臨床実習での学生の指導方法について 実習の学生と指導者の振り返りからの一考察

実習の際には、実習地を訪問し、課題の進捗状況を指導者と学生から聞き取り、問題が生じていれば、その原因と解決方法を共に考え対処し、実習の課題到達を目指している。今回精神領域の評価実習の訪問時、学生は「指導者に迷惑をかけたくない」「実習の場でどのように行動したら良いかわからない」との訴え、課題の進捗状況の確認に時間を要した。「実習ではできない事を見つけそれを練習する事が大切」と事前に学びの姿勢を伝えていが、学生は指導者にどう思われているかを優先していた。　この原因を知りたく、実習生と指導者それぞれに実習の振り返りを実施した。振り返りは、実習生には困った事と受けた援助、指導者には実習生が困っていた事と実施した援助にカード化した。学生と指導者それぞれのグループでKJ法を用い概念化し、結果を共有した。　学生が困った事については、学生自身よりも指導者の方が具体的に把握し、学生は自身が困った事を言語化できていなかったことが示された。この言語化できていないことが自身の実習課題の達成よりも指導者からの評価に視点がむいた原因と考えられたThe present study involved students undergoing practical training and their supervisors, and focused on supervisors’ approaches to help students complete assignments. Students who have had problems and their supervisors at a training site are supposed to report the status of progress made in assignments and discuss the causes and solutions together. Reports submitted by students who had undergone training in psychiatry included: “They did not want to cause trouble for supervisors” and “They did not know what to do at the training site”, and it took time to confirm the status of progress. Although students had been informed of a recommended learning attitude: “In practical training, it is important to identify what you cannot do and practice it for improvement” in advance, they were more occupied with their supervisors’ evaluations.Both students and supervisors were asked to reflect on the training sessions to examine the causes; the students reflected on problems they experienced and support they received, and the supervisors reflected on those problems and the support they provided. The results of the reflections were described on cards. The descriptions obtained from the student and supervisor groups were conceptualized using the KJ method, so that they could share the results.The supervisors had understood problems experienced by the students more comprehensively than the students themselves. The students had difficulty verbalizing their problems, which is considered to be the reason for their attaching greater importance to evaluation by supervisors rather than the completion of assignments

作業教示が作業遂行時のワーキングメモリに及ぼす影響(第2報) 高齢者に対する検討

高齢者に対する作業療法で,日常生活活動の遂行を目的とした作業活動が,様々な原因が伴い持続困難な場合もある.その一因と考えられる注意の制御能力の低下は,ワーキングメモリ機能の不活発な影響が関与していると推察した.本研究では健常な高齢者7名に,作業課題を複数の工程に分けて,順番に各工程を達成しながら作品を完成する作業を設定した.その課題を複数回実施することで各工程の内容を創意工夫する作業遂行となり,ワーキングメモリに影響をおよぼすと推察した.そこで,ワーキングメモリの構成要素の音韻メモ,視空間メモの2つの補助システムに着目し,課題に対して言語と視覚を介する教示方法の違いがワーキングメモリに及ぼす影響を,酸素モニタ装置NIRSと認知機能検査を用いて比較検討をした.言語を介する教示による課題の作業遂行は左右のDLPFC領域の酸素化ヘモグロビン濃度が有意に賦活し,認知機能検査では視覚を介する教示と比較してPASAT2秒が有意に向上した.今回の高齢者の箱つくりにおいて言語を介する教示は, 視覚を介する教示と比較して内言語を方略としたワーキングメモリの関与を推察し,目標志向性が明確化しやすくワーキングメモリの活性に適度な負荷につながる教示方法になったと考えた.Elderly people undergoing occupational therapy sometimes have difficulty continuing tasks assigned to them to improve their daily activities for several reasons. We developed a hypothesis that aggravated attention deficit of the elderly, a probable cause of the above-mentioned difficulty, is influenced by their inactive working memory functions. In the present study, seven healthy elderly people were asked to complete a task consisting of multiple processes. We asked them to perform the task repeatedly because we expected them to use their inventiveness while completing each process, which would influence their working memory functions. We focused on two systems - phonological loop and visuospatial sketchpad, as components of the working memory, and conducted a comparative study to examine the effects of differences in two methods based on verbal and visual instructions provided to implement the task on the working memory, using an oxygen monitoring device (NIRS) and a cognitive function test. When the task was completed by the elderly after receiving verbal instructions, deoxygenated hemoglobin concentrations in the left and right DLPFC (dorsolateral prefrontal cortexes) significantly increased, and there were significant improvements in their performance in “PASAT2” compared with when visual instructions were provided, as suggested by the results of the cognitive function test. The elderly were asked to complete a task of creating boxes after receiving verbal and visual instructions. Verbal instructions promoted the deeper involvement of the working memory through endophasia, helped the elderly to become more goal-oriented, and appropriately increased loads to activate the working memory more, compared with visual instructions

作業教示が作業遂行時のワーキングメモリに及ぼす影響

注意の制御能力の低下の一因に、ワーキングメモリを要する機能の不活発が関与しているのではないかと推察した。注意障害に関する認知リハビリテーションにおいて、繰り返して練習した作業の処理スピードは速くなるといった効果が報告されている。繰り返しおこなう作業遂行で、教示方法の違いがワーキングメモリの活性に影響すると推察した。本研究では、2種類の教示方法を用いて箱つくりをおこなった。教示方法によるワーキングメモリの活性化について酸素モニタ装置NIRSと認知機能検査を用いて比較検討した。視覚教示は、同寸法の箱を作製するため効率よく自身のペースで箱を作製でき、繰り返しおこなう事でワーキングメモリよりも短期記憶の要素が強くなったと考えた。箱つくりがDLPFCの脳血流量の変化に影響を与えたと推察したが、ワーキングメモリの活性化には、対象者のワーキングメモリの容量や作業課題の選択、認知負荷の容量などを考慮する必要がある。Contribute to the reduction of the control capability of attention, inactivity of functions that require working memory I have assumed or not you\u27re involved.In cognitive rehabilitation on attention disorders, the treatment speed of the work has been practiced repeatedly effect have been reported, such as faster.In the work performed to repeated, the difference of the teaching methods were presumed to affect the activity of the working memory.In this study, it was subjected to a box made by using the two methods of instruction.And were compared using the oxygen monitoring device NIRS cognitive function testing for the activation of the working memory by instruction method.Visual instruction, it can be produced a box at a rate of efficiency itself for producing a box of the same dimensions, thought of short-term storage than the working memory by repeating became strongly.Boxes make it was presumed to have influenced the change in cerebral blood flow in DLPFC, but the activation of the working memory, the selection of capacity and working issues working memory of the subject, it is necessary to consider such as capacitance cognitive load is there

リハビリテーション医療系大学1年生の状態不安状況について : 入学から前期定期試験1週前までの縦断的研究

2014 年の文科省の調査では，高校から大学への“円滑な移行”ができていないことを理由に退学した者の割合は，18.9％に上った．現在，入学後のまもない時期が適応への重要な移行の時期であるとされている．本研究では，大学への円滑な移行，適応という観点から，リハビリテーション医療系大学１年生の『不安』に焦点をあてた．本研究の目的は，大学入学直後から定期試験1 週間前までの４期における，『不安』点数の変化の特徴を縦断的に捉えることである．結果，性別により状態不安点数の変化に大きな差異が見られた．男性は，入学１ヵ月目に状態不安点数が最も低くなり，定期試験１週前に最も高くなる特徴があった．一方女性は，3期まで状態不安は上がり続け，試験1週前で，最も低くなる特徴が見られた．これらは，性別による大学生活に求める志向の違いが反映されていると推察された．現段階ではデータからの推察が中心となっており，今後各期に行った不安対象についてのアンケート内容の整理，分析を補完的に行うことが必要と考えられた．The survey by Ministry of Education, Culture, Sports, Science and Technology of 2014, the ratio of student who quitted school for reasons of "the smooth transition" from the high school to the university not being done was 18.9%. It is reported that it begins after a university admission at the time when it is important to the　adaptation to the university. In this study, we focused on "the anxiety" of the first grader of the rehabilitation medical care university from the viewpoint of smooth transition and adaptation to the university. A purpose of this study is to clarify the characteristic of the change of "the anxiety" mark between the fourth until one week before the regular examination for running from the university admission. As a result, a difference was considerably seen in the change of the state-anxiety mark between genders. Men, state anxiety mark for admission 1 months is the lowest, also it was the highest in a regular test 1 week before. On the other hand women, state anxiety continues to rise up to three terms, was the lowest in a week before the test. These differences may reflect the difference in orientation to seek the adaptation of university life by gender. At this stage, since it is inferred from the data, it is necessary to organize and analyze the questionnaire contents of anxiety interest

リハビリテーション医療系大学生における学業および大学生活適応尺度の作成

現在、高等学校卒業者のおよそ50%が大学へ進学している一方、休学・中退者の数は増え続けており、社会問題化している。文科省は休学・退学の要因として、高校と大学教育のギャップが生む『学業不振』を挙げている。必ずしも学業に重きをおかない、多様な価値観を持った学生のグローバル化が背景にある中、リハビリテーション医療系大学生は、一方で明確に学業をクリアすることを求められるという特徴がある。本研究の目的は、リハビリテーション医療系大学生を対象にした、学業および大学生活適応尺度を作成することである。作業療法学教員2名によって精選された35項目に対して、学生122名に反応を求めた。探索的因子分析の結果、感情・心理因子(6項目)、積極性因子(6項目)、適合感因子(4項目)、他者性因子(3項目)、自己対処因子(3項目)の5因子構造が得られた。信頼性に関しては,Cronbach α係数は高値を示し、因子間相関ではすべての因子間に有意な正の相関が見られ、一定の内的整合性、信頼性は保たれていた。Recently about 50 percent of the new graduates from high school enroll to university. However, the number of temporary absent or drop out students from university continue to grow up, and it becomes a social issue now. Ministry of Education, Culture, Sports, Science and Technology states that one of the factor of long term absence and dropping out from the university is poor academic performance that occurs from educational gap between high school and university . While the students with various senses of values are increasing, it\u27s important to give fixed academic performance for the student who try to be a rehabilitation related occupation. The purpose of this study is to develop the scale of relationship between academic performance and adaptation skill in university life for the OT students of Shijonawate—gakuen University.122 OT students were involved to answer the 35 questions which were selected by 2 OT teachers of the university. As a result of searching factor analysis, 5 factors which are consisted by feeling and psychological factor(6 items),initiative factor (6 items),feeling of conformity factor(4 items), other related factor(3 items) and self-cooping factors(3 items).The reliability by the Cronbach of coefficient shows high score and meaningful equilateral correlation among the factors also shows significantly high

運動方向の違いが到達把持運動時の指先距離に与える影響

本研究は、運動方向の違いが到達把持運動時の指先距離に与える影響を検討する事を目的とした。対象は、健常成人12名である。大球・中球・小球の3種類の物品を、正面(以下;F)、右45°(以下;R)、左45°(以下;L)に設置し、各物品に対する"F"・"R"・"L"の運動方向へ到達把持運動を実施し、動作解析法を用いて、動作開始から物品接触までの指先距離を抽出し,3群間で比較検討した。結果、大球の比較では、60～90%の時点において、"F"が、"L"より、指間距離は有意に広く、さらに"L"が"R"においても指先距離は有意に広かった。中球比較では、70～90%の時点で、"F"が"L"より、有意に指先距離が広く、さらに"R"が"L"より有意に広かった。小球では、60～95%の時点で、"L"が"F"より有意に指先距離が広く、さらに"L"が"R"より有意に広かった。これらのことから、"L"への到達把持運動では"F"・"L"と異なったパターンを示し、これらの要因として、肩関節・手関節における関節の自由度に対する方向調整と適応調整による動作パターンの違いが考えられ、運動方向の違いでの手指の形成パターンは異なることが明らかとなった。This study was intended to examine whether the difference in the movement direction affects the distance of the fingertip at the time of reaching the gripping movement. The subject is a healthy adult 12 people. Target is the large ball, medium ball and small ball, which is the three types. Placed of the target is a Front("F") and Right45°("R"), left 45 °("L") . Between three groups by extracting the distance of the fingertip with reach and grasping motion is compared motion analysis to each target. Result, In the comparison of large ball, "L" is significantly wider distance of the fingertip at time of 65-90% than the "F". "L" was more significantly wider than "R". In the comparison of medium ball, "F" is significantly wider distance of the fingertip at the time of 20-40% than the "L", "L" was significantly wider than "R". In the comparison of small ball, "L" is significantly wider distance of the fingertip at the time of 60-95% than the "F". "L" was significantly wider than "R". From these things, this study showed that the difference in the movement direction affects the fingers forming the pattern

リハビリテーション医療系学生の抑うつ状況について : 学習性無気力の観点から

リハビリテーション医療系学生は、授業の多さとそれに伴う課題の多さ、長期にわたる実習、国家試験などストレッサーとなる出来事が数多く長期に継続する特徴がある. 長期にわたるストレッサーの中、学生は「学習性無気力」の状況にあるのではないかと考え、学生の抑うつ傾向をはじめ自尊感情・ストレス反応など心理的状況を調査した. 結果として、抑うつ傾向・ストレス反応が高くまた自尊感情は低い状況が明らかになった. また家庭内に相談できる人物が多いこと、また睡眠・休養・食事のいわゆる生活リズムが確立していることが、抑うつ傾向を抑えることが示された. 学生生活や精神状態について家族と情報を共有すること、また生活リズムの確立に向けた援助が、教員として必要であると考えられた.Rehabilitation Medical student, there is a feature event to be a large number of stressors and challenges of multi-class, training for a long period of time, such as the national examination to continue in the long-term number. Under the influence of the stressor long-lasting, and is in a situation of "learned helplessness"to students, I guess. And I investigated the psychological conditions such as stress response and self-esteem and depression of students. That as a result, stress response and depression is high, self-esteem is low have been revealed. Which of the following influence to suppress the tendency of depression, it was that there is more than one person you can talk to family. Further, it may life including diet and rest and sleep is stable affects the suppression of depression was shown. I was considered the assistance for the establishment of life rhythm, is necessary as a teacher and that, to share information with the family about the mental state and student life

利き耳・非利き耳側への聴覚刺激が重心動揺に与える効果 足圧中心(COP)総軌跡長・矩形面積・外周面積に着目して

本研究は，利き耳・非利き耳側からの聴覚刺激が重心動揺に与える効果について検討した．被験者は健常若年者30名である．本研究は横断研究である．重心動揺の測定には重心動揺計を使用し，足圧中心（COP）総軌跡長・矩形面積・外周面積を抽出して比較検討した．研究条件は条件①：聴覚刺激無，条件②：利き耳側からの聴覚刺激，条件③：非利き耳側からの聴覚刺激である．結果，聴覚刺激無（条件①）と，利き耳側から聴覚刺激（条件②）では両群で有意な差を示さなかった．非利き耳側からの聴覚刺激（条件③）は，聴覚刺激無（条件①）と利き耳側から聴覚刺激（条件②）を比較したところ重心動揺が有意に減少していた．これにより，非利き耳側から入力された聴覚刺激は脳の側性化により対側半球の空間認知機能局在に情報が伝搬され，姿勢の調整に影響を与えていることが推察された．The purpose of this study was to examine the effect of auditory stimulation from dominant ear/nondominant ear on body sway. The subject were 30 healthy young people. This study was a Cross-Sectional study. The assessment of body sway was taken as the total length of Center of pressure（COP） displacements, Rectangular area, and Environmental area of COP using the stabilometer. Research Condition ①：Conditions that do not give auditory stimulation. Research Condition ②：Conditions of giving an auditory stimulus from the dominant ear side. Research Condition ③：Conditions for giving an auditory stimulus from the non-dominant ear side. As a result, Condition ① and Condition ② showed no significant difference in both groups. Condition ③ decreased significantly than Condition ① . Condition ③ also decreased significantly than condition ② . These results, auditory stimulation input from the non-dominant ear is sent to the cerebral hemisphere on the opposite side by laterality. From this, it is considered that the effect was given the body sway

緊張性振動反射が動作学習に与える影響 : 脳血管障害患者の肘関節伸展動作に着目して

本研究は脳血管障害患者8名を対象に麻痺側肘関節伸展動作の介入時に、緊張性振動反射（Tonic Vibration Reflex; TVR）を用いる事での動作学習への効果とその持続時間について明らかにする事を目的とした。研究デザインはクロスオーバー比較試験であり、条件①（肘関節屈曲伸展動作を自動運動で30回実施する条件）、条件②（条件①実施の際、肘関節伸展時に上腕三頭筋へのTVR を与えて実施する条件）の2条件である。各介入5、10分後にactive-ROMを測定して効果を検討した。介入5分後では両群共に条件②が条件①よりも有意に肘関節伸展角度が大きかった。介入10分後では両群共に条件間で有意差を示さなかった。このことからTVRを用いた機能的介入は即時効果としての促通効果に繋がる一方で、長期的な効果は認められなかった。これは本研究での介入期間が短すぎたことから、運動段階での内在的Feedbackに繋がらなかった事で忘却したものと考えられたThe purpose of this study was to examine effective use of TVR（Tonic Vibration Reflex） in motor training. Research Condition 1： The first condition consists of extending and flexing of a test subject\u27s elbow joint 30times without the use of TVR with a range of motion test of five and ten minutes. Research Condition 2： The second condition consists of using TVR on the triceps of the test subject\u27s elbow joint before extending and flexing the test subject\u27s elbow joint again 30times with a range of motion test of five and ten minutes. Results： After completing both tests, results shows that there is a significant and visible difference of the extension angle of the elbow joint while using TVR during the first five minutes of testing with both research conditions. However, there was not any significant or visible difference after the use of TVR after the ten minutes intervals of testing. Conclusion： TVR has an immediate effect in motor training. However, the TVR effect is only for a short amount of time. The possible reason for these results may be the short amount of time that was used to conduct the testing

作業目標を効率よく達成する作業遂行が認知機能面に及ぼす影響

注意の制御能力の低下から作業活動の持続が困難な対象者には、作業活動の一部の工程の反復練習をおこなうことも治療的に意味がある. 注意の制御能力の低下の一因に、ワーキングメモリを要する機能が不活発な影響も関与しているのではないかと推察した. 本研究では、作業活動の一部の工程を反復した作業課題よりも幾つかの工程を積み重ねて作業遂行することでワーキングメモリに関与する機能の活発化を仮定した. 健常成人10名を対象に4工程からなる箱つくりと、工程の一部を反復した箱の展開図を繰り返し作成する作業課題をおこない、作業後のワーキングメモリ機能に着目した認知機能検査を比較検討した. 4工程を順番に実施する箱つくりにおいて、対象者自身で効率の良い動作を制御する機会が増え、記憶の保持と処理が並列的におこなわれたことからワーキングメモリの機能に着目した認知機能検査に影響を与えた.It is therapeutic to practice some processes of occupation action repeatedly to the subject that persistence of working action is difficult from degradation of ability for control of care, and there is a meaning. We speculated whether the mechanism which needed working memory in a cause of degradation of ability for control of care did not contribute to inanimate influence either. We supposed functional activation to contribute to working memory by we piled up some processes than the occupation problem that repeated some processes of working action by this study, and accomplishing occupation. We did an occupation problem we repeated development of the box which repeated a box structure comprising four processes and a portion of a process for ten normal adults, and to make, and comparison reviewed the cognitive function examination that paid its attention to working memory mechanism after occupation. The opportunities that controlled good movement of the efficiency of we increased by, subject oneself in a box structure to carry out four processes in turn, and mnemonic containment and disposal affected the cognitive function examination that paid its attention to mechanism of working memory from what was done multiply