課題および状況により左半側空間無視行動に差異を呈した症例の作業療法

An occupational therapy for a patient who showed discrepant USN behaviors according to tasks and conditions

要旨：右後大脳動脈領域の梗塞により，検査課題および環境状況の相違によって左半側空間無視行動の出現に差異を呈した症例に作業療法を行った結果，検査上およびADL・APDL上の左半側空間無視が改善した．本症例の左半側空間無視の発現には，視覚過程の障害，つまり左視覚性消去現象が関与していると考えられ，本症例において機能的によく保たれていた視覚的記憶表象や心的表象マップを意識化する訓練を行うことにより，トップダウン型の代償行動が獲得され，左半側空間無視行動が改善したと考えられた．

　This article examines a patient with left unilateral spatial neglect after occlusion of right posterior cerebal artery.

　Characteristic of her neglect behavior : She showed discrepant results of the following neglect tests : copying of geometrical figure and picture, line bisection, line extension, line cancellation. She also showed discrepant neglect behaviors according to occasional conditions. These varied results were thought to be an interaction between two-fold mechanisms. She was good at applying visual representations and mental maps, but she showed conspicuous visual extinction. It was thought that she reorganizes the degraded visual sensory inputs by the spared visual representations.

　Treatment: Adjustment to strange environment by activating a representational map, and direct perceptual practices of double visual stimulation were applyed to her for 6 months.

　Outcomes: Her neglect behaviors were not found in ADL and activities parallel to daily living.

　Discussion: Perceptual level neglect was thought to be overcome by top down strategy of applying visual representation.