四肢切断者へのADLおよび機能的アプローチ—電動車いすによるADL拡大と水中運動療法からの発展

Approaches for extending ADL and the impairments to a quadruple amputee: The development of ADL on a specific electric wheel chair and a new point of view by using hydrogymnastics

要旨：四肢極短断端切断者に対して，義肢を使用せずに日常生活動作の拡大を支援した．その結果，1．電動車いすの操作やベッドと車いす間の乗り移りなどの移動動作，2．歯磨き，整髪，髭剃りなど道具を固定したセルフケア，3．うがい，洗濯，喫煙などマウススティックによる日常生活関連動作が可能となった．しかし，症例が各種の活動が可能となるに従い必然的に固有の姿勢動作の傾向が強まり，肩こりなどの二次的な機能障害が生じた．これらの問題に対して，体幹や頸部筋のリラクゼーションおよび関節可動域の回復を目的に，プールでの運動やフィンを用いた水泳を行ったところ，症状の改善とともに水泳の楽しさを感じるなどの効果もみられた．

　Let us introduce one particular patient who is an amputee with four very short stumps. We tried to extend his ADL without any prosthesis. The approach finally made him succeed in the following :

　1. locomotion activity including driving a specific electric wheelchair and transfer between bed and the electric wheel chair.

　2. self-care with fixed devices, which were reformed by the occupational therapist, to brush his teeth, comb and shave.

　3. ADL using a mouth stick to smoke, wash and rinse his mouth.

　On the other hand, those new activities gave him stiff shoulders and back pain because he always performed them in the same position. We brought him to a swimming poor in order to mobilize and relax his neck and trunk. He was able to swim with a fin fixed on his waist and found it very fun to float on the water. And then the secondary impairments got better.