작업치료사를 위한 인지재활

제1부 인지재활 이론 및 평가

제1장 ·인지란 무엇인가? [김영근, 대구보건대학교] ···································································· 17
1.1 인지에 대한 개념 ····························································································· 19
1.2 정보처리 관점에서 인지에 대한 해석 ······················································· 21
1.3 인지와 지각의 구분과 분류 ·········································································· 25
1.4 메타인지에 대한 개념 ····················································································· 30
1.5 사회인지 ·············································································································· 33
1.6 상황인지 ·············································································································· 36
1.7 인지재활 ·············································································································· 38

제2장 작업수행과 인지 [홍승표, 동남보건대학교] ········································································ 45
2.1 인 지 ···················································································································· 47
1. 국제기능.장애.건강 분류 / 48
2. 작업치료 실행체계에서의 인지 / 52
2.2 인지장애 ·············································································································· 54
2.3 근거 중심 인지재활치료 ················································································· 56
1. 연구방법 / 56
2. 인지재활분야에서의 작업치료 연구 / 59
3. 향후 연구의 방향 / 63
2.4 요 약 ···················································································································· 64

제3장 인지재활의 이론적 배경 [김영근, 대구보건대학교] ························································ 69
3.1 작업치료 철학과 인지재활 이론의 틀 ······················································· 71
3.2 두 가지 방향의 치료 접근법 ········································································ 73
3.3 작업치료 이론의 틀(인지재활을 중심으로) ····················································· 75
1. Toglia의 인지재활 / 75
2. 역동적 상호작용 모델 / 84
3. 알렌 인지장애 이론의 틀 / 92
4. 인간작업 모델 / 97
5. 재훈련 접근 / 101
6. 신경기능 접근 / 103
7 재활.보상적 모델 / 104
3.4 기능인지 ·············································································································· 107
1. 기능인지 개념 / 107
2. 기능인지 평가 / 108
3. 기능인지 중재 / 112
4. 기능인지의 발전 / 113
3.5 CO-OP ··············································································································· 114
1. CO-OP 기초 개념 / 114
2. CO-OP 출현과 발전 / 115
3. CO-OP 3핵심원리 / 116
4. CO-OP 적용대상 / 116
5. CO-OP 임상적 목적 / 117
6. CO-OP의 7가지 핵심특징 / 117

제4장 인지재활 임상적 추론 [오윤택, 세브란스재활병원] ······················································· 129
4.1 어떤 치료를 할 것인가?: 인지재활에서 임상추론 ································ 131
1. 추론의 종류 / 133
4.2 추론의 과정 ······································································································· 138
1. 정보의 수집 / 138
2. 가설 설정과 우선순위 결정 / 138
3. 치료 계획 / 143
4.3 전문가의 조건과 추론 기술 발전 단계 ····················································· 144
1. 초보자 수준 / 144
2. 발전된 초보자 수준 / 144
3. 만족할 만한 수준 / 145
4. 능숙한 수준 / 145
5. 전문가 / 145
4.4 임상추론의 기술을 향상시키는 방법 ·························································· 145

제5장 인지평가 [홍승표, 동남보건대학교] ···················································································· 149
5.1 인지평가 시 고려할 사항 ·············································································· 151
5.2 표준화된 평가도구의 시행 ············································································ 153
5.3 기능인지 평가 ··································································································· 158
5.4 요 약 ···················································································································· 173

제2부 인지재활의 영역 및 치료적 접근

제6장 인지재활의 신경행동학적 접근 [오윤택, 세브란스재활병원] ····································· 181
6.1 신경행동 ·············································································································· 183
6.2 활동분석과 작업수행 ······················································································· 185
1. 환자의 일상생활의 관찰 / 187
2. 뇌졸중 환자들의 신경행동학적 손상들 / 189
6.3 뇌졸중 환자의 치료접근 ················································································· 190
1. 적절한 접근의 선택 / 191
2. 치료 시 고려사항 / 192

제7장 지각 손상과 치료적 접근 [권재성, 청주대학교] ·························································· 195
7.1 개 요 ···················································································································· 197
1. 지각의 정의 / 197
2. 대표적인 지각 이론 / 197
7.2 시지각 ·················································································································· 199
1. 시각기능 / 199
2. 시지각 과정 / 209
7.3 기타 지각 ··········································································································· 216
1. 운동지각 / 216
2. 입체지각 / 217
7.4 지각의 손상 ······································································································· 218
1. 편측무시 / 218
2. 실인증 / 224
3. 실행증 / 227
7.5 요 약 ···················································································································· 231
사례 실행증 환자의 인지재활 사례 ······································································ 232
1. 환자 정보 / 232
2. 평 가 / 232
3. 중 재 / 233
4. 결 과 / 235

제8장 집중력 손상과 치료적 접근 [육진숙, 서울아산병원] ·················································· 241
8.1 개 요 ···················································································································· 243
1. 집중력의 정의 / 243
2. 집중력의 이론적 메커니즘 / 249
8.2 집중력 장애의 임상적 양상 ·········································································· 251
1. 집중력 장애의 특징 / 251
2. 집중력과 다른 인지 기능과의 연관성 / 252
8.3 치료적 접근 ······································································································· 253
1. 집중력 장애의 접근 소개 / 253
2. 교정적 접근 방법 / 254
3. 기능적 접근 / 257
4. 집중력 향상을 위한 근거 중심 치료방법들 / 260
8.4 요 약 ···················································································································· 262

제9장 기억력 손상과 치료적 접근 [육진숙, 서울아산병원] ·················································· 267
9.1 개 요 ···················································································································· 269
1. 기억력의 정의 / 269
9.2 기억의 분류 ······································································································· 271
1. 감각기억 / 271
2. 단기기억 / 271
3. 장기기억 / 272
9.3 치료적 접근방법 ······························································································· 278
1. 기억장애의 접근방법 소개 / 278
2. 기억 단계별 교정적 기억 전략 / 281
3. 기능적인 치료접근 / 285
4. 기억력 향상을 위한 근거중심 치료방법들 / 287
9.4 요 약 ···················································································································· 290

제10장 실행(집행)기능 손상과 치료적 접근 [권재성, 청주대학교] ··································· 295
10.1 개 요 ···················································································································· 297
1. 실행기능이란 무엇인가? / 297
2. 실행기능의 이해를 위한 뇌 기능: 이마엽 / 299
10.2 증상 및 평가 ····································································································· 301
1. 실행기능 손상으로 인한 증상 / 301
2. 임상모델 / 303
3. 평 가 / 305
10.3 치료적 접근 ······································································································· 309
1. 환경 통제적 접근 / 311
2. 과제 중심적 접근 / 313
3. 메타인지 ? 자기 통찰적 접근 / 317
4. 보상적 접근 / 319
5. 최근 실행기능 장애를 위한 근거 중심중재 / 320
10.4 요 약 ···················································································································· 321

제3부 인지재활의 적용

제11장 ·의식 회복과 작업치료 중재 [오윤택, 세브란스재활병원] ············································ 329
11.1 개요 ······················································································································ 331
11.2 의식의 회복과 작업치료 ················································································· 332
1. 의식의 평가 / 333
2. 인지수준에 따른 작업치료 접근 / 338
11.3 요약 ······················································································································ 341

제12장 뇌병변 환자를 위한 인지재활 중재 [권재성, 청주대학교] ······································ 343
Ⅰ. 뇌혈관장애 환자를 위한 인지재활 중재 / 345
12.1 지각기능 ·············································································································· 345
1. 개 요 / 345
2. 지각기능 손상의 평가와 중재 / 347
12.2 인지기능 ·············································································································· 356
1. 개 요 / 356
2. 인지기능 손상의 평가와 치료 / 358
사례Ⅰ 저산소증 뇌손상 환자의 인지재활 사례 ·················································· 367
1. 환자 정보 / 367
2. 임상모델 / 367
3. 평 가 / 368
4. 중 재 / 369
5. 결 과 / 370
사례Ⅱ 뇌혈관장애 환자의 인지재활 사례 ······························································ 371
1. 환자 정보 / 371
2. 임상 모델 / 371
3. 평 가 / 371
4. 중 재 / 372
5. 결 과 / 374
Ⅱ. 외상성 뇌손상 환자를 위한 인지재활 중재 / 375
12.1 개 요 ···················································································································· 375
12.2 평 가 ···················································································································· 376
1. Glasgow coma scale / 376
2. 외상후기억상실 / 377
3. Rancho Los Amigos Scale of Cognitive Functioning / 378
4. 치료 현장에서 사용할 수 있는 인지기능 평가 / 379
12.3 전형적인 증상에 따른 치료적 접근 ···························································· 380
1. 혼돈과 불안.초조 / 380
2. 작업기억의 손상 / 381
3. 충동반응 / 382
4. 실행기능장애 / 383
Ⅲ. 가정환경에서의 인지재활 중재 / 385

제13장 치매환자를 위한 인지평가 [조현진, OTD, OTR/L., Occupational therapist,
Northside Gwinnett Medical Center, Extended Care, GA, U.S] ·········································· 391
13.1 개 요 ···················································································································· 393
13.2 정신장애 진단 및 통계편람에 의한 치매진단 ········································· 395
13.3 치매 진행단계에 따른 증상 및 기능저하 ················································· 396
13.4 평 가 ···················································································································· 398
1. 초기평가 / 398
2. 신경심리 평가 / 400
3. 작업치료 평가 / 406

제14장 치매환자를 위한 인지재활 중재 [조현진, OTD, OTR/L., Occupational therapist,
Northside Gwinnett Medical Center, Extended Care, GA, U.S] ·········································· 423
14.1 개 요 ···················································································································· 425
14.2 중재모델 ·············································································································· 428
1. 알렌 인지 장애 이론 / 428
2. 인간작업 모델 / 428
3. 치매 돌봄을 위한 심리사회적 장애 모델 / 429
4. 가족중심 돌봄 모델 / 429
14.3 개입의 실제 ······································································································· 429
1. 인지재활 / 430
2. 인지자극치료 / 431
3. 전산화 인지 훈련 / 431
4. 일상생활활동 / 432
5. 일 또는 자원봉사 / 433
6. 여가활동과 사회적 참여 / 433
7. 회상기법 / 434
14.4 개별 프로그램 ··································································································· 435
1. 목 적 / 435
2. 시행절차 / 435
3. 개별개입 사례 / 436
14.5 집단 프로그램 ··································································································· 439
1. 목 적 / 439
2. 운영방법 / 440
3. 회기의 구성 / 440
4. 활동 선정 / 442
14.6 가족교육 ··········································································································· 443
사례 치매안심센터 내 작업치료 사례 ································································ 446
1. 치매진단 및 지원서비스 및 사례 / 446
2. 치매환자쉼터 / 449
3. 치매 환자 가족 지원 서비스 사례 / 463

제15장 디지털 치료제: 디지털 인지재활 중심 [김영근, 대구보건대학교] ·························· 471
15.1 디지털 치료제의 개념 ····················································································· 473
1. 디지털 치료제의 개념 / 473
2. 디지털 치료제 유형과 작업치료 / 474
15.2 전산화 인지재활 시스템 ················································································· 477
1. 전산화 인지재활 시스템의 출현과 필요성 / 477
2. 전산화 인지재활 시스템의 특성 / 478
3. 전산화 인지재활 시스템 필수 조건 / 481
4. 전산화 인지재활 시스템의 효과적 사용 방법 / 483
15.3 가상현실 플랫폼 기반 인지재활 시스템 ··················································· 485
1. 개념과 원리 / 485
2. 가상현실 재활시스템의 효과 / 486
3. 가상현실 인지재활 시스템의 특성과 차별화 / 487
15.4 원격 인지재활 시스템 ····················································································· 488
1. 원격 인지재활 시스템의 강점과 단점 / 489
2. 원격 인지재활시스템의 유형과 활용 사례 / 490
15.5 요 약 ···················································································································· 492
찾아보기 ·························································································································· 497