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雑誌文献

理学療法ジャーナル46巻1号

2012年01月発行

文献概要

特集 運動学習と理学療法

脳障害と運動学習

著者: 長谷公隆1

所属機関: 1慶應義塾大学医学部リハビリテーション医学教室

ページ範囲:P.37 - P.44

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はじめに

 中枢神経疾患に対する運動療法の目標は,感覚―運動統合を促して運動制御能力を高め,患者のパフォーマンスを最適化することにある.その治療成果は,課題の難易度を調整し,患者が利用できるフィードバック(以下,FB)を駆使して,運動スキルを再構築する過程を推し進める運動学習によってもたらされる.「顕在記憶と手続き記憶をいかにして操作するか」がニューロリハビリテーションにおけるパラダイムシフトのひとつとして位置づけられており1),感覚―運動統合を高めるためには,どのようなFBを呈示して行くべきかが検証されつつある.本稿では,運動学習を司る神経機構を概説しながら,運動制御に問題を生じた患者に運動スキルを習得させていくために利用できる運動学習の方法について述べる.

参考文献

1)Nadeau SE:A paradigm shift in neurorehabilitation. Lancet Neurol 1:126-130, 2002
2)長谷公隆:運動学習を支える神経機構.長谷公隆(編著):運動学習理論に基づくリハビリテーションの実践,pp14-33,医歯薬出版,2008
3)Ivanco TL, et al:Morphology of layer 3 pyramidal neuron is altered following induction of LTP in sensorimotor cortex of the freely moving rat. Synapse 37:16-22, 2000
4)Iacoboni M, et al:The mirror neuron system and the consequences of its dysfunction. Nature Rev Neurosci 7:942-951, 2006
5)Ashe J, et al:Cortical control of motor sequences. Curr Opin Neurobio 16:213-221, 2006
6)Ridderinkhof KR, et al:The role of the medial frontal cortex in cognitive control. Science 306:443-447, 2004
7)Johansen-Berg H, et al:Relevance of structural brain connectivity to learning and recovery from stroke. Front Syst Neurosci 4:146, 2010
8)Sharma N, et al:Motor imagery after stroke:Relating outcome to motor network connectivity. Ann Neurol 66:604-616, 2009
9)Guillot A, et al:Functional neuroanatomical networks associated with expertise in motor imagery. Neuroimage 41:1471-1483, 2008
10)Nyberg L, et al:Learning by doing versus learning by thinking:An fMRI study of motor and mental training. Neuropsychologia 44:711-717, 2006
11)Liu KP, et al:A randomized controlled trial of mental imagery augment generalization of learning in acute poststroke patients. Stroke 40:2222-2225, 2009
12)Liu KP, et al:Mental imagery for promoting relearning for people after stroke:a randomized controlled trial. Arch Phys Med Rehabil 85:1403-1408, 2004
13)Malouin F, et al:Working memory and mental practice outcomes after stroke. Arch Phys Med Rehabil 85:177-183, 2004
14)Pearson KG:Role of sensory feedback in the control of stance duration in walking cats. Brain Res Rev 57:222-227, 2008
15)Nielsen JB:Motoneuronal drive during human walking. Brain Res Rev 40:192-201, 2002
16)Gordon KE, et al:Ankle load modulates hip kinetics and EMG during human locomotion. J Neurophysiol 101:2062-2076, 2009
17)Hase K, et al:Effects of therapeutic gait training using a prosthesis and a treadmill for ambulatory patients with hemiparesis. Arch Phys Med Rehabil 92:2011(In Press)
18)Kawato M, et al:The cerebellum and VOR/OKR learning models. Trends Neurosci 15:445-453, 1992
19)Boyd LA, et al:Cerebellar stroke impairs temporal but not spatial accuracy during implicit motor learning. Neurorehabil Neural Repair 18:134-143, 2004
20)Harrington DL, et al:Does the representation of time depend on the cerebellum? Effect of cerebellar stroke. Brain 127:561-574, 2004
21)Werner S, et al:Visuomotor adaptive improvement and aftereffects are impaired differentially following cerebellar lesions in SCA and PICA territory. Exp Brain Res 201:429-439, 2010
22)Criscimagna-Hemminger SE, et al:Size of error affects cerebellar contributions to motor learning. J Neurophysiol 103:2275-2284, 2010
23)Ilg W, et al:Intensive coordinative training improves motor performance in degenerative cerebellar disease. Neurology 73:1823-1830, 2009
24)Dirnberger G, et al:Separating coordinative and executive dysfunction in cerebellar patients during motor skill acquisition. Neuropsychologia 48:1200-1208, 2010
25)Leggio MG, et al:Cognitive sequencing impairment in patients with focal or atrophic cerebellar damage. Brain 131:1332-1343, 2008
26)Berger A, et al:Task switching after cerebellar damage. Neuropsychology 19:362-370, 2005
27)Marsden FA, et al:The functions of the basal ganglia and the paradox of stereotaxic surgery in Parkinson's disease. Brain 117:877-897, 1994
28)Hikosaka O, et al:Central mechanisms of motor skill learning. Curr Opin Neurobiol 12:217-222, 2002
29)Brooks DJ:Imaging basal ganglia function. J Anat 196:543-554, 2000
30)Schultz W, et al:A neural substrate of prediction and reward. Science 275:1593-1599, 1997
31)Vakil E, et al:Motor and non-motor sequence learning in patients with basal ganglia lesions:the case of serial reaction time(SRT). Neuropsychologia 38:1-10, 2000
32)Boyd LA, et al:Providing explicit information disrupts implicit motor learning after basal ganglia stroke. Learn Mem 11:388-396, 2004
33)Muslimovic D, et al:Motor procedural learning in Parkinson's disease. Brain 130:2887-2897, 2007

掲載誌情報

出版社:株式会社医学書院

電子版ISSN:1882-1359

印刷版ISSN:0915-0552

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