更衣に必要な手の操作—痙直型両麻痺児2症例を通して

Hand manipulation for dressing skills: Through occupational therapy for two children with spastic diplegia

要旨：リーチ範囲が限定し，手の操作も粗大な握り離しの状態にある痙直型両麻痺児2症例に対し，上着の着脱動作を改善させる目的で作業療法を実施した．上着の着脱を，頭部や上肢の身体通過部位を企図的に探り出す探索活動と考え，手の探索的操作の向上を作業療法では優先させた．企図に沿った手の探索的操作を連続させるために「ごっこ遊び」を利用し，両手動作の向上につなげた．2症例共，両手の操作性が改善すると共にリーチ範囲も拡大した．そしてTシャツ着脱動作時の手の操作も変化し，改善が認められた．探索活動としての更衣動作を手の探索的操作と関連づけながら考察し，手の操作性の意義を確認する．

　In the case of two children with spastic diplegia, with limited reach and gross motor hand function, we were able, with occupational therapy, to improve their dressing skills when putting on upper garments. We believe that, through this explorative activity, we can better understand upper-garment dressing skills and more effectively identify the various passage ways with regard to head, arms, and body scheme movements. In a warm up activity, we controlled their hands' explorative manipulation employing a scheme, making use of make-believe therapies, such as drama plays, in order to improve the hand action in both cases. As a result, hand-action manipulation was improved through this activity with regard to spread reach. Thus, in both cases, hand manipulation activities improved when putting on and taking off T-shirts, along with a variety of other actions, helping dressing skills, in general, to improve. In fact, we learned that, for us, explorative manipulation actually confirmed the very meaning of hands manipulation.