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		<h1 class="title">感覚入力で挑む<span class="version"></span></h1>
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					常任編集：斉藤秀之（医療法人社団筑波記念会）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">虚弱高齢者・脳卒中・小脳失調・運動器疾患・スポーツ障害の予防・子供・慢性疼痛の場合，どのように感覚入力を適用しているかを解説し，体性感覚と運動感覚・能動的知覚・身体図式・脳の可塑性・異種感覚入力の統合・知覚機能に対する運動の実時間的影響・タイミングの感覚・運動イメージの脳内再生・ヒトの発達に伴った運動に関連する感覚において理学療法に必要な「感覚」の知識を解説．感覚入力を知る魅力について紹介する１冊．</section><section class="preface">序<br><br>　「感覚入力で挑む」，今回このようなタイトルで本書の編集に挑んだ．この目的語は，何か？それは，臨床的にわれわれが対象とすることが多い運動機能障害は当然のこと，感覚障害，疼痛など，さまざまな疾患によって生じる感覚機能と運動機能にまつわる障害であると考えている．<br>　20世紀の終盤，“21世紀は○○の時代”と表現される○○の一つとして，“脳”があった．すなわち，“21世紀は脳の時代”ということである．その頃私は，大学院で研究と臨床のトレーニングをしていた時分であったが，そのような言葉を目にしたときには，漠然と，将来霧が晴れるときがやってくるのかもしれないとワクワクした．“霧”というのは，臨床的問題に関して，その機序や解決方法など，たくさんのわからないことが存在していたことによる頭の中の“モヤモヤ感”のことである．すでに，21世紀は15年が過ぎた．この間，脳に関するたくさんの情報が発信され，その恩恵は理学療法においても実を結ぶ方向に向かっていると感じる人は多いのではないだろうか．さらに，生物学や理工学などさまざまな科学領域の貢献により，理学療法の臨床は確実にポジティブな影響を受けていると感じる．このような社会的背景の中で，さて，われわれが取り組むべき課題とは？ 取り組むべき研究とは？ 臨床に取り入れるべき科学的知見とは何か？<br>　方向性を示す一つの提案は，システム神経科学的知見に則って運動機能の向上を感覚入力という視点から考えるというものである．これは，中枢神経系における感覚と運動の統合メカニズムと脳の可塑性の誘導を理解することに近い．ヒトの身体を臓器別ではなく，システムとしてより深く理解し，その理解に基づいて治療へ応用したいという想いの表れとして本書を上梓する．この企画は，20年ほど前からある想いに端を発する．筋骨格系の条件がある程度整っている場合，何かしらの高いパフォーマンスを発揮するためには制御系の機能向上が必要であるが，そのためには一度，実現したいパフォーマンスを“自分がやったつもり”になるように錯覚させて感覚を教えることが有効なのではないか（つまり，100mを10秒で走る壁にぶつかっている選手には，あたかも自分自身が9秒台で走ったかのように錯覚させながら体験させるというような），という何とも検証が難しい，希望的な仮説である．<br>　想いはどうあれ，運動に関連した感覚に関する知識が臨床に役立つように整理され，あまり類をみない書籍となったと思う．漠然とした依頼内容と難解な“感覚入力で挑む”というコンセプトであったにもかかわらず，ご執筆いただいた著者の皆様には，非常に充実した内容となったことに感謝と敬意を表したい．ここで提供される学術的情報と臨床的ノウハウが，少しでも日常の取り組みのヒントになること，そしてさらなる探究の入り口となることを願う．<br><br>平成28年2月<br>ゲスト編集　金子文成</section><section class="indexes">PartⅠ　総論<br>1　どうして感覚入力について学ぶのか<br>　　新しいのか？　古いのか？<br>　　神経可塑性の視点<br>　　運動学習の視点<br>　　おわりに<br>PartII　このようにしている！　感覚入力<br>1　虚弱高齢者の場合<br>　　運動療法へのバーチャルリアリティの応用<br>　　外在性フィードバックを利用する！<br>　　バーチャルリアリティ・トレーニングのエビデンスは？<br>　　バーチャルリアリティを用いたツールの実例<br>　　 ミニレクチャー  私はこうしている 1　口腔機能向上のための感覚入力<br>2　脳卒中の場合<br>　1） 立ち上がり，立位，歩行<br>　　正常動作を行う場合に，正しい感覚入力は大切である！<br>　　表在感覚障害は随意運動にどのように影響するか？<br>　　深部感覚障害は随意運動にどのように影響するか？<br>　2） 上肢運動の場合<br>　　感覚障害とは？<br>　　感覚・知覚・認知障害の頻度と生活に与える影響<br>　　障害部位による感覚・知覚・認知障害が上肢機能に与える影響<br>　　手の運動と感覚・知覚・認知<br>　　手の感覚・知覚・認知障害改善のメカニズム<br>　　感覚・知覚・認知障害における上肢へのアプローチの参考となる基礎研究<br>　　感覚・知覚・認知障害のアプローチの参考となる臨床研究<br>　　感覚・知覚・認知障害とパフォーマンスの関連<br>　　重度の感覚・知覚・認知障害を呈した患者に対する課題志向型アプローチの実際<br>　　症例<br>3　小脳失調の場合<br>　　外的な刺激量＝知覚ではない<br>　　どこに注意を向ける？　運動と注意の関係<br>　　フィードバックすべき感覚モダリティとは？<br>　　小脳疾患による運動感覚障害？　予測と感覚の密接な関係<br>　　何で判断する？　適切な運動難易度設定<br>　　有効？　弊害？　介助・誘導と運動の誤差情報<br>　　失調なのに固い？　運動失調と同時収縮の関係<br>　　小脳失調に対する二重課題は有効か？<br>　　ロボティックデバイスを用いた感覚入力とは？<br>　　 ミニレクチャー  私はこうしている 2　中枢神経疾患の筋緊張に対して<br>4　運動器疾患の場合<br>　1） 下肢運動器疾患の場合<br>　　はじめに〜運動器とは何か？〜<br>　　下肢運動器障害を感覚入力システムの不全として捉える！<br>　　OKCとCKCの感覚入力（外力負荷）に対する応答の違い<br>　　OKCとCKCにおける筋出力制御特性<br>　　感覚入力を駆使した筋協調性収縮のトレーニング<br>　2） 肩関節疾患の場合<br>　　はじめに<br>　　問診・愁訴<br>　　機能評価，治療場面における取り入れ方<br>　　おわりに<br>　　 ミニレクチャー  私はこうしている 3　感覚入力における注意すべき要点<br>5　スポーツ障害の予防<br>　1） 膝関節靱帯損傷の場合<br>　　膝関節靱帯とACL損傷<br>　　ACL損傷を引き起こす外力と足部接地パターン<br>　　ACL損傷の時間と予測<br>　　アスリートの注意と予測的姿勢制御<br>　　おわりに<br>　2） 足関節捻挫の場合<br>　　スポーツで最も頻発する外傷：足関節捻挫<br>　　足関節捻挫後の運動パターン変化<br>　　再発予防のための理学療法<br>　　 ミニレクチャー  私はこうしている 4　トップアスリートへの感覚の伝え方<br>　3） 腰部疾患の場合<br>　　stabilization exerciseの基本はdraw─in！<br>　　bridge exerciseで体幹筋を評価＆促通<br>　　筋筋膜経線を意識した体幹筋エクササイズ<br>　　 ミニレクチャー  ‌私はこうしている 5　徒手による感覚入力 1<br>　　　　　　　　　　　─腰痛疾患に対する理学療法戦略ポイント─<br>6　子供の場合<br>　　子供の知覚運動障害とは？<br>　　子供の知覚運動障害をどうとらえるか？<br>　　どのような場面で子供の知覚運動障害が顕著となるのか？<br>　　どのように知覚運動障害の評価・分析するか？<br>　　理学療法による感覚・知覚入力をどのように考えるか？<br>7　慢性疼痛の場合<br>　　慢性疼痛における触覚機能の低下について<br>　　慢性疼痛における固有感覚機能の低下について<br>　　触覚入力を用いたアプローチ<br>　　視覚入力を用いたアプローチ<br>　　固有感覚入力を用いたアプローチ<br>　　まとめ<br>　　 ミニレクチャー  ‌私はこうしている 6　徒手による感覚入力 2<br>　　　　　　　　　　　─疼痛や過度な緊張を和らげるために─<br>PartIII　感覚入力を知る！　理学療法に必要な「感覚」の知識<br>1　‌ボトムアップおよびトップダウンで起こる運動の知覚と運動の意図<br>　─統合と理学療法とのかかわり─<br>　　体性感覚とは？<br>　　運動感覚とは？<br>　　安静なのに運動感覚が生じるの？<br>　　安静かつ感覚入力がない状態でも運動感覚を知覚できる？<br>　　収束することに治療的意義がある？　〜感覚入力と運動の意図の同期〜<br>　　忘れてならない，まずは反射<br>　　おわりに<br>2　能動的知覚─その研究史と生理学メカニズム─<br>　　皮膚感覚の要素感覚理論<br>　　Katzの先駆的研究<br>　　Reveszの研究<br>　　Gibsonの研究<br>　　その後の能動的知覚研究<br>　　アクティヴタッチは優れているか<br>　　探索する手ではなく対象が認識される仕組み<br>　　能動的触知覚における運動指令の重要性<br>　　その他の研究<br>　　能動的認識の生理学的メカニズム：サル体性感覚野での研究<br>　　おわりに<br>　　 ミニレクチャー  ‌末梢からの求心性入力 1　電気刺激による感覚入力を活用した<br>　　　　　　　　　　　歩行理学療法の促進<br>3　身体図式─行為を支える脳内身体表象─<br>　身体図式とは？<br>　脳は矛盾を嫌う！：身体錯覚にみる身体図式のはたらき<br>　道具の“身体化”<br>　身体図式を利用した“近位空間”の表現<br>　4感覚入力と脳の可塑性─一次体性感覚野は運動学習に必要か？─<br>　体性感覚に関連する大脳皮質領域はどこか？<br>　神経の可塑的変化とは？<br>　感覚入力によって一次運動野の興奮性は変化するのか？<br>　脳損傷後の動作パフォーマンス向上は何に起因しているのか？<br>5　‌異種感覚入力の統合により生じる運動感覚<br>　─正確な運動を知覚するために必要な感覚は？─<br>　はじめに<br>　他動的に誘導される運動感覚<br>　感覚入力が統合されると運動感覚は変化するのか？<br>　異なる感覚種は統合されるのか？<br>　各種感覚入力はどのように運動感覚に影響するのか？<br>　おわりに<br>6　‌知覚機能に対する運動の実時間的影響とトレーナビリティ<br>　　─体性感覚入力の処理過程は，柔軟に変化する！─<br>　体性感覚入力の中枢処理過程<br>　運動と体性感覚入力系<br>　トレーニングによって体性感覚入力系が変化する!?<br>　 ミニレクチャー  ‌私はこうしている 7　徒手による感覚入力 3<br>　　　　　　　　　　─感覚入力による筋活動の定量化，視覚化を図る─<br>7　‌タイミングの感覚とトレーナビリティ<br>　─運動に利用する時間，運動が変える時間─<br>　はじめに<br>　本当はいつ起こったのか？　外界で起こるイベントの「真」のタイミングを知る難しさ<br>　経験がものを言う？　入力信号の統計的性質を利用した感覚入力タイミングの把握<br>　投手の癖を運動に生かす！　ボールはいつ来るのかのタイミング予測も経験に依存<br>　運動場面における時間の推定：知覚時間は長くなったり，短くなったり？<br>　運動のタイミングと内容の乖離：何をするか決まっていなくても，運動タイミングを準備できる？<br>　結　語<br>8　‌運動イメージの脳内再生とトレーナビリティ<br>　─臨床応用のために運動イメージの脳内神経基盤を理解する─<br>　運動イメージの定義<br>　運動イメージの神経相関とは？<br>　運動イメージ能力を評価する<br>　運動イメージ能力の個人差<br>　運動イメージを用いたアプローチのトレーナビリティ<br>　　 ミニレクチャー  私はこうしている 8　運動経験が少ない人への感覚の伝え方<br>9　子供の運動感覚と個人差─運動感覚と身体表象の発達─<br>　自ら動き，知覚することがはじまり<br>　構成論的手法に基づく身体表象発達の理解<br>　運動感覚を生み出す受容器<br>　感覚受容器の初期発達<br>　触覚反応の広がりとダブルタッチの発達的変化<br>　他者の観察によって形成される運動感覚<br>　運動感覚の個人差〜発達障害児を通して考える〜<br>　重度脳性麻痺の1例〜運動性障害と運動感覚〜<br>　精神運動発達遅滞の1例〜知的発達障害と運動感覚〜<br>　まとめ<br> ミニレクチャー  ‌末梢からの求心性入力 2　体重免荷環境での全身運動による振動刺激を<br>　　　　　　　　　用いた重症心身障害児・者に対する新しい理学療法<br>索引</section></article>
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