神経疾患のリハビリテーション治療—急性期を中心に

Rehabilitation Therapy for Acute Brain Disease

Point

・高度急性期の病床機能の明確化が進むなかで，早期リハビリテーションが重要視されるようになってきた．

・脳損傷後，原則48時間以内に多職種がチームとして総合的な早期離床・リハビリテーションを行うことが推奨される．

・バイタルサインと意識状態を適宜確認しながら安全を担保した上で，高頻度の介入が推奨される．

　Early mobilization and rehabilitation therapy are becoming more critical in acute stroke, traumatic brain injury, and neurological disorder. Better functional prognosis for patients are obtained by performing comprehensive early mobilization and rehabilitation by a multidisciplinary team, generally within 48 hours after the onset. Early and frequent mobilization and rehabilitation therapy are recommended unless systemic management is paramount, such as hemodynamic instability, increased intracranial pressure, or active bleeding. Future considerations to be verified include implementation of rehabilitation in the very early phase（e.g., within 24 hours after the onset）, selection of patients（e.g., when to start rehabilitation for each disease type）, amount of exercise load in the intensive care unit（ICU）, and content of training at the early stage. In addition, there are still few established methods for evaluating motor activity that can be performed in bed. It is also necessary to consider the nature of the rehabilitation team and leadership that were poorly addressed.