著者
鈴村 彰太 大沢 愛子 植田 郁恵 森 志乃 近藤 和泉 前島 伸一郎
出版者
一般社団法人 日本脳卒中学会
雑誌
脳卒中 (ISSN:09120726)
巻号頁・発行日
pp.10430, (Released:2016-09-15)
参考文献数
20

失行は日常生活活動(activities of daily living: ADL)に大きな影響を及ぼすが,症候が複雑で行為の誤り方に個別性・多様性が存在するためリハビリテーション手法の確立は困難で,その障害や治療に関する詳細な検討もほとんどない.我々は左頭頂側頭葉のアテローム血栓性脳梗塞で,ごく軽度の右片麻痺と感覚障害に加え,観念失行・観念運動失行・肢節運動失行を呈した82 歳女性を経験した.特に食事動作に関し,右手では困難な動作をまず左手で実施し,その後道具を右手に持ち替える方法を取り入れ,誤りなし学習を徹底したところ,動作の自立を果たした.本症例の改善機序として,左上肢の使用により右上肢の体性感覚が補われたことで,誤りの認知や道具使用に関する意味概念への到達が可能となり,正しい運動プログラムの惹起が促進されて,右手の運動学習につながったものと推察された.
著者
近藤 和泉
出版者
The Japanese Association of Rehabilitation Medicine
雑誌
リハビリテーション医学 (ISSN:0034351X)
巻号頁・発行日
vol.37, no.4, pp.230-241, 2000-04-18 (Released:2009-10-28)
参考文献数
29
被引用文献数
2 1

There are now various therapeutic interventions for cerebral palsied children. Many of them were developed based on the theoretical speculation or empiricism, because it was difficult to know the pathophysiological process, which occurred in the injured brain before its development. It, however, is believed that synaptic formation and synaptic rearrangement play a main role in the first instance of motor development. In the therapeutic approach for cerebral palsied children, we should adopt the appropriate strategy based on the knowledge of neuro-developmental science. As same as the other diseases, for the cerebral palsy, we also should treat the various levels of problems, which was classified by WHO as impairments, disabilities (activities), and handicaps (participation). Therapeutic interventions for children with cerebral palsy have been directed mainly toward impairments of this pathological condition, such as spasticity, joint contracture and abnormal movement pattern. We should pay attention for the cerebral palsied children also to their function in the home activities and participation to the social affairs. At the end of the 20th century health professionals are expected to produce evidence of the effectiveness of the treatments that they provided to the clients. What we require in addition are measures that capture the “health status” of people. We have not been making enough effort to evaluate the effectiveness of therapeutic intervention for cerebral palsied children with the scientific documentation. In North America, various scales have been developed in the recent decades under the concept of the framework for health measurement indices. These scales were also standardized and were endurable for multi-institute's use. In the area of rehabilitation of cerebral palsied children, Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) were developed with this new concept. In this review article, the summary and the process of standardization in Japan of these scales were presented.
著者
細川 賀乃子 近藤 和泉 岩田 学
出版者
社団法人日本リハビリテーション医学会
雑誌
リハビリテーション医学 : 日本リハビリテーション医学会誌 (ISSN:0034351X)
巻号頁・発行日
vol.43, no.1, pp.51-62, 2006-01-18
参考文献数
35
被引用文献数
1

Lymphedema is defined as a swelling of the arms or legs induced by an obstruction in lymph fluid circulation or by an abnormality in lymph fluid production. In most patients, lymphedema can be diagnosed from the clinical history and physical examination. The lymphangiogram and lymphangioscintigraphy are also used as additional diagnostic tools. Lymphedema developed from an obstruction of the lymphatic system is called secondary lymphedema. Lymphedema is classified into two categories : primary and secondary, and primary lymphedema is rare and is caused by a defect at birth or a congenital lymph system abnormality. The most frequent complication with lymphedema is cellulites. The protein-rich lymph fluid can be a source of bacteria proliferation leading to cellulites, which is an infection in the subcutaneous layers. But if therapy is started from the onset, the risk of infection in edema patients can be lessened. The primary management of lymphedema consist of conservative treatment called complex decongestive physical therapy : CDP or decongestive lymphatic therapy : DLT. The treatment includes skin care, manual lymph drainage, compression therapy, and exercise with bandage or compression garment. If the conservative management does not produce a sufficient effect or the edema worsens, surgical interventions such as microsurgical lymphaticovenular anastomosis and other techniques may be indicated. In Japan, the health insurance system does not offer enough support for patients with lymphedema. The treatment of lymphedema from the early stage is usually effective, and it is therefore necessary for clinicians to have a working knowledge of lymphedema management.
著者
原 豪志 戸原 玄 近藤 和泉 才藤 栄一 東口 髙志 早坂 信哉 植田 耕一郎 菊谷 武 水口 俊介 安細 敏弘
出版者
一般社団法人 日本老年歯科医学会
雑誌
老年歯科医学 (ISSN:09143866)
巻号頁・発行日
vol.29, no.2, pp.57-65, 2014-10-16 (Released:2014-10-25)
参考文献数
32

経皮内視鏡的胃瘻造設術は,経口摂取が困難な患者に対して有用な栄養摂取方法である。しかしその適応基準はあるが,胃瘻造設後の経口開始基準や抜去基準はない。 われわれは,胃瘻療養中の脳血管障害患者の心身機能と摂食状況を,複数の医療機関にて調査したので報告する。133 名 (男性 72 人,女性 61 人)を対象とし,その平均年齢は77.1±11.3 歳であった。患者の基本情報,Japan Coma Scale (JCS),認知症の程度,Activities of daily living (ADL),口腔衛生状態,構音・発声の状態,気管切開の有無,嚥下内視鏡検査 (Videoendoscopic evaluation of swallowing,以下 VE)前の摂食状況スケール (Eating Status Scale,以下 ESS),VE を用いた誤嚥の有無,VE を用いた結果推奨される ESS (VE 後の ESS),の項目を調査した。 居住形態は在宅と特別養護老人ホームで 61.3%を占め,認知症の程度,ADL は不良な対象者が多かったが,半数以上は口腔衛生状態が良好であった。また,言語障害を有する対象者が多かった。対象者の82.7%は食物形態や姿勢調整で誤嚥を防止することができた。また,VE 前・後の ESS の分布は有意に差を認めた (p<0.01)。胃瘻療養患者に対して退院後の摂食・嚥下のフォローアップを含めた環境整備,嚥下機能評価の重要性が示唆された。