通所リハビリテーションにおける多職種・家族・企業との連携をマネジメントした段階的な介入により復職に至った一事例

A case study of return to work through step-by-step intervention in a daycare rehabilitation center with management of collaboration among multiple professions, family members, and companies

要旨：10ヵ月前に左被殻出血を発症し，重度の右片麻痺と高次脳機能障害を呈した40代男性に対し，職場から遠方の通所リハにおける就労支援を行った．復職には県外での一人暮らしに向けた入浴や家事，通勤のための公共交通機関の利用，「建築積算」という仕事の習得が必要であった．多職種・家族・企業との連携をマネジメントした段階的な介入を行ったことで，介入42月で復職を達成した．就労支援において，対象者と企業が障害特性を理解することが重要であり，そのために実際の環境での評価・練習は必要不可欠であった．作業療法士が状況設定や支援者との連携をマネジメントする意義は大きく，通所リハにおいても就労支援の必要性は高いと考える．

　A man in his 40s who developed a left capsular hemorrhage 10 months earlier and presented with severe right hemiplegia and higher brain dysfunction was provided with employment support in a daycare rehabilitation center far from his workplace. In order to return to work, he needed to bathe, do housework, use public transportation for commuting, and learn the job of “construction estimation” in order to live independently outside of the prefecture. Through a step-by-step intervention managed in collaboration with multiple professions, family members, and companies, the subject returned to work after 42 months of intervention. In employment support, it was important for the subject and the company to understand the characteristics of the disability, and evaluation and practice in an actual environment were essential for this. The occupational therapist's role in setting up the situation and managing the collaboration with supporters is significant, and we believe that there is a high need for employment support in daycare rehabilitation as well.