In January 2004, a panel of experts (chairman : Satoshi Ueda) commissioned by the Health and Welfare Bureau for the Elderly, the Ministry of Health, Labor and Welfare, came up with an idea suggesting a direction the nation’s rehabilitation project for the aged should take in the future. This has rekindled the debate over the way the rehabilitation work for the old people should be carried out the inevitable subject of discussion that had been taken place on and off since the nursing care insurance system came into being.We have been involved in the rehabilitation of those people mainly with the after-effects of strokes since the early 1960’s when the Japanese government embarked on the rehabilitation project for the elderly.In this paper, we examined our ways of grappling with the task of rehabilitation for the aged people in retrospect. At the same time, from the standpoint of the philosophy that the rehabilitation work for the aged should be aimed at recovering their mental and physical functions to improve their quality of life, we envisioned the future of the rehabilitation project for the old people with stress placed on the following two points :(1) the working on a rehabilitation program for the aged after the model of the international classification of functioning, disability and health ; and(2) the building up of a community-based rehabilitation system interlocked with an overall program for the promotion of health care, welfare and security in the local community.
Rehabilitation aspects ; Work ; Future ; Elderly ; Rehabilitation therapy

Introduction : Every day, patients undergo rehabilitation training under the guidance of a physical therapist person-to-person, but it ends in a short time. A patient who are taking walking exercises in the rehab center is confined to a wheelchair when that patient returns to the hospital ward. Such being the situation, we introduced part of the rehabilitation program into daily routine in the ward life. All the staff of the convalescent ward joined forces to help the patients restore their ability to perform the basic activities if daily living (ADLs) and motivate them to return to normal. The results of our efforts shall be reported here.Subjects and Methods : A total of 10 patients who were undergoing training in the rehab center were the subjects for this study. The progression of rehabilitation was observed and documented. The target of rehabilitation at the hospital ward was set. Their ability to perform ADLs were assessed.Results : Eight of the 10 subjects achieved the objective. Two persons failed because they got out shape. Two of the eight subjects who could attain the objective became eager to do daily routine.Discussion : Before this study, we only drove the patients to and from the rehab center, but when the study got started, we came to observe the patients from various angles because we had opportunities to grasp the situation about rehabilitation, to asked physical therapists questions about care and exercises and exchange views with them. We thought that the introduction of part of the program implemented in the rehab center into daily routine in the ward life and the setting of the target of rehabilitation contributed to the enhancement of the levels of the patient’s ability to perform the ADLs. The old people exhibit a peculiar state of mind due to physical inactivity and aging. When they are hindered from performing daily activities, they feel frustrated and plunge into helplessness. We thought that it is important to make them take an interest in what they can do instead of what they cannot do, if we are to uplift their ability to perform ADLs and improve the quality of their life.Conclusion : Giving the patients rehabilitation training in concert with physical therapists results in the improvement of their ability to do the activities of daily living.
Patients' Rooms ; Rehabilitation aspects ; Hospitals ; Training ; Rehabilitation therapy

It is now accepted that in developing countries community-based rehabilitation (CBR) is the most effective way to meet the needs of the disabled. The proportion of the population of Papua New Guinea (PNG) having access to CBR is not known. The purpose of this project was to clarify the extent of rehabilitation services in PNG. It was hoped that by establishing the extent of services, communication and cooperation between them would increase, leading to more efficient and effective use of the limited resources (human and otherwise) available for rehabilitation in PNG. A questionnaire was sent to all known existing rehabilitation services, all provincial health departments, provincial hospitals and church health services. A 47% response rate was achieved. Results showed that most provinces have some form of rehabilitation available but rehabilitation is not spread equally throughout PNG. Most of the services are based in the urban centres and the rural population is badly served except in the Highlands Region and the Sepik provinces, which appear to be more comprehensively served by CBR. The services that do exist are hampered by lack of human and material resources and difficulty accessing clients due to transport difficulties. There needs to be a greater movement of rehabilitation into the community with government backing. The greatest effort is being made by Callan Services for Disabled Persons based in Wewak with its group of Special Education Resource Centres that also carry out CBR. CBR would appear to be an appropriate way to address the needs of the disabled PNG population, but in order to be successful it requires greater backing and more trained personnel.
Rehabilitation aspects ; Papua New Guinea ; Disabled Persons ; Rehabilitation service ; seconds

Basal ganglia are an area where cerebral haemorrhage occures frequenthy. Recently our knowledge of the brain and its function increases rapidly, but this knowledge is not much used in rehabilitation yet. Parallel neural networks (Hikosaka, 1999) are a model of sequential procedures learning, and basal ganglia perform an important function in it. Using this model, we designed a rehabilitation approach and applied it to a patient with left putamen hemorrhage. In the early stage, we promoted passive movement of her paralysed arm and fingers in the spatial coordinates with her eyes opened. Afterwords, we guided her to motor leaning in the motor coordinates with somatic sensation with her eyes closed. We intended to integrate the spatial coordinates and motor coordinates, by which we encouraged her to move her arm and fingers with her eyes opened after her recognition of motion perception improved. Her motor paralysis of fingers in particular improved by rehabilitation, which lasted about 1.5 month. We recognized some improvement in her arm, but it was slightly insufficient than her fingers. We considered that a difference in the degree of improvement occurred because she could not confirm enough on her shoulder in the early stage.
Fingers, unit of measurement ; Neural Network Simulation ; Rehabilitation aspects ; Arm ; Approaches

Based on progress in home visits for rehabilitation and health guidance since 1979, the trend after the Nursing Care Insurance Law was enforced in 2000 was investigated. In home visits for rehabilitation, cooperation with many related organizations is required, and reorganization of the network built before the enforcement of the said Law is needed. The role of each home visiter for rehabilitation is being formed and cooperation with care managers is being strengthened. The tendency that the participation of the local government may decrease can't be denied. Connection with the hospital and the local government should be maintained, and a new community-based network needs to be built.
Rehabilitation aspects ; Community ; Management ; network ; Encounter due to convalescence

This paper proposes a method for evaluating and scoring the activities of rehabilitation service users in order to pinpoint the problems with the health service of this kind and set the adequate targets for each user. Sincs the Nursing Care Insurance System was introduced in Japan in 2000, it has been argued that home-visit rehabilitation services should be excluded from home-nursing care services. However, the methods of certifing that nursing care is required are not fully established yet for setting the rehabilitation targets for service users. As things stand, it is recommended that such a method as the Functional Independence Measure (FIM) or the Barthel Index (BI) should be utilized. However, these methods only evaluate “performing activities” (the activities that a user usually performs). In order to set the users' targets, we thought it necessary to establish a method for evaluating “possible activities” (the activities that a user is able to perform at his/her full capacity). We have established a method called Functional Scoring (FS) which evaluates and scores the both performing and possible activities based on the same evaluation items. We conducted experimental evaluations on the home-visit rehabilitation users for one year from October 2005 to September 2006. When the first evaluations in 2005 were compared with the second evaluations in 2006, the total score of the performing activities significantly increased from 44.1±13.7 to 47.8±14.2 (P<0.05). Although the total score of the possible activities did not significantly increase, it demonstrated an upward trend from 49.6±13.2 to 51.6±13.5. The result suggests that our method is useful for distinguishing between the performing and possible activities. The proposed method enables us to adequately recognize the problems each user has, and to set the rehabilitation target for each user, which can be shared between the user, care personnel, and care service provider.
Rehabilitation aspects ; Functional ; FS ; Care given by nurses ; Published Comment

seconds ; Human Females ; Social Problems ; Rehabilitation aspects ; Case Report

Disability is a major public health problem, particularly in developing countries, where there is a close link between poverty and disability. The complex nature of disability allows it to be addressed from a number of different perspectives. Community-based rehabilitation (CBR) is a holistic approach towards disability which is currently being supported in many parts of the world, including Papua New Guinea (PNG). Unfortunately CBR is frequently implemented in resource-poor contexts, which limits the scope for research. As a result little effort is put into determining a need before CBR programs are established, or into evaluating CBR programs following implementation. This research in the Middle Ramu, Madang Province, tested a method for acquiring information for the purposes of CBR planning in PNG. The method used an adapted form of the Ten Questions Screen for Childhood Disability. Quantitative and qualitative methods were further utilized to determine the types of disability presenting, the biomedical and perceived causes of the various disabilities, help-seeking behaviours, the disabled individual's participation in village activities, and the needs of both disabled individuals and their caregivers. A total of 158 disabled individuals were identified in a population of 4946 people and 20 in-depth interviews were conducted. The data obtained were analyzed to formulate an appropriate 'CBR package' that would cater for the specific needs of this population in the Middle Ramu. Evaluation of the basic survey method revealed that it was more sensitive than other methods previously tried in PNG, with an overall disability prevalence of 3.2% obtained. Qualitative methods allowed the fieldworkers to get a much deeper insight into the feelings and perceptions of disabled individuals. The methods tested for this research in the Middle Ramu could have application for CBR workers in other parts of PNG.
Disability, NOS ; Disabled Persons ; Median Site ; Research ; Rehabilitation aspects