反応の乏しい重症心身障害者のコミュニケーションを促すための作業療法的働きかけに関する分析とその考察

Identification and analysis of intervention behaviors used in facilitating communication of cerebral palsied adults with severe handicaps

要旨：コミュニケーションを促すことは，反応が乏しい重症心身障害者(以下，重心者)の作業療法における重要な目的の一つである．今回我々は，重心者4名に対する事例研究を行い，これまでコミュニケーションを促すために無意識的に行ってきた働きかけの内容を言語化し，かつカテゴリー化することを試みた．またそれらの働きかけがどのような反応を引き出しているかを検討した．その結果，4事例に対しカテゴリーにして89種(大カテゴリー，13種)の働きかけを展開していたことがわかった．また反応が乏しい重心者であっても働きかけには相応の反応を表すこと，中立的な働きかけには反応が乏しいこと，更には反応に種々の個性があることが明らかになった．

　One important issue in occupational therapy is facilitation of communication in severely handicapped adults with cerebral palsy, especially those who have become very passive in everyday life. For this study, we examined occupational therapy interventions spontaneously provided to facilitate communication in four severely handicapped subjects and operationally defined those interventions and categorized them. In addition, we researched for relations between operationally defined interventions and subjects' responses.

　Eighty-nine forms of intervention were identified and subsumed into 13 categories. By means of this categorization, stimulus-response relations were discovered in situations that had previously been regarded simply as poor responsiveness. Lack of intervention was shown to be asociated with lack of responsiveness on the part of the subjects. In some instances, lack of responsiveness was interpretable as disappearance of formerly expected discomfort. Intersubject variations were also noteworthy.