HAM（HTLV-1 associated myelopathy）患者に対するリハビリテーションの有効性

Efficacy of Rehabilitation for Patients with HAM（HTLV-1 associated myelopathy）

要旨：HAM患者は，排尿障害を伴う痙性対麻痺を呈し下部体幹及び骨盤・股関節周囲筋の筋力低下が特徴的であった．これまでに，HAM患者のリハビリテーション（以下，リハ）に関する報告は少なかった．我々は，下部体幹及び骨盤・股関節周囲筋の筋力増強訓練を中心としたプログラムを作成しリハの有効性を検討した．対象は，男性2例，女性10例の12例で，平均年齢53.2歳，平均罹病期間20.5年間で，平均リハ日数41日であった．リハ前後で納の総合運動機能評価OMDS及びFIM，Barthel Indexにて改善を認めた．そして，リハ実施後の下部体幹では体幹屈筋群，体幹伸筋群，体幹回旋群が有意に改善し，股関節周囲筋では腸腰筋，大殿筋，中殿筋でも有意な改善がみられた．この運動機能やADLの改善は，HAM患者では罹病期間は長いがリハの経験も少なく神経原性変化も軽かったので，リハの有効性を示唆している．

Abstract : The effectiveness of rehabilitation in patients with HTLV-1associated myelopathy (HAM) was evaluated. The HAM patient is characterized by chronic progressive spastic paraplegia with dysuria and muscular weakness of the lower trunk, as well as the pelvic and hip muscles. However, the muscular strength of the lower limbs and feet is relatively well maintained. The 12 subjects enrolled in this study included 2 men and 10 women. Their average age was 53.2 years, their average duration of disease was 20.5 years, and they were involved in training for an average of 41 days. The rehabilitation program involved muscular strength training of the lower trunk, pelvic, and hip muscles. After all patients completed the rehabilitation program, a significant improvement was seen in the truncal flexors, the truncal extensors, and the truncal rotators in the lower trunk. As for the hip muscles, a significant improvement was seen in the iliopsoas, the gluteus maximus, and the gluteus medius. The improvement was evaluated using Osame's Motor Disability Score (OMDS), the Functional Independence Measure (FIM) and the Barthel Index. The patients' improvements in motor function and ADL suggest that rehabilitation was effective.