中風個案的職能調適經驗

Occupational Adaptation Experiences of Persons with Stroke

林美伶(Mei-Ling Lin) ； 羅鈞令(Jin-Ling Lo) ； 張玲慧(Ling-Hui Chang)

《職能治療學會雜誌》 32卷1期 (2014/06) Pp. 9-34

https://doi.org/10.6594/JTOTA.2014.32(1).01

摘要

本研究從中老年中風者的觀點了解他們刪選與從事日常職能時使用的調適策略，以及考量因素。研究結果有助職能治療師擬定貼近個案想法與期待之介入計畫。本研究為一國科會研究計畫的一部份，採立意取樣，從18位55歲（含）以上、居住在社區、中風後1年（含）以上，且無嚴重語言與認知損傷的中風者中選擇5位由子女主要照顧且子女亦願意參與研究者，雙方皆接受1到2次深入訪談與參與觀察。我們遵循紮根理論原則做質性分析及確保研究品質。中風者年齡介於60至89歲，皆為女性。4位聘有外籍看護。中風者使用的職能調整策略包括著重從事能夠維持身體功能或身體健康的活動、安排從事自己可勝任的活動、自我限制或停止參與可能造成負面影響或子女負擔的活動、接受外籍看護協助、與規律化生活作息。我們以刪選、最佳化與代償策略模式（Selection, optimization, and compensation model）進一步檢視調適策略。中風者視活動性質、個人理念與子女對照顧的期待，於選擇與執行職能的過程結合使用刪選、最佳化與代償策略。結果突顯「自我限制或停止參與可能造成負面影響或子女負擔的活動」與「接受或安排外籍看護協助」對中風者及其家庭的調適與正面意涵，有別於傳統介入偏重協助個案重拾病前看重的活動與最大化功能獨立之方向。

關鍵字

職能調適 ； 中風 ； 「刪選、最佳化與代償模式」

並列摘要

This study explores the adaptive strategies in daily occupations from the perspectives of middle-aged and older adults following stroke. The findings help occupational therapists design intervention consistent with the clients' expectations and needs. This study is part of a research project funded by National Science Council. 5 women and their 7 primary adult child caregivers were purposefully selected from the original 18 adults who met the criteria of ＂living in the community, at least one-year-post-stroke, and no significant language and cognitive impairments. Both patients and caregivers were interviewed and observed one to two times each year for two years. Grounded theory was adopted as an analytic reference. Five women were aged from 60 to 89, and four hired foreign domestic helpers. The adaptive strategies were ＂limit or cease participation in activities that may contribute to negative outcomes or impose caregiving burdens,＂ ＂emphasize activities that maintain or improve physical health and function,＂ ＂maximize participation in the activities with which they felt competent,＂ ＂ask for the assistance of foreign domestic helpers,＂ and ＂regularize daily routines.＂ We use ＂Selection, optimization, and compensation model＂ to examine the data further. A combination of selection, optimization, and compensation strategies were used according to the activity characteristic, personal values, and caregivers' expectations. Limited participation in occupations and receipt of assistance is associated with adaptive and positive meanings, contrary to the traditional occupational therapy approach that emphasizes restoration of previous valued occupations and maximization of functional independence after stroke.

並列關鍵字

Occupational adaptation ； Stroke ； ＂Selection, optimization and compensation model＂