Change of Quality of life by support focusing on Meaningful Occupation : Client-Centered Practice for a case with aphasia using Day Service
| Autor: | Shintaro, MORIMOTO |
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| Jazyk: | japonština |
| Rok vydání: | 2020 |
| Předmět: | |
| Zdroj: | リハビリテーション科学ジャーナル = Journal of Rehabilitation Sciences. 15:51-67 |
| Popis: | 実践報告 Practical report 本稿では，あるデイサービス施設において失語症により言語表出が困難となった1 事例に対し，「意味のある作業に焦点をあてた「クライエント中心」の支援を実践し，日常生活の作業遂行，利用中の活動状況，QOL の変化を多角的に分析することで「利用者本位」に資するデイサービス支援の一端を探索的に明らかにすることを目的とした．方法は，作業療法士が，言語表出が極力少ない方法で評価を行い，事例の「意味のある作業」を同定し「意味のある作業」の遂行に焦点を当てた介入を「クライエント中心実践における共通概念」に沿って約6 ヶ月間実施した．また，介入前後で，日常生活の作業遂行（作業バランス自己診断），利用中の活動状況（参加観察），QOL（WHO QOL26）を実施し，変化を多角的に分析した．その結果，日常生活における「意味のある作業」の数が増加及び肯定的な意味付けに変化し，能動的に施設を利用できるようになった．また，WHO QOL26 の「肯定的感情」や「健康と社会的ケア等の複数の下位項目にて得点の上昇を認めた．以上のことから，失語症を患う表出困難な利用者に対し，「利用者本位」のデイサービスを提供するためには，作業療法士が利用者の状況と表出能力を見極め「心身機能，活動，参加，背景因子」をバランスよく評価し，利用者の「意味のある作業」に焦点を当てた相互主体的な関わりの中で，肯定的なQOL を構築し続けることが重要であると示唆された． In this study, client-centered support was practiced focusing on the meaningful occupation of one case where verbal expression was difficult due to aphasia in a day-service facility. This study aimed to clarify one piece of day-service support that contributed to client-orientation through various analyses of daily occupation performance, activity status during use, and changes in QOL. Methods included an occupational therapist’s evaluation in a manner that minimized verbal expression, identification of the case’s meaningful occupation, and intervention that focused on performing meaningful occupation. This method was conducted for approximately six months that concurred with common concepts in client-centered practice. Moreover, daily occupation performance (occupation balance self-diagnosis), activity status during use (participation observation), and QOL (WHO QOL26) were measured, and changes before and after the intervention were analyzed in various ways. Results showed the number of meaningful occupations in daily life increased, and they took on a positive meaning, making it possible to use the facility actively. Moreover, scores increased for multiple WHO QOL26 sub-items such as positive emotions, health, and social care. Based on these findings, it became clear that to provide client-oriented day service to clients with expression difficulties, it is important for an occupational therapist to determine a client’s status and expression ability and evaluate mind–body functions, activity, participation, and background factors and to continue to build a positive QOL in mutually subjective relationships focusing on the client’s meaningful occupation． |
| Databáze: | OpenAIRE |
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