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1 シンポジウム Key words : frontal dysfunction, rehabilitation, behavioural modification, neuro - functional imaging) 2007 ; : % % % % % % % % % % % % % % % % 1 Wilson 2 I. target behavior 78 Japanese Journal of Cognitive Neuroscience

2 target behavior : : : : : : 1 1. target behavior ADL IADL Instrumental ADL 1 2 ADL IADL restorative training ADL 3,4 Vol. 11 No

3 5 constitutional training Diller a Physical b Interpersonal c Social a. b. comprehensive 7 8 II Japanese Journal of Cognitive Neuroscience

4 No. 1 TBI WAIS-R/MMSE VIQ PIQ FIQ No. 2 TBI No. 3 TBI No. 4 TBI No. 5 TBI No. 6 AVM No. 7 TBI MMSE : 28/30 No No MMSE : 15/30 No. 10 TBI MMSE : 14/30 No. 11 TBI ~ <45 ~ No ~ No. 13 TBI No No. 15 TBI No. 16 TBI No. 17 TBI No. 18 TBI No No. 20 TBI No. 21 TBI DAI No. 22 TBI No No. 24 TBI No TBI traumatic brain injury : AVM arteriovenous malfor mation : DAI diffuse axonal injury : WAIS-R Wechsler Adult Intelligence Scale revised : MMSE mini-mental state examination Vol. 11 No

5 FIM+FAM 1 6 No No No No No No No No No No FIM Functional Independence Measure, FAM Functional Assessment Measure 82 Japanese Journal of Cognitive Neuroscience

6 25 1 WAIS R Wechsler Adult Intelligence Scale revised MMSE mini mental state examina- - - tion FIM Functional Independence Measure +FAM Functional Assessment Measure FIM+FAM awareness Ruff III Vol. 11 No

7 図 2. 図 3. 積み木課題遂行中の前頭前野の活動 上段 : 健常者 下段 : 重度脳外傷者 達成率 健常者群 No における Wisconsin Card Sorting Test 施行中の神経活動 図 内は課題 CA : 達成カテゴリー数 適応群 No と未適応群 No の 比較 Wisconsin Card Sorting Test 施行中の神経活動 Japanese Journal of Cognitive Neuroscience

8 3. VIQ/PIQ/FIQ No M 106/83/96 No F PIQ<45, No M 95/90/92 No M 65/90/73 No M 57/78/60 No M 122/97/112 No M MMSE=30 VIQ verbal intelligence quotient, PIQ performance intelligence quotient, FIO Full intelligence quotient ADL WAIS R - NIRStation 48 MRI 2 11 MRI : : Wisconsin Card Sorting Test WCST MRI Glasgow Coma Scale No. 1~No. 11 : No. 12~15 3 No. 16~18 MRI WCST : Br. 9, 10, 46 Br. 44, 45Br. 11, 12, 47 Br. 24Br. 31, 32 Br. 22, 42Br. 39, 40 3 Vol. 11 No

9 Wilson BA, Herbrt CM, Shiel A Behavioural approaches to cooperation with treatment: The effects of mood, insight, and motivation. In : Behavioural approaches in Neuropsychological Rehabilitation. Psychology Press : New York, Cicerone KD, Dahlberg C, Malec JF, Langenbahn DM, Felicetti T, Kneipp S, Ellmo W, Kalmar K, Giacino JT, Harley JP, et al Evidence - based cognitive rehabilitation : updated review of the literature from 1998 through Arch Phys Med Rehabil 86, Cappa SF, Benke T, Clarke S, Rossi B, Stemmer B, van Heugten CM European Federation of Neurological Societies. EFNS guidelines on cognitive rehabilitation : report of an EFNS task force. Eur J Neurol 12, Salter K, Teasell R, Bitensky J, Foley N, Bhogal S Remediation of executive functioning and problem solving. Cognitive Disorders and Apraxia. Evidence - Based Review of Stroke Rehabilitation 10 th Edition Canadian Stroke Network. pp ebrsr.com 6 Diller L 1987 Neuropsychological rehabilitation, In : Meier M, Benton A, Diller L. ed Neuropsychological Rehabilitation. The Guilford Press : New York Semlyen JK, Summers SJ, Barnes MP Traumatic brain injury : efficacy of multidisciplinary rehabilitation. Arch Phys Med Rehabil 79, Turner - Stokes L, Disler PB, Nair A, Wade DT Multi - disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev 20 ; 3 : CD , Ruff RM, Niemann H Cognitive rehabilitation versus day treatment in closed - injured adults : is there an impact on emotional and psychosocial adjustment? Brain Inj 4, Laatsch LK, Thulborn KR, Krisky CM, Shobat DM, Sweeney JA Investigating the neurobiological basis of cognitive rehabilitation therapy with fmri. Brain Inj 18, Cazalis F, Feydy A, Valabrègue R, Pélégrini - Issac M, Pierot L, Azouvi P fmri study of problem - solving after severe traumatic brain injury. Brain Inj 20, Japanese Journal of Cognitive Neuroscience

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