病棟参加型Transfer packageによるCI療法が麻痺手の参加頻度へ及ぼす影響

Effects of CI therapy on paralyzed hands of stroke patients using transfer package of a hospital ward

要旨：麻痺手の実使用を増やすためにCI療法のTransfer package（以下，TP）を修正し，病棟と協業することを目的とした．修正TPは以下の手順で実施した（①TPの対象となる活動の映像を撮影，②看護師に動画を用いて伝達，③ADLで病棟看護師が動画を参考に実動作を指導）．対象者は回復期病棟入院中の4名とした．4症例の変化量の結果を以下に示す．4症例ともにMotor Activity Log（以下，MAL）のQuality of Movement（以下，QOM）が向上した．本研究では，2症例が先行研究のMAL（QOM）の臨床上重要な最小変化量を超えた．病棟での看護師によるTPは，麻痺手の使用行動に良い影響を与える可能性がある．

　Purpose: In Constraint-induced movement therapy (CI therapy), we modified the methodology of transfer package to be able to increase the real-world use of the affected arm by collaboration between therapists and nurses in a hospital ward. Method: We modified the transfer package as follows: 1) The therapist photographed the exercises of the target activity of transfer package; 2) The therapist conveyed the precise exercise context to the nurses using the photographs;and 3) In real activities of daily living, nurses instructed the precise movements of the target activity of transfer package to the patients, referring to the photographs taken during exercise time. The participants in this study were 4 patients in a convalescent rehabilitation ward. Results: Four patients exhibited an improvement of Quality of Movement scores (QOM) in Motor Activity Log (MAL). Conclusion: The QOM scores in MAL of 2 patients in participants improved more than minimal clinically important difference defined by previous studies. Therefore, these results indicate that modified transfer package might influence the behavior of the affected arm in the real world for subacute stroke patients.