広汎性発達障害（自閉スペクトラム症）のある髄芽腫症例に対するリハビリテーション治療

Rehabilitation Treatment of Medulloblastoma in a Patient with Pervasive Developmental Disorder (Autism Spectrum Disorder)

はじめに

　髄芽腫は，主に小児の小脳に発生する悪性脳腫瘍であり，日本脳脊髄腫瘍統計によると1984〜2000年の5年生存率は48.3〜52.5％と報告されているが¹⁾，手術・放射線治療・化学療法は進歩しており，2006年の欧米の報告では，5年生存率は70〜85％と報告されている²⁾．このように，治療成績の向上により，治療後に復学指導を行う機会が増加すると予想される．

　今回，われわれは広汎性発達障害（現在の自閉スペクトラム症）をもつ中学生の髄芽腫症例に，入院中のリハビリテーション治療と復学指導を行った．発達障害に小脳損傷に起因する失調症状が加わった重複障害児例である．厚生労働省および文部科学省の調査によると，発達障害児は今後もさらに増加する傾向にある^{3, 4)}ことから，本事例を通して，こうした重複障害事例のリハビリテーション治療について，文献的考察を含めて報告する．

　なお，本症例報告にあたり，患児のご両親に書面で同意をいただいている．

We provided inpatient rehabilitation treatment and return-to-school guidance to a junior high school student with medulloblastoma and pervasive developmental disorder (autism spectrum disorder). Here we describe the rehabilitation treatment for patients with physical and developmental disabilities. A 13-year-old boy who was diagnosed with pervasive developmental disorder at 4 years of age was able to perform activities of daily living independently and attend junior high school. However, he was admitted to our hospital with new-onset ataxia. Magnetic resonance imaging revealed a cerebellar tumor. After total tumor excision was performed, pathological analysis revealed medulloblastoma, which was treated initially with radiation therapy and then chemotherapy for 1 year. Rehabilitation was initiated 2 days post-surgery. We evaluated his communication abilities. He showed stereotypical behavior owing to the autism spectrum disorder；therefore, we performed low-intensity repetitive exercises. The functional independence measure score at discharge was 67/126 (motor 44/91, cognitive 23/35). We taught his teachers how to properly assist him, and he successfully returned to school post-discharge. Although this was a case in which the child had multiple disabilities, ataxia caused by the medulloblastoma aggravated his developmental disability. Thus, understanding the characteristics of communication and its strengths was vital in determining a treatment plan that enabled his return to school.