心理的要因による脳卒中後麻痺側上肢使用の低下に対する定量的上肢活動量評価を用いた行動変容介入の効果—症例報告

Psychological factors of behavioral intervention for reduction in affected arm use following stroke: A case study using quantitative accelerometry-based assessment of upper limb activity

要旨：実生活での麻痺側上肢使用に対する自己効力感が低下し，上肢活動量の低下を認めた右片麻痺患者に対して麻痺側上肢使用を促した．しかし，他者への目線を気にする神経質な性格から，病院環境での使用に至らなかったため，自宅環境での麻痺側上肢使用を促した．入院中の作業療法は週2日，退院後は週1日の訪問リハビリテーションを利用し，継続的な麻痺側上肢活動の促しを行った．使用状況は3軸加速度計を用いて評価し，本人へフィードバックをした．結果，自己効力感が向上し，上肢機能および上肢活動量の長期的な改善を認めた．入院中から自宅環境での行動変容を促し長期的に支援することは，上肢活動量の向上に寄与する可能性が示唆された.

　A patient with mild right hemiplegia showed a reduction in the use of the affected arm in an hospital environment despite previously being able to use it. This was due to the patient's low self-efficacy, nervous personality, and reluctance to have others observe the use of the affected arm. To address this, the patient was encouraged to leave the hospital more often, and the use of the affected arm was monitored using inertial sensors to provide feedback. As a result of these behavior modifications, the patient's self-efficacy, arm function, and activity of the affected arm improved. After being discharged from the hospital, his affected arm activities improved further, approaching unaffected arm activities through continued behavior modifications during home-visit rehabilitation. For patients with mild right hemiplegia, it is important to address the psychological barriers related affected arm use. Changes in the environment (e.g. more frequent outings) and the use of feedback devices can improve self-efficacy and lead to better the use of the affected arm.