半側空間無視患者に対する段階的な視覚性注意練習と車椅子駆動スキル練習の試み

Exercises in gradual visual attention and wheelchair driving skill for patients with unilateral spatial neglect: A case report

要旨：右半球広範の病巣で，重度の麻痺と半側空間無視（以下，USN）を呈する患者は，車椅子駆動の自立を必要とされるが，獲得困難なことが少なくない．筆者らは，左方向の探索課題・文字読み課題，および右左転換課題で構成した「視覚性注意練習（以下，VAE）」とUSN症状を考慮して課題を設定した「車椅子駆動スキル練習（以下，WDSE）」を考案した．2つの練習は別々のタイミングで導入し，各々が最後の課題まで確実に行えるようになった時点で2つの練習を組み合わせた結果，車椅子駆動が自立に至った症例を経験した．このVAEとWDSEの段階的プログラム内容と重度USNの典型例と言える本症例の作業療法経過を報告する．

　Stroke patients who develop severe hemiplegia and unilateral spatial neglect (USN) due to extensive right hemisphere damage need to be able to safely operate a wheelchair by themselves. However, this can be difficult. In this report, we devised “visual attention exercises (VAE)”, which were composed of leftward search tasks, reading tasks, and right-left alternating tasks, and “wheelchair driving skill exercises (WDSE)”, which were specifically designed for patients with USN. The two sets of exercises were initially performed separately, but were subsequently combined after the subject was able to complete each exercise. As a result, a patient with severe USN was able to safely operate a wheelchair independently. We describe the use of these gradual VAE and WDSE programs and occupational therapy progress in a typical case of severe USN.