脳梗塞のリハビリテーション治療

抄録

Stroke is clinically characterized by hemiplegia and exercise intolerance, both of which not only interfere with the ability to perform activities of daily living (ADL), but also significantly reduce quality-of-life (QOL). Neurological and functional recovery occurs mainly within the first 6 weeks after onset of stroke, but the process continues for several months, with maximal functional recovery usually achieved within 6 months. In Japan, convalescent rehabilitation wards play an important role in the rehabilitation of post-stroke patients who have impaired ADL and health status after the acute phase. Various physiotherapies have been developed to improve functional recovery in patients with hemiplegia due to stroke, including the facilitation technique with proprioceptive neuromuscular facilitation, and constraint-induced movement therapy. A novel facilitation technique is repetitive facilitative exercises (RFE), which promote the functional recovery of the hemiplegic limbs to a greater extent than conventional rehabilitation sessions.

Functional electrical stimulation (FES) is a technique used to produce contractions in paralyzed muscles by the application of small pulses of electrical stimulation to the nerves that supply the paralyzed muscle. FES is used as an orthosis to assist walking, and also as a means of practicing functional movements for therapeutic benefit. New training technologies involving the use of robots have recently been developed to help in the rehabilitation of post-stroke patients.

Robot-assisted rehabilitation therapy provides functional training of the upper and lower limbs in an effective, easy and comfortable manner. Furthermore, the robot-assisted training paradigm offers intensive, repetitive, sufficient, and accurate kinematic feedback along with symmetrical practice while reducing the workload for the therapist, thus reducing the cost of post-stroke rehabilitation. Exoskeleton-type robotic devices have robot axes aligned with the anatomical axes of the wearer. These robots provide direct control over individual joints, which can minimize abnormal posture or movement. Robot-assisted gait training is effective in the long term in improving balance and walking ability, and it has a positive impact on patients' QOL. Several well-designed studies have provided evidence that robot-assisted training promotes motor recovery and functional improvement in post-stroke patients. However, the evidence is insufficient to draw conclusions about the effectiveness because of small samples sizes, methodological flaws, and heterogeneous training procedures. More well-designed randomized controlled trials are needed.