3事例の脳性麻痺片麻痺児に対する修正CI療法を用いた取り組み

Intervention using modified constraint-induced movement therapy in three cases of children with hemiplegic cerebral palsy

要旨：脳性麻痺片麻痺児に対する治療にCI療法があるが，本邦では取り組みの報告は少ない．今回，脳性麻痺片麻痺児の3事例に対してCI療法に両手動作練習を加えた修正CI療法を行った．加えて家族へのTransfer packageの実践，外部機関との連携などの工夫を行った．結果，麻痺側上肢を用いた個々の目標の達成または一部達成と，麻痺側上肢機能，生活の中での使用頻度，動作の質の向上，そしてそれら1年経過後の効果の維持，継続した向上がみられた．修正CI療法は，脳性麻痺片麻痺児の麻痺側上肢の使用行動に良好な変化をもたらす可能性が示唆された．

　Constraint-induced movement therapy (CIMT) is used to treat hemiplegia in children. However, its application in Japan is rarely documented. This report analyzes the treatment of 3 children with hemiplegic cerebral palsy using CIMT combined with bilateral practice (modified CIMT). The therapy was tailored to make the use of the paralyzed upper limb enjoyable by adjusting the difficulty level of play activities. Additionally, a transfer package was designed for family members, and information was shared across external partner organizations. As a result, each child achieved or partially achieved their individual goals using the paralyzed upper limb. Improvements were noted in the function, frequency of use in daily life, and quality of movement of the paralyzed upper limbs. These effects were maintained and improved after one year. Modified CIMT may lead to positive changes in the behavioral use of the paralyzed upper limb in children with cerebral palsy.