理学療法ジャーナル52巻1号

2018年01月発行

特集 筋力低下と理学療法

パーキンソン病の筋力低下と理学療法

著者： 松尾善美¹

所属機関： ¹武庫川女子大学健康・スポーツ科学部

ページ範囲：P.21 - P.27

はじめに

　パーキンソン病は，中脳黒質緻密部のドパミン作動性ニューロンの脱落により生じる緩徐進行性疾患である．振戦，筋固縮，無動・寡動，姿勢反射障害の四大徴候などの運動症状とうつ，睡眠障害などの非運動症状が出現し，患者の健康関連QOLを低下させている．薬物治療と並行して理学療法が実施されている．

　パーキンソン病患者は，無意識にできていた行為および運動やスキルの学習をより認知的に関与させようとする．目標志向型トレーニングと有酸素運動を組み合わせた研究では，運動制御の認知と自動的要素の双方を向上させるという結果が示される可能性がある．患者に即した効果的な運動学習と自動化に時間を費やすことが重要である^1）．このように，ニューロリハビリテーションはパーキンソン病患者の機能的能力を最大化させ，二次的合併症を最小化する^2）．

　しかし，これらの介入に対してパーキンソン病の筋力低下とその理学療法が語られることは少なく，本稿ではパーキンソン病患者の筋力低下の機転と特徴およびそれに対する理学療法について先行研究をもとに以下に論じる．

参考文献

1）松尾善美：パーキンソン病患者の理学療法における脳科学と運動学習理論の応用．理学療法34：405-410，2017

2）Nieuwboer A, et al：Motor learning in Parkinson's disease：limitations and potential for rehabilitation. Parkinsonism Relat Disord 15 Suppl 3：S53-58, 2009

3）Koller W, et al：Muscle strength testing in Parkinson's disease. Eur Neurol 25：130-133, 1986

4）Nogaki H, et al：Muscle strength in early Parkinson's disease. Mov Disord 10：225-226, 1995

5）Kakinuma S, et al：Muscle weakness in Parkinson's disease：isokinetic study of the lower limbs. Eur Neurol 39：218-222, 1998

6）野垣　宏：パーキンソン病に筋力低下は存在するのか．山口医53：207-213，2004

7）Nogaki H, et al：Movement velocity dependent muscle strength in Parkinson's disease. Acta Neurol Scand 99：152-157, 1999

8）Nogaki H, et al：Muscle weakness in Parkinson's disease：a follow-up study. Parkinsonism Relat Disord 8：57-62, 2001

9）Oliveira MA, et al：Strength and isometric torque control in individuals with Parkinson's disease. Exp Brain Res 184：445-450, 2008

10）Pedersen SW, et al：Dynamic strength in Parkinson's disease. Quantitative measurements following withdrawal of medication. Eur Neurol 33：97-102, 1993

11）McAuley JH, et al：Levodopa reversible loss of the Piper frequency oscillation component in Parkinson's disease. J Neurol Neurosurg Psychiatry 70：471-476, 2001

12）Corcos DM, et al：Strength in Parkinson's disease：relationship to rate of force generation and clinical status. Ann Neurol 39：79-88, 1996

13）Robichaud JA, et al：Greater impairment of extension movements as compared to flexion movements in Parkinson's disease. Exp Brain Res 156：240-254, 2004

14）Frazzitta G, et al：Differences in muscle strength in parkinsonian patients affected on the right and left side. PLoS One：e0121251, 2015. doi：10.1371/journal. pone. 0121251

15）Scherfler C, et al：Left hemispheric predominance of nigrostriatal dysfunction in Parkinson's disease. Brain 135（Pt 11）：3348-3354, 2012

16）Cano-de-la-Cuerda R, et al：Is there muscular weakness in Parkinson's disease? Am J Phys Med Rehabil 89：70-76, 2010

17）Allen NE, et al：Bradykinesia, muscle weakness and reduced muscle power in Parkinson's disease. Mov Disord 24：1344-1351, 2009

18）Paul SS, et al：Reduced muscle strength is the major determinant of reduced leg muscle power in Parkinson's disease. Parkinsonism Relat Disord 18：974-977, 2012

19）Darvas M, et al：Contributions of signaling by dopamine neurons in dorsal striatum to cognitive behaviors corresponding to those observed in Parkinson's disease. Neurobiol Dis 65：112-123, 2014

20）Gustafsson H, et al：Low muscle strength in late adolescence and Parkinson disease later in life. Neurology 84：1862-1869, 2015

21）Drey M, et al：Associations between early markers of Parkinson's disease and sarcopenia. Front Aging Neurosci 9：53, 2017. doi：10.3389/fhagi. 2017. 00053. ecollection 2017.

22）Barichella M, et al：Sarcopenia and dynapenia in patients with parkinsonism. J Am Med Dir Assoc 17：640-646, 2016

23）Tinetti ME：Clinical practice. Preventing falls in elderly persons. N Engl J Med 348：42-49, 2003

24）Robinson K, et al：Falling risk factors in Parkinson's disease. NeuroRehabilitation 20：169-182, 2005

25）Inkster LM, et al：Leg muscle strength is reduced in Parkinson's disease and relates to the ability to rise from a chair. Mov Disord 18：157-162, 2003

26）Inkster LM, et al：Postural control during a sit-to-stand task in individuals with mild Parkinson's disease. Exp Brain Res 154：33-38, 2004

27）Nallegowda M, et al：Role of sensory input and muscle strength in maintenance of balance, gait, and posture in Parkinson's disease：a pilot study. Am J Phys Med Rehabil 83：898-908, 2004

28）Nocera JR, et al：Knee extensor strength, dynamic stability, and functional ambulation：are they related in Parkinson's disease? Arch Phys Med Rehabil 91：589-595, 2010

29）Allen NE, et al：Reduced muscle power is associated with slower walking velocity and falls in people with Parkinson's disease. Parkinsonism Relat Disord 6：261-264, 2010

30）Dibble LE, et al：High-intensity resistance training amplifies muscle hypertrophy and functional gains in persons with Parkinson's disease. Mov Disord 21：1444-1452, 2006

31）Dibble LE, et al：High intensity eccentric resistance training decreases bradykinesia and improves quality of life in persons with Parkinson's disease：a preliminary study. Parkinsonism Relat Disord 15：752-757, 2009

32）Dibble LE, et al：Exercise and medication effects on persons with Parkinson disease across the domains of disability：a randomized clinical trial. J Neurol Phys Ther 39：85-92, 2015

33）Corcos DM, et al：A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease. Mov Disord 28：1230-1240, 2013

34）Kelly NA, et al：Novel, high-intensity exercise prescription improves muscle mass, mitochondrial function, and physical capacity in individuals with Parkinson's disease. J Appl Physiol 116：582-592, 2014

35）David FJ, et al：Progressive resistance exercise restores some properties of the triphasic EMG pattern and improves bradykinesia：the PRET-PD randomized clinical trial. J Neurophysiol 116：2298-2311, 2016

36）Schlenstedt C, et al：Resistance versus balance training to improve postural control in Parkinson's disease：A randomized rater blinded controlled study. PLoS One 10：e0140584, 2015. doi：10. 1371/journal. pone. 0140584. eCollection 2015

37）Brienesse LA, et al：Effects of resistance training for people with Parkinson's disease：a systematic review. J Am Med Dir Assoc 14：236-241, 2013

38）Tambosco L, et al：Effort training in Parkinson's disease：a systematic review. Ann Phys Rehabil Med 7：79-104, 2014

39）Cruickshank TM, et al：A systematic review and meta-analysis of strength training in individuals with multiple sclerosis or Parkinson disease. Medicine（Baltimore） 94：e411, 2015

40）Roeder L, et al：Effects of resistance training on measures of muscular strength in people with Parkinson's disease：a systematic review and meta-analysis. PLoS One 10：e0132135, 2015. doi：10.1371/journal. pone. 0132135

41）Chung CL, et al：Effectiveness of resistance training on muscle strength and physical function in people with Parkinson's disease：a systematic review and meta-analysis. Clin Rehabil 30：11-23, 2016

42）Ramazzina I, et al：Systematic review on strength training in Parkinson's disease：an unsolved question. Clin Interv Aging 12：619-628, 2017