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<title>臨床実践 変形性膝関節症の理学療法 | 株式会社文光堂</title>


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<meta name="description" content="本書前半では，理学療法評価と治療アプローチに関して各執筆者の臨床上の工夫を含めて記載している．後半では，クリティカルパス通りに進まない場合のアプローチ，歩行（歩容）の改善など，臨床で遭遇する症例への対応，さらには，対象者を取り巻く心血管疾患を中心とした内科的問題を併発する場合の運動療法の進め方，荷重関節疾患との関連がある肥満に関する考慮のポイント，日常生活を含めた患者教育の実践と工夫などを，豊富な">

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		<h1 class="catchCopy">ベテラン理学療法士による，臨床での創意工夫！その技術の集大成!!</h1>
		

		<h2 class="series">教科書にはない敏腕PTのテクニック&nbsp;&nbsp;</h2>
		
		<h1 class="title">臨床実践 変形性膝関節症の理学療法<span class="version"></span></h1>
		

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					編集：橋本雅至（大阪河﨑リハビリテーション大学教授）
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				<ul class="property"><li class="disc">B5判・196頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-4541-9</li><li class="disc">2016年5月20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">本書前半では，理学療法評価と治療アプローチに関して各執筆者の臨床上の工夫を含めて記載している．後半では，クリティカルパス通りに進まない場合のアプローチ，歩行（歩容）の改善など，臨床で遭遇する症例への対応，さらには，対象者を取り巻く心血管疾患を中心とした内科的問題を併発する場合の運動療法の進め方，荷重関節疾患との関連がある肥満に関する考慮のポイント，日常生活を含めた患者教育の実践と工夫などを，豊富な図表を用いて詳細に解説している．本書にはこれまで紹介されていない敏腕PTならではの技術のコツも要所で紹介しており，長年の創意工夫により臨床現場で行われ結果を出している技術の集大成となる一冊．</section><section class="preface">［臨床実践　変形性膝関節症の理学療法］　序文<br><br>　本書は「教科書にはない敏腕PTのテクニック」というシリーズ名に示されるとおり，実際に臨床現場で行われ，結果を出している変形性膝関節症（knee osteoarthritis：膝OA）に対する理学療法テクニックを解説するという編集方針にて企画いたしました．<br>　本書の前半は，総論として理学療法士（PT）が知っておくべき変形性膝関節症の病態の理解，機能解剖と病態運動学の観点，メカニカルストレスに対する考慮，外科的治療とその後療法，保存療法における多角的な理学療法評価と治療について紹介しています．特に理学療法評価と治療アプローチに関して各筆者の臨床上の工夫を含めて解説しています．後半の各論では，両側同時手術後のアプローチ，治療に難渋するケース（関節可動域改善や筋力増強の不良例）などクリティカルパスどおりに進まない場合のアプローチ，理学療法の目標となる歩行（歩容）の改善など，臨床上経験することを想定して解説しています．さらに，対象者を取り巻く心血管疾患を中心とした内科的問題を併発する場合の運動療法の進め方，荷重関節疾患との関連がある肥満（体重過多）に関する考慮のポイント，日常生活を含めた患者教育の実践と工夫を取り上げています．<br>　総論，各論ともに多数の変形性膝関節症例をみている厳選した敏腕理学療法士が執筆していますので，臨床現場で変形性膝関節症の治療を実践されている理学療法士諸兄には，治療の際に大いに参考になることを期待しています．<br>　理論的背景を理解したうえでの理学療法の実践は最も優先しなければなりません．そのうえで，本書の執筆者は，臨床で患者に向き合い，日頃の発想や感性を大事にし，現場で創意工夫をしながら，少ない時間で大きな成果を上げるような理学療法の評価や治療のテクニックが大変重要であるという立場を共有しています．それらを実際の症例に応用し，これまで紹介されていない敏腕理学療法士ならではの技術のコツも要所に盛り込まれています．<br>　本書が変形性膝関節症へ積極的に挑戦し，対象者の満足を得るための，結果にこだわった理学療法の臨床実践に貢献しうることを心より願っています．<br><br>2016年5月<br>大阪河﨑リハビリテーション大学　橋本雅至</section><section class="indexes">病態・評価・治療方針の理解<br>　膝OAの病態から理学療法士の位置づけを理解する<br>　　Ⅰ　膝OAの病態<br>　　　1　関節の摩耗<br>　　　2　疼　痛<br>　　　3　関節動揺性<br>　　　4　関節可動域障害<br>　　Ⅱ　膝OAの理学療法<br>　　　1　筋力強化<br>　　　2　標準的な治療<br>　　　3　高齢者<br>　機能解剖から膝OAの評価とアプローチを考える<br>　　Ⅰ　膝OAに屈曲拘縮膝が及ぼす影響<br>　　　1　関節不安定性と屈曲拘縮膝<br>　　　2　歩行障害と膝関節屈曲拘縮<br>　　Ⅱ　屈曲拘縮を機能解剖学的にとらえる<br>　　　1　皮　膚<br>　　　2　筋　膜<br>　　　3　筋<br>　　　4　関節包<br>　　Ⅲ　膝窩部の筋に対する動態正常化のためのアプローチ<br>　　　1　半膜様筋へのアプローチ<br>　　　2　膝窩筋へのアプローチ<br>　　　3　腓腹筋内側頭へのアプローチ<br>　膝OAの疼痛に積極的に介入する<br>　　Ⅰ　疼痛部位を鑑別，限局化する<br>　　　1　膝OAの疼痛評価<br>　　　2　疼痛に対する評価の実際（問診から局所）<br>　　　3　 疼痛に対する評価の実際（荷重下におけるストレステスト）<br>　　Ⅱ　疼痛に対する理学療法アプローチ<br>　　　1　疼痛に対する対症療法（局所の疼痛軽減を図る）<br>　　　2　疼痛に対する運動療法<br>　　　3　疼痛に対する装具療法<br>　膝OAの外科的治療を理解し術後に活かす<br>　　Ⅰ　人工膝関節全置換術（total knee arthroplasty：TKA）<br>　　　1　TKAとは<br>　　　2　術後理学療法への展開<br>　　Ⅱ　TKA以外の外科的治療 <br>　　　1　単顆片側型人工膝関節置換術（unicompartmental knee arthroplasty：UKA）<br>　　　2　高位脛骨骨切り術（high tibial osteotomy：HTO）<br>　　　3　関節鏡視下手術<br>　膝OAの術前・術後評価を運動機能の改善に活かす<br>　　Ⅰ　手術を回避する保存療法の重要性<br>　　Ⅱ　保存療法の着眼点<br>　　　1　アライメント<br>　　　2　ROMとtracking<br>　　　3　筋力・筋機能<br>　　　4　歩行機能と日常生活活動<br>　　　5　理学療法プログラムの実際<br>　　Ⅲ　術後評価のポイントと理学療法の考え方<br>　　　1　手術方法と合併症<br>　　　2　評価ポイントと理学療法アプローチ<br><br>実践と結果に基づく理学療法手技<br>　両側同時TKAの特徴を踏まえ介入する<br>　　Ⅰ　両側同時手術の適応と特徴<br>　　Ⅱ　機能障害の特徴と理学療法介入ポイント<br>　　　1　術後早期の理学療法介入ポイント<br>　　　2　術後中期以降の理学療法介入ポイント<br>　　　［CT］ハーフシッティングトレーニング<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　歩行トレーニングの進め方<br>　　　2　歩容の改善<br>　　　3　目標設定：両側同時手術と二期的片側手術の違い<br>　膝OAの術後に難渋する関節可動域改善に挑む<br>　　Ⅰ　術前の関節可動域制限の因子が術後にも関与する<br>　　　1　一般的な関節可動域制限の因子について考える<br>　　　2　膝OA患者の術前可動域制限の因子について考える<br>　　Ⅱ　手術侵襲による影響が関与する<br>　　　1　手術侵襲による影響<br>　　　2　術後炎症による影響<br>　　　3　術後アライメント変化による影響<br>　　　4　インプラントによる影響<br>　　　［CT］術後の関節可動域制限因子の変化を考える<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　術後の膝関節屈曲可動域拡大に向けた介入<br>　　　2　術後の膝関節伸展可動域拡大に向けた介入<br>　膝OAの術後の筋力増強を効果的に行う<br>　　Ⅰ　膝OAの病態と筋力低下<br>　　　1　膝OAの発生要因と筋力低下<br>　　　2　膝OAの病態と筋力低下<br>　　　3　パターン化した姿勢・動作と筋力低下<br>　　Ⅱ　姿勢・動作の改善を目的とした筋力増強<br>　　　1　姿勢の特徴からみた術後の筋力増強<br>　　　［CT］加齢による姿勢変化の影響を考える<br>　　　2　歩行の特徴からみた術後の筋力増強<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　大腿四頭筋に対する筋力増強<br>　　　2　股関節周囲筋に対する筋力増強<br>　　　3　下腿・足部周囲筋に対する筋力増強<br>　　　4　脊柱伸筋に対する筋力増強<br>　膝OA患者の術前・術後の歩容改善をねらう<br>　　Ⅰ　左右の体重移動<br>　　　1　左右の体重移動を体幹と股関節を中心に行う一般的な戦略<br>　　　2　膝OA患者の歩行時における左右への体重移動と膝関節<br>　　　3　手術適応のある膝OA患者の術前歩行<br>　　　4　膝OA患者の術後歩行<br>　　　［CT］体幹体重支持機能テスト（TRT）<br>　　Ⅱ　前方への推進力の発揮<br>　　　1　通常の歩行<br>　　　2　膝OA患者の術前歩行<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　左右の体重移動の調整<br>　　　2　前方への推進力（後方への蹴り）の向上<br>　　　3　歩容改善のチェックポイント<br>　心血管疾患を伴う膝OAの運動療法を考える<br>　　Ⅰ　心血管疾患によるリスクの把握 <br>　　　1　心血管疾患によるリスク<br>　　　2　循環動態の把握<br>　　　［CT］モニター心電図<br>　　Ⅱ　安全かつ効果的な運動負荷①<br>　　　1　運動頻度<br>　　　2　運動強度<br>　　　3　運動時間<br>　　　4　運動方法<br>　　　5　歩行距離を延長するための適切な補助具の利用<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　日常的な心疾患によるリスクの把握<br>　　Ⅳ　安全かつ効果的な運動負荷②<br>　　　1　運動負荷量<br>　　　2　ウォームアップ，クールダウン<br>　　　3　運動療法中止基準<br>　　　4　運動方法<br>　肥満のコントロールから膝OAにかかわる<br>　　Ⅰ　なぜ体重コントロールが必要なのか？ <br>　　　1　日本人の肥満の現状<br>　　　2　肥満と肥満症とは<br>　　　3　肥満と膝OAの関係<br>　　Ⅱ　減量に対して行動変容のための認知行動療法を行う <br>　　　1　運動習慣の現状<br>　　　2　認知行動療法とは<br>　　　［CT］行動変容ステージモデル（TTM）<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　体重コントロール<br>　　　［CT］水中運動の利点と運動強度における注意点<br>　　　2　行動変容<br>　膝OAの患者教育のポイントを見極める<br>　　Ⅰ　患者教育とは <br>　　Ⅱ　指導内容を正しく理解してもらうために<br>　　　1　患者目線で考える<br>　　　2　自分の常識が他人の常識ではない<br>　　　3　多角的な視点を持つこと<br>　　Ⅲ　指導内容を正しく実施してもらうために<br>　　　1　行動変容アプローチの活用<br>　　　2　コーチング・テクニックを用いた指導<br>　　　［CT］“質問”のテクニック<br>　　　3　独自の指導テクニックの確立<br>　　Ⅳ　理学療法プログラムの実際<br>　　　1　臨床における具体的な指導例<br>　　　［CT］杖のカチカチ音の修理方法<br><br>索　引 <br><br>［CT］＝クリニカル・テクニック</section></article>
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