道具の使用障害に対する歯磨き動作に着目した一例

Toothbrushing in tool-use disorders: A case study

要旨：【目的】くも膜下出血後の患者に見られた行為および動作の障害を，歯磨き動作に着目して詳細に分析し，概念失行およびAction Disorganization Syndrome（ADS）に対する作業療法介入の結果を報告する．【方法】道具の手渡しやエラーレスラーニングを中心に，視覚的手がかりとして絵カードを導入した．【結果】絵カードを用いることで行動の構成要素と順序が整理され，概念失行やADSによる誤反応が減少した．最終的に介助なしで歯磨き動作を遂行できるようになった．【結論】概念失行とADSの各病態に応じた介入方法を展開したことが，歯磨き動作の改善に結びついたと考える．

　Objective: This study aimed to analyze the tool-use and action disorders observed in a patient after a subarachnoid hemorrhage, with a particular focus on toothbrushing, and to report the outcomes of occupational therapy interventions targeting ideational apraxia and Action Disorganization Syndrome (ADS). Methods: The interventions centered on errorless learning and tool handovers, with the introduction of picture cards as visual cues. Results: The use of picture cards facilitated the organization and sequencing of actions, reducing errors associated with ideational apraxia and ADS. Ultimately, the patient was able to perform toothbrushing independently. Conclusion: Individualized interventions tailored to the specific pathologies of ideational apraxia and ADS were effective in improving toothbrushing performance.