지역사회 거주 뇌졸중 환자의 가정방문 작업치료 효과: 사례 연구
Effect of Home-Visit Occupational Therapy on Community Dwelling Stroke Survivors: A Case Study
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목적 : 본 연구는 재가 뇌졸중 환자를 대상으로 가정방문 작업치료를 제공한 사례를 통해 가정방문 작업치료서비스의 효과성을 검증하고자 하였다. 연구방법 : 서울시 소재 보건지소에 가정방문 작업치료 서비스를 신청한 뇌졸중 환자 두 명을 대상으로가정방문 작업치료 프로그램은 대상자의 일상생활동작 기능, 작업수행 기능, 인지기능, 정서 기능을평가하고 클라이언트 중심 접근(Client-centered approach)을 기반으로 작업치료 목표를 설정하고 중재를 계획하였다. 작업치료 프로그램은 클라이언트의 주요 문제를 바탕으로 여가 활동 탐색 및 참여를목표로 설정하여 12회기의 프로그램으로 구성하였다. 결과 : 두 사례 모두 COPM 점수에 향상이 있었고, 사례 2에서 MBI와 K-MMSE 점수의 향상이 있었다. 또한 사례 1에서 KGDS 점수의 향상이 있었다. 결론 : 가정방문 작업치료는 뇌졸중 환자의 삶의 질 향상 및 경제적 부담 등을 고려하면서 뇌졸중 환자의일상생활활동, 인지, 정신적 기능의 변화가 있음을 확인하였다. 가정 및 지역사회 통합에 있어 기관중심재활에서 지역사회중심재활로 지속적이고 연속된 재활 서비스가 활성화가 요구되어지며, 병원에서 퇴원하는 뇌졸중 환자들의 신체적, 인지적, 정신적 및 사회적 접근의 증진을 위한 적극적인 가정방문 작업치료서비스가 필요하다.
Abstract
Objective : The purpose of this study was to verify the effectiveness of home-visit occupational therapy in stroke patients. Methods : Two patients with stroke who applied for home-based occupational therapy services at a health center in Seoul were enrolled. The home-visit occupational therapy program evaluates the subject's daily living, task performance, cognitive, and emotional functions, sets occupational therapy goals and plans interventions based on a client-centered approach. Occupational therapy programs consisted of 12 sessions based on the client's major problems. Results : COPM scores improved in both cases, there was an improvement in COPM scores, and in Case 2 there were improvements in MBI and K-MMSE scores. There was also an improvement in KGDS scores in Case 1. Conclusion : Home-visit occupational therapy was found to be effective in improving daily activities, cognition, and mental function of stroke patients. During home and community integration, continuous and continuous rehabilitation services need to be activated from institutional rehabilitation to community-based rehabilitation. Active home-visit occupational therapy is needed to promote physical, cognitive, mental and social access in stroke patients discharged from hospitals.
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