外来で促通反復療法導入によって片麻痺上肢機能改善が認められた1症例

Functional recovery of a hemiparetic stroke patient after outpatient rehabilitation using a newly designed repetitive facilitation exercise

要旨：川平が提唱する促通反復療法は1パターン100回実施により脳卒中片麻痺上下肢が機能回復すると報告されている．今回，訓練時間や回数が少ない通院作業療法（以下，外来リハ）で脳卒中片麻痺患者に促通反復療法を実施した．通院は週3回，1回1時間の機能回復訓練の中で，促通反復療法9パターン100回と箸操作やペグ操作などの上肢機能訓練を取り入れた結果，5ヵ月後に上田式12段階片麻痺テストで上肢がgrade 7から11，手指がgrade 10から11，簡易上肢機能検査で19点から87点と上肢機能が改善し，食事で自助箸を使うなど麻痺側上肢の使用が増えた．退院後も外来リハで促通反復療法を行うことは片麻痺機能回復に有効であると考えた．

　A new repetitive facilitation exercise using 100 repetitions of each pattern has been reported to improve movement in hemiplegic upper limbs and fingers. In this study, we applied the repetitive facilitation exercise to the hemiplegic upper limb of a stroke patient in outpatient rehabilitation within the sixty-minute time limitation set by medical insurance.

　The patient hoped to recover functional use of his hemiparetic hand and agreed to 60 minute sessions in outpatient rehabilitation 3 times a week using the repetitive facilitation exercise (100 times, 9 patterns each). He was treated with the repetitive facilitation exercise and with comprehensive occupational training, including manipulating pegs and using chopsticks. After 5 months of outpatient rehabilitation, the patient improved from grade 7 to 10 in Ueda's Grade of the upper limb, from grade 10 to 11 in Ueda's Grade of the fingers, 11 Points to 84 points in the Simple Test for Evaluating Hand Function (STEF), and recovered using chopsticks while eating.

　In conclusion, the new facilitation repetitive exercise of 100 times per pattern is effective in functional recovery of hemiparetic upper limbs and hands for outpatient rehabilitation.