The course of physical therapy in patient with spasticity paraparesis with intrathecal baclofen therapy : a case report

痙縮に対する治療法としてバクロフェン髄腔内投与療法(Intrathecal Baclofen Therapy, ITB療法)がある。ITB療法後の痙縮改善に関する報告は散見されるが,理学療法経過に関する報告は少ない。今回,進行性の痙性対麻痺により歩行障害を呈した患者に対しITB療法を行い,術後理学療法を経験した。患者は15年前より歩行障害がみられ,術前には屋外歩行が困難であった。術後,痙縮が減少し2週後には歩行能力が向上した。しかし,投薬による副作用や,体調不良により一時的な歩行能力の低下を認めた。投薬量の調整や継続的な理学療法により,自立歩行を獲得し,最終的に職場復帰可能となった。今回,定量的な評価を施行することにより下肢筋の協調運動の改善や歩行能力が客観的に向上したことが示された。ITB療法後の理学療法場面において,痙縮軽減による活動量の変化や副作用の影響により身体機能が低下する危険性が考えられる。そのため,ITB療法後には症状の変化に応じた理学療法が重要である。Intrathecal baclofen (ITB) therapy is an effective treatment for the patient with severe spasticity due to the spinal disorders. There are many reports on ITB, but few reports on physical therapy with ITB. A 59 years-old man with chronic progressive spastic paraparesis, had had the difficulty to stand and walk since 15 years. He was given ITB therapy, followed by physical therapy for 10 weeks. Gait time was improved for postoperative 2-3 weeks with the spasticity reduction with ITB administration starting; however, it was temporally deteriorated from postoperative 4 to 8 weeks for 5 weeks. Finally his spasticity was improved, resulting into gaining the standing and walking ability outside. His walking distance, Manual Muscle Test, and motor Functional Independence Measure were also improved over 10 weeks of ITB therapy. As a result of having continuous physical therapy and medical management, he has gotten the ability to walk and work outside. A significant improvement in the patient's symptoms with ITB was found, and physical therapy was effective to improve the coordination of low extremities, the increasing muscle output, and the relearning of his gait pattern. It is important for patients with severe spasticity with ITB administration to receive physical therapy that is suitable to their condition