リストバンド型活動量計を用いた継時的な上肢活動量計測によって日常生活における麻痺手使用が促進された脳梗塞後右片麻痺の1例

Prompting affected arm use in the real-world by measuring upper limb activity with 3-axis accelerometry: A case report

要旨：右上肢麻痺を呈した亜急性期脳梗塞患者1例に対して，リストバンド型活動量計を用いた行動心理学的介入（Transfer Package）を行った．作業療法介入は，第17病日から1回2時間，週3回，計10回行った．また上肢活動量計測は1週ごとに実施し，対象者に示した．その結果，麻痺側上肢機能と日常生活における麻痺手の使用頻度は改善し，外来終了2ヵ月後にも維持された．上肢活動量の客観的計測は，対象者と作業療法士の双方が麻痺手の使用状況を客観的に振り返ることができ，Transfer Packageをより効率化できると思われた．今後はケースシリーズ研究や比較研究を行い，その有効性を確認する必要がある．

　We describe the case of a male patient suffering from stroke induced right hemiplegia, who received behavioral training with activity monitoring of the affected arm to improve real-world use of the paretic arm and hand. The intervention was administered in an outpatient unit for 2 hour intervals, 3 times a week for a total of 10 times. The training conformed to the behavioral strategies (transfer package) in constraint-induced movement therapy. Paretic arm activity in daily life was monitored every week, and the results were reported to the patient. Following training, the function of the paretic upper limb and real-world arm use improved. The effect was maintained even 2 months after completion of the training. Both the patient and occupational therapist were able to objectively review the degree of functioning of the paretic hand via arm activity monitoring. We concluded that real-world arm activity monitoring can be a useful tool to enhance the effectiveness of transfer package.