身体障害者更生相談所において補装具処方を受けた者のADL分析

Analysis of ADL in using Assistive Devices Users at a Rehabilitation Counseling Center for Persons with Disabilities

要旨：当センターにおいて過去1年間に行われた7種目の補装具直接判定について，申請者393人の機能的自立度評価法（FIM）を用いた日常生活活動（ADL）評価値と処方内容との関連を調べ，更生相談所において補装具処方を受けた者のADL分析を行った．因子間の解析により，補装具処方の際のいくつかのADLパターンが明らかとなった．義手と義足ではADL全般が良好であった．重度障害者用意思伝達装置では表出を除く認知評点のみが良好であるという固有のパターンを示した．下肢装具では運動面と認知面のADL組合せによるいくつかのパターンを示した．座位保持装置・車いす・電動車いすでは3つが重複した群分けがなされ，移動手段として積極的に使用される群，身辺動作や認知評点が低い中での使用，ほかのパターンが見られた．ADLから見たいくつかの処方根拠が明らかとなり，補装具適応を判断する際の1つの目安になるものと考えられた．

Abstract : At this Center, we directly interviewed 393 applicants for prostheses, orthotics, or other assistive devices in the last year and assessed their activities of daily living (ADL) using the functional independence measure (FIM). By investigating the relationship between the FIM scores and the prescription of prostheses, orthotics, or other assistive devices, we analyzed ADL in persons prescribed for assistive devices at a rehabilitation counseling center for persons with disabilities. This analysis revealed that there were some ADL patterns on the occasion of preparing medical writings and prescriptions. The FIM scores were totally good with upper or lower limb prostheses. In the case of computer based communication systems, there appeared a specific pattern wherein cognitive ratings except ”expression” were good. Some patterns in ADL covering a combination of physical aspects and cognitive ones were found with the lower limb prostheses. ADL patterns were found to be overlapping among seating systems, wheelchairs and powered wheelchairs. Some patterns were seen in active usage for locomotion, some in usage with low physical and cognitive aspects, and others in different usages. From the viewpoint of ADL, some prescription grounds became clear, and it was shown that these grounds could be one of the guidelines used for the indication of assistive devices.