視空間認知障害を合併した脳卒中片麻痺患者に対する応用行動分析学に基づいた上衣着衣練習の効果—単一事例研究

The trail of upper-body dressing training based on the time-delay and visual prompt fading methods for a stroke inpatient with severe hemiplegia and visual-spatial deficit

視空間認知障害を呈した左片麻痺症例に対し，単一事例実験研究による応用行動分析学に基づいた上衣の着衣練習の有効性を検証した．着衣動作を6つの工程に分割し，それぞれに対して介助量によって点数付けをし，その得点と着衣動作の遂行時間を計測した．ベースライン期では試行錯誤による着衣練習，介入期では時間遅延法と視覚的プロンプト・フェイディング法による着衣練習を行った．その結果，介入期ではベースライン期に比べて着衣の遂行時間と得点が有意に改善し，その後も着衣動作が継続的に可能となった．これらより，応用行動分析学に基づいた着衣練習は，視空間認知障害を呈した片麻痺患者に対する有効な訓練方法であると示唆された．

　This study examined the effect of upper-body dressing training based on the time-delay and visual prompt fading methods using applied behavior analysis on a stroke inpatient with severe hemiplegia and visual-spatial deficit (left-homonymous hemianopsia and ocular motility disorder). In this single-case experimental study, to assess the effect of the intervention, the performance times of upper-body dressing and amounts of dressing scores in the baseline and intervention phases were measured and compared. Statical analysis was performed by the split-middle line method and a binomial test. As a result, performance times of upper-body dressing were shortened and amounts of the dressing score increased significantly in the intervention phase compared to the baseline. Moreover, these outcomes were also consistent during the follow-up. These results suggest that upper-body dressing training based on the time-delay and visual prompt fading methods are effective in improving upper-dressing ability in a stroke patient with impaired visuospatial ability.