低頻度の通所リハビリテーションによって麻痺手の機能改善を示した脳卒中後重度片麻痺の一例

Functional improvement of the paralyzed hand by infrequent day-care rehabilitation in severe post-stroke hemiplegia: A case study

要旨：通所リハビリテーションを利用する脳卒中慢性期の重度上肢機能障害例に対し，ボツリヌス療法と，Constraint-induced movement therapy（以下，CI療法）に準じた課題指向型練習やTransfer packageを併用して介入した．1回20分の介入を週2回，約1年間継続したところ，麻痺手の運動機能や使用頻度，痙縮の程度がいずれも測定誤差を超えて改善した．加えて，ボツリヌス療法における施注量が減少し，定期であった施注間隔も長くなった．低頻度であっても適切な介入を実施することで，慢性期の重度上肢麻痺を改善できる可能性が示唆された．

　In this study, we intervened in a case of severe upper limb dysfunction in chronic stroke patients using day-care rehabilitation by combining botulinum therapy with task-oriented exercises and a transfer package similar to constraint-induced movement therapy (CI therapy). After one year of 20-minute interventions twice a week, the motor function, frequency of use, and degree of spasticity of the paralyzed hand improved beyond the measurement error. In addition, the amount of botulinum therapy administered decreased, and the interval between injections increased. The results suggest that appropriate interventions, even at a low frequency, can improve severe upper limb paralysis in the chronic phase.