促通反復療法：最近の知見

Repetitive Facilitative Exercise : Recent Developments

はじめに

　近年，脳卒中片麻痺上肢に対して機能回復を促すための新しいアプローチが次々と開発され，その有効性が示されてきている^1～4）．これらのシステマティックレビューやメタアナリシスによると，有用なアプローチにまず共通する要素は，訓練量を増やす，すなわち訓練の時間を長くする，あるいは訓練の頻度（反復回数）を増やすことにある．次に大切な要素は訓練の内容，すなわちどのようなことを行うかということになるが，課題関連的（task-related），あるいは目的志向的（task-oriented）な訓練，すなわち，ある課題や動作を獲得するために集中的に特定の課題に取り組む，あるいは患者に必要な課題の獲得を目標に掲げて取り組むことが有用と考えられている．そこで，近年Constraint induced movement therapy（CI療法）^5）やロボティクス治療^6），両上肢の繰り返し運動^7），ミラーセラピー^8），筋力増強訓練^9），課題関連的バーチャルリアリティー^10）など多くの訓練法がいずれも運動機能を向上させうる治療法としてエビデンスが蓄積されつつあるが，これだけ多種多様に存在するということは，訓練の内容にかかわらず，共通する訓練量の増加が重要な要素であることは明白であろう．

Abstract : Recent systematic reviews have demonstrated that increases in either the time devoted to or number of repetitions involved in an intervention are associated with improved functional outcome. The nature of the therapy delivered also appears important : task and context specific approaches may be particularly promising. Repetitive facilitative exercise (RFE), a combination of high repetition and neurofacilitation, is a recently developed approach to the rehabilitation of stroke-related limb impairment. We conducted a randomized controlled evaluation of RFE compared with a duration-matched conventional rehabilitation program in the treatment of subacute stroke-related upper extremity impairment (Shimodozono et al, 2013). The study's primary and secondary outcomes were, respectively, improvement in motor function as measured by the Action Research Arm Test (ARAT) and improvement in motor control as measured by the Fugl-Meyer Arm Motor Scale (FMA). As a result, RFE, at least during the subacute phase of stroke, demonstrated both statistically and clinically significant benefits over conventional rehabilitation in improving upper-limb motor function. In addition, the findings on ARAT were mirrored by a lessening of stroke-associated impairment, FMA. Recently, the benefits of RFE have been reported not only by our colleague but also by researchers in other facilities. More research is needed, but RFE could conceivably be integrated with other approaches to achieve further improvement in its capabilities.