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<title>理学療法プログラムデザインⅤ　神経系・内部障害編 | 株式会社文光堂</title>


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<meta name="description" content="理学療法プログラムデザインシリーズⅤ巻の本書では，神経系疾患と内部障害疾患の患者に対する理学療法を取り上げている．片麻痺，パーキンソン病，運動発達遅滞，脳性麻痺，循環器，呼吸，糖尿病，がんの8つを章テーマとして，個々の悩めるケースに応じた理学療法の組み立てを全99ケース紹介．セラピストが臨床場面で直面する難渋してしまうケースに対する理学療法のポイントと具体的なアプローチ手法を豊富なイラストとともに">

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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">理学療法プログラムデザインシリーズⅤ巻の本書では，神経系疾患と内部障害疾患の患者に対する理学療法を取り上げている．片麻痺，パーキンソン病，運動発達遅滞，脳性麻痺，循環器，呼吸，糖尿病，がんの8つを章テーマとして，個々の悩めるケースに応じた理学療法の組み立てを全99ケース紹介．セラピストが臨床場面で直面する難渋してしまうケースに対する理学療法のポイントと具体的なアプローチ手法を豊富なイラストとともに解説．養成校で学んだことや教科書の知識のみでは解決できなくて困った時・悩んだ時にヒントをくれる．信頼できる理学療法プログラムを厳選した実践書．</section><section class="preface">序<br><br>　「理学療法プログラムデザイン」は，理学療法の臨床で直面するさまざまなケースに関して，どのような理学療法を行うかを具体的に記載した書籍であり，2009年に出版された．疾患の説明や評価の方法などの詳細は省き，理学療法のポイントと実際を中心に書いた全く新しい本として，当時注目を浴びた．続編である「理学療法プログラムデザインⅡ」（2012年）を出版してから，かなりの年月が経過した2019年に，さらに続編を3編に分けて出版することを計画し，2020年10月に運動器（下肢）編（理学療法プログラムデザインⅢ），2021年11月に運動器（上肢・体幹）・高齢者編（理学療法プログラムデザインⅣ）を出版した．<br>　この度，第3弾である「理学療法プログラムデザインⅤ　神経系・内部障害編―ケース別アプローチのポイントと実際」を出版することとなった．「理学療法プログラムデザインⅢ」は，下肢を中心とした運動器疾患のケースについて，「理学療法プログラムデザインⅣ」は，上肢・体幹を中心とした運動器疾患と高齢者のケースについてまとめたが，「理学療法プログラムデザインⅤ」では，神経系疾患と内部障害疾患のケースを紹介している．<br>　本書では，21名の執筆者による99ケースを掲載している．前書と同じように，疾患の説明や評価の方法などの詳細は省き，ケース別に理学療法のポイントと実際を中心に執筆していただき，適切な理学療法として臨床現場で役立つものをわかりやすく記載した．<br>　神経系・内部障害編とした本書は，第1章　片麻痺（45ケース），第2章　パーキンソン病（8ケース），第3章　運動発達遅滞（3ケース），第4章　脳性麻痺（6ケース），第5章　循環器（6ケース），第6章　呼吸（16ケース），第7章　糖尿病（7ケース），第8章　がん（8ケース）という8つの章からなる．神経系疾患と内部障害疾患に関する99ケースの理学療法の実際について，どういった症状の患者にどのような理学療法を行うとよいかを，豊富なイラストとともになるべく具体的に記載した．養成学校で学んだことや，教科書，ガイドラインに書かれていることだけでは，どのように理学療法をプログラムしたらよいかがわからないケースが数多くある臨床現場で，前書4 冊とともに役立てていただければ幸いである．<br>　最後に，本書を企画・出版するにあたり協力していただいたすべての方々に心より感謝いたします．<br><br>2022年6月<br>京都大学大学院医学研究科人間健康科学系専攻<br>市橋則明</section><section class="indexes">第1章　片麻痺<br>　01　肩関節の亜脱臼があるケース<br>　02　麻痺手の母指外転が困難なケース<br>　03　麻痺手の遠位指節間関節の伸展が困難なケース<br>　04　脳損傷後急性期において随意収縮が得られにくいケース<br>　05　麻痺側下肢の伸筋群の緊張が低いケース<br>　06　体幹低緊張で座位保持が困難なケース<br>　07　骨盤・体幹と下肢の分離が不十分なケース<br>　08　動作時に麻痺側下肢筋の痙縮が増大するケース<br>　09　座位保持自体が困難な重症脳卒中のケース<br>　10　麻痺側への傾斜姿勢により座位保持や歩行が困難なケース<br>　11　感覚障害が重度で左右均等に荷重する立ち上がりが行いにくいケース<br>　12　立ち上がり時に麻痺側下肢に荷重がかかりにくいケース<br>　13　立ち上がり時に麻痺側下肢が伸展・内転し，麻痺側にバランスを崩すケース<br>　14　立ち上がり時に麻痺側下肢が屈曲し，足底接地が困難なケース<br>　15　立ち座り時に失調が強く，身体動揺が大きくなるケース<br>　16　立位時に膝のロッキングが生じるケース<br>　17　立位時にプッシングを呈するケース<br>　18　lateropulsion（側方突進）のために立位保持が困難なケース<br>　19　歩きはじめや方向転換に時間がかかるケース<br>　20　半側空間無視により歩行時に麻痺側下肢へ注意を向けられないケース<br>　21　下肢の麻痺は軽度にもかかわらず，歩行中の麻痺側への荷重が不十分なケース<br>　22　麻痺側下肢の機能が比較的良好にもかかわらず歩行速度が遅いケース<br>　23　上肢の緊張が強く歩行時に体幹回旋が得られないケース<br>　24　無意識下では立脚期の収縮が不十分なケース<br>　25　歩行立脚期に麻痺側の骨盤が過度に後方回旋してしまうケース<br>　26　歩行全周期にわたり膝関節が屈曲位となるケース<br>　27　歩行立脚前期に麻痺側の膝関節屈曲が増強するケース<br>　28　歩行立脚期に股関節が内転位となりバランスを崩しそうになるケース<br>　29　短下肢装具を装着しても歩行立脚期に反張膝が生じるケース<br>　30　歩行立脚初期に生じる膝関節の過伸展を短下肢装具で制御できず蹴り出しが困難なケース<br>　31　歩行立脚前期に膝関節が過伸展してしまうケース<br>　32　歩行立脚終期に反張膝が生じるケース<br>　33　歩行立脚後期の麻痺側の体重支持やプッシュオフが弱いケース<br>　34　歩行立脚終期に股関節が外旋位になるケース<br>　35　歩行遊脚期に股関節が外旋・内転位となるケース<br>　36　歩行遊脚期の引きずりや歩行立脚期の不安定性がみられるケース<br>　37　歩行遊脚期の足の振り出し位置のばらつきが生じるケース<br>　38　短下肢装具を装着しても歩行遊脚初期に足尖部が引っかかるケース<br>　39　失調歩行で蹴り出しを強められないケース<br>　40　stiff knee gaitを呈するケース<br>　41　非麻痺側の伸び上がり歩行が生じるケース<br>　42　歩行時に非麻痺側の振り出しが短いケース<br>　43　移乗動作の際に起立後の身体回転がうまくいかないケース<br>　44　麻痺側への車椅子移乗が困難なケース<br>　45　車椅子駆動時にずり落ちそうになるケース<br><br>第2章　パーキンソン病<br>　01　固縮が強く，小刻み歩行がみられるケース<br>　02　後方重心で小刻み歩行が著明なケース<br>　03　すくみ足により歩行開始困難なケース<br>　04　着座動作時にすくみ足があるケース<br>　05　すくみが強いため立ち上がりが困難なケース<br>　06　歩行障害が顕著になってきたケース<br>　07　頸部・体幹の可動域制限により呼吸・嚥下能力が低下しているケース<br>　08　首下がり症候群を呈したケース<br><br>第3章　運動発達遅滞<br>　01　粗大運動時に脊柱・骨盤の回旋を伴う運動が困難なケース<br>　02　伝い歩きまで獲得した後，独歩の獲得が難しくなっているケース<br>　03　足部の扁平足がみられるケース<br><br>第4章　脳性麻痺<br>　01　不随意運動により上肢動作が困難なケース<br>　02　座位で骨盤後傾が強まるケース<br>　03　左右非対称な動きが目立つケース<br>　04　自発的な姿勢変換が困難なケース<br>　05　体幹の低緊張が著明なケース<br>　06　協調運動障害により座位または立位保持が困難なケース<br><br>第5章　循環器<br>　01　起居動作（重力負荷）に伴い血圧が低下するケース<br>　02　心不全増悪因子を抱え運動療法に難渋するケース<br>　03　重複障害を有する心疾患のケース<br>　04　下肢動脈疾患に心疾患が並存しているケース<br>　05　整形外科手術後に肺血栓塞栓症を発症したケース<br>　06　心肺機能低下により歩行距離がのびないケース<br><br>第6章　呼吸<br>　01　人工呼吸管理が長期間となり抜管に難渋するケース<br>　02　開胸術後，開腹術後の早期離床に難渋するケース<br>　03　開胸術，開腹術の術前からフレイルを有するケース<br>　04　肺炎の急性増悪を認めるケース<br>　05　低酸素血症を伴う息切れによって活動が制限されているケース<br>　06　低酸素血症を伴わないが息切れによって活動が制限されているケース<br>　07　活動は制限されていないが低酸素血症が強いケース<br>　08　ゆっくりとした深呼吸を行うと，かえって呼吸困難が強まるケース<br>　09　息切れによって筋力トレーニングが実施できないケース<br>　10　端座位で息切れが生じて離床が進まないケース<br>　11　筋力はあるが歩くとすぐに下肢疲労が生じるケース<br>　12　労作時呼吸困難感が強く歩行での移動が困難なケース<br>　13　上肢活動に伴う呼吸困難感が強いケース<br>　14　喀痰排出が困難で持続的な誤嚥を招いているケース<br>　15　高流量酸素療法中の患者で粘稠痰を自己喀痰できないケース<br>　16　慢性閉塞性肺疾患で栄養不良によって十分な理学療法を提供できないケース<br><br>第7章　糖尿病<br>　01　血糖変動が不安定で薬物療法による低血糖リスクの高いケース<br>　02　運動が嫌いな肥満を伴う小児2型糖尿病のケース<br>　03　糖尿病罹病歴が長い患者で糖尿病性神経障害の合併により歩行時の足底圧変化に注意するケース<br>　04　糖尿病性足病変リスクの高い患者で予防的なフットケアを考慮するケース<br>　05　糖尿病を合併した人工膝関節全置換術後のケース<br>　06　足に傷があるが歩行獲得を目指す糖尿病患者のケース<br>　07　足病変により痛みが強いケース<br><br>第8章　がん<br>　01　造血器悪性腫瘍に対する骨髄移植術のためリスク管理が必要になったケース<br>　02　脊椎転移による脊髄圧迫・病的骨折に対するリスク管理が必要になったケース<br>　03　頸部リンパ節転移に対する頸部郭清術後に僧帽筋が麻痺したケース<br>　04　乳がん術後に肩関節屈曲が制限されたケース<br>　05　化学療法により身体機能が低下したケース<br>　06　がん由来の下肢リンパ浮腫が認められるケース<br>　07　がん性疼痛によりリハビリテーションが進まないケース<br>　08　末期がんのため緩和ケアが必要となったケース<br><br>索引</section></article>
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