F-3-16-03
EVALUATION OF THE USE OF VIDEOPHONE NETWORK IN COMMUNITY-BASED REHABILITATION PROGRAM
K. Nakamura, T. Takano, C. Akao, K. Takasaki (Tokyo Medical and Dental University, Tokyo, Japan) K. Yamamoto, H. Ito (Health and Social Welfare Center, Daito-Osaka, Japan) H. Imafuku, M. Matsumoto, M. Kobayashi (Itabashi Home Care Support Center, Tokyo, Japan)
Application of videophone technology to support living of the elderly with long-term care needs has been practically considered in recent years. The purpose of this paper is (1) to examine if the use of videophone network is effective in improving the level of independence of the elderly with long-term care needs in community; and (2) to elucidate elements needed for effective community-based rehabilitation program when we employ videophone network. Videophones (Fujitsu IS-100 or VS-700 using ISDN) were installed in the homes of 45 subjects with different levels of disability. The main cause of disability were varied; 18 suffering from cerebro-vascular disease, four from Parkinson's disease, two from orthopedic arthritis, two from femur fracture, two from old myocardial infarction, two from progressive muscular dystrophy, and others. Videophone network was developed to communicate among patients' homes, community-based centers with rehabilitation programs, a health care nursing home, and a videophone therapy room at an university. Rehabilitation program through videophone was provided for at least a three-month period. Rehabilitation program using videophone elicited positive outcome to improve level of independence in ADL, communication and social cognition. Videophone network facilitated communication among rehabilitation team members to carry out program efficiently. In conclusion, videophone use network is effective to improve the level of independence of the elderly with long-term care needs in community. Further potentials of the use of videophone into community-based rehabilitation programs were discussed.
F-3-16-04
DISABILITY CASE-MANAGEMENT: USING RECOVERY TRAJECTORIES AND SUPPLY/DEMAND ANALYSIS TO OPTIMIZE FUNCTIONAL OUTCOMES
Michael W. Kita, MD (UNUM Life Insurance Company, Portland, ME) and Masayoshi Soma, MD, PhD, (UNUM Japan, Tokyo, Japan)
Disability is the sociomedical concept that bridges rehabilitation medicine (functional capacity) and insurance medicine (work-capacity) at the critical interface of outcomes-management. In most countries, three major systems are involved in disability-adjudication and outcomes-assessment-social insurance programs, workers compensation schemes, and private insurance programs for both short-term and long-term disability. When a clinical outcome like "maximal medical improvement" is the key rehabilitation-outcome of interest, certain types of disabilities fail to achieve even greater holistic outcomes like "return-to-work" (RTW), incurring the kinds of personal and societal tolls that persistent invalidism can produce.
Recovery-trajectory plots and similar analytical tools help to clarify dynamic supply/demand considerations that arise as functional capacity is progressively regained, and help to identify medical and non-medical obstacles to achieving optimal outcomes. This study describes the contribution that such tools make to active case-management, using a series of private-disability claims filed with an international disability carrier, and also summarizes recent work done in collaboration with the World Health Organization, to modify the current ICIDH (the International Classification of Impairment, Disability, and Handicap) to broaden its general applicability to disability-evaluation and disability-management in an international environment.
When such tools are consistently applied, return-to-work occurs with greater frequency, shortening disability-durations and promoting higher overall functional-status recovery. The self-esteem that accompanies a re-established work-identity and restored societal productivity are collateral benefits.
