Webによる中間型アウトリーチに視覚障害生活訓練等指導者（歩行訓練士）の介入が奏効した2例

Visual rehabilitation through intermediate outreach with an orientation and mobility specialist

要約　目的：視覚障害者にとって視覚障害生活訓練等指導者（歩行訓練士）の果たす役割は大きいものの，地域偏在が問題になっている。山形県も歩行訓練士が近距離に不在である。今回，患者の来院日に遠方の歩行訓練士とweb会議システムを用いて連携し中間型アウトリーチによる遠隔視覚リハビリテーション（視覚リハ）を行った2例の経験を得たため報告する。

症例：症例1は80代，女性。両眼の緑内障と網脈絡膜萎縮，さらに左眼には硝子体黄斑牽引症候群を伴い視覚障害4級であった。独居生活の継続に困難を感じ高齢者施設への入所を検討するも，一般的な高齢者施設での視覚障害者対応に不安を感じていたため相談に至った。症例2は70代，女性。両眼の網膜色素変性症で視覚障害1級であった。デイサービス利用時の疎外感や介護施設とのかかわりについて相談があった。

結果：症例1では，一般の高齢者施設への転居時に，当院の医療スタッフおよび医師から視覚障害者への対応について留意点を伝えることが提案された。症例2では，同居家族からケアマネジャーに相談することになった。

結論：両症例とも相談後に視覚障害者の言動が前向きに変化し，特に症例2では本人も同居家族も表情が和らぐ様子が観察された。歩行訓練士への相談方法として，web会議システムを用いた遠隔視覚リハが有効であることが示唆された。

Abstract　Purpose：We report our experience with two cases of visual impairments（VI）, which were consulted with an orientation and mobility（O&M） specialist through an online meeting as an intermediate outreach approach, because there were no O&M specialists were available in close proximity to our prefecture.

Cases：Case 1 involved a woman in her 80s with bilateral glaucoma and chorioretinal atrophy, in addition to vitreomacular traction syndrome in the left eye, who was certified as having a Grade 4 visual impairment. She experienced difficulty in continuing to live alone and was considering admission to a residential care facility for older adults. Meanwhile, she was anxious about whether general elderly care facilities would provide adequate supports for individuals with visual impairments. Case 2 involved a woman in her 70s with bilateral retinitis pigmentosa and Grade 1 visual impairment. She consulted us regarding feelings of isolation while using day-care services in care facilities.

Results：In Case 1, following web-based consultation, it was planned that the medical staff in our hospital would communicate with the person in an elderly care facility under consideration for admission. In Case 2, it was decided that a cohabiting family member would consult the care manager regarding the issues identified at the facility.

Conclusion：In both cases, especially in Case 2, the behavior and attitudes of the visually impaired individuals became more positive after the consultations. These cases suggest that consultations with O&M specialists through a web-based conference system is effective as an intermediate outreach model.