Goal Attainment Scalingを用いた目標設定の具体的手段の検討—作業と機能に着目し目標の段階付けを行った事例

Examination of specific means of goal setting using Goal Attainment Scaling: A case study of goal gradation focusing on occupations and functions

要旨：近年，リハビリテーションの実践において，本人の意志決定を伴う目標設定が重要視されているが，目標設定から介入に至るまでのプロセスを提示している報告は少ない．今回，我々は書字の獲得を目標としたものの，その介入に躊躇し目標の修正が必要となった脳卒中片麻痺事例を経験した．その事例に対して，①作業の意味的分析，②動作分析，③Goal Attainment Scaling（GAS）を用いて目標の再設定と段階付けを行い，上肢機能の改善と作業の実現を支援した．本報告は，作業療法目標の再設定が必要となった事例に対して行った評価と目標設定の具体的な方法を明らかにして，臨床の一事例としての結果を考察するものである．

　In recent years, goal setting involving patient decision making has been emphasized in rehabilitation practice. However, there are few reports that present the process from goal setting to intervention. This study presents a case of stroke hemiplegia in which the patient's goal was to acquire the ability to write. However, the initial intervention was inadequate, and the goal needed to be modified. Therefore, we reset and graded this goal by using 1) Frame of meaning of occupation, 2) Activity analysis, and 3) Goal Attainment Scaling, resulting in attaining the goal and improving upper limb function. This report clarifies the specific methods of evaluation and goal setting for the case in which resetting of occupational therapy goals was necessary and discusses the results as a clinical case study.