慢性期脳卒中後の上肢運動障害に対するTransfer packageを中心とした週1回20分の外来作業療法の取り組み—事例報告

A trial of the transfer package to treat outpatient occupational therapy 20 minutes per week for affected arm dysfunction in chronic phase from stroke onset: A case report

要旨：学習性不使用による慢性期脳卒中後の上肢運動障害に対し，Constraint-induced movement therapy（以下，CI療法）の主要コンセプトであるTransfer packageを，外来作業療法にて実施した．低頻度（週1回20分）であったが，4ヵ月後には臨床上重要な最小変化を大きく超える，麻痺手の使用行動と上肢機能の改善を認めた．さらに，事例が目標とした活動の多くを獲得することができた．CI療法は，訓練時間や医療保険適応の問題が指摘されているが，事例の状態によっては，必要なコンセプトを中心に，低頻度の介入でも効果が得られる可能性が示唆された．

　OT outpatient treatment for arm dysfunction caused by learned non-use of the affected arm of a stroke patient included the transfer package as one of the main concepts of Constraint-induced movement therapy (CI therapy). Through low frequency intervention over a short time (20 minutes per week), the upper-extremity function of the patient improved more than the minimal clinically important difference 4 months after onset of intervention. Additionally, the patient was able to achieve many pre-intervention goals. Several researchers have indicated that CI therapy has problems related to manpower and insurance costs. However, this case study showed that patients in good condition might improve their affected arm function and use in the real world in a short time through low frequency intervention.