シンポジウム Key words : frontal dysfunction, rehabilitation, behavioural modification, neuro - functional imaging) 2007 ; 899 2007 899 : 734 90 77 400 44.5% 382 42.5% 364 40.5% 363 40.4% 263 29.3% 90 10.0% 77 8.6% 56 6.2% 43 4.6% 183 20.4% 162 18.0% 145 16.1% 97 16.1% 95 10.6% 76 8.5% 42 4.7% 1 Wilson 2 I. target behavior 78 Japanese Journal of Cognitive Neuroscience
target behavior : : : : : : 1 1. target behavior ADL IADL Instrumental ADL 1 2 ADL IADL restorative training ADL 3,4 Vol. 11 No. 1 2009 79
5 constitutional training Diller a Physical b Interpersonal c Social 3 6 2 a. b. comprehensive 7 8 II. 9 80 Japanese Journal of Cognitive Neuroscience
No. 1 TBI 46 1156 1. WAIS-R/MMSE VIQ PIQ FIQ 65 90 73 No. 2 TBI 24 1278 57 78 60 No. 3 TBI 28 3164 81 72 74 No. 4 TBI 29 2112 85 95 86 No. 5 TBI 62 913 122 97 112 No. 6 AVM 23 1538 No. 7 TBI 24 3195 MMSE : 28/30 No. 8 26 1826 68 79 71 No. 9 26 2252 MMSE : 15/30 No. 10 TBI 60 695 MMSE : 14/30 No. 11 TBI 23 281 ~ <45 ~ No. 12 26 ~ 94 90 91 No. 13 TBI 30 1932 No. 14 15 71 62 61 No. 15 TBI 30 3900 No. 16 TBI 25 5487 65 70 61 No. 17 TBI 31 576 88 67 77 No. 18 TBI 54 420 110 92 103 No. 19 61 506 No. 20 TBI 28 2400 No. 21 TBI 36 5766 DAI No. 22 TBI 41 1339 100 84 93 No. 23 70 297 No. 24 TBI 20 1984 No. 25 73 2910 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. 1 2009 81
2. 1 7 FIM+FAM 1 6 No. 1 1 7 4 5 5 5 5 5 6 6 6 4 5 5 5 5 5 6 6 6 No. 2 1 7 6 3 4 4 2 4 6 5 5 6 5 6 5 4 4 6 5 5 No. 3 1 7 5 5 5 2 3 1 6 3 2 5 5 6 5 5 3 7 5 5 No. 4 1 7 6 3 3 4 4 3 6 5 7 6 5 5 6 5 4 6 5 7 No. 5 1 7 3 3 4 2 2 2 5 4 5 5 5 5 4 3 4 5 5 5 No. 6 1 7 4 4 4 2 3 3 5 4 4 5 4 5 5 5 4 5 5 6 No. 7 1 7 6 6 6 5 7 6 6 6 7 6 6 6 5 7 6 6 6 7 No. 8 1 7 1 4 3 1 1 3 2 2 2 3 5 5 4 2 4 4 4 4 No. 9 1 7 1 2 3 1 1 3 2 2 2 3 5 5 3 3 2 3 4 4 No. 10 1 7 3 4 5 2 2 2 5 3 4 3 4 5 4 4 2 5 3 4 FIM Functional Independence Measure, FAM Functional Assessment Measure 82 Japanese Journal of Cognitive Neuroscience
25 1 WAIS R Wechsler Adult Intelligence Scale revised MMSE mini mental state examina- - - tion 1 18 3 19 25 7 2002 10 2004 4 3 1 4 FIM Functional Independence Measure +FAM Functional Assessment Measure 25 2004 4 3 10 1 10 2004 4 FIM+FAM 2 2 1 7 awareness Ruff 10 4 8 2 III. 3 22 3 20 4.5 Vol. 11 No. 1 2009 83
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. 1 11 における Wisconsin Card Sorting Test 施行中の神経活動 図 4. 84 内は課題 CA : 達成カテゴリー数 適応群 No. 12 15 と未適応群 No. 16 18 の 比較 Wisconsin Card Sorting Test 施行中の神経活動 Japanese Journal of Cognitive Neuroscience
3. VIQ/PIQ/FIQ No.12 25 M 106/83/96 No.13 24 F PIQ<45, No.14 28 M 95/90/92 No.15 52 M 65/90/73 No.16 30 M 57/78/60 No.17 67 M 122/97/112 No.18 30 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 8 5 9 11 No. 1~No. 11 : 50 12.4 7 36 16.4 3 4 No. 12~15 3 No. 16~18 MRI WCST 2 3 3 11 11 4 : Br. 9, 10, 46 Br. 44, 45Br. 11, 12, 47 Br. 24Br. 31, 32 Br. 22, 42Br. 39, 40 3 Vol. 11 No. 1 2009 85
12 12008 2 Wilson BA, Herbrt CM, Shiel A. 2003 Behavioural approaches to cooperation with treatment: The effects of mood, insight, and motivation. In : Behavioural approaches in Neuropsychological Rehabilitation. Psychology Press : New York, 93-110. 3 Cicerone KD, Dahlberg C, Malec JF, Langenbahn DM, Felicetti T, Kneipp S, Ellmo W, Kalmar K, Giacino JT, Harley JP, et al. 2005 Evidence - based cognitive rehabilitation : updated review of the literature from 1998 through 2002. Arch Phys Med Rehabil 86, 1681-1692. 4 Cappa SF, Benke T, Clarke S, Rossi B, Stemmer B, van Heugten CM. 2006 European Federation of Neurological Societies. EFNS guidelines on cognitive rehabilitation : report of an EFNS task force. Eur J Neurol 12, 665-680. 5 Salter K, Teasell R, Bitensky J, Foley N, Bhogal S. 2007 Remediation of executive functioning and problem solving. Cognitive Disorders and Apraxia. Evidence - Based Review of Stroke Rehabilitation 10 th Edition Canadian Stroke Network. pp 37-38. http://www. ebrsr.com 6 Diller L 1987 Neuropsychological rehabilitation, In : Meier M, Benton A, Diller L. ed Neuropsychological Rehabilitation. The Guilford Press : New York. 3-17. 7 Semlyen JK, Summers SJ, Barnes MP. 1998 Traumatic brain injury : efficacy of multidisciplinary rehabilitation. Arch Phys Med Rehabil 79, 678-683. 8 Turner - Stokes L, Disler PB, Nair A, Wade DT. 2005 Multi - disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev 20 ; 3 : CD004170. 9 2005 7, 59-64. 10 Ruff RM, Niemann H. 1990 Cognitive rehabilitation versus day treatment in closed - injured adults : is there an impact on emotional and psychosocial adjustment? Brain Inj 4, 339-347. 11 Laatsch LK, Thulborn KR, Krisky CM, Shobat DM, Sweeney JA. 2004 Investigating the neurobiological basis of cognitive rehabilitation therapy with fmri. Brain Inj 18, 957-974 12 Cazalis F, Feydy A, Valabrègue R, Pélégrini - Issac M, Pierot L, Azouvi P. 2006 fmri study of problem - solving after severe traumatic brain injury. Brain Inj 20, 1019-1028. 86 Japanese Journal of Cognitive Neuroscience