観念運動失行症例の箸操作に着目した一例—箸の把握形態の学習により疲労が軽減した介入報告

Reducing fatigue through manipulation of chopsticks in a patient suffering from ideomotor apraxia: A case study

失行症状を含む高次脳機能障害と運動麻痺を呈した症例は，「箸を使ったら疲れる」と訴え食事に1時間かかった．各評価および動作特性から，主な病態は症例がイメージする適切な箸の把握形態の構成が難しく，努力的な箸操作につながっていた．さらに箸の使いにくさを感じながら運動の誤りに気づけず，自己修正が困難で疲労感の増大を助長させていると解釈した．介入方針は，症例が最適な箸の把握形態が構成できて，その把握形態を定着することとした．介入は体性感覚情報を基に自己の運動に置き換えることと，物品から把握形態を想起し構成することを実施した．その結果，症例がイメージした箸の把握形態が定着し，箸操作の疲労感や食事時間が改善した．

　A case of higher brain dysfunction including apraxia and motor paralysis caused by cerebral infarction complained of fatigue while manipulating chopsticks during mealtime. OT evaluation and movement characteristics indicated that due to the pathological condition, the patient was unable to grasp the chopsticks appropriately, leading to strenuous chopstick manipulation, an inability to recognize and correct errors in movement, and increased fatigue. OT intervention included helping the patient establish an optimal chopstick grasping form through replacing the somatosensory information with the patient's own movement and constructing the grasping form by looking at the object. As a result, the grasping form of the chopsticks imagined by the patient was established, and the fatigue of chopstick manipulation during mealtime was reduced.