Rehabilitation Centers (Hospital and Home) for Children with Physical Disabilities in Japan

History,Present Status and New trends sourrounding Rehabilitation Centers for Children with Physical Disabilities

1.History of rehabilitation centers for children with physical disabilities

Rehabilitation services for the children with physical disabilities have been included in the Child Welfare Law, which was inaugurated soon after the end of the war(1947). "Rehabilitation" was not a new concept in this country. The late Prof.Kenji Takagi, emeritus professor of orthopaedics, Tokyo University School of Medicine, realized that merely medical science was not enough to bring a real happiness to children with disabilities, and that it should meet their physical, mental, social and vocational requirements. Led by this belief, he started a campaign to establish a rehabilitation program in 1914.

In 1924 Prof. K. Takagi presented his paper on the hospital and home for children with physical disabilities. Unfortunately, people did not understand him at that time, and he was suspected as a socialist and secretly put under the supervision of the police authorities in his daily conducts. His long-standing and untiring efforts did not go waste. After all these hardships and difficulties he finally succeeded in organizing an association which is called today "The Japanese Society for Disabled Children". This society started the rehabilitation center "Seishi Ryougoen" for children with physical disabilities in Tokyo (1942).

Prof.K.Takagi is called "Father of the Rhouiku". What is the meaning of the Ryouiku ? "To be conducted with all modern sciences,we should conquer their physical disorder as much as we can. Then some convalescence might be to come up. We make the best use of the potential ability in their body, so the Ryouiku could be meant to grow up the children to be an independent living." The Ryouiku means Habilitation in English. The potential ability is not only the ability of remains, but also means the convalescent ability and the ability of replacement.

According to the Child Welfare Law, the Ministry of Health and Welfare began to subsidize prefecture governments for constructing such rehabilitation center for children with physical disabilities. After that, these centers have been set up in every prefecture. and in 1969 special schools were established for them in each prefecture also,thus providing medical treatment , guidance for dailyliving activities and education for independent living.

Dr Humihide Koike succeeded to the works and devoted his life for children with disabilities as second president of "Seishi Ryougoen". The diseases were markedly changed during over 60 years. Poliomyelitis and Tuberclous arthritis disappeared and developmental hip dislocation a tenth part. Central nerve diseases including cerebral palsy (CP) stand first (70%) in the children who need long-term treatment in these rehabilitation centers.

Now there are 64 rehabilitation centers for them in Japan.

2.Present status of rehabilitation centers for children with physical disabilities

Number of newborn babies is now decreasing continuously in Japan and number of long term hospitalization children also. These rehabilitation centers continue to work as a magnificent community center of rehabilitation for children with physical disabilities, variously supported by individual local government and others.

Early detection and early intervention is important for children with disabilities especially for cerebral palsied. The Maternal and Child Health Law requires medical examination screening of babies at 4 months,7 months and 9 th or 10th month.A premature baby is especially to be followed by public health center staffs.When the baby is suspected of CP in medical evaluation at the public health center, he/she needs to be followed up under the guidance of medical doctor or if necessary to be sent to the outpatient clinic of rehabilitation centers for further evaluation and management. The center has facilities to accommodate both the mothers and young infants about under the age of 3 years for short duration hospital treatment. Of the treatment methods for the infant with CP,neuro- developmental treatment(Bobath)is more popular than any other approach to develop physical and mental growth as a whole child.Vojta method is used by some doctors in the parts of Japan. Orthopaedic treatment has also important roles for children with CP. Reconstructive surgery for children with spastic CP is most frequently undergone and increases in the hip joint and decreases in the ankle joint by caseユs severer tendency. (Surgical cases during recent forty years were CP, developmental hip dislocation, spina bifida, osteogenesis imperfecta and others on ).

Social needs for long term institutionalization is also necessary for protection of children from family dysfunction or child abuse with total care "Ryouiku". Battered children with disabilities are about 150 in 2000, which occupied about 4.5% on children in Hospital and Homes. The number of families who take advantage of respite care system in Hospital and Homes, that is short stay, is rapidly increasing now.

Recently childrenユs disability become severer and severer (Fig. 1.2), and variously overlapped. Half of children are CP in the centers. CP has not only a motor dysfunction but also many kinds of associated conditions such as mental retardation, epileptic seizures, visual, hearing,speech and emotional problems. Respiratory troubles become main problem, so relaxation and positioning become more important. Almost all centers have a specially equipped ward for management of children with severely disabled in addition to ward for general medical care. About one thirds of centers have a department for children with severe physically and mentally disabilities. Outpatient clinics have about 110,000 children per month in all centers. They include outpatient rehabilitation clinic, day care centers for young children with disabilities and medical service department. Adults with disabilities are partially covered under the continuos medical and social care. One fourth have department for adults with physical disabilitie

3.New trends surrounding rehabilitation centers for children with physical disabilities

"Concept of Normalization" must be shared with all with disabilities. Family support in the community for any disabilities will become more important, so Hospital and Homes will be further provide many assists in this aspect including home visiting.

"Idea of International Classification of Function" is also a keypoint in the total approach for children with physical disabilities. Tasks may be further shifted from medical model to social model, Hospital and Homes will prepare so many menus in these aspects for social and environmental needs.

National Rehabilitation Center for Children with Disabilities
Department of Orthopaedics
Director of Seishi Ryougoen
Mamori Kimizuka

Fig.1 ADL of children in the centers at 1.May 2003. About half are totall assistsed for each ADL.

Fig.2 Intelligence Quotinent of children in the centers at 1.May 2003. IQ of about half are below 50.