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要旨:当院で在宅訪問診療を行っている筋萎縮性側索硬化症(ALS)患者の在宅リハビリテーション実施状況と訪問主治医の役割を検討することを目的とした.2001年4月から2006年12月までの間,ALSの診断名で在宅訪問診療を開始した7例(男性4例,女性3例,平均年齢65歳)を対象とした.初診時の移動能力は室内介助例を含め全例歩行可能で,呼吸器や胃瘻の使用症例はなかった.最終評価時,2例は気管切開後人工呼吸器を装着し,それぞれ胃瘻または中心静脈による栄養管理のもとADLは全介助状態であった.訪問リハビリテーションは5例で実施されたが,リハビリテーションの必要性はALSによる身体状態,介護力,支援制度の利用状況,疾患の受容状況などにより個別性が認められた.家族や在宅支援各職種との連携は不可欠であるが,それらを介した日常的なリハビリテーション設定も有効と思われた.在宅訪問医は患者や家族の自己決定を支持しつつ,生活を基盤とした視点での対応も求められる.
Abstract : This study is aimed at reviewing both the rehabilitative program and the role of the home visit physician regarding ALS patients living at home. Seven ALS patients were chosen as subjects for this study. Two of these patients required a mechanical ventilation system and nutritional support such as gastrostomy or central venous infusion, and all patients were found to be totally dependent on their physical care for activities of daily living. Although home visit rehabilitation services were planned for 5 of the patients, it was found that the individual rehabilitation needs of each patient differed depending on the progression of the ALS or the patient's impairment, the level of care that can be given, public support system usage, and the patient's acceptance of their ALS. Cooperation between family members and multidisciplinary care members was essential for effective daily management of the medical and rehabilitation needs of these patients. The home visit physician should provide appropriate care from the viewpoint of the patient's life, based on the decisions of the patient and their family.
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