脳卒中リハビリテーション―評価とチームアプローチ

Stroke rehabilitation:assessment and team approach

　リハビリテーション医療は，脳卒中により生じた患者の能力障害と社会的不利を最小化し，機能的能力を最大化して，患者の社会復帰を支援することを目的とする．その診療は，障害の医学モデルにおける機能形態障害，能力障害，社会的不利の概念に基づく．治療計画はこれら3つの領域の課題を明らかにする．機能障害の評価には片麻痺の回復程度を分類するBrunnstrom stageや痙性の重症度を分類するAshworth scaleなどがある．能力障害の程度はBarthel indexなどADLの評価により判定される．治療介入では医師，看護師に加えて理学療法士，作業療法士，言語聴覚士，臨床心理士，医療ソーシャルワーカーなど多数の専門職によるチームアプローチが特徴である．

Rehabilitation medical service aims to help the post-stroke patients to return to their premorbid social setting through maximizing functional ability and minimizing disability and handicap.　Rehabilitation practice is based on the concepts of impairment, disability, and handicap after the medical model.　The problems in these three areas must be clarified in the planning of therapeutic intervention.　Assessments of impairments include the Brunnstrom stage and the modified Ashworth scale.　The former classifies motor recovery stages and the latter defines severity of spasticity in post-stroke hemiplegics.　The degree of disability is examined by activities in daily living assessments such as the Barthel index.　Core members of the interdisciplinary team may include typically a rehabilitation physician, a rehabilitation nurse, a physiotherapist, a occupational therapist, a speech therapist, and a medical social worker.