Parkinson病の非薬物療法：マネジメントと最新リハビリテーション

抄録

Even with optimal management with drug and surgical therapies, patients with Parkinson's disease (PD) are faced with progressively increasing motor and non–motor problems. Rehabilitation combined with the treatment have a possibility of the further improvement of the symptoms of PD. It is necessary for physicians to know the intervention methods of rehabilitation for Parkinson's disease. In this presentation, I introduce new intervention methods of rehabilitation including the evidence shown with “Parkinson's disease treatment guidelines 2011 and the new” by Societas Neurologica Japonica including a new method to evaluate PD gait and severity using a portable gait rhythmogram (PGR) and music therapy.

Exercise and motor training are effective for health related QOL, muscular strength, balance, walking speed, UPDRS–III, reaching performance. Walk training with the treadmill and Nordic events walking are also effective. The frequency of the fall decreases with physiotherapy.

It is important for PD rehabilitation to choose an appropriate intervention method for their severity. Disused syndrome is also an important problem in PD. In an early stage, education is very important to keep their life–style. In middle stage, exercise and motor training is necessary for motor function, for example, gait problems as well as speech and swallowing disturbance. Lee–Silverman Voice Treatment improves speech and swallowing function. Tai chi exercise improves the stability of the posture. And a cue strategy method, for example, the walk training using the external auditory stimulation is effective including music therapy.

Furthermore, I make a presentation about a new evaluation method using an acceleration sensor (PGR). Finally, it is necessary to make high evidence intervention methods from the multidirectional points of view including an evaluation of compliance such as continuity and motivation in order to offer better rehabilitation.