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<title>極める脳卒中の理学療法 | 株式会社文光堂</title>


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<meta name="description" content="PART I では脳卒中の病態・治療・脳画像の見かたについての解説に加え，急性期から回復期までをシームレスにつなぐ理学療法についての道標を示す．PART II～V では病期ごとに，できるだけエビデンスに基づき，評価を具体的にして，そこからどのようにより科学的なアプローチをするか提示し，次の病期の理学療法士に望むことを提言する．PART VI では対象者がどのような心理状態であるか，集団的アプローチ">

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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">PART I では脳卒中の病態・治療・脳画像の見かたについての解説に加え，急性期から回復期までをシームレスにつなぐ理学療法についての道標を示す．PART II～V では病期ごとに，できるだけエビデンスに基づき，評価を具体的にして，そこからどのようにより科学的なアプローチをするか提示し，次の病期の理学療法士に望むことを提言する．PART VI では対象者がどのような心理状態であるか，集団的アプローチのポイントと効果を再確認している．</section><section class="preface">序<br>「エビデンス思考に基づくアプローチ」<br><br>　脳卒中は「がん」「心筋梗塞」「肺炎」についで，日本人の死亡原因の第4位である．死亡原因では第4位であるが，寝たきりの原因としては，第1位の病気である．また，65歳以上の国民医療費でみても，脳血管疾患や高血圧性疾患などの推計患者数も65歳以上で多く，要介護度別にみた介護が必要となった主な原因も脳血管疾患をはじめとした生活習慣病が3割を占める．このことから，脳血管疾患の理学療法をエビデンス思考に基づき施行することは，医療費削減はもちろん，脳血管疾患患者とその家族の生活をより豊かなものにするためにも大変重要なことである．<br>　本書では，脳卒中に対する理学療法を，急性期・回復期・生活期・終末期に分け，回復期においてはさらにさまざまな視点からのエビデンス思考に基づいた治療戦略について述べた．また，これらを学ぶために必要な脳卒中の病態や医師が行う脳卒中に対する治療，脳卒中の治療に必要な脳画像の見かたなども加えた．そして，ミニレクチャーでは，実際の理学療法のポイントや，最近開発・応用がめざましいリハビリテーションロボット・非侵襲的脳刺激療法（TMS／tDCS）・CIセラピーなども加えた．<br>　近年，脳卒中治療ガイドラインなどが発表されているが，そもそも「evidence-based medicine（EBM）」とは，「個々の患者におけるケアについての意思決定において，良心的で明確かつ賢明な態度にて現段階における最良のエビデンスを使用することである．そのEBMの実績は，系統的な検索による最良で入手可能な外的な臨床エビデンスにおける臨床的な専門知識の統合を意味している．」（Sackett D, et al：BMJ. 312（7023）：71-72, 1996）ということである．本書では，各項でエビデンス思考に基づくアプローチを可能な限り記載した．エビデンスが不十分な部分においては，臨床経験に基づき，客観的に臨床思考を展開するようにした．本書全体では，図表やフローチャートを多用し，わかりやすい構成を心がけた．本書が，脳血管疾患患者とその家族の生活をより豊かなものにするために努力を惜しまない理学療法士の一助となれば幸いである．<br><br>平成30年10月<br>ゲスト編集　松﨑哲治</section><section class="indexes">Part I 脳卒中とは？<br>1　脳卒中の病態<br>　　脳卒中の分類<br>　　脳卒中発症後に変化する神経症候<br>　　脳卒中発症後の注意すべき合併症<br>2　脳卒中に対する治療<br>　　急性期治療<br>　　急性期の血圧管理<br>　　急性期の合併症対策<br>　　生活期<br>3　脳画像の見かた<br>　　CT<br>　　MRI<br>　　脳の形態解剖<br>4　脳卒中理学療法における道標─急性期から生活期までをシームレスにつなぐ─<br>　　地域包括ケアシステムとシームレス<br>　　シームレスな理学療法の実際─プッシャー症候群（pusher syndrome）─<br>　　おわりに<br>　ミニレクチャー  前大脳動脈（ACA）領域梗塞における理学療法のポイント<br>　ミニレクチャー  中大脳動脈（MCA）領域梗塞における理学療法のポイント<br>　ミニレクチャー  後大脳動脈（PCA）領域梗塞における理学療法のポイント<br>Part II 急性期における脳卒中理学療法<br>1　急性期における脳卒中理学療法<br>　　根拠に基づく急性期理学療法の実践にあたり<br>　　急性期理学療法の理論的背景<br>　　理論的背景を用いた取り組み・実践<br>　　予後予測<br>　　回復期の理学療法士に望むこと<br>　ミニレクチャー  ラクナ梗塞における理学療法のポイント<br>Part III 回復期における脳卒中理学療法<br>1　基本動作に対する理学療法<br>　　基本的動作に対する理学療法<br>　　回復期の片麻痺患者における動作の特徴<br>　　基本的動作の評価方法<br>　　先行研究から確認されている寝返り動作（背臥位から非麻痺側方向への寝返り）の特徴─健常者と片麻痺患者─<br>　　FAHBを用いた研究から確認された片麻痺患者における起居動作遂行時の運動学的特徴─53名を対象として─<br>　　先行研究から確認されている起き上がり動作（背臥位および側臥位→長座位および端座位）の特徴─健常者と片麻痺患者─<br>　　FAHBを用いた研究から確認された片麻痺患者における起き上がり動作（片肘つき側臥位パターン）の運動学的特徴─53名を対象として─<br>　　先行研究から確認されている起立動作（端座位→立位）の特徴─健常者と片麻痺患者─<br>　　FAHBを用いた研究から確認された片麻痺患者の起立動作（端座位→立位）の運動学的特徴─53名を対象に─<br>　　おわりに<br>2　歩行に対する理学療法<br>　　回復期脳卒中患者の歩行に対する機能回復と運動学習<br>　　歩行の安定<br>　　歩行自立<br>　　歩行速度<br>　　歩行の対称性<br>　　回復期脳卒中患者の歩行の予後予測<br>　　急性期・生活期理学療法に望むこと<br>3　装具療法<br>　　装具療法の理論的背景<br>　　装具療法の実践<br>　　急性期，回復期，生活期の理学療法に望むこと<br>4　日常生活活動と高次脳機能障害に対するリハビリテーション<br>　　はじめに<br>　　評　価<br>　　アプローチの前に<br>　　高次脳機能障害に対するアプローチについて<br>　　高次脳機能障害と脳の半球間抑制<br>　ミニレクチャー  被殻出血における理学療法のポイント<br>　ミニレクチャー  視床出血における理学療法のポイント<br>　ミニレクチャー  小脳出血における理学療法のポイント<br>　ミニレクチャー  脳幹出血における理学療法のポイント<br>　ミニレクチャー  皮質下出血における理学療法のポイント<br>Part IV 生活期における脳卒中理学療法<br>1　訪問リハビリテーション<br>　　訪問リハビリテーションの理論的背景<br>　　理論的背景を用いた取り組み，実践<br>　　訪問リハビリテーションの予後予測<br>　　急性期・回復期の理学療法士に望むこと<br>2　通所リハビリテーションと再発予防<br>　　通所リハビリテーションの現状<br>　　通所リハビリテーションは「集団」に対するアプローチである<br>　　イメージとして“質”を担保し“量”を確保する<br>　　脳の可塑性は果たして6ヵ月でプラトーとなるのか<br>　　先入観を前向きにコントロールする<br>　　環境・空間の脳科学的戦略<br>　　デバイスを使用した麻痺側の良いイメージの構築<br>　　脳卒中と歩行<br>　　再発予防への取り組み<br>　　急性期・回復期の理学療法士に望むこと<br>　ミニレクチャー  非侵襲的脳刺激療法（TMS／tDCS）<br>　ミニレクチャー  CIセラピーの効果<br>　ミニレクチャー  リハビリテーションロボット<br>Part V 介護・終末期リハビリテーション<br>1　介護・終末期リハビリテーション<br>　　序にかえて<br>　　いつから終末期とするのか<br>　　終末期ケアの実際と理学療法<br>　　終末期の評価<br>　　おわりに<br>Part VI 理学療法における集団的アプローチによる心的課題へのかかわり<br>1　理学療法における集団的アプローチによる心的課題へのかかわり<br>　　はじめに<br>　　関心のベクトル<br>　　社会的孤立と孤独感を癒やせるのは仲間<br>　　集団アプローチの意味<br>　　集団訓練の実際<br>　　おわりに<br>　　索引</section></article>
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