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はじめに
臨床神経学において，ヒトの二足直立と歩行は自動的かつ感覚系の制御を受ける運動としてとらえられてきた。感覚系の障害による徴候としては，前庭・小脳系病変による平衡障害，Romberg徴候（下肢固有感覚と視覚の遮断による直立の破綻）などがその代表である。痙性歩行，パーキンソニズム，小脳性運動失調は求心性制御を受ける運動出力の異常であり，運動器の障害による徴候としてはTrendelenburg徴候，鶏状歩行などがある。これらの徴候の神経学的局在診断上の価値は改めて述べるまでもないが，近年の研究は，この直立と歩行に対する高次脳機能の関与，すなわち，自動的あるいは反射的な制御だけではない，能動的な中枢性制御に注目している。
われわれは1994年にastasia without abasiaを発表し，その病態生理を「停立を維持する姿勢運動」を用いて説明した。すなわち，直立姿勢においては，歩行のみならず停立（quiet standing）の維持にも能動的な運動が関与していることを示した1，2）。同じ頃にCollinsとDe Lucaは，停立時姿勢動揺の指標である足底圧中心（center of foot pressure：COP）の移動を統計力学的方法によって解析し，COP移動は無秩序（random）ではなく，確率的な秩序（deterministic chaos）を持つことを示した3－5）。さらにHausdorffら6，7）は，歩行における歩幅の変動においてもこの秩序を検出した。ヒトの停立と歩行においては，フィードバック制御（closed-loop control）だけではなく，能動的な下降性制御（open-loop descending control）が存在する。
本総説では停立と歩行の下降性制御と，その高齢者または認知症患者の“転倒”への関与を述べる。
臨床神経学において，ヒトの二足直立と歩行は自動的かつ感覚系の制御を受ける運動としてとらえられてきた。感覚系の障害による徴候としては，前庭・小脳系病変による平衡障害，Romberg徴候（下肢固有感覚と視覚の遮断による直立の破綻）などがその代表である。痙性歩行，パーキンソニズム，小脳性運動失調は求心性制御を受ける運動出力の異常であり，運動器の障害による徴候としてはTrendelenburg徴候，鶏状歩行などがある。これらの徴候の神経学的局在診断上の価値は改めて述べるまでもないが，近年の研究は，この直立と歩行に対する高次脳機能の関与，すなわち，自動的あるいは反射的な制御だけではない，能動的な中枢性制御に注目している。
われわれは1994年にastasia without abasiaを発表し，その病態生理を「停立を維持する姿勢運動」を用いて説明した。すなわち，直立姿勢においては，歩行のみならず停立（quiet standing）の維持にも能動的な運動が関与していることを示した1，2）。同じ頃にCollinsとDe Lucaは，停立時姿勢動揺の指標である足底圧中心（center of foot pressure：COP）の移動を統計力学的方法によって解析し，COP移動は無秩序（random）ではなく，確率的な秩序（deterministic chaos）を持つことを示した3－5）。さらにHausdorffら6，7）は，歩行における歩幅の変動においてもこの秩序を検出した。ヒトの停立と歩行においては，フィードバック制御（closed-loop control）だけではなく，能動的な下降性制御（open-loop descending control）が存在する。
本総説では停立と歩行の下降性制御と，その高齢者または認知症患者の“転倒”への関与を述べる。
参考文献
1) Hirayama K, Nakajima M, Kawamura M, Koguchi Y: Astasia without abasia due to peripheral neuropathy. Arch Neurol 51: 813-816, 1994
2) 中島雅士: Astasia without abasia（歩行可能－停立不能). 臨床神経33: 1313-1316, 1993
3) Collins JJ, De Luca CJ: Open-loop and closed-loop control of posture: a random-walk analysis of center of pressure trajectories. Exp Brain Res 95: 308-318, 1993
4) Collins JJ, De Luca CJ: Random walking during quiet standing. Phys Rev Lett 73: 764-767, 1994
5) Collins JJ, De Luca CJ: Upright, correlated random walks: a statistical-biomechanics approach to the human postural control system. Chaos 5: 57-63, 1995
6) Hausdorff JM, Peng CK, Ladin Z, Wei JY, Goldberger AL: Is waking a random walk? evidence for long-range correlations in stride interval of human gait. J Appl Physiol 78: 349-358, 1995
7) Hausdorff JM, Purdon PL, Peng CK, Ladin Z, Wei Y, et al: Fractal dynamics of human gait: stability of long-range correlations in stride interval fluctuations. J Appl Physiol 80: 1448-1457, 1996
8) 平山惠造, 河村 満: Astasia without abasia（歩行可能－停立不能): 末梢神経病変にみられる特異な起立障害. 神経進歩35: 294-299, 1991
9) Nashner LM, McCollum G: The organization of human postural movements: a formal basis and experimental synthesis. Behav Brain Sci 8: 135-172, 1985
10) Horak FB, Nashner LM: Central programming of postural movements: adaptation to altered support-surface configurations. J Neurophysiol 55: 1369-1381, 1986
11) McCollum G, Leen TK: Form and exploration of mechanical stability limits in erect stance. J Mot Behav 21: 225-244, 1986
12) Dietz V: Human neuronal control of automatic functional movements: interaction between central programs and afferent input. Physiol Rev 72: 33-69, 1992
13) Dichgans J, Mauritz KH, Allum JHJ, Brandt T: Postural sway in normals and atactic patients: analysis of the stabilizing and destabilizing effects of vision. Agressologie 17C: 15-24, 1976
14) Mauritz KH, Dietz V: Characteristics of postural instability induced by ischemic blocking of leg afferents. Exp Brain Res 38: 117-119, 1980
15) Collins JJ, De Luca CJ, Burrows A, Lipsitz LA: Age-related changes in open-loop and closed-loop control mechanisms. Exp Brain Res 104: 480-492, 1995
16) Inglin B, Woollacott M: Age-related changes in anticipatory postural adjustments associated with arm movements. J Gerontol 43: M105-113, 1998
17) Skinner HB, Barrack RL, Cook SD: Age-related decline in proprioception. Clin Orthop 184: 208-211, 1984
18) Jette AM, Branch LG, Berlin J: Musculoskeletal impairments and physical disablement among the aged. J Gerontol Med Sci 45: M203-208, 1990
19) Winter DA, Patla AE, Prince F, Ishac M, Gielo-Perczak K: Stiffness control of balance in quiet standing. J Neurophysiol 80: 1211-1221, 1998
20) Rougier P, Caron O: Center of gravity motions and ankle joint stiffness control in upright undisturbed stance modeled through fractional Brownian motion framework. J Mot Behav 32: 405-413, 2000
21) Benjuya N, Melzer I, Kaplanski J: Aging-induced shifts from a reliance on sensory input to muscle contraction during balanced standing. J Gerontol A Biol Med Sci 59: 166-171, 2004
22) Laughton CA, Slavin M, Katdare K, Nolan L, Bean JF, et al: Aging, muscle activity, and balance control: physiologic changes associated with balance impairment. Gait Posture 18: 101-108, 2003
23) Bernard-Demanze L, Dumitrescu M, Jimeno P, Borel L, Lacour M: Age-related changes in posture control are differentially affected by postural and cognitive task complexity. Curr Aging Sci 2: 139-49, 2009.
24) Shumway-Cook A, Woollacott M, Kerns KA, Baldwin M: The effects of two types of cognitive tasks on postural stability in older adults with and without a history of falls. J Gerontol A Biol Sci Med Sci 52: M232-240, 1997
25) Lacour M, Bernard-Demanze L, Dumitrescu M: Posture control, aging, and attention resources: models and posture-analysis methods. Clin Neurophysiol 38: 411-421, 2008
26) Shik ML, Orlovsky GN: Neurophysiology of locomotor automatism. Physiol Rev 36: 465-501, 1976
27) Dietz V: Neurophysiology of gait disorders: present and future applications. Electroencephal Clin Neurophysiol 103: 333-355, 1997
28) Hausdorff JM, Ashkenazy Y, Peng CK, Ivanov PC, Stanley HE, et al: When human walking becomes random walking: fractal analysis and modeling of gait rhythm fluctuations. Physica A 302: 138-147, 2001
29) Ashkenazy Y, Hausdorff JA, Ivanov PC, Stanley HE: A stochastic model of human gait dynamics. Physica A 316: 662-670, 2002
30) West BJ, Scafetta N: Nonlinear dynamical model of human gait. Phys Rev E Stat Nonlin Soft Matter Phys 67: 051917, 2003
31) Scafetta N, Marchi D, West BJ: Understanding the complexity of human gait dynamics. Chaos 19: 026108, 2009
32) Delignieres D, Torre K: Fractal dynamics of human gait: a reassessment of the 1996 data of Hausdorff et al. J Appl Physiol 106: 1272-1279, 2009
33) Hausdorff JM, Mitchell SL, Firtion R, Peng CK, Cudkowicz ME, et al: Altered fractal dynamics of gait: reduced stride-interval correlations with aging and Huntington's disease. J Appl Physiol 82: 262-269, 1997
34) Maki BE: Gait changes in older adults: predictors of falls or indicators of fear. J Am Geriatr Soc 45: 313-320, 1997
35) Hausdorff JM, Edelberg HK, Mitchell SL, Goldberger AL, Wei JY: Increased gait unsteadiness in community-dwelling elderly fallers. Arch Phys Med Rehabil 78: 278-283, 1997
36) Hausdorff JM, Rios D, Edelberg HK: Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 82: 1050-1056, 2001
37) Springer S, Giladi N, Peretz C, Yogev G, Simon ES, et al: Dual-tasking effects on gait variability: the role of aging, falls, and executive function. Mov Disord 21: 950-957, 2006
38) Grabiner MD, Troy KL: Attention demanding tasks during treadmill walking reduce step width variability in young adults. J Neuroengineering Rehabil 2: 25, 2005
39) Hausdorff JM: Gait dynamics, fractals and falls: finding meaning in the stride-to-stride fluctuations of human walking. Hum Mov Sci 26: 555-589, 2007
40) AGS Guidelines: Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc 49: 664-672, 2001
41) Morris JC, Rubin EH, Morris EJ, Mandel SA: Senile dementia of the Alzheimer's type: an important risk factor for serious falls. J Gerontol 42: 412-417, 1987
42) Koutsavlis AT, Wolfson C: Elements of mobility as predictors of survival in elderly patients with dementia: findings from the Canadian Study of Health and Aging. Chronic Dis Can 21: 93-103, 2000
43) Weller I, Schatzker J: Hip fractures and Alzheimer's disease in elderly institutionalized Canadians. Ann Epidemiol 14: 319-324, 2004
44) Lundin-Olsson L, Nyberg L, Gustafson Y: "Sops walking when talking" as a predictor of falls in elderly people. Lancet 349: 617, 1997
45) Weeks DL, Forget R, Mouchnino L, Gravel D, Bourbonnais D: Interaction between attention demanding motor and cognitive tasks and static postural stability. Gerontology 49: 225-232, 2003
46) Hausdorff JM, Yogev G, Springer S, Simon ES, Giladi N: Walking is more like catching than tapping: gait in the elderly as a complex cognitive task. Exp Brain Res 164: 541-548, 2005
47) Wollacott M, Shumway-Cook A: Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture 16: 1-14, 2002
48) Sheridan PL, Hausdorff JM: The role of higher-level cognitive function in gait: executive dysfunction contributes to fall risk in Alzheimer's disease. Dement Geriatr Cogn Disord 24: 125-137, 2007
49) Yogev-Seligmann G, Hausdorff JM, Giladi N: The role of executive function and attention in gait. Mov Disord 23: 329-342, 2008
50) Marquis S, Moore MM, Howieson DB, Sexton G, Payami H, et al: Independent predictors of cognitive decline in healthy elderly persons. Arch Neurol 347: 1761-1768, 2002
51) Verghese J, Lipton RB, Hall CB, Kulansky G, Katz MJ, et al: Abnormality of gait as a predictor of non-Alzheimer's dementia. N Engl J Med 347: 1761-1768, 2002
52) Waite LM, Grayson DA, Piguet O, Creasey H, Bennett HP, et al: Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney older persons study. J Neurol Sci 229: 89-93, 2005
53) Verghese J, Wang C, Holtzer R, Lipton R, Xue X: Quantitative gait dysfunction and risk of cognitive decline and dementia. J Neurol Neurosurg Psychiatry 78: 929-935, 2007
54) Yaffe K, Barnes D, Nevitt M, Lui LY, Covinski K: A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med 161: 1703-1708, 2001
55) Abbott RD, White LR, Ross GW, Masaki KH, Curb JD, et al: Walking and dementia in physically capable elderly men. JAMA 292: 1447-1453, 2004
56) Weuve J, Kang JH, Manson JE, Breteler MM, Ware JH, et al: Physical activity, including walking, and cognitive function in older women. JAMA 292: 1454-1461, 2004
57) van Gelder BM, Tijhuis MA, Kalmijn S, Giampaoli S, Nissinen A, et al: Physical activity in relation to cognitive decline in elderly men: the FINE study. Neurology 63: 2316-2321, 2004
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