脳性麻痺の脊柱側弯変形に対する動的脊柱装具の介護者からみた効果の検討

Effectiveness of a New Dynamic Spinal Brace for Scoliosis in Cerebral Palsy

要旨　目的：脳性麻痺患者における脊柱側弯変形は日常生活動作に著しい障害をもたらす．我々は独自に開発した動的脊柱装具（Dynamic Spinal Brace：DSB）を用いた脊柱側弯変形に対する治療の有効性を患者，介護者の状況の変化において検討した．方法：DSB治療中の脳性麻痺患者222人を対象に，介護者へのアンケート調査および側弯変形のX線計測を行った．結果：アンケートでは日常生活動作において座位・姿勢で80％以上，介助（移乗，移動）・食事のしやすさは50％以上で改善を認めた．筋緊張は年齢が18歳以上の患者において改善を認めた．呼吸・筋緊張は側弯が高度なほど改善を認めた．結論：脳性麻痺患者の脊柱側弯変形に対するDSB治療は患者，介護者の座位・姿勢，介助や食事のしやすさの改善において有効性を認めた．また成長期以降の筋緊張や高度な側弯変形を有する患者の呼吸や筋緊張に対しても有効であると考えられた．

Abstract　Objective : Scoliosis in cerebral palsy can seriously disturb the patient's daily life. To help alleviate this we developed a new original orthosis and named it the Dynamic Spinal Brace (DSB)． In this study, we investigated the effectiveness of the DSB in daily life with patients and caregivers. Methods : We studied 222 cerebral palsy patients treated with the DSB. We carried out a questionnaire survey of the caregivers and measured X-ray results of the scoliosis deformities. Results：In the questionnaire, more than 80％ of the patients improved in their sitting position and posture and more than 50％ of the patients improved in the transfer or ambulation assistance and meal assistance requirement by the caregivers. Higher age (over 18 years old) revealed improved muscle tonus. Breathing and muscle tonus showed improvement as scoliosis was advanced. Conclusion : DSB for scoliosis in cerebral palsy showed effectiveness in the sitting position, posture, transfer or ambulation assistance and meal assistance. DSB is also effective for muscle tonus in patients after growth maturity and breathing and muscle tonus in patients with severe scoliosis.