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<title>ベッドサイド理学療法の基本技術・技能（電子版のみ） | 株式会社文光堂</title>


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<meta name="description" content="PARTⅠでは診療記録，ベッドサイドの理学療法評価で特に大切なこと，バイタルサイン，意識障害，運動麻痺・機能，呼吸機能，リスク管理，関節可動域運動，筋力維持・強化運動，座位耐性練習，呼吸循環管理，物理療法について論じ，ベッドサイド理学療法の基本技術・技能を再確認する．PARTⅡではICU・SCU・一般病棟での理学療法の基本となる技術・技能を図解し，一般的な評価ツールやエビデンスおよび運営にも触れて">

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		<h1 class="catchCopy">ベッドサイドにおける理学療法の基本技術・技能の要点を確認しよう！</h1>
		

		<h2 class="series">臨床思考を踏まえる理学療法プラクティス&nbsp;&nbsp;</h2>
		
		<h1 class="title">ベッドサイド理学療法の基本技術・技能（電子版のみ）<span class="version"></span></h1>
		

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					常任編集：嶋田智明（元 神戸大学）
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					<span class="transparent">常任編集</span>　有馬慶美（新潟保健医療専門学校）
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					<span class="transparent">常任編集</span>　斉藤秀之（筑波記念病院）
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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">PARTⅠでは診療記録，ベッドサイドの理学療法評価で特に大切なこと，バイタルサイン，意識障害，運動麻痺・機能，呼吸機能，リスク管理，関節可動域運動，筋力維持・強化運動，座位耐性練習，呼吸循環管理，物理療法について論じ，ベッドサイド理学療法の基本技術・技能を再確認する．PARTⅡではICU・SCU・一般病棟での理学療法の基本となる技術・技能を図解し，一般的な評価ツールやエビデンスおよび運営にも触れている．<br>☆図版39点，表組40点，モノクロ写真41点，イラスト・線画2点</section><section class="preface">「臨床思考を踏まえる理学療法プラクティス」発刊にあたり<br><br>　「実践MOOK　理学療法プラクティス」は2008年5月に「これだけは知っておきたい脳卒中の障害・病態とその理学療法アプローチ」「これだけは知っておきたい腰痛の病態とその理学療法アプローチ」の2冊を皮切りにMOOKの形で定期的に発刊される新人理学療法士の「指南書」として企画されたものである．その後，2011年5月の「運動連鎖～リンクする身体」に至るまで12に及ぶ企画を3年間にわたり取り上げた．<br>　そのテーマは，大きく「疾病・障害構造の理解」と「機能障害の捉え方・治療へのアプローチ」の2つである．さらにそのコンセプトは，前者では，疾患を運動機能障害等の一面で捉えるのではなく，それと関連する多くの障害と共に多面的・包括的に捉え，これを評価や治療の背景とすることで，理学療法士は多くの治療選択肢を得ることができるという，常に持っていて欲しい臨床に向かう姿勢を示したものである．後者では，診断・治療する上で，対象者を常に患部から全体へ，また逆に全体から患部へと捉える意味・重要性はいつの世でも変わらないということを示したものである．<br>　今は亡き嶋田智明常任編集者のこうした熱き想いが新人理学療法士や学生に理解して頂く第1期MOOKシリーズとして構築されたのである．今回第2期MOOKを開始するにあたり，第1期から第2期に引き継ぐ面と，第2期で独自に構築していく面の2つを編集・企画方針の根底とした．<br>　引き継ぐ面は，理学療法の基本的知識と技術を身につけてもらうよう，一度に多くのことを詰め込まず，重要で優先度の高い順序で段階を踏みながら成長できる内容を企画することであり，「熱き想い」も引き継ぐつもりである．一方，独自に構築していく面は，「reasoningのhow toを可視化する，出来ればevidenceを示す」である．言葉，イラストだけでは計り知れない体内の動きを「見る」ことでそこに記されている理学療法技術，手技の根拠が理解できるよう，理学療法技術，手技の根拠を解剖，生理，運動から説明していく方向も打ち出したいと考えている．さらに同じ障害であるが，程度の違い，病態（病因）の違いや，特に高齢者は基礎疾患をしっかり押さえて理学療法を提供する姿勢を伝えたい．また，「診療録等を見に行く」「ベッドサイドの患者を見に行き」「発症からどの位経っているか（病期）を確認する」などとともに，リスク管理，マナー（接し方）にも触れていきたい．<br>　理学療法士のキャリアを構築する上で重要となる10年の始まりとなる新人時代に，形式知と経験知で構成された「指南書」が個々人の手元にあることは，臨床において，すなわち対象者の幸福を支援する理学療法において，間違いなく役に立つと信じてやまない．こうした「指南書」として，今回新たに開始される第2期MOOKシリーズが寄与することになれば，第1期MOOKから引き継いだ編者としてこれ以上の喜びはない．<br><br>平成25年5月<br>常任編集者　嶋田智明・有馬慶美・斉藤秀之</section><section class="indexes">PartⅠ　コモンな基本技術・技能をレビューする<br>　1 診療記録を素早く，ポイントをおさえて読み，評価および治療計画を立案する─診療記録の見方とその解釈のしかた─<br>　　診療記録を見る前に！<br>　　必要な情報は推移する<br>　　患者の人生歴を想像しよう<br>　　必要な情報とは？　具体的なイメージが大事！<br>　　診断名がすべてではない！<br>　　薬を知ることが転倒予防の第一歩！<br>　　知り得た情報をまとめて評価や治療の推論を展開する<br>　　診療記録は100％ではない！<br>　2　ベッドサイドでの理学療法評価で何が特に大切か？<br>　　痛み刺激を正確に行うことが意識レベル評価のカギ<br>　　呼吸状態をどう評価するか？<br>　　循環状態をどう評価するか？<br>　　全身観察の重要性と血液検査結果との関連<br>　　離床時は評価を同時進行することでリスク管理を<br>　3　バイタルサインの重要性<br>　　基本的事項の整理<br>　　症例検討<br>　　おわりに<br>　　 ミニレクチャー 　皮膚管理も忘れずに<br>　4　意識障害は見分けられるか？<br>　　「意識」ってなに？<br>　　意識はどのようにして維持される？<br>　　意識障害ってどんな状態？<br>　　意識障害の原因<br>　　意識障害患者の評価で重要なのは？<br>　　理学療法中に偶発的に起こり得る意識障害<br>　5　運動麻痺・機能の評価のポイント<br>　　運動麻痺と機能，どう関連？<br>　　評価する前に確認しておくことは？<br>　　臥位期の運動麻痺・機能評価，何をみる？<br>　　随意性評価の捉え方<br>　　体幹機能を臥位でみる<br>　　運動機能は非麻痺域も含めて確認<br>　　座位獲得期の運動麻痺・機能評価<br>　　座位耐性を初めにみる<br>　　座位で麻痺評価<br>　　座位を課題とした機能評価：静的座位と座位バランス<br>　　立位可能期の運動麻痺・機能評価のポイント<br>　　立位の麻痺の評価<br>　　立位機能のみかた＝歩行の前段階<br>　6　ベッドサイドでできる呼吸機能の評価<br>　　臥床期・座位獲得期・立位可能期共通の評価<br>　　臥床期の評価<br>　　座位獲得期の評価<br>　　立位可能期の評価<br>　　 ミニレクチャー 　低栄養は機能予後の阻害因子<br>　7　リスク管理は大変だから冷静に<br>　　ベッドサイドでの理学療法の流れ<br>　　ベッドサイドでの理学療法の各ポイント<br>　　いつベッドサイドに行くのか？<br>　　こんなこともある<br>　　理学療法士への期待<br>　8　たかが，されどの関節可動域運動<br>　　「たかが，されどの関節可動域運動」とは？<br>　　ROM運動を始める前に！<br>　　ROM運動を効果的に進めるためには？<br>　　ROM運動は，どの程度行えば良いのか？<br>　　ROM制限に進展させないための「ポジショニング」の視点<br>　9　工夫次第の筋力維持・強化運動<br>　　ほとんどの対象者が筋力増強を必要とする！<br>　　筋力低下の原因（疾患）は？<br>　　安静臥床は必要だが…<br>　　筋力増強の原則と基本的な方法は<br>　　筋力増強のプログラムをどう変化させるか？<br>　　具体的な方法<br>　　 ミニレクチャー 　排菌しているのは医師と理学療法士？<br>　　座位耐性練習は回復期への架け橋<br>　　各疾患や病態の特性を理解する！<br>　　脳卒中の病態を理解する！<br>　　心疾患の病態を理解する！<br>　　廃用症候群がもたらす身体反応の変化を理解する！<br>　　実際に座位耐性練習を実施してみる！　ケース１：脳卒中（左中大脳動脈領域の脳塞栓症）<br>　　実際に座位耐性練習を実施してみる！　ケース２：心疾患患者<br>　　呼吸循環管理は重要だけど振り回されないように<br>　　まずは基本的な病態を把握する<br>　　疾患を見るな！　個人を診ろ！<br>　　日々進行する廃用症候群に立ち向かう<br>　　チームアプローチすることの意味<br>　　物理療法の有効性も考えよう<br>　　物理療法<br>　　物理療法を有効に使うために<br>　　ベッドサイド理学療法で物理療法？<br>　　ベッドサイド理学療法での物理療法の使用の実際<br> 　　ミニレクチャー 　急性期ベッドサイド理学療法の質とアウトカム<br>PartII ベッドサイドの理学療法の実践─基本的技術・技能で要点を解明する<br>1．ケアユニットでの理学療法<br>　1　ICU<br>　　ICUにおけるリハビリテーションとは<br>　　“鼻がきく”理学療法士を目指す！？<br>　　ベッドサイドに行く前にすべきこと<br>　　重症度を知る！<br>　　少量頻回の理学療法が基本<br>　　忘れないで！　感染対策！<br>　　ポジショニングの工夫<br>　2　SCU<br>　　SCUとは<br>　　急性期脳卒中診療の流れを理解する<br>　　SCUにおける理学療法の実際<br>　　 ミニレクチャー 　チーム医療も臨機応変<br>　　 ミニレクチャー 　時差出勤も知恵次第<br>　　 ミニレクチャー 　モニター機器の昨今<br>2．運動障害に対する一般病棟での理学療法<br>　1　成人脳卒中<br>　　歩行訓練開始には，クリアしなければならない条件がある！<br>　　歩行訓練はベッドサイドから始まっている！<br>　　早期からの長座位訓練導入が，座位保持自立や座位バランス向上への近道！<br>　　介助歩行訓練に向けた立位訓練の患側下肢立脚相・遊脚相の反復練習は必須！<br>　　介助歩行訓練は後方骨盤介助で行うべし！<br>　　痙性の出現・亢進と分離運動の低下は表裏一体！<br>　　脳卒中治療ガイドライン2009の理解・実践が大切！<br>　　早期からの集中的介入とチーム担当性が運営の鍵<br>　2　四肢骨折と関節症<br>　　骨折のポイントを整理しよう<br>　　関節症のポイントを整理しよう<br>　　ベッドサイド理学療法のポイントを整理しよう<br>　　 ミニレクチャー 　固定は基本<br> 　　ミニレクチャー 　代償動作を見逃さずに<br>3．心肺障害に対する一般病棟での理学療法<br>　1　心機能障害<br>　　具合が悪くなっていませんか？「フィジカルアセスメントの話」<br>　　理学療法士に求められていることとは？<br>　　病態理解へのポイント<br>　　患者と話そう<br>　2　呼吸器障害<br>　　理学療法評価の技能・技術<br>　　理学療法介入の技術・技能<br>　　他職種との連携<br> 　　ミニレクチャー 　フットケアも忘れずに<br> 　　ミニレクチャー 　告知の考え方<br>索引</section></article>
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