学位論文 脳血管障害者のADL自己評価における心理介入効果の研究

堀, 翔太

pp.1 - 13 , 2015-03-25
内容記述
回復期リハビリテーション病棟に入院中の7名の脳血管障害者に対し,自己への気づきを促すため,認知行動療法を応用したカウンセリングを2か月間,計16回実施した.評価として開始時と中間(1か月後),最終(2か月後)でADL自己評価とFIM,FIM合計,うつ状態,情動障害の測定を実施した.またADL自己評価とFIMの違いを評価比と定義し,ADL自己評価と客観的評価であるFIMとの差から評価比を算出した.その結果,各ADL項目の評価比で有意な変化はみられなかったが,FIMでは有意な改善がみられ,うつ状態,情動障害においても有意な改善がみられた.各ADL項目の評価比とうつ状態,情動障害との関連性はみられなかったが,ADL自己評価を安定させるためには対象者のうつ状態や情動障害の軽減だけでなく,自己効力感の評価や自己効力感を考慮した作業療法訓練とカウンセリングが必要であることが示唆された.
In order to facilitate patients' self-awareness, applied Cognitive Behavioral Therapy, counseling has been conducted sixteen times in two months for stroke patients admitted in the recovery phase rehabilitation ward. The self-evaluation of ADL, FIM, total FIM, depressive state and emotional disturbance were evaluated at the start, in the middle (after one month), and at the end (after two months) of this study. Given the definition of discrepancy between self-evaluation of ADL and FIM as evaluation ratio, it was calculated from the remainder between self-evaluation of ADL and FIM as an objective evaluation. As a result, there were no significant differences in evaluation ratio of each ADL item, but there were significant improvements in total FIM, depressive state, and emotional disturbance. There was no direct relationship between evaluation ratio of each ADL item and depressive state and between the ratio and emotional disturbance. Therefore, the following factors seem to be important to make self-evaluation of ADL stable; occupational therapy and counseling with self-efficacy of stroke patients taken into consideration and also evaluation of self-efficacy as well as improvements in depressive state and emotional disturbance.
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