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京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24810号 / 人健博第116号 / 新制||人健||8(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 青山 朋樹, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DGAM

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Research has documented the positive effects of physical therapy as a treatment for limb motor symptoms associated with Parkinson's disease (PD). Previous studies have shown that speech and voice measures can be reflective of overall cardiovascular health and fitness in young, middle-aged, and older adults. In healthy individuals, increased respiratory drive has been found to influence vocal function and speech articulation. The rationale for the present study was that improved lower limb function might lead to improvements in overall fitness, which then may influence speech in individuals with Parkinson's disease. To investigate this premise, 10 participants diagnosed with mild to moderate idiopathic PD were involved in an intensive lower limb training program called Resistance Exercise via Negative-Eccentric Work (RENEW). The speech of the participants was recorded before and after the RENEW treatment in both medication-on and medication-off conditions. Following treatment there was a statistically significant increase in spirantization of the stop gap in DDK repetition in the medication-on condition and a decrease in diphthong duration in the medication-off condition. After treatment in the medication-on condition there was an increase in spirantization and a reduction in first and second formant transitions for the diphthong /ɔI/ compared to the medication-off condition. These results represented a slight worsening of articulatory precision and movement following treatment in response to PD medication. Overall, the present study found that intensive lower limb training did not influence the acoustic measures of speech articulation examined in the present study.

BACKGROUND AND OBJECTIVES: Research on in utero opioid exposure impacts has focused on Neonatal Opioid Withdrawal Syndrome (NOWS). However, possible impacts on fetal growth and newborn wellbeing have emerged, with inconsistencies likely driven by methodological issues. Our goal was to compare birth outcomes between newborns with prenatal opioid exposure and a matched control group. METHODS: Participants were identified manual review of electronic medical records of all deliveries over five years within a regional health system (6 delivery hospitals across 2 states). From over 18,000 births, 300 with prenatal opioid exposure and 300 control newborns matched on exposure, medical, and background factors were included. Additional factors were statistically controlled. Outcomes included pregnancy/delivery complications, newborn size, and newborn health complications. RESULTS: Compared to biochemically verified controls, exposed newborns had higher rates of fetal growth restriction, weighed less, had decreased length and head circumference, and had higher rates of respiratory distress, sepsis, and jaundice. No significant differences in gestational length, Apgar scores, or neonatal hypoglycemia were found. Adjusted regression analyses revealed that compared to controls, those exposed had an average 150 g decrease in birth weight, a two-fold increased risk for IUGR (OR = 2.09), a nearly three-fold (OR = 2.80) increased risk for jaundice, a more than seven-fold (OR = 7.40) increased risk for respiratory distress, and a thirty-fold (OR = 30.47) increased risk for sepsis. CONCLUSIONS: Results suggest significant pregnancy and newborn outcomes beyond NOWS following pregnancy opioid use, informing clinical screening and treatment decisions to enhance health and wellbeing in pregnancy, during the neonatal period, and beyond.

Idiopathic Scoliosis, IS, affects only about 5% of the population but can produce very disabling deformities, affecting other major systems in the body. The most commonly affected are young females between the ages of 8 and 16 years of age. The specific cause of IS is unknown but it is hypothesized to be a multisystem disorder. The purpose of this descriptive study was to measure the neuromuscular factors of joint laxity, muscle strength, and sensory processing in female adolescents (N = 90), 46 who were being treated for IS and 44 age matched controls who were screened for scoliosis and found to have no spinal curves. Based on the analysis of variance of the subjects with IS, the experimental group had significantly more joint laxity at the knee and elbow (p $\le$ 0.0001) as well as tactile defensiveness (p $\le$ 0.0001) and tested weaker in quadriceps femoris strength (p $\le$ 0.003 and p $\le$ 0.008) left and right respectfully. Those with IS were more likely to have a history of difficult births (42% vs. 28%). Those with difficult births were more likely to have larger thoracic curves (p $\le$ 0.013), greater weakness in the left quadriceps (p $\le$ 0.0015) and greater tactile defensiveness (p $\le$ 0.0437). The findings in this study confirm the presence of neuromuscular skeletal difficulties. It is conceivable that joint laxity is related to difficulty in sensory processing and reduced postural tone that impairs postural righting against gravity. It is not clear if these imbalances can be remediated. Further studies on postural righting and stabilization along with EMG analysis during functional activities could clarify what intervention strategies might be used to provide the stability necessary to prevent further curve progression or improve the spinal alignment.

OBJECTIVE: To investigate the effect of a 12-week exercise-based physical therapy on movement-evoked pain (MEP) in knee osteoarthritis (OA) and assess the relations between baseline psychological factors and treatment responses based on MEP. BACKGROUND: Pain during movement (i.e., MEP) is one of the most common complaints amongst people with knee OA, which induces greater functional challenges during daily activities. Although the worsening of pain during exercise appears to hinder activity-based treatment adherence, the assessments of MEP tend to be overlooked in the pain management in knee OA. METHODS: The data analyzed in this study was from the parent study, Wearable Sensors in Knee Osteoarthritis (WESENS-OA) study, a longitudinal, single-arm clinical trial of a 12-week exercise intervention in people with symptomatic knee OA. In the WESENS-OA (n = 60), participants self-reported pain intensity during the nominated activity as well as psychological symptoms (Center for Epidemiologic Studies Depression Scale), cognitive pattern (Pain Catastrophizing Scale), and central sensitization (Central Sensitization Inventory). Pain intensity during functional tasks and strength testing were collected during the laboratory visits. Three characteristics of MEP outcomes were assessed: (1) pain during the nominated activity, (2) functional MEP, and (3) exercise MEP. The participants reported the pain intensity during the nominated activity that is most troublesome due to their knee pain weekly using the 11-point numerical rating scale (NRS, range: 0-10). Pain intensity during or immediately after functional tasks (i.e., 6-minute walking, chair stand, climbing the staircase, range: 0-10) and strength testing (i.e., maximal voluntary isometric contractions of knee extensors and flexors, isokinetic knee flexion-extension at 60°/s and 120°/s each, range: 0-10) were evaluated to measure functional MEP or exercise MEP, respectively. MEP index score (i.e., maximum pain corrected for baseline pain) was reported as the outcome. Mixed model repeated measures (MMRM) analysis was utilized to evaluate the effect of an exercise intervention on the change in movement-evoked pain from baseline to 12 weeks, and least square means with the standard error were reported simultaneously. Each participant’s treatment response was determined by comparing the change in MEP from baseline to Week 12. A participant with a difference of ≥ 2 points in NRS for pain-nominated activity was classified as a responder, and for functional MEP and exercise MEP, treatment responder classification was done based on the hierarchical agglomerative clustering analysis. After dichotomizing participants, using binomial regression, the relative risk (RR) was reported to explore the predictive ability of CSI, CES-D, and PCS on treatment response based on MEP. RESULTS: For pain during nominated activity, the mean difference (MD) from baseline to Week 6 was -1.72 with 95% CI (-2.35 to -1.08; P <0.0001), and the difference at Week 12 was -2.41 with 95% CI (-2.92 to -1.89; P <0.0001). For functional MEP, MD with 95% CI at Week 6 was -0.34 (-0.52 to -0.16; P = 0.0003), and at Week 12 was -0.44 (-0.58 to -0.31; P<0.0001). Unlike the other MEP measures, for exercise MEP, MD was measured at one timepoint, at Week 12, which was -0.58 with 95% CI (-0.88 to -0.27; P = 0.003). Our secondary analysis did not provide evidence that baseline measures of CSI, CES-D, and PCS were associated with the treatment response based on the change in MEP measures after the exercise intervention. CONCLUSION: In conclusion, our study strongly supports the effect of exercise on reduction in three measures of MEP—pain during nominated activity, functional MEP, and exercise MEP. Our hypothesis to confirm the predictive ability of psychological factors on treatment response based on MEP was not reached, with insufficient evidence to substantiate such a notion. However, our findings hold strength to pioneer discovering the underlying mechanism of understudied MEP in knee OA. / 2026-02-28T00:00:00Z

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The purpose of this dissertation was to explore methods for generating neuroplastic changes in healthy individuals using transcutaneous spinal cord stimulation (TSCS) and perturbation-based training in order to improve balance performance. This was done to gain an understanding of their effects on healthy individuals, which could then be used in designing treatments for both healthy and motor-impaired subjects. Three studies were undertaken. First, we set out to show that the Robotic Upright Stand Trainer (RobUST) could generate improvements in balance after perturbation balance training (PBT). In this same study, we showed that the assist-as-needed support of RobUST generates postural control improvements. Balance performance metrics including (i) margin of stability (MOS), (ii) metrics based on the center of pressure (COP) and center of mass (COM) excursions, (iii) postural muscle activations, (iv) balance strategy selection (between ankle and hip strategies) were used in this study. Electromyographic data were also collected from 11 subjects who participated in this study. Subjects were split into a RobUST assisted group (FF) and a non-assisted group (NF). An analysis of variance (ANOVA) was carried out to identify the main effects of the two factors, i.e., training and grouping. We also studied the interaction effects between the two factors in the performance variables. After training, the threshold of the forces that destabilize balance increased for all participants. In addition, the area within which they could withstand perturbations without falling also increased. Muscle activation decreased in most muscles for subjects in both groups indicating that subjects improved balance while demonstrating more energetically efficient strategies. The post-training behavior of the two groups differed in the following way: the NF group adapted towards faster reactions to perturbations, greater use of the hip strategy, and more use of the erector spinae muscle, while the FF group adapted towards slower responses and less MOS. These results show that although balance adaptations with RobUST-assisted PBT are not the same as without RobUST, it is still a platform capable of improving balance performance. Second, the effect of TSCS as a means of boosting neuroplasticity and a replacement for epidural stimulation were tested. Eight subjects were given TSCS for 30 mins while lying supine, and their neurophysiological and balance performance measures were tested before and after the intervention. T-tests were used to assess the difference in performance, and it was found that TSCS caused hypopolarisation of the sensory neurons, which increased the synaptic efficacy of sensory afferent–motoneuron synapses. This change was evidenced by increased H-reflex recovery and a leftward shift of the H-reflex recruitment curve. No improvement in fall frequency was observed, although balance adjustments were made that reduced muscle activity. This experiment showed that TSCS could be used to modulate the excitability of the spinal cord in healthy subjects. Third, TSCS was combined with a training intervention in order to study how these two sources of plasticity interact. TSCS was applied to eleven subjects while they underwent a training intervention in which they played a game in virtual reality (VR) while their balance was perturbed by forces applied by RobUST. Balance characteristics were measured both with and without TSCS, before and after the intervention. It was found that TSCS initially caused an increase in muscle activity and an increase in fall frequency for perturbations in the forward direction. With more practice, though, muscle activity decreased. It was postulated that the CNS adjusted to the initial elevated levels of muscle activity caused by TSCS by suppressing muscle activity in order to ensure successful motor control. These results suggest that TSCS can be used to elevate the resting potential of neurons in the dorsal (close to the back of the body) root, making them more easily excited by cortical signals. These changes induced by TSCS can be beneficial to spinal cord injury patients.

Bakgrund: Migrän och huvudvärk av spänningstyp (HST) är två vanligt förekommande hälsoproblem. Traditionellt behandlas dessa åkommor farmakologiskt men på senare tid har fysioterapeutisk behandling blivit allt vanligare. Aerob träning är en av många fysioterapeutiska behandlingsmetoder som kan verka smärtlindrande för dessa patienter. Syfte: Att undersöka effekten av aerob träning på upplevd smärtnivå för personer med migrän och/eller HST. Metod: Studiens design var litteraturstudie. Systematiska sökningar genomfördes i databaserna PubMed och PEDro. Sökresultatet granskades utefter urvalskriterierna. Inkluderade artiklars risk för snedvridning bedömdes utifrån PEDro granskningsmall och det sammanvägda resultatets tillförlitlighet utvärderades med hjälp av GRADEstud. Resultat: Efter urvalsprocessen inkluderades åtta randomiserade kontrollerade studier. En av artiklarna bedömdes ha hög kvalitet och resterande hade måttlig kvalitet. Inkluderade artiklars olikheter gällande intervention och population ledde till subgruppering av resultaten. Antal dagar med migrän per månad minskade inom samtliga grupper som hade aerob träning som intervention men mellangruppsjämförelserna var ej statistiskt signifikanta. Samma minskning gick inte att se gällande HST. Den sammanvägda tillförlitligheten utifrån GRADEstud bedömdes som låg eller mycket låg gällande alla subgrupper. Konklusion: Baserat på artiklarnas resultat, låga kvalitet och det sammanvägda resultatets låga tillförlitlighet kan inga säkra slutsatser dras gällande effekten av aerob träning på upplevd smärtnivå för personer med migrän och HST. Fler studier behövs. / Background: Migraine and tension-type headache (TTH) are two common health problems. These health problems are traditionally treated pharmacologically but physical therapy has lately gained popularity as a treatment option. Aerobic exercise is one of many physiotherapeutic treatments that can reduce pain for these patients. Purpose: To examine the effect of aerobic exercise on perceived pain level for individuals with migraine and/or TTH. Method: The study design was literature review. Systematic searches were performed in the databases PubMed and PEDro. The search result was reviewed according to the selection criteria. The risk of bias in the included articles was assessed using PEDro scale and the certainty in evidence of the articles summarized outcomes was assessed using GRADEstud.  Results: Eight randomized controlled studies were included after the selection process. One article was considered to have high quality and the remaining seven to have fair quality. The results were sub-grouped due to differences in the included articles regarding intervention and population. Number of days with migraine per month decreased within all groups with training as intervention but the between group comparisons were not statically significant. The same reduction could not be found regarding TTH. The certainty in evidence of the articles summarized outcomes was considered to be low or very low in all subgroups. Conclusion: No certain conclusion could be drawn regarding the effect of aerobic exercise on perceived pain level in individuals with migraine and TTH based on the articles results, low quality, and low certainty in evidence. More studies are needed.