以職能治療任務導向途徑改善女性中風患者穿內衣技巧：重度體感覺損傷患者之個案報告

Use of The Occupational Therapy Task-oriented Approach to Improve Bra Dressing Skill for A Woman with Severe Somatosensory Impairment after Stroke

李佳靜(Chia-Ching Li) ； 許世賓(Shih-Pin Hsu) ； 徐宇璇(Yu-Hsuan Hsu)

《臺灣職能治療研究與實務雜誌》 13卷1期 (2017/06) Pp. 34-46

https://doi.org/10.6534/jtotrp.2017.13(1).34

摘要

目的：穿女性內衣是複雜的、有意義且高私密性的自我照顧活動，中風後偏癱的患者，尤其合併體感覺失能，過去介入採取代償途徑，矯治途徑的成效未知。職能治療任務導向途徑目的是改善患者的職能表現和動作功能，本篇個案報告描述職能治療任務導向途徑介入慢性中風患者穿內衣困難的過程與成效。方法：一名50歲的女性病患，8年前因中風造成右側輕癱和體感覺功能損傷，希望穿著一般內衣，並且於背後扣鉤子。患者於地區診所接受一天90分鐘，每週3到5天的職能治療任務導向途徑訓練，包含單手任務和雙手任務；除了動作訓練，也加入感覺電刺激和冷熱刺激於患側，提供大量感覺輸入。結果：經過40次職能治療任務導向介入，患者習得背後穿扣內衣的技巧，不需他人協助，時間花費為1.5分鐘，一個月後追蹤，患者依然可獨自穿脫內衣。評估量表的分數指出，患側上肢的動作功能、肌力和體感覺功能均有提升。結論：職能治療任務導向途徑結構化的評估架構和治療原則，解決該名女性中風患者雙手穿後扣式內衣的問題，同時改善患側上肢的個體因素。此案例中，多元感官介入有助於職能治療任務導向途徑的成效，此發現值得未來研究進一步探討。

關鍵字

穿脫衣物 ； 任務導向途徑 ； 中風 ； 體感覺損傷

並列摘要

Objective: Bra dressing is a complex, meaningful and private occupation. In literature, occupational practitioners use compensatory approaches to prevent sequela after unilateral stroke (esp. sensory impairments) from becoming difficulty of dressing bra. Effect of remedial approach is unknown. The aim of occupational therapy task-oriented approach is to promote occupational performance by optimizing motor performance. This case report demonstrated the process used this approach to improve the bra dressing skill for a patient with chronic stroke. Method: A 50-year-old woman suffered a left hemispheric stroke with right hemiparesis and severe somatosensory impairment 8 years ago. She hoped that she would be able to put on back-fastening bras in back with two hands. She participated in 90-minutes occupational therapy, involving unilateral and bilateral tasks. Augmented afferent inputs (electrical and thermal stimulation) were also integrated into the program. The frequency of treatment was 3-5 sessions per week. Result: After 40 sessions, patient wore her bra in back bimanually and consumed 1.5 minutes to finish the task independently. This performance was maintained at 1 month follow-up. Sensorimotor outcomes of the affected upper extremity showed positive changes over time. Conclusion: Structural evaluation framework and treatment principles described in this approach was effective in assisting the patient in reusing two hands to dress a bra and improving relevant person factors. Multi-sensory inputs may be a potential therapeutic component to enhance the efficacy of this approach. This hypothesis should be further evaluated.

並列關鍵字

Dressing ； Task-oriented approach ； Stroke ； Somatosensory impairment