Occupation-based Occupational Therapy for an Youth With Sensory Integrative Dysfunction - A Single Case Study

감각통합기능장애를 가진 청소년의 작업수행에 초점을 맞춘 작업치료 사례

Introduction : Sensory Integration(SI) theory, science it is developed by an occupational therapist A. Jean Ayres, is the one of the most popular frames of reference used in occupational therapy(OT) intervention. It has been proved as a scientific theory especially in neuroscience discipline through abundant research and practice. Occupational therapists apply the SI therapy with strong clinical reasoning to improve adaptive behaviors of their clients and try to link the adaptive behaviors with occupational performance in the clients' everyday life. One of the manners regarding clinical reasoning is Top-down approach. In occupational therapy discipline, Top-down approach is well-reflected within two evaluation tools; Canadian Occupational Performance Measure(COPM) and Assessment of Motor and Process Skills(AMPS) and two models of practice; Canadian Model of Occupational Performance(CMOP) and Occupational therapy intervention process model(OTIPM). Objective : The purpose of this paper demonstrates how SI therapy can be employed within OTIPM and how the OT process (evaluation-intervention-outcome) can be structuralized based on the Top-down approach. This single-case study recognizes the impact of a SI therapy for a male adolescent on his occupational performance. Intervention Examined : "P" was 16 years old male adolescent with no diagnosis and junior of the high school when he was referred. P was always with mouth opened, showed difficulties in gathering things need to be prepared and managing and paying money for shopping, and his colleges dislike getting close to him because he can't was his body well. AMPS was administrated in initial evaluation and reevaluation of P's occupation performance, Bruininks-Oserestky Test of Motor Proficiency-2(BOT-2) was carried out to assess motor functions and perception skills related in sensory integration, and occupational therapist performed clinical observation in order to complement the evaluation quantitatively and quantitatively. Based on the evaluation, it is concluded that the SI therapy is primary means to improve P's occupational performance, and three therapeutic approaches were constructed; restorative, acquired and compensatory approach. P showed improved motor and process skills in occupational performance after undergone the occupational therapy. Conclusions : The sensory integration therapy was practical enough to build the bridge between the occupational performance(Top) and the underlying component problems (Bottom). The OTIPM was helpful to identify meaningful occupation for P and P's family within P's contexts, and the AMPS was valuable to analyze and clarify the cause of difficulties in the chosen occupational performance.

서론: 감각통합은 작업치료의 치료적 중재 근거이론(frames of reference)들에서 가장 중요하고 널리 사용되는 것 중 하나이다. 이는 작업치료사인 Jean Ayres가 클라이언트의 적응행동을 향상하기 위한 목적을 두고 발전된 이론이며, 시작된 이래로 많은 작업치료사들이 같은 목표를 가지고 적용해 왔기 때문이다. 감각통합이론을 적용하는 작업치료사로써, 임상에서 감각통합과 그 목표가 되는 적응행동인 작업수행을 치료의 결과로써 증명해 내는 것은 작업치료의 목표가 작업수행의 향상을 전제로 하는 것이기에 매우 중요하며 도전이 되는 것이다. 본론: 본 연구는 작업치료중재과정모델인 OTIPM(Occupational Therapy Intervention Process Model)이라고 하는 하향식(Top-down) 접근의 중재모델을 감각통합의 기능장애를 가지면서 일상의 작업수행에 어려움을 보이는 16세의 청소년에게 적용하여, 감각통합이론의 적용이 작업수행향상에 어떠한 의미를 가지는지 살펴보고자 하였다. 결론: 본 연구에서 적용한 OTIPM의 적용 사례를 통해, 감각통합적인 접근은 클라이언트가 일상에서 수행하기 어려웠던 작업수행에 대한 원인을 추론하는 데 유용하였다. 본 연구의 사례에서 감각통합적인 관점과 접근은 작업수행(Top)에 영향을 주는 기본적인 요소적 문제(Bottom)를 연결하는 첫단계의 중재로써 큰 의미를 가졌고, OTIPM의 적용과정은 클라이언트에게 의미 있는 작업수행을 발견하고 이에 초점을 두어 가장 우선되는 중재를 단계적으로 전개하여, 감각통합치료 이후 실제 작업수행에 초점을 둔 접근을 전개하는 데 유용하였다.