介護保険下の脳卒中維持期リハビリテーション

Abstract

Based on the Regional Inter-hospital Referral Model, the rehabilitation of poststroke patients under long-term care insurance at home including associated problems is presented in this paper. 1. The tools for assessing visiting rehabilitation that we have developed from necessity to evaluate poststroke patients' overall activity are also introduced. 2. Thirty-five out of 39 poststroke patients, who were institutionalized at our Geriatric Health Service Facility from the Convalescence Rehabilitation Units, returned home and showed a significant improvement in their Barthel index scores. Eleven out of 39 poststroke patients improved their ambulation ability. 3. The focus of training has shifted from recovery of impairment to improvement in activity. Before returning home, transfer of the patients to Geriatric Health Service Facilities from Convalescence Rehabilitation Units meets the burden of long-term care insurance rather than that of medical insurance. 4. As for the function of the intermediate institution between Convalescence Rehabilitation Units and poststroke patients' homes, Geriatric Health Service Facilities are important for those patients who are predicted to require a wheelchair after returning home. Moreover, a social rehabilitation support system for poststroke patients in their forties and their elders is required. 5. Each Ambulatory Rehabilitation service is systematically shown in its use purpose-oriented function. 6. As a result of a 10-month visiting rehabilitation period, the Barthel Index in 30 poststroke patients showed a significant improvement, and the time taken in IADL also demonstrated a significant increase. This upward tendency of leisure-time activity led to a further spread to areas of everyday activity. Thus, visiting rehabilitation had some positive effect. 7. Each rehabilitation service under long-term care insurance plays a central role in supporting the independent living of poststroke patients at home and improving their QOL.