ターミナル期の作業療法の一例

Occupational Therapy for a Terminal Stage Malignant Tumor Patient

要旨：重度四肢麻痺，人工呼吸器装着の19歳男子の夕一ミナル期にOTを施行した．患者は悪性脊髄腫瘍により急速に四肢麻痺・呼吸筋麻痺に陥り，気管切開と人工呼吸器装着が必要となった．疾患を告知されていないこと，コミュニケーションが取れない事，強固な疼痛があることなどにより高度の不眠を伴う精神的不安定状態を呈していた．OTは本症例に対しコミュニケーションエイドの工夫，本人および家族への心理的援助を行い，その結果，障害を理解し，精神的安定を得ることができ，著しくQOLの向上が見られた．本症例のOT治療経過を紹介し，夕ーミナル期におけるOTの目的とアプローチについて考察した．

　We experienced the successful application of OT for a patient with tetraplegia in the terminal phase. This patient, a nineteen year-old boy, became tetraplegic and could not survive without artificial respiration, due to a malignant spinal cord tumor. Unawareness of his disease being malignant, incapability of having communication, and intractable pain caused him to be psychologically unstable with severe insomnia. We produced an original device to use a communication aid, supported him and his family psychologically, and intensively controlled the pain. These procedures helped him to gain a better QOL and to be in a more stable mental condition, in particular. We described the details of the therapy, and estimated the successful factors of this case.