回復期において脳梗塞後の上肢麻痺に対する課題指向型アプローチと機能指向型アプローチの上肢機能および使用行動に関する比較検討

Comparison of task- and impairment-oriented approaches for upper limb function and usage behavior among patients with upper extremity paralysis after cerebral infarction in the recovery phase

要旨：当院では脳卒中後の麻痺手に対し，課題指向型アプローチ（TOA）とTransfer packageおよび機能指向型アプローチ（IOA）とTransfer packageのプロトコルがある．今回，これらの差について報告する．対象はTOA＋Transfer package群7名とIOA＋Transfer package群6名でそれぞれの上肢機能（FMA）および麻痺手の使用行動（MAL/AOU，QOM）について比較検討した．結果，FMAは有意な変化を認めなかったが（p＝0.18），MALはTOA群がIOA群に比べ有意な変化を認めた（MAL AOU：p＝0.04，MAL QOM：p＜0.01）．よって，TOAは同じTransfer packageを実施したとしても，より効率的に練習で獲得した機能を生活に転移できる可能性が示された．

　In our hospital, protocols differ between the Task-oriented approach (TOA) and Transfer package (TP), and the Impairment-oriented approach（IOA) and TP for paralyzed hands after stroke. 13 subjects participated in the study: 7 in the TOA/TP group and 6 in the IOA/TP group. The upper extremity function (FMA) and the usage behavior of the paralyzed hand (MAL/AOU, QOM) were compared, and results indicated no significant change in FMA (p＝0.18), but MAL changed significantly in the TOA group compared to the IOA group (MAL AOU: p = 0.04, MAL QOM:p <0.01). These results suggest that TOA could transfer the functions acquired in practice to life more efficiently even if the same TP is performed.