全盲で失語症を呈した症例に対するコミュニケーション援助

Communication support for a case of totally blind patient presented with aphasia

　脳出血により中等度のウェルニッケ失語を呈した全盲の症例を経験した．症例は，発症により喚語困難・音韻性錯語および語性錯語・新造語などの発話面の障害，聴覚的理解力低下，熟練していた点字の音読・読解・表現困難を呈した．訓練で点字の音読や読解を実施し，実用的コミュニケーション手段として点字コミュニケーションボードを導入した．教材の準備にあたっては盲学校の協力を得た．結果，点字コミュニケーションボードを用いて日常の基本的欲求表現が可能となり，生活の質は大きく改善した．点字使用者は失語症により点字使用に障害が起こり得ること，実用的コミュニケーション手段として点字を有効に活用できる可能性があること，全盲失語症者におけるコミュニケーション能力の向上は晴眼の場合に比し生活への影響がより大きいこと，視覚障害者への支援に当たり関連施設との連携が重要であることが示唆された．

　We report on the case of totally blind patient presented with moderate Wernicke's aphasia due to cerebral hemorrhage.　The patient showed speech disorders including word-finding difficulty, phonemic paraphasia, verbal paraphasia, neologism, and declining auditory comprehension as well as difficulty in writing in braille and reading braille orally or silently, which the patient had been skilled at prior to aphasia.　To improve his communication, the patient was trained in reading braille orally and silently, and a braille communication board was introduced as a practical communication method.　We obtained cooperation from a school for the blind for preparing such training materials.　As a result, the patient has become able to express his daily wants using the communication board, so that the quality of life of the patient has been greatly improved.　Considering the course of this case, the following points have been suggested:(1) Braille users may find some difficulty in using braille due to aphasia as in the current case;(2) Braille may be effectively used as a practical communication method, (3) Compared with non-blind patients, improving communication abilities of totally blind patients with aphasia has a greater effect on the patients' quality of life, and (4) Cooperating with relevant institutions is vital for supporting blind persons.