脳卒中後に生じた自己認識障害に起因した麻痺手の使用行動の低下に対するTransfer packageを用いた実践—症例報告

Occupational therapy using the transfer package for behavioral disorders of the paralyzed hand caused by self-awareness impairment after stroke: A case study

要旨：軽度の運動麻痺と感覚障害に加え，左半側空間無視や麻痺手の使用低下，自己認識障害を認めた右前頭葉の脳梗塞患者に対し，上肢機能練習に併せ，CI療法のTransfer packageを実施した．その結果Motor Activity LogのAmount of Use，Quality of Movementともに臨床的に意味のある最小変化量を超える改善が見られた．また，自己認識障害を評価するAwareness Questionnaireにおいても良好な得点が得られた．本対象者は，Transfer packageが自己認識機能を促進させ，実生活における麻痺手の不使用に対する認識を改善した可能性がある．

　A right frontal lobe stroke patient with mild motor and sensory deficits, left hemisphere neglect, decreased use of the affected upper extremity, and self-awareness disorder received constraint-induced movement therapy combined with the transfer package (TP) for the upper extremity. Consequently, the Amount of Use and Quality of Movement Scales in the motor activity log were improved beyond the minimal important difference, and the Awareness Questionnaire, which assesses a client's self-awareness disorder of one's situation, showed improvement as well. The results of this case study indicate that the TP might improve self-awareness functioning and awareness of affected upper extremity use in the real-world.