近位部に優位な麻痺を呈した急性期脳卒中症例の上肢機能に対し課題特異型訓練と課題指向型訓練を組み合わせた介入の効果

Effects of task-specific training and task-oriented training for proximal dominant paresis of the upper extremity in an acute stroke patient: A case study

要旨：上肢近位部に優位な麻痺を呈する脳卒中片麻痺事例に対し，肩周囲から肘にかけての近位機能に対しては課題特異型訓練，随意運動機能が比較的良好な手関節および手指の遠位機能に関しては課題指向型訓練を行う，という部位別の機能水準に沿った作業療法介入を試みた．先行した作業療法介入期間と比較したところ，Fugl-Meyer AssessmentおよびAction Research Arm Testにおいて改善程度がより大きいことが確認され，Fugl-Meyer Assessmentの改善程度は臨床的に意義のある最小変化量を超えていた．部位により麻痺の程度が異なる事例には，その水準に応じた介入が効果的である可能性が示唆された．

　We performed task-specific training in proximal parts and task-oriented training in distal parts for a stroke patient with severe paralysis in proximal parts of the upper extremity. Comparing this intervention with the usual occupational therapy resulted in changing the scores of both the Fugl-Meyer Assessment and the Action Research Arm Test. In addition, the improvement of the Fugl-Meyer Assessment exceeded minimal clinically important differences. This case study suggests that depending on the stage of recovery of each part of the upper extremity, upper extremity paralysis training in stroke patients is important in choosing appropriate treatments.