ENDOWED COURSES AT FUJITA HEALTH UNIVERSITY

Our vision for the community-based rehabilitation with robotic technology

The role of community-based rehabilitation should not be confined solely to medical rehabilitation, but it should instead be seen as a system in which rehabilitation services are accessible to the community in a multi-level approach by utilizing the nursing care insurance and welfare system.
It should encompass preventive rehabilitation to promote better health, as well as community development, such as creating a barrier-free environment using universal design that is accessible to the whole community, including people with disabilities. Thus, community-based rehabilitation can also be seen as the foundation for an integrated community care system.

This endowed course was established for the purpose of developing community-based rehabilitation through the utilization of robotic technology in Toyota city.
Kikuo Ota has been appointed as the instructor for the endowed course at Toyota Regional Medical Center since August 2018. At present, our vision is to start verification studies of robotic and IT technology at Toyota Regional Medical Center through industry-academia-government partnership, and use the results to promote the development of community-based rehabilitation in partnership with Toyota city.

Development of rehabilitation medicine at Toyota Regional Medical Center

1. 1

   Seamless rehabilitation that utilizes robotic technology

   • Inpatient rehabilitation will be offered to patients who were admitted under acute care and then moved to the recovery ward for the purpose of recovering their walking functions and improving their ADL performance, and assistance will be provided seamlessly even after they are discharged for undergoing rehabilitation under nursing insurance or undergoing medical rehabilitation as outpatients.
     This will be achieved by strengthening the coordination between acute care, recovery and post-recovery stages, so that patients can continue to have an active life within the community after being discharged.
   • Since October 2018, walking training using the gait exercise assist robot, Welwalk WW-1000, has been carried out in the rehabilitation ward for patients with severe paralysis who are in the recovery stage. Fig 1
   • Since January 2019, treadmill walking training with WalkAide using functional electrical stimulation therapy has been carried out for outpatients with chronic phase paralysis.
     The visual feedback feature of Welwalk WW-1000 is used on the treadmill to improve their gait and walking performance.
   • Balance Exercise Assistant Robot (BEAR) is used to assess balance learning, based on which a balance strengthening program is developed. There are three games on BEAR, each with 40 difficulty levels. Fig 2
     In these games, the user learns to control their center of gravity back-and-forth and side-to-side with feed-forward mechanism, and to strengthen their feedback mechanism in response to disturbances. The learning attainment curve from these games can be used to assess which balance function needs to be strengthened in particular.
     A balance assessment and training program was started in April 2019 for patients who can walk and are undergoing rehabilitation as inpatients or outpatients.
   • The third rehabilitation Robot is ReoGo-J which has been used for improving U/E function of hemiplegia since April 2020. Fig 3

   

   

   

2. 2

   Commencing specialized rehabilitation based on the latest scientific evaluation

   • Dysphagia rehabilitation based on video fluorography(VF) and video endoscopy(VE) is currently being carried out. Indirect training aimed at strengthening a patient’s swallowing function and direct training using dysphagia diet are offered depending on the type of dysphagia. Moreover, swallowing training is provided using a device that provides electrical sensory stimulation to the superior laryngeal nerve (Gentle Stim), as well as balloon distension training for patients with severe bulbar palsy.
   • Training using the latest brace or walking assistance devices: In order to link the walking training that utilizes robotic technology with actual walking within the community, a walking training is carried out using the latest brace such as SPS and RAPS. Moreover, Welwalk WW-1000 is used, which is a treadmill equipped with a suspension walker and a suspension device.
   • Botulinum treatment for spasms in upper and lower legs: Intramuscular injection of botulinum toxin is applied precisely using ultrasound or electrical stimulation needle, followed by training such as stretching to aid function recovery.
   • Diagnosis and comprehensive cognitive rehabilitation are provided to patients with higher brain dysfunction caused by a traumatic brain injury. Moreover, social participation is encouraged for patients and families by introducing them to social support services with the goal of finding employment or education and training opportunities.

   

   

3. 3

   Partnership with the department of general medicine

   • From 2019, in partnership with the department of general medicine, we are now in charge of rehabilitation medicine in the general practitioner training program at Toyota Regional Medical Center, where students can learn the basic rehabilitation techniques and how to draw up a rehabilitation program.
     In 2019, two physicians will be undergoing two to three months of training at our division. We hope that the number of general clinicians with rehabilitation training will increase, which will in turn contribute to the development of community-based rehabilitation.

Plans for the development of community-based rehabilitation with robotic technology at Toyota Regional Medical Center

After the completion of the new hospital in January 2021, examination centers and facilities with improved home assistance function for community-based healthcare are scheduled to be refurbished. The course on community-based rehabilitation medicine with robotic technology will also support the seamless development of community-based rehabilitation from medical care to nursing care and welfare by providing rehabilitation services that utilize robotic technology and IOT.

First, Welwalk WW-1000 and BEAR will be installed at the rehabilitation center, and an IOT system to evaluate a patient’s physical activities will be introduced in the training spaces at the recovery ward, the community-based comprehensive care ward and the rehabilitation center in order to promote a more active life for patients while they are in hospital as well as outside the hospital.

Furthermore, people in the rehabilitation center will have access to the rooftop garden, and we also plan to provide an environment where patients can socialize with local residents. We are currently making preparations to transform the hospital into a community hospital, which will also serve as a place to promote health by continuing to offer health check-ups for local residents, as well as a space where patients who require nursing care and their families can interact with the latest nursing care robots and experience robotic smart homes.

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