C1高位頸髄損傷患者に対する作業療法の経験—ベッドサイドから自宅退院までのかかわり

Experience of occupational therapy for a patient with C1 high quadriplegia: A case report

要旨：人工呼吸管理下のC1高位頸髄損傷例に対し，急性期から自宅退院までの作業療法(OT)経過について報告した．入院期間を3期に分けて，全身状態，OTアプローチ，他職種との関連，心理面について検討した．OTでは全身状態，心理状態に合わせてコミュニケーション訓練を中心に進めた．その結果，症例はマウススティックを用いた実用的なコミュニケーション手段の獲得に至った．実用的なコミュニケーションの獲得が障害受容を進め，症例は自己表現，自己決定が可能となり，自宅退院に向けてスムーズな取り組みが可能であった．

　In this paper, we present an interesting case of the patient with C1 high quadriplegia breathing through a respirator. The purpose of this study was to consider the rule of occupational therapy for patients between the acute phase and living at home. The pcocess of the occupational therapy was divided into three periods considering general condition: occupational therapy approach, the relation to another section, and a state of psychological condition. As a result, the occupational therapy helped with patient training communication in each period. And he could be attentive in the practical communication aid used with the mouth stick. This is probably due a clear grasp of his general condition and his mental condition. The patient could decide what he should do next, and he could discharge smoothly. We feel further consideration is required with regard to economical aspects of living at home.