理学療法ジャーナル57巻3号

2023年03月発行

特集 システムとしての姿勢制御—メカニズムの解明から臨床応用まで

注意操作を用いた姿勢制御アプローチ

著者： 植田耕造¹²

所属機関： ¹JCHO滋賀病院リハビリテーション部 ²畿央大学大学院健康科学研究科

ページ範囲：P.291 - P.297

Point

●姿勢脅威や姿勢制御障害により注意の内的焦点化が起こる

●健常若年者や高齢者では身体への内的焦点化と比べ外的焦点化，さらに二重課題により姿勢動揺の減少を認める報告がある．一方，脳卒中患者では対象者の特徴により適応が変わる

●姿勢脅威により変調する姿勢制御や心理面の一部は二重課題時に軽減する可能性がある

参考文献

1）Young WR, et al：How fear of falling can increase fall-risk in older adults：applying psychological theory to practical observations. Gait Posture 2015；41：7-12

2）Aloraini SM, et al：Motor behavior concepts in the study of balance：a scoping review. J Mot Behav 2020；52：97-121

3）Salihu AT, et al：Effect of cognitive task complexity on dual task postural stability：a systematic review and meta-analysis. Exp Brain Res 2022；240：703-731

4）Ueta K, et al：Effects of voluntary and automatic control of center of pressure sway during quiet standing. J Mot Behav 2015；47：256-264

5）Brown LA, et al：Postural compensations to the potential consequences of instability：kinematics. Gait Posture 1997；6：89-97

6）Adkin AL, et al：New insights on emotional contributions to human postural control. Front Neurol 2018；9：789. doi：10.3389/fneur.2018.00789

7）Huffman JL, et al：Does increased postural threat lead to more conscious control of posture? Gait Posture 2009；30：528-532

8）Zaback M, et al：Threat-induced changes in attention during tests of static and anticipatory postural control. Gait Posture 2016；45：19-24

9）Chow VWK, et al：Revisiting the relationship between internal focus and balance control in young and older adults. Front Neurol 2019；9：1131. doi：10.3389/fneur.2018.01131

10）Brown LA, et al：Attentional demands for static postural control after stroke. Arch Phys Med Rehabil 2002；83：1732-1735

11）Tse CM, et al：Attentional requirements of postural control in people with spinal cord injury：the effect of dual task. Spinal Cord 2017；55：915-920

12）Johnson KJ, et al：Repeated exposure to the threat of perturbation induces emotional, cognitive, and postural adaptations in young and older adults. Exp Gerontol 2019；122：109-115

13）Pasman EP, et al：Balance problems with Parkinson's disease：are they anxiety-dependent? Neuroscience 2011；177：283-291

14）Cleworth TW, et al：The effect of unilateral vestibular loss on standing balance during postural threat. Otol Neurotol 2020；41：e945-e951. doi：10.1097/MAO.0000000000002485

15）Kal E, et al：Are the effects of internal focus instructions different from external focus instructions given during balance training in stroke patients? A double-blind randomized controlled trial. Clin Rehabil 2019；33：207-221

16）Lajoie Y, et al：Continuous cognitive tasks improve postural control compared to discrete cognitive tasks. J Mot Behav 2016；48：264-269

17）Lajoie Y, et al：Continuous and difficult discrete cognitive tasks promote improved stability in older adults. Gait Posture 2017；55：43-48

18）Richer N, et al：Automaticity of postural control while dual-tasking revealed in young and older adults. Exp Aging Res 2020；46：1-21

19）Polskaia N, et al：Continuous cognitive task promotes greater postural stability than an internal or external focus of attention. Gait Posture 2015；41：454-458

20）Richer N, et al：Continuous cognitive task promotes greater postural stability than an internal or external focus of attention in older adults. Exp Aging Res 2017；43：21-33

21）Wulf G, et al：Optimizing performance through intrinsic motivation and attention for learning：The OPTIMAL theory of motor learning. Psychon Bull Rev 2016；23：1382-1414

22）Kal EC, et al：Balance capacity influences the effects of conscious movement processing on postural control in older adults. Hum Mov Sci 2022；82：102933. doi：10.1016/j.humov.2022.102933

23）Johnson KJ, et al：The effects of distraction on threat-related changes in standing balance control. Neurosci Lett 2020；716：134635. doi：10.1016/j.neulet.2019.134635

24）Ellmers TJ, et al：Consciously processing balance leads to distorted perceptions of instability in older adults. J Neurol 2021；268：1374-1384

25）Ghorbanpour Z, et al：Overload of anxiety on postural control impairments in chronic stroke survivors：the role of external focus and cognitive task on the automaticity of postural control. PLoS One 2021；16：e0252131. doi：10.1371/journal.pone.0252131

26）植田耕造，他：立位時に恐怖心のある脳卒中患者の姿勢動揺と恐怖心に対する認知課題付加の影響．理学療法学2016；43（Suppl 2）

27）Ellmers TJ, et al：Standing up to threats：translating the two-system model of fear to balance control in older adults. Exp Gerontol 2022；158：111647. doi：10.1016/j.exger.2021.111647