メディカルスタッフレクチャー
明日から役立つ，Parkinson病の外来リハビリテーション指導
2020 年 37 巻 4 号 p. 572-576
詳細
2020 年 37 巻 4 号 p. 572-576
There is increasing evidence that rehabilitation is useful for Parkinson's disease (PD). In–hospital rehabilitation is reported to be effective. However, because of the small number of medical facilities capable of performing intensive rehabilitation and the inconvenience of health insurance system in Japan, not all the PD patients can receive in–hospital rehabilitation. Therefore, we need to make good use of outpatient rehabilitation.
The important point is that rehabilitation is the only method that patients themselves participate positively and are responsible for the results. As a key to the success of continuous rehabilitation, we need to provide a cheerful rehabilitation program and need to let the patients consider the exercise as a part of usual daily life.
Appropriate rehabilitation program for PD patients is composed of a mixture of the following 4 parts ; 1 : aerobic exercise to keep physical strength better, 2 : stretch exercise, 3 : muscular exercise, and 4 : rehabilitation programs to relieve PD–specific problems including abnormal posture, freezing of gait, etc. Paradoxical movement induced by external cue is frequently utilized as PD–specific rehabilitation. In addition, cognitive movement strategy is also often used and is sometimes very effective.
Falling is one of the important troublesome matters in PD. Not only the rehabilitation but confirmation of the falling pattern and the preparation of housing environment are also important to protect patients from falling.
Apart from rehabilitation, various methods such as dances, yoga, music therapy, and vibration therapy are tried and some are reported to be effective. Among these, we have been interested in whole body vibration therapy. Assuming that slow gentle vibration to the whole body may be effective, we loaded whole body vibration with 0.3Hz frequency for 10min to 12 PD patients and found a significant improvement in PD symptoms. Although precise mechanism of the vibration effect and the optimal stimulation parameters are still unknown, we believe that whole body vibration therapy could be one of the future devices to cure PD.
