ゲルストマン症候群を心的イメージの操作障害と捉えた作業療法

Occupational therapy for a patient with Gerstmann syndrome as a deficit of mental imagery manipulation

要旨：ゲルストマン症候群を呈した73歳の男性に，2ヵ月間作業療法アプローチを行った．症例は4徴候の他に構成障害があり，道具の操作や更衣動作に時間がかかった．特徴は，対象物との向きを合わせるなど空間内での操作と位置付けの障害であった．この症例の中核症状を心的イメージの操作障害と捉え，道具の操作に段階付けた作業療法アプローチを行った．患者にとって必要度の高い箸や操作が単純なはさみなどは実用的となったが，爪切りやボタンはめ，ネクタイなどは操作が複雑で介助が必要であった．道具の選択には使用頻度が高く慣れたものであること，段階付けた取り組みが重要と思われた．

　This study reports on the 2-month occupational therapy of a 73-year-old man with Gerstmann syndrome. He has been unable to manipulate tools, chopsticks, scissors, nail scissors, and so on. In addition, the Gerstmann syndrome is manifested through finger anomia, right-left disorientation, dysgraphia and dyscalculia.

　His dyscrasic characteristics included difficulty operating and positioning objects in space.

　We regarded his symptoms as a disorder of mental imagery, and performed a step-by-step method of occupational therapy that assisted the subject's operation of tools. As a result, he showed improvement in manipulation of the chopsticks and the scissors, since they were tools of a high degree of need for him. However, he still required assistance in using nail scissors, buttons and a necktie. These results suggest that it is important to choose high frequency tools with real-world applications, and intervene using a step-by-step method.