失調を呈した症例に対する誘導介助方法によるADL訓練

Guidance and assistance of ADL exercise for a case with severe ataxia

要旨：今回，失調が強く一定した動作が行えない症例に対し，よりよい動作肢位を覚えさせ，正しい動作肢位で動作を行えるように，動作の確実性を向上させる誘導介助方法と仮称した訓練を実験的に行った．訓練開始1ヵ月では，誘導介助にて正しい動作の型・軌跡・速さの反復訓練を行った．また，目的動作の前段階の動作(目的動作を安定に行うための準備的動作)や，基礎となる動作の順序性・確実性を重点的に訓練した．この際，右上肢の動きをOTRが肩・肘・手関節を保持して，全介助で目的物まで誘導し，距離感や運動・動作を学習させた．左上肢には，様々な形の物を把持させた際に手背より握りを介助し，把持の仕方を再学習させた．また，起居・移乗に関しては，各工程毎に動作を区切り行った．これらの方法により，ADLは全介助から監視となり，食事・排泄は自立した．

　This paper reports the method of ADL exercise for a case with severe ataxia.

　Guidance and assistance were important to acquire safe movement of ADL for this case, and it was achieved through the repeated exercise of correct motion form, motion tracing, and its speed.

　Our goals were to make it possible for the case to take a meal by herself with her right hand and excrete with a portable toilet on her own.

　To achieve these goals, we made her learn the distance by tracing right upper extremity motion with complete guidance and assistance.

　Also, we made her left hand learn to grasp various articles with assistance.

　Then, execrcise of basic movement was done, each part of the process being separated. Finally, the case became capable of having a meal and excreting independently, and she returned home with minimal assistance for ADL.