急性期脳卒中後の上肢麻痺に対する修正CI療法の1年後経過—ケースシリーズ研究

A one-year follow-up after modified constraint-induced movement therapy for acute stroke patients with a paretic arm: A case series study

要旨：本邦では，急性期でのCI療法後の長期経過を観察した研究は見当たらない．今回，急性期にて1日2時間以内の修正CI療法を実施した複数の対象者について，介入から1年後までの長期間の追跡調査を行い，麻痺側上肢の回復経過を観察した．結果，FMA，MALともに，介入後・介入1年後と時点の固定効果で有意な差を認めた．またMALは，短期・長期ともにMCIDを超える変化を認めた．さらに，長期的なFMAの改善は，MALと強い関連があることが示された．本研究から，急性期においても適応患者によっては，修正CI療法が長期的にも上肢機能と麻痺手の使用行動に良好な変化を与える可能性が示唆された．

　In Japan, there are no long-term follow-up studies of CI therapy of stroke patients in the acute phase. This study conducted a long-term follow-up study of several subjects in the acute phase who received modified CI therapy for 2 hours or less per day up to 1 year after the intervention and observed the progress of recovery of the paralyzed upper limb. Results showed significant differences in both FMA and MAL in the fixed effects at post-intervention and 1-year post-intervention. MAL showed changes that exceeded MCID in both the short- and long-term. Furthermore, long-term improvement in FMA was strongly associated with MAL. This study suggests that even in the acute phase, modified CI therapy may have favorable long-term changes in upper limb function and paralytic hand use behavior in some patients.