回復期リハビリテーション病棟の言語聴覚療法患者の変遷と課題

Changes and issues in patients undergoing speech-language-hearing therapy in intensive rehabilitation wards

　回復期リハビリテーション病棟の言語聴覚療法患者の変遷的知見を得るために，当院に入院した言語聴覚療法患者2,061例(2003年～2009年)の言語聴覚療法処方と重複障害患者の割合，失語症の重症度，日常生活動作能力，転帰先の経年変化を分析した．その結果，構音障害と摂食・嚥下障害の処方数，ならびに重複障害患者数に相対的な経年増加を認め，診療報酬改定を契機とした言語聴覚障害像の複雑化がうかがえた．また，失語症の重症度は軽度～中等度と最重度に二極分化しつつある可能性が示され，特に2009年の失語症患者の約30％は机上検査そのものの実施が困難であった．言語聴覚療法患者の転帰先は自宅50～60％，医療機関20～30％であり，これらの知見は言語聴覚療法患者の重症化を示唆していた．今後，多施設の回復期リハビリテーション病棟による大規模調査と併せ，患者実態に即した言語聴覚療法の指針作成が必要である．

　In order to find the changing trends in the characteristics of patients undergoing speech-language-hearing therapy in intensive rehabilitation wards, we examined the records of 2,061 patients who were hospitalized at our hospital and who had received speech-language-hearing therapy during the 7-year period from 2003 to 2009. Specifically, we looked at the speech-language-hearing therapy prescriptions, rates of multiple disorders, severity of aphasia, levels of activities of daily living, and patients' destination at discharge. Over the time, there was an increase in the number of patients who underwent rehabilitation for motor speech disorders, and/or eating/swallowing disorders(dysphagia) and those with multiple disorders. This indicated that the patients' speech-language-hearing disorders have become more complicated following the revision of the medical service fee. The severity of aphasia seems to be polarizing into two categories(mild to moderate, and the most severe), and regular testing was difficult in approximately 30% of patients with aphasia in 2009. At discharge, 50 to 60% of patients receiving speech-langauge-hearing therapy go home while 20 to 30% are referred to a medical center, which indicates that the severity of the patients has increased. Creating guidelines for speech-language-hearing therapy according to the current state of patients as well as large-scale investigations in intensive rehabilitation wards of multiple centers are now needed.