半側空間無視を有する脳卒中患者の機能的予後に関する文献検討

A Literature Review on Functional Prognosis in Stroke Patients with Neglect

要旨

　目的：脳卒中患者におけるNeglectと機能的予後との関連について，海外文献の知見を整理し，患者の予後とNeglectの関連を明らかにし，患者の看護ケアへの示唆を得ること．

　方法：MEDLINE，PsycINFO(収載：1968年～2006年)をデータベースとし，キーワード，stroke，neglect，functional prognosisを用いて収集した23観察研究の文献について，整理し検討した．

　結果：文献は「損傷大脳半球部位により，左大脳患者と右大脳患者に分けた群間比較」と「Neglectを有する右大脳患者に焦点を当てた」予後に関する文献に分類された．右大脳患者は左大脳患者より機能的予後が悪く，Neglect発症後から慢性期においても日常生活活動・セルフケア能力，リハビリテーションへのリスク因子であることが示唆されたが，Neglectが患者の日常生活に具体的どのように影響するかについての関連は明らかではなかった．

　結論：Neglectは右大脳患者の日常生活活動やセルフケア能力へのリスク因子である．今後は，Neglectによる具体的な生活障害を検証しケア方法の確立を行うとともに，看護においても神経心理学的評価方法の活用可能性の検討と標準化を行うことの必要性が示唆された．

Abstract

　Purpose：The purpose of this study was to clarify functional prognosis in causal association with neglect after a stroke for the purpose of informing nursing care.

　Method：A literature review covering the period from 1968 to 2006 was carried out using electronic databases (MEDLINE, PsycINFO), using the following key words； stroke, neglect, and functional prognosis. Twenty-three observational researches concerning functional evaluation methods and periods and functional outcome were reviewed.

　Results：The articles were classified into two types of research：comparison of left-brain damaged and right-brain damaged stroke patients, focusing on the right-brain damaged stroke patients with neglect. The findings revealed that right-brain damaged stroke patients have poorer functional prognosis than left-brain damaged patients, and neglect is a risk factor for independence in activities of daily living, self care ability,and rehabilitation in the chronic phase after onset. However, knowledge is still unclear how neglect concretely influences patient's daily life.

　Conclusion：Neglect is the risk factor in activities of daily living and self-care ability among right-brain damaged stroke patients. Further studies and challenges are suggested as follows： clarifying concrete daily-life difficulties related to neglect, establishing caring method for stroke patients, and examining usability and standardization of neuropsychological assessments in nursing practices.