回復期リハビリテーション病棟における脳卒中片麻痺患者の運動麻痺重症度別の経時変化

Changes in the Affected Side Motor Function According to the Severity of Motor Paralysis in Hemiplegic Stroke Patients during Convalescent Rehabilitation

要旨　目的：回復期リハビリテーション（以下，リハ）病棟入院期間中の麻痺側運動機能の経時変化を，部位別・重症度別に分析した．方法：対象は当院回復期リハ病棟に入院し，FIT Programを実施したテント上に一側性病変を有する初発脳卒中片麻痺患者1903名である．重篤な併存症，入院中の再発・急変，発症から当院入院までの期間が61日以上の患者を除外した1634名を対象とし，この中から，入院から8週間以上入院した917名を選択した．入院時から2週毎にStroke Impairment Assessment Set（SIAS）の麻痺側運動機能5項目を評価した．結果・結論：歩行やADL訓練を主体に1日中活動的に過ごした脳卒中患者の麻痺側運動機能は，回復期リハ病棟入院時から8週時にかけて有意に改善した．また，上肢項目よりも下肢項目，遠位部よりも近位部の運動麻痺が改善しやすく，その傾向は重度麻痺ほど顕著であった．

Abstract　Objective : We analyzed changes in the affected side motor function according to the region and severity of motor paralysis in patients during convalescent rehabilitation. Methods : The subjects recruited were 1,903 hemiplegic patients with primary stroke from a supratentorial unilateral lesion, for which a full-time integrated treatment (FIT) program was implemented. We excluded patients with severe complications, those in whom the stroke recurred or its condition rapidly changed during hospitalization, and those in whom the duration from the onset to admission to our hospital was 61 days or longer. The remaining 1,634 patients served as the study subjects, from among whom we chose 917 patients who had been hospitalized for 8 weeks or longer. The affected side motor function was assessed using 5 motor items of the Stroke Impairment Assessment Set (SIAS) every 2 weeks starting from admission. Results and Conclusion : The affected side motor function significantly improved from admission to a convalescent rehabilitation ward through to week 8 in stroke patients, who were actively engaged in daily routines and had mainly walking and ADL exercise. In addition, improvement was more likely to occur for the lower-limb compared to upper-limb, as well as for the proximal compared to distal motor function. This tendency was more marked for more severe cases of paralyses.