運動機能の改善が見込まれた脳腫瘍症例に対する作業療法の経験

Occupational therapy for a brain tumor patient with expected improvement of motor function

要旨：覚醒下手術で右補足運動野と運動前野に広がる腫瘍が摘出された症例を担当した．術中評価で左環小指の随意性低下を認め，術後には，これらに加えて，つまみ動作を主体とした巧緻運動の能力低下を認めた．術後の頭部MRI所見から摘出部位周辺に浮腫を認めたが，錐体路の損傷はなく，浮腫の改善と腫瘍摘出後の機能代償作用により手指の運動機能が改善する可能性が推察された．左手指の巧緻運動に対する訓練を実施したところ，術後早期から左手のつまみ動作の著明な機能改善が認められ，その後も手指の巧緻運動に改善を認めた．術中・術後の運動機能の評価結果と，先行研究に基づいた作業療法が，予測された良好な機能改善をもたらした．

　Occupational therapy was carried out for a patient who received conscious surgery to resect a brain tumor in the right supplementary motor cortex and premotor cortex. Upon resection of the tumor, motor dysfunction of the left ring and little fingers appeared, and the surgery resulted in decreased skilled movement including pinching. Brain magnetic resonance images revealed edema surrounding the area of resection. However, the corticospinal tract including the primary motor area in the right hemisphere was spared, indicating improvement in movement. Occupational therapy included specific training programs which focused on finger function resulting in a significant improvement in skilled movement. The functional assessment during and after the conscious surgery, and occupational therapy based on previous studies could lead to predicted functional improvement.