脳幹出血後に右片麻痺，運動失調を有する重度要介護者への訪問作業療法—動作方法の変更や環境調整により排泄動作が自立に至った1例

Home-visit occupational therapy for right hemiplegia and ataxia after brainstem hemorrhage: A case study of excretion movement leading to independence through changing the movement method and environmental adjustment

要旨：脳幹出血により右片麻痺，四肢と体幹に運動失調のある重度要介護者に対し，訪問作業療法を実施した．当初はADLにほぼ全介助を要したが，介入10ヵ月後，起居動作が自立し徐々にADLの改善が見られた．12ヵ月後，排泄動作を立ち上がって移乗する方法から座位横移動に変更し，17ヵ月後に通所リハビリテーション，20ヵ月後に安全のためポータブルトイレが動かないよう足部4点に滑り止め素材を貼るなどの環境調整をした．さらに訪問介護と連携し，22ヵ月後には排泄動作が自立した．訪問作業療法は重度要介護者の身体機能，ADL動作，生活環境を評価して多職種連携を行い，生活場面に直接介入し生活行為向上のため在宅生活を支援できることが示された．

　Visiting occupational therapy for persons with severe disabilities including right hemiplegia, and ataxia at the four limbs and the trunk by brainstem hemorrhage was investigated. Initially, almost 100% ADL was required. However, 10 months post-intervention saw improvements in independent ADL. After 12 months the excretion method was changed from standing to seated positions. Seventeen months later, outpatient rehabilitation was carried out, and 20 months later, portable toilet safety was improved by putting safeguard materials on four points of foot parts. Finally, 22 months later, elimination was performed independently. Results indicate that visiting occupational therapy is useful in evaluating physical function, ADL behavior, and living environments of persons requiring critical care. Also, performing multi-occupational collaboration, and directly supporting living situations improved living behavior.