ADLが自立している在宅脳卒中後遺症者の自信と参加の関係の検討

Examining the relationship between self-esteem and participation among CVA patients at an independent level of ADL

要旨：ADLが自立している在宅脳卒中後遺症者（以下，脳卒中者）の参加と自信の関係を検討することを目的に，参加状況と自己効力感および有能感について健常者を対照群として調査し関係を分析した。その結果，脳卒中者は発症前より自己効力感が低下していること，また約3割に社会的参加の機会がなく社会的参加のない者は自己効力感と有能感の低下が認められ，さらに作業に対する価値も低い傾向にあった．このことから，社会的参加のない脳卒中者の作業行動は消極的で自信低下により諦めが生じ，満足度の固定化や興味の狭小化など悪循環となっていると考えられた．そのため参加を促す脳卒中者への支援として自信への働きかけの必要性が示唆された．

　This study is aimed at examining the relationship between participation and self-esteem among patients who suffered Cardio Vascular Accidents (CVA), and whose Activities in Daily Living (ADL) were at an independent level. Data on participation and self-esteem was gathered and analyzed from people with and without disabilities due to CVA. As a result, three discoveries were made: (1) selfefficacy scores from the people with CVA declined after strokes, (2) 30 % of the people with CVA lacked opportunities for social participation, and they indicated lower self-efficacy, competence and lower regard for daily activities and (3) intervention based merely on improvements of function and ADL didn't promote social participation. It was suggested that the clients who lacked social participation had experienced vicious cycles of lower self-esteem and passivity toward occupational behavior. Therefore, occupational therapy interventions that addressed volitional factors from an early stage were essential for CVA clients' participation.