外来通院中の在宅リウマチ患者118名を対象にFunctional Limitation Profile(FLP)によってQuality of Life (QOL)の特徴を検討し,構造解析を試みた.歩行,セルフケア,移動は半数以上が自立していたが,家事は約半数が実施せず,リクリェーションは60%が活動性が低下していると回答した.その一方で心理的問題の存在を回答したものは30%だった.FLP全体に与える影響と項目間相互の関係を数量化理論第1類,第3類を用いて解析した.その結果,身体的機能,社会的活動性,心理的問題が相互に対等な要因関係にあることを明らかにした.このことからこれらの項目はQOLを評価する上で欠かせないことを述べた.

抄録全体を表示

脳性麻痺児の移動運動能力は,早期訓練が始められかつ継続されても,当初の脳損傷の程度と経過年数でその能力獲得の限度があるが,訓練の限界について明示した報告はない.私達は1968年～1987年の20年間に出生し,できるだけ早期に治療訓練を開始した73症例の痙直型脳性麻痺児について,少なくとも11年以上経過をみた結論は,屋外独歩獲得の限界は7歳,訓練としての独歩あるいは屋内独歩の限界は9歳,杖歩行の屋外移動獲得の限界は10.5歳,訓練としての杖歩行あるいは屋内杖歩行獲得の限界は11歳であり,6.7歳を過ぎると四つ這い移動獲得が難しいということであった.療育の観点からいえば,これら訓練と年齢の限界を見極めての適切な医療が肝要である.

抄録全体を表示

当科では,1998年7月以降,眼瞼攣縮患者6例にボツリヌス毒素の眼輪筋への局所注射を施行した.患者は平均年齢60.0±9.7歳,罹病期間は2～5年(2.5±1.3年),男女3例ずつであった.初回投与では,全例に眼輪筋の攣縮・瞬目数の減少などがみられ有効であったが,一過性の閉瞼不全・複視などの副作用も3例に経験した.眼瞼攣縮に対するボツリヌス毒素初回投与効果と副作用に関して,過去の報告と比較検討した.

抄録全体を表示

There are now various therapeutic interventions for cerebral palsied children. Many of them were developed based on the theoretical speculation or empiricism, because it was difficult to know the pathophysiological process, which occurred in the injured brain before its development. It, however, is believed that synaptic formation and synaptic rearrangement play a main role in the first instance of motor development. In the therapeutic approach for cerebral palsied children, we should adopt the appropriate strategy based on the knowledge of neuro-developmental science. As same as the other diseases, for the cerebral palsy, we also should treat the various levels of problems, which was classified by WHO as impairments, disabilities (activities), and handicaps (participation). Therapeutic interventions for children with cerebral palsy have been directed mainly toward impairments of this pathological condition, such as spasticity, joint contracture and abnormal movement pattern. We should pay attention for the cerebral palsied children also to their function in the home activities and participation to the social affairs. At the end of the 20th century health professionals are expected to produce evidence of the effectiveness of the treatments that they provided to the clients. What we require in addition are measures that capture the “health status” of people. We have not been making enough effort to evaluate the effectiveness of therapeutic intervention for cerebral palsied children with the scientific documentation. In North America, various scales have been developed in the recent decades under the concept of the framework for health measurement indices. These scales were also standardized and were endurable for multi-institute's use. In the area of rehabilitation of cerebral palsied children, Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) were developed with this new concept. In this review article, the summary and the process of standardization in Japan of these scales were presented.

抄録全体を表示