脳損傷後の高次脳機能障害に対する包括的集中リハビリテーションの効果

The Effect of Comprehensive Intensive Treatment on Social Participation in Persons with Acquired Brain Injury

要旨：脳損傷者の社会参加（復職・復学）を目標とした多職種による集中的入院訓練プログラム（プログラムA）の効果を検討した．同時に家族支援・復職支援を含めた包括的リハビリテーション（以下，リハ）を行った．対象はプログラムA（1日6時間，週5日）を実施した脳損傷者17名（平均年齢30.5歳，男性 17例，女性0例）．プログラム開始から108.4±73.7日でFunctional Independence Measure（FIM），Wechsler adult intelligence scale（WAIS-Ⅲ）のPIQ，FIQ，リバーミード行動記憶検査（RBMT），Trail Making Test（TMT）が有意に改善した．プログラム非参加の対照群には有意な変化はなかった．対象は15例で対照は3例で復職・復学となった．集中的訓練プログラムの有効性が示された．早期の入院環境で包括的集中リハプログラムを行うことは社会参加を支援するうえで意義がある．

Abstract : The purpose of this study was to estimate the effect of our post-acute comprehensive intensive inpatient treatment (Program A) on persons with acquired brain injury in the hospital. Program A, designed for work or school, consists of daily six hours sessions for three months, personal and group sessions, and family support. It was designed to build cognitive and behavioral skills through a transdisciplinary approach and 17 patients with acquired brain injury were enrolled in the program. Seventeen program non-participants were selected as our control. Cognitive functions were measured with FIM, WAIS-Ⅲ, RBMT, and TMT before and after the program. Significant cognitive improvements (especially attention) and increased societal participation were obtained for the Program A participants compared with non-participants. Considering that Program A improved both the cognitive function and level of social participation in program participants, we suggest that it is valuable to perform intensive treatment programs in an inpatient condition for acquired brain injury patients.