Citation

Sato M, Shiba T, Jinushi C, Sawaya Y, Kiryu S, Abe M, Urano T. Nippon Ronen Igakkai Zasshi 2022; 59(1): 102-109.

Vernacular Title

脳梗塞発症後，通所リハビリテーション利用にて注意機能訓練実施により安全運転のための運転能力向上を認めた1例

Copyright

(Copyright © 2022, Japan Geriatrics Society)

DOI

10.3143/geriatrics.59.102

PMID

35264524

Abstract

In recent years, the assessment of and support for the safety of driving for people with higher brain dysfunction to allow them to resume car driving have become issues to be addressed in Japan. It is difficult to determine whether or not people with higher brain dysfunction may safely resume car driving; in addition, methods of supporting this resumption have not been established. To support people with higher brain dysfunction and allow them to live at home in areas where public means of transportation may be insufficient, initiatives promoting the resumption of car driving are necessary in healthcare sectors, including day rehabilitation facilities. We provided support to a patient with an attention disorder due to left thalamic infarction, with the aim of achieving sufficient independence to drive a car, in a day rehabilitation facility. We herein report this case from the perspective of a speech-language-hearing therapist. The patient was a right-handed man in his 60s who had higher brain dysfunction with attention disorder as the main symptom. No marked motor paralysis of the extremities was observed. Use of a day rehabilitation service was started approximately two months after the onset of symptoms. Rehabilitation and support aimed at the resumption of car driving were provided approximately one month after the start of the day rehabilitation service use. To determine whether or not the patient was fit to drive a car, higher brain function tests for the intellectual function, attention function, and frontal function, as well as a theoretical evaluation based on the Stroke Drivers' Screening Assessment Japanese Version (J-SDSA) and monitoring of daily behaviors were performed. In addition, after the patient was given permission from an attending physician to drive a car on the condition that the patient did not drive fast and the patient's wife always accompanied him while driving, a safety assessment was also performed. As a result, approximately 10 months later, the J-SDSA theoretical evaluation score showed a passing grade, in contrast to the failing grade he had previously earned. Furthermore, errors in performing household activities due to a decreased attention function became unremarkable with respect to daily behaviors; therefore, we determined, together with the attending physician, that the patient now had sufficient independence to drive a car. In our day rehabilitation facility, the number of requests for advice on car driving from people with higher brain dysfunction living in the community had been increasing. Multisectoral assessments, training, and instruction should be continued in collaboration with attending physicians, other facilities located within the community, and driving schools in order to support people with higher brain dysfunction and help them once again be able to drive a car.

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近年，本邦では高次脳機能障害者が自動車運転を再開するための，運転の安全性に関する評価および支援が課題となっている．高次脳機能障害者の運転再開については，その可否判断が難しく，支援方法も確立されていない．交通機関が充実していない地域において，高次脳機能障害者の在宅生活を支援するためには，通所リハビリテーション施設などでも運転再開に向けた取り組みが必要となる．今回，左視床の脳梗塞によって注意障害を呈した1例に対し，通所リハビリテーションにおいて運転自立を目標とした支援を行ったので，言語聴覚士の立場から報告する．

症例は60歳代の右利き男性で，脳梗塞により高次脳機能障害（注意障害が主症状）を呈した．著明な四肢の運動麻痺は認めなかった．発症から約2カ月後より，通所リハビリテーションの利用を開始した．自動車運転再開を目標としたリハビリテーションおよび支援は，通所リハビリテーション開始から約1カ月後より実施した．自動車運転の可否に関する評価は，知的機能，注意機能，前頭葉機能に関する高次脳機能検査，脳卒中ドライバーのスクリーニング評価日本版（J-SDSA）による机上評価と日常生活における行動観察を実施した．また，主治医から，スピードを出さない，妻が必ず同乗する条件付きでの運転の許可を得て，安全性の評価も行った．その結果，約10カ月後には，机上評価において，J-SDSAの成績が不合格判定から合格判定となった．日常生活の行動観察においても，注意機能低下に起因する家事の誤りが目立たなくなったことから，主治医とともに自動車運転自立であるとの判断を行った．

当通所リハビリテーション施設では，地域で生活する高次脳機能障害者からの自動車運転に関する相談が増加している．高次脳機能障害者の運転再開の支援を行うためには，主治医や地域にある他施設，さらには自動車教習所とも連携し，多方面より評価や訓練・指導を進める必要があると考えられた．

Language: ja

Keywords

Cerebrovascular disease; Day rehabilitation service