The present state and future prospects of occupational therapy using technical aids : From an analysis of Japanese Occupational Therapy Society journals for the last ten years.

日本作業療法学会の文献を対象とし,福祉用具による作業療法アプローチの実態を検討した.その結果,作業療法士によって提供された福祉用具には入浴用具,排泄用具のみならず移動用具,コミュニケーション用具も含まれていた.福祉用具の製作は5割強を占めていた.それらの中で効果があったとする文献では,計画の策定,評価,是正のマネジメントが7割で行われていた.シミュレーションの実施が7割,クライエントの満足度は9割であった.他の職種との連携は,9割の割合で連携がとれていた.これに対して,作業療法士同士との連携の割合は2割程度であった.フォローアップの実施状況は1割程度であった.作業療法士の情報通信技術(IT)の活用状況は1割であった.福祉用具に対する安全性の配慮は1割で,福祉用具の製作における製造物責任法への対処は僅かしかなかった.The present state of occupational therapy using technical aids was assessed by examining journals of the Japanese Occupational Therapy Society for the last ten years. The findings were that occupational therapists offered not only bathing aids and excretion aids, but also locomotion and communication aids. Technical aids manufactured by occupational therapists accounted for a little over 50% of the total number. Of the technical aids which the journals had deemed effective, in 70% of cases planning, evaluation, and correction had been performed by occupational therapists. The simulation of technical aids was carried out at a rate of 70%. The degree of satisfaction with technical aids by clients was 90%. Cooperation with other professionals was 90% of the rate. On the other hand, the rate of cooperation with occupational therapists was about 20%. Although follow-up was carried out, it was little more than 10%. Only 10% of occupational therapists utilize IT. The Product Liability Law in the manufacture of technical aids was hardly dealt with

Notable signs observed in the growth process of “siblings" of handicapped children : their cause and mother's care of ""siblings"

本研究の目的は,障害児の母親と障害児の兄弟姉妹(以下「きょうだい」)への面接を行い,①発達の過程で「きょうだい」に見られた気がかりな徴候(以下サイン)とその原因を明らかにすること,②養育者としての母親が「きょうだい」を養育するうえで配慮してきた事柄を明らかにすることである.調査の結果,20名の母親が養育する障害児の「きょうだい」32名中12名にサインが見られた.その内10名のサインの原因が障害を持つ同胞と関係していた.その原因は,「障害児の入院付き添いによる母親不在や家族内の緊張の高まり」,「母親が障害児のことで手一杯で「きょうだい」の育児が手薄になったこと」,「きょうだいが障害児を援助する役割を担い,自分を出しにくいこと」,「友達の障害者への接し方から生じる葛藤」であった.母親が「きょうだい」を育てる上で配慮していることは,「きょうだいに意識して関わる」,「障害児ときょうだいの関係が円滑にいくように配慮する」の大きく2つに分類できた.この具体的な方法として示唆された「きょうだいとだけの時間を持つ」,「障害を持つ同胞のことをきょうだいが理解し尊重できるように配慮する」などの事柄は,障害児ときょうだいを養育する母親へのアドバイスとして有用であると思われる.また,母親が障害児と「きょうだい」を平等に扱うように配慮していても,どうしても障害児の方に母親の注意が向いてしまうこと,母親と「きょうだい」が考える平等の間にはズレが生じやすいなど,同胞が障害を持つことで難しさを伴う事柄も見受けられた。「きょうだい」の順位や障害児の能力を加味した個々の事例に応じたきめ細かな対応の必要性が示唆された.※本研究では,「きょうだい」と記した場合,障害児の兄弟姉妹を表し,同胞とした場合には障害児を表す。The purpose of this study was to elucidate anxiety symptoms (hereafter referred to as “signs") observed in the growth process of brothers and sisters of handicapped children (hereafter referred to as “siblings"), their cause, and the special attention of the mother in bringing up the siblings by interviewing handicapped children's mothers and “siblings". The results of the investigation revealed that 12 of 32 siblings of handicapped children brought up by 20 mothers showed some signs, and 10 of 12 siblings showed certain characteristics, whose causes were related to their handicapped brethren. The causes comprised the following factors : “mother's absence or increased strain in a family due to hospital attendance for the handicapped child" ; “preoccupation of the mother with the handicapped child; as a result of which childcare for the siblings became insufficient" ; “siblings bear the role of helping the handicapped children and cannot easily take an initiative for themselves ", and “conflict produced by how their friends treat the handicapped children." The special attention of the mother in bringing up the siblings is classified roughly into two categories: “communicating consciously with the siblings" and “taking care to maintain a smooth relationship between the handicapped child and the siblings." The following subjects are inferred to be effective as advice to mothers who are bringing up handicapped child and siblings: “allocate time for spending exclusively with the siblings" and “take care that the siblings understand and respect brethren who are handicapped." Moreover, cases of special difficulty were observed in relation to handicapped brethren: even if a mother takes care to treat the handicapped child and siblings equally, the mother's attention inevitably tends toward the handicapped child; alternatively, there is sometimes a gap in the concepts of equality between the mother and the siblings. Delicate care is suggested according to each case considering the order of the siblings and the potential of the handicapped child. In this study, “siblings" denotes handicapped children's sibship, while “brethren" denotes handicapped children

Employment status and its related factors in adults who experienced traumatic brain injury in Korea

脳外傷者の就業状況や脳外傷者の就業を促進する要因と妨げとなる要因を明らかにし,今後の就業援助のための示唆を得ることを目的に,韓国の地域職業リハビリテーションセンターに過去約5年間(1995～2000)求職相談に訪れた障害者,1542名のうち65名を脳外傷と同定し,その就業状況を公式記録から得て分析した.65名のうち,初回求職相談後2000年8月の調査時点までに一度でも就業を経験した者は36名であった.調査時点に就業中であった者は25名で,そのうち事業所に就業して1年以上勤続していた者は6名のみであった.求職相談後の就業にプラスに働いた要因は,居住地域がセンターの近隣または都市部であったこと,受傷後求職相談に訪れるまでの間に何らかの教育・職業訓練経験,就業経験があったこと,及び,求職相談時に就業斡旋と判定され,実際にセンターの就業斡旋を受けたことであった.また,勤続にプラスに働いた要因には障害が軽度で,障害受容ができたこと,家族,会社,職業リハビリテーション機関からのサポートがあったことで,マイナス要因には,本人の身体的・精神的能力の問題,作業の不適合性,会社内の対人関係の問題や物理的・制度的環境の不備,経済状況などがあった.The purpose of this research was to investigate the employment status of people with traumatic brain injury and factors related to their employability in Korea. From the official documents of a local vocational rehabilitation center, 65 people were identified as victims of head trauma among 1542 people with disabilities over 4 years and 8 months (1995-2000). Information about their demographical factors, disabilities, educational/vocational experience after disability, the vocational rehabilitation services of the center and vocational experience after registration was gathered and analyzed descriptively. The factors which influenced employment were also analyzed by logistic regression. Educational and/or job experience after the injury, accessibility to the vocational rehabilitation service, and job introductions from the center were related to their employment after registration to the center. The results were further analyzed with reference to the Canadian Model of Occupational Therapy (CMOP). Finally, this article suggests the necessity of a client-centered vocational rehabilitation program for people with traumatic brain injury in the community

脳血管障害者が経験する退院後生活のギャップとその要因 : 回復期リハビリテーション病棟における作業療法への示唆

研究論文Original Articles　背景と目的：自宅退院した脳血管障害者の中には，想定していた退院後生活と実生活との間にギャップを経験することがある．本研究の目的は，この要因を明らかにし，ギャップを小さくするための作業療法のあり方を検討することである．　方法：回復期リハビリテーション病棟における脳血管障害者7 名に対し想定していた退院後生活と退院後の実生活についてインタビューを行い，質的分析を行った．　結果と考察：退院後生活で想定通りの生活が出来た対象者と，ギャップを感じている対象者に分けられ，想定通りの生活が必ずしも良くないことや，ギャップがあってもポジティブに捉えていることがあった．この要因には，実際的なリハビリの不足と援助者への情報提供不足が考えられた．作業療法では，対象者や援助者と協働して退院後生活に合わせたプログラムを行い退院後も生活が拡大できるように調整することで，理想的な想定通りの生活に貢献できる可能性が示唆された．　Background and purpose: Some individuals with cerebrovascular disorder discharged home after hospitalization may experience a gap between post-discharge expectations and real life. The purpose of this study was to clarify this experience and examine how occupational therapy reduces this gap. 　Method: In the convalescent rehabilitation ward, interviews were conducted with seven individuals with cerebrovascular disorder to qualitatively analyze the gap between postdischarge expectations and real life.　Results and discussion: The individuals in this study were divided between those who were able to live as expected after discharge and those who experienced a gap between expectations and real life. Clearly, the individual who is living as expected is not necessarily good. Even if that individual experiences a gap, it is considered to be positive. It is believed that lack of rehabilitation may be a factor in determining whether the individual experiences a gap between expectations and real life. Rehabilitation can help the individual prepare for discharge, and information can be provided to family members and supporters. Occupational therapy contributes to an ideal experience with daily life after discharge by working cooperatively with the individual and the family members to implement a program tailored to life after discharge. This experience will help the individual adjust so that life experiences can be expanded even after discharge from the hospital

箸動作利き手交換における効果的練習方法の検討 : 脳血流動態，難易度及びパフォーマンスの観点から

研究報告Original Articles　背景：作業療法では，脳血管疾患後，利き手が麻痺した際に箸動作利き手交換を行う．これまで経験的に，つまみやすい箸から日常の箸に，つまみ易い物から難しい物へと段階づけて練習を行ってきた．　目的：箸動作利き手交換の方法について，実験的検討を行い，効果的方法を提案する．方法：右利き健常男性11 名に，非利き手で3 種の箸（箸ぞう，割り箸，塗り箸），物体（スポンジ，木片，大豆）について計9 課題のデータ収集を行った．測定項目： 1．主観的難易度（難易度），2．つかみ離しが出来た個数（パフォーマンス）3．前頭前野領域脳血流動態とした．　結果：①脳血流量は難易度が高いと判断された課題は多く増加した．②注意・集中ができパフォーマンスにおいてミスが少ない場合に増加した．③課題の難易度は対象者の主観（課題の特性・傾向）より4 段階に分類された．その結果，箸動作の利き手交換練習の効果的方法の順番は，箸ぞう−木片 ，箸ぞう−スポンジ，割り箸−スポンジ，割り箸−木片， 塗り箸−スポンジ，箸ぞう−大豆 ，塗り箸−木片，割り箸−大豆，塗り箸−大豆が良いことが示唆された．　[Introduction] Chopsticks are traditionally used at meals in Japan. In case of dominant hand paralysis after stroke, exchange of dominant hand for chopstick manipulation is performed in occupational therapy. Practices are performed conventionally in a phased manner using easyto-manipulate chopsticks first and those of ordinary types later and easy-to-pickup objects first and hard-to-pickup ones later. [Objective] Propose effective methods for exchanging dominant hand of chopstick manipulation after experimental review. [Method] Collect data of nine types of tasks making 11 healthy right-handed males manipulate objects (2cm3 of sponge and wood chip soybeans) using three types of chopsticks (Hashizo, throwaway chopsticks, lacquered chopsticks) by non-dominant hand. Measurement items: ① Cerebral blood flow kinetics in prefrontal area, ② Difficulty level, ③ Number of objects picked up and released successfully (performance) Each task performed within 30 seconds [Results] Difficulty level was higher and performance was better in orders of Hashizo, throwaway chopsticks and lacquered chopsticks, and wood chip, sponge and soybeans respectively. With larger difference in cerebral blood flow between individuals, its rate tended to be higher in tasks with low difficulty level and high performance (Hashizo-wood chip) and with high difficulty level and low performance (lacquered chopstickssoybeans) and lower in a task with moderate difficulty level and performance (lacquered chopsticks-wood chip) as a result of consideration in order. [Discussion] Such tendency was observed that cerebral blood flow increased in tasks achieved steadily and earlier and those with significant difficulty and decreased in tasks required for concentration and carefulness. It was suggested effective to provide tasks by considering their characteristics

東日本大震災被災地仮設住宅における音楽セッションの提供

実践報告Practical reports　東日本大震災に伴う津波により被災した岩手県T 村S 地区の仮設団地で，筆者らは震災一年後に「意味のある作業開発」を目的に活動を開始した．本稿は，その内の第4 回目の訪問時（2013年3 月）に行った音楽を中心とした文化的活動（以下，音楽セッションとする）の報告である．「ふる里」をテーマとし，参加者と筆者らが住む地域の共通する話題に沿って音楽セッションを行った結果，親和的な双方向のコミュニケーションが展開したので，その経過と結果及びアンケート結果について報告する．The project aiming at the development of meaningful activities began one year after the Great East Japan Earthquake in the temporary housing complex in the Iwate Prefecture, where survivors of the tsunami disaster have been staying. This article is a report of the activity whichwas undertaken at the fourth stage （March, 2013） of the project. The theme was set as “myhometown” and cultural activities which focused on music were performed in accordance withtopics common to the local community and that of the authors. As a result, a friendly nteractivecommunication developed. The process and the results of the sessions are introduced in thearticle

我が国作業療法の現状と今後の展望

総説Literature Review昭和38(1963)年、我が国初の作業療法士養成校がWHOの勧告の元、東京都北多摩郡清瀬市に出来て43年が経過した。この総説ではまず、その後の作業療法士養成の推移とその社会的背景について述べ、現在示されている今後の作業療法士需要予測では、高齢者が圧倒的多数を占めることを指摘した。次に、老年期障害、身体障害、発達障害、精神障害領域の作業療法についてそれぞれ現状と今後の展望あるいは課題について述べた

東日本大震災被災地における意味ある作業の開発：岩手県Ｔ村T 仮設団地S 地区女性部メンバーを対象としたアクションリサーチ

実践報告Practical reports　2011 年3 月の東日本大震災によって岩手県沿岸部の漁村，S 地区は壊滅的な被害を受けた．Ｔ仮設団地に暮らすＳ地区女性部メンバーを対象に「研究者と対象者が共同して望ましい作業を展開する」アクションリサーチを行った．2012 年7 月から2013 年8 月まで6 回訪問し，参加者は14 ～ 20 名であった．プログラムは，各種物作りと話合い・歌などで構成し，参加者のフィードバックをもとに新たな作業を展開した．これまでに行った作業は，物作りでは，生キャラメル，布草履，ケーキ，クッキー，アンデルセン，おでん，樹脂粘土のアクセサリーであり，そのほかに，KJ 法による話合い，ハープと歌，歌の集い，ワールドカフェなどを行った．2013 年度になって始めたアクセサリー作りは参加者の気持ちを捉え，また，販売と収益に結び付くものになりつつある．A village located in a seaside area of the Iwate Prefecture was tremendously damaged by thetsunami of the Great East Japan Earthquake in March, 2011. The purpose of this project was to provide meaningful occupations for the residents of temporary housing. Between forteen to twenty menbers of district S, living in temporary housing, participated in this project. The occupations provided were decided each time according to the results of interviews or questionnaires. Occupations provided were as follows: 1. September 16, 17, 2012 : Making of soft caramel （Nama-caramel）. Discussion and conclusions using the KJ method. Making of fabric sandals.（ 18 participants） 2. November 11, 2012 : Providing “Feel Easy” time: tea time, songs with a harp accompanimen（t 19 participants） 3. March 23, 24, 2013 : Baking of cakes and cookies, making Andersen bracelets, preparing the Shizuoka hot pot stew, and sing song.（ 18 participants） 4. July 14, 15, & Aug. 20, 21, 2013 : Making necklaces & bracelets with Polymer clay.（ 16 & 21 participants respectively） This program can be roughly categorized into craftwork, sweets making, music, food and drink, and discussion. Participants seemed refreshed after experiencing a number of differentoccupations, as many desired variety. The results of the questionnaire conducted in Marchalso showed that requests for new occupations were more than numerous for those alreadyperformed. We provided various kinds of occupations according to the requests from the participants, though not enough, in their time of need

注意障害事例の行動の特徴と機能評価との関連性：観察記録のテキストマイニングによる分析とTrail Making Test の検討より

研究報告Original Articles　本研究は，注意機能の評価として広く一般的に行われているTrail Making Test（TMT）の評価結果と，日常における行動の特徴との関連性を明らかにすることを目的とした探索的研究である．対象は，日本における医学論文情報のインターネット検索サービスである医中誌WEB に1999 年～2012 年までの13 年間に登録された文献のうち，“ 作業療法” と，“ 注意障害” をキーワードとして検索した（2013 年5 月検索）．その結果31 例の作業療法士が報告する症例を得たが，それらの内でTMT を評価として用いていた17 症例を対象とした．17 症例の報告から，34 組の行動の観察記録とTMT の評価結果を抽出し，行動の観察記録をテキストマイニング手法により分析した後，TMT の結果と照らし合わせて比較検討した．検討の結果，4 段階に分かれたTMT の遂行レベルについて，各々の段階の行動の特徴が明らかとなった．　The present exploratory study was aimed to examine the relationship between the results of the trail-making test (TMT), a common test to assess attentional function, and the behavioral characteristics in people with attentional deficits in daily life. A search of documents for a thirteen-year period, between 1999 and 2012, was conducted in May 2013, using Ichushi-Web, an Internet search service containing information on Japanese medical papers, with the keywords : “occupational therapy” and “attention deficits”. There were 31 papers written by occupational therapists, and 17 which adopted the TMT for assessment were selected. Observation records of the behaviors of 34 subjects and TMT assessment results were extracted from the 17 papers. The observation records were analyzed using text-mining, and the analysis results were compared with those of TMT assessment. The TMT assessment results were classified into four levels, and the characteristics of the behaviors at each level were identified

慢性障害者の役割再獲得に関する研究

研究期間:平成11-12年度 ; 研究種目:基盤研究C2 ; 課題番号:11835019原著には既発表論文の別刷を含む