半側空間無視と全般性注意障害を有した事例の下衣着脱動作に対する応用行動分析学的アプローチの効果

Effects of a behavioral approach for lower-body dressing on cognitive dysfunction

要旨：左半側空間無視および全般性注意障害患者の下衣着脱動作に対する応用行動分析学的アプローチの効果について，シングルケースデザイン（AB法）を用いて検討した．ベースライン期（A）には，動作の中断や麻痺側操作の忘れのため，工程ごとに言語指示や介助が必要だった．介入期（B）には，14工程の下衣着脱動作に対して，先行刺激（3段階のプロンプト：間接的言語指示・直接的言語指示・身体的ガイド），強化刺激，ターゲット行動の設定を用いて応用行動分析学的アプローチを行った．先行刺激なしで遂行できた工程数を数え，2SDのband法を用いて検討した結果，動作は有意に改善した．先行刺激，強化刺激，ターゲット行動の設定により，課題を明確化し，適した行動を形成することができたと考えらえる．

　The purpose of this study was to evaluate the effectiveness of using a behavioral approach to teach a person with unilateral neglect (USN) and attention deficit disorder (ADD) to put on pants. A male in his forties with severe left-side motor paralysis who volunteered for the study had USN and ADD, and required lower-body dressing assistance due to overlooking his left-side and stopping his movement frequently. The A-B treatment single subject experimental design was used, which utilizes a behavioral approach consisting of prompting, positive reinforcement and goal planning. During the intervention phase (B), the patient received the behavioral approach in putting on pants which included 14 components. We gave him 3 prompts: indirect verbal instructions, direct verbal instructions and assistance. When he could perform each action of a given component, verbal reinforcement was provided. The goal was “to be able to put on pants by himself”. As a measurement, we counted components which he could achieve without any prompts. In order to assess differences between the A and B phases, a 2SD band method was used. During the baseline phase (A), he could achieve only 4-6 component actions by himself. During the intervention phase (B), he could achieve 9-11. The change in performance was significant, as three of the intervention scores were outside the 2SD band. The treatment produced improvement in his ability. Prompting, reinforcement and goal planning made the task clear to the subject, thus improving the ADL in cognitive dysfunction.