理学療法ジャーナル49巻1号

2015年01月発行

特集 姿勢と歩行—理学療法士の診るべきこと 生理的変化か異常か適応か？　各病態における姿勢と歩行の解釈

2．パーキンソン病患者における姿勢と歩行

著者： 堀場充哉¹

所属機関： ¹名古屋市立大学病院リハビリテーション部

ページ範囲：P.29 - P.37

パーキンソン病の姿勢異常と歩行障害

　歩行障害はほとんどすべてのパーキンソン病に出現し，移動能力の低下や死亡率増加の原因となる．パーキンソン病の歩行障害は，歩幅や歩隔の減少，歩行速度の低下，歩行中の腕振り減少や消失といった運動症状だけでなく，すくみ足，加速歩行に代表されるような，精神症状，認知症状などの非運動症状あるいは環境にも影響を受ける症状としての側面も有する^1）．

　また，パーキンソン病の歩行障害の特徴は疾病の進行によっても変化する．発症早期から中期では，歩幅の減少や歩行速度の低下が特徴であるが，はっきりしない場合も多い．年齢や気分障害（抑うつ）などの他の要因やサブタイプによっても歩行障害の程度，特徴は影響される．一方，進行期以降になると，歩行障害はより複雑になり，すくみ足や加速歩行，姿勢不安定性が出現し，転倒に至る患者も著しく増加する．この病期になると，いわゆるパーキンソン姿勢と呼ばれる前傾前屈姿勢（stooped posture）に加え，頸部前屈やcamptocormia，Pisa徴候など頸部や体幹の姿勢異常を呈する場合もある．本稿では，パーキンソン病の姿勢異常や歩行障害について概説するとともに，理学療法やその効果に関する知見を紹介する．

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