心理的側面に配慮したADLアプローチが在宅復帰に繋がった血管型Ehlers-Danlos Syndromeの事例

Effects of combining psychological considerations with ADL training on returning home of a patient with vascular Ehlers-Danlos Syndrome: A case study

要旨：血管型Ehlers-Danlos Syndrome患者に対し，入院中に関節症状や血管脆弱性によるリスクと心理的側面に配慮しながら介入した結果，在宅復帰し，その後社会参加に繋がった．事例は痛みや血管破裂に対する恐怖感が強く，ADL場面で動作の手順や方法に固執していた．そのため血管脆弱性のリスクを考慮し，移乗の際に足をぶつけないよう状況に応じて安全に動作が行えるよう様々な移乗手段の指導と自助具の導入を行った．また恐怖感を軽減させるため，動作の反復練習や退院後に使用する福祉用具を訓練場面や病棟生活で取り入れた．身体症状のみならず不安や恐怖感を取り除けるよう心理面に配慮した関わりが重要であった．

　Interventions were performed during hospitalization for a patient with vascular-type Ehlers-Danlos Syndrome, taking into consideration psychological aspects and the risks due to joint symptoms and vascular fragility. The patient was highly adverse to pain and blood vessel rupture and continued his own procedures and methods to maintain ADL. Therefore, considering the risk of vascular fragility, we instructed the patient in various methods of transfer and introduced a self-help device so that transfer operations could be performed safely according to the situation to prevent the patient's feet from being hit during transfer. In addition, to reduce the patient's fear of pain and blood vessel rupture, we used repeated movement exercises and safety equipment after discharge from the rehabilitation program and the hospital ward. It is important to consider psychological aspects during ADL training so that not only physical symptoms, but also anxiety and fear can be eliminated.