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		<h1 class="catchCopy">症例を通して学ぶ実践アプローチ！</h1>
		

		<h1 class="copy">理学療法士のための</h1>
		<h1 class="title">在宅療養者の診かた（電子版のみ）<span class="version"></span></h1>
		<h2 class="subTitle">評価をプログラムに反映させる</h2>

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					編集：杉元雅晴（神戸学院大学教授）
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				<ul class="property"><li class="disc">B5判・200頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-4524-2</li><li class="disc">2015年5月15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">症例を通して，在宅療養者に対する理学療法の評価からプログラムの立案まで，実際の流れに沿って解説した実践書．冒頭に症例を掲げて，理学療法評価を実施する順に記述．最後に初期評価の結果をまとめ，どのように理学療法プログラムへ反映させるか，根拠を示しながら解説した．用語や手技などの説明はMEMOとして，臨床の現場で役立つヒントや工夫はクリニカルヒントとしてまとめた．<br>☆図版136点，表組47点，カラー写真20点，モノクロ写真58点，イラスト・線画12点</section><section class="preface">序　文<br><br>　本書は理学療法士が療養者の自宅に伺い，訪問理学療法を行うときに活用できる身体所見の診かたを手軽に勉強してもらう目的でまとめた書籍である．在宅で見かける症例を通して，評価から治療プログラムの立て方のコツをまとめた．安心して，生き生きとした療養生活を支援<br>できる理学療法士への一助となることを願っている．<br>　在宅療養者は外来通院が困難であるが，入院するほどでもない方である．とは言っても，決して医学的治療が必要ない方ではない．訪問理学療法では，臨床検査データもなく，画像データ（超音波診断画像，X線画像など）をその場でみることができない．だからといって，医学情報が何もないわけではない．非侵襲的な身体所見から得られる情報は，高額な医療機器を使わなくても，リアルタイムで繰り返し確認のできる情報となる．訪問理学療法士が身体所見を診るときに直接かかわる技術，間接的に対応していく必要がある知識について，実践的な指導書という視点を踏まえて内容を整理した．<br>　まず，訪問時には，ここ数日の家での生活を聞き，確認する必要のある身体所見の項目を考え，簡単な器具などを利用して確認していく手順を身につけていただきたい．そして，本書は大学教育で学んだ典型的な検査・測定手技を実用的な方法で，身体所見や障害像を確認するヒントを提供できると思っている．定型的な検査手技にとどまらず，臨床像を診やすくするヒントや工夫を「クリニカルヒント」として，用語・検査などの説明を「MEMO」として，随所に散りばめた．また，療養者の身体所見，病態像，障害像をより確実に診るためには，医療用具に一工夫を加えることにより測定結果の信頼性を高め，治療前後で比較できるようになる事例なども紹介している．身体所見を診るときに役立つ器具などを提示し，具体的な活用法を記載しているので，ぜひ理解を深めていただきたい．<br>　本書では，「脳卒中」，「パーキンソン病」，「脊髄小脳変性症」，「脊髄損傷」，「脳性麻痺」，「心不全」，「呼吸不全」，「切断」，「骨折」，「認知症」，「褥瘡」，「摂食嚥下障害」，「栄養管理」，「排泄障害」，「言語障害」などの疾患や障害をもった療養者をとりあげ，専門領域の先生方に執筆していただいた．また，理学療法士だけではなく，医療・福祉専門職連携（IPW：inter-professional work）をすることが，生きがいのある療養生活に高めることができることを紹介した．在宅療養者は生活期のリハビリテーション医療の対象者であるが，突如，急性期におちいることがある．私たちが療養者宅に伺うときには，他の医療関係者が同行することが少ない．そのときに，医療者の一員として，適切に対応できる心構えと医療技術「緊急対応の仕方」を紹介している．<br>　訪問理学療法を担当する若い理学療法士にとって，折に触れて読み返すような書籍になれば，この上なく嬉しいことである．また，本書に記述されているエキスパートオピニオン（expert opinion）や「臨床的に重要と感じていること（good practice point）」にもかかわらず，研究による科学的根拠（evidence）が証明されていないことが多い．そこで，本書を読んだ臨床研究者が，より確実な臨床的な手技として，理学療法評価を確立する思いを抱いていただいたら，編集した甲斐があったと思える．<br><br>2015年5月6日<br>神戸学院大学　杉元　雅晴</section><section class="indexes">脳卒中<br>　症例1<br>　症例2<br>　症例3<br>　機能分化と理学療法の課題<br>　脳卒中による脳のシステム障害と理学療法<br>　脳卒中の歩行障害の理解<br>　座位，立位にかかわる股関節の解剖<br>　理学療法プログラムへの反映<br>パーキンソン病─動作緩慢とすくみが強く屋内での起居移動動作が困難な患者─<br>　症　例<br>　問　診<br>　バイタルサインの確認<br>　パーキンソン病の重症度および症状の検査<br>　関節可動域検査<br>　筋力検査<br>　姿勢観察<br>　動作観察<br>　バランス能力検査<br>　ADL検査<br>　その他の検査<br>　初期評価の結果<br>　理学療法プログラムへの反映<br>脊髄小脳変性症─屋内での自立歩行が困難な患者─<br>　症　例<br>　問　診<br>　バイタルサインの確認<br>　重症度の把握<br>　協調性検査<br>　バランス能力検査<br>　起居動作能力の検査<br>　ADL検査<br>　筋力検査<br>　その他の検査<br>　環境調査<br>　初期評価の結果<br>　理学療法プログラムへの反映<br>脊髄損傷─転倒により中心性頸髄損傷を呈した一症例─<br>　症　例<br>　初期評価項目と内容<br>　初期評価の結果<br>　理学療法プログラムへの反映<br>脳性麻痺─骨粗鬆症を合併した成人脳性麻痺─<br>　症　例<br>　問　診<br>　バイタルサインの確認<br>　合併症<br>　関節可動域検査<br>　筋力検査<br>　筋緊張の評価<br>　バランス反応テスト<br>　運動能力評価<br>　ADL評価<br>　QOL評価；生活時間構造<br>　家族の介護力評価<br>　住宅構造の評価<br>　本症例の障害像<br>　理学療法プログラムへの反映<br>心不全<br>　症　例<br>　訪問リハビリテーション介入開始前の<br>　確認事項<br>　病状把握に必要なアセスメント<br>　問　診<br>　視　診<br>　触　診<br>　聴　診<br>　バイタルサインの確認<br>　その他のアセスメント<br>　運動機能評価<br>　その他の評価<br>　初期評価の結果<br>　理学療法プログラムへの反映<br>呼吸不全<br>　症　例<br>　問　診<br>　症例の初診時評価（予後予測）<br>　フィジカルアセスメント（身体的評価）<br>　息切れの評価<br>　酸素化の評価<br>　炭酸ガス排泄能の評価<br>　呼吸機能の評価<br>　呼吸筋力の評価<br>　胸郭可動域<br>　運動耐容能の評価<br>　健康関連QOL（HRQOL）の評価<br>　理学療法プログラムへの反映と経過<br>切　断<br>　症　例<br>　健康状態<br>　身体機能・構造<br>　活　動<br>　環境因子<br>　初期評価の結果<br>　理学療法プログラムへの反映<br>骨　折─糖尿病を合併した下肢骨折─<br>　症　例<br>　問　診<br>　バイタルサインの確認<br>　皮膚の観察<br>　視力検査<br>　感覚検査<br>　関節可動域検査<br>　筋力検査<br>　眩暈の確認<br>　平衡機能（バランス）検査<br>　その他の検査<br>　初期評価の結果<br>　理学療法プログラムへの反映<br>認知症─大腿骨頸部骨折を呈した重度認知症患者─<br>　症　例<br>　問診（ことばの理解と表出能力の観察）<br>　バイタルサインの確認<br>　日常生活動作の観察<br>　痛みの確認<br>　BPSDの確認<br>　生活リズムの確認<br>　介護負担感の確認<br>　自己認識検査<br>　認知機能検査<br>　失行，失認の確認<br>　歩行能力の推測<br>　関節可動域検査<br>　初期評価の結果<br>　理学療法プログラムへの反映<br>褥　瘡─大転子部と仙骨部に褥瘡を発生した寝たきり高齢者─<br>　症　例<br>　問　診<br>　褥瘡の重症度<br>　創感染<br>　滲出液の管理方法と肉芽の評価<br>　ポケットの有無<br>　肉芽の色調<br>　病的骨突出の有無<br>　知覚麻痺，意識レベル，精神疾患<br>　体位変換能力<br>　栄養摂取方法，栄養状態の確認<br>　不顕性誤嚥・胃内容物逆流の評価<br>　理学療法プログラムへの反映<br>摂食嚥下障害<br>　症　例<br>　問　診<br>　末梢神経系の評価<br>　呼吸路の安全性を確保できる機能の確認<br>　口腔・咽頭機能<br>　食事内容の調整<br>　初期評価の結果<br>　理学療法プログラムへの反映<br>栄養管理<br>　症　例<br>　問　診<br>　食事摂取状況，内容，エネルギー充足率の確認<br>　身体状況の確認<br>　栄養フィジカルアセスメントの実施<br>　症例の栄養アセスメントの結果<br>　栄養ケアの提案<br>排泄障害<br>　症例1<br>　問　診<br>　バイタルサインの確認<br>　手術創の観察<br>　排便状況とストーマ装具の観察<br>　心理状態の観察<br>　初期評価の結果<br>　理学療法プログラムへの反映<br>　症例2<br>　問　診<br>　バイタルサインの確認<br>　排泄状態の観察<br>　皮膚状態の観察<br>　栄養状態の観察<br>　胃瘻の観察<br>　初期評価の結果<br>　理学療法プログラムへの反映<br>在宅におけるinterprofessional work（IPW）：専門職連携<br>　interprofessional work（IPW）とは<br>　症例1<br>　症例2<br>　入院中の日常生活動作<br>　退院に向けての準備<br>　退院日に同行訪問でわかった日常生活で使える身体機能<br>　同行訪問を終えて<br>　IPW（チーム医療）実践に必要なもの<br>緊急対応（応急手当）の仕方<br>　症　例<br>　緊急対応の手段<br>　訪問時における緊急対応の流れ<br>　意識消失（心肺停止）が生じた場合の確認事項と対応手順<br>　事例1発生時の状況<br>　事例1の対応<br>　創傷（出血）が生じた場合の確認事項と対応手順<br>　事例2発生時の状況<br>　事例2の対応<br>　熱傷が生じた場合の確認事項と対応手順<br>　事例3発生時の状況<br>　事例3の対応<br>言語障害<br>　症　例<br>　問　診<br>　バイタルサインの確認<br>　言語能力の検査<br>　口腔構音器官の検査<br>　その他の検査<br>　初期評価の結果<br>　理学療法プログラムおよび訪問リハビリテーション医療の際の注意点<br>在宅訪問かばんの中<br>　当日の病態を確認する器具<br>　知覚検査器具<br>　運動機能検査器具<br>　特殊機器<br>　評価用紙<br>　その他<br>索　引</section></article>
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