上肢運動失調患者が箸操作に至るまでの過程—事例に物・道具と手の運動を意識づけた介入

Improvement of instrument manipulation of ataxic arm and hand of a cerebellar hemorrhage patient

要旨：小脳出血により右上肢の運動失調を呈する事例に対して，箸操作の自立を目標に作業療法を実施した．事例は，麻痺側右手に過剰に力が入った状態で，箸を握り込むように把持していた．そして，右手の揺れを止めようとして箸の握り込みが強まり，操作対象からの感覚情報とその変化を知覚することが困難な状態にあった．手指の目的的な活動を促通するために，手全体で物品を握るおよび扱う活動で，手指の屈曲・伸展を連続的に誘導した．その後，切る，混ぜる，つまみ上げる，の3つの工程に分けた箸操作を実施し，箸先を整える動作を誘導した．その結果，事例は実用的に箸を使用することが可能となった．

　The patient with ataxia of the upper right limb caused by cerebellar hemorrhage was provided occupational therapy to attain independent chopstick-use. The patient initially grasped the chopsticks using excessive force with the paralyzed right hand. Moreover, to stop the right hand from shaking, the patient strengthened its grip on the chopsticks and had difficulty perceiving the sensory information from the operation target. To promote purposeful finger action, the patient was instructed to perform continuous flexions and extensions of the fingers while objects were grasped and handled with the entire hand. Thereafter, the patient manipulated the chopstick in three ways: cutting, mixing, and picking up material. That was subsequently instructed to perform movements to straighten the tips of the chopsticks, resulting in the improvement of chopstick-use.