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

Risk Factors for Fracture in Adult Patients with Cerebral Palsy

Most studies on risk factors for fracture in patients with cerebral palsy have been conducted in children. We examined the relationships between age, body mass, gender, osteoporosis, osteomalacia and mobility level with history of a previous fracture in adult patients with cerebral palsy. We studied 124 institutionalized adults (52 men, age: 21-56 years, and 72 women, age: 24-47 years) with cerebral palsy. Antero-posterior radiographs of the pelvis were examined for osteoporosis and graded using the Singh index. Serum calcium, phosphate and alkaline phosphatase were measured. Osteoporosis was defined as grade 1-4 in Singh index. Osteomalacia was defined as calcium 220 U/l. Body mass index (BMI) was calculated from body height and weight. Medical records were examined for history of previous fractures and mobility levels (ambulatory /nonambulatory). A history of previous fracture was noted in 17 patients (6 men and 11 women). The proportion of osteoporosis in non-ambulatory patients was higher than in ambulatory patients. Multiple logistic regression analysis showed that presence of osteoporosis and mobility level (ambulation) were two factors that significantly correlated with a history of fracture. The latter did not correlate with age, BMI, gender and osteomalacia. Our findings suggest that osteoporosis is an important risk factor for fracture in adults with cerebral palsy. Since falling is also a risk factor for certain fractures, fractures seem to be more likely to occur in ambulatory patients through falling despite the low prevalence of osteoporosis

ブラゼルトン新生児行動評価の方位反応から見た低出生体重児の新生児行動

LBW児の新生児行動を正常出生児を基準としてみることは母親の不安を増大させる可能性がある．LBW児にはLBW児の新生児行動の特性があると考え，新生児行動評価（NBAS）を用いて検討した．103例のLBW児に対し，のべ316回のNBASを行った．NBASの評価項目の中から方位反応に関する6項目を抽出し，1）評価時期による相違，2）刺激する感覚による相違，3）刺激の質（生命刺激か非生命刺激か）の相違について統計処理を行った．結果として，1）換算45週以降群は各項目の得点が有意に高かった，2）視覚と聴覚の組み合わせによる刺激への反応が高かった，3）視覚および聴覚への単独刺激において生命刺激への反応が高かった．Mothers of low birthweight (LBW) infants often grow anxious as they compair the neonatal behavior of their infants with normal neonatal behavior. In this study, LBW infants were assessed concerning knowledge of a characteristic of neonatal behavior by using Brazelton\u27s Neonatal Behavioral Assessment Scale (NBAS). The assessment was carried out a total of 316 times on 103 LBW infants. Six NBAS orientation items were chosen and were statistically analyzed by 1) difference in age at assessment (measured in terms of gestation), 2) difference in type of sensory stimulation, and 3) difference between inanimate and animate stimulation. Results were that: 1) the group aged at 45 weeks scored significantly higher on every item, 2) combination of visual and auditory stimulation evoked better reaction than other methods, 3) animate stimulation was better than inanimate stimulation in generating infant reaction to both visual and auditory stimulation

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

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's 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