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Japanese Occupational Therapy Research Volume 23, Issue 2 （April 2004）

作業療法 23巻2号（2004年4月発行）

Japanese English

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◆研究と報告

体幹正中矢状面より左側で無視を呈した症例における行動観察と机上検査との関連について Correlation between daily behavior and a paper-pencil task of a patient with body-centered left neglect : A case report 太田久晶 ¹ , 藤井俊勝 ² , 川端早苗 ³ , 阿部順 ³ , 山鳥重 ² Hisaaki Ota ¹ , Toshikatsu Fujii ² , Sanae Kawabata ³ , Jun Abe ³ , Atsushi Yamadori ² ¹医療法人医仁会中村記念病院 ²東北大学大学院医学系研究科高次機能障害学分野 ³医療法人医徳会介護老人保健施設さつき苑 ¹Nakamura Memorial Hospital ²Division of Neuropsychology, Department of Disability Medicine, Tohoku University Graduate School of Medicine ³Geriatric Health and Care Service Facility Satsuki-En キーワード：左半側空間無視 , USN , 行動観察 , 検査 , Left unilateralspatial neglect , USN , Observation , Task Keyword: 左半側空間無視 , USN , 行動観察 , 検査 , Left unilateralspatial neglect , USN , Observation , Task pp.99-105

発行日 2004年4月15日 Published Date 2004/4/15

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要旨：左無視を呈した一症例を対象に，行動観察と図形識別課題を用いた評価を行い，それらの結果の関連を検討した．行動観察の結果から左無視を認めたが改善したもの，左無視を認め改善しなかったもの，観察当初から左無視を認めないものに分類できた．図形識別課題の結果から，本症例は体幹正中より左側にある対象の無視（body-centered left neglect；BCLN）を呈していたことが明らかとなり，さらに経過とともに症状の軽減を認めた．以上の結果より，改善を認めた行動はBCLNに関連があると考えられた．改善を認めなかった行動と左無視を認めなかった行動に関しては，別の要素の関与が考えられた．

　According to the frame of reference theory, there are two different types of left unilateral spatial neglect (USN) : body-centered left neglect (BCLN) and stimulus-centered left neglect (SCLN). To differentiate these two types of neglect, we developed a figure discrimination task. Although there are some reports that discuss correlation between results from paper-pencil tasks and those from ADL evaluation for patients with left USN, no study reports the relationship between daily behavior and results of paper-pencil tasks in terms of BCLN and SCLN. We herein report relationships between results from an observation of daily life and those from the figure discrimination task in a patient with left USN.

　One patient was an 86-year-old woman, who developed right cerebral infarction. She showed left hemiparesis and disturbance of touch, manifesting in deep left-side sensations. She showed left USN on a line bisection task and a circle cancellation task.

　To evaluate whether she showed left USN in daily behavior, two occupational therapists and one physical therapist, who were in charge of her case, observed her daily activities. To assess whether she showed BCLN and/or SCLN, we used the figure discrimination task.

　The therapists gave her personal exercises twice or three times a week, including sitting without backrest, transfer, and standing. She also participated in a group exercise. Based on results obtained from the observation, we found three kinds of USN related behavior : one with left USN, which improved, one with left USN, which did not improve, and one without left USN. On the figure discrimination task, our patient showed only BCLN, which improved over time.

　These results suggested that the improved behavior was related to BCLN, but the other behaviors were less related to BCLN and were affected by other factors.