運動失調症での上肢動作能に対する短期リズムタッピング訓練の効果の検討

Abstract

運動失調症10例でリズムタッピング訓練を行い, 訓練前後でタッピングテストにてタッピングの interval, duration time を測定し, 時間的正確性, 運動方向変換能を検討した。運動失調症では, interval, duration の延長があり, 特に duration の分散は左手で大きかった。リズムタッピング訓練は, 時間的正確性に対して7例で効果があったがその程度は様々であり, 3例においては効果を認めなかった。訓練による学習の受け入れ, 記憶, 呼び出しの過程のどこかに障害があると, 訓練効果は得られなかったり動作能に陰性的に働くと推定した。クロックパルスの障害と, 動作能の障害あるいはリズムタッピング訓練効果と関連がある可能性を推測した。

In 10 patients suffering from ataxia, we examined the effect on upper limb function of a tapping exercise performed in time to a rhythmic sound. Eight of the patinets had spinocerebeller degeneration, one had tabes dorsalis, and the remaining patient had severely impaired deep sensation in the upper limbs secondary to an abnormality at the atlas and axis. The rhythmic tapping exercise consisted of alternately tapping two points in time to a beep tone rhythmically generated from a computer. Forty taps comprised one performance of the exercise. The beep tone was emitted at rates of 40,60,80,…, 200 beeps per minute. The right hand and the left hand each performed the series of taps at the defferent beep rates. Motor skill was assessed by measuring the interval between successive taps and the duration of the press for each tap. These temporal measures were sampled on line by an MSX computer to which the device for pressing was wired. The rhythmic tapping exercise was effective, though to varying degrees, in seven of the subjects. The remaining three subjects experienced on beneficial effect from the exercise, and in fact performance even became worse in some instances. Failure to improve may have been due to impairment somewhere in the motor lerning system of the cerebellum. If the body can be considered to have a clock-pulse function something like that of a computer, the rhythmic tapping exercise might not help improve motor skill of the hands in patients wheos internal clock-pulse functions are impaired.