脳卒中後重度上肢麻痺に対するGraded Repetitive Arm Supplementary Program（GRASP）と電気刺激併用の効果—シングルケースデザインによる検討

Effect of Graded Repetitive Arm Supplementary Program (GRASP) combined with Functional Electrical Stimulation (FES) in subacute stroke with severe upper-extremity paresis: A case study

要旨：重度上肢麻痺患者に対するGraded Repetitive Arm Supplementary Program（GRASP）と電気刺激の併用効果をABAシングルケースデザインにて検討した．方法はA期で通常作業療法，B期でGRASPに電気刺激を併用し，1日60分実施した．各期を4週間に設定した．電気刺激は，麻痺がより重度であった上肢近位部へ実施した．結果，B期で上肢機能と生活内使用行動は臨床的に意味のある最小変化量（MCID）を超える変化を示し，生活内における麻痺手の補助的使用が可能となった．重度上肢麻痺に対するGRASPと電気刺激の併用は，上肢機能と生活内使用を改善する可能性が示唆された．

　The effect of Graded Repetitive Arm Supplementary Program (GRASP) combined with Functional Electrical Stimulation (FES) on stroke patients with severe upper limb paralysis was investigated in an ABA single case design. The method was the usual occupational therapy in phase A and the GRASP combined with FES in phase B, which was performed for 1 hour per day. Each period was set for 4 weeks. FES was applied to the proximal part of the upper limb where the paralysis was more severe. The results showed that the changes in upper limb function and real-world arm use exceeded the minimum clinical important difference in phase B. The patient was able to use the paralyzed hand as a support in daily life. The results suggest that the combination of GRASP and FES for severe upper limb paralysis may improve upper limb function and real-world arm use.