注意機能の変化をみる段階的作業課題とその利用—課題達成度の変化からみた注意機能の改善プロセスと臨床的推論

Stepwise tasks for patients with attention deficit: Improvement of attention function based on the change of the achievement level of the task, and clinical reasoning based on the stepwise task

要旨：注意機能をスクリーニングし，日常生活活動能力の予後予測を含めた臨床的推論を簡易的に行うため，注意障害の病態に基づいて段階づけた課題を設定した．本研究は，設定した課題達成度の変化を観察し，既存の評価との関連性を検証した．対象は発症2ヵ月以内に入院した脳卒中患者14名とした．結果，対象者の課題達成度および評価得点は有意に向上し，課題達成度と神経心理学的検査および日常生活動作能力には有意な相関が認められた．本研究で設定した課題の達成段階を目安にして，注意機能の改善プロセスを概観し，日常生活活動の達成度を推察できる可能性が示唆され，対象者の注意機能に合わせた課題や場面設定をすることが可能と考えられた．

　The purpose of this study was to facilitate screening of attentional functions and to simplify clinical reasoning including prognostic predictions of daily activity. We created and conducted stepwise tasks to observe the improvement process of the attention deficit for every achieved level. Subjects were 14 patients (6 males and 8 females, mean age: 74.9 (8.7) (SD)) with cerebrovascular diseases, admitted within 2 months of onset. Using the change of the achievement level of this task, we analyzed the improvement process of the attention function and the relationship between outcomes of the task and existing assessments and daily activity. As a result, the achievement level of the task and existing assessments scores of the subjects were significantly improved. In addition, achievement of the tasks in the initial and final stages significantly correlated with the initial and last scores of existing assessments and daily activity. The achievement level in this task suggested that we could infer an achievement level of daily activity in patients with attention deficits. The present study suggests that a program and scene setting on matching the level of individual attention deficits were possible.