脳卒中後右片麻痺者への13年間の作業療法―就労を支えた上肢の機能回復・維持および自己管理への治療的援助─

13-year occupational therapy practice for right hemiplegia after stroke: Therapeutic intervention for recovery and preservation of upper extremity function and self-management for occupational support

要旨：脳梗塞により右上肢に重度な麻痺のある症例に対して発症初期より日常生活活動，職場復帰への援助，麻痺側上肢の機能回復を目的に作業療法を実施した．職場復帰し，麻痺側上肢機能回復への援助を外来にて行った．手指の痙縮が強かったために回復は遅れたが，長期にわたり改善がみられ廃用手から実用手になった．機能回復により獲得した機能は積極的に使用され，仕事やADLにて両手を同等に使用できるようになった．経過中には仕事上のニードが高く，過度な使用による肩痛・頚部痛が出現し対応する必要があった．麻痺手を積極的に使う例については，回復した機能の維持のため定期的な状態の確認と，麻痺手の使い方への援助が必要であると考えられた．

　Occupational therapy was carried out to support to activities of daily living (ADL), return to full-time employment, and improve upper limb function on the paralyzed side in cases of severe right upper limb hemiparesis due to acute stroke. Exercise to recover upper limb function on the paralyzed side was conducted for outpatients during the transition to reinstatement. In the long term, the upper limb function improved to practical activity level from useless level, although recovery was delayed due to severe digit spasticity. Function, gained by recovery of mobility, was positively utilized so that both hands could be used both for work and ADL equally. Furthermore, patients relied heavily on hands for work, resulting in frequent shoulder and neck pain.

　Periodic monitoring and support of hand use are indispensable to maintain recovered function in cases of upper limb paralysis.