慢性期片麻痺の上肢に対し促通反復療法が有効だった小児の1例

Functional improvements of chronic severe upper limb hemiplegia by Repetitive Facilitation Exercise in a child with acquired cerebral hemorrhage

要旨：促通反復療法は『脳卒中治療ガイドライン2015』において推奨される治療法（グレードB）であるが，これまで小児例への実施の可否や治療効果を検討したものは極めて少ない．今回，脳出血を発症し重度片麻痺を呈した小児例を経験した．発症後1年から促通反復療法によるリハビリテーション（以下，リハ）を受け，当院での外来リハを継続した結果，麻痺側上肢と手指に機能の改善を得ると同時に，学校活動や遊びを通じた上肢の使用促進と強化を認めた．促通反復療法が，成人片麻痺だけでなく小児においても有効である可能性が示された．入院によるリハ後も，麻痺の機能に応じ効率的かつ継続的に提供できるリハのサポート体系・体制づくりが求められる．

　Repetitive Facilitation Exercise is a grade B therapy recommended in the 2015 Japanese Guidelines for the management of stroke. However, no reports have described its application or therapeutic effect in pediatric cases. We report on a 7-year-old female child with severe hemiplegic limb following acquired cerebral hemorrhage. Treatment with Repetitive Facilitation Exercise was initiated one year after onset. We were able to reduce paralysis of the upper limb, promote functionality and strengthen her upper limb use during activities and play peculiar to young children. On Ueda's 12-grade motor function test, the function of her upper limb and fingers improved from 6 to 10 and 1 to 5, respectively. Repetitive Facilitation Exercise is expected to improve functional plasticity after stroke in both adults and children. We strongly recommend that children with stroke receive high quality therapy as soon as possible. Furthermore, a medical system and framework for long-term therapy should be established in parallel with school enrollment and/or return to school.