S-1-02-05
Home rehabilitation for home - bound physically hadicapped people in Yokohama
Akira Hakuno (Yokohama Rehabilitation Center)
A home visit rehabilitation project for home-bound chronically ill patients, who encounter difficulties in daily living due to severe physical disabilities, has been deployed in Yokohama since 1987. The aim of this project is not to offer medical rehabilitation services to further functional recovery of patients in either acute or recovery stages in place of medical institutions, but rather to optimize the clients' quality of life by providing out-reach comprehensive rehabilitation measures within their actual living environment.
The services are offered by rehabilitation professionals, including physiatrists, occupational therapists, physical therapists, prosthetists and orthotists, rehabilitation engineers and social workers. Over the past eight and a half years, 7,652 clients have been included in this project.
The system of the project, patient profile, offered services and the results of a study which evaluated the program will be presented. Strategies deployed and problems encountered in home rehabilitation practice will be discussed.
WS-1-01-01
Cardiac Rehabilitation in the Coronary Intervention Era
Yoichi Goto, Hiroshi Takaki, Toru Satoh, Naohiko Aihara, Yoshio Yasumura, Isao Morii, Satoshi Yasuda, Yasushi Hara (National Cardiovascular Center, Suita, Japan)
Recently, coronary thrombolysis, angioplasty, and/or stenting are frequently performed for the treatment of acute myocardial infarction (AMI). Early coronary reperfusion by these new modalities may have significant impact on cardiac rehabilitation (CR). 1) The in-hospital mortality has decreased and the stay in CCU has been shortened. The shortening of hospital stay may change the main goal of CR from recovery from physical deconditioning to secondary prevention of ischemic heart disease. 2) Although early reperfusion reduces infarct size, residual stenosis may precipitate myocardial ischemia during exercise. Also, coronary restenosis occurs in 30-40% of patients after angioplasty, which may interrupt CR. While the effect of CR on the restenosis rate has been reported to be neutral, CR may serve as a monitor for recurrent myocardiai ischemia in patients after coronary intervention. 3) Because the advance of the treatment of AMI rescues high-risk patients (i.e., elderly and low cardiac function), more such patients may enter the CR program. The optimal level of exercise intensity for these high-risk patients should be established in this coronary intervention era.
