日本の作業療法における対象者理解の歴史的変遷 : 脳血管障害の作業療法からみる健康観と主体性

本稿では過去40年間の日本の作業療法実践が時代とともに変遷いまだその中で対象者の健康やその主体性をどのようにみているのかを検討するため,G. Kielhofnerが示したパラダイムの構成要素参照し,脳血管障害に対する作業療法に関する文献の検討を行なった。その結果,パラダイムの変遷は確認できたが,健康や主体性についての視座の乏しさがみられた。変遷した要因としては,(1)米国の実践や理論の影響を強く受けていること,(2)QOL概念の導入により,医療者中心の治療主義から対象者中心の生活モデルへ視点が変化しつつあること,(3)医療技術の進歩による疾病構造の変化,(4)高齢社会の到来による,要介護者の増大という4点が考えられた。また対象者の健康や主体性に対する視座が乏しい点については,海外の実践や理論の平行使用による理論と実践の乖離,日本独自の実践理論の未成熟による哲学的基礎の欠如という2点から考察を加えた。The purpose of our work is to examine how occupational therapy practices in Japan as well as therapists\u27 views of health and initiative of clients have changed over the last forty years. We conducted research, based on the paradigm theory modeled by G. Kielhofner, on the literature on occupational therapy for patients with cerebrovascular disorder. As a result, a paradigm shift was confirmed, however there were relatively few mentions of therapists\u27 views of health or initiative of clients. Identified as the reasons for the paradigm shift were ; (1) the influence of practices and theories dominant in the United States, (2) introduction of the Quality of Life concept, which led to a gradual change in viewpoint from a therapist-centered, treatment-oriented model to a client-centered, life-oriented one, (3) the change in disease pattern caused by development of medical technology, and (4) the increase of the frail elderly and clients requiring long-term care in our aging society. As for the reasons why little attention was being paid to health and initiative of clients, two topics were discussed ; (1) the disparity between theory and practice due to the application of several foreign practices and theories in parallel, and (2) the lack of the philosophical foundation due to the immaturity of Japan\u27s original practice theories