脳卒中後のボツリヌス毒素を用いた上肢機能のリハビリテーション…安保　雅博，竹川　　徹　179

高次脳機能障害外来のあるべきすがた—当院の取り組みと現状—…平岡　　崇　183

整理・連携・報告が求められる嚥下障害のリハビリテーション外来診療…藤谷　順子　187

義肢装具療法の外来診療におけるポイント…浅見　豊子　191

高齢者のリハビリテーション外来—機能維持のためのポイント—…飯島　　節　196

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救命救急センターにおけるリハビリテーション…中村　俊介　200

ICUと術直後からのリハビリテーション導入…中村　　健，佐々木裕介，幸田　　剣，田島　文博　205

超急性期呼吸リハビリテーションの実際…安藤　守秀　209

硬膜外患者自己調節鎮痛法下術後早期リハビリテーションによる術後回復能力強化への取り組み…石村　博史，山内　康太，島添　裕史，三井　信介　214

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目的：脳梗塞急性期の片麻痺上肢への促通反復療法を持続的低周波電気刺激下で行う同時併用療法が麻痺と浮腫，関節可動域に及ぼす影響について検討した．対象：対象は2011 年4 月から2 年間に当院に入院した急性期脳梗塞片麻痺患者で，片麻痺と麻痺側手に浮腫があった患者30 名である．方法：単盲検無作為化比較試験を用い，促通反復療法と持続的低周波電気刺激との同時併用療法群（介入群）と関節可動域訓練群（対照群）に割付け，それぞれの治療を30 分，2 週間実施した．効果の評価はUpper Limb Fugl-Meyer Assessment（FMA），浮腫の測定，関節可動域テストを治療の前後に行った．結果：治療によって，介入群は全ての評価が有意に改善した．対照群はFMAに有意な改善を認めたが浮腫と関節可動域は改善がなく，改善度も介入群がFMAと浮腫，関節可動域で対照群より有意に大きかった．結語：促通反復療法と持続的低周波電気刺激の同時併用療法は，急性期片麻痺上肢の運動麻痺回復と麻痺側手の浮腫軽減を促進する．

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Alien hand syndrome (AHS) is a rare neurologic disorder in which movements are performed without conscious will. Cognitive rehabilitation is usually first considered for treating AHS. However, we proposed different modalities for the treatment. This is the first case report showing therapeutic effects of the NEURO-15 program that consists of low-frequency repetitive transcranial magnetic stimulation and intensive occupational therapy on AHS symptoms and upper limb dysfunction caused by a stroke one year and three months before. A 68-year-old male developed right upper limb palsy secondary to cerebral infarction on the medial side of the left frontal lobe. On admission, he exhibited disturbed skilled motor behavior, compulsive grasping of the right upper limb, and dissociated behavior of the right hand independent from the left. The right hand interfered with the actions executed by the left hand. The left hand restricted the right hand in its actions by holding it. Six months after the onset, his Activities of Daily Living improved and he was discharged from hospital to home. However, his compulsive grasping of the right upper limb symptoms remained, and he underwent NEURO-15 one year and three months after the onset. His right upper limb function improved. Compulsive grasping of the right upper limb disappeared, and the contradictory action of the right upper limb was rarely seen. These results suggested that NEURO-15 influenced the neural network including the primary motor cortex and supplementary motor area.

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