体性感覚による代償と手順の言語化によるアプローチが奏功した着衣障害の一例—衣服の構造理解が困難な症例への作業療法

Dressing disability due to difficulty understanding the structure of clothes which was successfully treated by occupational therapy utilizing somatosensory compensation and verbalization of procedures: A case study

要旨：脳梗塞後の出血により着衣障害を呈した60歳代男性の作業療法を報告する．本症例は着衣工程の分析から，身体と衣服の位置関係の理解，着衣手順の誤りを認め，さらに，衣服の構造を理解できないため，着衣開始に際しての衣服の準備（設定）が困難だった．各障害に対し代償的アプローチを用いた．衣服の構造・手順を言語的に代償し，体性感覚を用い，両ファスナーを辿り，襟タグを確認することで着衣開始の設定が可能となった．本症例は重度の構成障害を認めたが，その背景には視覚認知および視空間認知障害があると思われ，視覚以外にも多感覚モダリティを利用した代償的アプローチが有効であることが示唆された．

We report the occupational therapy of a man in his 60s who had dressing disability due to bleeding after cerebral infarction. In this case, an analysis of the dressing process revealed errors in grasping the positional relationship between the body and the clothes and in the dressing procedure. Furthermore, since the structure of the clothes could not be understood, it was difficult to prepare（set）the clothes at the start of dressing. A compensatory approach was used for each disability. By linguistically compensating for the structure and procedure of clothing, using somatosensory sensation, tracing both fasteners, and confirming the collar tag, it became possible to set the start of dressing. In this case, severe structural disorder was observed, but it is thought that visual cognition and visuospatial cognition disorders are behind it, suggesting that a compensatory approach using multisensory modalities other than vision is effective.