急性期における見通しのつけ方

The role of the speech-language-hearing therapist in assessment during the acute phase of rehabilitation

　近年，診療報酬改定に伴い脳卒中患者の在院日数の短縮化が年々はかられ，高次脳機能障害を含むコミュニケーション障害への対応も早期から求められ，言語聴覚士による早期介入の重要性が認識されつつある．急性期からの当院における取り組みの紹介と，高次脳機能障害を呈した自験例2例の急性期における言語聴覚士の臨床活動について報告した．急性期において効率のよい臨床活動を行う際には，①現病歴やCT，MRI，家族などの情報から，生じている高次脳機能障害をある程度推定する．②推定した高次脳機能障害を中心に評価を実施し，症状出現の程度やコミュニケーション上に与えている影響を見定める．③軽快すると予想される症状と，残存すると考える症状に対して，関わる関連スタッフと情報を共有し，家族にも的確な指導を行うことによって質の高い医療を提供することができると考えた．

　Following the changes in the medical fee system, there has been a recent trend toward reducing the length of hospitalization of cerebrovascular accident patients.　Early interventions for patients with communication disorders, including higher brain functional disorders, have been also called for, and the importance of intervention by speech-language-hearing therapists (SLHT) in the acute phase has been gaining recognition.　We report our system of acute phase rehabilitation and two cases of cerebrovascular patients with higher brain functional disorders whom we treated.　First, we inferred the nature of their higher brain functional disorders based on their medical and family histories and the results of CT and MRI studies.　Based on this inference, we evaluated the patients' higher brain function in order to determine its influence on communication ability and symptoms.　Sharing the results of our evaluation, especially our prediction regarding transient and persistent symptoms, with the relevant staff was helpful in providing an appropriate guidance to the family members and improving medical care for these patients.