小脳・脳幹梗塞後に重度球麻痺，中枢性低換気を呈した患者に対する包括的リハビリテーションの訓練経過—摂食嚥下リハビリテーションを中心に

Training process of comprehensive rehabilitation focusing on dysphagia rehabilitation for a patient with severe bulbar paralysis and central hypoventilation after brainstem infarction

要旨：片側性の小脳・延髄外側梗塞で重度球麻痺，失調症，中枢性低換気を呈した症例に対して，包括的リハビリテーション（以下，包括リハ）を実施した．主治医や呼吸サポートチームと連携し，人工呼吸器管理から離脱を図り，日常生活動作（以下，ADL）を改善した．また，栄養サポートチームとも連携して，栄養方法を確立し，嚥下造影検査を用いた積極的な摂食嚥下リハビリテーションを実施した．約1年間の入院後，経口摂取が可能となり，ADL自立の状態で自宅退院となった．人工呼吸器管理など重度の重複障害例に対しては，多職種による包括リハが必要となり，患者の機能予後に好影響を与えると考えられた．

　Comprehensive rehabilitation was performed for the patient with unilateral cerebellum and lateral medullary infarction who had severe bulbar paralysis, ataxia, and central hypoventilation. We collaborated with the primary physician and the respiratory support team to wean the patient off mechanical ventilation and improve activities of daily living (ADL). Furthermore, we determined a nutrition program in cooperation with the nutrition support team and performed active dysphagia rehabilitation by evaluating a videofluorography. After hospitalization for approximately a year, the patient's ADL improved, including oral intake, resulting in the patient being discharged to home. We inferred that comprehensive rehabilitation is effective for severe multiple disability cases such as mechanical ventilation and has a positive effect on the functional prognosis of patients.