著者

荻野 美恵子

出版者

日本神経学会

雑誌

臨床神経学 (ISSN:0009918X)

巻号頁・発行日

vol.50, no.11, pp.1026-1028, 2010 (Released:2011-03-28)

参考文献数

5

被引用文献数

8 7

---

In March 2009 we sent out the questionnaire to the 4,478 board certified neurologist to ask about the palliative care in ALS. 1,495 anonymous responses (33%) have been returned. 21% of the respondents prescribe morphine, which shows a drastic increase from the 14% in the 2007 survey. However, 77% of them had only less than 5 patients, 47% of them studied and trained themselves. It illustrates that most of the neurologists are not well experienced with morphine, and that they are isolated in practice. However, 47% of the respondents answer that they would prescribe morphine whether or not the national insurance pays. As for the withdrawal of the permanent ventilation, 21% of the respondents were asked by their patients to turn off the ventilation. While 24% of the respondents believe that the withdrawal right not should be promoted, 46% believe that such right should be granted if the decision made by the patient and/or his/her family members can explicitly be recognized. The result illustrates that the physicians are also divided. It may be the time to lay the foundation for the Japanese ALS physicians to discuss openly and candidly together to deal with the wants and wishes of their patients.

著者

荻野 美恵子

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.33, no.3, pp.298, 2016

著者

上出 直人 柴 喜崇 前田 真治 荻野 美恵子

出版者

公益社団法人日本理学療法士協会

雑誌

理学療法学 (ISSN:02893770)

巻号頁・発行日

vol.32, no.3, pp.130-134, 2005-06-20

被引用文献数

1

---

進行性核上性麻痺患者に対し, 部分体重免荷トレッドミルトレーニングを含んだ短期集中練習を施行し, 歩行能力への影響を検討した。症例は69歳男性。介入開始時の歩行能力は, 屋内歩行最小介助レベルであった(FIM移動下位項目:4)。介入方法は, 体重免荷装置を用いて, 体重の30%以内を免荷した状態で, トレッドミル上での歩行トレーニングを3〜5分間施行した。トレッドミルの速度は, 症例が耐えうる最大の速度とし, トレーニング回数毎に漸増させていった。全8回のトレーニングを含んだ短期集中練習実施後, 症例の歩行速度, 歩幅は改善を示した。しかし後方易転倒性は変化せず, ADL上の移動能力や転倒頻度については改善しなかった。部分体重免荷トレッドミルトレーニングは, 歩行時の両下肢の協調的なステッピング運動を短期間で向上させる効果を有するが, バランス能力には効果が小さいことが示唆された。ADL上での移動能力の向上につなげるためにはバランストレーニングとの併用が必要であることが示唆された。

著者

荻野 美恵子

出版者

日本神経学会

雑誌

臨床神経学 (ISSN:0009918X)

巻号頁・発行日

vol.48, no.11, pp.973-975, 2008 (Released:2009-01-15)

参考文献数

8

被引用文献数

12 15

---

Because the whole of the management of ALS is palliative care, in this paper I presented about the management of each symptom, respiratory care, decision making of the mechanical ventilation, and the end of life care in Japan. We must be aware that the patients with ALS can continue to live if they decide to wear the tracheostomy ventilation (TV) even just before death, it is completely different form situation in cancer patients. In Japan about 20% of ALS patients choose TV, this figure is much higher than western countries. On the other hand, only 14% of neurologist have experience of opioids usage for ALS in 2007, much lower than western countries. We started to use opioids for ALS patients in 2005. We use morphine 10-30mg/day as maintenance dose in early phase without sever side effect. Eighty-eight percent patients reported relief of breathlessness, in 4 patients out of 9, PCO2 was decreased. It is big problem that the health insurance does not cover the cost of opioids for ALS. I want to emphasize that the best effort should be taken to relieve suffering not only for cancer patient but for every patient.