Departmental Bulletin Paper 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
Effective Training Method for Exchanging Dominant Hand of Chopstick Manipulation : From the Viewpoints of Cerebral Blood Flow, Difficulty Level and Performance

佐野, 哲也  ,  宮前, 珠子  ,  中島, ともみ

 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.

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