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Title 上肢麻痺の重症度に合わせた作業療法
Subtitle 特集 / 脳血管障害の片麻痺患者へのリハビリテーション治療マニュアル
Authors 濱口豊太*
Authors (kana) はまぐちとよひろ
Organization *埼玉県立大学大学院保健医療福祉学研究科, 教授
Journal MB Medical Rehabilitation
Volume
Number 282
Page 43-52
Year/Month 2022 / 12
Article 報告
Publisher 全日本病院出版会
Abstract 「Abstract」脳卒中による運動麻痺は, 重症であるほど回復量が小さく, ADLで機能的に用いることが困難となり, 不使用の手となりやすい. しかし, 急性期から回復期までに積極的に行われている機能回復練習は, 反復経頭蓋磁気刺激(rTMS)に代表されるneuromodulationを促通できる治療法によって維持期までカバーされるに至った. 麻痺の回復量に合わせたADL練習は使用依存的可塑性(UDP)の原理に基づいて行われ, その練習計画に工夫が凝らされている. 分離運動を促す自動・介助運動手技は伝統的に行われてきたが, これに反復練習の運動回数と時間が推計され, 練習計画の参考とされている. 他方, ADLで手を使うレパートリーの変更練習は, 重症度の回復に合わせて手の機能を高める運動療法と併用されるが, その計画は未だ科学的裏付けを得られていない. 現在はrTMSやボツリヌス毒素療法のように中枢と末梢から同時に麻痺の回復を促しつつ, 運動療法と作業療法が後続として回復に貢献しているが, 練習法はさらに患者の重症度に照合して最適化する方略の開発を要する.
Practice 医療技術
Keywords 片麻痺(hemiparesis), 作業療法(occupational therapy), 上肢運動療法(exercise for paretic upper extremity), 使用依存的可塑性(use-dependent plasticity), 麻痺側上肢機能回復(recovery of upper extremity function)
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