Fujita Health University
Rehabilitation Organization

2006
FHU is established in 1964

Fujita Health University Rehabilitation Organization
Atsuta Campus

Toyoake Campus

Eiichi Saitoh M.D., D.M.Sc.
Professor and Chairperson, Department of Rehabilitation
Medicine, School of Medicine
Principal, Academy of Rehabilitation
Chairperson, Rehabilitation Organization
Fujita Health University
esaitoh@fujita-hu.ac.jp
http://www.fujita-hu.ac.jp/~rehabmed/index.html

Fujita Health Univ Rehab Organization &Department of Rehabilitation MedicineTokyoOsakaNagoya

Fukuoka

Dept Rehab Med, School Med
Faculity Rehab, School Health Sci! Academy Rehab! Dept Rehab, Univ Hospital! Dept Rehab, Bantane Hospital! Nanakuri Rehab Center! Society Rehab & Kinesiology!
!

Nanakuri Rehab. Center

Fujita Health Univ Rehab Organization
Membership: 188

MD: 39, PT: 64, OT: 52
ST: 10, Nrs: 9, Others: 14

Achievement in 2005

Fujita Health Univ Rehab Organization

Department of Rehabilitation Medicine

Overview of Rehab. Patients ofUniversity Hospital (2005, Toyoake)(April 1 2005 ~ March 31 2006)•Total New Patients: 2,586•Inpatients / Outpatients: 2,102 / 484•Age: 59.8 ± 21.9 yo (0~104, Med 65 yo)•Gender: male 1,256 female 1,330•Length of Stay: 60.2 ± 66.7 days

Patient No: new 3,174, total 123,720
PT&OT national exam pass rate: 100% (for 9 years)
Free-Paper/Lecture : 235, Paper/Book: 122
Host of conference: 1, Host of lecture: 14
Public research grant: 9, Press report: 4
http://www.fujita-hu.ac.jp/~rehabmed/index.html
E-mail: rehabmed@fujita-hu.ac.jp

Overview of Rehab. Patients (2005)
2,586 Patientsmean Age: 59.8 yo

University Hospital

Depts in Charge
Distribution of Age

2,586 Patients1Overview of Rehab. Patients (2005)
2,586 Patients

University Hospital

FIM change at AD/DCFIM at AD: 75.1, at DC: 90.9

Etiologies

Major Research Projects of FHU-R● WPAL project: Reconstruction of Paraplegic Locomotion● HOW project: a new AFO (APS-AFO) Development● Tomy project: Integrated Treadmill Gait Analysis● FIT project: Integrated Stroke Rehabilitation Program● COSPIRE project: Clinical Oriented Education System● Clover project: Unified Database for FHU-R● Phi project: Multidimensional Dysphagia Research
Atsuta Campus

Nanakuri Rehab. CenterToyoake Campus

1,978 PatientsReconstruction of Paraplegic Locomotion
W/C usage should continue forever?

Primewalk - WPAL project
Reconstruction of Paraplegic Locomotion

W/C
W/C

W/C
W/C

W/C
W/C

Walk
Walk

Walk
Walk

Futures of locomotive function

PrimeWalk system
Developing a modified Medial Single Hip (MSH)
Joint System with Tims Co. Ltd.

Powering Primewalkwith FES, Motor, & Motor-FES Hybrids
FES Hybrid

Motor Hybrid

Motor-FES Hybrid

Saitoh et al. 1994

Saitoh et al. 2000

Uno et al. 2002

• Compatible with W/C usage• Less constraint by trunk-free• Good standing balance by MSH• Better gait function by virtual hip axis
Saitoh E et al. 2000

2Powering with Control
Developing Robot
WPAL project

WPAL project in 2005

Robbot + Orthosis
Medial System

Wearable Power-Assist Locomotor

Getting 3,000,000 $ for 3 years from the NEDO
•Fujita H. Univ.
Univ.
•Toyohashi Univ.Tec.
Univ.Tec.
•Aska Co. Ltd.
•Tims Co. Ltd.

Wearable Power-Assist Locomotor

start at 2005
• Fujita H. Univ.
• Toyohashi Univ.Tec.

Achievement of ConvenientStanding-up & Walking

Development ofActuator System

Development of Learning System

Treadmill Gait Analysis

Motion Analysis
Computer Simulation

Development ofTraining System

Gyro sensor• Aska Co. Ltd.
• Tims Co. Ltd.

Pressuresensor

Active EMG

Development of Sensor& Control System

User Commitment
2 Paraplegic Physiatrists and Many Rehab Patients

Shape of Shoehorn AFO & Misdirection of Movement! Along with calf

HOW project! Make rigidity(Hemiplegic Orthotic Walking)a new AFO Development(the Adjustable Posterior Strut AFO)

! Problem of motion
direction

not flex but twist
direction of flexion!!!!of plate-shape materials

Developing an Adjustable Posterior Strut AFO: APS-AFO

weight bearing

Effect of APS-AFO• Guide for movement by Posterior StrutMizuno et al. 2004
(deg)

25mm

ER

Setting of Starting Position

Not Make Plantarflex. moment

610APS(deg)• Adjustable by a simple joint

Plantar Flex

Dorsal Flex

0Adjustable Neutral & Stop Positions

0.7

IR15mmAdjustable Resistance

Gait Velocity

020mm

from Yamamoto 1997

6ER10mm

PF010(deg) DF20IR
90 60 45 30 0 30 45 60 90
LateralMedialAPS-AFO**AllHemipl

Parapl

1073

*

0.5
0.4

60.305mm**

0.6m/sec

Assist of Dorsiflexion

0.2

610SHB0PF10(deg)

20DFCase: 48yo, male, Infarction,Lt-hemiplegia,, TAO: 1Y4M
Lt-hemiplegia

0.103

Tomy Project for Gait Analysis
Tomy project
Integrated Treadmill Gait Analysis

Integrated Treadmill Gait Analytic (ITGA) System!Force Plate Measure

by FHU-R Tomy Project since 2000

Clinical-oriented
Research Interest :Quantitative! Bipedal Locomotion
Gait Analysis! Inverted Pendulum
Need in Clinic:! Central Pattern Generator! Heavy Burden! Passive walking
Bridge ! Abnormal Patternetc.
! Gait exercise! Evidence of Txm! Prevent of FallasCh! New Instrumentetc.

Expression using Lissajous's Figurea healthy subject

1 variables!EMG Analysis

CGUp 91 CG in Frontal Planecm

ADAL 3D Treadmill :Techmachine Co. Ltd.

!3-D Motion Analysis

UpLt-CCD cam1

I/FIEEE1394
HUB Rt-CCD cam2

Analytic PC

02cm

46

Lt-CCD cam2

Pst

トレッドミル

7230

RtAnkle in Sagittal Plane

KN

cm

Rt-CCD cam1-2

20
16128
40
Dn 20

MakersCalibrator

CG-yy & AnkleCGAnkle-yy

8076cmGait Analytic EMG :under development withNihon Kohden Co. Ltd.

84cm

9089888786
Dn -4
Lt2 variables

4060 80cm

100 120

Ant11010090807060
305070cm

90110

ANK

Knee-yy & AnkleKneeAnkle-yy

5070
cm

90110

ANK

Ohtsula et al. 2003

Kinema Tracer : under development with Kissei Comtec Co. Ltd.

ITGA assists
clinical decision• Abnormality Index
Quantified assessment of gait
pattern abnormality• Learning Index ( variation index )Evaluation of restorative process of gait ability
by quantification of unevenness in movement

toe off insufficiency
Trendelenburg

100806040
200knee breaking

circumduction

knee stiffness

external hip rotationin swing phaseheel contact insufficiency

knee locking

LissajousC/G
frontal pl.
Rt knee sagittal pl.
Lt knee sagittal pl.
Rt heelsagittal pl.
Lt heelsagittal pl.
Rt heelhorizontal pl.
Lt heelhorizontal pl.
Average
Rt
Ltstart
20.4
13.6
32.3
6.6
15.3
4.6
24.3
9.6
26.1

2w
14.2
6.4
24.3
2.4
12.3
6.4
8.3
4.7
17.3

4w
6.1
3.3
12.1
1.4
3.1
1.3
3.2
2.3
7.6

8w
2.8
2.1
8.8
1.0
3.1
1.1
8.0
1.6
7.1

Change in Coefficient of VarianceFIT project
Full-time Integrated Treatment program
named by Prof. Palmer

Integrated Stroke Rehabilitation Programat Fujita Health University Nanakuri Hospital4

Framework of FIT program

Weak Points of Rehab Approach! to increase exercise dose

! Ward gymnization: an integration of ward andgymnasium! Triangle-pairs (TriP) : a new therapist team systemfor everyday therapy! Learning requires More Time! Learning requires
Active Participationof Patient and Family! Teamwork requires
Much Informational Cost

! to encourage motivation of patient and family! Activity-affordable corridor! Weekly stroke class! to enrich the communication among staff! LAN-based online database systema New Rehab. Unit for the FIT program

Ctrl
OT

Bed No: 52
Single : 18 m2 , Fours : 36 m2
Total Area : 2023 m2
PT : 318 m2
Activity-affordable corridor of 6
OT : 147 m2
m-widthST : 40 m2
Dining : 170 m2
BathRmRest Rm

ExRm

50

ADL

ST

Rest Rm

Pts Rm

FIT

40

FIM-motor Gain

Started from Dec. 2000 at Nanakuri Rehab. Center

FIM-motor gain and LOS

302010PT00Nrs station

Pts RmDiningDayroom

Ward gymnization: an integration of ward and gymnasium

LOS (days)
FIM-gain
FIM-efficiency

4080

120

LOS (Days)
Ctrl: 80
FIT: 70
Ctrl: 12.7 FIT: 20.3
Ctrl: 0.16
FIT: 0.30

160
Sonoda S et al. 2003

P<0.05
P<0.001
P<0.001

COSPIRE project
Clinical-Oriented System for Progression & Innovation of Rehabilitation Education(co:with, spire:respiration; mutual inspiration)

COSPIRE project
Clinical Oriented Education System
the Clinical-Oriented System for Progression & Innovation of Rehabilitation Education!Integration of Clinic, Education, & Research!Fruitful Reproduction of Rehab. Specialists!Disposition Mixture of Clinician, Teacher, & Scientist!Promotion of Integrated Clinical Research!Promotion of Postgraduate Education!Co-education of physician & therapist!Utilize an advantage of the FHU-R

5

Enhanced Clinical Training

Open a New Faculty of Rehabilitationin School of Health Sciences
for the COSPIRE project! 1,520-hours, about 2 times morethan average! 2/3 of program carried in FHU-R! First-class clinicians as teachers

6,000 m2
7 floors

800

NationalAverage

844

FHU-R

Start at Spring 2004

PT: 45, OT: 350

Professor Sawa S, OTR

First-class clinicians participate inempathy with the COSPIRE

Government
Standard1520
400

800

1,200 hours 1,600

Professor Tomita M, RPT

the Unified Database for FHU-R
Clover project

Clover project
the Unified Database for FHU-R

Used in conferences

quantified prognostication by using data-base

qpdb!

FIM at AD: 76.7, at DC: 89.8
1,829 Inpatients in 2004

FIM examination

Multidimensional Dysphagia Researches! Repetitive Saliva Swallowing Test (RSST) (Oguchiet al. 2000) & Non-VF Flow Chart (Baba et al. 2001)

Phi project! Clinical application of the Process Model (Shibata

Multidimensional Dysphagia Research"et al. 2003-)! FES for the Bulbar Palsy (Kagaya et al. 2004-)! Reconsideration about Positional Effect (Okada etal. 2005)! Outcome of the Bulbar Palsy (Ozeki et al. 2005-)

6Non-VF Flow Chart

Repetitive Saliva Swallowing Test (RSST)
Accumulated time (sec)

40(Oguchi et al. 2000)

Normal data!"30 Young: 28.9 ± 6.9 y/o
35 #"30 Elderly: 68.1± 6.8 y/o30
**

1540

130

*

100No50

205

Sensitivity：
Sensitivity： 1.00
Specificity ：0.91
False positive：positive：0.40
False negative：
negative：0.00

Dysphagic patients

25

*
*

1$$$2$$$3$$$4$$$5

Repetition No

20

VFG

10at 2nd time

0!32RSST101• Counting dry swallow numbers in 30 sec• Becoming a standard screening test in Japan

23(Baba et al. 2001)

NPO

4

Aspirationin VFG

Join with Professor Palmer

1,2,3

Decision making forstarting direct therapy

tube status
OKMWST

1,2,3
SwXP
2,3,4,5
I-Tx

4,5
FT
4,5

4,5

I-Tx
&D-Tx

Modified FT

adjustment
trouble

SwXP

1,2,3

1

2,3,4,5FT
4,5 1,2,3

VFG

Caution about SA•I-Tx: Indirect therapy•D-Tx: Direct therapy•MWST: Midified water swallowing test
•FT: Food test
•SwXP: Swallowing X-P test
•VFG: Videofluorography

Clinical application of the Process Model

Joint Conference on Dysphagia Rehabilitation,
co-sponsored by the Johns Hopkins University and Fujita Health University(Shibata et al. 2003)
MIX - Chewing (ex. female, 31 years)• 1996 Oct:
• 1998 Aug:• 2000 Feb:
• 2000 Sep:
• 2001 Apr:
• 2003 Oct:
• 2004 Sep:NISAH in Nagoya
1st Joint Conference at JHU
2nd Joint Conference at JHU
6th JSDR in Kurashiki
3rd Joint Conference at JHU
4th Joint Conference at FHU
10th JSDR in Niigata &5th Joint Conference at FHU• 2005 Aug: 6th Joint Conference at JHU

Location of leading edge of bolus at swallow onset
LQD - Command (29) 31.0

37.9

LQD - Chewing (30) 10.0

20.0

CBH - Chewing (30) 10.0
COK - Chewing (30) 3.3

36.7

3.4
33.3

30.0

60.0

16.7

MIX - Chewing (27)027.6

70.0 10.0
37.0

2063.0406080100%

OC: Oral Cavity

UOP: Upper oropharynx area

VAL: Valleculae areaHYP: Hypopharynx area

Products for Dysphagia Rehabilitation
Jelly for dysphagic patients (2005)
Swallow Cup (2002)

Balloon catheter (2003)
Adjustable chair for VFG (2001)

7