化学療法誘発性末梢神経障害による異常感覚を呈した悪性リンパ腫患者に対する作業療法—理容師としての復職を目指した症例

Occupational therapy to restore the work ability of a barber with malignant lymphoma with abnormal sensations in the distal parts of both fingers due to chemotherapy-induced peripheral neuropathy

要旨：化学療法誘発性末梢神経障害による異常感覚を呈した悪性リンパ腫の症例に対し，理容師としての復職を目標に作業療法を行った．症例は，両側手指末梢に痺れや痛みを主体とした異常感覚を有し，巧緻動作が困難であった．作業療法では，巧緻動作練習，書字や箸操作の課題志向的練習，さらに理容作業練習を段階的に行った．結果として，症例の異常感覚の変化はわずかであったが，巧緻動作は可能となり，理容師として復職できた．このことから，異常感覚を有した手の使用を促進するためには，脱過敏療法を参考とした段階的な物品操作課題や，課題実施において手の健常感覚部位の触覚を活用すること，また症例の役割に立脚した目標と作業練習が重要と考えられた．

　We performed occupational therapy to restore the work ability of a barber with malignant lymphoma with abnormal sensations in the distal parts of both fingers due to chemotherapy-induced peripheral neuropathy. The patient experienced numbness and pain in the distal part of both fingers, facing difficulty with fine motor skills, such as writing and using chopsticks. Occupational therapy gradually introduced the practice of fine movements, such as writing, using chopsticks, and utilizing scissors. A slight improvement was observed in the sensations in both fingers, leading to increased finger mobility and resumption of work as a barber. To promote the use of hands with abnormal sensations, it seems effective to perform systematic article manipulation with reference to desensitization therapy and use tactile sensations in the healthy sense area of the hands for task execution. Furthermore, it is essential to set occupational therapy goals based on the professional role of the patient.