低出生体重児を対象としたブラゼルトン新生児行動評価による精神発達遅滞児の判別

ブラゼルトン新生児行動評価法（Neonatal Behavioral Assessment Scale；NBAS）による精神発達遅滞児の鑑別診断の有効性を確認するため，追跡調査の結果を用いた判別分析による検討を行った．対象は新生児期にNBASを行い，3才までの発達経過を確認した低出生体重児86例である．これらの対象児を修正3才時のマッカーシー知能発達検査の結果から，境界値を含む一般知能指数90未満の17例（遅滞群）と，一般知能指数90以上の69例（正常群）の2群に分類し，この2群が胎齢44週時のNBASの結果から既知のグループに正しく区別されるかどうかについて，フィッシャーの線型判別式を用いた判別分析を行った．その結果，胎齢44週時のNBASの結果から正常群では69例中61例（88.5％）が，遅滞群では17例中12例（70.6％）が既知のグループに正しく分類され，その全体に対する割合は84.9％であった．また，一般知能指数と判別結果では指数70～79の遅滞域の4例中1例（25.0％），指数80～89の境界域の9例中4例（44.4％），指数90～120未満の正常域の69例中8例（13.0％）が誤判別であった．次に，関数値と各変数値とのグループ内相関を算出した結果，NBASのクラスターのうち「意識状態の幅」，「運動の調整」，「補足項目値」，「意識状態の調整」，「方位反応」のクラスターが順に統計的に影響力が強く，新生児期の行動評価の必要性を示した．以上より，胎齢44週時のNBASから低体重出生の精神発達遅滞児の判別は高い精度で可能で，早期診断と介入，療育の適応決定に有効であると考えられた．また，より長期的なフォローの必要性も示唆した．The results of a follow-up study were reviewed by discriminant analysis to verify the effectiveness of differential diagnosis for mentally retarded infants by the Brazelton Neonatal Behavioral Assessment Scale (NBAS). The subjects were 86 low birthweight infants for whom the NBAS was performed in the neonatal period and whose developmental progress through age 3 years was confirmed. These infants were divided into 2 groups according to the results of the McCarthy Scales at revised age 3 years, i.e., 17 cases of intelligence quotient (IQ) of less than 90 including borderline area (retarded group) and 69 cases of IS 90 or more (normal group). Fisher\u27s linear discriminant analysis was performed to see if these 2 groups are properly distinguished to the known groups in reference to the results of the NBAS at gestational age 44 weeks. As the result, 61 of the 69 cases in the normal group (88.5%) and 12 of the 17 cases in the retarded group (70.6%) were found to be properly classified in the known groups. The overall rate of proper classification was 84.9%. False discrimination was found in 1 of the 4 cases (25.0%) in the retarded area of IQ 70-79, in 4 of the 9 cases (44.4%) in the borderline area of IQ 80-89, and in 8 of the 69 cases (13.0%) in the normal area of IQ 90-<120. Then, the pooled within-groups correlations between discriminating variables and canonical discriminant functions were calculated. The results showed statistical influences by such NBAS clusters as state range, motor performance, supplemental items, state regulation and orientation, in descending order, indicating the necessity of behavioral assessment in the neonatal period. From the above, it was considered that discrimination of mental retardation in low birthweight infants in reference to the NBAS at gestational age 44 weeks is available at a high accuracy, and that the NBAS is effective on early diagnosis and on determining the application of early intervention and care. It was also indicated that follow-up for a longer period is necessary

ブラゼルトン新生児行動評価の臨床活用

我々はこれまでブラゼルトン新生児行動評価法（NBAS）を未熟児やリスクを有する成熟児の早期発達評価と介入手段として応用してきた。今回は未熟児を対象にNBASの評価結果から発達障害を予測された児の新生児行動上の特性を4つの行動系に分けて整理し，我々の実施している早期療育プログラムについて報告した。また，これまでフォローした児について発達経過を加えた。We have applied the Brazelton\u27s Neonatal Behaviour Assessment Scale (NBAS) for the evaluation of early development stages in both premature infants, and mature risk infants, as well as for the clinical application of early intervention method. This paper reports the neonatal behaviour peculiarities of premature infants forecast by NBAS to have mental-motor delays. This paper also report on our practical application of the early intervention program. Finally, we conclude with the progress made in these infant\u27s developments

脳性麻痺股，膝関節屈曲拘縮に対する治療効果

歩行不能例を含めた脳性麻痺患者78例108肢の股，膝関節屈曲拘縮に対し，腸腰筋，ハムストリングを含めた屈筋群および他の軟部組織の解離，延長術を施行した．　手術目的は，屈曲拘縮の除去，屈筋共同収縮の抑制および伸筋群の機能強化により，股関節周囲筋のインバランスを改善し，股関節の求心性を改善すると同時に立位姿勢保持機能および移動能力を高めることにあった．　78例中55例71％に立位姿勢保持機能および移動能力に改善をみた．移動能力の改善には術後6カ月～2年間かかり，重度であればあるほど長期間を要した．B，C群において，手術の最もよい適応年齢は4～5歳であった．股関節亜脱臼例においてレ線上SF角，CE角，骨頭被覆率に明らかな改善を得た．Soft tissue release operations to the hip and knee flexion contracture were performed on 108 extremities of 78 cerebral palsy patients including non-ambulatory cases. A successful operation requires accurate assessment of contracture and complete elimination of flexion contracture. Furthermore, postoperative physiotherapy is essential for having the patient detach from the preoperative pathological postural reaction mainly involving hyperactivities of the flexors and acquiring normal postural reaction to a possible extent primarily initiated by the extensors. The ability of locomotion was improved in 55 of 78 cases or in 71%. In severe cases, generalized hypertonia was alleviated. Improvement of the ability of locomotion after the operation required 6 months to 2 years in proportion to the severity of motor dysfunction. The most appropriate age for non-ambulatory groups (B and C groups) was 4 or 5 years. Roentgenograms generally disclosed definite improvement of sacro-femoral angle, and in subluxation cases, CE angle and covered ratio of the femoral head

正常発達を遂げた未熟児または脳性麻痺となった未熟児の新生児行動評価と超早期療育

発達指数では，修正年齢6ヶ月のPDIおよび12ヶ月のMDIにおいて，危険率5％でSFD児がAFD児より低値を示したが，36ヶ月の時点では有意差がなかった．　6ヶ月時の家庭環境値（Caldwell）と発達指数との間に，有意な相関を認めた．　新生児行動評価の個々のクラスター値のみからは発達障害児の予後診断は困難であるが数回の評価を通して，低クラスター値の持続期間とそれらの重複度数とから可能となる．したがって，high risk児に対してはNBASを介入手段として早期評価を実施し，必要に応じて早期療育下に発達経過を観察することが肝要である．In the development of SFD infants, the indices at 6 months and 12 months were significantly lower (P<0.05) compared to AFD infants, whereas the indices at 36 months didn\u27t show significant differences. The environment scores at 6 months by Caldwell (Home) significantly affected the development indices. Prospective diagnosis of high risk infants is difficult when it is based only on the scores of individual clusters for the neonatal behavioral assessment. However, such a prospective diagnosis in the neonatal period is available to some extent when the duration of low cluster scores and the frequency of overlapped lowscores are taken into consideration. It seems essential to perform assessment of high risk infants using the NBAS as a means of early intervention and to observe the process of development under early treatment and care. We would like to carry out further studies with more cases

Neuropsychological and MRI Assessment of Young Adults with Hemiplegic Cerebral Palsy

We assessed 12 young adults with hemiplegic cerebral palsy, aged from 14 to 33 years, by intellectual quotient (IQ) and magnetic resonance imaging (MRI), and obtained the following findings. First, the IQ scores were relatively lower than those predicted by their social activities. Second, there were two cases who seemed to have right or bilateral hemisphere representatives of language; their IQ scores were within normal range, while MRI demonstrated extensive brain damages including usual ones in language areas. Third, IQ scores and MRI findings were correlated to some extent; however, a case of limited brain damage on MRI had low IQ score, while five cases of brain damage located excluding their language areas had normal or high IQ scores. The results of the present study indicate the necessity of follow-up MRI for prospective observation of the brain damage acquired at or around birth