遂行機能障害を示した右被殻損傷例への作業療法

An occupational therapy for a patient who showed disturbance of executive function after right putaminal hemorrhage

要旨：右被殻出血により，目的や状況に適した動作の手順に障害を示し，日常生活上もそれに起因する様々な問題行動を呈した症例を経験した．皮質下の障害である本症例の症状発現には，被殻と皮質問の線維連絡や，被殻自体の性質の関与が推察された．作業療法では話し合いによる障害理解の援助や，日常生活訓練，手工芸を利用した手順遂行や自己抑制の学習を行った．その結果，障害の理解や，病院内での日常生活活動の技能的側面の効果をもたらした．しかし，環境が変わるなどの状況の変化には対応できず，決まりきった手順の中での行動学習にとどまったため，新規な環境下での行動に対する治療的な関わりを模索する必要性が考えられた．

　We reported a case of a 52-year-old male with peculiar apraxia due to a right putaminal hemorrhage. He failed in the plan of the performance that was adaptable to the purpose and the situation, and he didn't notice his symptoms. For example, when he intended to transfer from a wheel chair to a stool, he ran around the wheel chair. We speculated that the executive disorder of the present case was produced by the dysfunction of interactions with the cortex and/or the putamen.

　We supported, through communication with the patient, his efforts to notice his symptoms during sequenced ADL training and a craft activity.

　As a result, the patient comprehended his disability and became able to perform ADL appropriate for the purpose and the situation in hospital. The problem with the patient at present: he failed with regard to suitable planning in a new situation. There is a need for us to grope for intervention with the patient so he can act in a new environment.