NATIONAL REHABILITATION CENTER

FOR CHILDREN WITH DISABILITIES

Seishi-Ryougoen

Institute for children with mainly physical disabilities

Murasaki-Aiikuen

Institute for children and adults with profound mental and motor disabilities

Gairai-Ryouikubu

Outpatient Clinic for children with disabilities

1-1-10 Komone Itabashi-ku Tokyo 173-0037 Japan
Tel: 81-3-3974-2146 Fax: 81-3-3554-6176

FUNCTION AND SERVICES

Our center is a comprehensive institute for children with various types of disabilities. We provide medical, rehabilitational and care service for them. Our center is one of the largest centers of pediatric orthopaedics and pediatric neurology in Japan. The main operating policies for this center are determined by the Ministry of Health, Labor and Welfare. The Japanese Society for Disabled Children is responsible for general operations.

Our center consists of the following sections;

1. Seishi-Ryougoen :

This institute is mainly for children with physical disabilities. The section consists of three wards. The first ward is for orthopaedic surgery and postoperative therapy (about 36 beds). The second ward is for nursing and rehabilitation care for children with impairments mainly due to brain damage (about 36 beds). The third ward is for mothers and their severely disabled children, mostly very young. About seven pairs of mother and young children stay six to eight weeks and a rehabilitation team (pediatric doctor, physical therapist, occupational therapist, speech therapist, psychologist, nursery teacher, social worker and nurse) provides comprehensive medical and rehabilitation services. We also have a medical and social emergency unit in the third ward (about 15 beds).

2.Muasaki-Aiikuen :

This institute is for children and adults who have both severe mental and physical disabilities. We, rather than their families, take care of them. Although this institute started as an institute for children, many patients stay for long periods of time, often until the end of their lives. Currently we have children and adults living in this section. Their mean age is around forty.

3. Gairai-Ryouikubu :

This section has medical clinics including orthopaedic, pediatric, neuropediatric, dental, urology and otolaryngology clinics. We also provide rehabilitation service to children and some adults at the outpatient division. We have a huge network of supporting functions for community care systems including hospitals, community health centers, community day care centers and medical social workers in all areas of Japan, especially around Tokyo Metropolitan area. We send our staff to these places for assistance, and they refer children to our center. In recent years about 1,000 new patients are referred to us annually.

4. Ryouiku-Kenshusho:

At this section we have various postgraduate educational courses for staff working for children with disabilities. They come from all areas of Japan.

Staff : We have over 300 full-time staff and a lot of part-time staff.
Main full-time staff:
Doctors: 7 orthopaedic doctors, 11 neuropediatric doctors, 1 dentist as full-time members.
Rehabilitation staff: 19 physical therapists (RPT), 14 occupational therapists (ROT), 5 speech therapists (RST.)
Care assistance staff: about 100 registered nurses, 30 nursery teachers and nearly 50 other care staff.
Others: 5 clinical psychologists, 3 medical social workers, 4 pharmacists, 2 X-ray technicians, 4 laboratory technicians

PAST AND PRESENT

"Rehabilitation" is not a new concept in this country. The late Dr. Kenji Takagi, emeritus professor of orthopaedics, Tokyo University School of Medicine, realized that medical science was not enough to meet the needs of disabled children, but physical, mental, social, and vocational approaches were also needed. Led by this belief, he started a campaign to establish a rehabilitation program in 1914. Unfortunately, people did not understand him at that time; to make the matter worse, he was suspected as a socialist and secretly put under police supervision of his daily conducts. However his long-standing and untiring efforts survived all these hardships and difficulties and he finally succeeded in organizing an association which is called today "The Japanese Society for Disabled Children." The hospital and rehabilitation center "Seishi Ryougoen" was founded for children with disabilities in 1942 (though a limited number of patients had been treated before this time). It was a magnificent community center of rehabilitation with 105 beds for children and adults with physical handicap, but was tragically ruined by the war during 1945. Almost all the facilities were destroyed. However, this did not result in a total regression of the rehabilitation work which had been demonstrated by the great pioneer. The program for children with physical handicaps was incorporated into the Child Welfare Law, which was inaugurated soon after the end of the war. (The law for adults with handicaps was enacted separately a few years later) According to the Child Welfare Law, the Ministry of Health and Welfare began to subsidize prefectural governments to construct institutions (hospitals and homes) for children with physical handicaps, and at the same time the Ministry of Health and Welfare started to reconstruct the center with national governments funding in 1950. Since then, this institution has undergone reconstruction work by the national government, and its operation was assigned to the Japanese Society for Disabled Children. In 1967, when the Child Welfare Law was modified, a special institution for children with severe and multiple handicaps "Murasaki-Aiikuen" was established in the compound of the hospital. It now has about 130 beds for long term care. In 1980, the outpatient clinic was expanded to a total care service center for children with disabilities, called "Gairai-ryouikubu" and the name of the whole center was changed to "The National Rehabilitation Center for Disabled Children." (This institution is run on a semi-government basis as a national rehabilitation center.)

In Japan there are now about 62 centers for children with physical disabilities and about 130 institutes for patients with the severe handicaps. Both are supported by the local government.

CASES

Our center accepts all children with any handicaps, regardless of type or severity. Formerly services were only limited to the physically handicapped, such as tuberculosis arthritis, poliomyelitis, scoliosis, congenital hip joint dislocation, several bone and joint diseases, and limited cases of cerebral palsy. But recently due to advances in medical science, many diseases like poliomyelitis have disappeared or markedly decreased. Instead, the need for care of children with various kinds of brain damage is increasing. Besides their motor handicap they have a lot of other handicaps - mental, psychological, verbal, visual, auditorial and feeding problems. So we provide many and varied services. We offer services such as orthopaedic surgery and various rehabilitation programs. Some of the children need quite intensive medical treatment, so the center also has high level medical equipment such as CT scanners, MRI, arterial oxygen monitors, and laboratory autoanalyzers.

In 1975 we started a program for early detection and early treatment of children with cerebral palsy. Now this program has expanded to all kinds of disabilities, and we can offer quite comprehensive care services from a very early age. Also recently "Integration and Normalization" has been spreading rapidly. Instead of residential care systems, or education in special schools, many children with handicap are now spending their daily life in the home and the community, and they are going to regular schools. So year by year the number of children who need residential care service is decreasing. Things are now changing quite rapidly.

COST

For inpatient services: Medical care insurance schemes pay for 70 - 80% of the total cost during hospitalization including all kinds of treatment. National and prefectural goverment pay the remainder according to the income of the family.

For outpatient services: Seventy percent of the cost is paid from medical insurance schemes. Families should pay the remainder but there are a lot of supporting systems based on the national or prefectural government, so the costs are quite low.

CHIEF of Staff

President Mamori Kimizuka MD
Director of Seishi-Ryougoen Mamori Kimizuka MD
Director of Murasaki-Aiikuen Eiji Kitazumi MD
Chief of administrative Dept. Katsumi Yoshida
Chief of Medical Out-Pt. Dept. Akira Yoneyama MD
Chief of Rehabilitation Devision Shinji Matsumura RPT

UNICEF Support Helps Handicapped Children (Tuesday October 30,1979 The Japan Times) “History of Seishi Ryogoen Hospital: Stigma Gives Way to Hope and Pride” ( By JAN CORASH)

Although the stigma of having a handicapped child dies hard in Japan, feelings of shame are now at last giving way to hope, expectation, even pride. The history of Seishi Ryogoen Hospital in Tokyo is really the history of that change.

In the dark days following the end of the second World War, when Japan was still at the receiving end of assistance from the United Nations Children's Fund (UNICEF), part of UNICEF's help went to the still young Seishi Ryogoen, which had been devastated in the fire bombings of Tokyo and was struggling to get on its feet again.

Today, the government of Japan has singled Seishi Ryogoen out of further substantial expansion and improvement as one of its major projects for the International Year of the Child (IYC). The hospital, in Tokyo's Itabasi Ward, is to become more than ever the mainspring of Japan's efforts to give the disabled child a generous place in the sun.

Birth and Resurrection

One of the first leaders in the struggle to overcome attitudes of shame toward children with physical handicaps in Japan was the late Dr.Kenji Takagi, professor of orthopaedics at Tokyo University of Medicine. As early as 1914 he campaigned for the establishment of a rehabilitation program for children with physical handicap. Misunderstood, suspected of propagating subversive views, he nevertheless persevered, and in 1935, succeeded in organizing what is known today as the Japanese Society for Crippled Children. In 1942 the society established a 105-bed hospital and rehabilitation center for crippled children. This was Seishi Ryogoen.

When the war ended, only the nurses' dormitory was still standing. The dormitory quickly became the new hospital. There, the treatment of some 25 children continued.

Assistance

UNICEF assistance to Japan began in 1949 with donations of powdered skim milk, and today many "UNICEF babies" are rising to positions of influence and responsibility in Japanese society. UNICEF also provided cotton and wool from which bracket and clothing were manufactured for the needy. Its assistance to Seishi Ryogoen can be linked to the early efforts of Dr. Fumihide Koike, present president of the hospital.

In1950 Dr. Koike traveled to the United States on a United Nations fellowship grant to study the most modern methods of orthopaedic rehabilitation. The report he wrote on his return brought Dr. Mareia Hays, at that time California State director of social services, to Japan as a World Health Organization (WHO) consultant.

Next five doctors from Seishi Ryogoen went as WHO fellows to the United States for training, and UNICEF donated therapy equipment, modern medical textbooks and beds. As one nurse reminisces, the staff was overwhelmed by the large, well-equipped beds complete with pulleys and rings for traction. The hospital had previously possessed only Japanese tatami mats and wooden beds. The shortage of materials was, indeed, so severe at that time that even wood from the packing crates was kept and used.

Later in the 1950's UNICEF also donated books and equipments to the fledgling prefectural rehabilitation centers.

Government Support

In 1947 the Japanese government first acknowledged the problem of the handicapped by including disabled children in the existing Law. This was an important event, because it recognized not only the existence of such children in Japan, but also their right to be helped. It acknowledged that rehabilitation was possible. For that watershed development Seishi Ryogoen could legitimately claim some part of credit.

Equally important were the economic consequence of the new law, which empowered the Ministry of Health and Welfare to begin subsidizing the construction of new national and prefectural rehabilitation centers throughout Japan. Since then, Seishi Ryogoen - now recognized as the "National Center for the rehabilitation of the Handicapped"- has been put on a semi-governmental basis.

Effect of IYC

As part of its IYC commemoration, the government is -as one official put it -attempting to "open the door more widely for the handicapped".

Seishi Ryogoen will become a general medical treatment center for handicapped children. In addition to advice and treatment, it will conduct research and train personnel. As a first order of business, the operating room will be completely overhauled at a cost of $1.5 million. Special appropriations have also been made to equip 20 major cities throughout Japan to become "welfare cities for the handicapped."

Seishi Ryogoen 1979

Seishi Ryogoen today is the friendliest hospital I have ever visited. Nowhere else have I seen doctors playing with their small patients; the atmosphere throughout is warm, kind, and cheerful. Doctors, nurses, therapists, aides and trainees work as a team. The equipment is thoroughly modern, and diagnostic and medical techniques totally up to date. Seisi Ryogoen is at a unique position to enlighten the public about the possibilities of the handicapped.

Take, for example, the mother and child class. From all over Japan they come, because, in the words of one mother, "There is nothing like this where I live. " Mothers and the children live together in the hospital throughout the three-month course. The mothers learn about their children's special needs and how to care for them.

Since its inception in 1953, the course has served to bring the parents of handicapped children out of their isolation. Because of lingering feelings of dishonor and disgrace many of these mothers previously had not been able to talk with mothers facing similar difficulties. It may be the first experience for many of these children to interact with others.

Seishi Ryogoen has set out to educate the public about the crucial importance of early diagnosis. As a result it is not uncommon today to see treatment beginning at the age of 6 months.

A change in attitude also accounts for the enormous growth in the number of outpatients undergoing treatment. Much of the impetus generated by IYC will, in fact, be directed toward the establishment of a comprehensive outpatient center at Seishi Ryogoen. As planned, that center will even have a dental facility - to compensate for a lingering reluctance on the part of dentists in private practice to spend precious time on handicapped children. It will have other new facilities as well- ophthalmology, otolaryngology and urology - these in addition to the existing orthopaedics and pediatrics.

In this time of changing attitudes, Seishi Ryogoen has no intention of resting on its laurels. On the contrary, it means to continue fighting for total rehabilitation. In the words of Dr. Koike: "We want to raise each child to his or her fullest potential so that as many children as possible can enter society and live useful lives." This emphasis on the need for the children to lead normal lives in their communities explains the upsurge in outpatient treatment.

Celebrations for children are being held all over the world this year in commemoration of IYC. But what greater cause of celebration can there be than a handicapped child cuddled in the love of his parents and assured of a place in the sun?