ロボット開発と医療福祉分野の特殊性…榊　泰輔　483

上肢訓練支援ロボットの無作為化比較試験…蜂須賀研二　489

動力歩行装置Lokomatを用いた歩行リハビリテーション…河島則天，小川哲也，緒方　徹，赤居正美，中澤公孝　495

バランス練習アシストロボットの効果…平野　哲，才藤栄一，伊藤慎英，田辺茂雄，尾崎健一，宮内享輔，川端純平，伊藤和樹，植木友梨，村上　涼，鴻巣仁司，渡部浩康　500

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痙縮の病態生理…正門由久　505

脳卒中上下肢痙縮に対するボツリヌス療法の手技とこつ…大田哲生　511

上肢痙縮に対するボツリヌス療法の実際…中馬孝容　515

上肢機能向上と社会参加…松嶋康之，蜂須賀明子，蜂須賀研二　520

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認知機能に対する薬物療法とエビデンス…生駒一憲　525

認知リハビリテーションのエビデンス〈総説〉…渡邉　修　530

高次脳機能障害のリハビリテーション－帰結調査からみた医療と福祉の連携－〈原著〉…浦上裕子，山本正浩，中島八十一　536

高次脳機能障害の社会復帰と職場復帰…岡﨑哲也　543

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Protraction of RA induces joint function disorders resulting in a deterioration in the activities of daily living (ADL), which can cause a change in the patient's household role and limit their social participation. As there is not at present a curative treatment for RA, once functional disorders develop, they cannot be recovered easily or completely. However, it was recently reported that disorders progress rapidly within a few years from RA disease onset in terms of the changes wrought by joint damage and the resulting functional disorder inflicted on the patient. Therefore, it is proposed that adequate administration of methotrexate should be started initially and that RA treatment should be based on the recommendations under the regime of Treat to Target (T2T). Rehabilitation for RA patients includes various kinds of exercises and approaches such as physical therapy in the early stage and nursing home service with caregiver insurance in the terminal RA phase. In terms of the principles of T 2 T, the aim of the RA treatment is to improve the patients' long-term QOL as much as possible during their lifetime through the restoration of body functions and their participation in social activities. The ultimate aim of rehabilitation is the same as that of T 2 T because it is to let people with disabilities live normal lives by diminishing the difficulties RA patients face in daily life and improving their QOL. It is therefore very important to keep in mind that RA is a complex condition that includes people with various afflictions and difficulties in meeting their daily living tasks and not just one disease.

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【目的】脳性麻痺の運動機能の問題に筋のインバランスがあり，股関節周囲では屈筋・内転筋が優位となり股関節脱臼が生じる．放置すると屈曲内転拘縮が進行して様々な障害を招くため，早期から予防に努めることが重要である．手術的治療の1 つとして選択的筋解離術があり，その有効性は示されているが手術時期について一致した見解はない．そこで年齢による成績の違いを調べた．【対象と方法】当センターで股関節周囲筋解離術（松尾の方法を一部改変）を行い6 カ月以上経過観察ができた26 例52 股．術後はギプスや補装具を用いて外転位を保持した．股関節単純X線写真でMP（migration percentage）を計測し，改善率（術前MP－最終観察時MP／術前MP×100％）を比較した．【結果】手術時年齢6 歳未満の方が，6 歳以上に比べて改善率が高かった．【結論】6 歳未満での手術が良好な成績につながると考えられる．

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The most important factors in determining the outcomes of patients with traumatic brain injury (TBI) is the degree of severity and types of primary brain damage, and the secondary damage to the brain such as low-oxygen and low-blood pressure et al. For severe TBI patients, prompt and appropriate decompression to reduce intracranial pressure (ICP) and ICU management are commonly required. The second edition of "Guidelines for the Management of Severe Head Injury" was published by the Japan Society of Neurotraumatology (JSNT) in 2006. These guidelines include a wide range of topics in the management for severe TBI, from prehospital care, primary care, ICU management and surgical treatment. The essence of extended decompression and neuroprotection for TBI is also focused in the JNST Guidelines. The pathophysiological event in the acute stage of severe TBI is quite variable ; therefore, an appropriate individual based approach in ICU management is necessary under experienced medical teams.

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