脳卒中後の上肢麻痺に対する運動観察療法（AOT）の有効性および作業療法への適用可能性

Application of action observation therapy for upper limb hemiparesis after stroke in occupational therapy

要旨：脳卒中上肢麻痺に対し，目的動作の動画観察後に動作を練習する治療法（運動観察療法；以下，AOT）がある．その有効性は示されつつあるが臨床適用に必要な情報は十分ではない．本研究では，AOTの作業療法での適用を検討するため先行研究を整理した．結果，12論文が抽出され，AOTの有効性・臨床的有意性は，回復期と維持期，軽度麻痺と中等度麻痺に示された．課題志向型訓練を段階づけて毎日行う実施方法はほぼ共通であったが，その他は多様であった．AOTは，患者の負担も少なく特別な機器や手技を必要とせず，治療前に自主訓練として動画観察させると治療時間が有効活用できる．AOTは作業療法の有用な治療法となりうるが，実施方法は検証の必要がある．

　Action observation therapy (AOT), which involves observing target motions with a monitor before physical practice, has been focused on recently as an approach for upper limb hemiparesis after stroke. The effectiveness of AOT has been shown in previous studies; however, they did not show details such as subjects' characteristics, and the procedures were insufficient for clinical application. This paper reviews previous studies, from March 2007, focusing on clinical application of AOT. Twelve papers were extracted and the effects of AOT were proved in moderate hemiparesis in convalescent phase and mild to moderate hemiparesis in chronic phase. The common procedures of AOT in the twelve studies, were “performing graded task-oriented training every day”. However, the procedures of AOT were diverse in terms of treatment period, time structure, and so on. AOT could be a potential treatment in occupational therapy because it has a low burden on patients, and its instruments and procedures are simple. Observing videos prior to physical practice in occupational therapy could enhance the treatment effect. Further studies on the AOT protocol are necessary for more effective clinical application.