Tani Keisuke, Matsugi Akiyoshi, Uehara Shintaro, Kimura Daisuke
Graduate School of Human and Environmental Studies, Kyoto University, Japan.
Faculty of Rehabilitation, Shijonawate Gakuen University, Japan.
J Phys Ther Sci. 2016 Oct;28(10):2979-2983. doi: 10.1589/jpts.28.2979. Epub 2016 Oct 28.
[Purpose] Post-stroke astasia is an inability to stand without external support despite having sufficient muscle strength. However, the dysfunction underlying astasia is unclear. We tested the hypothesis that astasia is the result of an abnormal bias in vertical perception, especially subjective postural vertical (SPV), mediated by somatosensory inputs. [Subjects and Methods] A patient with a right posterolateral thalamus hemorrhage had a tendency to fall toward the contralesional side during standing after 8 weeks of treatment. SPV, standing duration, and physical function were evaluated before and after a 1 week standard rehabilitation baseline period, and after a 1 week intervention period, where standing training requiring the patient to control his body orientation in reference to somatosensory inputs from his ipsilateral upper limb was added. [Results] SPV was biased toward the contralesional side before and after the 1 week baseline period. However, SPV improved into the normal range and he could stand for a longer duration after the intervention period. [Conclusion] This case suggests that abnormal SPV is one of the functional mechanisms underlying astasia, and it indicates the effectiveness of standing training with somatosensory information to improve abnormal SPV and postural disorders.
[目的] 中风后起立不能是指尽管有足够的肌肉力量，但在没有外部支撑的情况下无法站立。然而，起立不能背后的功能障碍尚不清楚。我们检验了这样一个假设，即起立不能是由体感输入介导的垂直感知异常偏差的结果，尤其是主观姿势垂直（SPV）。[对象与方法] 一名右侧丘脑后外侧出血患者在治疗8周后站立时倾向于向对侧倾倒。在1周的标准康复基线期前后，以及在1周的干预期后，评估SPV、站立持续时间和身体功能，干预期增加了要求患者根据来自同侧上肢的体感输入来控制身体方向的站立训练。[结果] 在1周基线期前后，SPV均偏向对侧。然而，干预期后SPV改善到正常范围，并且他能够站立更长时间。[结论] 该病例表明异常SPV是起立不能的功能机制之一，并且表明利用体感信息进行站立训练对改善异常SPV和姿势障碍是有效的。
