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<meta name="description" content="急性期・回復期・生活期の３部構成となっており，各期において歩行再建を目指した真摯な取り組みを紹介している．10年前には考えられなかった“歩行の力学的パラダイム”として知られる“倒立振子モデル”を形成した歩容の獲得や，実用的な速度を有する歩行能力の再獲得は，装具が技術的に進歩したという背景がある．完全麻痺の患者でも歩行再建がより高いレベルでなされるようになった中枢神経系理学療法のあり方の一つを提示す">

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					編集：阿部浩明（広南病院リハビリテーション科総括主任）
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				<ul class="property"><li class="disc">B5判・210頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-4573-0</li><li class="disc">2019年3月16日発行</li></ul>

				
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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">急性期・回復期・生活期の３部構成となっており，各期において歩行再建を目指した真摯な取り組みを紹介している．10年前には考えられなかった“歩行の力学的パラダイム”として知られる“倒立振子モデル”を形成した歩容の獲得や，実用的な速度を有する歩行能力の再獲得は，装具が技術的に進歩したという背景がある．完全麻痺の患者でも歩行再建がより高いレベルでなされるようになった中枢神経系理学療法のあり方の一つを提示する．</section><section class="preface">序<br><br>　小生が理学療法士となって20有余年が経過した．この間，実に様々な変化があったわけだが，身近なところでその変化を感じるものの一つに電話があろう．小生が子供の頃にはどこの家庭にもあった黒電話がいつの間にやらプッシュ式の電話に変わり，ついには携帯電話が普及し，瞬く間にsmartphoneが拡がって，今や“一人が一台以上のモバイル端末を所有する時代”と言ってよいだろう．その凄まじいスピード感はないものの，神経理学療法に関わる知識や技術もまた少しずつ変化を遂げてきたように思う．神経理学療法に深く関連した科学的技術の著しい変化はロボティクスに代表されるが，様々な課題を抱え現時点では臨床に広く普及しているとは言いがたい．一方，装具療法においてはその普及と進歩を穏やかながらも体感できるのではないだろうか．本書は，実際の臨床のフィールドに従事する理学療法士が歩行再建を目指した取り組みを紹介した書であり，各執筆者が果敢に，そして，真摯に挑んだ軌跡がひしひしと伝わってくる．ここにある取り組みは，少なくとも10年前の小生の眼には，非常識な治療として映ったであろう．　<br>　これまでの常識として，“脳卒中片麻痺者の回復の特性として，末梢である足部の機能の回復に限界があることは少なくないが，股関節や膝関節などの近位の回復は良好なことが多い”という概念がある．これはおそらく多くの方の共感を得ることができるであろうし，事実であろう．このためか，足部は動きを制限することが第一選択となり，股関節や膝関節の動きは制限せずに足部の関節自由度を制限する短下肢装具が理学療法では多用されてきた．本書で紹介される“歩行の力学的パラダイム”として知られる“倒立振子モデル”を形成した歩容の獲得や，実用的な速度を有する状態での歩行能力の再獲得は，10年前には考えられなかった．このような治療がなされるようになった背景には，装具そのものの技術的進歩が影響していることは自明で，これらの発展を臨床応用することによって，完全麻痺と表現される症例においても，理学療法士の介入によって，大きな歩幅で前型歩行をすることができる．<br>　神経理学療法に関わるツールの発展が顕著である一方，残念ながら，神経理学療法の技術そのものは何も変わっていないと表現されることもある．確かに，機能障害を改善させるという側面では大きな変化はないのかもしれない．しかし，能力という側面でみたときにはどうであろうか．この書の多くの章で提示していただいた治療経過は，機能障害そのものを改善しているものは少ないかもしれないが，そのような状況でも能力は大きく向上しているものが多い．つまり運動麻痺や感覚障害そのものは改善していなくても新しい取り組みによって歩行能力を改善させていると言えよう．簡単に対比することはできないが，10年前には受け入れ難かったであろう介入によって，10年前には達成できない治療効果が得られ，歩行再建がより高いレベルでなされるようになった．<br>　ロボティクスや再生医療などは凄まじい速度でますます進歩を遂げ，やがては多くの一般の臨床のフィールドにおいても普及するであろう．しかも，そう遠くないはずである．おそらくここ数年で装具療法のあり方も大きく変化が生じることであろう．今，この時期に，最も治療効果を上げる可能性のある下肢装具を用いた中枢神経系理学療法のあり方の一つを提示する書として，この書を世に送り出したい．<br><br>2019年1月<br>阿部 浩明</section><section class="indexes">I 急性期の下肢装具療法事例<br>概論　1 急性期の理学療法においてどのように装具療法を進めるか<br>実践　2 下肢筋緊張亢進例に対する理学療法評価に基づいた装具療法<br>　　　3 筋電図を用いた治療方針の選択と下肢装具療法<br>　　　4 下肢装具作製の必要性を適切に判断するために必要な脳画像情報の活用<br>　　　5 皮質脊髄路の完全損傷を認めた若年重度片麻痺者に対する下肢装具を用いた歩行トレーニング<br>　　　6 実用的な歩行能力の獲得が困難と思われた高齢重度片麻痺例の装具作製と理学療法<br>　　　7 離床の遅れにより廃用が生じた外減圧術後脳梗塞例に対する歩行能力の再獲得を目指した下肢装具を用いた取り組み<br>II 回復期から在宅復帰に向けた取り組み事例<br>概論　8 回復期の理学療法においてどのように装具療法を進めるか<br>実践　9 長下肢装具からのカットダウン後に歩容異常が出現した左内頸動脈閉塞による右片麻痺例の歩容および歩行能力改善に向けた取り組み<br>　　　10 脳卒中発症後6か月経過し歩行に全介助を要する重度片麻痺を呈した症例に対する下肢装具療法<br>　　　11 脳血管障害による視床吻側部の損傷例─意識障害の改善，自宅復帰を目指した症例<br>　　　12 油圧制動付短下肢装具を用いた歩行トレーニングにより歩行能力が改善した運動失調例<br>　　　13 軽度運動麻痺と麻痺側運動失調が混在した視床出血例<br>　　　14 円背と認知症を伴う高齢脳卒中例に対する下肢装具を用いた歩行トレーニング<br>　　　15 右麻痺を呈した全盲の症例に対する装具を用いた歩行トレーニングと在宅復帰に向けた取り組み<br>III 生活期の下肢装具療法事例<br>概論　16 生活期の理学療法においてどのように装具療法を進めるか<br>実践　17 下肢装具の再作製と反復ステップ練習により歩行機能が改善した生活期片麻痺例<br>　　　18 足部内反が悪化した生活期片麻痺者に対する油圧制動付短下肢装具を使用した下肢装具療法<br>　　　19 重度の反張膝と足部内反が出現した生活期片麻痺者に対する油圧制動付長下肢装具を使用した下肢装具療法<br>　　　20 進行性疾患に対する外来での装具療法<br>　　　21 短下肢装具にて自立歩行していた脳卒中既往のある症例に対する長下肢装具を用いた歩行トレーニング<br>　　　22 足関節背屈制限を有する生活期重度片麻痺者に対する長下肢装具を用いた歩行トレーニング<br>索引</section></article>
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