脳梗塞急性期における片麻痺上肢への促通反復療法と持続的低周波電気刺激法の同時併用療法による運動機能と浮腫の改善

Effects of Repetitive Facilitation Exercise Combined with Continuous Low-frequency Electrical Stimulation on Upper-limb Motor Impairment and Hand Edema during an Acute Phase of Cerebral Infarction

要旨　目的：脳梗塞急性期の片麻痺上肢への促通反復療法を持続的低周波電気刺激下で行う同時併用療法が麻痺と浮腫，関節可動域に及ぼす影響について検討した．対象：対象は2011年4月から2年間に当院に入院した急性期脳梗塞片麻痺患者で，片麻痺と麻痺側手に浮腫があった患者30名である．方法：単盲検無作為化比較試験を用い，促通反復療法と持続的低周波電気刺激との同時併用療法群（介入群）と関節可動域訓練群（対照群）に割付け，それぞれの治療を30分，2週間実施した．効果の評価はUpper Limb Fugl-Meyer Assessment（FMA），浮腫の測定，関節可動域テストを治療の前後に行った．結果：治療によって，介入群は全ての評価が有意に改善した．対照群はFMAに有意な改善を認めたが浮腫と関節可動域は改善がなく，改善度も介入群がFMAと浮腫，関節可動域で対照群より有意に大きかった．結語：促通反復療法と持続的低周波電気刺激の同時併用療法は，急性期片麻痺上肢の運動麻痺回復と麻痺側手の浮腫軽減を促進する．

Abstract　Purpose : To study the effect of repetitive facilitation exercise combined with continuous low-frequency electrical stimulation on upper-extremity motor impairment or hand edema during the acute phase of cerebral infarction. Subjects : Thirty inpatients with both hemiplegia and hand swelling, who were admitted to a hospital from April 2011 to March 2012. Methods : In this randomized, controlled, observer-blinded trial, we randomized the subjects into two groups and provided treatment on a 2-week, 30 minutes/day schedule. Subjects in the intervention group received repetitive facilitation exercise concurrent with continuous low-frequency electrical stimulation, while subjects in the control group were provided passive range-of-motion (ROM) exercise. Upper Limb Fugl-Meyer Assessment (FMA), edema and passive ROM were evaluated at baseline and at two weeks. Results : At two weeks, the intervention group showed significant improvements on all measurements. However, the control group showed significant improvement only in their FMA. The intervention group had significantly greater improvements than the control group on all three measurements. Conclusion : Repetitive facilitation exercise concurrent with continuous low-frequency electrical stimulation therapy is effective not only for recovery from motor impairment but also for reducing swelling of the hand during the acute phase of cerebral infarction.