著者
辻 哲也 園田 茂 千野 直一
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.33, no.5, pp.301-309, 1996-05-18
参考文献数
13
被引用文献数
26 51

機能的自立度評価法(FIM)を用いて, 脳血管障害患者190例の入院・退院時のADL評価を行った.項目別自立度により運動, 認知項目の難易度パターンを調べ, Rasch分析により運動, 認知項目の合計点別に各項目の点数分布を分析した.運動項目では, 難易度パターンは入院・退院時とも同様であり, 損傷病巣側, 年齢による差もなかった.認知項目では損傷病巣側により差がみられた.痴呆は難易度パターンに影響を与えていた.また, Rasch分析により, 運動項目は合計点別に50点未満の介助群から80点台後半の応用歩行自立群までの5つのグループに分けられた.一方, 認知項目では症例の一元性に問題があり, Rasch分析以外の解析手法を検討すべきであると思われた.
著者
小口 和代 才藤 栄一 馬場 尊 楠戸 正子 田中 ともみ 小野木 啓子
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.37, no.6, pp.383-388, 2000-06-18
参考文献数
10
被引用文献数
36

131名の機能的嚥下障害患者の「反復唾液嚥下テスト」(the Repetitive Saliva Swallowing Test: RSST)と嚥下ビデオレントゲン造影(videofluorography : VF)所見を比較し,RSSTの妥当性を検討した.RSSTはVF所見と相関が高く,カットオフ値として3回/30秒間が妥当であると思われた.誤嚥の有無の判別に関する感度と特異度は,0.98,0.66と,感度が非常に高かった.摂食・嚥下障害の診断・評価としては,まずRSSTでスクリーニングを行い,3回/30秒間未満の場合はさらに詳細な病歴,身体所見をとり,必要と判断されればVFを行い,治療方針を決定するのが適当である.
著者
園田 茂 榊原 美紀 森 光代 山本 純子 岡島 康友 千野 直一
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.35, no.9, pp.641-644, 1998-09-18
被引用文献数
2

サウンドスペースプロセッサRSS-10を用いたヘッドフォン方式の音方向覚検査の信頼性を検討した. 15名の難聴でない健常被験者を対象に, ホワイトノイズ(WN)および女声(FV)を正面と, 左右に30度, 60度, 90度の計7点より3回ずつ呈示した. 音は全試行とも方向覚を持って聞こえ, 平均正答率62%, 呈示音と回答とのずれの角度は5〜18度, 平均12度(SD=9) (WN), 1〜19度, 平均11度(SD=8) (FV)であった. WNを左から右, 右から左に被験者の前を通るように約10秒で移動させ, 正中を通過したと感じられる時点の位置の平均はそれぞれ正面から-11.1度(SD=8.0), 3.4度(SD=7.5)であった. RSS-10を用いた音方向覚検査は再現性が高く, 臨床上有用と考えられた.
著者
大高 洋平 里宇 明元 宇沢 充圭 千野 直一
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.40, no.6, pp.374-388, 2003-06-18
被引用文献数
11

Fall prevention is one of the major issues in health care in our aging society. The aim of this review is to provide useful information for researchers and practitioners who plan to start fall prevention programs for elderly persons with various risk levels and in different settings. Fifty-three randomized controlled trials (RCTs) and several metaanalyses retrieved with extensive literature search formed the basis for this review. Available evidence suggests that several preventive strategies have been proven beneficial in fall prevention. For the community-dwelling elderly, two RCTs and one meta-analysis demonstrated that an individually tailored home exercise program provided by nurses or physical therapists could reduce the rate of falls and injuries. One RCT suggested that Tai Chi Chuan might have a high potential to reduce falls. Two large RCTs indicated that programs including group exercise classes could also reduce the number of fallers. For people with known risk factors living in the community, three RCTs showed that home visits to address multiple risk factor modification were an effective way to reduce falls. One RCT with a relatively small sample showed that psychotropic withdrawal redeced falls in elderly persons taking psyshotropic medication. A subgroup analysis of one RCT showed that home hazard reduction at hospital discharge reduced subsequent falls in patients with a past history of falls. However, more evidence is needed to prove its effectiveness, because this effect was also observed outoside of homes. Dual chamber pacemaker for elderly persons with hypersensitive carotid sinus, who were detected when investigated for undiagnosed falls, markedly redeced subsequent falls with or without syncope. In institutional settings, two RCTs showed that comprehensive risk assessment and modification redeced the rate of falls and fractures or the number of recurrent fallers. Three RCTs performed in hospital settings failed to show any effectiveness. However, a meta-analysis of 3 controlled trials and 7 cohort studies with a historical control suggested that fall prevention program in hospitals could be promising. There are some methodological problems in fall prevention research such as the definition, measures, and monitoring method of falls, inadequate sample size and a short follow-up period. In the future, we need research based on strong and comprehensive methodological designs.
著者
大高 洋平 里宇 明元 宇沢 充圭 千野 直一
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.40, no.6, pp.389-397, 2003-06-18
被引用文献数
2

The cecond part of the review discusses some inportant issues associated with fall prevention and future perspectives on fall related research. Currently, many kinds of interventions ore availavle for the treatment of patients suffering from osteoporosis, i.e. nutritional supports, medications acting on bone metabolism and exercise. However, a series of meta-analyses showed that only alendronate and risedronate have been proven to prevent non-vertebral tractures in persons with osteoporosis. Anaerobic and weight bearing exercises are known to have a positive effect on the bone mineral density of the spine. There is, however, no reliable data for fracture prevention with exercise alone. Also, the synergistic effect of a combination of these interventions has noto been clearly proven. Although there is evidence that the use of hip protectors in institutional settings reduces the rate of hip fractures, this approach faces the problem of patient acceptance and compliance. Psychosocial problems related to falls such as fear of falling, post-fall syndrone and cost-effectiveness of the prevention programs are becoming increasingly important in elderly health care, but little evidence of such has been reported in the literature. In future perspectives on fall relared research, a theory-based approach for fall prevention needs to be included to explore more effective interventions. We must also consider the double-edged effects of interventions that may increase certain fall risk factors while reducing another. Especially, the relation between activities and incidence of falls is important to consider, because increased activity itself may increase the change of falls. When applying exercise or rehabilitative approaches, the interaction between falls, activity levels, frailty, and injury must be studied much more carefully. In addition, one has to always think about what is the true aim of a program, because the aim of fall prevention goes beyond preventing falls. Although some research has so far been conducted in Europe and the U.S.A. by researchers and practitioners in various fields, the quantity and quality of fall prevention research are still lacking and the available data is therefore insufficient to suggest appropriate decision-making in clinical practice. Especially in Japan, there have been only a few RCTs to determine the effectiveness of fall prevention programs. Because there are many differences in the characteristics of our native population and health care systems vs those of Europe and the U.S.A., it is a critical issue for us to establishi fall prevention programs suited to Japanese population and health care system.
著者
笛吹 亘 園田 茂 鈴木 亨 岡本 さやか 東口 高志 才藤 栄一
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.45, no.3, pp.184-192, 2008-03-18
参考文献数
24
被引用文献数
3 1

回復期リハビリテーション病棟での栄養サポートチーム(NST)介入効果をFIMを用いて後方視的に検討した.脳卒中患者304名を対象にNST介入対象者を栄養強化群と減量群に分類し,各々をNST介入非対象者(非NST群)と比較した.FIM利得は栄養強化群17.3±15.9,非NST群16.7±12.5と両群に有意差はなかったが,FIM効率は栄養強化群0.20±0.19,非NST群0.27±0.19と有意差を認めた.入院時FIM得点が54点以下の患者ではFIM利得,FIM効率ともに両群に有意差を認めなかった.入退院時BMI変化とFIM変化の間で一定の傾向を認めなかった.栄養介入を要した栄養強化群は一般的には予後不良の群と判断されるにもかかわらず,非NST群と差がなかった今回の結果は,NSTという栄養介入が有用であった可能性を示唆している.
著者
横串 算敏 成田 寛志 瀧内 敏郎 山下 敏彦 野坂 利也
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.33, no.7, pp.488-491, 1996-07-18
被引用文献数
3

5例の下腿切断者を対象に, ICEROSSを使用したTSB義足とPTB義足の比較検討を行った.歩行時の安定感, 総合評価の点では, 全例がTSB義足はPTB義足より優れていると評価した.運動学的評価では, TSB義足歩行時の遊脚後期と立脚初期での加速度垂直成分は, PTB義足歩行時に比べ有意に減少していた.歩行時の膝関節屈曲角度は, 両義足間で差はなかった.
著者
岡本 隆嗣 橋本 圭司 大橋 正洋 宮野 佐年
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.41, no.12, pp.868-874, 2004-12-18
参考文献数
25

2000年5月から2003年11月までに,当院入院しリハビリテーションを行った蘇生後脳症患者14名(男性13名,女性1名,平均年齢45.3歳)の機能予後および問題点を,当院入院時データより検討した.発症から入院までの期間は264±294日であった.家族の介護負担感の観点から,発症より1.5〜6.5年経過した2004年5月現在の監視の程度をSuper-vision Rating Scale(SRS)により評価し,自立〜部分監視(SRS1〜7)であった6名を予後良好群,常時監視(SRS8〜13)が必要であった8名を予後不良群とした.診療録より後方視的に,Japan Coma Scale(以下JCS)3桁持続期間,脳画像所見でのびまん性脳萎縮の有無,神経心理学的検査,Functional Independence Measure(FIM),当院退院時の転帰,現在の社会参加状況,障害者手帳取得状況について検討を行った.2群間の比較で,JCS3桁持続時間,びまん性脳萎縮の有無,Mini-Mental State Examination(以下MMSE),Wechsler Adult Intelligence Scale-Revised(以下WAIS-R),FIM運動,認知でそれぞれ有意差を認めた.リハ病院入院時における,予後予測因子として,これらは有用であると考えられた.予後良好群では,退院後,社会復帰可能となった例が多く見られた.予後不良群では,入院中,神経心理学的検査を施行できない例がみられ,またFIM認知項目は入院中に有意な改善を認めなかった.また身体,認知の両方とも障害されている例が目立ち,退院時と1.5〜6.5年経過時の監視程度はほとんど変わらず,手帳,介護保険でのサービスを多く利用していた.
著者
鎌倉 矩子
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.14, no.1, pp.57-72, 1977-01-18

The positional change of the wrist during activities using fingers is not precisely known. The lack of the control of the wrist could be one of the reasons why the quadriplegic patients are not actually using flexor hinge splints as expected. Minor attention to the role of the wrist in training the hemiplegic hands could make the affected hands less functional than potentially capable of. The purpose of this study is to provide some fundamental data regarding the functional adjustment of the wrist in the normal hand. 52 subjects volunteered. In Series I, discs of 5 different sizes, cylinderes of 3 different sizes, a pin and a card were transferred, rotated or turned on or between the various height. In Series II, 15 selected objects for the daily use were picked up, used and relocated. With use of the electrogoniometer developed for this study, the upper and lower terminal values (UTV, LTV) in extension-flexion plane of the wrist and the range of these two (U-L range) were measured for each task for each subject. The individual variation in each task demonstrated the normal distribution with the range of 40-50 degrees usually. Objects of ordinary sizes were transferred on the desk, with the wrist in sligth to moderate extension, demonstrating less than 10 degrees of U-L range. Thin, very small, very large or heavy objects located on the desk inclined the wrist position to flexion. Location of objects on higher horizontal plane or handling on the wall increased extension, usually without exceeding 65 degrees of extension. Consequently, the transfer task between planes of different height or different direction increased U-L range. Rotatory or turning task increased U-L range too, lowering LTV. Any tasks in Series II demonstrated the higher amount of U-L rane than simple transfer tasks on the desk in Series I. The amount of U-L ranges in use of selected objects for the daily use frequently exceeded the ones in single rotatory tasks or single transfer tasks between different planes, indicating the high frequency of the combination of these two factors in daily hand activities. The position of the wrist in the process of picking up selected objects for the daily use were quite similar to those of rotatory tasks in Series I. In use some tools, the position of the wrist was limited to only extension. However, many of selected objects for the daily use required the wide change of the wrist position including both flexion and extension. This was particularly so in objects handled on the surface of the body, such as a comb or toilet paper. For instance, in use of a pencil, the variation range demonstrated by 95% of subjects was [Ext. 15°-45°] in LTV, and [Ext. 30°-55°] in UTV, although in use of toilet paper, [Flex. 60°-25°] in LTV, and [Ext. 20°-60°] in UTV. In order that the position should not be deviated more than 3 standard deviations from the mean, the minimal dynamic range of the wrist was estimated to be Flex. 15°to Ext. 35°, (Flex. 25°to Ext. 40°in order to be within 2 standard deviations) allowing the associated finger movements.
著者
寺山 久美子
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.10, no.1, pp.25-32, 1973-01-18

It was reported by the author that a system named "ADL fiinger strain-gauge system" is useful for kinesiological analysis of fine finger activities included in usual ADL items and that this system was used for analysis of writing activities. At that study, several results were obtained about handwriting activities. Similar study were also obtained in feeding and scissoring activities. The study of feeding activities revealed that; 1. The pressure between each of 3 fingers and the tea-spoon is 51g on an average. 2. This pressure is about 1/1000 of total hand pressure, 1/200 of pinch-pressure between the thumb and index finger, 1/5 of total writing pressure, and 1/2.5 of finger-pressure during handwriting. 3. Minimum pressure for spooning is about 23 g on an average. 4. Maximum pressure for spooning is about 100 g on an average. 5. Chop-stick activities was also investigated, but the present method of investigation was found inadequate for this purpose. 6. and some others. In the study of scissoring activities, western type scissors and Japanese ones were compared and similar results with those of feeding activities were obtained.
著者
戸島 雅彦 西谷 幹雄 萩原 良治
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 (ISSN:0034351X)
巻号頁・発行日
vol.38, no.4, pp.268-276, 2001-04-18
被引用文献数
11

脳梗塞発症後3日以内に入院した157例に初期治療からリハビリテーションまで施行し,早期自宅退院を阻害する要因を検討した.症例を入院期間と退院先より群分類し,年齢,性比,病型,脳卒中既往歴,同居家族数,入院時機能障害,退院時能力低下,経時的FIMの8因子を各群間で比較した.長期入院した自宅退院群は短期入院群に比して4週目のFIM総合,運動合計,浴槽,階段でのみ有意に低得点で,この差が退院時期決定に関与した.長期入院した自宅退院群と療養施設転院群との間には,同居家族数,FIM 総合,移動,社会的認知で有意差を認めた.入院期間の短縮には予後予測や患者家族への情報提供が大切であると考察した.(リハ医学 2001;38:268-276)