脳卒中片麻痺のリハビリテーションと脳循環および代謝に関する研究

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In order to deduce the rehabilitation potential of the hemiplegic patients after stroke, the author examine the relation between cerebral hemodynamics measured by nitrous oxide uptake method and the rehabilitation effect by means of activities of daily living (ADL). The conclusion obtained were as follows : 1) Compared with healthy persons, hemiplegic patients show the disturbances in cerebral hemodynamics, namely, the decrease in cerebral blood flow (CBF) and cerebral exygen consumption (CMRO_2) and the increase in mean arterial blood pressure (MABP) and cerebral vascular resistance (CVR). 2) A certain degree of correlation can be seen in hemiplegic patients between ADL adn cerebral hemodynamics. In general, the rehabilitation potential tends to be poor in the cases of severe disturbances in cerebral hemodynamics. 3) In those patients in whom the advanced arteriosclerotic changes are to be seen in cerebral angiography, the disturbances in cerebral hemodynamics are of high degree and ADL are also poor, but no definite tendency is to seen in the cases of cerebral artery occulsion. The arteriosclerotic changes are considered, therefore, to be an important factor for the rehabilitation potential. 4) In many cases of poor motivation and emotional incontinence after cerebrovascular accident, the disturbances in cerebral hemodynamics, in particular, the pronounced reduction cerebral oxygen consumption (CMRO_2) are observable and ADL are also poor in such cases. 5) The muscle strength in the affected side of hemiplegic patients is lowered, but the muscle strength in non-affected side is also lowered by 26.9% In many patients in whom the muscle strength in non-affected side is lowered, the disturbances in cerebral hemodynamics are and marked ADL are also poor, so that the muscle test in the non-affected side is useful in consideration of rehabilitation potential. 6) The comparion of cerebral hemodynamics between the age group older than 60 and younger than 45 in hemiplegic patients, revealed that the disturbances in the former showed a little higher than in the latter, but no great difference was observed in ADL between the two. It seems that many other factors are responsible for ADL. 7) After rehabilitation grogram, the improvement in cerebral hemodynamics is observed in general, especilally in the improved cases in ADL. There are, however, cases in whon some improvement in ADL can be seen without improvement in cerebral hemodynamics. It is certain that many other factors are responsible for such results. 8) In most cases of poor ADL, namely, in most cases of dependent group in daily living, the disturbances in cerbral hemodynamics are of high degree and many other factors disturbing rehabilitation effect are observable. The cerebral hemodynamics measured by nitrous oxide uptake method has some limitation for clinical use, because it shows the blood circulation in the brain as a whole, but does not show them in the affected region of the brain. By summarizing the author's studies, however, it is conceivable that the measurement of cerebral hemodynamics in the postapoplectic hemiplegic patients is of significance as one of the means by which to deduce the rehabilitation potential.
社団法人日本リハビリテーション医学会の論文
1968-04-18

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国分文夫
東北大学医学部温泉医学研究施設物療内科部門 : 東北大学医学部付属病院鳴子分院内科

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