課題の工程分析に基づいた段階的な難易度調整によるトイレ移乗動作練習を実施した一例

An approach to toilet transfer by step-by-step difficulty adjustment based on analysis of individual subtasks

要旨：重度左片麻痺と高次脳機能障害を呈した脳卒中患者に対して，トイレ移乗動作の介入を反復して実施するも自立度の改善を認めなかったため，介入方法を見直すためにToileting Tasks Assessment Form（以下，TTAF）を用いたトイレ動作の詳細な工程分析を行った．得られた結果をもとに，段階的な難易度調整を施したトイレ移乗動作の練習を行った結果，一部の工程において自立して動作が可能となり，その他の工程の自立度も向上した．TTAFは，トイレ動作の詳細な評価に基づいた介入の立案とその効果判定を可能とし，症例の自立度の改善に貢献した可能性がある．

　A stroke patient with severe left hemiparesis and cognitive dysfunction underwent repetitive practice for toilet transfer upon hospital admission, but no improvement was observed in the degree of independence of the patient's performance. To reexamine the practice strategy, we assessed the individual subtasks that comprised the toilet transfer using the Toileting Tasks Assessment Form (TTAF). Intervention was done by combining partial practice with stepwise difficulty adjustments according to the independence degree for each subtask and total practice throughout the series of tasks. As a result, the patient was able to perform some of the subtasks independently, and the independence degree in the other subtasks also improved. The assessment of each subtask using the TTAF may contribute to the improvement of the patient's level of independence by enabling the planning of interventions based on a detailed assessment of toileting behavior and the determination of their effectiveness.