Esercizio Terapeutico Conoscitivo Aichi

著者：Nagai  Koutatsu,et al.

タイトル：Effects of fear of falling on muscular coactivation during walking.

掲載：Aging Clin Exp Res. 2012 Apr;24(2):157-61

参考：https://www.ncbi.nlm.nih.gov/pubmed/21606665

 

Abstract

Background and aims: Increased fear of falling is associated with greater muscular coactivation during standing postural control. Excessive muscular coactivation reduces the performance of agonist muscles. Although several recent studies have observed increased muscular coactivation during walking in older adults, little is known about the relationship between fear of falling and muscular coactivation during walking. The purpose of this study was to compare muscular coactivation during walking between older adults with fear of falling and older adults without fear of falling.

Methods: Thirty-eight healthy older adults (82.3 ± 6.8 years) participated in this study. Walking speed and step length were measured. Electromyography (EMG) data were collected from the tibialis anterior and soleus during walking to calculate the co-contraction index (CI). Subjects were divided into those with fear of falling and those without fear of falling, on the basis of a modified Falls Efficacy Scale (FES). Stepwise multiple regression analysis was used, with CI as the dependent variable, and fear of falling, experience of falling (during the past year), walking speed, step length, and age as independent variables.

Results: Mean values of CI during walking, walking speed, and step length were 51.9 ± 11.7%, 0.90 ± 0.40 m/s, and 0.43±0.11 m, respectively. Eight subjects (21.1%) had fallen within the past year, and 19 subjects (50.0%) had fear of falling. All subjects without fear of falling had FES scores of 10 (maximum score). Subjects with fear of falling had a median FES score of 17 (interquartile range, 13 to 25). Stepwise multiple regression analysis revealed that fear of falling remained significantly associated with CI (p<0.01): CIs for subjects with fear and those without fear were 59.5 ± 12.2% and 46.7 ± 8.5%, respectively.

Conclusion: Individuals with a fear of falling have increased muscular co-activation at the ankle joint during walking, at least in a certain subgroup of older adults. Further research is needed to clarify negative and positive effects of muscular coactivation during walking in fearful subjects.

 

感想

転倒恐怖感を有する高齢者の歩行中の前脛骨筋とヒラメ筋の同時収縮を測定（co-contraction index:CI）をした結果、転倒恐怖感を有する高齢者は一般的な高齢者と比較して歩行中の足関節周囲筋の同時収縮が増大したというのがこの論文の概要である。歩行に対する転倒恐怖感を有している患者に多く遭遇する事があるものの、具体的に転倒恐怖感がどのように歩行に影響するのか理解せずに歩行訓練を行なっている場面を見かける事も多い。歩行時に前脛骨筋とヒラメ筋の同時収縮が出現すればスムーズな歩行は得られない。つまり転倒恐怖感をどのように無くしていくのかが、今後の重要なポイントになってくるように思われるが、具体的な改善策はあまりない。しかし、認知課題（3-back課題）により前頭前野が情動に関与する扁桃体を抑制する事も報告されており、また認知神経リハビリテーションにより前頭前野の活性化が報告されている事から認知神経リハビリテーションが転倒恐怖感を抑制していく可能性があるのではないかと考えられるのではないだろうか。しかし、多くの研究者が報告しているように運動から感情が作られるという学説もある。今回の場合、感情から運動が作られる事を前提に感想を述べている事を考慮するとまだまだ考察の余地は否めない。

​（文責：岡崎南病院　首藤）