両上肢機能全廃を呈したCIDP患者の食事動作自立に向けたOTアプローチ

Occupational therapy for independent eating in a chronic inflammatory demyelinating polyneuropathy patient with upper limb dysfunction

要旨：慢性炎症性脱髄性多発神経炎のために，両上肢が機能全廃状態となり食事動作が全介助になった事例に対して，在宅での食事動作自立を目標にOTアプローチを行った．対象者の体幹および下肢の残存機能を使って，ポータブルスプリングバランサーの操作を行い，肘関節屈曲動作の補助としてイレクターを導入し，同時にケンジースプーンや，すくいやすい皿などの食事用自助具を活用することで，食物の把持や口への運搬が可能となった．さらに，ポータブルスプリングバランサーのセッティングの再現性や装着の簡略化を図るために，バランサー用カフに自作の前腕手関節保持装具などを付加することで，在宅での食事動作が自立した．

　We provided occupational therapy interventions to a patient with chronic inflammatory demyelinating polyneuropathy (CIDP) who needed full assistance in eating due to complete dysfunction of both upper limbs. The therapeutic goal was mealtime independence at home. The intervention included incorporating supportive devices such as a portable spring balancer, which assists use of the remaining ability of the trunk and lower limbs, erector pipes and joints that support flexion of the elbow joint, and assistive eating devices namely the Kenji spoon and a specialized dish, which increase accessibility to food. In addition, we proposed an easier resetting-and-detachment of the portable spring balancer by applying a handmade wrist immobilizer to the balancer's cuffs that resulted in the achievement of independent eating at home by the patient.