NAKAJIMA TOMOMI

先行研究では,脳血管疾患患者の清拭動作獲得の難易度は高いとの報告がある.今回,回復期リハビリテーション病棟に入院した脳出血重度右片麻痺患者に対して,作業療法士による機能訓練に加えて,家族に同意をいただいた上で家族参加型の自主訓練を導入した.その結果,退院時の洗体動作が監視に至った症例を経験した.セラピストが運動学,生理学的エビデンスを踏まえた機能訓練を積極的に進め,さらには患者教育,家族教育と職種間連携により十分な自主トレーニングが確保できたことが機能回復につながり,退院時の洗体動作の改善につながったのではないかと考える.(著者抄録)

ウェルウォークWW-1000(以下、ウェルウォーク)は脳卒中片麻痺患者の歩行練習支援を目的に開発されたロボットである。今回は体幹機能障害・pusher現象を呈した脳卒中片麻痺者に対して、通常の理学療法に加えてウェルウォークによる歩行練習を実施し、移乗動作の介助量軽減に至った症例を経験したため報告する。症例は左被殻出血により右片麻痺を呈した60代男性である。重度運動麻痺に加えて、体幹機能障害とpusher現象を認めた。移動動作はFunctional Independence Measure(以下、FIM)1点で、2人介助を要した。ウェルウォークによる介入期間は10週間。ウェルウォークによる歩行練習開始後より体幹機能の向上やpusher現象の軽減を認めた。また移乗動作はFIM3点と介助量の軽減を認めた。ウェルウォークによる歩行練習はアシスト機能を用いることで低歩行能力の状態から一定の練習量が確保できたことにより、体幹機能の向上やpusher現象の軽減に寄与したと考える。ウェルウォークによる歩行練習は移乗動作の介助量軽減に対して有効な練習方法となる可能性が示唆された。(著者抄録)

Original ArticlesFor the purpose of exploratively identifying the process of learning in clinical practicum, written reflections from post-fieldwork students were analyzed. The results confirmed that students became able to self-reflect, and became able to recognize the necessity of not only basic knowledge acquisition but also the type of thinking that seeks evidence as well as analytical thinking for problem solving. These kinds of thinking are considered as expert level in the Dreyfus model. Educators' involvement in development of reflection sheets may have partly contributed to the fact that the students, who were at novice level, became able to recognize thinking at expert level. Additionally, it was found that those students, who feel communication is a challenging task, considered doing things in order of priority is also challenging. As it is difficult to learn to act in order of priority during clinical practicum, it was also suggested that on-campus instruction prior to commencing the practicum is important.

Original Articles

作業療法の臨床において、直接刺激法は注意機能を直接的に改善することで、学習すべき活動や作業、誤りのない活動の遂行と学習を促進する役割があることを明らかにできた。また、open taskの即時効果が認められたことから、リハビリテーションへの応用として、open taskを用いて、注意機能の促通を図ったうえで、その汎化効果を用い、様々な作業を学習するような手法により効果が期待できるのではないかといった、注意障害のリハビリテーションの手法について提言できる可能性が示唆された。（博士論文）

Original ArticlesThe present exploratory study was aimed to examine the relationship between the results of the trail-making test (TMT), a common test to assess attentional function, and the behavioral characteristics in people with attentional deficits in daily life. A search of documents for a thirteen-year period, between 1999 and 2012, was conducted in May 2013, using Ichushi-Web, an Internet search service containing information on Japanese medical papers, with the keywords : "occupational therapy" and "attention deficits". There were 31 papers written by occupational therapists, and 17 which adopted the TMT for assessment were selected. Observation records of the behaviors of 34 subjects and TMT assessment results were extracted from the 17 papers. The observation records were analyzed using text-mining, and the analysis results were compared with those of TMT assessment. The TMT assessment results were classified into four levels, and the characteristics of the behaviors at each level were identified.

Original ArticlesIn the study, we examined exercise tasks in stimulation therapy, which is one of methods used in rehabilitation for attention difficulties. As a method known to directly stimulate the brain region involved in attentional function by repeated practice, the stimulation therapy is aimed at restoring the attentional function itself. We examined, using functional near infrared spectroscopy, whether the brain region involved in attentional function is activated by repeated practice of the PC character input exercise, which is currently used in stimulation therapy. We also considered whether any difference arises in the activation of the brain depending on learning methods.As a result, a possibility has been suggested that the activity of the brain region associated with attentional function is reduced as the learning progresses regardless of the learning methods.

作業環境に変化のある客体操作（open task）の学習を，誤りなし学習errorless learning（以下EL）と誤りありの学習errorful learnin（以下EF）で行い，注意機能関連脳領域の活動の差異を検討した．健常成人に，描画課題におけるペンタッチ入力操作（非利き手）を学習させ，遂行時の前頭葉の脳血流動態を，機能的近赤外線分光法にて測定し比較した．その結果，EF群で左前頭極と左背外側前頭前野の脳血流内の酸素化ヘモグロビンの濃度が有意に上昇した．本研究の結果，open taskのEFは，注意機能関連脳領域を賦活する可能があることが示唆された．（修士論文）