脳血管障害患者の機能的ゴール達成時期に関する検討

Length of stay in the rehabilitation hospital required for the attainment of functional goals in adult patients after cerebrovascular accidents

要旨：身体機能障害の固定の時期は発症後6カ月とされているが，発症後180日前後での機能的状態の変化の有無，変化の見られなくなるまでの期間について検討を行った．運動機能，知的機能，ADLともに有意な改善を認めた．本研究で機能的状態の変化が見られなくなるまでの期間は発症後6カ月，入院後3カ月であることが示されたが，発症からの期間は患者間でばらつきが大きく，妥当なリハ期間は一概に発症後6カ月とはせず，患者の身体機能・高次脳機能の状態や合併症の有無を考慮し，柔軟に設定されるべきであると考えられた．リハゴールの達成を全人的に考えると社会参加・QOLや環境整備などを考慮したより包括的なアプローチが必要である．

　For adults who have suffered cerebrovascular accidents (CVA), it has been said that their physical impairments become fixed at about six months from onset. However, there are few studies which attempt to examine the legitimacy of this notion. In this study, data on CVA inpatients at Nozomi Hospital were analyzed to determine : (1) whether they show functional changes either during or after the first 180 days following the onset of stroke, and (2) when a functional plateau can be said to have been reached. This study utilized demographic data, findings from medical records, and results of functional tests, including the Motor Age Test, the Mini-Mental State Examination, and the Barthel ADL Index. To acquire empirical data for verification of (1), T-tests of these indices were administered to eighty-six patients. The results revealed significant changes in tested functions both during and after the initial 180 day period. Analysis of data on an expanded group of 228 patients showed that they generally reached their functional plateau at six months after the onset of CVA, or three months after their hospitalization. More variation was noted when measuring from the onset of CVA than when measuring from the start of hospitalization.

　Case examples are also presented to show the reasons why some patients needed long-term rehabilitative treatments. Patients with severe physical problems, cognitive deficits, internal diseases, and/or secondary problems due to functional disuse or misuse seemed to require longer times of rehabilitation to reach their maximum ADL skills. A young patient with a memory deficit who stayed in the hospital more than seven months from the onset of CVA in order to receive prevocational training is also presented. The length of rehabilitation treatment and its goals should be determined following careful evaluation of the patients' physical and cognitive states.