理学療法場面における脳性麻痺児・者の呼吸器疾患に対する予防的観点
呼吸器疾患は脳性麻痺児・者において好発する問題であるため，呼吸器疾患の発症あるいは再発の予防は極めて重要となる。本総説では，主に脳性麻痺の呼吸器疾患の病態や危険因子，理学療法の実践における予防的な観点について概説する。...
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| Published in | 呼吸理学療法学 Vol. 4; no. 1; pp. 47 - 56 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本呼吸理学療法学会
21.03.2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2436-7966 |
| DOI | 10.51116/kokyurigakuryohogaku.4.1_47 |
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| Abstract | 呼吸器疾患は脳性麻痺児・者において好発する問題であるため，呼吸器疾患の発症あるいは再発の予防は極めて重要となる。本総説では，主に脳性麻痺の呼吸器疾患の病態や危険因子，理学療法の実践における予防的な観点について概説する。 |
|---|---|
| AbstractList | 呼吸器疾患は脳性麻痺児・者において好発する問題であるため，呼吸器疾患の発症あるいは再発の予防は極めて重要となる。本総説では，主に脳性麻痺の呼吸器疾患の病態や危険因子，理学療法の実践における予防的な観点について概説する。 |
| Author | 佐藤, 春彦 木村, 優希 楠本, 泰士 武田, 憲子 |
| Author_xml | – sequence: 1 fullname: 武田, 憲子 organization: 北里大学病院 小児外科 – sequence: 1 fullname: 楠本, 泰士 organization: 福島県立医科大学 保健科学部 理学療法学科 – sequence: 1 fullname: 木村, 優希 organization: リニエ訪問看護ステーションキッズ世田谷 – sequence: 1 fullname: 佐藤, 春彦 organization: 関西医科大学 リハビリテーション学部 理学療法学科 |
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| ContentType | Journal Article |
| Copyright | 2025 一般社団法人 日本呼吸理学療法学会 |
| Copyright_xml | – notice: 2025 一般社団法人 日本呼吸理学療法学会 |
| DOI | 10.51116/kokyurigakuryohogaku.4.1_47 |
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| References | 15) 大森慶太郎，大毛 宏喜：低栄養患者における感染症．日内会誌 108: 2291-2296, 2019. 34) 高橋幸利: 1. 抗てんかん薬の副作用. 日内会誌 96: 1608-1613, 2007. 47) Novak I, Morgan C, Fahey M, et al.: State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep 20: 3, 2020. 24) Sellers D, Mandy A, Pennington L, et al.: Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy. Dev Med Child Neurol 56: 245-251, 2014. 2) Blair E, Langdon K, McIntyre S, et al.: Survival and mortality in cerebral palsy: observations to the sixth decade from a data linkage study of a total population register and National Death Index. BMC Neurol 19: 1-11, 2019. 44) Main E, Rand S: Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis. Cochrane Database Syst Rev 5: CD002011, 2023. 8) 椎名英貴：脳性麻痺の摂食嚥下障害に対するリハビリテーション．小児耳鼻 40: 203-208, 2019. 45) Chaves GS, Freitas DA, Santino TA, et al.: Chest physiotherapy for pneumonia in children. Cochrane Database Syst Rev 1: CD010277, 2019. 50) Chatwin M, Ross E, Hart N, et al.: Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness. Eur Respir J 21: 502-508, 2003. 13) Desai B, Lesser DJ, Sunwoo BY: Managing pulmonary complications in adults with cerebral palsy. CHEST Pulmonary 1: 1-10, 2023. 39) Blackmore AM, Gibson N, Cooper MS, et al.: Interventions for management of respiratory disease in young people with cerebral palsy: a systematic review. Child: Care, Health and Development 45: 754-771, 2019. 14) van Kaam AH, Lachmann RA, Herting E, et al.: Reducing atelectasis attenuates bacterial growth and translocation in experimental pneumonia. Am J Respir Crit Care Med 169: 1046-1053, 2004. 29) Fernando T, Goldman RD: Management of gastroesophageal reflux disease in pediatric patients with cerebral palsy. Can Fam Physician 65: 796-798, 2019. 5) Bear NL, Wilson A, Blackmore AM, et al.: The cost of respiratory hospitalizations in children with cerebral palsy. Dev Med Child Neurol 66: 344-352, 2024. 16) Boel L, Pernet K, Toussaint M, et al.: Respiratory morbidity in children with cerebral palsy: an overview. Dev Med Child Neurol 61: 646-653, 2019. 42) 神津玲：呼吸理学療法のスタンダードと新たな展開．理学療法学 41: 754-771, 2014. 36) Ruiz Brunner MLM, Cieri ME, Rodriguez Marco MP, et al.: Nutritional status of children with cerebral palsy attending rehabilitation centers. Dev Med Child Neurol 62: 1383-1388, 2020. 55) Verschuren O, Peterson MD, Balemans ACJ, et al.: Exercise and physical activity recommendations for people with cerebral palsy. Dev Med Child Neurol 58: 798-808. 2016. 11) 上田章人：呼吸器内科医の立場からみた誤嚥性肺炎．日呼吸ケアリハ会誌 29: 264-269, 2020. 28) Whitworth J, Christensen ML: Clinical management of infants and children with gastroesophageal reflux disease. J Pediatr Pharmacol Ther 9: 243-253, 2004. 32) 仲田惣一，久守孝司，石橋脩一，他.：当科における気管切開術後患者に対する喉頭気管分離術．日重症心身障害会誌 43: 419-424, 2018. 3) Ryan JM, Peterson MD, Ryan N, et al.: Mortality due to cardiovascular disease, respiratory disease, and cancer in adults with cerebral palsy. Dev Med Child Neurol 61: 924-928, 2019. 54) Grychtol R, Chan EY: Use of non-invasive ventilation in cerebral palsy. Arch Dis Child 103: 1170-1177, 2018. 7) Gibson N, Blackmore AM, Chang AB, et al.: Prevention and management of respiratory disease in young people with cerebral palsy: consensus statement. Dev Med Child Neurol 63: 172-182, 2021. 9) Parkes J, Hill N, Platt MJ, et al.: Oromotor dysfunction and communication impairments in children with cerebral palsy: a register study. Dev Med Child Neurol 52: 1113-1119, 2010. 48) Kaltenbach T, Crockett S, Gerson LB: Are lifestyle measures effective in patients with gastroesophageal reflux disease? an evidence-based approach. Arch Intern Med 166: 965-971, 2006. 19) Kwong KL, Wong SN, So KT: Epilepsy in children with cerebral palsy. Pediatr Neurol 19: 31-36, 1998. 37) Romano C, van Wynckel M, Hulst J, et al.: European Society for paediatric Gastroenterology, Hepatology and Nutrition guidelines for the Evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J Pediatr Gastroenterol Nutr 65: 242-264, 2017. 53) Simpson AJ, Allen JL, Chatwin M, et al.: BTS clinical statement on aspiration pneumonia. Thorax 78: s3-s21, 2023. 35) Zhao Y, Tang H, Peng T, et al.: Relationship between nutritional status and severity of cerebral palsy: a multicentre cross-sectional study. J Rehabil Med 55: jrm00367, 2023. 56) 並木千鶴，原豪志，柳田陵介，他.：夜間の唾液誤嚥に対する簡易的な口腔内装置（唾液吸引マウスピース）の作製と臨床応用．日摂食嚥下リハ会誌 28: 43-49, 2024. 12) Piccione JC, McPhail GL, Fenchel MC, et al.: Bronchiectasis in chronic pulmonary aspiration: risk factors and clinical implications. Pediatr Pulmonol 47: 447-452, 2012. 22) Palisano R, Rosenbaum P, Walter S, et al.: Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39: 214-223, 1997. 18) Patil P, Weber ARB: Epilepsy in cerebral palsy: a brief narrative review. OBM Neurobiol 6: 129, 2022. 40) Winfield NR, Barker NJ, Turner ER, et al.: Non-pharmaceutical management of respiratory morbidity in children with severe global developmental delay. Cochrane Database of Syst Rev 10: CD10382, 2014. 26) 日本語版Eating and Drinking Ability Classification System 摂食・嚥下能力分類システム-アルゴリズム．https://www.sussexcommunity.nhs.uk/documents/142-edacs-japanese-algorithm/file（2024年10月17日引用） 33) 及川敬太：重症心身障害児に対する喉頭気管分離術のマネジメント．小児耳鼻 31: 257-263, 2010. 51) Natale JE, Pfeifle J, Homnick DN: Comparison of intrapulmonary percussive ventilation and chest physiotherapy. a pilot study in patients with cystic fibrosis. Chest 105:1789-1793, 1994. 43) Belli S, Prince I, Savio G, et al.: Airway clearance techniques: the right choice for the right patient. Front Med 8: 544826, 2021. 30) 柏木秀幸，青木照明，小村伸朗：3．外科療法．日内会誌 89: 74-79, 2000. 49) 脳性麻痺リハビリテーションガイドライン第2版．http://www.jarm.or.jp/wp-cntpnl/wp-content/uploads/2017/05/member_publication_isbn9784307750387.pdf（2024年10月17日引用） 38) 望月弘彦：総論 身体計測の方法．日静脈経腸栄会誌 32: 1137-1141, 2017. 4) Elema A, Zalmstra TAL, Boonstra AM, et al.: Pain and hospital admissions are important factors associated with quality of life in nonambulatory children. Acta Paediatr 105: e419-e425, 2016. 52) King M, Phillips DM, Gross D, et al.: Enhanced tracheal mucus clearance with high frequency chest wall compression. Am Rev Respir Dis 128: 511-515, 1983. 31) Eisele DW: Surgical approaches to aspiration. Dysphagia 6: 71-78, 1991. 27) Erasmus CE, Van Hulst K, Rotteveel LJC, et al.: Drooling in cerebral palsy: hypersalivation or dysfunctional oral motor control?. Dev Med Child Neurol 51: 454-459, 2009. 1) Rosenbaum P, Paneth N, Leviton A, et al.: A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 109: 8-14, 2007. 6) Marpole R, Marie Blackmore A, Gibson N, et al.: Evaluation and management of respiratory illness in children with cerebral palsy. Frontiers in Pediatrics 8: 333, 2020. 21) Blackmore AM, Bear N, Blair E, et al.: Predicting respiratory hospital admissions in young people with cerebral palsy. Arch Dis Child 103: 1119-1124, 2018. 17) 徳光亜矢：重症心身障害児（者）における経腸栄養の合併症とその対策．日重症心身障害会誌 41: 87-92, 2016. 57) Sato H: Postural deformity in children with cerebral palsy: why it occurs and how is it managed. Phys Ther Res 23: 8-14, 2020. 20) Gong C, Liu A, Lian B, et al.: Prevalence and related factors of epilepsy in children and adolescents with cerebral palsy: a systematic review and meta-analysis. Front Pediatr 11: 1189648, 2023. 25) EDACS Eating and Drinking Ability Classification System 摂食・嚥下能力分類システム．https://www.sussexcommunity.nhs.uk/documents/141-edacs-japanese/file（2024年10月17日引用） 46) Rutka M, Myśliwiec A, Wolny T, et al.: Influence of chest and diaphragm manual therapy on the spirometry parameters in patients with cerebral palsy: a pilot study. Biomed Res Int: 6263973, 2021. 41) Bilan N, Poorshiri B: The role of chest physiotherapy in prevention of postextubation atelectasis in pediatric patients with neuromuscular diseases. Iran J Child Neurol 7: 21-24, 2013. 23) GMFCS-E&R 粗大運動能力分類システム 拡張・改訂されたもの．https://www.fujita-hu.ac.jp/FMIP/GMFCS_%20ER_J.pdf（2024年10月17日引用） 10) Mandell LA, Niederman MS: Aspiration pneumonia. N Engl J Med 380: 651-663, 2019. |
| References_xml | – reference: 4) Elema A, Zalmstra TAL, Boonstra AM, et al.: Pain and hospital admissions are important factors associated with quality of life in nonambulatory children. Acta Paediatr 105: e419-e425, 2016. – reference: 43) Belli S, Prince I, Savio G, et al.: Airway clearance techniques: the right choice for the right patient. Front Med 8: 544826, 2021. – reference: 10) Mandell LA, Niederman MS: Aspiration pneumonia. N Engl J Med 380: 651-663, 2019. – reference: 25) EDACS Eating and Drinking Ability Classification System 摂食・嚥下能力分類システム．https://www.sussexcommunity.nhs.uk/documents/141-edacs-japanese/file（2024年10月17日引用） – reference: 2) Blair E, Langdon K, McIntyre S, et al.: Survival and mortality in cerebral palsy: observations to the sixth decade from a data linkage study of a total population register and National Death Index. BMC Neurol 19: 1-11, 2019. – reference: 6) Marpole R, Marie Blackmore A, Gibson N, et al.: Evaluation and management of respiratory illness in children with cerebral palsy. Frontiers in Pediatrics 8: 333, 2020. – reference: 16) Boel L, Pernet K, Toussaint M, et al.: Respiratory morbidity in children with cerebral palsy: an overview. Dev Med Child Neurol 61: 646-653, 2019. – reference: 21) Blackmore AM, Bear N, Blair E, et al.: Predicting respiratory hospital admissions in young people with cerebral palsy. Arch Dis Child 103: 1119-1124, 2018. – reference: 51) Natale JE, Pfeifle J, Homnick DN: Comparison of intrapulmonary percussive ventilation and chest physiotherapy. a pilot study in patients with cystic fibrosis. Chest 105:1789-1793, 1994. – reference: 11) 上田章人：呼吸器内科医の立場からみた誤嚥性肺炎．日呼吸ケアリハ会誌 29: 264-269, 2020. – reference: 15) 大森慶太郎，大毛 宏喜：低栄養患者における感染症．日内会誌 108: 2291-2296, 2019. – reference: 53) Simpson AJ, Allen JL, Chatwin M, et al.: BTS clinical statement on aspiration pneumonia. Thorax 78: s3-s21, 2023. – reference: 26) 日本語版Eating and Drinking Ability Classification System 摂食・嚥下能力分類システム-アルゴリズム．https://www.sussexcommunity.nhs.uk/documents/142-edacs-japanese-algorithm/file（2024年10月17日引用） – reference: 33) 及川敬太：重症心身障害児に対する喉頭気管分離術のマネジメント．小児耳鼻 31: 257-263, 2010. – reference: 14) van Kaam AH, Lachmann RA, Herting E, et al.: Reducing atelectasis attenuates bacterial growth and translocation in experimental pneumonia. Am J Respir Crit Care Med 169: 1046-1053, 2004. – reference: 8) 椎名英貴：脳性麻痺の摂食嚥下障害に対するリハビリテーション．小児耳鼻 40: 203-208, 2019. – reference: 49) 脳性麻痺リハビリテーションガイドライン第2版．http://www.jarm.or.jp/wp-cntpnl/wp-content/uploads/2017/05/member_publication_isbn9784307750387.pdf（2024年10月17日引用） – reference: 35) Zhao Y, Tang H, Peng T, et al.: Relationship between nutritional status and severity of cerebral palsy: a multicentre cross-sectional study. J Rehabil Med 55: jrm00367, 2023. – reference: 31) Eisele DW: Surgical approaches to aspiration. Dysphagia 6: 71-78, 1991. – reference: 36) Ruiz Brunner MLM, Cieri ME, Rodriguez Marco MP, et al.: Nutritional status of children with cerebral palsy attending rehabilitation centers. Dev Med Child Neurol 62: 1383-1388, 2020. – reference: 27) Erasmus CE, Van Hulst K, Rotteveel LJC, et al.: Drooling in cerebral palsy: hypersalivation or dysfunctional oral motor control?. Dev Med Child Neurol 51: 454-459, 2009. – reference: 46) Rutka M, Myśliwiec A, Wolny T, et al.: Influence of chest and diaphragm manual therapy on the spirometry parameters in patients with cerebral palsy: a pilot study. Biomed Res Int: 6263973, 2021. – reference: 56) 並木千鶴，原豪志，柳田陵介，他.：夜間の唾液誤嚥に対する簡易的な口腔内装置（唾液吸引マウスピース）の作製と臨床応用．日摂食嚥下リハ会誌 28: 43-49, 2024. – reference: 7) Gibson N, Blackmore AM, Chang AB, et al.: Prevention and management of respiratory disease in young people with cerebral palsy: consensus statement. Dev Med Child Neurol 63: 172-182, 2021. – reference: 20) Gong C, Liu A, Lian B, et al.: Prevalence and related factors of epilepsy in children and adolescents with cerebral palsy: a systematic review and meta-analysis. Front Pediatr 11: 1189648, 2023. – reference: 52) King M, Phillips DM, Gross D, et al.: Enhanced tracheal mucus clearance with high frequency chest wall compression. Am Rev Respir Dis 128: 511-515, 1983. – reference: 17) 徳光亜矢：重症心身障害児（者）における経腸栄養の合併症とその対策．日重症心身障害会誌 41: 87-92, 2016. – reference: 41) Bilan N, Poorshiri B: The role of chest physiotherapy in prevention of postextubation atelectasis in pediatric patients with neuromuscular diseases. Iran J Child Neurol 7: 21-24, 2013. – reference: 34) 高橋幸利: 1. 抗てんかん薬の副作用. 日内会誌 96: 1608-1613, 2007. – reference: 29) Fernando T, Goldman RD: Management of gastroesophageal reflux disease in pediatric patients with cerebral palsy. Can Fam Physician 65: 796-798, 2019. – reference: 3) Ryan JM, Peterson MD, Ryan N, et al.: Mortality due to cardiovascular disease, respiratory disease, and cancer in adults with cerebral palsy. Dev Med Child Neurol 61: 924-928, 2019. – reference: 18) Patil P, Weber ARB: Epilepsy in cerebral palsy: a brief narrative review. OBM Neurobiol 6: 129, 2022. – reference: 30) 柏木秀幸，青木照明，小村伸朗：3．外科療法．日内会誌 89: 74-79, 2000. – reference: 38) 望月弘彦：総論 身体計測の方法．日静脈経腸栄会誌 32: 1137-1141, 2017. – reference: 45) Chaves GS, Freitas DA, Santino TA, et al.: Chest physiotherapy for pneumonia in children. Cochrane Database Syst Rev 1: CD010277, 2019. – reference: 24) Sellers D, Mandy A, Pennington L, et al.: Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy. Dev Med Child Neurol 56: 245-251, 2014. – reference: 32) 仲田惣一，久守孝司，石橋脩一，他.：当科における気管切開術後患者に対する喉頭気管分離術．日重症心身障害会誌 43: 419-424, 2018. – reference: 12) Piccione JC, McPhail GL, Fenchel MC, et al.: Bronchiectasis in chronic pulmonary aspiration: risk factors and clinical implications. Pediatr Pulmonol 47: 447-452, 2012. – reference: 13) Desai B, Lesser DJ, Sunwoo BY: Managing pulmonary complications in adults with cerebral palsy. CHEST Pulmonary 1: 1-10, 2023. – reference: 22) Palisano R, Rosenbaum P, Walter S, et al.: Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39: 214-223, 1997. – reference: 37) Romano C, van Wynckel M, Hulst J, et al.: European Society for paediatric Gastroenterology, Hepatology and Nutrition guidelines for the Evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J Pediatr Gastroenterol Nutr 65: 242-264, 2017. – reference: 28) Whitworth J, Christensen ML: Clinical management of infants and children with gastroesophageal reflux disease. J Pediatr Pharmacol Ther 9: 243-253, 2004. – reference: 1) Rosenbaum P, Paneth N, Leviton A, et al.: A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 109: 8-14, 2007. – reference: 47) Novak I, Morgan C, Fahey M, et al.: State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep 20: 3, 2020. – reference: 39) Blackmore AM, Gibson N, Cooper MS, et al.: Interventions for management of respiratory disease in young people with cerebral palsy: a systematic review. Child: Care, Health and Development 45: 754-771, 2019. – reference: 48) Kaltenbach T, Crockett S, Gerson LB: Are lifestyle measures effective in patients with gastroesophageal reflux disease? an evidence-based approach. Arch Intern Med 166: 965-971, 2006. – reference: 23) GMFCS-E&R 粗大運動能力分類システム 拡張・改訂されたもの．https://www.fujita-hu.ac.jp/FMIP/GMFCS_%20ER_J.pdf（2024年10月17日引用） – reference: 55) Verschuren O, Peterson MD, Balemans ACJ, et al.: Exercise and physical activity recommendations for people with cerebral palsy. Dev Med Child Neurol 58: 798-808. 2016. – reference: 5) Bear NL, Wilson A, Blackmore AM, et al.: The cost of respiratory hospitalizations in children with cerebral palsy. Dev Med Child Neurol 66: 344-352, 2024. – reference: 44) Main E, Rand S: Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis. Cochrane Database Syst Rev 5: CD002011, 2023. – reference: 42) 神津玲：呼吸理学療法のスタンダードと新たな展開．理学療法学 41: 754-771, 2014. – reference: 9) Parkes J, Hill N, Platt MJ, et al.: Oromotor dysfunction and communication impairments in children with cerebral palsy: a register study. Dev Med Child Neurol 52: 1113-1119, 2010. – reference: 19) Kwong KL, Wong SN, So KT: Epilepsy in children with cerebral palsy. Pediatr Neurol 19: 31-36, 1998. – reference: 57) Sato H: Postural deformity in children with cerebral palsy: why it occurs and how is it managed. Phys Ther Res 23: 8-14, 2020. – reference: 50) Chatwin M, Ross E, Hart N, et al.: Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness. Eur Respir J 21: 502-508, 2003. – reference: 40) Winfield NR, Barker NJ, Turner ER, et al.: Non-pharmaceutical management of respiratory morbidity in children with severe global developmental delay. Cochrane Database of Syst Rev 10: CD10382, 2014. – reference: 54) Grychtol R, Chan EY: Use of non-invasive ventilation in cerebral palsy. Arch Dis Child 103: 1170-1177, 2018. |
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| Snippet | 呼吸器疾患は脳性麻痺児・者において好発する問題であるため，呼吸器疾患の発症あるいは再発の予防は極めて重要となる。本総説では，主に脳性麻痺の呼吸器疾患の病態や危険因子，理学療法の実践における予防的な観点について概説する。 |
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| SourceType | Publisher |
| StartPage | 47 |
| SubjectTerms | 予防 呼吸器疾患 感染症 脳性麻痺 誤嚥 |
| Title | 理学療法場面における脳性麻痺児・者の呼吸器疾患に対する予防的観点 |
| URI | https://www.jstage.jst.go.jp/article/kokyurigakuryohogaku/4/1/4_47/_article/-char/ja |
| Volume | 4 |
| hasFullText | 1 |
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| ispartofPNX | 呼吸理学療法学, 2025/03/21, Vol.4(1), pp.47-56 |
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