急性期医療終了時に看過され，医療介入の断続した高次脳機能障害者34例の検討

抄録

This study was conducted to verify the characteristics of the cases suffering discontinuation of sequential medical intervention for higher cognitive dysfunction after the acute stage of traumatic brain injury (TBI).

Totally 34 concerned cases (D-group) from single institute were analyzed and the data were partly compared to those of other 73 cases (C-group) sharing in the benefit of continuous medical intervention under the same situation.

D-group was composed of 31 males ⁄ 3 females, 28.9 ± 13.4 years-old, and about 5 years passed precedent to be introduced to our institute. The reasons why such delay occurred were mainly drop-out by overlooking of higher cognitive dysfunction and misjudgment of functional outcome at the termination of the therapy in acute stage, and careless follow-up at outpatient clinic. The symptoms recognized by various neuropsychological examinations were memory disturbance (21), attention disturbance (21), decline of general intelligent quotient (20), execution disturbance (15), social behavior disturbance (13), etc. During follow-up period (mean 535 days) to such cognitive dysfunction, single or combined interventions were performed for all cases such as environmental arrangement, individual ⁄ group rehabilitation. Functional outcome-analysis by neuropsychological examinations before ⁄ after such interventions revealed that there was little improvement except attention disturbance. On the other hand, social outcomes were as follows: actual work ⁄ school attendance (8), participation to social life (11), being at home (10), being at hospital ⁄ welfare institute (5). These data indicated that rate of return to actual work ⁄school attendance in D-group (26.7%) was rather lower than that of C-group (39.3%). Furthermore, correlation of the results of neuropsychological examinations and social outcome in D-group was much weaker than those in C-group. It is suggested that environmental arrangement is the most important factor for the return to actual work ⁄ school attendance in D-group.

In conclusion, continuous medical intervention for higher cognitive dysfunction after the acute stage of TBI is much favorable for the improvement of QOL of the people concerned.