意味のある作業の共有により孤独感の軽減，希望感を強めた生活期重度脳卒中者の一症例—iPadを用いた家族とのコミュニケーション手段の獲得

A case of severe chronic stroke with a reduction in loneliness and strengthened hope through sharing meaningful occupations: Communication with a family using an iPad

要旨：重度片麻痺，重度構音障害を呈した症例に対して，症例の希望に沿った生活の実現を目指して，作業療法においてコミュニケーション手段の獲得を図った．パソコンを用いた後に，iPadを導入した．そして，症例と「自宅へ外出し，家族との時間を共有する」という共有の目標を設定した．多職種と連携を図り，症例は自宅へ外出することができた．症例はiPadを使用することで，家族とコミュニケーションをとることが可能となり，孤独感や希望，表情に変化を認めた．重度生活期脳卒中者において，症例と目標を共有した作業療法は，心理面に対して変化を促す可能性が示唆された．

　In cases presenting severe hemiplegia and dysarthria, efforts were made in occupational therapy to improve communication skills to realize the patient's desired lifestyle. First, we introduced communication methods using a personal computer, and later we introduced iPads. Subsequently, the patient and an occupational therapist set goals, such as going out from the hospital and spending time with family. Through an interprofessional approach, hospital discharge was accomplished. Furthermore, the use of the iPad enabled communication with the family, resulting in a reduction in loneliness assessed by the Japanese version of the University of California, Los Angeles Loneliness Scale Version 3, an increase in hope assessed by the Japanese version of Herth Hope Index, and changes in facial expressions. These findings suggest that occupational therapy involving sharing cases and goals has potential for inducing changes in psychological aspects for individuals with severe post-stroke disability.