内部障害のリハビリテーション：理論と実際

Visceral Rehabilitation : Theory and Practice

はじめに

　わが国は予想以上の速いペースで超高齢社会を迎えた．内部障害者数は急増し，2006年にはついに身体障害者総数の30％を突破し，肢体不自由者数と比較してその60％以上にも達した．また，内部障害の中での障害の重複化，特に心臓機能障害，呼吸器機能障害，腎臓機能障害の重複が目立ってきた．これまでの医療は寿命の延長（adding years to life），リハビリテーション（以下，リハ）は日常生活活動（ADL）や生活の質（quality of life：QOL）の改善（adding life to years）を主に目指してきたが，内部障害リハは生活の質の改善と寿命の延長（adding life to years and years to life）を達成できる医療である^1，2）．

　内部障害リハの対象疾患もますます拡大し，診療報酬改定においても普及のためのさまざまな配慮がなされてきている．運動療法やリハに取り組む各学会も規模を拡大し，会員数や発表演題数を着実に増やしている．このような状況から内部障害リハが，いまやすべてのリハ関連職種が精通すべき基本領域になったといえる．

　本稿では，内部障害リハの最近の進歩を踏まえ，心臓機能障害，呼吸器機能障害，腎臓機能障害，肝臓機能障害を中心にその理論と実際を述べる．

Abstract : Visceral impairment (VI), including cardiac, renal, pulmonary, hepatic, intestinal, urinary and rectal, AIDS is a worldwide public health problem. Recently, the number of patients with VI dramatically increased, reaching 30％ of the total population of disabled patients in Japan in 2006, which corresponds to 60％ of patients with limb impairment. Visceral rehabilitation (VR) is a coordinated, multifaceted intervention designed to optimize a patient's physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the disease, thereby reducing morbidity and mortality. VR includes five major components : exercise training, diet & fluid management, medication & medical surveillance, education, psychological & vocational counseling. VR is a feasible, effective (Class I, evidence label A) and safe secondary prevention strategy following VI, and offers a promising model for a new field of rehabilitation. Medical science basically aims to “Adding Years to Life” by increasing life expectancy. Rehabilitation generally aims to “Adding Life to Years” by helping patients with impairment achieve, and use, their full physical, mental and social potential. However, recent growing evidence suggests that rehabilitation for patients with VI not only improves exercise performance and quality of life, but also increases survival. Therefore, modern comprehensive rehabilitation for patients with visceral impairment does not simply aim to “Adding Life to Years” but “Adding Life to Years and Years to Life”, which is a new rehabilitation concept. Urgent efforts should be made to increase the implementation rate of VR.