脳卒中回復期において上肢の中等度麻痺に対し装具および電気刺激療法を併用したCI療法の取り組み—退院後1年間の経過調査

Efficacy of CI therapy combined with orthosis and electrical stimulation therapy for moderate arm paresis in stroke convalescence: Investigation of progress one year after discharge

要旨：脳卒中回復期にCI療法の適応基準外の中等度上肢麻痺の症例に対し，装具・電気刺激療法を併用した集中練習（課題指向型訓練と長期効果に影響を与えるTransfer package（以下，TP））を実施した．結果，入院期間中の介入前後に上肢機能の改善を認め，日常生活における麻痺手の使用頻度は向上した．しかし，退院1ヵ月後には，上肢機能と日常生活での麻痺手の使用頻度が低下した．これに対し，入院中の介入と同様のコンセプトで，週1回の外来リハビリテーションを実施した．その結果，1年後には若干の改善を認めた．したがって，中等度以下の上肢麻痺に対して従来のTPでは不十分であり，追加のフォローが必要であると考えられた．

　We treated subacute stroke patients with moderately affected arm function who met the exclusion criteria for constraint-induced movement therapy, using task-oriented intensive training and transfer package (TP) whose intervention had long-term effects for arm function. This was combined with both electro-stimulation and orthosis therapies. After the intervention, the affected arm function and amount of arm use in activities of daily living improved during inpatient settings. However, one month post-intervention, the affected arm function and amount of arm use in activities of daily living decreased again. By treating the affected arm function and amount of use in activities of daily living using an approach similar to intervention in inpatient settings once a week, the affected arm function and amount of use in activities of daily living improved. However, the arm function failed to improve as much as the original intervention in the inpatient setting. Therefore, we thought that the traditional TP might be insufficient to maintain arm function after the intervention, and additional treatment is required in concert with traditional TP.