理学療法ジャーナル49巻9号

2015年09月発行

特集 脳機能回復と理学療法

脳機能回復とConstraint-Induced Movement Therapy（CIMT）

著者： 村山尊司¹

所属機関： ¹千葉県千葉リハビリテーションセンター

ページ範囲：P.803 - P.811

はじめに

　近年，神経科学分野において，機能的MRI（functional Magnetic Resonance Imaging：fMRI）や，近赤外分光法（Near Infrared Spectoroscopy：NIRS），経頭蓋磁気刺激（Transcranial Magnetic Stimulation：TMS）などの神経の活動を可視化するニューロイメージング技術の発展により，脳損傷後に脳の可塑的変化や脳機能の再構築が起きることが明らかにされた．脳卒中や脳外傷などの脳損傷者の運動機能，認知機能の回復機序について多くの知見が蓄積され，リハビリテーション分野の発展に大きく貢献した．

　ニューロイメージングの発展を背景に，損傷後の神経機能回復促進を目的としたニューロリハビリテーションという概念が提唱されるようになった．電気刺激などで末梢器官から中枢神経系へ働きかけたり，麻痺肢を随意的に積極的に動かしたりすることで，脳の可塑的変化や神経ネットワークの再構築を促す治療である．

　ニューロリハビリテーションのなかで最も多くの知見が示されている治療法の一つが，CI療法（Constraint-Induced Movement Therapy：CIMT）であろう．CIMTは，非麻痺側肢の使用を制限しながら麻痺肢に対する段階的な集中トレーニングと，日常生活場面での積極的な使用を促すことで麻痺側上肢の機能回復と神経可塑性を誘導することを目的とした治療法である．臨床的アウトカムの報告に加え，ニューロイメージング技術を用いた報告も数多くなされ，治療効果の背景が明らかにされてきている．

　本稿では，CIMTの概要とfMRIによる先行研究，さらに下肢に対するCIMTなど近年報告が増えている応用形CIMTについて概説し，今後の展望を述べたい．

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