慢性期脳卒中後片麻痺患者に対する反復性低頻度経頭蓋磁気刺激と集中的リハビリテーションの併用療法の有効性を評価する指標の検討:JASMIDを用いた評価の妥当性について

摘要

我々は，慢性期脳卒中後片麻痺患者の上肢機能に対して，低頻度反復性経頭蓋磁気刺激(low-frequency repetitive transcranial magnetic stimulation;LF-rTMS)と集中的リハビリテーション(以下リハビリ)の併用療法であるNovEl intervention Using Repetitive TMS and intensive Occupational therapy(以下NEURO)を施行し，その有効性をFugl-Meyer Assessment(以下FMA)，Wolf Motor Function Test(以下WMFT)やAction Research Arm Test(以下ARAT)を使用した上肢機能評価にて示してきた．%The combination of low-frequency repetitive transcranial magnetic stimulation and NovEl intervention Using Repetitive transcranial magnetic stimulation and intensive Occupational therapy(NEURO)has been reported to be useful for patients with upper-limb hemiparesis after stroke and the evaluated the Fugl-Meyer Assessment,Wolf Motor Function Test and Action Research Arm Test.The Jikei Assessment Scale for Motor Impairment in Daily Living(JASMID)was developed to subjectively assess the motions of daily living in Japanese patients with upper-limb hemiparesis caused by strokes.In 2008 we started performing NEURO in 8 associated hospitals for patients with chronic hemiparesis after stroke.Therefore,in the present study we reviewed 1774 patients who had undergone the complete NEURO protocol.After treatment in all patients the JASMID scores for the amount of use and the quality of movement increased significantly and the Wolf Motor Function Test score decreased significantly.Furthermore,severeness distinction of JASMID total points,low and middle group score increased significantly.Our research suggest that in low and middle group,JASMID show the variability of upper-limbs function in patients who have chronic poststroke hemiparesis.It would not be seen in the activities of daily living(ADL)at an approximately difficult level in JASMID of Fugl-Meyer Assessment severe group that was not significantly improved.The patients of our research use more hemiparalyzed arm.Patients in the low and middle group use their paralyzed arm more easily than do patient in the severe group.Therefore,patients in the low and middle group frequently use their paralyzed arm in everyday life.