家庭における重度失語症者と家族のコミュニケーションに見られる困難とその解決について

本研究の目的は,家庭での重度失語症者と妻のコミュニケーションでどのような困難が生じ,どのように解決されるかを明らかにすることである.重度失語症者3名とその妻の昼食時の会話をビデオに記録し,すべて文章化した.その中から15分間を分析対象とし,話題の変化で区切り,その区分ごとにコミュニケーション困難の有無と原因,困難解決の有無と解決理由を調べた.その結果,3組の対象は,喚語困難,錯語,聴覚的理解障害等により,全話題の半分またはそれ以上にコミュニケーション困難を生じていたが,その内の約7割は解決されていた.解決行動には「言語的補完」「内容の明確化」「相手への行動の促し」「自己の身体の使用」「道具の使用」「共有情報の使用」等があり,どの行動を使用するかは対象の組,または患者・妻のいずれであるかにより異なっていた.全ての組で1話題をめぐる発話数が,困難の有無にかかわらず健常者よりも多くなっていた.

The purpose of the present study was to clarify what kinds of problems arose in communication between severe aphasics and their wives at home and how and to what extent they were solved. Three pairs consisting of a severe aphasic and his wife were asked to freely talk to one another during their lunch time at home, while they were videotaped. All the conversation was transcribed. 15 minutes from these typical communication scenes were selected and subjected to study. They were divided into "cuts" according to topics. Regarding each "cut", it was determined 1)whether a communication problem arose or not, 2)what caused the problem, if it occured, 3)whether the problem was solved or not, and 4)how it was solved, if this were the case. The results showed that each pair of subjects had the communication problems in half or more of the topics about which they communicated, because of word finding difficulty, paraphasia or impaired auditory comprehension and other problems. However, it was found that approximately 70% of the problems were solved by themselves. Their means of solving the problems were classified into six categories, namely "Verbal complementation", "Content clarification", "Encouraging of verbal expression", "Using their bodies", "Using of tools", "Guessing through previously shared information". Each pair, each patient and each wife, differed in what kind of solving procedure he or she used. Each pair showed a greater frequency of conversation turn for each topic than normally expected.