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		<h1 class="catchCopy">CI療法を臨床で実践するための技術と科学のエッセンス</h1>
		

		<h1 class="title">上肢運動障害の作業療法<span class="version"></span></h1>
		<h2 class="subTitle">麻痺手に対する作業運動学と作業治療学の実際</h2>

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					著：竹林　崇（大阪府立大学）
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				<ul class="property"><li class="disc">B5判・214頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-4571-6</li><li class="disc">2018年9月11日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">脳卒中後の麻痺手に対するCI療法を中心としたアプローチ方法を豊富な図表と科学的根拠をもとにレクチャー．実施するための具体的な評価法，実践的な課題指向型アプローチにおける課題の作成方法と膨大な数の課題一覧表を記載し，初学者でも方法論を理解できるような構成となっている．さらに，CI療法を中等度および重度の対象者に実施するための工夫や，効果を促進するための物理療法や他療法など，多くの併用療法の実際の他，行動学的手法であるTransfer packageにも触れている．多くの場面で，事例に関わるエピソードを記載しており，文字だけでなく，読者の実体験にも訴えかけ，学習が進むように工夫が凝らされている．</section><section class="preface">序　文<br><br>　筆者は2003年から脳卒中後の麻痺手に対するアプローチであるconstraint-induced movement therapy（CI療法）に関わり続け，はや15年が経過する．当初から，CI療法のことを，「作業療法を圧縮したようなアプローチ方法」だと考えていた．その理由としては，心理学を基盤としていることや，運動・行動学習などを基盤としていることなど，作業療法と共通する点が多岐にわたることもあるが，最も大きな理由は，目標の「作業」を成し遂げるために，「作業」を用いてアプローチする点にあると筆者は考えている．そして，最も重要な指標を生活での麻痺手の使用行動を測定するmotor activity logや，それらを促進するための行動学的戦略であるtransfer packageなども，強く作業療法を連想させるキーワードとなっていることは間違いない．<br>　ただし，このように作業療法とシンクロニシティが高いアプローチ方法だと筆者が考えていたにもかかわらず，世間の作業療法士からは「機能練習」として大きな誤解を受けていたことも事実である．その結果，2000年代は一部の作業を大切にする作業療法士からは，「機能的アプローチであるCI療法は私たち作業療法士の仕事ではない」とまで揶揄されることも少なくなかった．ただし，最近では多くの作業療法士がCI療法の本質を理解し，CI療法の代名詞でもある「エビデンス」に加えて，作業療法を成就するための一手法として市民権を得てきた印象がある．<br>　本書は6章から構成されており，I 章の作業療法とCI療法の歴史から始まり，II ，III 章では，実施するための具体的な評価方法について触れている．さらに，IV 章からは，実践的な課題指向型アプローチの課題の作成方法と膨大な数の課題一覧表を記載し，初学者が本書を手に取りながら，方法論を理解できるような構成となっている．さらに V 章では，CI療法を中等度と重度の対象者に実施するための工夫や，効果をより促進するための物理療法や他療法など，多くの併用療法の実際に触れた後に，VI 章にて行動学的手法であるtransfer packageにも触れている．多くの場面で，事例に関わるエピソードを記載しており，文字面だけでなく，読者の実体験にも訴えかけ，学習が進むように工夫を凝らしている点が特徴である．<br>　最後に，本書の出版にあたり，前職の兵庫医科大学病院にてCI療法を著者に教育し，多くの研究課題を提供してくださった，リハビリテーション医学教室主任教授である道免和久先生と，医師・作業療法士の皆さんには感謝の念をこの場を借りて述べたい．さらには，ここまでの研究や知見を提供してくださった多くの対象者の方にも深謝したいと思う．<br><br>2018年9月<br>竹林　崇</section><section class="indexes">I　作業療法における機能的アプローチの役割<br>　1　作業療法の機能的なアプローチに対するスタンス<br>　2　上肢アプローチの作業活動を用いたアプローチの台頭<br>　3　脳卒中後の上肢麻痺に対する課題指向型アプローチ<br>　　１　作業活動を用いたアプローチ＝課題指向型アプローチとは？<br>　4　脳卒中後の上肢麻痺に対する作業を用いたアプローチのエビデンス<br>　　１ CI療法が中枢神経システムの可塑性に関わるメカニズム<br>　　２ CI療法のエビデンス<br>II　作業を用いた上肢機能アプローチを行うための基本的な評価<br>　1　脳卒中後の上肢麻痺に対する特異的評価と運動学的評価の役割<br>　2　「 客観的数値」を示すための脳卒中後の上肢麻痺に対する特異的な検査<br>　　１ 身体機能・構造（body function）<br>　　　① Fugl-Meyer assessment（FMA）の上肢運動項目<br>　　　② ブルンストロームステージ（BRS）<br>　　　③ modified Ashworth scale（MAS）<br>　　　④ motricity index（MI）<br>　　２ 活動（activity）<br>　　　① action research arm test（ARAT）<br>　　　② Wolf motor function test（WMFT）<br>　　　③ box and block test（BBT）<br>　　　④ 簡易上肢機能検査<br>　　　⑤ assessment of motor and process skills（AMPS）<br>　　３ 参加（participation）<br>　　　① motor activity log（MAL）<br>　　　② カナダ作業遂行測定（COPM）<br>　　　③ stroke impact scale（SIS）<br>　　　④ 活動量計<br>　3　運動学的評価の役割<br>　4　事例を通した運動学的評価の実際<br>　　１ ボトムアップ評価<br>　　　① 異常な共同運動パターンを評価する<br>　　２ トップダウン評価<br>III　運動学的評価による課題作成とアプローチ手法の決定<br>　1　事例を通して運動学的評価を実践してみよう<br>　2　練習課題の作成<br>　　１ shaping<br>　　　① 肩の適合性を整える<br>　　　② 使用する物品を決める<br>　　　③ 課題のなかで使える手をつくる<br>　　　④ さらに分離を促し機能向上を目指す<br>　　　⑤ その他の手指，手関節に対するアプローチ<br>　　２ task practiceにつなぐためのshaping<br>　　　① 肩甲骨の適合性をつくる<br>　　　② 使用する物品を決める<br>　　　③ 課題のなかで使える手（近位上肢）をつくる<br>　　　④ 課題のなかで使える手（遠位上肢）をつくる<br>　　３ task practice<br>　　　① task practiceを導入するタイミング<br>　　　② task practiceにおける難易度調整<br>　　　③ task practiceにおける両手動作の位置付け<br>IV　練習課題の種類と運用方法<br>　1　作業課題のバリエーション<br>　　１ shapingの例<br>　　　１. ブロック移動／２. ひも結び／３. 液体をすくう／<br>　　　４. ボタンの着脱／５. 物品にバンテージを巻きつける／<br>　　　６. ビー玉をチラシで包む／７. タイピング／８. 書字動作／<br>　　　９. コイン操作／10. 手掌内でのボールの操作／11. おはじき弾き／<br>　　　12. ページめくり／13. 輪ゴム入れ／14. のりのキャップを開ける／<br>　　　15 .トランプめくり／16. 輪移動／17. ペグボード移動／<br>　　　18. ネジまわし／19. ベルクロ<sup>®</sup>を剝がす／20. レースボード／<br>　　　21. プラスチックコーンの移動／22. ピンチペグの移動／<br>　　　23. アークアンドリング／24. 手指で円を描く／<br>　　　25. ホッチキスやパンチを使用する<br>　　２ task practiceの例<br>　　　１. 爪切り課題／２. 身体を洗う／３. 髪をとく／<br>　　　４. ジャケットのジッパーを締める／５. 歯磨き／<br>　　　６. スープを食べる　飲み物を飲む／７. 衣服の着用／<br>　　　８. 靴下の着脱／９. 顔剃り／10. 手袋の着脱／<br>　　　11. マウスをクリックする／12. テーブルや壁を拭く／<br>　　　13. テーブルセッティング／14. 食材を切る／15. 携帯電話の操作<br>　2　作業課題の運用方法の実際<br>　　１ 適切な練習量<br>　　２ 練習量を担保するマネジメント<br>　　　① 家族にCI療法の教育を行う<br>　　　② ほかの医療スタッフと連携を図る<br>V　課題指向型アプローチを効率化する手法<br>　1　経頭蓋磁気・直流電気刺激<br>　2　末梢電気刺激<br>　3　ミラーセラピー<br>　4　振動刺激<br>　5　ロボット療法<br>　6　ボツリヌス毒素施注<br>VI　練習成果を生活環境に定着するための行動学的手法<br>　1　どうして行動学的手法が必要なのか<br>　2　行動学的手法であるtransfer packageとは<br>　　１ transfer packageの構成要素<br>　　　① 毎日MALのQOMを自己評価する（麻痺手の観察：monitoring）<br>　　　② 麻痺手に関わる日記をつける<br>　　　③ 実生活で麻痺手を使用するために存在する，障害を克服するための問題解決技法の獲得<br>　　　④ 行動契約<br>　　　⑤ 介助者との契約<br>　　　⑥ 自宅での麻痺手の使用場面の割り当て<br>　　　⑦ 自主練習の指導<br>　　　⑧ 毎日の練習内容の記録<br>　　２ CI療法の手続きの流れ<br>索　引</section></article>
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