単一システムデザインによる半側視空間失認患者に対する知覚—運動アプローチの効果

An Effectiveness Study of a Perceptural-Motor Approach for a Patient with Unilateral Spatial Agnosia Using a Single System Design

要旨：脳梗塞により，左麻痺と半側視空間失認症状を持つ73歳の男性患者に対して，独立変数としての機能的アプローチと風船バレーボールという知覚—運動的アプーローチには効果に差がみられるかどうかを検討するために，単一システムデザインのA-B-A法を用いた．従属変数にはAlbertの線分抹消テストの左側の抹消数を用いた．A期は7週間，B期は8週間，次のA期は7週間であった．その結果，視覚的にA-B-A間に変化があるかどうかの判定は困難であった．A，B期の自己相関係数が有意でなかったため，F検定を実施した結果，A-B-A間には有意差が認められた．さらに，異相間変化比率，±2標準偏差帯法，加減速線法によるスロープとレベルの変化などを検討した結果，レベルの変化を除いて有意な変動が認められた．このことから，風船バレーという知覚—運動的アプローチは有効であることが認められた．

　The A-B-A method of a single system design was employed to evaluate the effectiveness of perceptual-motor treatment for a patient with an unilateral spatial agnosia after a cerebral vascular accident. A balloon versus functional approach was selected as the independent variable. As the dependent variable, the numbers of the lines cancelled was chosen as measured by the Albert's Line Cancellation Test. For this patient, seven weeks were assigned for A phase, eight weeks for B phase, and another seven weeks for the last A phase.

　From the graphed data, it was difficult to judge any significant change between A and B phases through visual inspection. Since the auto-corelation coefficients of A and B phases were not significant, an analysis of variance and t tests were applied in order to determine the significant differences among mean scores in all phases. The results revealed significant differences between these conditions. A mean shift, ±2 standard deviation band method, shift of slope and level by celeration line method or the split-middle procedure were applied to determine if any significant differences were evident among the A, B and C phases. Except for the shift of level by the celeration line method, all other statistical tests showed significant differences between the phases. Thus, the results of this study support the effectiveness of a perceptual-motor treatment approach for unilateral spatial agnosia patients in occupational therapy.