急性期脳卒中者の結髪動作と料理の再獲得を目指して生活行為向上マネジメントと修正CI療法を併用した作業療法の実践

Occupational therapy combining the Management Tool for Daily Life Performance with modified CI therapy for an acute stroke survivor to reacquire hair dressing and cooking activities

要旨：急性期脳卒中者の結髪動作と料理の再獲得を目指し，生活行為向上マネジメントと修正CI療法を併用した作業療法を実践した．その結果，結髪動作を再獲得し，上肢機能，日常生活活動（以下，ADL）は臨床的に意義のある最小変化量を超える改善を示した．その後，生活目標と課題を回復期に引継ぎ，料理を再獲得できた．本介入で急性期から望む活動や参加を促進できることが示唆された．意味のある合意目標を支援者で共有し，適切なプログラムを切れ目なく行えたことが主体的な生活へ行動変容を導けた可能性がある．また，急性期作業療法は対象者の望む上肢機能獲得，ADL自立を図り，生活目標と課題を次の支援者に引き継ぐ役割が重要と考える．

　We conducted occupational therapy combined Management Tool for Daily Life Performance with modified CI therapy to help an acute stroke survivor reacquire hair dressing and cooking activities. As a result, the patient reacquired hair dressing abilities and upper limb function, and activities of daily living (ADL) improved beyond the minimum clinically meaningful change. The client was then able to reacquire cooking activities by transferring her lifestyle goals and tasks to the recovery phase. The results suggest that this intervention can promote desired activities and participation from the acute phase. It is possible that the supporters shared meaningful and agreed-upon goals, and that the appropriate program was implemented seamlessly, leading to behavioral change toward a proactive lifestyle. In addition, we believe that it is important for occupational therapy in the acute phase to acquire the desired upper limb functions and achieve ADL independence, and to pass on the goals and tasks of daily living to the next support person.