RESUMEN
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.
RESUMEN
At this Center, we directly interviewed 393 applicants for prostheses, orthotics, or other assistive devices in the last year and assessed their activities of daily living (ADL) using the functional independence measure (FIM). By investigating the relationship between the FIM scores and the prescription of prostheses, orthotics, or other assistive devices, we analyzed ADL in persons prescribed for assistive devices at a rehabilitation counseling center for persons with disabilities. This analysis revealed that there were some ADL patterns on the occasion of preparing medical writings and prescriptions. The FIM scores were totally good with upper or lower limb prostheses. In the case of computer based communication systems, there appeared a specific pattern wherein cognitive ratings except “expression” were good. Some patterns in ADL covering a combination of physical aspects and cognitive ones were found with the lower limb prostheses. ADL patterns were found to be overlapping among seating systems, wheelchairs and powered wheelchairs. Some patterns were seen in active usage for locomotion, some in usage with low physical and cognitive aspects, and others in different usages. From the viewpoint of ADL, some prescription grounds became clear, and it was shown that these grounds could be one of the guidelines used for the indication of assistive devices.