脳卒中後の麻痺手に対するmodified CI療法の効果—1日3時間2名ペアで実施した6ヵ月間の変化

The effects of modified constraint-induced movement therapy on paralyzed hands after stroke

要旨：CI療法原法は療法士の時間を集中的に使用するため，実施に限界があった．そこで，時間的コスト軽減を図ったmCI療法（自主練習を併用し，1日3時間2名ペアで実施）を考案し，脳卒中発症後180日以内の回復期症例31名に対して実施した．実施前，実施後，6ヵ月後に評価し，推移を観察したところ，STEF，FMA-UE，MAL-AOUの平均値は，実施後，6ヵ月後共に有意に改善．変化量は，MAL-AOUは実施後にMCIDを上回り，FMA-UEは6ヵ月後にMCIDを上回った．mCI療法はペアの難易度調整が随時可能という利点がある．ペアで実施することにより，対象者間で会話が生まれ，動機づけの向上や心理的な支援につながる可能性が示唆された．

　CI therapy known for being labor intensive for occupational therapists and has limitations in its implementation. We devised an mCI therapy (combined with voluntary practice and carried out by a pair of people for three hours a day) to reduce the therapy duration. The treatment was performed on 31 convalescent patients within 180 days of onset, and changes were observed before, during, and after 6 months. The average values of STEF, FMA-UE, and MAL-AOU improved significantly both before and after 6 months. MAL-AOU exceeded MCID in the amount of change before and after the implementation, and FMA-UE exceeded MCID after 6 months. mCI therapy has the advantage that the difficulty level of the pair can be adjusted at any time. These results suggest that conducting the test in pairs could lead to conversations between the subjects, which could result in increased motivation and psychological support.