著者らは，頚髄損傷の男性が受傷後36年目に独居および就労を目指し，取り組むのを支援した。クライエントの最初のニーズは独居生活に必要な自己導尿の技術を身につけることだった。9回の練習によってヘルパーの援助を受けながら部分的に自己導尿が可能となったものの，独居後の排尿管理の時間を少なくすることを優先し，最終的にカテーテルを留置することとなった。次に，作業療法では住環境や職場環境の整備についての助言，ケア会議における意見陳述，ADL 遂行技能の評価と介入を行った。とりわけ，ADLの練習では，自ら介護者に具体的に指示を出しながら介助を受けるよう指導した。事例を通して，地域における作業療法の役割は，作業遂行技能の改善や住宅改修の助言だけでなく，クライエントの思いや権利を代弁すること，作業的公正が図れるよう行政や社会に働きかけること，生活上の問題を自身で制御可能となるよう支援することであると提言された。

We supported a client with spinal cord injury in being able to live alone and get work. His main need was to get the skill of self-catheterization partially using an external catheter with a caregiver's assistance. Though he got this skill due to practicing nine times, he consequently accepted putting in an indwelling catheter, because he gave priority to reducing time for urination management after living alone. In addition, we offered the following for him: to advise on making house and workplace modifications, to evaluate and intervene regarding some activities of daily living (ADL) performance, to make statements in care meetings. We considered it important that he could concretely instruct the caregiver to assist his ADL performance. Through this case, we propose that occupational therapy's roles in the community are not only to improve occupational performance and advise on making house modification, but also to advocate for clients in order to realize their wished-for life, appeal to the administration in order to realize occupational justice and to support clients so that they can control their problems of life.

症例報告

Clinical Reports