小児総合医療施設における二分脊椎児のリハビリテーション診療

Rehabilitation Medical Services for Children with Spina Bifida at Children's Hospitals and Related Institutions in Japan

要旨

二分脊椎は，新生児期から成人期までライフステージごとに診療科横断的な治療が求められ，またさまざまなリハビリテーション診療が必要となる疾患である．本研究は，小児総合医療施設におけるよりよい二分脊椎児のリハビリテーション診療の実施につなげるために，その診療体制の現況を明らかにすることを目的として実施した．一般社団法人日本小児総合医療施設協議会会員施設を対象としたアンケートにより，調査を行った．二分脊椎を対象とした診療科横断的な連携は，小児総合医療施設の67％で行われていて，リハビリテーション科はほとんどの施設でその連携に参加していた．一方で，小児総合医療施設において整形外科急性期の運動器リハビリテーションは十分実施されているものの，回復期・生活期のリハビリテーション，教育機関・地域の療育施設との連携については十分実施されていない現状が明らかになった．小児リハビリテーション診療全般として，回復期・生活期のリハビリテーション診療については，療育センターなどの小児総合医療施設以外の施設で実際行っている，行うのが望ましい，との回答が多く，小児リハビリテーションにかかわる人材の確保・育成を含めた適切な診療体制や，地域施設との連携体制の構築が，二分脊椎のリハビリテーション診療を含むよりよい小児リハビリテーション診療を実施するために求められると考えた．

Spina bifida is a disease that requires cross-disciplinary treatment for each life stage from the neonatal period to adulthood. Various rehabilitation therapies are required depending on the life stage of patients. In this study, we aimed to clarify the current status of rehabilitation services at children's hospitals in order to improve quality of rehabilitation care for children with spina bifida. We performed a survey targeted at the Japanese Association of Children's Hospitals and Related Institutions. The framework of the cross-disciplinary co-operation of medical treatments for spina bifida existed in 67% of children's hospitals surveyed. In most of these hospitals, the departments of rehabilitation medicine participated in these frameworks. In the medical treatment for children with spina bifida, acute phase rehabilitation after orthopaedic surgery was adequately provided in children's hospitals. However, convalescent and community-based phase rehabilitation therapies, and the co-operation with education institutions or habilitation/rehabilitation facilities for children were determined to be inadequate. Regarding general paediatric rehabilitation, convalescent and community-based phase rehabilitation therapies were mainly provided outside children's hospitals：habilitation/rehabilitation facilities for children mainly provided convalescent and community-based phase rehabilitation therapies and were considered to be the desirable setting for such therapies. To improve paediatric rehabilitation, including the rehabilitation for children with spina bifida, several factors need to be considered. These include the construction of appropriate frameworks for medical services (such as personnel training and the recruitment of rehabilitation doctors, therapists, and related staff), and co-operation with regional education institutions or habilitation/rehabilitation facilities for children.