ABSTRACT
According to statistics from the Japanese Ministry of Health, Labour and Welfare for the last ten years, the number of people with physically disabled persons' certificates increased from about 4,370,000 in 2001 to more than 5 million in 2008 and reached about 5,110,000 in 2010. The incidence of stroke and various internal diseases are increasing following an increase in lifestyle-related diseases and the development of Japan's rapidly aging society. In this social background, the physiatrist has many chances to write a physically disabled persons' medical certificate during the patients' care-planning. The most important point to consider is to understand the reason why the patient wants to get a physically disabled persons' certificate. Patients have several needs in their care-plan requiring a physically disabled persons' certificate such as financial aid for medical bills and travel expenses, and also for the cost or supply for orthosis, prosthesis and other technical aids for the disabled. The degree of invalidity must correlate with the medical findings and impairment in the medical certificate. For example the medical findings are the grade of paralysis, joint range of motion and muscle weakness, etc. Activities of daily living (ADL) provide the evidence of those findings and the degree of invalidity. The best practice when writing a medical certificate for physically disabled is that there must be no discrepancy between the medical opinion for the degree of invalidity and the medical findings, impairment and ADL of the patients.
ABSTRACT
In this paper, we report the various actions and administrative steps taken by the Miyagi Prefectural Rehabilitation Support Center (MPRSC) to aid the disabled, following the Great East (Eastern) Japan Earthquake. Among various problems we encountered, it was alarming that the shelters set up for victims were not always accessible for disabled persons. These non accessible shelters had various barriers. Also, we noticed that many disabled people had lost their technical aids, i.e. canes, wheel chairs, orthoses and prostheses, etc. After the administrative vacuum caused by the disaster, we were able to restart community services for the disabled through reestablishment of local support center activities under MPRSC direction. During this process, we received much support from across the nation and from various specialist groups related to rehabilitation services. We now realize the need for the Disaster Acute Rehabilitation Team (DART) and the undergoing change in needs for the disabled people since the disaster. Finally, we comment on the importance of building a guideline of rehabilitation services, especially in case of a disaster, and having an everyday working intimate network established among the local administration office, medical associations and the other related parties.