people at risk of falling
because the dual-task training in many previous studies
involved performing a cognitive task while performing anactivity such as walking. In the present study, to solve thisproblem, we focused on working memory (WM) training.
WM training is a cognitive training to increase the WM
capacity. WM is a cognitive system that retains information
during short periods of time, and it consists of an active storage component and a processing component that enables
manipulation of information necessary to perform a giventask (Baddeley, 1992). However, WM has a limited capacity
to store and process information (Cowan, 2001; Miller,
1956). This limitation of capacity is known as the WM capacity. Several studies have reported that WM training increases

Correspondence address: Fuminari Kaneko, Laboratory of
Sensory Motor Science and Sports NeuroScience, First Division of
Physical Therapy, Sapporo Medical University, W17-S1
Chuoh-ku, Sapporo, Hokkaido, Japan. e-mail: f-kaneko@sapmed.
ac.jp
Color versions of one or more of the figures in the article canbe found online at www.tandfonline.com/vjmb.
388

■ORIGINAL ARTICLE

Analysis of reaching movements in stroke patientsusing average variability of electromyogram value
Tatsunori Sawada1, Fuminari Kaneko2, Toshiyuki Aoyama3, Masahiro Ogawa4,
Tsuneji Murakami5
1

Department of Occupational Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
Second division of physical therapy, School of health science, Sapporo Medical University, Sapporo, Japan
3
Division of physical therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
4
Graduate school of medicine, Kyoto University, Kyoto, Japan
5
Kure Kyosai Hospital, Hiroshima, Japan
2

Abstract: The hypothesis in this study was tested by conducting EMG experiments comparing the variability in muscle
activity during repetitive reaching movements in hemiplegic patients and healthy subjects. The present study investigated the characteristics of reaching movements in hemiplegic patients using the variability in average electromyogram(EMG) value. We studied 21 right-handed stroke patients with left-sided hemiparesis and 14 right-handed healthy
control subjects. Post-stroke patients (hemiplegic group) and normal subjects (control group) repeated a reaching movement 10 times. The variability in average EMG value of each muscle was defined as the average standard deviation of
the average rectified values (nARV-SDave). During the reaching movements, the nARV-SDave values was significantly
higher in the hemiparesis group than in the control group for the biceps and triceps brachii (P < 0.05). In the hemiparesis group, significant negative correlations between the variability in nARV-SDave values and the Fugl-Meyer assessment scores were observed in all muscle types (rs = −0.46 to −0.76; P < 0.05, P < 0.01). This study identified a direct
relationship between the variability in muscle activity and the severity of motor function deficit in post-stroke patients.
The selective impact on the biceps and triceps were related to the nature of the reaching task.
Keywords: stroke, upper extremity, reaching movement, electromyography, hemiplagia(Asian J Occup Ther 13: 13−21, 2017)

Introduction
A stroke is a medical emergency because a severe
reduction or interruption of blood flow to the brain
causes the cell death within minutes. The most common
complication following a stroke is a transient or permanent impairment of upper extremity functions, limiting
the patients’ autonomy [1]. As many daily activities involve reaching for an object, it is important for physicaland occupational therapists to understand the kinematicand kinetic characteristics of reaching movements inpost-stroke patients.

Received: 17 October 2016, Accepted: 21 February 2017
Corresponding to: Tatsunori Sawada, Department of Occupational
Therapy, School of Health Sciences, Tokyo University of Technology,
5-23-22, Nishikamata, Ohta-ku, Tokyo, 144-8535, Japane-mail address: sawadatn@stf.teu.ac.jp©2017 Japanese Association of Occupational Therapists

Several kinematic studies revealed that reaching
movements in stroke patients are characterized byenhanced variability, prolonged movements, and alower range of motion in the shoulder and elbow joints,
compared with healthy subjects or the non-affected side[2−7]. The higher movement variability suggests thatstroke patients are not able to stably perform reaching
movements when asked to repeat them several times.
In other words, stroke patients assume kinematicallyunstable reaching patterns, and the trajectory varies
during repetitive reaching movements. Electromyography (EMG) studies identified muscle activation abnormalities in stroke patients, such as prolonged agonist
bursts associated with reduced speed during elbow
flexion and extension [8], simultaneous co-contractionof agonist and antagonist muscles [9−13], and abnormal
muscle tone [14]. Muscle synergy and spasticity instroke patients generate specific movement patterns[15, 16]. Most studies characterized the patients using

Neuroscience Letters 629 (2016) 196–201

Contents lists available at ScienceDirect

Neuroscience Lettersjournal homepage: www.elsevier.com/locate/neulet

Research article

Surround inhibition in motor execution and motor imagery
Toshiyuki Aoyama a,∗ , Fuminari Kaneko b , Yukari Ohashi a , Hiroshi Nagata caDepartment of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-gun, Ibaraki, Japan
Laboratory of SensoryMotor Science and Sports Neuroscience, First Division of Physical Therapy, Sapporo Medical University, West 17- South 1, Chuo-ku,
Sapporo City, Japanc
Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-gun, Ibaraki, Japanbh i g h l i g h t s• We examined the extent of surround inhibition (SI) during motor execution (ME) and motor imagery (MI).
• There was a moderate correlation between the extent of SI during ME and MI.
• The extent of SI during MI was depended on the vividness of MI.
• A common neural substrate related to SI would be recruited during ME and MI.

a r t i c l e

i n f oArticle history:
Received 25 April 2016
Accepted 10 July 2016
Available online 11 July 2016
Keywords:
Surround inhibition
Motor execution
Motor imagery
Transcranial magnetic stimulationa b s t r a c t
Surround inhibition (SI) is a neural mechanism to focus neuronal activity and facilitate selective motor
execution (ME). The aim of the present study was to investigate whether SI is also generated during motor
imagery (MI). Furthermore, we investigated whether the extent of SI during MI depends on the strengthof SI during ME and/or vividness of MI. The extent of SI was examined during MI and ME of index finger
flexion. Transcranial magnetic stimulation was applied at rest, during initiation of the movement (phasic
phase) and during tonic muscle contraction of the index finger flexors. Motor evoked potentials (MEPs)
were recorded from a surround muscle, abductor digiti minimi (ADM) and a synergistic muscle, the firstdorsal interosseous muscle. The amplitude of ADM MEP was reduced during the phasic phase, whichindicates that SI occurred during ME. In seven of 14 subjects, SI was also observed during MI, although
this effect was not significant. There was a moderate correlation between the extent of SI during ME
and MI. Furthermore, good imagers who experienced vivid MI during the MI task showed stronger SI
than poor imagers. These results indicate that common neural substrates involved in SI during ME areat least in part recruited during MI. In clinical situations, the therapeutic use of MI to generate vivid MI
may be one of effective tool to develop the strength of SI, which facilitate selective execution of desired
movements© 2016 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
Motor imagery (MI) is the mental simulation of a given movement without any overt movement [1–4]. Functional imaging
studies [5–7] have revealed that motor execution (ME) and MI
share many common neural substrates, such as the primary motor
cortex, supplementary motor area, premotor cortex, parietal cor-Abbreviation: ADM, abductor digiti minimi; ANOVA, analysis of variance; EMG,
electromyography; FDI, first dorsal interosseous; GABA, !-amino butyric acid; MVC,
maximum voluntary contraction; MEP, smotor evoked potentials; ME, motor execution; MI, motor imagery; SI, surround inhibition.
∗ Corresponding author.
E-mail address: aoyamato@ipu.ac.jp (T. Aoyama).
http://dx.doi.org/10.1016/j.neulet.2016.07.012
0304-3940/© 2016 Elsevier Ireland Ltd. All rights reserved.

tex and cerebellum [3]. Some electrophysiological studies usingtranscranial magnetic stimulation (TMS) have shown increased
corticospinal excitability of the prime mover of the imagined movement during MI [8–13]. However, there have been conflicting
reports regarding the corticospinal excitability of surround muscles not involved in the imagined movement. Some researchers
have reported that corticospinal excitability of surround muscles
increases during MI [8,13], whereas others have reported no change
in surround muscles [9–12,14].
There are two reasons related to methodology that could explainthese inconsistent results. First, most MI studies did not define
the stimulation site as a ‘motor hot spot’ of surround muscles[9–12,14,15]. This may have resulted in an underestimation of
the change in corticospinal excitability of surround muscles [16].

ernational JIntbilitatio
n
eha
or

o
rnal f Neurou

ISSN: 2376-0281

Kaneko et al., Int J Neurorehabilitation Eng 2016, 3:3
http://dx.doi.org/10.4172/2376-0281.1000212

International

Journal of Neurorehabilitation

Research Article

Open Access

Acute Effect of Visually Induced Kinesthetic Illusion in Patients with
Stroke: A Preliminary Report
Fuminari Kaneko1,2*, Toru Inada3, Naoki Matsuda3, Eriko Shibata1,2 and Satoshi Koyama3
Laboratory of Sensory Motor Science and Sports Neuroscience, First Division of Physical Therapy, Sapporo Medical University, West 17- South 1, Chuo-ku, Sapporo
City, Japan
2
Development Research Group for Advanced Neuroscience-based Rehabilitation, Sapporo Medical University, West 17- South 1, Chuo-ku, Sapporo City, Japan
3
Asahikawa Rehabilitation Hospital, Midorigaokahigasi 1-1-1, Asahikawa City, Japan
1

Abstract
A kinesthetic illusion induces a feeling as if an individual’s own body is moving during sensory input, even though
the body is actually in a resting state. In a previous study, we reported that a visually induced kinesthetic illusion(KiNVIS) increases corticospinal tract excitability that is associated with activity of the motor-association regions. The
present study explored the acute effect of KiNVIS on motor function in five patients who had experienced stroke, as apreliminary study. Five Japanese patients with stroke, who had been otherwise healthy, participated in the present trial.
During KiNVIS, a display was set over the forearm so that the position of the display would give the illusion that thepatient’s forearm was actually the same as that depicted in a movie. The movie showed a hand grasping and opening
on the uninvolved side, and was repeatedly played for 15 min. Motor function was evaluated with the upper extremity
section of the Fugl-Meyer Assessment (FMA-UE) as a primary outcome. Furthermore, we measured a performance ofan appropriate motor task for each patient to detect change in motor function as a secondary outcome. In each patient,a positive effect on motor function was detected immediately after KiNVIS, and the appearance of reciprocal muscular
control was observed in surface electromyography. There was no difference in the FMA-UE score between before andafter the intervention; however, the score was slightly increased in two patients. Furthermore, upon comparison of theindividual measurement results, each examination indicated positive changes in motor function. KiNVIS may have anacute positive effect in patients with stroke. The study provides, for the first time, evidence for the therapeutic potentialof KiNVIS in stroke rehabilitation.

Keywords: Kinesthetic sense; Rehabilitation; Stroke
Introduction
We previously reported that a kinesthetic illusion, induced by a visual
stimulus using a movie video (KiNVIS), produces vivid kinesthetic
feeling in a healthy subject and in a patient with stroke, even though the
body is actually in a resting condition [1-3]. The subjective kinesthesia
felt in the first person during KiNVIS is generally vivid and, in our
experience, stronger than that experienced during mirror therapy. We
reported that, during KiNVIS, corticospinal tract excitability increases,
as determined by transcranial magnetic stimulation (TMS) [1,2].
Furthermore, we showed, by functional magnetic resonance imaging,that a neural network is activated in the same brain regions during
KiNVIS as is activated during actual movement execution [3]. Thus,
the findings of our previous studies indicated that KiNVIS may induce
a cerebral state similar to that induced by motor imagery, even though
the kinesthetic perception during KiNVIS is “passively” induced. On
the other hand, motor imagery describes the conscious and active
psychological representation of movement. Motor imagery thus resultsin the activation of movement execution-related neural networks inhealthy subjects [4-7].
A recently published consensus paper includes an approach torehabilitation of stroke patients, i.e., adjustment of the abnormal interhemispheric inhibition [8] (for example, by repetitive transcranial
magnetic stimulation, transcranial direct current stimulation, electricalneuromuscular stimulation, constraint-induced movement therapy
involving intensive use of the affected hand), combined with motor
relearning therapeutic exercises. Since KiNVIS increases corticospinal
tract excitability and induces similar cerebral network activation as
movement execution [3], we speculated that applying KiNVIS to apatient with stroke could induce a positive effect on sensory-motor
function.
Additionally, mirror therapy and motor imagery are new tools thatInt J Neurorehabilitation
ISSN: 2376-0281 IJN, an open access journal

are currently favoured as therapeutic interventions for sensory-motor
function recovery in patients with stroke. Several studies have indicatedthat mirror therapy has a positive effect on motor function in patientswith stroke [9-12]. The neural substrate during mirror therapy andKiNVIS may overlap somewhat, since these two approaches include thepsychological feeling of body ownership in the artificial body, in the
mirror or the movie, and kinesthetic perception. However, there is aclear difference between these approaches in terms of the absence ofactual movement of the patient’s own body during KiNVIS, which may
be reflected in some difference in brain activity. Moreover, although
the efficacy of motor imagery on patients with stroke is limited by thepatient’s underlying pathophysiology [13] and is poorly reported [14],there is evidence that suggests that motor imagery provides additional
benefits to conventional physiotherapy or occupational therapy [15].
Given this background, we speculated that KiNVIS may benefit
patients with stroke. We had already confirmed that watching thistype of movie could create an illusory perception of kinesthesia in a
subject who had experienced a stroke more than 10 years previously;
this patient also expressed a subjective feeling of desiring to move while
watching the movie, as he perceived it as movement of his own hand.
The aim of the present study was to assess the acute effect of KiNVIS on
motor function in patients with stroke, as a preliminary study.

*Corresponding author: Fuminari Kaneko, First Division of Physical Therapy,
Sapporo Medical University, West 17- South 1, Chuo-ku, Sapporo City, Japan, Tel:
81116112111 ext. 2870; Fax: 81116112143; E-mail: f-kaneko@sapmed.ac.jp
Received June 08, 2016; Accepted June 17, 2016; Published June 24, 2016
Citation: Kaneko F, Inada T, Matsuda N, Shibata E, Koyama S (2016) Acute
Effect of Visually Induced Kinesthetic Illusion in Patients with Stroke: A Preliminary
Report. Int J Neurorehabilitation 3: 212. doi:10.4172/2376-0281.1000212
Copyright: © 2016 Kaneko F, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author andsource are credited.

Volume 3 • Issue 3 • 1000212

Kaneko et al. Journal of NeuroEngineering and Rehabilitation (2016) 13:36
DOI 10.1186/s12984-016-0143-8

RESEARCH

Open Access

The association of motor imagery andkinesthetic illusion prolongs the effect oftranscranial direct current stimulation on
corticospinal tract excitability
Fuminari Kaneko1,2*, Eriko Shibata1,2, Tatsuya Hayami1,3, Keita Nagahata1,4 and Toshiyuki Aoyama1,5
Abstract
Background: A kinesthetic illusion induced by a visual stimulus (KI) can produce vivid kinesthetic perception.
During KI, corticospinal tract excitability increases and results in the activation of cerebral networks. Transcranial
direct current stimulation (tDCS) is emerging as an alternative potential therapeutic modality for a variety ofneurological and psychiatric conditions, such that identifying factors that enhance the magnitude and duration oftDCS effects is currently a topic of great scientific interest. This study aimed to establish whether the combinationof tDCS with KI and sensory-motor imagery (MI) induces larger and longer-lasting effects on the excitability ofcorticomotor pathways in healthy Japanese subjects.
Methods: A total of 21 healthy male volunteers participated in this study. Four interventions were investigated in thefirst experiment: (1) anodal tDCS alone (tDCSa), (2) anodal tDCS with visually evoked kinesthetic illusion (tDCSa + KI),(3) anodal tDCS with motor imagery (tDCSa + MI), and (4) anodal tDCS with kinesthetic illusion and motor imagery(tDCSa + KIMI). In the second experiment, we added a sham tDCS intervention with kinesthetic illusion and motor
imagery (sham + KIMI) as a control for the tDCSa + KIMI condition. Direct currents were applied to the right primary
motor cortex. Corticospinal excitability was examined using transcranial magnetic stimulation of the area associatedwith the left first dorsal interosseous.
Results: In the first experiment, corticomotor excitability was sustained for at least 30 min following tDCSa + KIMI
(p < 0.01). The effect of tDCSa + KIMI on corticomotor excitability was greater and longer-lasting than that achieved in
all other conditions. In the second experiment, significant effects were not achieved following sham + KIMI.
Conclusions: Our results suggest that tDCSa + KIMI has a greater therapeutic potential than tDCS alone for inducing
higher excitability of the corticospinal tract. The observed effects may be related to sustained potentiation of resultant
cerebral activity during combined KI, MI, and tDCSa.
Keywords: Transcranial direct current stimulation, Motor imagery, Kinesthetic illusion, Visual stimulation,
Transcranial magnetic stimulation, Corticospinal tract* Correspondence: f-kaneko@sapmed.ac.jp
1
Laboratory of Sensory Motor Science and Sports Neuroscience, First Divisionof Physical Therapy, Sapporo Medical University, West 17- South 1, Chuo-ku,
Sapporo City, Japan
2
Development Research Group for Advanced Neuroscience-based
Rehabilitation, Sapporo Medical University, West 17- South 1, Chuo-ku,
Sapporo City, Japan
Full list of author information is available at the end of the article© 2016 Kaneko et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Journal of Electromyography and Kinesiology 27 (2016) 66–72

Contents lists available at ScienceDirect

Journal of Electromyography and Kinesiology
journal homepage: www.elsevier.com/locate/jelekin

Effect of kinesthetic illusion induced by visual stimulation on muscular
output function after short-term immobilization
Toru Inada a,b, Fuminari Kaneko c,⇑, Tatsuya Hayami c,da

Graduate School of Health Science, Sapporo Medical University, Sapporo, Japan
Department of Rehabilitation, Asahikawa Rehabilitation Hospital, Asahikawa, JapanFirst Division of Physical Therapy, Sapporo Medical University, Sapporo, Japand
Division of Health Science Education, School of General Education, Shinshu University, Matsumoto, Japanbca r t i c l e

i n f oArticle history:
Received 27 April 2015
Received in revised form 4 January 2016
Accepted 18 January 2016

Keywords:
Short-term immobilization
Kinesthetic illusion
Muscular output function
Visual stimulation
Rehabilitationa b s t r a c t
Kinesthetic illusions by visual stimulation (KiNVIS) enhances corticomotor excitability and activatesmotor association areas. The purpose of this study was to investigate the effect of KiNVIS induction on
muscular output function after short-term immobilization. Thirty subjects were assigned to 3 groups:
an immobilization group, with the left hand immobilized for 12 h (immobilization period); an illusiongroup, with the left hand immobilized and additionally subjected to KiNVIS of the immobilized part during the immobilization period; and a control group with no manipulation. The maximum voluntary contraction (MVC), fluctuation of force (force fluctuation) during a force modulation task, and twitch force
were measured both before (pre-test) and after (post-test) the immobilization period. Data were analyzed by performing two-way (TIME ! GROUP) repeated measures ANOVA. The MVC decreased in theimmobilization group only (pre-test; 37.8 ± 6.1 N, post-test; 32.8 ± 6.9 N, p < 0.0005) after the immobilization period. The force fluctuation increased only in the immobilization group (pre-test;
2.19 ± 0.54%, post-test; 2.78 ± 0.87%, p = 0.007) after the immobilization period. These results demonstrate that induction of KiNVIS prevents negative effect on MVC and force fluctuation after 12 h ofimmobilization.
! 2016 Elsevier Ltd. All rights reserved.

1. Introduction
Long-term immobilization of skeletal muscle decreases muscle
output function (Seki et al., 2001a,b). Preventing the acute negative
effect on muscular output function may be important to preventthe long-term effects of immobilization. Thus, systematic
approaches for treating patients with immobilized extremities
are important. Previous reports have indicated that decreased
motor cortex excitability is associated with decreased muscle output function after immobilization (Kaneko et al., 2003). Corticomotor excitability is reduced by even short-term immobilization, in
the range of days or hours (Facchini et al., 2002; Huber et al.,2006; Avanzino et al., 2011; Bassolino et al., 2014) and affects
motor behavior (Moisello et al., 2008; Bassolino et al., 2012).
Therefore, muscle output function may decrease in parallel with
reduction in corticomotor excitability. Therefore, we hypothesized⇑ Corresponding author at: First Division of Physical Therapy, Sapporo Medical
University, West 17-South 1, Chuo-ku, Sapporo, Japan. Tel.: +81 11 611 2111; fax:
+81 11 611 2143.
E-mail address: f-kaneko@sapmed.ac.jp (F. Kaneko).
http://dx.doi.org/10.1016/j.jelekin.2016.01.006
1050-6411/! 2016 Elsevier Ltd. All rights reserved.

that muscle output decline after several hours of immobilization,even by means of a cast, can be prevented by motor cortex
activation.
We have reported that kinesthetic illusions induction by visual
stimulation (KiNVIS) significantly increases motor cortex excitability (Kaneko et al., 2007; Aoyama et al., 2012). We used a visual
stimulus method involving a monitor showing a movie, on the subject’s distal forearm, of another individual’s index finger moving(Kaneko et al., 2007). This method may prevent muscular output
function decline after cast immobilization, during which patients
must remain at rest without engaging in muscle contraction. KiNVIS induction appears similar to the action-observation technique(Fadiga et al., 1995); however, Kaneko et al. (2015) indicated thatthe motor-related areas of the fronto-parietal cortex, insula, andstriatum are more strongly activated during KiNVIS than duringsimple action observation. Furthermore, subjects reported feelingas if they were moving their own hand while watching a movie
that induced KiNVIS. Hence, we hypothesized that cerebral network activation during KiNVIS induction prevents motor output
function impairment during immobilization. However, the exact

札幌保健科学雑誌

原第5号

45−52（2016）著

半腱様筋の選択的筋疲労がハムストリング筋活動に及ぼす影響青木信裕1）、金子文成2）、片寄正樹）
1）

札幌医科大学保健医療学部理学療法学第二講座

2）

札幌医科大学保健医療学部理学療法学第一講座

本研究の目的は、神経筋電気刺激を用いて半腱様筋のみを選択的に筋疲労させ、選択的筋疲労が等尺性
膝関節屈曲運動時のハムストリング筋活動に及ぼす影響を解明することとした。13名の健康な成人男性が本研究に参加した。選択的筋疲労を誘起させるために、神経筋電気刺激を半腱様筋上に30分間実施した。

被験者は電気刺激前後に膝関節屈筋群の最大随意収縮課題と一定力出力課題を実施した。一定力出力課題
は、最大膝屈曲トルクに対して25％、50％、75％の目標力を膝関節屈曲105°位で実施した。課題中の膝屈曲トルクと筋電図積分値（iEMG）、中央周波数（MDF）を算出した。その結果、一定力出力課題において、半腱様筋のiEMGは電気刺激後に有意に上昇し、 MDFは有意に低下した。その一方で、半膜様筋と大腿二頭筋のiEMGは電気刺激後に有意に上昇したが、 MDFは変化しなかった。これらの結果は、神経筋電気刺激後に半腱様筋が選択的に筋疲労していることを示唆する。半腱様筋の選択的筋疲労によって最大屈曲トルクが低下したにも拘らず、協働筋である半膜様筋の最大随意収縮中における筋活動量は増大することが明らかとなった。

キーワード：ハムストリング、筋疲労、電気刺激、筋電図、膝関節

Evaluation

1）

of

the

hamstringmuscles

activity

fatiguecondition．

Nobuhiro

AOK11），

Fuminari

KANEKO2）， Masaki KATAYOSE1）

SecondDivisionof Physical

Therapy，

Schoolof2）FirstDivisionof

Therapy，

Schoolof

Healththehamstring

Physical

This

study

aimed

to

tasks

beforeandafter（NMES）．

was

elucidate

performed
Knee

and

flexiontorquefor all

after

men

at

muscles during

University

University

isometric

contraction

inthis study，

NMES

of

the

semitendinosus

musclebefore

and

after

NMES．

ln

the

constant−force

tasks、

subjects

25％，50％， and 75％maximum torque level at 105°knee flexion．

surface electromyography（EMG）， integrated EMG（iEMG）， and median fre−lntheconstant−force

iEMG

of

the

In

contrast，

MDF

musclesincreasedsuggest

that

was

seen

MDF．

These

resultsknee

flexionlessr

muscletorque．Maximum

activity ofsynergist

knee

the

declinedsignificantly．

NMES， whereas
femoriswords：hamstring

Medical

Medicalwere calculated． Maximum knee flexion torque declined significantly after

bicepsafter

SapporoSapporoandandsignificantly

Sciences，
Sciences，musclefatigue induced bY neuromuscular electrical stimulation

participatedtasks

semimembranosus

inofmusclesemitendinosus

tasks

joint angles．

significantly

actMtyHealththeinduce selective muscle fatigue． Subjects performed maximum voluntary

contraction

quency（MDF）during
NMES

young

min toconstant−force

isometric

thesemitendinosus

Thirteen healthy

performed for 30

contraction

Key

under

flexiontorquesemimembranosus

muscletasks，

significantly

semitendinosus
declined

after

semitendinosus

musclewhile the

after

NMES，

no

musclefatiguedue

semitendinosus

musclesignificant

toincreased

iEMG ofNMES

thechangereduces

fatigue．Neverthe−muscle during maximum voluntary contraction increased

fatigue．

muscle， muscle

fatigue，electrical stimulatien，electromyography，

SapPoroJ．

Health

knee

joint

Sci．5：45−52（2016）

DOI：10．15114／sjhs．5．45
受付日：2015年11月20日

受理日：2016年2月12日

く連絡先〉 青木信裕：〒060−E556

札幌市中央区南1条西／7］目

札幌医科大学保健医療学部理学療法学第二講座

一 45一Presented by Medical*Online

日本基礎理学療法学雑誌 第18巻２号（2015）

原著論文

動画を用いた視覚刺激による自己運動錯覚が随意運動の発現に及ぼす影響

阿部 大豊1）

金子 文成2,3）

柴田恵理子3）

木村 剛英1）

キーワード：自己運動錯覚 , 視覚刺激 , 反応時間 , Go/No go 課題 , 筋電図

これに対し，Kaneko らは，動画を用いた視覚刺激

諸 言により自己運動錯覚を誘起することを報告した11,12）．

自己運動錯覚とは，現実の運動を生じさせる筋収縮を伴わないにも関わらず，あたかも自身の四肢が動いてこの方法では，四肢が運動する動画を被験者自身の四肢と連続性が保たれるように観察させることで，錯覚

いるかのような感覚が引き起こされるものである1）．自を誘起する10,11）．そして自己運動錯覚誘起中には，皮己運動錯覚の誘起方法としては，これまで筋腱の振動

質脊髄路の興奮性が増大すること，さらに背側運動前

刺激

2,3）

たもの

4,5）

や皮膚の伸張 ，鏡像による視覚刺激を用い野，腹側運動前野，補足運動野，下頭頂小葉，線条体，6,7）などが報告されている．鏡像を用いて錯覚

島，後頭側頭皮質といった脳神経回路網の活動が生じを誘起する方法はミラーセラピーとよばれ，臨床的にることが報告されている13）．この中でも運動前野や補も応用されている6-9）．ミラーセラピーでは，まず対象

足運動野は，上肢到達運動などの随意運動時に一次運者の正面に鏡を置き，一方の手や足部を動かしている

動野よりも早く活動する脳部位である14）．このことか

光景を鏡に映す．そして，鏡に映した側とは反対側の四肢があたかも動いているかのように，鏡像をうまくら，自己運動錯覚が誘起されることによって，一次運
動野よりも上位の運動前野や補足運動野において，随見せることで錯覚が誘起できる．ミラーセラピーは上意運動と関連する脳神経活動が生じている可能性があ

6）下肢の切断症例における幻肢痛の抑制 や，脳卒中片るのではないかと考えた．臨床的経験として，肘関節麻痺症例の感覚運動機能を向上させる治療方法として自動屈曲が困難であった慢性期脳卒中片麻痺患者に対適用されている

7-9）．しかし，ミラーセラピーは非麻痺

し，視覚刺激を用いた自己運動錯覚を治療アプローチ側の運動を行わせるため，異常半球間抑制仮説に基づとして適用した場合，即時的効果として上腕二頭筋かく治療的アプローチとは矛盾したアプローチとなってら記録される筋電図量が増大し，肘関節自動運動可動10）域が改善したと報告されている15）．このことからも，いる ．

自己運動錯覚の誘起が運動機能に即時的な影響を及ぼすことは明らかである．
以上の先行研究より，自己運動錯覚による脳神経活

1）札幌医科大学大学院 保健医療学研究科
Graduate School of Health Sciences, Sapporo Medical
University
2）札幌医科大学 保健医療学部 理学療法学第一講座
First Division of Physical Therapy, Sapporo Medical
University
3）札幌医科大学 保健医療学部 未来医療ニューロリハビリ
テーション研究開発部門
Development Research Group for Advanced Neurosciencebased Rehabilitation, Sapporo Medical University
投稿責任者：金子文成
連絡先：北海道札幌市中央区南1条西17丁目，FAX：011−611−2150
電話：011−611−2150（内線2870）
e-mail：f-kaneko@sapmed.ac.jp

動は随意運動を遂行する際の脳神経活動にポジティブな影響を及ぼすのではないかと考えた．そこで本研究は，自己運動錯覚の誘起が随意運動に影響を及ぼすか明らかにすることを目的とした．
随意運動中には運動錯覚が生じないため，本研究では随意運動の直前まで自己運動錯覚を誘起することで，その後の随意運動に影響するか検討した．そのため，反応課題を検査方法として用いた．本研究で用いた反応課題は，音刺激に対する選択反応課題とした．
この反応時間は，刺激を認知して刺激に応じた運動を

27

RESEARCH ARTICLE

Brain Regions Associated to a Kinesthetic
Illusion Evoked by Watching a Video of One's
Own Moving Hand
Fuminari Kaneko1¤a, Caroline Blanchard1¤b, Nicolas Lebar1¤c, Bruno Nazarian2,
Anne Kavounoudias1, Patricia Romaiguère1*
1 Laboratoire de Neurosciences Intégratives et Adaptatives, NIA UMR 7260, FR3C FR3512, Aix Marseille
Université, CNRS, Marseille, France, 2 Institut des Neurosciences de la Timone, INT UMR 7289, IRMf
Center, Aix Marseille Université, CNRS, Marseille, France

a11111

OPEN ACCESS
Citation: Kaneko F, Blanchard C, Lebar N, NazarianB, Kavounoudias A, Romaiguère P (2015) Brain
Regions Associated to a Kinesthetic Illusion Evokedby Watching a Video of One's Own Moving Hand.
PLoS ONE 10(8): e0131970. doi:10.1371/journal.
pone.0131970
Editor: Matthew Longo, Birkbeck, University of
London, UNITED KINGDOM
Received: September 1, 2014
Accepted: February 12, 2015
Published: August 19, 2015
Copyright: © 2015 Kaneko et al. This is an open
access article distributed under the terms of theCreative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any
medium, provided the original author and source arecredited.
Data Availability Statement: Data are available from
Figshare: http://dx.doi.org/10.6084/m9.figshare.
1441326.

¤a Current address: Second Division of Physical Therapy, Sapporo Medical University, W17-S1 Chuo-ku,
Sapporo, Japan¤b Current address: School of Psychology, University of Nottingham, Nottingham, United Kingdom¤c Current address: Laboratoire de Neurosciences Cognitives, LNC UMR7291, FR3C FR3512, Aix Marseille
Université, CNRS, Marseille, France* Patricia.Romaiguere@univ-amu.fr

Abstract
It is well known that kinesthetic illusions can be induced by stimulation of several sensory systems (proprioception, touch, vision. . .). In this study we investigated the cerebral network
underlying a kinesthetic illusion induced by visual stimulation by using functional magnetic
resonance imaging (fMRI) in humans. Participants were instructed to keep their hand still
while watching the video of their own moving hand (Self Hand) or that of someone else's moving hand (Other Hand). In the Self Hand condition they experienced an illusory sensation that
their hand was moving whereas the Other Hand condition did not induce any kinesthetic illusion. The contrast between the Self Hand and Other Hand conditions showed significant activation in the left dorsal and ventral premotor cortices, in the left Superior and Inferior Parietal
lobules, at the right Occipito-Temporal junction as well as in bilateral Insula and Putamen.
Most strikingly, there was no activation in the primary motor and somatosensory cortices,
whilst previous studies have reported significant activation in these regions for vibrationinduced kinesthetic illusions. To our knowledge, this is the first study that indicates thathumans can experience kinesthetic perception without activation in the primary motor andsomatosensory areas. We conclude that under some conditions watching a video of one's
own moving hand could lead to activation of a network that is usually involved in processing
copies of efference, thus leading to the illusory perception that the real hand is indeed moving.

Funding: FK was supported by the Japan Society for
the Promotion of Science (JSPS Excellent Young
Researcher Overseas Visit Program) and JSPS
KAKENHI (Grant-in-Aid for Scientific Research (B)23300202).

Introduction

Competing Interests: The authors have declaredthat no competing interests exist.

Kinesthetic sensations usually result from movements, whether voluntarily executed or passively imposed. It is therefore difficult to discriminate which components pertain to the motor

PLOS ONE | DOI:10.1371/journal.pone.0131970 August 19, 2015

1 / 20理学療法学第 41 巻第 7 号

447 〜ロボティックデバイスによる上肢運動失調評価とその回復過程
454 頁（2014 年）

447

症例研究

ロボティックデバイスによる脳梗塞症例の＊
上肢運動失調評価とその回復過程
青 山 敏 之 1）＃ 金 子 文 成 2） 澤 田 辰 徳 3）
4）
2）
速水達也
青木信裕
要旨
【目的】本研究の目的は，脳血管障害により上肢運動失調を呈した一症例について，運動学的評価指標を用いた経時的な回復過程を明らかにすることであった。
【方法】症例は左中脳梗塞により右上肢運動失調を呈した 72 歳男性であり，回復期病院入院中の初期，中間（2 週後），最終（4 週後）に運動学的評価を実施した。課題はロボティックデバイスを用いた右上肢による水平面上での目標追従運動であり，目標物との座標誤差・速度誤差，X 軸・Y 軸移動範囲，総軌跡長，Jerk Index を解析対象とした。
【結果】座標誤差は初期，中間，最終と段階的に減少したが，その他の指標は初期から中間にかけて一時的に増大し，最終に減少した。鼻指鼻試験や手回内外試験は初期，最終ともに陽性であった。
【考察】本症例における運動学的評価指標の改善は，運動失調症状の変化のみでなく，代償的な運動制御戦略の変化を含んで表現された可能性がある。また，ロボティックデバイスを用いた運動学的評価は，運動失調の経時的変化をより定量的に評価する方法として有用であると考える。
キーワード 運動失調，ロボティックデバイス，運動学的評価指標

はじめに

2）3）

。さらに，このような運動失調特有の徴候は，た

フィードフォワード制御の障害により，時間的遅れを有

近年の小脳症候学の基礎を築いた Holmes は，第一次するフィードバック制御に依存する結果として生じると世界大戦の銃により小脳損傷を呈した患者の臨床所見をされ，振戦や測定過大等の一因になると考えられてい観察し，その運動学的特徴について，速度や加速度の不る

規則さと運動のタイミングの遅延が挙げられると報告し間的活動パターンの調節あるいは予測的な制御に重要なた

1）。また，Hallett らは筋電図や関節角度データを用

4）5）。これらのように，小脳は随意運動の時間的・空役割を果たしていると考えられている。

いて小脳性運動失調患者の運動学的解析を行い，主動筋

一方，理学療法の評価場面において，運動失調患者のの活動開始や活動増大，活動停止の遅延，拮抗筋の活動示す徴候は，鼻指鼻試験等の指標により評価されてい開始の遅延といった現象が生じることを明らかにしる。しかしながら，この検査は失調の有無を判断し，診＊Quantitative Analysis and Recovery Process of a Patient with
Ataxic Upper Limb Using a Robotic Device1）茨城県立医療大学保健医療学部理学療法学科（〒 300‒0394 茨城県稲敷郡阿見町阿見 4669‒2）
Toshiyuki Aoyama, PT, MSc: Department of Physical Therapy,
Ibaraki Prefectural University of Health Sciences
2）札幌医科大学保健医療学部理学療法学第二講座
Fuminari Kaneko, PT, PhD, Nobuhiro Aoki, PT, MSc: Second
Division of Physical Therapy, School of Health Science, Sapporo
Medical University
3）イムス板橋リハビリテーション病院リハビリテーション科
Tatsunori Sawada, OT, PhD: Division of Rehabilitation, IMS
Itabashi Rehabilitation Hospital
4）信州大学全学教育機構健康科学教育部門
Tatsuya Hayami, PhD: Division of Health Science Education,
School of General Education Shinshu University＃ E-mail: aoyamato@ipu.ac.jp（受付日 2014 年 2 月 4 日／受理日 2014 年 6 月 24 日）

断を補助するためのものであり，定量的な評価手法としては不十分であるといえる。よって，経時的な徴候の変化を表現するためには適さないと考える。また，Simple
Test for Evaluating Hand Function（以下，STEF）のように上肢機能をある程度定量的に評価する指標も用いられているものの，運動失調自体の評価は困難であり，徴候の変化がどの程度点数に反映されるかは不明である。
また，このような運動失調患者の運動学的評価指標の経時的変化を記録した研究は少ない。小脳梗塞により運動失調を呈した症例に対して 3 ヵ月の介入を行った先行研究では，運動の速度，加速度，運動時間といった指標

Kaneko et al. Journal of NeuroEngineering and Rehabilitation 2014, 11:94
http://www.jneuroengrehab.com/content/11/1/94

JNER

RESEARCH

JOURNAL OF NEUROENGINEERING
AND REHABILITATIONOpen Access

Motor imagery and electrical stimulation
reproduce corticospinal excitability at levels
similar to voluntary muscle contraction
Fuminari Kaneko1*, Tatsuya Hayami1,2, Toshiyuki Aoyama1,3 and Tomohiro Kizuka4
Abstract
Background: The combination of voluntary effort and functional electrical stimulation (ES) appears to have agreater potential to induce plasticity in the motor cortex than either electrical stimulation or voluntary training
alone. However, it is not clear whether the motor commands from the central nervous system, the afferent input
from peripheral organs, or both, are indispensable to induce the facilitative effects on cortical excitability. To clarify
whether voluntary motor commands enhance corticospinal tract (CoST) excitability during neuromuscular ES,
without producing voluntary muscular contraction (VMC), we examined the effect of a combination of motor
imagery (MI) and electrical muscular stimulation on CoST excitability using transcranial magnetic stimulation (TMS).
Methods: Eight neurologically healthy male subjects participated in this study. Five conditions (resting, MI, ES, ES +MI [ESMI], and VMC) were established. In the ES condition, a 50-Hz stimulus was applied for 3 to 5 s to the firstdorsal interosseous (FDI) while subjects were relaxed. In the MI condition, subjects were instructed to imagine
abducting their index finger. In the ESMI condition, ES was applied approximately 1 s after the subject had begun
to imagine index finger abduction. In the VMC condition, subjects modulated the force of index finger abduction
to match a target level, which was set at the level produced during the ES condition. TMS was applied on the
hotspot for FDI, and the amplitude and latency of motor evoked potentials (MEPs) were measured under eachcondition.
Results: MEP amplitudes during VMC and ESMI were significantly larger than those during other conditions; there
was no significant difference in MEP amplitude between these 2 conditions. The latency of MEPs evoked during MI
and VMC were significantly shorter than were those evoked during rest and ES.
Conclusions: MEP acutely reinforced in ESMI may indicate that voluntary motor drive markedly contributes toenhance CoST excitability, without actual muscular contraction.
Keywords: Electrical stimulation, Motor imagery, Corticospinal tract, Rehabilitation, Physical therapy

Background
Many studies have shown that paired associative stimulation with single transcranial magnetic stimulation(TMS) and ES, repetitive transcranial magnetic stimulation (rTMS), or transcranial direct current stimulation
can induce either short-term potentiation or a depressive effect in the motor cortex [1-7]. These facilitatory
or suppressive effects are believed to accelerate motor* Correspondence: f-kaneko@sapmed.ac.jp
1
Laboratory of SensoryMotor Science and Sports Neuroscience, Second
Division of Physical Therapy, Sapporo Medical University, West 17- South 1,
Chuo-ku, Sapporo City, Japan
Full list of author information is available at the end of the article

recovery in patients with stroke [8,9] because corticalplasticity plays an important role in motor recovery[10,11], as well as motor learning in healthy individuals[12,13]. In clinical situations, however, interventions
other than transcranial stimulation are needed to facilitate
cortical potentiation because of epilepsy, limited resources,
or patient preference. In such cases, we attempt to provide
some form of sensory input (e.g., visual input) [14] or ES,
which have been used to improve muscular strength for
purposes of rehabilitation.
The effect an exercise has on cortical excitability canbe augmented by ES [15,16]. Therefore, the combination© 2014 Kaneko et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.

Journal of Electromyography and Kinesiology 23 (2013) 1362–1369

Contents lists available at ScienceDirect

Journal of Electromyography and Kinesiology
journal homepage: www.elsevier.com/locate/jelekin

Effects of different movement directions on electromyography recorded
from the shoulder muscles while passing the target positions
Yoshinari Sakaki a,d, Fuminari Kaneko b,⇑, Kota Watanabe c, Takuma Kobayashi c, Masaki Katayose b,
Nobuhiro Aoki b, Eriko Shibata a, Toshihiko Yamashita caGraduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japand
Department of Rehabilitation, Hitsujigaoka Hospital, Sapporo, Japanbca r t i c l e

i n f oArticle history:
Received 29 January 2013
Received in revised form 7 August 2013
Accepted 28 August 2013

Keywords:
Rotator cuff
Shoulder joint
Electromyography
Movement direction
Motion analysis

a b s t r a c t
Purpose: We compared electromyography (EMG) recorded from the shoulder joint muscles in the same
position for different movement directions.
Methods: Fifteen healthy subjects participated. They performed shoulder elevation from 0! to 120!,shoulder depression from 120! to 0!, shoulder horizontal adduction from !15! to 105!, and shoulder horizontal abduction from 105! to !15!. The target positions were 90! shoulder elevation in the 0!, 30!, 60!,
and 90! planes (0!, 30!, 60!, and 90! positions). EMG signals were recorded from the supraspinatus (SSP)
muscle by fine-wire electrodes. EMG signals from the infraspinatus (ISP), anterior deltoid, middle deltoid,
and posterior deltoid muscles were recorded using active surface electrodes.
Results: During elevation and horizontal abduction, the SSP showed significantly higher activity than thatshown during depression and during horizontal adduction in the 0!, 30!, and 60! positions. During elevation, the ISP showed significantly higher activity than during depression and during horizontal adduction in the 90! position. During horizontal abduction, the ISP showed significantly higher activity thanduring depression in the 90! position.
Conclusions: When the movement tasks were performed in different movement directions at the same
speed, each muscle showed characteristic activity.
" 2013 Elsevier Ltd. All rights reserved.

1. Introduction
Shoulder surface muscles include the deltoid muscle and thepectoralis major muscle, which enable the execution of shoulder
movements. The rotator cuff acts to stabilize the glenohumeral
joint in various limb positions (Kronberg et al., 1990; Inman
et al., 1996; Wuelker et al., 1998). It was reported that in shoulder
joint diseases such as subacromial impingement, frozen shoulder
and thrower’s pathologic shoulder, the function of the rotator cuff
is relatively less than the function of the surface muscles (Williams
and Kelley, 2000). Therefore, to understand the mechanisms
underlying shoulder joint diseases and to provide the optimal
rehabilitation for rotator cuff, a thorough elucidation of the functional characteristics of the rotator cuff is necessary.
The functional characteristics of the rotator cuff have been
examined in the previous studies using techniques such as a cadaveric shoulder, electromyography, X-rays, and magnetic resonanceimaging (Kronberg et al., 1990; Inman et al., 1996; Wuelker

et al., 1998). It was reported that the supraspinatus (SSP) muscle
contributes to shoulder abduction movement (Howell et al.,
1986; Otis et al., 1994; Alpert et al., 2000), and that the
infraspinatus (ISP) muscle pulls the head of the humerus into the
glenoid fossa (Alpert et al., 2000; Yanagawa et al., 2008).
These studies only focused on the rotator cuff’s functional characteristics in a single movement direction. However, the shoulder’smovements in daily living and sports activities are multidirectional, and the movement direction that passes through the same
position in space is generally not one direction. In the previous
studies, it was not clarified whether shoulder muscle activity differs during different movement directions when the upper limb
is in the same position. The purpose of the present study was torecord electromyography from the shoulder joint muscles in thesame position for different movement directions.
2. Methods
2.1. Subjects⇑ Corresponding author. Address: West 17, South 1, Chuo-ku, Sapporo City, Japan.

Tel.: +81 11 611 2111.
E-mail address: f-kaneko@sapmed.ac.jp (F. Kaneko).

1050-6411/$ - see front matter " 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jelekin.2013.08.010

Fifteen healthy male subjects (aged 23.1 ± 1.2 years) who reported that they did not exercise regularly participated. The studyJ Orthop Sci (2013) 18:932–939
DOI 10.1007/s00776-013-0443-9

ORIGINAL ARTICLE

Analysis of effectiveness of therapeutic exercise for knee
osteoarthritis and possible factors affecting outcome
Miki Kudo • Kota Watanabe • Hidenori Otsubo •Tomoaki Kamiya • Fuminari Kaneko •Masaki Katayose • Toshihiko Yamashita

Received: 4 April 2012 / Accepted: 9 July 2013 / Published online: 2 October 2013
! The Japanese Orthopaedic Association 2013

Abstract
Background There are numerous reports and evidences tosuggest that exercise therapy is effective for knee osteoarthritis (knee OA). However, there is a lack of sufficientresearch concerning the factors influencing its applicationand effectiveness. The purposes of this study were toevaluate effects of the mode of treatment delivery on the
improvement of symptoms in knee OA, and to analyze
potential risk factors affecting improvement after exercise
therapies.
Methods The 209 women applicants diagnosed with knee
OA were randomly allocated into either a group performing group exercise in a class or a group performing home
exercise. The 90 min exercise program was performed
under the guidance of physiotherapists as a group exercise
therapy. The Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) of the subjects of bothgroups before and after intervention was compared to
examine the effect of exercise therapy. In addition, bodymass index, knee range of motion (ROM), the femorotibial
angle from radiographs, OA severity from Kellgren–

M. Kudo (&) ! K. Watanabe ! H. Otsubo ! T. Kamiya !
T. Yamashita
Department of Orthopaedic Surgery, Sapporo Medical
University School of Medicine, South-1, West-16, Chuo-ku,
Sapporo, Hokkaido 060-8543, Japane-mail: miky_ku@yahoo.co.jp
F. Kaneko ! M. Katayose
Department of Physical Therapy, Sapporo Medical University
School of Health Science, Sapporo, Japan
F. Kaneko
National Institute of Advanced Industrial Science andTechnology, 1-3-1 Kasumigaseki, Chiyoda-ku,
Tokyo 100-8921, Japan123

Lawrence grade, and meniscus abnormality and subchondral bone marrow lesions from MRI findings were statistically analyzed as factors that may affect exercise therapy.
Results A significantly greater improvement in WOMAC
was observed in the subjects of group exercise (81 subjects) as compared with the subjects of home exercise (122subjects). There was a significantly high proportion ofsubjects with knee flexion contracture among the subjects
participating in group exercise that showed only minor
symptom improvement (p \ 0.05). In addition, exercise
therapy proved to be highly effective for subjects withlimited quadriceps muscle strength (p \ 0.05).
Conclusions When prescribing exercise therapy for knee
OA, evaluation of a subject’s ROM and muscle strength isimportant in deciding whether to commence exercise
therapy and what type of exercise therapy to apply; it isalso important in predicting the effect of exercise therapy.

Introduction
Knee osteoarthritis (knee OA) is a condition often seen in
the elderly; thus, the number of affected individuals hasconsequently been increasing along with the aging ofsociety. It is imperative to systematize the treatment of thiscondition, and it is clear that conservative treatment isparticularly important from a medical-economic perspective. Four items are listed as intervention strategies forknee OA in the ‘‘National Strategy for OA 2010’’ publishedby the US Centers for Disease Control and Prevention(CDC) and Arthritis Foundation [1]: (1) self-management
education, (2) exercise therapy, (3) injury prevention, and(4) weight management. In particular, exercise therapy isviewed as being important in the treatment of knee OA. In
addition, randomized prospective studies and theAuthor's personal copy
Neuroscience Letters 541 (2013) 24–28

Contents lists available at SciVerse ScienceDirect

Neuroscience Lettersjournal homepage: www.elsevier.com/locate/neulet

Kinesthetic perception based on integration of motor imagery and afferent inputs
from antagonistic muscles with tendon vibration
E. Shibata a,b , F. Kaneko c,∗abcGraduate School of Health Sciences, Sapporo Medical University, West 17-South 1, Chuoh-ku, Sapporo city, Japan
Shinoro Orthopedic Hospital, Shinoro 4-5-3-9, Kita-ku, Sapporo city, Japan
Laboratory of Sensory Motor Science and Sports Neuroscience, Second Division of Physical Therapy, Sapporo Medical University, West 17-South 1, Chuo-ku, Sapporo city, Japanh i g h l i g h t s! Kinesthetic illusion disappeared with co-vibration to two antagonistic muscles.
! Disappeared kinesthetic illusion was reappeared when motor imagery was applied.
! Each afferent input from antagonistic muscles was integrated with motor imagery.
! Kinesthetic perception interacted with the velocity of the imagined movement.
! Kinesthetic perception interacted with the frequency of tendon vibration.

a r t i c l e

i n f oArticle history:
Received 25 June 2012
Received in revised form 30 January 2013
Accepted 2 February 2013
Keywords:
Muscle spindle
Afferent input
Motor imagery
Kinesthetic perception
Tendon vibrationa b s t r a c t
The perceptual integration of afferent inputs from two antagonistic muscles, or the perceptual integrationof afferent input and motor imagery are related to the generation of a kinesthetic sensation. However,it has not been clarified how, or indeed whether, a kinesthetic perception would be generated by motor
imagery if afferent inputs from two antagonistic muscles were simultaneously induced by tendon vibration. The purpose of this study was to investigate how a kinesthetic perception would be generated
by motor imagery during co-vibration of the two antagonistic muscles at the same frequency. Healthy
subjects participated in this experiment. Illusory movement was evoked by tendon vibration. Next, thesubjects imaged wrist flexion movement simultaneously with tendon vibration. Wrist flexor and extensor muscles were vibrated according to 4 patterns such that the difference between the two vibration
frequencies was zero. After each trial, the perceived movement sensations were quantified on the basis of
the velocity and direction of the ipsilateral hand-tracking movements. When the difference in frequency
applied to the wrist flexor and the extensor was 0 Hz, no subjects perceived movements without motor
imagery. However, during motor imagery, the flexion velocity of the perceived movement was higher
than the flexion velocity without motor imagery. This study clarified that the afferent inputs from themuscle spindle interact with motor imagery, to evoke a kinesthetic perception, even when the differencein frequency applied to the wrist flexor and extensor was 0 Hz. Furthermore, the kinesthetic perception resulting from integrations of vibration and motor imagery increased depending on the vibration
frequency to the two antagonistic muscles.
© 2013 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
Afferent inputs from peripheral tissues, i.e., muscle spindle,
or cutaneous, and efferent inputs before intentional movementfrom the central nervous system contribute to the generation of∗ Corresponding author at: Laboratory of Sensory Motor Science and Sports Neuroscience, Second Division of Physical Therapy, Sapporo Medical University, West
17-South 1, Chuo-ku, Sapporo city, Japan. Tel.: +81 11 611 2111;
fax: +81 11 611 2143.
E-mail address: f-kaneko@sapmed.ac.jp (F. Kaneko).
0304-3940/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.neulet.2013.02.009

kinesthetic perceptions. This study focused on the integration ofafferent inputs from the muscle spindle and efferent inputs fromthe brain during motor imagery.
Goodwin et al. [5] reported that tendon vibration applied to agiven biceps brachii in appropriate patterns evoked a kinesthetic
illusion of elbow extension without any overt movement. Mainly
Ia afferents from the muscle spindle primary endings were activated by the tendon vibration [8]; consequently, humans could
experience a vivid kinesthetic illusion of limb movement in the
direction which corresponded to stretch of the vibrated muscle. It issuggested that afferent inputs from the muscle spindle contribute日本基礎理学療法学雑誌 第16巻2号（2012）

原 著

デトレーニング期間中のメンタルプラクテイスが未経験運動の短期的練習効果の維持に及ぼす影響

岡和田愛実1），金子

文成2），柴田恵理子1），青木信裕2）キーワード：メンタルプラクティス，運動学習，剣道

フォーマンスが向上したと報告した．これらの報告か

緒言

ら，メンタルプラクティスは繰り返し運動を内的に再現することによって，パフォーマンスの向上に寄与す

スポーツ選手やリハビリテーションを受けている患

るということが示唆される．

者は外傷や発熱などにより，ある一定期間，トレーニングを休止しなければならない状況が発生することがこのメンタルプラクティスをデトレーニング期間にある．このようにトレーニングを一時的に休止，あるいは中止することをデトレーニングという1）．トレー行うことにより，習熟したパフォーマンスが維持されニングによって変化した筋出力や運動耐容能などは，

レーニング期間に行ったメンタルプラクティスがデト
レーニング後のパフォーマンスに及ぼす影響を報告しるということが近年報告されている7）．大場7｝は，デト

デトレーニングを行うことで，トレーニング前の状態
らの身体機能の低下に伴い，パフォーマンスも低下すた．まず，被験者はダーツ投げを4週間練習した．その後，3週間のデトレーニング期間を設けた．その結ると考える．

果，デトレーニング期間にメンタルプラクティスをに戻るということが報告されている1

2）．さらに，これ

一方，身体運動を伴わずに身体機能やパフォーマン行った群では習熟したダーツ投げのパフォーマンスをスを向上する方法として，メンタルプラクティスがあ維持することができたが，メンタルプラクティスを行る．メンタルプラクティスとは，技能習得を目的とわなかった群ではパフォーマンスが低下した．つまり，して，運動イメージを繰り返し実施することである3）．

デトレーニング期間にメンタルプラクティスを行うこ

また運動イメージとは，実際の運動は伴わずにその運とにより，長期間の練習によって向上したパフォーマ

動をイメージすることで，内的に運動を再現する能ンスが維持される可能性が示唆される．

一方，運動の鍛練者と非鍛練者ではメンタルプラク

動的な過程4）と定義されている．身体機能やパフォー

ティスの効果が異なるということも報告されている8

マンスに対するメンタルプラクティスの効果に関して，Yueら5）は小指外転運動のメンタルプラクティス
によって，筋肥大を伴わずに，小指外転筋の筋出力が9）．

Clark8｝はバスケットボールのフリースローにおいて，向Lしたと報告した．さらに，Pascual−Leoneら6）はピ鍛錬者では実際に練習した群とメンタルプラクティスを行った群で同じ程度パフォーマンスが向上したと報アノ練習のメンタルプラクティスにより，ピアノのパ告した．一一方，非鍛錬者ではメンタルプラクティスを行った群よりも実際の練習を行った群のほうがパ
フォーマンスは向上した．そのため，非鍛錬者はメンタルプラクティスによる効果が得らない可能性があ

1）札幌医科大学大学院保健医療学研究科（Graduate
MedicalSchoolHealth Sciences，ると報告した．また林ら9｝は，剣道の鍛練者と非鍛練

Sapporo者を対象として，イメージする運動の習熟度が運動イ

University）

2）札幌医科大学（Second

Medicalof

保健医療学部Division of

メージの効果に及ぼす影響を検討した．その結果，剣理学療法学第二講座

Physical Therapy，

道の面打ちの運動イメージ中に測定した運動誘発電位

Sapporoの振幅は，安静時と比較して鍛錬者では増大したが，University）（〒060−8556

非鍛錬者では変化がなかった．デトレーニング期間中

北海道札幌市中央区南1条西17丁目）

47
Presented by Medical*Online

Author's personal copy
Neuroscience Letters 514 (2012) 106–109

Contents lists available at SciVerse ScienceDirect

Neuroscience Lettersjournal homepage: www.elsevier.com/locate/neulet

The effects of kinesthetic illusory sensation induced by a visual stimulus on thecorticomotor excitability of the leg muscles
T. Aoyama a,b , F. Kaneko c,∗ , T. Hayami c,d , E. Shibata aaGraduate School of Health Sciences, Sapporo Medical University, West 17–South 1, Chuo-ku, Sapporo City, Japan
Department of Rehabilitation, IMS Itabashi Rehabilitation Hospital, Azusawa 3-11-1, Itabashi-ku, Tokyo, Japan
Laboratory of Sensory Motor Science and Sports Neuroscience, Second Division of Physical Therapy, Sapporo Medical University, West 17–South 1, Chuo-ku, Sapporo City, Japand
Division of Health Science Education, School of General Education, Shinshu University, Asahi 3-1-1, Matsumoto City, Japanbca r t i c l e

i n f oArticle history:
Received 20 October 2011
Received in revised form 17 February 2012
Accepted 18 February 2012
Keywords:
Kinesthetic illusion
Visual stimulus
MEP
TMS
Lower limb

a b s t r a c t
A novel method of visual stimulus, reported by Kaneko et al. [14], induced a vivid kinesthetic illusion andincreased the corticomotor excitability of the finger muscles without any overt movement. To explore
the effect of this method on the lower limbs, motor evoked potentials (MEP) were recorded from theleft tibialis anterior (TA) and soleus muscles using transcranial magnetic stimulation (TMS). A computer
screen that showed the moving image of an ankle movement was placed over the subject’s leg, andits position was modulated to induce an illusory sensation that the subject’s own ankle was moving(illusion condition). TMS was delivered at rest and at two different times during the illusion condition(ankle dorsiflexion phase: illusion-DF; ankle plantarflexion phase: illusion-PF). The MEP amplitude of theTA, which is the agonist muscle for ankle dorsiflexion, was significantly increased during the illusion-DF
condition. This indicated that the visual stimulus showing the moving image of an ankle movement could
induce a kinesthetic illusion and selectively increase the corticomotor excitability in an agonist muscle
for an illusion, as was previously reported for an upper limb. The MEP amplitude of the soleus, which is theagonist muscle for ankle plantarflexion, increased during the illusion-PF condition, but not significantly.
Because of the vividness of the illusory sensation was significantly greater during the illusion-DF condition
than the illusion-PF condition, we concluded that the vividness of the illusory sensation had a crucial rolein increasing corticomotor excitability.
© 2012 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
It is well known that kinesthesia plays a crucial role inmotor execution and motor learning [2,9,16,23–25]. Previous study
has demonstrated that humans can experience vivid kinesthetic
sensations of limb movement as a result of an external stimulus such as a proprioceptive or visual stimulus without any
overt movement [1,6–8,11–15,17–21,26,27]. Tendon vibration, oneof the most-investigated ways to induce kinesthetic illusions,increases muscle spindle activity, so that the subjects experiencea kinesthetic sensation of the vibrated muscle being stretched[11,15,17–21]. A number of neuroimaging and TMS studies haverevealed that vibration-induced kinesthetic illusions increase corticomotor excitability in a somatotopic manner [11,15,20]. On theother hand, a visual stimulus can also induce a kinesthetic illusion.

∗ Corresponding author at: Division of Applied Physical Therapy, Sapporo Medical
University, West 17–South 1, Chuo-ku, Sapporo City, Japan. Tel.: +81 11 611 2111;
fax: +81 11 611 2143.
E-mail address: f-kaneko@sapmed.ac.jp (F. Kaneko).
0304-3940/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.neulet.2012.02.069

A pioneering study by Tardy-Gervet et al. [26,27] demonstrated
segmentary vection, which is the induction of a kinesthetic illusory
sensation of forearm movement by means of a moving visual stimulus under the forearm. Kaneko et al. reported another novel methodof visual stimulus in which a moving image of someone else’s finger movement is shown on a computer screen above the subject’s
real hand [14]. Using this method, the vivid kinesthetic sensation of finger movement was induced, accompanied by increasing
corticomotor excitability. Since, in contrast to a vibration-induced
kinesthetic illusion, this visual stimulus should not excite directly
muscle spindle afferents, the neurological mechanisms must be
different between the two methods of inducing kinesthetic illusions. At the present time, however, little has been reported on themechanisms underlying visual-stimulus-induced kinesthetic illusions, while vibration-induced kinesthetic illusions have been wellinvestigated. In particular, it has not been clarified if a visual stimulus could induce a kinesthetic illusion in a lower limb accompanied
by increased corticmotor excitability. Since upper limb movement
has a strong relationship with visual input [10,14,22], there may
be functional differences between the upper and lower limbs invisual motor coordination. Accordingly, it is uncertain whether a

!"#$%&'()*+)*,--.,/0)*12,, 3*!"#$%&'()*+,-./0.1#234
Electromyography Analysis of Scapular Muscles in Baseball Pitching!
!""#$% &'()* #"&+,- $"!
!
!"%./0121234567829:8;!#"% <=>812?@>A2B;!
$"%./0124567822C3!

!
D6E6FG! HIJ&KLMNOJ&PQRS&ETUJVW!
Key words: Rhomboid muscle, Scapular muscles, Pitching, Fine Wire Electromyography,!
!" #"X9:YZ[\&PQRS]YKLMNOJ^YJ_R`abcdefghhijklm\&KnopqrYst@uv(12w x yhijkz{s|}6~Y&

\66F46p  QPQbjkpt\&T46Fbt

¡i&¢ b¡lmhijklmJ\&ETUJVWp&1HIJ&£HIJ! &¤¥J&¤¦J&§¨V©p&ª«J¥B¬]B¬¦B&­®Jb¯°ijk! £HIJ±²³1HIJ\t´µ¶ ·¸¹¸º¸»¼½¾¿À! ÁÂ¼Ã¸p ¸¼»ºÄ! ¹¿¹Å¾ÀÆ Ç º¼½¸! ¹¿¹Å¾ÀÆ! ÁÂ¼Ã¸ ²È¶ÉÊpËtJ_RÌÍjÎÏÐÑ¢ÒkÓj&­®J\ º¼½¸!
¹¿¹Å¾ÀÆ!ÁÂ¼Ã¸ Ô ¸¼»ºÄ!¹¿¹Å¾ÀÆ! Ç ·¸¹¸º¸»¼½¾¿À!ÁÂ¼Ã¸ ²È¶ÉÊpËtJ_RÌÍjÎÏÐÑ¢ÒkgµÕYÖ×ØÕ&1Ù£HIJ&­®JsÚYKLÛÜnoÔPQRS]YKnoÇKLMYÝÞa?ßpàáitfghÔâãäµjk!
!
!"#$%&'()*+)*,--.,/0)*12,, 3)* 456712,2 3 8 9 :2 6)* 4;6712,, 3 0 9 :, 6*<=>7* ?@AB* C:08D,,81* EFGHIJKLM 1.0/8.,0* NOPQ&!"#$%&'(%*RSTUVWX7* 2Y.18Y/.-+/8*ZW[\]*^_`_2-aWbWcdefWgdhWeij*!
$%" &'"

ý50ÿ¶PQRSp±tó6sno!Rb7

PQRSp±åfKLM±²³KLMNOJ(6efj-p&KLMYæçh8µÕNOJ^p\&KnoYæçhèésRêbëìefh

^YJ_RÔîïÌÍfhitfk9:&KLMtíîïsðñbòtfkóôp\&õöY9

æç±²³!RY;<\&PQ=>K!Yn!

:ÔPQRSpnef9:*×b÷øitf¶1êöý"º¸¾Ã¾Æ;!¸½!¼ºÑ!xx#;Ï¼º¸½½¼;!¸½!¼ºÑ!xx$ÿ&

Ô&t´µp±t¶KLMNOJ^&`pKL=>%+Y&1ØÕ¶KLÛÜnoY!R\èÛ Ü n o Y î ï a Ô ù úÕ µt fk û¾üº¸» Õép'µf(ïÔÍfht)fk!

ýxxþÿ\PQRS]YKLM!RYðñhi&iØi&gµÓÌp8YJ_RÇJ*+`ap"KL¥#noYÝÞ&$ÛÜ¥ÌY#%Ù&%tùútf¶Y\,stkõö\&-¿½¼½¿»!

!R&'T()*^b+,j-YK.

¹4.. Y _ R Ç = > p  t ù ú tf ý/º½¹Â¸Å!

Y/¥&Y 0 1b¥2tfkÓj&34»ÅÂ¼»½ Õ

¼À·!

166

0¾À¸Ã!

xx¢;3º¸1¾ÀÃ!

xx$;2º¿4Ã3¼À!

理学療法の医学的基礎第13巻第2号（2011）

原著論文

肩関節外旋筋群の疲労が肩関節位置覚に及ぼす影響飯田尚哉1）金子キーワード

位置覚，筋疲労，肩関節外旋筋

1．緒言

文成2）青木

信裕1）榊

善成1）

め，外旋筋群は遠心性収縮による制動を行うとされる9・10）．投球動作の反復による遠心性収縮の繰り返し

位置覚は自己の四肢や身体の各部位の相対的位置関により，外旋筋群は疲労し，さらには損傷しやすいと係を知る感覚と定義され1＞，一般的に記憶した関節角考えられている6）．金子ら11）は投球時に肩関節痛のあ度を再現する位置再現課題によって評価される2’4）．

る野球投手の肩関節内旋および外旋筋の等速性筋力を投球動作において，位置覚をはじめとする感覚機能は，測定し，健常野球選手と比較して外旋筋力が有意に低障害を避けるために必要なものであるとされている5）．

下していたと報告した．これらのことから，外旋筋群

よって，位置覚の低下は投球障害肩と関連する可能性の機能は投球障害肩と関連があると考える．

これらの先行研究を踏まえ，筋疲労が位置覚を低下があると考える。

させ，不良な動作を招き，障害を導くという1つのプ

位置覚を低下させる要因の一つに筋疲労が挙げられ
al．2）は等速性運動機i器を用いて膝関

ロセスがあるのではないかと考えた．しかし，位置覚

節伸展筋および屈曲筋を疲労させ，筋疲労前後で膝関を測定した先行研究では，投球障害肩と関連があると節伸展方向の位置覚を測定した．その結果，膝関節伸考えられる外旋筋群を単独で疲労させているものはな

展方向の位置覚は筋疲労後で有意に低下した．Vbightい．また，不良な投球動作である「肘下がり」と関連

etal．4）は等速性運動機器を用いて，が深いと考えられる肩関節外転方向の位置覚を単独の肩関節内旋筋および外旋筋を同時に疲労させ，筋疲労

筋の疲労前後で比較しているものはない．以上の2点

る2’4）．Skinneral．3＞やMyersetet

前後で肩関節内旋，外旋方向の位置覚を測定した．そを同時に考慮した研究デザインは独自性，新規性の高の結果，内旋，外旋方向ともに筋疲労後で位置覚が有いものであると考える．

したがって，本研究では肩関節外旋筋群の選択的な意に低下した．これらのことから，筋疲労が位置覚を

疲労が肩関節外転，内旋，外旋方向の位置覚にどのよ低下させるという一定の見解が得られている．

うな影響を与えるか検証することを目的とした．

投球動作の反復により疲労しやすい筋として，肩関節外旋筋が挙げられる6）．投球動作中における外旋筋

群の活動は，減速期に特に大きくなると報告されてい2．方る7）．減速期はボールリリース直後から肩関節最大内法

2－1．対象旋位に至るまでの局面を指し，ここでは内旋運動の急対象は肩関節に整形外科的，神経学的既往がない男

激な減速が生じる8）．内旋運動を急激に減速させるた子大学生10名（年齢20．9±1．9歳，身長171．1±7．4cm，
1）札幌医科大学大学院 保健医療学研究科
2）札幌医科大学 臨床理学療法学講座

体重66．4±7．2kg）とし，利き腕側を測定した．利き
腕は全員が右側であった．また，野球選手において，十〇60－8556

北海道札幌市中央区南1条西17丁目 札幌医科大学
電話：O11－611－2111
E－mai1：

非利き腕側より利き腕側の運動覚が低下しているとの（内線2974）

報告があるため12），野球経験の有無により位置覚にもn－iida＠sapmed．ac．jp

1

Presented by Medical*Online

BR A IN RE S E A RCH 1 3 72 ( 20 1 1 ) 4 1 –4 8

available at www.sciencedirect.com

www.elsevier.com/locate/brainres

Research Report

The effect of motor imagery on gain modulation of the
spinal reflex
T. Aoyamaa , F. Kanekob,c,⁎aGraduate School of Health Sciences, Sapporo Medical University, West 17, South 1, Chuo-ku, Sapporo City, Japan
Laboratory of Sensory Motor Science and Sports Neuroscience, Division of Applied Physical Therapy, Sapporo Medical University, West 17,
South 1, Chuo-ku, Sapporo City, Japanc
Institute for Human Science and Biomedical Engineering, National Institute of Advanced Industrial Science and Technology (AIST),
1-1-1 Higashi, Tsukuba City, Japanb

A R T I C LE I N FO

AB S T R A C T

Article history:

Motor imagery is well known to have a facilitatory effect on the corticospinal tract, but

Accepted 8 November 2010

conflicting opinions have arisen concerning its effect on spinal reflex excitability. The purpose of

Available online 20 November 2010

this study was to clarify the effects of motor imagery on gain modulation of the spinal reflex byfocusing on the physiological differences between the H-reflex and the stretch reflex. In

Keywords:

experiment 1, there were three conditions: rest, motor imagery of ankle dorsiflexion (MI-DF), andMotor imagery

motor imagery of ankle plantarflexion (MI-PF). The subjects were instructed to imagine 100%Stretch reflex

maximum voluntary isometric contraction (MI-100) in each direction of movement. To examine

H-reflex

the effects of the imagined effort level on spinal reflex excitability, the subjects also imagined
50% maximum voluntary contraction (MI-50) in experiment 2. The soleus H-reflex and thestretch reflex amplitude and background EMG (bEMG) activity were measured. There were no
significant differences in bEMG activity between the H-reflex and stretch reflex measurements.
In experiment 1, although the H-reflex amplitude did not change significantly among the three
conditions, the stretch reflex amplitude increased significantly under the MI-DF and MI-PF
conditions compared to the rest condition. In addition, the stretch reflex amplitude under the
MI-100 condition was significantly larger than that under the MI-50 condition in experiment
2. These results indicate that motor imagery has a selective facilitatory effect on stretch reflex
pathways. Furthermore, this excitability change may occur in untargeted antagonist muscles
as well as targeted agonist muscles and may depend on the imagined effort level.
© 2010 Elsevier B.V. All rights reserved.

1.

Introduction

A number of studies have revealed that motor imagery
facilitates the excitability of both the motor cortex (Porro et al.,
1996; Roland et al., 1980; Roth et al., 1996; Stephan et al., 1995)
and the corticospinal tract (Fadiga et al., 1999; Hashimoto andRothwell, 1999; Kasai et al., 1997; Kiers et al., 1997). However,conflicting opinions have arisen concerning the excitability ofthe spinal reflex pathways during motor imagery. Yahagi et al.
have reported that the H-reflex amplitude did not change while
the MEP amplitude was significantly increased during motor
imagery (Yahagi et al., 1996). They concluded that the excitability change occurred mainly at the cortical, not the spinal level.
This interpretation is compatible with studies that have used

⁎ Corresponding author. Fax: + 81 11 611 2143.
E-mail address: f-kaneko@sapmed.ac.jp (F. Kaneko).
0006-8993/$ – see front matter © 2010 Elsevier B.V. All rights reserved.
doi:10.1016/j.brainres.2010.11.023

理学療法学

第36巻第1号

9～17頁（2009年）

研究論文

能動的知覚に応じて出力する運動課題実施成績の評価指標に関する研究＊
一反復練習効果の検出から一
金子文成！）2）＃速水達也3） 横井孝志1） 木塚朝博3）

要旨【目的】本研究では，今回考案した運動感覚の能動的知覚に応じて運動出力する運動負荷方法である運動
平衡保持（K－E）法による練習介入を行い，我々が設定する変数が，練習介入の結果として生じる機能的変化を検出できるかどうかを明らかにする。また，従来からの運動感覚機能評価法である再現法による検査成績とK－E法による検査成績との関係から，K－E法の検査成績が，再現法によって評価される機能と関連しているのかどうかを明らかにする。【方法】健康な成人男性に対して，K：一E法による練習を2日間反復させ，その前後にK－E法および再現法による検査を実施した。運動は膝関節伸展方向とした。【結果】K－E法では，練習後の検査成績が有意に向上しており，設定した変数が運動感覚および運動出力の機能的変化を検出していることが示唆された。また，K－E法の検査成績と再現法の検査成績との間には，相関を認める変数の組み合わせが複数あった。【結論】以上のことから，我々が設定した変数は，K－E課題の成績を示す指標として妥当であるものと考えた。また，K－E法の成績は再現法の成績が反映する機能と独立ではなく，それらの機能と係わりがある可能性が示唆された。
キーワード

運動感覚，体性感覚，能動的知覚（ハプティクス）運動覚），②努力感，筋の張力，重量そしてスティフネ

はじめにスなど筋の力に関連した感覚（sense“運動感覚（kinesthesia）”という用語はBastian

sense

of

of

ef愉tもしくは

heaviness；力覚），③筋収縮のタイミングに関（1888）が採用した言葉で，皮膚，筋やその他の深部器する感覚，④姿勢および身体図式の大きさの感覚，の4官（腱，関節など）からもたらされる’“印象（impres－つである1）。“運動感覚信号（kinesthetic

sions）”を示すものであった。現在では，運動感覚およう用語には，末梢の筋，腱，関節周囲，皮膚などに数多

び固有感覚（proprioception）は，複数の感覚を包含すく存在する受容器からの入力だけでなく，同様に中枢かる意味で使用される。それは，①関節位置および四肢まらの運動指令入力［efference

たは体幹の動きなどの感覚（kinesthetic

corollarysense；位置覚，

signal）”といcopy（遠心性コピー），

discharge（随伴放電）］2）3）も含まれる。運動

感覚が運動出力に果たす役割に関する諸家の報告では，“

Researchon

Examination

lndicator

of

Motor

Performance

Corresponding to the Active Kinesthetic Perception：
Viewpoint of Detection of Repetitive Practice Effect1）独立行政法人産業技術総合研究所
Fuminari

Kaneko，

RPT，

from

the

Yokoi， PhD： lnstituteforI｛umanof

関節運動は可能である。②複数関節間の非協調が起こる。

人間福祉医工学研究部門

PhD， Takashi

Science and Biomedical Engineering， National
Advanced lndustrial Science and Technology

2）北海道公立大学法人札幌医科大学 保健医療学部（〒060－8556札幌市南1条西17丁目）

lnstituteTatsuya＃Hayami，MS，Graduate

UniversityofE－mail：（受付日

Tomohiro

SchoolKizuka， Phl）： HealthofComprehensiveとなる。⑤運動中の環境への適応が障害される。これらのことから，運動感覚が運動パフォーマンス（運動の正確さ，求められる技能の高さ，運動成績，などを含む）

人間総合科学研究科

Sciences，③運動方向，手の予期成形（preshaping）などの正確性が低下する。④歩行は可能であるが，不規則で非協調

理学療法学科

Fuminari Kaneko， RPT， PhD： Department of Physical Therapy，School of Health Sciences， Sapporo Medical University

3）筑波大学大学院

感覚を遮断する方法が多く用いられ，感覚遮断の影響として以下のようにまとめられる4－9）。①単純な筋出力や

Human

Tsukuba

and

Sport

Sciences，に影響することは明らかである。したがって，運動機能の向上を目的とした理学療法において，どのように運動

f－kaneko＠sapmedac．jp

2007年8月20日／受理日 2008年11月14日）

感覚と運動出力とを統合した機能（体性感覚一運動連関）

Presented by Medical*Online

理学療法学 第35巻第6号

原271～278頁（2008年）

著

長時間歩行時の下肢筋の活動状態：［18F］fluorodeoxyglucoseを用いた
Positron

Emission

Tomographyによる検討＊

島田裕之1）＃石渡喜一・2） 金子文成3）
古名丈人3） 鈴木隆雄1）

要旨

本研究の目的は，成人と高齢者の長時間歩行時の下肢筋活動を，［18F】且uorodeoxyglucoseを使用した
Positron

Emission

Tomography（FDG－PET）によるグルコース代謝評価から分析し，歩行時に主要な働きをする筋を明らかにすることである。対象は成人男性10名（平均年齢24．1±2．1歳）と高齢者男性6名（平均年齢75．5±2．1歳）であり，50分間のトレッドミル歩行を実施し，FDG－PET撮影を行った。関心領域（regionsofinterest：ROI）は， PET画像上，筋の同定が可能であった股関節，膝関節，足関節の屈曲，伸展，外転の主動作筋を対象とし，各ROIにおける糖代謝は標準化集積値（standardized
value，

uptake

SUV）を用いて評価した。各関節運動に関与する筋群間でFDG取り込み量のSUVを比較すると，成人の平均値では股関節外転筋群，足関節底屈筋群，足関節背屈筋群のSUVが有意に高く，高齢者では，股関節外転筋群が顕著に高値を示し，股関節屈曲，膝関節伸展，足関節底屈筋群間に有意差を認めた。山群ともに有意に高いSUVを示した股関節外転筋群では，成人では小殿筋が中殿筋の約3倍の値を示し有意に高値を示した。一方，高齢者では小殿筋と中殿筋間に有意差を認めず，大殿筋を含む股関節周囲筋群

全般にわたる高い糖代謝が観察された。また，成人で高値を示した足関節底屈筋群は，高齢者では低い
SUVを示した。以上の結果から，長時間の歩行遂行には，股関節外転筋群が重要な役割を果たし，高齢者では足関節底屈筋群の活動が相対的に低く，これらの筋群に着目した理学療法が歩行持久性を向上させる効果的な介入方法となり得る可能性が示唆された。
キーワード

緒

PET，＊唐代謝，

FDG

研究が盛んに行われてきた。歩行機能の分析や理学療法

言の対象として，速度，安定性，効率性，持久性といった歩行障害は日常生活に支障をきたす主要な要因であ側面からのアプローチがなされるが，地域社会で日常生

り1），歩行障害の機能的改善を目指す介入手段として，活を営む上では速度性や安定性に加えて効率性や持久性

理学療法は重要な役割を担っている。そのため，理学療が要求される。歩行は高度に最適化された動作であり，法分野において歩行のメカニズムや介入手段を検：討した

特別なフィードバックがない場合には，仕事量，時間，エネルギーといった観点から最適な状態を自己選択して行動する。たとえば，自己最適化された歩幅や歩行率を＊

Activationofof

Positron

Lower－Extremity

Emission

iMusclesTomographyduringUsing

Walking：A

Study［i8F］fiuorodeoxyglucose

1）東京都老人総合研究所（〒173－0015東京都板橋区栄町35－2）

久的運動を行う際に，エネルギーの経済性を高めること

Hiroyuki Shimada， RPT． PhD， Takao Suzuki，Metropolitan lnstitute of Gerontology

MD，

PhD： Tokyo2）東京都老人総合研究所ポジトロン医学研究施設

Kiichilshiwata

Metropolitan

PhD：lnstituteofPositron

MedicalCenter，TaketoFuruna．

RPT：

HealthSciences， Sapporo

Tokyo

of
＃

Kaneko．

Physical

RPT，Therapy．

PhD．

しい。ただし，酸素需要より神経筋系の疲労を最小にする必要性のほうが高いことも指摘されている4）5）。そのため，歩行持久性を筋の累積的活動の側面から検討する

Schoolof

University
E－mail： shimada（ftitmig．or．jp（受付目は重要であり，低い酸素需要で運動を行えることが望ま

Gerontology

3）札幌医科大学保健医療学部理学療法学科
Fuminari

変化させるとエネルギー消費は急激に上昇する2）3）。持

2008年2月19日 受理日 2008年6月21日）

Department
Medicalことは重要であると考えられる。

歩行時の筋活動の分析には，主として筋電図が用いら
れ，歩行遂行に重要な役割を担っている筋が同定されてPresented by Medical*Online

塊

原

肩関節外旋筋群の疲労が肩関節へ与える力学的変化に関する研究一

preliminary

Fatigueofduringpitching

theshoulderstudy

external

一 preliminary

rotators

study

車谷

キー・ワード：ShoU

lderjoint，

Kinetics，

一External

affects

shoulder

j

oint

force

produced’

洋＊1，村上恒二＊1，金子文成＊2，山崎和博＊1

rotatormusclegroup

肩関節，運動力学，外旋筋群〔要旨〕

肩関節外旋筋群の疲労が投球時の肩関節へ力学的影響を与えるのかを明らかにするための予備的研究を行った．対象は大学野球選手2名とした，両対象に肩関節外旋筋群疲労前および疲労後に直球の全力投球を行わせた．肩関節外旋筋群疲労前および疲労後の投球動作を三次元動作解析し，肩関節の勢断力および圧迫力を算出し，個人内で比較した．結果，両対象共に，フォロースルー期の肩関節前方勇断力が肩関節外旋筋群の疲労前に比して疲労後で有意に増加した．その他の肩関節力には有意な変化はなかった．
以上より，肩関節外旋筋群の疲労は肩関節前方勇断力に影響を与えること，及び肩関節外旋筋群は運動力学的側面から肩関節前方制動作用を有しているものと考えられた．

肩関節投球時痛を有する野球選手の肩関節外旋筋

1はじめに力，内旋筋力を調査し，健常野球選手に比して肩投球障害の要因には，投球動作に起因するも関節外旋筋／内旋筋力比が有意に低下していたとの，または関節など局所に起因するものなどがあ報告している．これは肩関節内旋筋力に対して外る．

旋筋力が相対的に低下していることを示してい投球動作自体に起因するものとしては，下肢かる．これらから，肩関節外旋筋群は連続投球にら生じる運動連鎖の破綻が要因の1つであるといよって筋疲労が生じる筋であり，さらに，肩関節われている1～3）．

外旋筋群の筋疲労により生じる筋機能低下が投球

局所的問題としては筋機能低下など，機能的側面の低下が挙げられる4’5）．杉山ほか4）は，200球の連続投球を行った際の肩関節外旋筋群および内障害肩に関係する可能性があると考えられる．

健常野球選手の投球動作中の肩関節に関する報告は散見される2’6～9）．

旋筋群の等速性筋力の変化を調査し，三関節外旋

筋電図を用いた報告において，DiGiovineほ筋群は投球数が100球までは等速性筋力は低下

か6）は，投球時の肩関節周囲筋の活動を筋電図にし，100球以降では等速性筋力はプラトーな状態て捉え，肩関節外旋筋群である棘下筋および小円であったと報告している．また，金子ほか5）は，

筋は投球動作のLate

cockingphase（以下，コッキング期）および小円筋はDeceleration＊1広島大学大学院保健学研究科＊2独立行政法人産業技術総合研究所人間福祉医学研究部門

420

phase

（以下，減速期）にて筋活動が高くなっていると報告している．すなわち，肩関節外旋筋群はコッキ

日本臨床スポーツ医学会誌：Vol，15

No．

Presented by Medical*Online

3，2007，

17

原著臨床神経生理学35（1）：17−26，2007

表面筋電図振幅値の平均変動度を指標とした脳卒中片麻痺の上肢到達運動に関する解析

澤田辰徳ユ・3）金子文成2）村上恒二3）

要旨 本研究の目的は片麻痺患者の麻痺側上肢到達運動の特徴を表面筋電図による平均振幅変動度によって明らかにし，その特徴と臨床で運動機能として評価されるスコアとの関係について検討することである。対象は左片麻痺患者15名（片麻痺群），健康な成人12名（対照群）とし，到達運動を断続的に10試技行わせた。筋電図を大胸筋，三角筋（前部・中部・後部線維），上腕二頭筋，上腕三頭筋から記録した。平均振幅変動度は10試技における整流平滑化した波形の標準偏差平均値（nARV−SDave：normalized
Recitified Value−SD average）とした。

AveragenARV−SDaveは対照群と片麻痺群間で有意差がなかった。片麻痺群のnARV−SDaveと臨床評価との間では，三角筋前部・後部線維上腕三頭筋に強い負の相関を認めた。本研究により片麻痺の上肢運動機能低下に並行して筋活動の変動の増大が起こることが示唆された。

はじめにス研究で示された変動の増大は，片麻痺症例が複数回

日常生活において対象物へ手を伸ぼす運動（到達運

反復して到達運動を行う際に，その運動を安定して再動）を行うことは多い。脳卒中後の運動麻痺は到達運

現できないことを示す。言い換えると，片麻痺症例群

動を困難にするため，患者の円滑な日常生活活動が阻は反復した上肢到達運動が不安定になるため，その運害される。

動軌跡が大きく変動するということである。それでは，片麻痺症例の上肢到達運動については様々な側面か

この反復する運動の不安定さの原因は，筋活動動態のらの研究がなされてきた。キネマティクス研究では，変動の大きさに起因すると考えることが出来るのであ

3次元動作解析により到達運動中の肩関節および肘関

ろうか。片麻痺症例の運動に関する表面筋電図

節の角度変化，速度，運動時間，関節協調等を捉えて（sEMG）による研究では，諸家らが片麻痺症例の上肢いる。これらの研究結果から，片麻痺症例群は健常群

運動機能を阻害する一因として，主動筋と拮抗筋の同と比較して，到達運動中の軌跡の変動が激しいこと，

時収縮があると報告した5・7）。一方で，片麻痺症例にお動作時間が延長すること，肩関節および肘関節の角度ける運動障害の原因は主動筋と拮抗筋によるという根変化が少ないこと等が示された1・3・4・15）。また，片麻痺症

拠はないという報告もある8）。さらにCanningらは片例の到達運動中の肩関節角度変化と肘関節角度変化と麻痺症例に麻痺側肘関節の屈曲，伸展運動を行わせ，の関係が特異的な様相を呈し，その様相は障害の重症

移動する対象物を追従させたところ，障害の重さに依度と関係することが示された4）。これらキネマティク

存して上腕二頭筋の過緊張が認められたことを報告し

1）聖隷クリストファー大学リハビリテーション学部
2）産業技術総合研究所人間福祉医工学研究部門
3）広島大学大学院保健学研究科

受付日：2005年7月25日
採択日：2006年11月8日

た2）。Dewaldらは片麻痺症例に等尺性運動を行わせた

結果，肩関節，肘関節の運動に関与する筋は共同運動に類似した筋活動動態を示したことを報告した5）。このようにsEMGによる研究では，運動に関わる筋群間Presented by Medical*Online

Neuroscience 149 (2007) 976 –984

KINESTHETIC ILLUSORY FEELING INDUCED BY A FINGER
MOVEMENT MOVIE EFFECTS ON CORTICOMOTOR EXCITABILITY
F. KANEKO,a* T. YASOJIMAa AND T. KIZUKAb

our visual stimulus method in the present study. The
method of visual stimulus presentation was a movie in
which someone else’s limb (an index finger in the present
study) is moving. The computer screen on which the movie
played was installed on an appropriate portion of the subject’s forearm, so that the performer’s hand appears as if itwere the subject’s hand. The objective of our study was toclarify whether an illusion originating from visual input affects cortical level excitability: that is to say, whether a“sensory” illusion induced by this novel approach has ameasurable “motor” effect. Since perceptual-to-motor transformation during tendon vibration was demonstrated by
motor unit activity recording from an antagonist muscle ofthe vibrated muscle (Calvin-Figuiere et al., 1999, 2000;
Romaiguere et al., 2005), if a similar effect were to befound in our experimental visual stimulus, it may be usefulto provide a facilitatory effect to the corticomotor pathways
corresponding to rehabilitation of patients with motor disorders of some kind.
Many experimental results stress a prevalent role ofvision over other senses in self-recognition, though it islargely context-dependent: we feel our hand where we see
it, not the converse (Jeannerod, 2003). Various studies
have concurred upon an understanding of the dominanceof visual afferent information with respect to awareness ofsomatosensory information, and also that such informationinfluences corticomotor excitability. The induction of a kinesthetic illusory sensation by moving visual stimulus ofambient circumstances surrounding a subject’s static hand
was reported by Tardy-Gervet et al. (1982, 1984). Furthermore, it was shown that a kinesthetic illusion could be
induced in arm-amputees by their observing a motion executed by the opposite, intact hand in a mirror. Ramachandran and Rogers-Ramachandran (1996) reported thatmost of the amputees who participated in the experiment
felt an emerging, vivid kinesthetic sensation of the phantom movement in the mirror. The condition in the present
study by which a movie is presented, is based on anotherkind of knowledge, that is, the evidence about the dominance of vision with respect to body image recognition thatis associated with having somatosensory information(Botvinick et al., 1998; van den Bos and Jeannerod, 2002).
The necessary condition is for there to be a precise alignment between the subject’s actual body and the performer’s body in the display. The condition settings adopted in
the present study are basically different from those used inprevious studies. The body observed by the subject is thatof someone else; there is no voluntary action on the contralateral side during the observation; the observed person’s hand faces away from the subject, and the observedaInstitute for Human Science and Biomedical Engineering, National
Institute of Advanced Industrial Science and Technology (AIST), 1-1-1
Higashi, Tsukuba City, Ibaraki 305-8566, Japanb

Graduate School of Comprehensive Human Sciences, University ofTsukuba, 1-1-1 Tennoudai, Tsukuba City, Ibaraki 305-8574, Japan

Abstract—The present study aimed to clarify whether a kinesthetic illusion arises in our experimental condition (visual
stimulus) and whether corticomotor excitability changes inparallel with the kinesthetic illusion. The visual stimulus wasa movie in which someone else’s limb was being moved. The
computer screen showing the movie was installed at an appropriate portion of the subject’s forearm, so that the performer’s hand appeared as if it were the subject’s hand (illusion). The experience of kinesthetic illusion under this condition was verified by interview using a visual analog scale.
Healthy male subjects participated in this experiment. Transcranial magnetic stimulation was applied to induce motorevoked potential (MEP) from the first dorsal interosseous andabductor digiti minimi muscle. Each subject was instructed
to watch the same computer display shown as in the illusion,
with his own stationary hand in full view (non-illusion) and to
watch a display of non-biological movement (moving text)(sham) as the control conditions. The present results showedsignificant facilitation of MEP under the illusion comparedwith the control conditions for the index finger abducting in
the movie, although not for adducting. MEP in the abductor
digiti minimi showed no change during either abduction or
adduction of the little finger. The present study demonstrated
that an illusion of self-motion can be created by a video of amoving abstract index finger, and inputs to the corticomotor
pathways during the self-motion illusion facilitated the corticomotor excitability. The excitatory effect of the illusion depended
on the movement direction of the index finger. © 2007 IBRO.
Published by Elsevier Ltd. All rights reserved.
Key words: kinesthesia, illusion, transcranial magnetic stimulation, motor-evoked potential, mirror neuron system.

It has been found that kinesthetic illusions of limb movement induced by tendon vibration against the muscle spindle alter sensorimotor cortex excitability with the receptionof sensory afferent input, despite the fact that the vibrated
limb remains immobile (Naito et al., 1999, 2002, 2005,
2006; Calvin-Figuiere et al., 1999, 2000; Romaiguere etal., 2003, 2005; Naito, 2004; Naito and Ehrsson, 2001,
2006; Casini et al., 2006). We investigate whether a kinesthetic illusory sensation could be induced in a subject by*Corresponding author. Tel: !81-29-861-7885; fax: !81-29-861-6660.
E-mail address: f-kaneko@aist.go.jp (F. Kaneko).
Abbreviations: ANOVA, analysis of variance; EMG, electromyography;
MEP, motor-evoked potential; TMS, transcranial magnetic stimulation;
VAS, visual analog scale.

0306-4522/07$30.00!0.00 © 2007 IBRO. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.neuroscience.2007.07.028976原著臨床神経生理学34（3・4）：160−169，2006

1週間の下肢関節固定による短潜時伸張反射応答及び筋腱複合体の機械的特性の変化
八十島崇1）金子文成1）山田洋2）増田正3）木塚朝博4）

要旨 本研究では，1週間の下肢関節固定による短潜時伸張反射（short−latency stretch

reflex：SLSR）応答性の変化と，筋腱複合体の機械的特性変化を検討した。健康な男性9名の右下肢を対象に，1週間のギプス固定を行った。関節固定前後にヒラメ筋と前脛骨筋の表面筋電図を記録しながら，足関節底屈運動時の最大随意収縮力（maximum

voluntarycontraction：MVC），ヒラメ筋のSLSR（潜時，振幅面積）及び下腿三頭筋の機械的特性として足関節受動トルクを計測した。足関節底屈運動時のMVCは，関節固定後に有意に低下した。短潜時伸張反射の振幅及び面積は関節固定後に有意な増大を示したが，足関
節受動トルクは変化しなかった。これらのことから，今回の方法で検出されるほど筋腱複合体における関節固定後の機i械的特性変化は著明でなく，SLSR応答性の増大には他の要因が関わっているものと考えた。

はじめに神経系の関与を除いた筋腱複合体そのものが発生可能

骨折等の整形外科的治療で行われる関節固定やベッな最大筋力を推定するものであった6・3°）。それゆえ，こド上安静などによって，全身あるいは身体部位の不活の低下は筋断面積で計測される量的な変化ではなく，動が強いられ，運動量は減少する。この身体の不活動

何らかの質的変化が筋腱複合体に生じたものであるとが続くことにより，神経・筋機能が低下し，筋出力機言える。また，経頭蓋磁気刺激（transcranial magnetic能の低下が生じる2・3・8・23）。また，一般に2週間程度の身

stimulation：TMS）による検討では，関節固定後に運体不活動で筋萎縮を生じることが知られてい動誘発電位（motor

る2，3・8・23）。

の有意な増大13）と，二連発刺激による皮質内抑制効果

evokedpotentia1：MEP）の振幅

我々は，できるだけ末梢の筋腱複合体に形態的変化の有意な減少14）が見られたことから，皮質脊髄路の入がない状況下で，選択的に神経・筋機能に関する身体

カー出力関係が変化し，上位中枢の興奮性が増大する

不活動の影響を明らかにすることを目的に，1週間のことを示した。以上のことから，1週間という関節固定

ギプス固定モデルによる実験を行ってき期間では筋断面積が変化しないものの，潜在的な筋収た13 v16，21・22，31）。山田ら31）は，

interpolation法で縮力が低下すること22・31），そして皮質脊髄路において潜在的最大随意収縮力を推定し，それが関節固定後に興奮性の増大が生じること13・14）が分かってきた。経頭15％程度低下することを報告した。この方法は，中枢蓋磁気刺激により誘発される運動誘発電位が関節固定

twitchにより増大する機序は明らかでないが，末梢を含む感
1）産業技術総合研究所人間福祉医工学研究部門
2）東海大学体育学部体育学科
3）東京医科歯科大学大学院疾患生命科学研究部
4）筑波大学人間総合科学研究科

受付日：2006年1月10日
採択日：2006年4月19日

覚入力機能，小脳及びその他運動関連領域からの入力
状況の変化に起因した結果であると推察した。

感覚入力系機能の変化については，我々が実施してきた関節固定による身体不活動モデルとは異なる実験

Presented by Medical*Online

Japanese
Physical Therapy
Therapy Assoclatlon
Association
Japar
ユese
Physlcal報

ll5 〜122 頁

第 32 巻 第 3 号

理学療法学

〔
2005 年 ）告

投 球動作 に お け る 肩 関節 周 囲筋 筋 電 図 の
連続 時 系 列 変 化 に 関 す る 分析＊1

金子 文 成 ）車 谷
2）

村 上 恒 二

2）

洋

増 田

正

3）

IJ根 雅 仁 4）［要旨
本研 究の 目的は ， ・連 の 投 球 動 作 中 に 変 化 す る 筋 活 動 の 様 相 に つ い て ，先 行 研 究 に あ る よ う に 投 球 相 毎に 平 均 化 す る の で は な く，連 続 的 時系 列 デ ータ と し て 動 的 変 化 を示 し ，

肩 関 節回 旋筋腱 板 を 構 成 す る 筋 に

お け る 活 動 動 態 の 差 異 に つ い て 検 討 す る こ とで あ っ た 。大 学生 野 球部投 手 1 名 の 投 球 中 （球 種は 直球）に ，
肩 関 節 回 旋 筋 腱 板 を 構 成 す る 4 筋 か ら 筋 電 図 を 記録 し た
電極 を 使 用 し た

棘 下 筋 に は 能 動 型 表 面 電 極 を用 い た

。

。

，

小 円筋

）

nRMS

の ぱ らつ き で あ る 変 動 係 数 は，筋 に よして ，

10球 分 の nRMS

nRMSavg（

を平均 したっ，肩 甲下 筋 に は ワ イ ヤ

筋電 図 は 振 幅お よ び 時 間軸 共 に 規格 化 した

各 関節運動 の 加 速 度は ビ デ オ カ メ ラ で 記録 した 画 像 か ら算出 した 。

nRMS
（

。

そ の うち 棘 上 筋。

て 異 な る特徴 を 示 した 。

） 曲線 の 最 大 値 出現 時 間 は

お い て 動 的機 能 が 重 要視 さ れ る 肩 関 節 回 旋 筋 腱 板 に お い て ，nRMSavg

反復 した投 球間 に お け る ，

筋活動動態 の 連続時系列的 変化 と，筋 毎 に 異 な っ て い た 。投球 にが 時 々 刻 々 と入 れ 代 わ る 様 子が 明

ら か に な っ た 。 筋 聞 の 相 関 性 も筋 の 組 み 合 わ せ に よ っ て 異 な り ，棘 下 筋 と 小 円 筋 が 強 く相 関 し て い た 。

復 し た 投 球 に お け る 筋 活 動 動態 の ば ら つ き ，連続 時 系 列 的 な nRMSavg

の 変化

反

，そ し て 筋 間 の 相 関 性 の 特

徴 は ，個 人 内で の 筋 活 動 動 態 の 特 徴 を検 出 す る た め の 指 標 と し て 有 効 で あ る 可 能 性 が あ る と 考 え た 。
キ ーワ ー ド

投 球 ，肩 関 節

，

筋電 図

ズ ム が 考 え ら れ て い る 1）

。そ し て ，投 球 に よ る 腱 板 炎 のは じ め に原 因の 一投 球 に よ る 肩関 節の 慢性的 な 障害 〔
投 球 障 害 ） は ，1）

わ ち，腱 板 の 表 面 が そ れ 以 外 の 器官 か ら 物理 的 刺激 を受つ

反 復す る 筋

・腱

は ，上 肢 の 減 速 に あ る と い わ れ て い る 。 す なの 微細 な外力 に よ っ て 微 細損傷 な ど のけ な く て も ，投 球 動 作 の 減 速 期 に 肩 関 節 の 水 平 内転 ，内わ ゆ る 疲 労 が 蓄 積 す る ，2） 疲 労 に 引 き続 い て 炎 症 症

旋 ，お よ び 肩 甲 上 腕 関 節 へ の 牽 引力 に 対 抗 して 遠 心 性 に

状 が 誘 発 さ れ 筋 機 能 が 低 ドす る t3 〕 筋 の 動 的 機 能 低 下

強 い 収 縮 を 強 い ら れ ，そ の 機 能 的役 割 自体 に よ り微 細 損

が 原 因 と な っ て 損 傷 部 位 が 広 が る ，と い う段 階 的 メ カ ニ

傷 を受 ける と い うこ と で あ る

い

へ

2）3 ｝

。こ の よ うな 投 球 障 害に 関 す る メ カ ニ ズム は 組 織 病 理 学 的 所 見 と投 球 動作 分 析＊Analysison the Sequentia Dynamic Change in Etectromyugram
Rec rded fru［n Shou且der Muscles during Throwing］ロ1） 独 i／t行 政 法 人 産 業技 術 総 合 丗 究 所 人 間 福 祉 医 工 学 研 究 部 門（〒 305 δ566 茨 城 県つ くば 市東 1 1 1）

一−−

FuuLinari Kancko ． RPT ， PhD
Neuromuscular Assistive
Techneiogy Group ，InsLLLutefor Iluman Science and Biomedica ］
Engineertng，
National Instituteof Advanced IndustrLaiScicnce
undTe hnutogy：じ2 ） 広 島 人 学 大 学 院保 健 学 研 究 科
Hiroshi Kurumadani ，
OTR ，
MS ，
Tsuneji Murakaml ．
MD ．
PltD
GruduateSchoot of Heatth Sciences，
HireshiinaUniver iLy
3 ｝ 東 京 医 科 歯 科 大 学 大 学 院疾 患 生 命 科学 研 究 部
Tadashi Masuda 、PhD School of BinmedLcul Science．Tokyo
MediCd 且and Dentul Untversity4） 広 島 東 洋 カ ープ
Masahito Yamane Hiroshima Toyo Cu叩 Coh Ltd．
＃
E・
mail
f−kaneko ＠ aist ．
go．
jp
ぐ受 付 日 2e02 年 5 月 27 日 受 理 口 2005 年 2 月 26 目 〕

：

＄

：

：

：

結 果 か ら 理 論 的 に 構 築 さ れ て き た も の で あ る 。こ の こ とか ら ，投 球 動 作 分 析 に よ り投 球 に 関 わ る 筋 の 機 能 的 役 割を 明 ら か に す る こ と は ，投 球 障 害 を予 防 ・治療 す る 際 の理論 構 築 の ため に 重 要 で あ る とい え る 。我 々 は ，筋 の 走
行 な どの 解 剖 学 的 知 見 と ，過 去 に 行 っ た 動 作 筋 電 図 学 的
研 究

−

7 9）

か ら 得 ら れ た 知 見 と を 考 え合 わ せ ，肩 関 節 回

旋筋腱 板 に 含 まれ る 筋 群 に お い て も，動 作 中 に 果 た す 機
能 的役 割 の 詳細 は 異 な る もの と の 仮 説 を持って い る、，実

際 に そ うで あ れ ば，そ の 機 能 的 役 割 を考慮 し た 理 学 療法
プ ロ グ ラ ム が立 案 さ れ る べ きで あ る 。 しか し，投 球動 作
を動 作 筋 電 図 学的 に研 究 した こ れ ま で の 報告

−

4 7，

で は

，

共通 して 投 球 動 作 の 相 毎 に 筋 電 図 を積 分 して 示 して い るーNNII-Electronic
エ エ Electronlc
Llbrary
Library

Service原著臨床神経生理学32（1）：1220，2004

ヒトの下肢関節固定による皮質脊髄路の入カー出力関係変化
金子文成1） 木塚朝博2） 山田 洋3） 増田 正4）

要旨

本研究は，身体不活動による筋出力調節運動中の皮質脊髄路興奮性変化を明らかにすることを目的に行った。身体不活動モデルとして7日間のギプス固定を実施した。健康な男性10名を対象とし，ヒラメ筋から筋電図を記録した。ギプス固定前後で，等尺性最大筋力（MVC），経頭蓋磁気刺激による運動誘発電位（MEP）の振幅，磁気共鳴画像による筋断面積を比較した。MVCは固定後には有意に低下した。安静時に誘発したMEP振幅
は，固定後に増大した。低負荷強度（5％MVC）の筋出力中に誘発したMEP振幅は，固定後に有意に増加していた。また，刺激強度に伴うMEP振幅の増大が固定後には大きくなっていた。筋断面積は変化しなかった。本研究により，外科的侵襲がない状態での短期間ギプス固定によって，皮質脊髄路の入カー出力関係が変化し，皮質脊髄路興奮性が増大する
ことが明らかになった。

はじめにの機能変化も関わっているものと推察できる。運動制

関節固定などの身体不活動後には様々な場面で筋出御機構を考えると，神経系機能は感覚入力系，運動企力パフォーマンスの低下が観察される。臨床的には，

図レベル，運動出力系に分けられる7）。本研究では，運ギプスを除去した後に動企図レベルからの信号をコード化して脊髄運動や，力を入れている感覚がない力を入れると筋が震えるなどの訴えを患者から聞くことが多い。この主観的感覚である

震え

は，筋

出力機能の一つである筋出力調節能力の低下として，ニューロンへ興奮を伝達し，特に巧緻的な運動制御に関与する皮質脊髄路（corticospinal

tract：CST）の興奮性変化について着目した。

力曲線の変動などによって客観的に捉えることができ

近年の経頭蓋磁気刺激（transcranial magnetic

る14・15）。力曲線の変動が増大する背景として，表面筋電stimulation：TMS）を使用した非侵襲的研究によっ

図の二乗平均平方根（rootsquare：RMS）の増て，成人においても感覚入力状況の変化により皮質レ加が認められる。また神経一筋運動単位のふるまいとし

ベルで一次運動野（M1）や体性感覚野の地理的対応領ては，ギプス固定を実施する前後で相対的に同じ負荷域が再構築（reorganization）されることが明らかにさレベルの筋出力をさせた場合に，ギプス固定後には運れてきた。例えば，Liepertらは足関節をギプス固定し動単位の発火頻度が低下する8，25）。これらのことから，た後に，M1における前脛骨筋支配領域が縮小するこ筋出力機能変化の原因として筋量の減少が考えられるとを示した16）。一方，上肢をおおよそ30日間固定した

ものの，それ以外に筋出力の制御に関わる神経系機能症例を対象にして関節固定の影響を検討したZanettemean

らは，安静時のCST興奮性が増大する結果を示し，そ1）独立行政法人産業技術総合研究所

人間福祉医工学研究部

門2）筑波大学体育科学系
3）東海大学体育学部体育学科
4）東京医科歯科大学疾患生命科学研究部

受付日：2003年4月15日
採択日：2003年8月8日の変化は軽度の筋収縮により検出されなくなることを報告した3°）。しかし彼らの実験では，筋収縮における出力の程度が規定されておらず，筋出力を調節している

最中のCST興奮性を検索したものではない。すなわ
ち，実際の筋出力調節運動を実施している最中のCST

Presented by Medical*Online

29

(3)

1.

Clinically Relevant

Reductions in Basal Limb Blood Flow andLumen Diameter after Short-Term Leg
Casting
JUN SUGAWARA1, KOICHIRO HAYASHI1, FUMINARI KANEKO1, HIROSHI YAMADA2,TOMOHIRO KIZUKA3, and HIROFUMI TANAKA4
1

Institute for Human Science and Biomedical Engineering, National Institute of Advanced Industrial Science andTechnology, Tsukuba, Ibaraki, JAPAN; 2 Department of Physical Education, Tokai University, Hiratsuka, Kanagawa,JAPAN; 3Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, JAPAN; and 4Department ofKinesiology and Health Education, University of Texas at Austin, Austin, TX

ABSTRACTSUGAWARA, J., K. HAYASHI, F. KANEKO, H. YAMADA, T. KIZUKA, and H. TANAKA. Reductions in Basal Limb Blood Flowand Lumen Diameter after Short-Term Leg Casting. Med. Sci. Sports Exerc., Vol. 36, No. 10, pp. 1689 –1694, 2004. Purpose: We
tested the hypotheses that short-term casting immobilization of a leg would reduce basal blood flow and vascular conductance andinduces structural alterations in femoral artery. Methods: Right knee and ankle joints of eight healthy young men were immobilizedwith casting for 7 d. Before and immediately after casting, and 14 d after the cast was removed, femoral artery hemodynamics andstructure were measured using a high-resolution ultrasound. Results: Femoral artery lumen diameter in the immobilized leg decreased
after the immobilization (P ! 0.05) and returned to baseline during the recovery period, in which the subjects did not receive any special
rehabilitation treatment. Femoral artery intima-media thickness (IMT) and IMT/lumen ratio in both legs did not show significant
changes throughout the interventions. In the immobilized leg, femoral artery blood flow and vascular conductance decreased ("23 to24%) after the immobilization (all P ! 0.05). These parameters returned to the baseline during the recovery period, and there were no
significant differences between the baseline and recovery values. In the control leg, femoral blood flow and vascular conductance did
not change throughout the investigation. After 7 d of casting, femoral arterial distension, an index of arterial distensibility, tended todecrease in the immobilized leg but not in the control leg. Conclusion: We concluded that a short-term immobilization of lower limb
decreases basal limb blood flow and arterial lumen diameter. These results suggest that basal limb blood flow and lumen diameterdecrease rapidly upon the cessation of muscular weight bearing and locomotor activity, and may be modulated by an ordinary levelof physical activity. Key Words: CASTING, DETRAINING, PERFUSION, ARTERIAL STIFFNESS

T

he effects of exercise conditioning reveal the remarkable ability of the cardiovascular system to respondand adjust to the physiological demands of regularexercise. For example, regular aerobic exercise induces the
expansive arterial remodeling in aorta (19) and femoral
artery (7,20) that are characterized by increases in lumen
diameter and reductions in intima-media thickness (IMT) (7).
Additionally, arterial compliance and arterial blood flow increase with regular exercise interventions (1,12,26,27). These

functional adaptations in the arterial system would act to improve the tolerance for the type of exercise encountered intraining and would facilitate the cardiovascular adjustment to
the particular exercise stress.
Much less is known about the effect of deconditioning onarterial system. Most of the studies conducted to date haveused long-term deconditioning research model, including
spinal cord injury and long-term casting of upper limbs(9,14,24). These studies have demonstrated that arterial
blood flow as well as lumen diameter decrease with along-term period of disuse (9,14,24). These arterial changes
observed as results of long-term deconditioning are generally considered to be an epiphenomenon for muscle wastingand indeed an appropriate response to reductions in metabolically active tissue mass. Currently, it is not known if ashort-term (i.e., 1 wk) lower limb immobilization, that is
associated with a slight atrophy in limb skeletal muscle(8,16), affects arterial structure and function in humans.
Moreover, most of the previous studies in this area haveused subjects who had casts placed for bone fractures andAddress for correspondence: Jun Sugawara, Ph.D., Institute for Human
Science and Biomedical Engineering, National Institute of Advanced Industrial Science and Technology (AIST), AIST Central 6, 1-1-1 Higashi,
Tsukuba, Ibaraki 305-8566, Japan; E-mail: jun.sugawara@aist.go.jp.
Submitted for publication February 2004.
Accepted for publication June 2004.
0195-9131/04/3610-1689
MEDICINE & SCIENCE IN SPORTS & EXERCISE®
Copyright © 2004 by the American College of Sports Medicine
DOI: 10.1249/01.MSS.0000142410.45142.28

1689

・原，

著

肘関節内側側副靱帯損傷術後リ八ビリテーション
ー術前筋力・術後筋力からリハビリテーションを考える一
Musclestrength

in

elbow

the

after

medialcollateral

ligament

joint

車谷

キー・ワード＝Medialreconstruction

collateral

ligament

洋＊1，村上恒二＊1，金子文成＊2

injury， Rehabilitation， lsokinetic

MuscleStrength

内側側副靱帯損傷，リハビリテーション，等速性筋力〔要旨〕肘関節内側側副靱帯再建術後リハビリテーションによる術前・術後筋力の検討を行なうために，
肘関節屈曲筋力・伸展筋力を術前症例および術後症例で横断的に測定した．対象は肘関節内側側副靱帯損傷と診断された野球選手，および肘関節内側側副靱帯再建術を受けた野球選手とした．それらの対象者を観血的治療前（術前群），靱帯再建術後（術後4ヶ月群，術後6ヶ月群，術後8ヶ月群，術後14ヶ月群）に分類した．また，肘関節に障害の既往のない社会人野球選手を対照群とした．これらに対して，等速性肘関節屈曲・伸展筋力測定を行ない，得られた指標（屈曲筋力，伸展筋力，屈曲／伸展筋力比）を各群間にて検討した．結果，肘関節屈曲筋力において対照群に比して術後4ヶ月症例が有意に低値を示した。その他の指標では有意差はなかった．術後早期からのリハビリテーションを実施しているが，術後4ヶ月の段階では，
肘関節屈曲筋力は競技レベルまでの筋力は十分に得られなかった．このことは，生物学的側面に配慮した
段階的リハビリテーションおよび手術後の固定期間による影響があるものと思われる．しかしながら，ス
ローイングプログラム開始時点にあたる術後6ヶ月の段階では有意差はなく，三関節筋力は術前および対照群と同様な程度であった．これらの調査結果および先行研究より，リハビリテーションプログラムの考察を行なった．

る強大な外反ストレスを考慮した診断，観血的治

灘はじめに療，リハビリテーションなどが必要となってくる．

肘関節障害には内側側副靱帯損傷，肘部管症候群，変形性肘関節症，肘頭疲労骨折，離断性骨軟骨炎など様々な疾患がある．それらの中でも，肘関節内側側副靱帯損傷はスポーツにおける肘関節

肘関節内側側副靱帯の靱帯再建術は術者により再建方法が異なるが1～6），術後のリハビリテーシ

ョンでは競技復帰までに概ねユ0ヶ月～ユ年程度の期間を必要としている8～11）．これらの靱帯再再建術などが治療として行なわれている1～7）．こ建術後リハビリテーションに関する報告は散見されるが8～12），機能回復がどのような過程をとる

れらの障害は主に投球動作を必要とする選手に多かについて調査したものは少なく，靱帯再建術後いことから，投球障害と分類され，投球動作によの肘関節周囲筋筋力に関する報告も少ない8・13・14）．

障害の代表的な疾患の一つで，保存的治療や靱帯よって，本研究の目的は肘関節内側側副靱帯再建
L島大学医学部保健学科
ﾆ 立行政法人 産業技術総合研究所 人間福祉医工学

＊1
＊2

研究部門
526

術後の肘関節周囲筋筋力を三関節屈曲筋力および伸展筋力の側面から調査すること，およびそれらから得られた結果より術後リハビリテーションプ

日本臨床スポーツ医学会誌＝Vol．11No．3，2003．

Presented by Medical*Online

Japanese Physioal
Japanese
Physical Therapy
Therapy Assooiation
Association

理 学療 法学報2003 年）
第 30 巻第 5 号 280 一287 頁 （告急 速 な運 動 の 動作分析 を 目的 と し た ワ イ ヤ 電 極 に よ る＊
筋 電 図 記 録 方法 の 改 良
金 子 文 成

1）

村 上 恒

増 田
2）
二

正

1）

車 谷

洋

2）

3）

山 根 雅 仁要旨
本研 究 の 目 的 は ，投 球 の よ う な急 速 な運 動 巾 の 筋活 動 を ワ イ ヤ 電 極 で 分析 す る に は ，ど の よ う な シ ス テ
ム が 必 要な の か を詳細 に提示 す る こ とで あ る。対 象 は 健 康 な 男 子 大 学 生 1 名 で あった 。投 球 動 作 中 に 三 角筋 中 部 線維 と 棘 上 筋 か ら 筋電 図 を 記 録 し た 。電 極 は 棘 上 筋 に は ワ イ ヤ 電 極 を 使 用 し 三 角 筋 に は 能 動 型 表 面
電極 を 用 い た 。投 球 動 作 を ビ デ オ カ メ ラ で 撮 影 し ，各 関節 運 動 の 加速 度 を 算出 し た 。ワ イ ヤ 電 極 は 刺 入 部
付 近で バ ッ フ ァ ア ン プ （入 力 イ ン ピ ーダ ン ス 10M，増 幅 ma10 倍 ） 連 結 し ，腰 部 に 装 着 し た メ イ ン アバン プ で 増幅 したフ
ア ン プ の ワ イ ヤ 電 極 接 合 部 分 に は ，ス プ リ ン グ を 採 用 し た 。A ／D 変換 後 の データ を低 域 遮 断 周 波 数 70Hz ，高域 遮 断周 波 数 500 Hz で 4 次 の バ ン ドパ ス フ ィ ル タ ーを 通 し た 結 果 ，視 覚
ン ア ーチ フ ァ ク トと思 わ れ る 周 波 数成 分 の 信 号 が 除 去 さ れ た
的 に は モ ーシ
周 波 数 分 析 に よ り徒 手 筋 力ース
検 査 実 施 時 と投 球 時 に 記 録 さ れ た 筋 電 図 パ ワ
ク トラ ム 密 度 分布 が ほ ぼ 相似 形 で あ た そ れ に よ り，
。

ッ

Ω

へ

ァ

ョ

。

ペ

今回の

っ

デ ータ 採 集 お よ び 処 理 の 手 続 き が 十 分 に 適 当 で あ り ，モ ーショ。

ーチ フ ァ ク トが 少 な い 状 態 で 急ンア

速運 度中の 筋電図 を得 る こ とが で きた と考 え る。
キ ーワ ード

筋 電 図 ，ワ イ ヤ 電 極 ，投 球

器が 必 要で ある 。

は じ め に一 に 筋電 図 に よる 分 析が あ る 。

運動学 的分析方法 の

肩 関 節 を例 に 挙 げ る と ，動 的 安 定 化 機 構 と し て 重 要 で あ（Ballistic） な運 動 （急 速 運 動 ）

る と さ れ る 回 旋 筋 腱 板 か ら筋 電 図 を 記 録 す る た め に は ，投 球 障 害や ラ ン ニ ン グ 障 害 は ，

急速 （
Rapid ） か つ 急 激

つス ポ ーッ 動 作 の よ うなに よ り慢 性 的 に 微 細 損 傷 が 加 わ る こ と に よ っ表層筋か ら の 信号混入 を避 け る た め に ワ イヤ 電 極 に よ りて 生 じる 病

しか し，Soderberg と Cook1〕

態 の 代 表 的 な 例 で あ る 。そ の よ うな 病 態 に 対 す る 理 学 療

記 録 す る こ と が 望 ま しい

法 の 理 論構 築 に お い て は ，そ れ を 引 き起 こ す 運 動 学 的現が 述 べ て い る よ う に ，ワ イヤ 電 極 に よ る 筋 電 図 記 録 で は象 を 解 明 す る こ と が 重 要 で あ る 。急 速 運 動 に つ い て 運 動

モ

学 的 手 法 に よ り定 量 分 析 す る に は ，比 較 的緩 慢 な 動 作 をが多分 析 す る 場 合 よ りも，さ ら に 高 い 精 度 の 技 術 も し くは 機

イ ヤ 電 極 を使 用 す る こ と は 非 常 に 難 し い 。

ーシ

ン ア

ョ

ーチ フ

。

ァ

ク トな ど の ノ イ ズ が 混 入 す る こ と，急 速 運 動 の 動 作 分 析 を す る た め に ワ

この ため

い

。

こ の 解 決 方法と し て ，記 録 さ れ た 信 号 に フ ィ ル タ を か け る こ と や 記 録
時 に バ＊

Improved Electromyogram Recording
Techniqueuslngr Fine Wire
Electrodesduring Rapid and Ballistic
Movement

1） 独 立行 政法 人 産業 技術 総 合 研 究 所 入 間 福 祉 医 匚学 研 究 部 門〔〒 305 8566 茨 城 県 つ くば市 東 1 1 1）−−
Fuminarl Kaneko 、 RPT ， PhD ． Tadashi Masuda ， PhD
Institutefor Human
Neuromuscular AssistiveTeChnology
Group，
Science andBiomedical Engineering，NationaL 工nstitute of−：Advanced IndustriaLScienceand Technoh）gy2 ）広 島大 学 医 学 部 保 健 学 科
Hiroshi Kurumadani ，OTR ，MS 、Tsuneji Murakami 、MD ，PhD
Instituteof HeaithSciences，School of Medicine，Hiroshima：

University3 ） 広 島 東 洋 カ ープ
Masahlto Yamane Hiroshima Toyo Carp Co ．
，Ltd ．
（
受付 日 2002 年5 月 27 日／ 受 理 日 2003 年 3 月 15 日 ）：るッフ ァ ア ン プ を使 用 す る 等 の 方法 が 用 い2 〕3 ）。し か し ，

デ ータ が 提 示 さ れ て い な

い

−

4 11）

，方 法 の 詳 細 や 生
3
ま た ，田 中 ら
場 合が 多い

研 究 を 行 っ た 諸家 らの 報告のられ

ワ イ ヤ 電 極 を使 用 して 動 作 筋 電 図 学 的
で は

）

。

報 告 に よ り動 作 分 析 に お け る バ ッ フ ァ ア ン プ の 有 効 性，そ の 有 効 性 は 歩 行 動 作 で の 検 討 にる
留ま てす な わ ち ，こ れ ま で に ワ イ ヤ 電 極 に よ る
筋 電 図 記 録 の 方 法 を 検 討 す る 報 告 は 散 見 さ れ ，急 速 運 動
は 確認 され て い る がっい。

の 筋 電 図 学 的 分 析 もワ イ ヤ 電 極 に よ っ て 行 わ れ て き た にも 関 わ らず ，過 去 の 報 告 を 踏 襲 し て 急 速 運 動 の 筋 電 図 を一

NNII-Electronic
工 工 Eleotronio
Library
Library

Service輪坐説，、，

野球選手のポジション別
肘関節屈曲・伸展筋力の比較
The

musclebaseballstrength

in

elbow

flexorandextensorfor

positioned

play

in

healthy

players

車谷

キー・ワード：Elbow

joint，

Isokinetic

musclestrength，

洋＊1，村上恒二＊1，金子文成＊2

Baseball

肘関節，等速性筋力，野球〔要旨〕 本研究の目的は，肘関節に障害のない野球選手の肘関節屈曲・伸展筋力，およびポジション別に

肘関節屈曲・伸展筋力を比較することである．対象は全例社会人野球選手とし，全症例の投球側と非投球側で比較した．また，ポジション別の4群に分類し，投球側肘関節屈曲，伸展ピークトルク値および屈曲／
伸展筋力比を各忌詞で比較した．全症例では投球側と非投球側に有意差はなかった，ポジション別では投手の筋力が野手の筋力に比して感応を示していた．これらの結果は，今後のリハビリテーション，トレー
ニングなどの一般的指標の一つになると思われる．

に少ない．

欝はじめに

今回の目的は，肘関節屈曲および伸展筋力に関野球選手の筋力は，障害を有する選手または観する一般的指標を得ること，およびポジション別

血的治療を受けた選手のリハビリテーション時に野球選手の肘関節屈曲および伸展筋力を明らかに，競技復帰に向けた機能的回復を測る指標の一にすることである．

つになると思われる．野球選手の筋力に関する先行研究では，肩関節周囲筋筋力に関するものは散■対象と方法見される1～5）．しかしながら，肘関節は肩関節に

対象は，本研究の主旨を十分に説明し承諾の得

次いで野球での障害発生が多い関節と言われている6）にもかかわらず，障害を有していない野球選られた，肘関節に障害の既往のない社会人全国大手の肘関節周囲筋筋力を検討したものは非常に少ない．

また，野球ではポジション別に役割が異なって会出場レベルの社会人野球選手29名とした．ポジション別には，投手12名，捕手5名，内野手
6名，外野手6名であった．対象の身体的特徴（身長，体重，年齢，野球歴）は表1に示す．

異なってくると考えられる．しかし，ポジション

肘関節屈曲および伸展筋力測定にはCybex
NORMTMを使用し，角速度は60deg／secにて実別に肘関節周囲筋筋力を検討しているものは非常施した．測定肢位は背臥位とし，測定時には代償くるため，ポジションによって求められる筋力も運動を可能な限り減少させるために，ストラップ＊ユ

L島大学医学部保健：学科＊2独立行政法人産業技術総合研究所

人聞福祉医工学研究部門

80

で体幹を固定する他に，検者による徒手的な固定も加えた．運動開始角度の決定のために，まず肘関節が最大伸展位となる位置を肘関節屈曲・伸展
日本臨床スポーツ医学会誌：Vol．11No．1，2003．

Presented by Medical*Online

肘関節投球障害を有する野球選手における肩関節筋力の検討
AnalysiswithofShoulderMuscleStrength

Elbow

Throwing

DisorderinBaseball車谷

キー・ワードShoulderjoint， Elbow

throwing

disorder，Muscle

原著

Player

洋＊1，村上恒二＊1，金子文成＊2strength

肩関節，肘関節投球障害，筋力〔要旨〕肘関節投球障害を有する野球選手の肩関節周囲筋筋力について調査することを目的とした．対象は肘内側側副靱帯損傷群，変形性肘関節症群，肘尺骨神経障害群，および肩関節・肘関節に障害の既往のない野球選手（対照群）とした．これらの対象の投球側肩関節外旋筋力および内旋筋力を測定し，各群間で比較検討した．肩関節外旋筋力において，対照群と肘内側側副靱帯損傷群および肘尺骨神経障害群との間に有意差があり，肘内側側副靱帯損傷群および肘尺骨神経障害群が有意に低値を示していた．このような傾向は後内側部痛を伴う変形性肘関節症群ではみられず，肘関節投球時内側部痛を有する野球選手で特徴的であった．

るといわれている6）．また，臨床において，肩関

霧はじめに

節および肘関節投球障害を合併している症例を経

著者らは肘関節投球障害を有する野球選手の肘験することは少なくない．これらのことから，投関節筋力について調査を行ってきた1・2’4）．それ

球動作の上肢運動連鎖を通して，肩関節障害が肘らの中から，肘関節障害では障害別に肘関節筋力

関節に，また逆に肘関節障害が肩関節に何らかのが特徴的な傾向をとるという結果を得ている．

影響を与える可能性があると考えられる．しかし一方，肩関節筋力についての先行研究では，肩ながら，上肢の投球障害部位に隣接する関節にど関節投球障害を有する野球選手の肩関節筋力について，金子ら4）は肩関節90。外転位での肩関節のような影響が及ぼされているのかということに

等速性筋力を測定し，肩関節投球障害を有する野

そこで，本研究では肘関節障害を有する野球選

球選手は肩関節外旋／1内旋筋力比が健常野球選手

手の肩関節に着目し，肘関節投球障害を有する野より低下していると報告している．このように肩球選手の肩関節を外旋筋力および内旋筋力の側面

関節障害を有する野球選手の肩関節筋力に関するから調査することを目的とした．

報告は散見される5）．

他方，投球動作分析より，肩関節と肘関節は運動連鎖で肩関節から肘関節ヘエネルギーを伝達す＊1

関して検討している報告は非常に少ない．

羅対象と方法広島大学附属病院リハビリテーション部肩・肘スポーツ外来を受診し，初診時に診断が確定された，肘関節内側側副靱帯損傷15名（以下MCL

L島大学医学部保健学科
ﾆ 立行政法人産業技術総合研究所人間福祉医工学研究

群と略す），変形性肘関節症8名（以下OA群と略

部門す），および肘尺骨神経障害11名（以下UND群と

＊2

500

日本臨床スポーツ医学会誌lVo1，11No．

Presented by Medical*Online

3，2003．

G D

Correlation o f effective ness indices o f m e c ha nic al w o r k utiliｭzation for locom otio n ,vith the lo c om o tion speed
Takashi Y O K O ! ", T oshiharu Y O K O Z AW A •. , Hiroshi YAMADA •,Fuminari K A N E K O . , Kazunori HASE•, Kikue S A

E l of the targel locomotion, firslly w e need 10 confinn correlation be‑
1wccn E l and the locomotion speed.T hen, if El correlates wi1h locomo‑
1ion speed,it m ay be necessary 10 consider 1hc effect of locomo1ion speed
in the interpre1a1ion of El
K e y w o rds :Effectiveness index of m echanical w ork utilization, Locoｭ
motion, Locomotion speed, Correlation, Motion skill

lnstitule of Advanced Industrial Science an d Technology, • • Doc tora l
Program in H ealth and Sport Sciences, Univ.of Tsukuba, ·••D octora levaluation

Program of Comprehensive H u m a n Sciences, Univ.ofTsukuba)

1.

index of mechanicalenergy milization (EI) is defi ned

T heby the
EI ~Performance nndIor Effect.ive energy (rutd/ or W o r k)
M e c h anical energ y (an d/or Work)evaluating skilled motion in ltu•
T h e generic definition of E l is
m a n m ovem elll from 1hc viewpoint of effective usage of m e chanical enｭ
ergy and/ or w ork: Effectiveness index

Certain correlations between EI and locomotion speed were observedin several loco111otion studies using El. If the EJ has
com otion speed, however, interpretation
E l is com plicated. In thepresent s111dy. El w as applied to the evaluation of walking and runningm otion in order to e x a mine if El correlates with lo c o m otion speed.
T w o subjects were asked to perform 15 walks andatseveral speede n erg y(work)｣ /=P e r f o r m a n c e a n d /o r Effeccive e n e r g y ( a n d /o r W or k)IM e chanical en erg y ( a n d o r W o r k )levels. The trials in each speed level w ere measured using an auto m atic
coordinate acquisition system and a force
Then 1he E ls withseveral numerntors representing pcrfomiance and/or effective energy
ut1ltza11on were calculated. T h e n u merators were P, ( = 0.5 x body m ass
x (locomouon speed)2), Pv ( = body m ass x locomouon speed) ,Po ( =body m ass x step length) and Pov ( = body mass x step length x locomoｭtion(absolute work in a cycle obtained based on joint torquepower) w as used as the denom inators of E l.
T he all E ls exainincd in this study have significant correlations w tih loｭ
carnation speed. In these cases, correlation coefficientsas rcgrcsｭ

sion
d ifferent a mong subjects, movemenlS and the nuｭ
merators of E L B ased on these results, in order to a1,propriatcly examine• Y O K O! T a kashi, Y A M A D A Hiroshi, K A N E K O F u m i nari
H AS E K az unori :,• • Y OK O Z AW A Toshiharu :K e y w o rd s :

Ell
IOI

灘原著灘

〈Contribution＞ Evaluationandpsychological

of

space

characteristics

dimension

of

based

standing－up

on

and

kinematic

sittingtdown

movements， by Takashi YOKOI， Fuminari KANEKO， Hiroshi
YAMADA， Kazunori HASE， Kikue SATOH ＆ Takeshi AKIHIRO．

立ち座り動作における動作・心理特性にもとづいた空間寸法の評価＊

横井孝志＊＊，金子文成＊＊，山田 洋＊＊，長谷和徳＊＊，佐藤紀久江＊＊＊，秋廣武志＊＊＊＊Thedistance

between

a

wall

and

the

anterior

kinematicandpsychologicalcharacteristics

experimentwascarriedsetting

distance

adultbetweensubjects

a

wall

were

positions

in

asked

to

evaluateupavariable

experimental

thesubject’s

bodyvariedtoperform

standing－up

trial

movements

werepressure

sensation

based

to

above

According

chair

and

wall

down，

while

the

movementsup

andsitting－down

3）

ln

the
（D

were

were

on

the

and

using

not

by

pressure

therestrictedmovements

at

body

and

feeling

space． Bothrandom

of

in

was

the

2）

ln

by

the

wall，

able

to

the
but

be

a

done

chair

heightexperimental

by

based

of

few

when

body

landmarkwaswall

during

the

the

up

the

sensation

without

distanceandsitting

standing－

was

any

felt．

pressure

sensation．

立ち座り動作における運動学的，心理的特性にもとづいて身体前面壁と身体との距離を評価した．寸法が可変の実験用空間を設け，9種の壁距離と3種の椅子座面高とをランダムに組み合わせて空間を設定し，動作計測実験を行った．健康な19名の成人被験者に立ち座り動作を行わせ，体表に付けた標点の位置を二次元の自動画像計測装置で測定した．被験者には，動作中に壁から受ける主観的圧迫感も尋ねた．測定
データを検討した結果，次の知見を得た．（1）椅子一言距離（D［m］）≦0．8のとき，動作中に壁から圧迫感を感じ，動作は制限される．（2）0．8＜D＜L3のとき，動作の制限はないがわずかに圧迫感を感じる．（3）1．3≦
Dのとき，圧迫感も動作の制限もない．
（キーワード：空間寸法，空き寸法，動作特性，主観的圧迫感，評価指標式）

多様な居住者に適した人体寸法が不可欠である．このよ1．はじめにうな観点から，わが国においても人体寸法が大量あるい本研究は，比較的狭い居住空間を対象に，動作中の運た7刷さらに，このような人体寸法を空間設計におい動学的要因，心理的要因にもとづいて空間寸法を決定すて円滑に利用するため，基本姿勢での手の到達域の数値るための基礎知見を得ようとするものである．

化やコンピュータマネキンの利用も試みられてきは詳細に計測され，様々なかたちで提供されてき建築計画において，人体寸法は空間寸法を決定する際た9’一11）．

の基本データとして必要なものである1～6）．特に居住空人体寸法にもとづいて空間寸法を適正に決定するに間等の人と密接にかかわる空間を適正に設計するには，は，人体寸法値だけでなく空間内でとられる動作や姿勢によって，どれだけのスペース（動作寸法）が必要かを知る必要がある3～6）．利便性や快適性等に配慮するには，＊受付：2003年2月19日 受理：2003年5月12日＊＊産業技術総合研究所
National

lnstituteofAdvancedlndustrial

ScienceandTechnol－＊＊＊＊}波大学人間科学総合研究科

Doctoral

Programsity

TsukubaofofCornprehensive

Human

Sciences， Univer－

Program

Tsukubain

ような空き寸法を適正に決定するには，姿勢・動作の運動学的特徴と空間寸法との関係を明らかにすること，空}波大学体育研究科
Master

これに加えて，空間寸法に持たせるべき余裕（空き寸法）を適正に確保しておかなければならない12・13）．この

ogy
＊＊＊

HealthandSport

Sciences， Universityof間内で動作を遂行する際の心理的な側面を考慮することが重要である12一一15）．

原著・立ち座り動作における動作・心理特性にもとづいた空間寸法の評価

Presented by Medical*Online

the

’The

subject

O．8〈D〈1．3，pressure

andsetup．

Eachstanding

naturallyon

movement． The

obtained： 1） When

both

case

the

system．

given

were

felt

evaluatedmovements． The

pressure

results

sensation

wassitting－down

motion－capture

wall．

were

human

sitting－downaexperiment， following

restricted

1．3SD， theweremeasured［m］）＄O．8， themovements

of

the

by

motion．

caseofstanding－up

andbetween

the

side

the

out

asked

these

of

145

Clinical Neurophysiology 114 (2003) 2397–2403
www.elsevier.com/locate/clinph

Decreased cortical excitability during motor imagery after disuseof an upper limb in humans
Fuminari Kanekoa,*, Tsuneji Murakamib, Kiyoshi Onarib,
Hiroshi Kurumadanib, Kotaro Kawaguchiba
Neuromuscular Assistive Technology Group, Institute for Human Science and Biomedical Engineering,
National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Higashi, Tsukuba, Ibaraki 305-8566, Japanb
Institute of Health Sciences, Faculty of Medicine, Hiroshima University, Hiroshima, Japan

Accepted 16 July 2003

Abstract
Objective: The present study investigated the effect of joint immobilization on corticomotoneuronal excitability to only intracortical input
from a hierarchical level above the primary motor cortex.
Methods: Motor evoked potentials (MEPs) and H-reflexes in the flexor carpi radialis muscle were elicited from 8 orthopedic patients with
splints and 8 healthy volunteers. Each patient was examined on the day of splint removal (disuse stage) and 2 months after that day (recovery
stage). Both potentials were recorded under 3 conditions: at rest, while imagining motor movement (during motor imagery), and during 10%
of maximum voluntary contraction (10% MVC).
Results: In the patient group, the amplitude of surface electromyography during voluntary maximum wrist flexion was lower at the disuse
stage than at the recovery stage, although the supra-maximum M-wave amplitude did not change between stages. Compared to both thepatient group at the recovery stage and the control group, patients at the disuse stage recorded significantly lower MEPs, but only during
motor imagery. In contrast, the H-reflex amplitudes were not significantly changed under any of the 3 conditions for both patients and control.
Conclusions: The present results indicated a strict parallelism between motor execution (the reduction of electromyography during mvc
after immobilization) and motor imagery (the reduction of MEP-amps after immobilization). This parallelism suggests that a functional
reorganization or decreased excitability in the cerebral cortex area involved in executing movement likely decreases the motor capability to
produce voluntary muscular output after immobilization.
q 2003 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
Keywords: Transcranial magnetic stimulation; Motor evoked potential; H-reflex; Motor imagery; Disuse; Immobilization

1. Introduction
A number of studies have pointed out the involvement ofneurological factors [e.g. dysfunction at the neuromuscularjunction (Grana et al., 1996), reduced motor unit activation(Duchateau and Hainaut, 1990; Seki et al., 2001), involvement of the spinal reflex loop (Eccles and McIntyre 1953;
Anderson et al., 1999)] in the disruption of voluntary output
following disuse. One such factor appears to be the intensity
needed for the central command to produce maximal
voluntary output (Enoka 1997; Kaneko et al., 1997; Suzuki
et al., 1994; White and Davis 1984). This suggests a
possibility that training solely at the level of the central* Corresponding author. Tel.: þ 81-298-61-6658; fax: þ81-298-61-6660.
E-mail address: f-kaneko@aist.go.jp (F. Kaneko).

nervous system – that is, without actual muscular contraction, as is the case during motor imagery – can lead to therecovery of at least a little of the lost muscular output. A
study is therefore necessary to demonstrate a concrete
functional alteration in the central nervous system following
muscular disuse, as this would help to establish a therapeutic
theory by which to approach brain motor function without
actual voluntary contraction.
A few studies demonstrated the reorganization of the
primary motor cortex following disuse (Liepert et al., 1995;
Zanette et al., 1997). Liepert reported that the target
muscle’s motor cortex area, observed at rest with atranscranial magnetic stimulation (TMS) technique, wassmaller after muscular disuse. Zanette showed that theamplitude of motor evoked potentials (MEPs) after disuse1388-2457/$30.00 q 2003 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/S1388-2457(03)00245-1

原著臨床神経生理学31（6）：482−488，2003

等尺性疲労収縮中の前脛骨筋より導出した
筋線維伝導速度の加齢変化
山田洋1）

岡田守彦2） 木塚朝博3） 金子文成4）

増田

正5）

要旨 本研究の目的は，等尺性疲労収縮中に前脛骨筋より導出した表面筋電図の筋線維伝導速度（muscle fiber

conduction

velocity：MFCV）の変化を高齢者と若年者で比較する

ことにより，加齢に伴う筋神経系の適応を評価することであった。63名の健康な女性（若年者，n＝24；高齢者，

n＝39）が本研究に参加した。最大随意収縮（maximal

voluntarycontraction：MVC，5秒間）および最大下収縮中（60％MVC，疲労困態まで）にMFCVを算出した。MVC中の背屈トルクと， MFCVを計算するための相互相関係数は，両群において差が認められなかった。MVC時のMFCVは，若年者で高齢者と比較して有意に大きかった（p〈0．05）。最大下収縮中，全ての被験者において筋電図の振幅は増大し，徐波化した。これらは局所筋疲労の進行を示していた。疲労進行に伴い，MFCVは有意に低下し（p＜O．Ol），回帰解析より算出したMFCVの疲労による変化速度は，若年者と比較して高齢者で有意に小さかった（p＜0．01）。これは，同じ相対強度の収縮で，高齢者は若年者

ほど疲労しないことを意味していた。これらの結果から，高齢者は，加齢によるFT（fasttwitch）線維の選択的な萎縮に起因する筋神経系の劣化を処理するための運動適応戦略を持っていることが示唆された。

はじめにトするということが示されている1°・2°）。近年，EMG振筋疲労に関する研究は，神経生理学において極めて幅や周波数パラメータにくわえ，筋組織の代謝状態を重要な問題のひとつである。人口構造が急速に変化し，反映する筋線維伝導速度（muscle

fiber

conduction

高齢化しつつある日本を含めた先進国において，疲労velocity：MFCV）が，他のEMG変数よりもその記録特性の把握は，社会経済的な重要性をもつ。これは，状態に影響を受けづらいという理由から，疲労評価にとりわけ，高齢者の日常生活行動に不可欠な移動に関広く用いられるようになっている24・26）。

しかしながら，MFCVを用いた若年者との比較によ連した下肢の筋にあてはまる。

筋疲労の生理学状態を評価するために，表面筋電図

る高齢者の筋疲労の特性は，いくつかの研究を除いてが従来広く用いられており，リアルタイム，かつ非侵あまり調べられていない8・18・29）。これらの研究において襲的であるという利点をもつ。例えば，疲労進行に伴も，計測される被験者は少なく，単に疲労前後の値のい，表面筋電図の振幅が増大し，周波数が低域にシフ

比較のみに焦点が当てられている。これらの研究の不1）東海大学体育学部
2）筑波大学先端学際領域研究センター
3）筑波大学体育科学系
4）産業技術総合研究所人間福祉医工学研究部門
5）東京医科歯科大学疾患生命科学研究部

受付日：2003年1月17日
採択日：2003年3月8日

十分さの理由は，実験において多数の若年被験者と高齢被験者を集めることが難しいだけでなく，フィールドにおいて精度の高いMFCV計測をすることが難しい点に起因すると考えられる。

本研究の目的は，加齢に伴う筋神経適応の非侵襲的Presented by Medical*Online

源：、

碧・

野球選手の変形性肘関節症
症例における筋力特性
Musclestrengthcharacteristics

inbaseballplayers

with

elbow

osteoarthritis

青山信一＊1，村上恒二＊2，車谷 洋＊2
金子文成＊1，松原麻子＊1，澤田辰徳＊1

キー・ワード：elbow

osteoarthritis，

musclestrengthcharacteristic，

extensionstress

変形性肘関節症，筋力特性，伸展ストレス〔要旨〕野球選手の変形性肘関節症症例における筋力特性（肘関節屈曲，伸展時の最大トルク，最大トルク
発揮角度，最大仕事量）を肘関節に障害の既往のない社会人野球選手と比較し，検討を行った．結果は，最大トルクは屈曲，伸展時とも両者間に有意な差はみられなかったが，伸展時の最大トルク発揮角度および伸展時の最大仕事量は変形性肘関節症症例において有意に低値となった．

伸展時の最大トルク発揮角度の低値は，投球時の肘伸展ストレスを減弱させるにあたり，より小さな関節arcで処理している可能性が示唆された．これらの結果は，変形性肘関節症を有する野球選手にみられる
投球終末時の痺痛と何らかの因果関係を有するものと考えられる．

野球選手の変形性肘関節症3～5）の臨床症状は肘霧はじめに後側部の障害として肘頭，肘頭窩にみられること

野球は日本で最も人気のあるスポーツの1つでがほとんどである．これは，強い屈曲を要求されある．野球の動作には投，打，走，守などがみらる柔道などの競技とは異なり，野球は肘関節の伸れるが，これらのうち投球動作は野球を構成する

展側に過度の負荷が要求される競技特性によるも最も重要な要素である．

のと考えられている．

投球動作によって生じる肘関節部の障害を総称
して野球肘1’2）（baseball

野球を含め，上肢を過度に使用するスポーツに

elbow）と呼び，骨，軟よる変形性肘関節症では，伸展時の疹痛，伸展可

骨，靱帯，筋腱付着部の障害が含まれる．野球肘

動域の制限が主訴となることが多い．特に競技レは肘関節のどの部位に負荷がかかって発生したか

ベルの現役選手にとって，痙痛や関節可動域制限

により，外側型，内側型，後側型に大別される．

は競技スキルに関わる大きな問題となってくる．

外側型は擁骨頭と上腕骨小頭部との圧迫により引

しかし，肘関節に障害がある野球選手に関するき起こされ，内側型は肘関節内側の過緊張，後側

文献は，整形外科領域，リハビリテーション領域

型は肘関節伸展強制によりそれぞれ障害を引き起において散見されるが，筋力特性についての報告

こす3）．

は非常に少ない．

そこで本研究の目的は，野球選手の変形性肘関
＊1

＊2

76

L島大学大学院医学系研究科保健学
L島大学医学部保健学科

節症症例における筋力特性を肘関節に障害の既往のない社会人野球選手と比較検討し，明らかにす

日本臨床スポーツ医学会誌：Vol．10No．1，2002．

Presented by Medical*Online

of Athletic Rehabilitation No.3,2000ｷ200 I'
ORIGINAL ARTICLE

Factors of Functional Disruption in Quadriceps
Femoris Muscle Following A C L Reconstruction a n d
Providing Logical Support for Rehabilitation
Program Based o n Evidence
Fuminari K A N E K O * ,Yoshikazu N A K A M U R A **,Kotaro K A W A G U C H I * * *,Yukio U R A B E ** *,Kiyoshi O NA R I * * *Key w o r d s:anterior cruciate ligament quadriceps-—
ABSTRACT
It w as dem onstrated that the functionalchanges of human quadriceps fem oris m uscles
on the two kind of perfor mance levels(l.maximum voluntary contraction (M VC),
2.reaction time during M V C ) follo wing
anterior cruciate ilgament reconstruction.T hem uscles, rehabilitation

M orphological and physiological factors, for
explanation in examined parameters in ourprevious studies, w ere discussed in tl1e present
article.T he goal ofthis article
indicate apare oftl1e logical background of rehabilitation
program co improve the disrupted quadriceps
femoris m uscles function during
m onthsfollowing A C L reconstruction.
* NationalInstitute of Bioscience andTechnology
1‑1‑1 Higashi, Tsukuba, lbaraki 305‑8566
E‑mail: f‑kaneko@aist.go.jp**Hiroshima Kyorits u Hospital** * Institute of Health Science,Faculty ofMedicine
Hiroshi ma University ｷ

79

`
Effects o f b o d y s e g m e n t inertia parameters o n b i o me chanicala n aly sis o f walking m o v e m e n t

1.

Takashi Yokoi", T oshiharu Yokozawa'', Hiroshi Y a m a d a". Fuminari
Kaneko", Kikue Satoh" ("National Institute of Advanced Industrial Sciｭencc and T echnology, 2'Doctoral Program in Health and S p o n Sciences,
Univ. or Tsukuba,"Doclornl Program of Comprehensive H u man Sciｭenccs, U niv. ofTsukuba)
Effects of body segrnc111 inertia pararne1crs (B S P ) on biomechanical inｭ
terpretation were invcs1iga1ed through lhe biomechanical analysis ofs e g m e n t ine rtia param e ters ;walking al four speed levels.
T w o subjectS were asked 10 perform 15 walks at each speed level. T he
15 walking trials in each speed level w ere measured using an automaticcoordinate acquisition system and a force platform. Kinematic and kinetic
variables were computed using five sets of B S P ; I) B S P O: Averagevalue for young aduh athletes reported by A e et al. (l992). 2) B S P I :Average value for 1he elderly m ale reported by Okada cc al. (1996), 3)
B S P 2 :Average
the elderly female reported by Okad.i cl al.
(1996), 4) B S P 3 :A verage value for the aged cadavers rcpOJ1ed by
Chandler ct al. (1975) ,5) B S P 4 : Average value for three‑year‑old chilｭ
dren reported by Yokoi el al. (1986).
T h e significant differences of m echanical variable,

walkingment appeared a m o n g B S P sets and a m ons speed levels. H owever, thetendencies of differences in the m echi!nk al variables a mong B S P sets
were similar in all speed levels. A lso,changes in the variables due 10 1heincrease in speed level were observed to have similar tendencies in fiveet al

B S P sets. Therefore, as far as w e apply one B S P to a certain subject andfocus on relative characteristics of m echanical variables calculated by usｭ
ing a B S P set, the use of inappropriate B S P values m a y have liulc effecton the resul1s and their interpretation obtained through 1hc biomcclia11ical
analysis of h u man movcmcnl.
K e y w o r d s : Body segm ent inertia parameters, B i̲om,,;.cha̲nical m otion
analysis,Walking m m ion"Y O K O ! T a k ashi, Y A M AD A Hiroshi
K.A.N E K O F u minari :.,..
2'Y O K OZ A W A Toshiharu :31SATOH Kikue :Keywords :96

Je n s en

1986,Start/Renew Form
Journal of Orthopaedic & Sports Physical Therapy
Official Publication of the Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Association

Electromechanical Delay After ACL
Reconstruction: An Innovative Method forInvestigating Central and Peripheral
Contributions! Please start my one-year subscription to the JOSPT.

! Please renew my one-year subscription to the JOSPT.

Individual subscriptions are available to home addresses only. All subscriptions are payable in advance, and all rates include
normal shipping charges. Subscriptions extend for 12 months, starting at the month they are entered or renewed (for example,
September 2002-August 2003). Single issues are generally available at $20 per copy in the United States and $25 per copy whenmailed internationally.
USA

Institutional
Individual
Student! $215.00! $135.00! $75.00

International! $265.00! $185.00! $125.00

Agency Discount! $9.00

Subscription Total: $________________

Shipping/Billing
Information
Fuminari Kaneko,
PT, PhD 1
Kiyoshi O nari, M D, PhD 2
Name _______________________________________________________________________________________________
Kotaro Kawaguchi, PT, PhD 3
Address_____________________________________________________________________________________________
Kazuhiro
Tsukisaka, M D 4Serge_____________________________________________________________________________________________
H. Roy, PT, ScD 5
Address
City _______________________________State/Province __________________Zip/Postal Code _____________________
Phone _____________________________Fax____________________________Email _____________________________
Objectives:
this study
was toupdates
investigate
therenewal
electromechanicalof
Would
you likeThetopurpose
receiveof JOSPT
email
and
notices?properties! Yes

muscle fiber-type composition, or a decrease in! No
atrophied muscle in patients with anterior cruciate ligament (ACL) reconstruction and to examinefunction of the excitation-contraction coupling
the relationship of changes in these properties for a voluntarily elicited maximal isometric
process). A prolonged electromechanical delay
contraction and peripherally stimulated twitch contraction.
in twitch response can also explain the
Payment
Information
Background:
It is not known if, following ACL reconstruction, a prolonged reaction time to a
prolonged electromechanical delay observed
sudden stimulus is due to impaired proprioception in the knee joint, a prolonged processing
for MVC. These findings suggest that prolonged! Check(madepayableJOSPT).
intervalenclosed
in the central
nervoussystem,toor thea greater
elasticity in the series elastic component of thetotal reaction time in MVC, when secondary toquadriceps femoris.
a visual stimulus in atrophied human! Credit Card (circle one)
MasterCard
VISA
American Express
Methods: Seventeen patients were recruited 2 to 3 months following a unilateral ACL
quadriceps femoris muscle after ACL
reconstruction. Both the involved leg (ACL-invo group) and the uninvolved leg (ACL-uninvo group) reconstruction, may be principally due to
Cardwere
Number___________________________________Expiration
Dategroup)_________________________________________
studied.
Twenty-two athletes (training group) and 18 control subjects (control
were
prolongation of electromechanical delay
also tested. These subjects performed voluntary maximal isometric contraction (MVC) of the
produced by peripheral physiologicalSignature______________________________________Date__________________________________________________
quadriceps
femoris. Maximal twitch response was also elicited by a supramaximal
electricalalterations. However, the contribution of
stimulation to the femoral nerve, and surface electromyograms were recorded from the vastus
premotor time to prolonged total reaction timelateralis in all four groups.
was not revealed. O ur results do not
Results: Total reaction time for MVC in the ACL-invo
group(250.47ms)
wasprolonged
compared
completely
eliminate the possibility that central
To order call, fax, email or mail to:to that of the control and training groups. Twitch response in the ACL-invo group (25.26 ms) was
nervous system processing time and other1111
FairfaxPremotor
Street, time
Suiteduring
100,bothAlexandria,
VA 22314-1436
prolonged compared to that of theotherNorth
three groups.
MVC and twitch
neural factors are involved in the prolongation
response did not differ among
the 877-766-3450
four groups. Electromechanicaldelay during•MVC(53.62ms)of reaction time. J Orthop Sports Phys TherPhone
• Fax 703-836-2210
Email:
subscriptions@jospt.org
and the evoked electromechanical delay in twitch response (20.04 ms) were prolonged in the
2002;32:158–165.
ACL-invo group as compared to the other three groups.
Thank you for subscribing!
Key Words: anterior cruciate
Conclusions: Prolonged electromechanical delay in twitch response may be due to peripheral
ligament, electromechanical delay,
physiological disruptions (eg, stiffness of the series elastic component, changes of peripheral

electromyography, muscle atrophy,
series elastic component

1

Research scientist, Neuromuscular Assistive Technology Group, Institute for Human Science andBiomedical Engineering, National Institute of Advanced Industrial Science and Technology, Tsukuba,
Japan.
2
Professor, Institute of Health Sciences, Hiroshima University School of Medicine, Hiroshima, Japan.
3
Research associate, Institute of Health Sciences, Hiroshima University School of Medicine, Hiroshima,
Japan.
4
Physician, Division of Orthopaedics, Hiroshima Kyoritsu Hospital, Hiroshima, Japan.
5
Associate professor, Neuromuscular Research Center, Boston University, Boston, MA.
This study was approved by the Institutional Review Board of the Faculty of Medicine at Hiroshima
University.
Send correspondence to Fuminari Kaneko, National Institute of Advanced Industrial Science andTechnology, Institute for Human Science and Biomedical Engineering, 1-1-1 Higashi, Tsukuba, Ibaraki
305-8566, Japan. E-Mail: f-kaneko@aist.go.jp
158

A

reduction in muscle
strength is often accompanied by muscle
atrophy.2,6,13,20,23,25,
28,30,31,33
However, thisreduction in strength may be relatively greater than the decrease

Journal of Orthopaedic & Sports Physical Therapy

ttL／II 高煤@IIl

瞬旧卜㌦

亡」マ㌧萎；齢評EiI’

暴

1肘関節内側側副靱帯再建術後の1リハビリテーション
Rehabilitation

iil
ii
lii
jli

programforelbow．medialcollateral

一磁1ligament／／、ii卜冨？：

reconstruction

馨
ゼ

馨

［
iill’1’

蜂
藩
舞
押
亀
卜

薪
，，．i，ii，，，，xt，a，Li．．，；，」／is，．frvaeg，：：v，vsi：r．，，，：’／i／’

L’i，，一，，L

i，”．””．：i／“x・／’””ii

”i’

’

’wi

”f’E’”’’

tin’tv’”’”’ti’”w”

金子文成＊1，車谷
悔ご竃雛」一i！l冨III∂・wl・

キー・ワード：Elbow，Medialcollateral

ligament

洋＊2，村上恒二＊2：1

riiiii番鼎『IiL・1隅織職転；餌首II㌔11・1轡il｝いIIIII㌦BII噸Ii・li”，tll

IrllII

IIIr

IliIIIIIIIIIボ戦野1／噛ll

injury， Rehabilitation

肘関節，内側側副靱帯損傷，リハビリテーション〔要旨〕肘関節内側側副靱帯再建術後は，再建靱帯の生着過程を十分に考慮し，段階的なプロトコールに従ったりハビリテーションを行うことが必要である．しかし，本邦においては靱帯再建術後早期から完全復帰までの靱帯再建術後リハビリテーションの内容について詳細に述べた論文は比較的少ない．本論文では，
まず初めに靱帯再建後リハビリテーションの科学的根拠となる生体力学および組織学的研究をレビューした．その後に，それらの研究を基にして我々が実践してきた，段階的靱帯再建術後リハビリテーションプロ
グラムを紹介するとともに，機能回復に関するデータを供覧した．

が実践してきた靱帯再建術後プログラムを紹介す■はじめにるとともに，機能回復に関するデータを供覧す

村上らはこれまでに三関節内側側副靱帯再建（以下，靱帯再建）術後，スポーツ復帰の成績が比る．

また，ここでは特に病院内における理学療法で較的良好であることを報告してきた11・29）．特はなく，外来による定期的な診察および理学療法に，靱帯再建後のスポーツ復帰を考えたときにの指導を中心に考えたりハビリテーションの内容

は，再建靱帯が動的な場面で生じる肘関節外反スとした．そのため，医療機関への頻繁な通院や理トレスに抗した力学的強度を獲得するとともに，学療法士が徒手的に行わなくてはならないような

その外反ストレスから靱帯を保護iする役割をにな

理学療法の内容はできるだけ少なくできるようにう筋機能の獲得が重要であると考えられる．この配慮した．

ため，段階的なプロトコールに従ったりハビリ
テーションを行うことが必要である．しかし，本邦においては靱帯再建術後早期から完全復帰までの靱帯再建術後リハビリテーションの内容につい襲投球動作と肘関節内側側副靱帯に生じるストレス
肘内側側副靱帯前方線維（以下，AMCL）は肘て詳細に述べた論文は比較的少ない．そこで本稿

関節のprimary

では，リハビリテーションプログラム作成の過程

め，投球やテニスのストロークなどの投換働作にで根拠となる生体力学的研究をレビューし，我々よる靱帯損傷は肘関節内側側副靱帯（以下，MCL）のなかでもとりわけAMCLに多いことが明

＊1

＊2

312

stabilizerである19’26）．このたらかになっている1ユ・ユ2・20

ﾆ 立行政法人産業技術総合研究所
L島大学医学部保健学科’一25）．この原因となるストレスは，動作中の肘関節外反トルクにより生
日本臨床スポーツ医学会誌：Vol，9No．3，2001．

Presented by Medical*Online

III

I．1．一

・㌧興、 lr轟㌦Ieゾ／t

1日糊」IIIII一一｝髭揖ザ、三半㌦．－－曲i脇～罷暁識烹黙’

第19回ユニバーシアード
冬期競技大会一理学療法室活動報告と今後の展望一

瀞
－
喬
蕪
鵬
・
腎

The

present

quarters’

siade

忌

articlemedicaldescribes

office

of

the
the

work

of

Japaneseaphysicaltherapist

teamduring

the

19th

in

the

Winterhead－

Univer－

蹟

Games

！
l

金子文成＊1，大西祥平＊2！
！illt

配川1、1
細嘱

遜鑑、藤；il｛、・・略11概．・「キー・ワード’．蔀麗II融il圭1」EII「ニパ∫IP「』r「1．II．ll

11

Universiade， Physical

II

11111

ll

＿・ぞ

I峠ILマ、華・’ P，ご照∴華ll牽へ肖髄PP騒旨騨II．1レ

へ謂［徹therapy，Athletic

II1」…

：：漆齢㌧．’：Fttlll．旨

1！．IIIIIill二一／1一一］d・lt．11く．慧…il｝甥跳童ド111

trainer

ユニバーシアード，理学療法，トレーナー〔要旨〕

第19回ユニバーシアード冬期大会における選手団本部理学療法室の活動を報告する．

まず理学療法室の運営，処置部位やその内容，処置件数などを資料として提示した．つぎに，本大会においては選手団本部理学療法室は各選手団に帯同したトレーナーも協1同利用できるようオープンルーム化したが，他のメディカルスタッフとの関わりの重要1生および国内外の世界大会における今回のスポーツ医科学サ

ポートシステムの有用性について考えた．ユニバーシアード大会は，トレーナーシステムを考える上でス
ポーツ界全体の縮図のような側面をもっており，このような大会においてシステムを模索していくことは重要であるものと思われた．

後は，まず医務室開設の準備を行うとともに，選懸はじめに

手村内の衛生環境を含めた住環境の把握に努め

第19回ユニバーシアード冬期大会は1999年1月22日から1月30日に渡って，スロバキアで開催さ
表1

れた．参加国数は40力国，総参加選手・役員は
1，412名であった．そのうち，日本選手団は選手78名（男性57名，女性21名），役員33名，そしてエ

キストラオフィシャル19名の合計130名であった．日本が参加した競技種目はスキー（アルペン，クロスカントリー，ジャンプ，ノルディック
複合，スノーボード），スケート（フィギュア，ショートトラック），アイスホッケーであり，今

1
ス
キ
ー

＊1

＊2

L島大学大学院医学系研究科保健学瘴`塾大学スポーツ医学研究センター

競技

帯同

人数

医療資格等

アルペン

トレーナー

1

コンディショニングコーチ

Nロスカントリー

トレーナー

1

柔道整復士，鍼灸師，}ッサージ師Wヤンプ
mルディック複合
一

回はバイアスロン競技にのみ参加しなかった．

本部医務班は他の本部職員およびアイスホッケー選手団とともに残る競技団体選手団に2日先立って，1月16日に出発した．このため現地到着

各競技に帯同したメディカルスタッフの詳細

Xノーボードgレーナー

鍼灸師，マッサージ師
1

Fアスレティックト
戟[ナー

フィギュア
スケート

Vョートトラック

医師

1

整形外科

医師

1

内科

トレーナー

1

鍼灸師，マッサージ師

アイスホッケー日本臨床スポーツ医学会誌：Vol．9No．2，2001．

Presented by Medical*Online

251Discrimination of athleti c characteristics b a s e d o nexercise physiology a n d se r u m biochemistry
Kotaro Kawaguchi1 l,Fuminari K a neko 2i,Yusuke Hanafusa3l ,Yukio Urabe1 l,
Kiyoshi Onari Iiand Tsuneji Murakami 1iwords) : 1. Institute ofH ealth Sciences, Hirosh i ma University Faculty of M edicine

2.N ationalInsti tute ofA dvanced Industrial Science and T echnology
3. G raduate School of M edicine, Hiroshima University

T he purpose of the present study is to determine

It is w ell k n o w n that in athletic sports the results are

w hether athletic characteristics can be discriminated bylargely depen dent on physical strength and skill (11 ) .

changes in ser u m components during exercise which are

Ikai h as dem o nstrated that from the standpoint of theconsidered to reflectsystemic endurance capacity,m uscle

ability to display energy, the three elements involved instreng th, and the energy m etaboli sm system. Thirteenp hysical stre ng th are m uscle strength, speed, andm ale long‑distance athletes and 8 m ale sh ort‑distance andendurance (8). A n u m ber of reports have been m a de on

fi eld athletes performed an increm ental exercise test,th e m uscle strength and endurance of athletes (2‑4,7) ,m uscle strength, and endurance test
. T h ey w ere also

and a consistent relationship has been observed between

ob served for changes in serum co m p on e nts duringslow twitch fibers and m axim um.It can therefore be understood that the m uscle

exercise .A ccordin g to data analysis, the discriminantfiber ty pe of athletes sho w s a ch aracteristic patternfunction thus obtained w as:
Z ; 0.8220 X peakV
M VC +X A T + 0.0010 X(‑0.0276) X 60

M V C 50% time +consumption (Vaccording to the type of sport.
Histochem ical evaluation of specimens obtained by

d eg/sec + 0.2629 X(‑0.8715) ?
< U N + 36.1659 ̲m uscle biopsy is co m mon ly employed in evaluatmg(peak V 02: m easured value of peak V 02,A T: % peakV 02,

m uscle fiber type (14) .M uscle biopsy, being an invasive

M V C: m easured value of th ~ isometric m uscle strength,

procedure,con stitutes a considerable burden on athletes,

60 d eg/se c: peak torque of th e iso kine ti c m u scle

and thus, co nsiderable difficulty is faced in its u se incontraction at 60 deg/sec, M V C 50% time: the time for

sport. F rom this vie wpoint, G erdle et al. (6), Moritani etthe previously determined isometric m uscle strengthal. (13), and N agata (15) h ave d eveloped non‑invasive

value to beco m e less than 50% , UN: the increase rate ofm uscle fiber type evaluation procedures with the use of

U N from the value at restto the m a x i m u m value) .

electromyography. It has b ecom e possible with these

Subjects w ere classified into the actual group correctly,

procedures to predict a m uscle fiber type ratio, but as thisw hile the erroneous discriminant rate w a s 0.73% . Inm uscle fiber type ratio is only one of the factors w hichparticular, weighting of the discriminant coefficient ofexpresses athletic characteristi cs, analysis from various

peak V 02 and U N w as large, indicating that these areangles is n ecessary to ad eq uately ascertain athleti cu seful as p a r a meters for discriminatin g athletic

characten stics.
T he purpose of the present study is to determine

characteristics.

w h ether athletic ch aracteristics can be discriminated bychanges in ser u m co m p o nents during exercise,which areconsidered to reflect systemic endurance capacity, m uscle
strength,and the energy m etabolism system.

V ol. 1(1) : 78‑84. 2001

78

Presented by Medical*OnlineLigament reconstruction for the medial collateral ligament of the elbow

Ligament reconstruction,

elbow joint,

medial collateral ligament

1 ).

1.
*

Vol. 7 No. 3,

Presented by Medical*Online

1999.

241

performｭ

ligaments and dyｭ
na mic.3.4 .9. 11. 12).

l

)
7
3

10.13.17) .

*]

*2

1306

Vol. 15, No. JI (1998‑11)

Presented by Medical*Online

3
2

0‑14
15‑19
20‑24
25‑29

l

5

11
3

35‑39
40‑44
45‑49

4
2
I

I

l

l

5
2
2

55‑59
60‑64
65‑69
19

16

21. l

37 .5

I

l

l

l

(1983.10‑ 1997 .10)

1)
16
l
1
l
2)

l

3)

l

4)

l
(1983.10‑ 1997.10)*

V ol. 15, No. 9 (1998‑9)

Presented by Medical*Online

1037

AP

peak

1.

. 180deg/

•1

2.

• 2

Vol. 15, No. II (1998‑11)

Presented by Medical*Online

1293

115

Physical Medicine) 9 (2) : 11 5‑120, 1998.

,..̲,K e y words:

torque) ,male) ,of strength )contraction,
contraction,

Reliabil ity of measurements of isokinetic test of m uscle strengths ‑ c om p are w ith concentric contraction andeccentric contraction‑
M asashi M I U R A , Fuminari K A N E K O , Keiko S U GIYA, K iyoshi O N A RI, Y ukio U R A B E , Kotaro
K A W A G U CH I

理学療法の医学的基礎第1巻（1997）11・一16

萎縮筋の最大随意収縮時における筋活動動態の
筋電図学的検討金子文成1），大成浮志2），浦辺幸夫2），川口浩太郎2），
三浦雅史1），月坂和宏3），尾方恵子4）緒
言
筋力低下は2週間以上の活動性低下により生じる

要であると思われる。しかし，長期活動性低下により萎縮した筋を対象に筋電図学的手法を用いた研究

ことが報告されている16）。また長期間の活動性低下は少ない。そこで本研究では長期間の活動性低下ににより筋量の減少や筋断面積の減少が認められる15）。

よる萎縮筋について，最大努力下での筋活動を表面

筋力は筋の断面積や筋量に比例する5・15）ことから考筋電図により検討することを目的とした。

えると，筋萎縮に伴い筋力低下が生じることが予想される。しかし長期活動性の低下による筋量の減少と，筋力低下を比較したSuzukiらの研究により，筋

方

法

A．対象

力低下の割合は筋量が減少する割合以上に生じてい対象はスポv・・一一ツ活動中に膝前十字靭帯（ACL）損ることが明らかにされ，筋力低下の原因は筋萎縮の傷を受傷し，ACL再建術を受けた女性12名であり，
年齢は25．4±4．6歳，身長は159．1±7．6そして体

みならず神経筋機能の変化にも原因があると考えら
れている15）。このような神経筋機能の変化を捉えるためには，筋の形態的な変化と筋力の低下を検討するだけでは不十分であり，電気生理学的な手法が必重は49．3±6．8であった。ACL再建術は関節鏡視下で行われ，再建靭帯には患側の半腱様筋健と薄筋腱を採取し，それらの腱でLeeds－Keio人工靭帯を挟み込んだものが使用された。このため今回検討した
大腿四頭筋に対する手術侵襲はなかった。

1）広島大学大学院医学系研究科保健学専攻（〒734－0037広島市南区霞1－2－3）
Fuminari

Kaneko，PT，

Graduate

Schoolof

MasashiMedicalB．測定

Miura，

測定は術後4ケ月に実施し，大腿部周径，等尺性膝PT：Sciences，

Hiroshima

した。大腿周径はテープメジャーを用いて膝蓋骨上University

縁から上方10cm（Above2）広島大学医学部保健学科
KiyoshiOnari，MD，

Yukio

Kawaguchi，PT：

SchoolMedicine，

ofInstitute

Urabe，
ofHiroshima

Kazuhiro

Tsukisaka，

Hiroshima

Kyoritsu

Kotaro（AP15）で計測した。計測は全ての被験者に対して同一の検者が行った。筋力測定はKIN－COM APを用いて，端座位にて膝関節goo屈曲位で測定した。最University

大随意努力下で5秒間の等尺性膝伸展運動を行わせ，

MD：

H

Divisionof

Orthopedics，

ospita1

Divisionof

大腿直筋（RF）より導出した。

Rehabilitation，

Hiroshima Kyoritsu Hospital（受付日 1997年8月29日／受理日

筋収縮中は常に検者により声がかけられた。この時のEMGを内側広筋斜走線維（VMO），外側広筋（VL），

4）広島共立病院リハビリテーション科
Ogata，PT：

Patella：AP10），15cm

Sciences，PT，Health3）広島共立病院整形外科

Keiko

関節伸展筋力（筋力），および筋電図（EMG）を測定

1997年12月10日）

EMGの導出には直径10mの銀一塩化銀皿電極を用い，電極中心間距離を25mとして双極導出にて行った。なお，電極を貼付

一11一
Presented by Medical*Online

11

A C

Key words

LJ

,,,.

,;

oｷ

oｷ

2
O 0ｰ

O
8

O

paired""I——...!'!.

,.

‑ ｷｷｷ

•

~ --·-~ ..

̲,..•

I 'I

.

I:J

,,. I .,..
.

t

I

8. 8

... ·~ ·

,

·.'•,

,.̲,

.

,

•

, .

2. 9

,

lO O

—

,ｷ.‑ｷ

K I N ‑ C O M

d e g. / s e c
‑

‑ b)

—21-

2

0

..

,,

27 Does muscle fatigue influence electromyogram?
G r a d u a te S ch o o l o f M ed ic a l S c ie n c e s .
llas as h i M I U R A. R P T

t:ni v e rs i Ly .

F umi n ari K AN E KO.

RP T[n s t i tu t e o f H eal th S c ie n c e s. H iro s h i m a Uni v e r s i ty o f S c h oo l o f M e di c ine.
K i y os hi ONARI. M D

Y uki o UR A BE.

RPTm uscle fatig ue, e lectrom yogram .
K ey W ords
isom etric strength. integrated electromyogram . m ean

Ko laro K A¥VA G UC lll, R P T

M uscle fatigue has various kinds of sym ptom s,
decrease in strength is thought to be a major problem

group oriented alo ng the m uscle be l y. T he raw E MG
signals w ere stored in data recorder. T he digitization of
the analog signals w as perform ed at a s a m pling
frequency of 2 00 0 per seco nd with M a c Lab analog todigital converter. A nalysis of data w as done on a
personal co m p uter. T he E M G signals w ere processedin m any clinics. l¥fostby integration (I E:,,!G ) an d by calculating m e an pow e r

p o w er frequency.

of m uscle fatigue havereported about E M G changes over a shon period oftime. but no t m uch is know n abo ut E M G changes overa long period. In this study, w e de fined m uscle fatig ue
w as decreased m uscle strength. T he purpose of thisstud y w as investigated the re lationship between
muscle fatigue and E M C analysis, to evaluate thechanges in m e an force and E M C of knee extensors for
6 days.
( Materials and M ethods]
T h e subjects w ere fi vemales. A l subjects
w ere dedicated right knee quadriceps m uscle. T hey
had no history of injury in the low er extremity.
A verag e of dat.1s w ere age
22 to26), height w as
cm (range, 169.0 to J74 .2)
kg (range, 57.5 to 72.0). All
and w eig ht w as
subjects let them to k n o w a p1u‑pose of this ex perim ent,
and then got agreem ents. W e m easured strength ofknee extensors during isom etric m a x i mal contraction
for each six days. W e used K I N‑C OM A P . T he subjects
w e re asked toknee .i n 6 0 t.legrees flexed for 5
seconds. T his test w as carried out for 5 tim es. T heresting tim e w a s given to the sulijects for 10 seconds
during each test. A t the sam e ti m e w e recorded
surface E M C o f the rectu s fem o1is(R f). vastus
m edialis( V M ), and vastus lateralis(YL). W e asked thesubjects to report each test w hen ever they felt anf
JJa ln.

A fter the initial iso m euｷic test, the subjects w ere

fre quency (M P F)(Fig 1).

1,,. '" I
I
lootygnO h

I

•

•

\
Fig 1. EM G recording
E M G signal:; andthat w as provided byisom etric test recort.led in data recorder. O n the basisof peak force. m ean force w as calculated for front and0 .5 seconds, total su m of l second. IE M G andM P F w ere calculated
the sa m e I seconds(Fig 2).

"
U M

Ul

Fig 2. Data analysis

asked to repeat the isokine tic exercise in sitting
position for JO times as one set. A ngular ve locity w as

in m ean force, I E MG and M P F w ere
using one w ay re1ieated measures A N O V A
and T ukey test.

60 degrees per second and the exercise rang e w as 90
to 10 degrees in tlexec.l position. T he sul.>jects w e re(R esults)

given 10 seconds for the testingT h e m uscle fatigue w as judged w hen the
not com ple te o ne set exercise.
E M C

from

ex perim en L
could
three m uscle

locations(Rf, V M. V L). Bip<,Iar sud ace electrodes w ere
consistently placed

mid regio n of each m uscle

C h anges

T he m ean repeated isokinetic ex ercise until
exhaustio n of the extensors w ere(range,190 to 260). M uscle soreness w as not reported during
this study. C hanges of m ean force is show n on F ig 3 .
ln initial test, the m ean force w as ‑131 N .

the 1stday after initial test. it w as 345 N . M ean force
decreased 'about 2 0% .
the 2nd day ;tfter, it w a s 353

26Electromyographic study for shoulder interna 1 andexternal rotators during isokinetic shoulder rotation

Institute of Health Sciences. School or Medicine. Hiroshima University
Fuminari KANEKO. RPT

Kiyoshi ONARI. MD

Yukio URABE. RPT

Kotaro KAWAGUCHI. RPT

Masashi MIURA, RPI
exam ined in supine with the

key words : E M G , shoulder, isokinet1c

abducted

to 90 degrees and the elbow flexed to90 degrees.
Isokinetic muscle strength of shoulder internal

T h e forearm was positioned m i d way between

rotators and external rotators has been studied

supinationby m a n y investigators̲. M a n y of these studies

particular position because it roughly simulated aused peak torque (PkT) as the parameter forthrowing m otion and thus would be applicable toanalysis. Although isokin etic testing is used forassessment of a throwing shoulder. With theshoulder dysfunction,<1.J·5·5·'·~101
a standard profile

subject supine, w e set O degrees as the verticalof nonnal muscle activity for shoulder

position of the forearm. Isokinetic trials began

during isokinetic testing has yet to be established.

from 7 0 % of the passive range of motion at bothSo, it is not clear whether P k T reflects rotator

internal andmuscle function.

1n1tially performed four submaximal repetitwns

T h e purpose of this study was thus to examm eand only one maximal contraction as an isokinetic

nonnal muscle activity during isokinetic exerCJse

warmup, to minimize any learning effect before

m relation to h o w peak torque is generated, andactual testing.

to reconsider for availability of P k T as param eter

E M C

for shoulder rotator function.

E M G activity was recorded via bipolar platmum<Methods]

w1re electrodes. T he insertion sites of these

Subjectselectrodes were based on Delagi et aJ.2l for theW e studied five subjects for isokinetic testmg

mfraspinatus,and E M G examination. T h e y had no history of

B efore insertion of the electrode? into the teres

injury in the upper extremity, nor were theymajor and teres minor, these muscles were

athletes. Their age, height and weight sh o w at

by palpation. For the subscapularis,

the slide. T h e right side was the dominant side

̲fine wire electrodes were inserted followmg a

for all subjects.

method described by Kadaba'l. E M G signal,

Isokinetic Examination

torque, and joint angle were recorded online byof each subject was

T h e dominant
exam m e d

with

a

dynamometeratdegreessecconds.

peran

KIN‑COM

AP

isokinetic

angular velocity of 60
Eachsubjectwasandpronation. W eexternalteress~lectedrotation.

major,

T he

thissubject

and teres mmor.

an F M tape recorder. T h e analog signals w e resubsequently

digitized

at 2000

samplespersecond by a M a c Lab analog‑to‑digital converter.
Analysisof data was

done

on

a personal

Japanese Physioal
Japanese
Physical Therapy
Therapy Assooiation
Association

第 23 巻 第 5 号

理 学療 手雲学

291〜 298頁 〔1996年 ）介

紹

第 12 回 ア ジ ア 競技 大会 広 島選 手 村 診療所
理 学療 法 室 の 活動＊＊＊

梶 村 政 司門 田 正 久金 子 文 成佐々 木

弓 削

浦 辺 幸 夫

佐 々木久登川 口浩太郎真類

富 樫 誠 二要旨

第 12 回 ア ジ ア 大会組織委員会 よ り依頼 を 受 け 選 手村診療所
内 に 理 学 療 法 室 を 設 け理 学 療 法 サ ー ビ ス を 行 た
約 4 週 間 の 開 村 期 間 中 に 延 べ 541 名 の広 島県理 学療 法 士 会 は

，

，

っ

。

理 学 療 法 士 が 参 加 し， 34 ケ 国 の 延 べ 731 名 の 選 手 が 理 学 療 法 室 を 利 用 した

処方 さ れた ス。

ポ ーッ 外 傷 の 内容 は 筋疲労 に 対 す る もの が 179件

多か っ たシ ョン。

（
外傷種類別分類 の 約 60％ ） と圧 倒 的 に
リラ ク セ ー
急 性 外傷後 の 処 置 も 約 27％ 含 ま れ て い た
治 療 目 的 は 疲 労 回復。

， 除 痛 な どが 多 か

グ な ど の 順 に 多 く，

足」 や

っ

た

。

理 学 療 法 の 内容 は マ

総数 は 1 512 件 に の ぼ

っ

，

た。

，

ー ジ ， 超 音波 治 療 ， ス
ッ サ

トレ ッ チ ン

参加 し た 理 学療法士 の 感想で は 「語 学力不「ス ポ ー ッ 理 学療法 に 対 す る 勉 強不 足」 と い う項 目が 多 く あ げ ら れ た

こ れ らは，ー
効 果 を す ぐに 出す と い う こ と が 期待 さ れ る ス ポ ッ 選 手 に 対 す る 理 学 療法 を ， 公 用 語 で あ。

る 英 語 を 用 い て 行 わ な けれ ば な らな か っ た た め で あ ろ う。

本大会 は わ が 国 に お け る 国際的 な ス ポ ー ッ 大会 で 理 学療 法 士 の 活動 が 最 も大 が か り に かっ組 織 的 に 行 わ れ た 最 初 の も の と 位 置 づ け られ る。

キ ーワ ー ドア ジ ア 競技 大 会 ， ス ポ ー ッ イ ベ

は じ め にント， ス ポの ス ポ ー ッ の 祭典 で ， 口 本 が 参 加 す る 国 際大会 の一

中 で は オ リ ン ピ ッ ク よ り 大 きな 選 手団が 形成 さ れる。

ア ジ ア 競 技 大 会 は 4 年 に 一度 開 催 さ れ る ア ジ ァーツ 外 i−

1994 年 の 第 12 回 ア ジ ア 競技大会 は 10 月 2

口 か ら 16 日 ま で の 2 週 間，

広島市 の 広 島 広 域 公

園 を 中心 に 広 島県 全域 で 開催 さ れ た 。

広 島県＊Physical Therapy

理学 療 法 上会 （以下，士 会 ）で は ア ジ ァ 競技 大 会 組＊

織 委 員 会 の 依 頼 を受 けSServices in the Village Medical
Center of the ユ2th Asian Games Hiroshima 1994
広 島 県理 学 療 法 士 会 ，ア ジ ア 競 技 大 会 選手 村 診 療 所理 学
療 法室 ，世 話 人

Kotaro Kawaguchi ，RPT ，Masaji KaJimura，RPT ，，RPT ，Fuminari Kaneko ，RPT ，
Makoto Sasaki，RPT ，Lui Yuge ，RPT ，Yuklo UI’abe ，
RPT ，Hisato Sasaki ，RPT ，Seiji Togashi ，RPT ：Hiroshi a Physical Therapy Associatjon （Dept．of
PhysicalTherapy ，VillageMedical Center）
Masahisa

Monden皿（受付 日1995年 12 月 23 口 ／受 理 日 1996年 5 月 25 日 ）の 選手 に，選 手村 診 療 所で 参 加 各国

対 し理 学療法 サ ー ビ ス を 行 う 機会 を 得 た。

わ が 国 の 理 学療 法士 は 国 内で 開催 され た冬 の アバ ー シ ア ー ド
冬の大 会 ，神 戸
バ ーシ ァ ー ド
大 会 な ど の 国 際大 会 に か か わ て き

ジア 大会

，

ユ

ニ

ユ

ニ

っ

た が ， 今 回 は 最 大 規 模 の 活動 が 行 わ れ た 大 会 と

なっ た

。

一

NNII-Electronic
工 工 Eleotronio
Library
Library

ServiceKey W o r d s :ankle sprain, ankle eversion , peroneal m u s cles

Test posi. ti.on4l ‑ B)

KIN‑COM

2 ) 3)

4
3

3

1‑

425

• Effect of Posture o n the Activity of Should er —RotatorM uscles during Isometric Internal an d External R otaｭtion

Hiroyuki Fuj isawa, R P T : D ept. of Rehabilitation,
Noboribetsu Branch Hospital, H o kkaido University
School of Medicine
Katsunori Suzuki, M D : Dept. of Orthopaedic S urgery,
Hokkaido University School o f M edicine
T a k a k o Urashima, R P T : Dept. of Rehabilitation, T oya
Hospital
Fuminari Kaneko, R P T : D ept. ofNoboribetsu Koseinenkin H ospital

R eha bilitation,

M isak o W a t ay a, R P T : Dept. of Physical Therapy,
Sapporo M i n a m i Orthopaedic H ospital