認知運動療法の概念に基づいた中枢性片麻痺患者の上肢機能回復治療訓練の検討

Therapeutic effect of rehabilitation for the upper extremity of a patient with hemiplegia performed on the basis of the concept of cognitive therapeutic exercise

要旨：重度の右片麻痺患者の上肢機能回復治療訓練について，運動と「道具」の概念に基づいた認知運動療法を実施した．対象は，23歳の女性で上肢手指のブルンストロームステージはⅢ，感覚機能は正常であった．治療の結果，MFSの得点は導入前(19→28)と比較し導入後(28→76)に大きく上昇し，予後予測に基づき検討を行った結果，大きな改善が得られた．治療にあたっては，運動の意味を身体と環境の相互作用として検討する作業により治療課題を決定していく方略がとられた．この作業を通じて作業療法におけるアクティビティの意味を検討した．

　We performed cognitive therapeutic exercises to rehabilitate the upper extremity of a patient with severe hemiplegia. This therapy is principally performed on the basis of the concept of exercise and 'instrument'. The patient is a 23-year-old woman with Brunnstrom stage 3 of impaired motor functions of the upper extremity but with normal sensory functions. The MFS score dramatically rose up (28→76) after therapy, compared with the score obtained before therapy (19→28). Analysis on the putative prognosis of the patient demonstrated remarkable improvement. Upon treatment for the patient, we determined a series of exercise plans with her through a step-by-step exercise through which mutual relationships between physical and surrounding conditions can be understood by her. We examined the clinical significance of therapeutic exercise throughout this study.