重度失調患者への動作再獲得のための段階的な誘導介助方法

Supports with step-wise guidance for daily activities restoration in severe ataxic patients

要旨：クモ膜下出血による重度失調と軽度右片麻痺の症例に，ADLの介助量軽減を目的に誘導介助を行いながら失調を軽減させる訓練を実施した．結果，坐位の安定と食事動作自立を得た．しかし，排泄動作は誘導介助のみでは動作可能にならなかった．これは，立位保持をはじめ，立ち上がりや足踏み等，排泄動作を構成する個々の動作が不安定なためであった．そこで，排泄動作という一連の動作を細かく11段階・5期に段階付け，その個々の動作を誘導介助し，反復して安定させた上で，次の段階へと順次進めた．4期までに必要な基本動作を習得させ，5期に自宅トイレの状況をシミュレーションした訓練を行い，結果，1年半で排泄動作を自立させ得た．

　The patient had severe ataxia and mild hemiplegia on the right side, secondary to subarachnoid hemorrhage and cerebellar arteriovenous malformation. Training under loads resulted in little alleviation of the symptoms of ataxia in pertaining to the capability to remain sitting or to move the right arm. We therefore provided another training, involving assistance to motion, to the patient for the purpose of restoring the capability to remain sitting and to move the right arm. This training alleviated ataxia and allowed the patient to eat unassisted. Following this result, we provided additional training to alleviate ataxia of the right arm, trunk and lower extremities, with the ultimate goal of making it possible for the patient to urinate and evacuate without assistance. This training was provided two or three times a week for 1.5 years at the outpatient clinic. To improve the performance during motion, the motions of standing and walking were divided into 11 stages, and assistance was given at each point when a motion was followed by another motion during each stage, so that the patient could change one body position to another position supporting the new center of gravity in a safe and reliable manner, while ensuring the stability of each position to support the center of gravity. The ease/difficulty of motion was rated at multiple stages, from the first to last stages of motion. The results indicate that guiding the patient to advance one motion to another in a step-wise manner is useful in helping the patient to restore activity.