suzuki megumi

OBJECTIVES: The purpose of this study was to capture the lifestyle characteristics of traumatic brain injury (TBI) patients by administering the Frenchay Activities Index (FAI), a self-assessment questionnaire used for assessing life-related activities, among TBI patients. METHODS: This study was conducted using the revised FAI Self-Assessment Form, administering an interview-based questionnaire survey to TBI patients and healthy participants. The target group comprised 60 traumatic brain injury patients who had progressed from at least 1 year since the injury, with a comparison group of 788 healthy participants. RESULTS: A comparison of FAI scores between TBI patients and healthy participants by questionnaire revealed that TBI patients exhibited significantly higher FAI scores than healthy participants for outdoor walking and transportation use (Mann-Whitney U test, P<0.01). A comparison by occupation revealed that TBI patients were significantly less among the unemployed and other categories (Mann-Whitney U test, P<0.01). For office workers, government employees, high school students, and college students, scores were higher among TBI patients compared with healthy participants, although the differences were not significant. CONCLUSIONS: Although TBI patients were less active than healthy participants in life-related activities, their scores for cleaning up after meals and cleaning and putting things in order were close to those of healthy participants, indicating that TBI patients cannot be considered to be inactive. The findings also revealed differences in TBI patients' engagement in life-related activities and frequency of activities depending on their social position.

OBJECTIVE: To evaluate the effectiveness of a dyadic outpatient rehabilitation program focused on improving the real-life daily activities of patients with mild cognitive impairments or dementia and their caregivers. DESIGN: Retrospective study. SUBJECTS: Eight patients with mild cognitive impairments or dementia and their caregivers. METHODS: The rehabilitation program comprised eight 1-hour sessions by occupational therapists with patients and his/her caregivers. Patients were assessed for motor function, cognitive function, and quality of life, and their caregivers were assessed for depression and caregiver burden. Participants were assessed at pre-program and post-program, and 3-month follow-up. RESULTS: The scores of caregiver-assessed Quality of life in Alzheimer's disease scale in patients significantly improved at post-program (median [interquartile range], 30.0 [7.0]) compared with pre-program (27.0 [2.8], effect size = 0.77, p = 0.029). In caregivers, the Zarit Caregiver Burden Interview scores decreased significantly at post-program (16.5 [13.0]) compared with pre-program (22.0 [17.5], effect size = 0.72, p = 0.042). There were no significant differences in other assessments. CONCLUSIONS: The rehabilitation program focused on real daily activities and demonstrated to improve patients' quality of life and caregivers' depression and caring burden through patient-caregiver interaction. Future enhanced follow-up systems are warranted.

BACKGROUND: The International Classification of Functioning, Disability, and Health (ICF) Generic-30 (Rehabilitation) Set is a tool used to assess the functioning of a clinical population in rehabilitation. The ICF Generic-30 consists of nine ICF categories from the component "body functions" and 21 from the component "activities and participation". This study aimed to develop a rating reference guide for the nine body function categories of the ICF Generic-30 Set using a predefined, structured process and to examine the interrater reliability of the ratings using the rating reference guide. METHODS: The development of the first version of the rating reference guide involved the following steps: (1) a trial of rating patients by several raters; (2) cognitive interviews with each rater to analyze the thought process involved in each rating; (3) the drafting of the rating reference guide by a multidisciplinary panel; and (4) a review by ICF specialists to confirm consistency with the ICF. Subsequently, we conducted a first field test to gain insight into the use of the guide in practice. The reference guide was modified based on the raters' feedback in the field test, and an inter-rater reliability test was conducted thereafter. Interrater agreement was evaluated using weighted kappa statistics with linear weights. RESULTS: The first version of the rating reference guide was successfully developed and tested. The weighted kappa coefficient in the field testing ranged from 0.25 to 0.92. The interrater reliability testing of the rating reference guide modified based on the field test results yielded an improved weighted kappa coefficient ranging from 0.53 to 0.78. Relative improvements in the weighted kappa coefficients were observed in seven out of the nine categories. Consequently, seven out of nine categories were found to have a weighted kappa coefficient of 0.61 or higher. CONCLUSIONS: In this study, we developed and modified a rating reference guide for the body function categories of the ICF Generic-30 Set. The interrater reliability test using the final version of the rating reference guide showed moderate to substantial interrater agreement, which encouraged the use of the ICF in rehabilitation practice.

理学療法士は臨床経験が増すにつれ、毎年より多くの転倒などの事故を経験するか、さらに実務の最初の年に事故を経験することが2年目の事故に関連しているか調べた。療法士642名を臨床経験年数(1年、2年、3年、4年、5〜20年)に基づいて5群(それぞれ138名、112名、117名、58名、217名)に分け、8年間で報告された事故を集計した。1〜3年群と5〜20年群の間で有意差が明らかになり、5〜20年群の療法士は他の群よりも事故が少なかった。1年目に事故に遭遇した療法士は、そうでなかった療法士と比較して、2年目に事故が有意に増加した。以上より、1〜3年の臨床経験の療法士は5年を超える臨床経験のある療法士よりも事故に遭遇する可能性が高く、事故を経験した若い療法士は、将来事故を起こしやすいと結論づけられた。

発病から15年の慢性脳血管障害者で介護保険利用の14名と非利用の14名を対象とし、能力障害(ADL)と社会参加障害(IADL)の推移を調査した。内訳は男性20名、女性8名、年齢は67.0歳±9.7であり、診断名は脳出血10名、脳梗塞16名、その他2名で、麻痺11例、片麻痺17例であった。発病から15年間のADLとIADLを追跡調査した。その結果、介護保険利用者と非利用者におけるADLの推移に特徴がみられた。本研究から抽出された地域包括ケアシステムの課題として、ADLの自立支援や介護予防、就労支援で適切な介入時期を個々に発見すること、生活期リハビリテーションにおける訪問リハビリテーションやデイケアで適切な介入プログラムを設定して社会参加を促すプランを作り、積極的に解決に向けて粘り強く進めること、があげられた。

BACKGROUND: Modification of the home environment, together with rehabilitative interventions, is important for maximizing the level of functioning after an individual with disability undergoes rehabilitation in the hospital. OBJECTIVES: We developed a simple screening scale - the home environment checklist (HEC) - to identify any mismatch between an individual's abilities and their home environment to help clinicians monitor the appropriateness of the home environment to which individuals with disability will be discharged. We also examined the psychometric properties of the HEC. METHODS: The HEC was developed by a multidisciplinary panel of rehabilitation experts using information routinely collected in rehabilitation clinics before discharge. The reliability of the checklist was assessed in 60 individuals undergoing rehabilitation. The inter-rater agreement and internal consistency of the scale were assessed by weighted kappa statistics and Cronbach's alpha, respectively. Rasch analysis was performed with 244 rehabilitation individuals to evaluate the internal construct validity, and the known-groups validity was confirmed by a comparison of the daily activity levels of 30 individuals with disabilities under rehabilitation to the HEC score. RESULTS: The HEC was developed as a simple, 10-item checklist. The weighted kappa statistics ranged from 0.73 to 0.93, indicating excellent inter-rater reliability. Cronbach's alpha was 0.92, indicating high internal consistency. Rasch analysis with a testlet approach on 3 subscales demonstrated a good fit with the Rasch model (χ2=13.2, P=0.153), and the demonstrated unidimensionality and absence of differential item functioning supported the internal construct validity of the HEC. HEC scores were significantly different (P<.01) among individuals with disability and 3 levels of restrictions in their activities (no limitation, home-bound, and bed-bound), which demonstrates the known-groups validity of the HEC. CONCLUSIONS: The HEC has good reliability and validity, which supports its utility in rehabilitation clinics.

在宅慢性脳卒中者における心身機能維持・改善のためのリハビリテーション(リハ)練習について、その目的や練習結果等について発病から10年間にわたり在宅調査を行った。初発脳卒中で発病半年以内に入院しリハ医療を行った40歳以上の脳卒中者125名のうち、発病10年時に在宅調査が可能であった36名(男性27名、女性9名)を対象とした。本調査は前向きコホート研究であり、同一調査員が一貫して調査し、原則在宅訪問で行った。心身機能の10年間の推移を調べたところ、入院中にADL(FIM)は有意に改善し、退院後はほぼ維持されていた。IADL(FAI)の改善は乏しく、低値で推移した。リハ練習(自主トレーニングを含む)は、36人全員が「必要」としていたが、発病2年時から「必要なし」が2人から4人とでてきた。リハ練習意欲は「十分にある」が減り、「少しある」が増え、「全くない」が発病4年時から1人、2人と出てきたが、10年時では少数にとどまった。リハ練習は、1年時は全員が行っていたが、「十分に行っている」が年々減り続け、逆に「行っていない」が徐々に増えてきた。その理由は、「良くなったから」が増える反面、「諦めた」および「面倒くさい」が増え、「その他」として仕事をあげた人が多かった。自主リハ練習は、発病1年時で83%が行っていたが、発病10年時では75%に減少した。リハ練習の結果、主観的な改善度は、発病1年時では66%が改善、34%が不変と答えていたが、10年時には、改善が30%、不変が59%、悪化が11%と答えた。

慢性脳卒中患者の総合的追跡調査から、退院時のHealth Locus of Control(HLC)と退院後の在宅での発病5年までの保健行動との関連性について検討した。脳卒中で入院した211名のうち、在宅で発病5年までの保健行動が聴取できた36名(男性30人、女性6人、発病時平均57.8±8.4歳)を対象とした。退院時のHLCの評価得点をもとにInternals群17名(11〜21点、I群)、Moderate群6名(中間値22点、M群)、Externals群13名(23〜33点、E群)の3群に分けた。M群ではQOLで有意な向上が示され、I群では脳卒中後の機能の改善と手の実用度が有意に改善、E群では手の実用度のみ有意に改善していた。保健行動の内訳に関して、「外来リハビリテーション」の利用はどの群でも80%以上を示していたが、「自主練習」ではI群が10人(77%)で、E群9人(59%)を上回っていた。また、「食事への配慮」はI群では13人全員が行っていたが、E群では12人(70%)にとどまっていた。

<p>Objectives: Patients with right-hemisphere brain lesions often show unilateral neglect, which causes various difficulties in their daily lives. Disturbances in visuospatial cognition, including unilateral neglect, can be tested quantitatively using questionnaires, yet visuospatial cognition is related not only to the visual system, but also to other cognitive and behavioral functions. Such functions should be assessed by integrative visuo-cognitive tasks. Therefore, the objective of the present study was to clarify visual disturbances in patients with brain lesions using multi-modal visual function tests including three-dimensional and dynamic visual tasks.</p><p>Methods: We recruited 29 patients, 14 with right- and 15 with left-hemispheric brain lesions, and age-matched control subjects. We conducted depth perception tests and static and active motion detection tests to clarify subjects' three-dimensional visual recognition performance.</p><p>Results: There were no significant differences between the patients and controls on any of the visual function tests, except for the static detection test with a mosaic background. However, patients' total scores on the visual function tests were lower than those of the controls.</p><p>Discussion: The observed decline in total visual function scores suggests that visual dysfunction caused by stroke should be evaluated not by a single visual function test, but by a series of such tests. We propose that visual functioning in daily life should be evaluated using multi-modal visual function tests.</p>

72歳女.脳梗塞,左片麻痺であった.発症後6ヵ月以上の経過に対してmirror therapyを継続的に実施し定量的評価を試みた.その結果,客観的に手指機能の改善が認められた.Mirror therapyの効果と機序にとしては,麻痺側から感覚入力により運動野の再構築が行われた可能性があることと,鏡を通して麻痺側の手が動いているように「見える」という視覚入力によって,mirror neuronが賦活された可能性が推測された

全国で行われている摂食・嚥下リハの現状を知るためのアンケート調査を実施した.第二次調査では,第一次調査で問題点として多く挙げられた検査とチームアプローチについて,更に詳しく調査した. 1)「不十分な検査に不安を覚えながらも訓練を行い,一方で危険に対する認識が不十分である現状」が明らかになった.簡便な評価方法の確立と普及,及び今後の教育・啓蒙活動の充実が待たれる. 2)多くの施設で複数職種によるチームアプローチが行われており,各職種の専門性を生かした役割分担がなされていた