脳卒中を呈したクライエントに対するCognitive Oriented to daily Occupational Performance（CO-OP）を基盤とした訪問作業療法実践

Home-visit occupational therapy based on the Cognitive Orientation to daily Occupational Performance (CO-OP) approach to improving participation after stroke

要旨：脳卒中を呈したクライエントに対して，Cognitive Oriented to daily Occupational Performance（CO-OP）を基盤とした訪問作業療法を実施した．この実践では，自身の目標であった調理などの作業を，問題が生じない方法を自ら考えながら練習することで，それらの技能も獲得できた．この経験を牡蠣養殖の仕事といった他の作業へ応用することにより，その技能を獲得することができた．在宅における自立支援を考えた際に，自ら問題に気づき対処する方策を獲得することは非常に重要であり，本実践の有用性が示唆された．加えて，一連の技能獲得に麻痺手を有効活用するなどの計画を立てたことで，麻痺側の上肢使用頻度が向上し機能も回復した．

　Home-visit occupational therapy based on the cognitive orientation to daily occupational performance (CO-OP) approach was provided to a stroke patient who was able to acquire the skills to cook, which was the client's goal, by practicing a trouble-free method devised by the patient. Furthermore, by applying this approach to other tasks such as oyster aqua-culture, the client was able to acquire these skills. Considering the level of self-reliance at home, it is very important to allow the client to realize his/her own problems and acquire measures to cope with them. Thus, we suggest this practice is useful. In addition, the client used the paralyzed hand effectively to acquire a series of skills, which increased the frequency and function of the paralyzed upper extremity.