回復期の弛緩性片麻痺患者にMental Practiceと課題指向型訓練を併用した一例

Combined mental practice and task-oriented training for a flaccid hemiplegic patient after stroke in the subacute phase: A case study

要旨：【はじめに】弛緩性片麻痺によりActivities of Daily Living（以下，ADL）での利き手の使用が困難となった事例に対し，Mental Practice（以下，MP）と課題指向型訓練を併用した．【対象】短期間に二度の脳梗塞（左小脳，左放線冠）を発症した50代男性．発症後2ヵ月時点でBRS上肢・手指Ⅰ．運動イメージ能力・運動主体感の低下を認めた．ADLで麻痺手を使用不可．【方法】MP，課題指向型訓練等を3ヵ月間ADL実施．【結果】BRS上肢・手指Ⅴ．ADLで麻痺手を実用手として使用可能．【考察】本事例は錐体路・小脳損傷により麻痺手を使用不可となり，半球間抑制や学習性不使用の影響も推測されたが，病態を考慮した複合的な介入が回復に寄与した可能性がある．

　[Introduction] We report a case of flaccid hemiplegia in which the patient had difficulty using his dominant hand for Activities of Daily Living (ADLs). [Subject] A man in his 50s who had two cerebral infarctions (left cerebellum and left corona radiata) in a short period of time. Initially, he had difficulty using his dominant hand for ADL due to flaccid hemiplegia. [Methods] Mental practice, video observation task, task-oriented training, and praise from others were performed for 3 months. [Result] The affected hand can be used as the dominant hand in ADL due to functional improvement of the affected hand. [Discussion] The patient had difficulty using his affected hand due to damage to the pyramidal tract and cerebellum. Although interhemispheric inhibition and learned non-use of the affected hand were also assumed to have affected the patient's recovery, it is possible that combined interventions contributed to the patient's recovery.