重度半側空間無視患者に対するnumberingとcountingを利用した食事動作自立を目指した介入

Therapeutic approaches using numbering and counting to improve feeding in a patient with severe unilateral spatial neglect

要旨：半側空間無視が食事動作自立の妨げとなっている症例に対し，数を数えながら番号をふる介入(numbering)，器の数を数える介入(counting)を導入し，10週間の訓練を実施した．Numberingは，介入初期から抹消試験の短期的改善をもたらし，最終的にnumberingなしで左方への探索が可能となった．食事動作ではcountingによって品物を発見できるようになり，最終的にcountingを促す必要はなくなった．Numberingやcountingは発動性を外的に誘導して探索の持続性を向上させるほか，繰り返し実施することで自発的に利用される方略となり，食事動作を含む探索行動自体の改善につながると考えられた．

　We report the effect of approaches using numbering in cancellation tasks and counting in the feeding activity in a patient with severe unilateral spatial neglect. As reported previously, numbering improved the performance of the cancellation task immediately after its introduction. After 10 weeks of rehabilitation with these approaches, the patient maintained her improved spatial exploration without external cues to number targets. Similarly, counting of dishes and cups helped her locate left-side foods in the feeding activity. She learned to spontaneously use the counting strategy, and finally she was able to find and eat foods on the left as well as the right side of the table without overt counting. The results suggest that a long period (e.g., 10 weeks) of rehabilitation including numbering and counting may improve spatial exploration in patients with unilateral spatial neglect.