訪問作業療法の介入後に狭小な生活空間が広がるまでの変遷—本人と母の言動からの分析

Expanding living space after home-based occupational therapy: Analysis of verbal behavior of a client and her mother

要旨：脳出血発症後，約50年経過した事例は母と2人だけの閉鎖的な日常生活を送っており，過去に様々な福祉サービスを拒否した後，訪問作業療法を導入するまでに難渋した．約8ヵ月間，作業療法士は2人に対して傾聴と共感をしながら，提案と体験を繰り返すことにより，2人の価値観や思いを徐々に明確にすることができた．また，事例ができる活動を見出したことをきっかけに，事例が自らやりたい活動を表出するようになり，活動範囲と生活空間が広がり，母はその様子を見守るようになった．なぜ2人の行動が変化したのか，作業療法経過を振り返り，事例のできる活動と2人の言動から後方視的に分析し，訪問作業療法の効果について報告する．

　After developing a cerebral hemorrhage, the client and her mother have lived in isolation for about 50 years, constantly refusing various welfare services, which lead to difficulty introducing home-based occupational therapy. For about 8 months, the occupational therapist repeatedly intervened with suggestions while listening to and sympathizing with the client and her mother. As a result, their values and preferences gradually became clear, and the occupational therapist discovered the client's preferred activities. The client shared her broad sphere of activities and living space as her mother began watching over the client. This study reviews efficacy of home-based occupational therapy, analyzes the client's new activities along with the client's and her mother's verbal behaviors, and discusses why the behavior of the two people changed.