脳卒中リハビリテーション最前線

抄録

To minimize social burden of stroke as the main disease causing the disabled elderly, primary and secondary prevention of the disease, early therapeutic intervention, focused rehabilitation and risk control of its complications are definitely important. In terms of rehabilitation, Kaifukuki (convalescent) Rehabilitation Ward was introduced to the Japanese national medical insurance system in 2000. The number of beds for KRW has been increasing steadily up to 70,000 in 2015 providing intensive inpatient rehabilitation for postacute stroke patients. The remaining problems are establishing suitable rehabilitation environment for acute stroke and community–based rehabilitation system for chronic stroke. The other important issue is extending pool for evidence based rehabilitation strategies that meet patients' needs in each stage after the insult.

Recent advance in functional neuroimaging and neurophysiological technique has confirmed that functional recovery after stroke is associated with functional and structural reorganization of the spared brain network and that such plastic changes are induced by promoted use of the affected limbs, use–dependent plasticity. Based on such findings, task–oriented practice is believed to be the most efficient strategy for maximizing behavioral recovery as well as optimizing adaptive reorganization of the brain network. The essential factors of successful task–oriented practice include dose, content of practice according to the principle of motor learning and environment promoting behavioral empowerment for the use of the paretic limbs in daily life. In addition, several trials for neuromodulation techniques to induce adaptive plasticity are breaking topics in recent neurorehabilitation field. Brain stimulation such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, brain–machine interface and neurofeedback are promising new strategies that are currently tested in the clinical settings.