筋電義手導入前の装飾用義手が乳児に与える影響について—生後4ヵ月の先天性前腕欠損児への装飾用義手の装着指導経験から

The influence of wearing an ornamental prosthetic hand before wearing a myoelectric prosthetic hand on infants: Instructing a passive prosthetic hand for a 4-month-old infant with congenital forearm deficiency

要旨：片側前腕欠損児への筋電義手の装着では，乳児の段階で義手を用いた身体図式を促すために，装飾用義手が導入される．今回，生後4ヵ月の左前腕欠損児へ発達に合わせた装飾用義手を作製して装着し，歩行を獲得した生後14ヵ月まで，発育状況に合わせた欠損肢の使用を促した．また，母親からの聞き取りや動画記録，リモートを活用した支援にて，発達に伴う義手の使用状況を確認した．その結果，歩行獲得までに義手を活用した両手動作での認知・運動発達が促され，自発的に義手を使用する場面が観察された．重量のある筋電義手の装着には，基礎的な身体・認知機能への働きかけとして，乳児からの発達段階に応じた義手の導入は有効であった．

　In the fitting of myoelectric prostheses for children with unilateral forearm deficiency, a decorative prosthetic hand is recommended at the infant stage. The aim is to become familiar with prothetics and to encourage body diagramming with a prosthetic hand. We fabricated a developmentally appropriate decorative prosthetic hand for a four-month-old child with a left forearm defect. Thereafter, the child was encouraged to use the prosthetic hand according to his development until 14 months of age, when he began to walk. The use of the prosthetic hand at home was confirmed by interviewing the mother, checking her video recordings and using telerehabilitation. As a result, we confirmed his voluntary use of the prosthetic hand at home. Bimanual movements utilizing the prosthetic hand facilitated the child's cognitive and motor development. Considering the fitting of myoelectric prosthetic hands, it is necessary to work on basic physical and cognitive functions. Therefore, fitting a prosthetic hand according to the developmental stage from infancy is effective.