29

Japanese Journal of Comprehensive Rehabilitation Science (2019)

Original Article

The long-term process of recovering self-leadership in patients withdisabilities due to acquired brain injury
Shinichi Wada, MD, MPH, PhD,1 Miki Hasegawa, MD2, 3Moriyama Rehabilitation Clinic, Shinagawa-ku, Tokyo, Japan
Sangenjaya Rehabilitation Clinic, Setagaya-ku, Tokyo, Japan
3
The Japan Society of a Caring Community for People with Brain Injury, Setagaya-ku, Tokyo, Japan1
2

ABSTRACT
Wada S, Hasegawa M. The long-term process ofrecovering self-leadership in patients with disabilities
due to acquired brain injury. Jpn J Compr Rehabil Sci
2019; 10: 29-36.
Objective: To create a model that makes it easier tounderstand the “process of recovering self-leadership(shutaisei),” which is linked to long-term improvementin the lives of patients with disabilities due to acquired
brain injury.
Methods: We held the 18th Self-Leadership (Shutaisei)
Research Conference comprising eighteen membersthat included patients, formal caregivers, medical
personnel, and researchers. Results of semi-structured
interviews with members related to “long-term recoveryof daily activities at home” and “self-leadership(shutaisei)” in patients with disabilities due to acquired
brain injury were qualitatively analyzed using amodified grounded theory approach.
Results: Forty-five concepts were generated after ananalytical review of the analysis worksheet. Five
recovery axes and five recovery stages emerged fromthe concepts related to individuals’ progression
courses. The cognitive element of understanding one’s
self and one’s surroundings formed the base of themodel, supporting the three elements of self-leadership(motivation, self-reliance, and confidence). It was
shown that increased self-esteem can be expected toresult from changes in personal values if selfleadership is recovered.
Conclusion: The model is considered to be useful as it
Correspondence: Shinichi Wada, MD, MPH, PhD
Moriyama Rehabilitation Clinic, 1-11-17 Nishi-Nakanobu,
Shinagawa-ku, Tokyo 142-0052, Japan.
E-mail: wada@aoi-med.org
Received: April 4, 2018; Accepted: February 16, 2019.
The authors have no conflicts of interest directly relevant tothe content of this article. This work was supported by the
Yuumi Memorial Foundation for Home Health Care and
JSPS KAKENHI Grant Number 17K01582. The funding
sources had no influence on this paper.
©Kaifukuki Rehabilitation Ward Association 2019
doi.org/10.11336/jjcrs.10.29

is able to broadly assess the stages of patients withacquired disabilities, to grasp their characteristics, andto serve as a form of information that can be sharedwith others.
Key words: self-leadership, stroke, traumatic brain
injury, life-stage rehabilitation, in-home rehabilitation
Introduction
Many patients with acquired disabilities due tocerebral stroke and other brain injuries have residual
impairments and activity limitations. Treatment andrehabilitation for these acquired disabilities are usually
initiated early in the post-stroke period under aphysician’s direction, while the patients have a passive,
dependent role. However, in clinical practice, we
encounter patients who actively rebuild a new life withenduring self-leadership and determination, whose
long-term recovery may take place up to several years
later, such that they may notice one day that they arecapable of doing things that were previously difficult.
In fact, some of these people with acquired disabilities
may go on to become even more active than they were
before the stroke [1, 2].
The patients’ recovery in “reconstructing their lifein their own way” despite the disabilities is as
important as seeking functional recovery. To achieve
this reconstruction of daily life, there must be a shift
from a dependent relationship in which the medical
personnel have the leading role and the disabled
person has the passive role to one characterized by thedisabled person as the leader and medical personnel as
the formal caregivers [1].
The importance of “shutaisei” (self-leadership) in
people with disabilities has been emphasized manytimes in the areas of healthcare, long-term care, andwelfare [2-7]. However, the details of “shutaisei (selfleadership) associated with recovery of life in people
with disabilities” have not been clarified. “Selfleadership” is the approximate translation of theJapanese term “shutaisei,” which is more commonlytranslated as “autonomy” in English. Many reports
Jpn J Compr Rehabil Sci Vol 10, 2019

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Wada S et al.: Long-term recovery of self-leadership in brain injury patients

have emphasized the importance of “autonomy” indiscussing patient-centered nursing, long-term care,and rehabilitation [8-11]. However, we realized that amore complete definition of this word was required, as“autonomy” only reflects part of what “shutaisei”
encompasses.
Although there are some cases in which the“shutaisei (self-leadership)” of the patient undergoes achange and concomitant long-term improvements inliving occur after a long period of stroke, they areoften discounted as exceptions, and no further
investigation is performed.
The paths that individuals take to an active recovery
from the desperation, anxiety and loss of confidence
experienced in the early post-stroke period are not
identical. However, there may be some common
trends. It is understood that “self-leadership” serves a
crucial role in rebuilding a new life, but the definitionof “self-leadership” in individuals with disabilities is
unclear and there are no indices for measuring it.
Generalizing the trends in the process of recovery
from stroke and the types of interactions withsurrounding people that promote this recovery will be
useful for people with disabilities in care andrehabilitation settings and in their homes. We
previously reported on the concepts of “shutaisei”(self-leadership) that lead to long-term recovery ofcommunity-dwelling patients with disabilities
following stroke or brain injury [12].
The present study aims to create a clear model that
illustrates the “process of recovering self-leadership”
linked to long-term improvement in the lives ofpatients with disabilities due to acquired brain injury
and to elucidate the manner and type of improvementsthat follow the recovery of self-leadership.
Our conferences yielded a wealth of informationthat exceeds the scope of a single study. The present
report focuses on the model outlining the long-term
process of recovering self-leadership. Other reports
provide more detail on the concept of “shutaisei” (selfleadership) that promotes recovery [12] and theinteractions with surrounding people that promote
self-leadership.
Methods
This study was approved by the Ethics Committeeof Aoi Medical Corporation.
1. Research participants
A Self-Leadership (Shutaisei) Research Conference
was held once a month for approximately two hours
per session starting in February 2015, with participantsthat included multidisciplinary medical personnel
from multiple institutions (physicians, nurses, physicaltherapists, occupational therapists, and a speech/
hearing therapist), formal caregivers (welfare andlong-term care), researchers (sociology, psychology,
Jpn J Compr Rehabil Sci Vol 10, 2019education, and philosophy), and patients withdisabilities. The topic of discussion was patients withdisabilities due to acquired brain injury (cerebral
stroke or other brain injuries) who made long-term
recovery of functions, activities, and participation
essential for living. Each conference session was heldwith around 20 participants, including 18 regularmembers representing 10 institutions and several guest
participants.
2. Data collection
Anonymous, semi-structured interviews wereconducted with the Self-Leadership Research
Conference members during the period from February
to June 2015 about the “recovery of life at home thattook more than half a year” and “shutaisei (selfleadership)” of people with acquired disabilities due tocerebral stroke that the interviewees witnessed, heard
about or experienced themselves. There were five tonine responses for each of the 10 questions. Sevencases were presented by members, and other cases
were also shared in conference discussions. The
questions are displayed in Table 1.
3. Analysis
Although various factors are reported to promote orinterfere with recovery, focus was placed on therecovery (reacquisition) of self-leadership, which isthought to be associated with long-term rebuilding oflife. The Delphi technique was used in the first six
months of the conferences, i.e., collective feedback
was provided to members by summarizing answers to
the questions to allow experts to revise their opinions
for the next conference. This process was repeated tofacilitate the convergence of opinions. After thisprocess was completed, common aspects of thepatients’ long-term recovery of life and the process ofrecovery of self-leadership were discussed to induce amodel through “bottom-up” logic based on independentcases.
The modified grounded theory approach (M-GTA)
was used for qualitative analysis [13, 14]. Discussion
was conducted on the analytical theme “Elucidating
the process of the recovery of self-leadershipassociated with people with acquired disabilities due
to cerebral stroke, and their interactions withsurrounding people,” on the following subjects:“Patients who were able to achieve recovery in life
over the long-term despite acquired disabilities caused
by non-progressive acquired brain injury.” Theanalytically-focused person was “People such as
medical staff, specialists and family who interact withthe people with the acquired brain injury” regarding“The patient’s progress” and “Interactions withsurrounding people.” Furthermore, stabilization of
acute symptoms and somewhat stabilized financial
and social conditions were assumed as premises of theanalysis.

Wada S et al.: Long-term recovery of self-leadership in brain injury patients31

Table 1. Questions and answers.
First request:
We ask that you relate anecdotes of “Episodes related to shutaisei (self-leadership)” as specifically as possible.
There is no set format; please give them to us as they come to mind. Reported cases: 4 cases/7 examples
Second request:
Please give some examples deemed independent “behavior (actions or words).” There will be subsequent
questions for discussing the “Preparation” stage and “Encouragement by others” later, but they can also bementioned here. Answers: 7
Behavior with shutaisei (self-leadership), including actions and words, are understood to require a preparatory
stage or antecedent factors. Please name these stages of “Preparation” (state of preparation and antecedentfactors). Answers: 6
What “Encouragement by others” is required for behavior with shutaisei (self-leadership)? Please name them.
Answers: 6
Please share any other opinions you may have regarding “shutaisei (self-leadership).” Answers: 5
Third request:
Tell us your thoughts on the “points in common of the stages and flow” of recovery (improvement) fromdisability. Answers: 7
Tell us your thoughts on the “points in common of the factors that promote” recovery (improvement) fromdisability. Answers: 6
Tell us your thoughts on the “points in common of the basis and preparatory stage” of recovery (improvement)from disability. Answers: 8
Tell us your thoughts on what is improved in the long run. Answers: 9
Share any other opinions you may have regarding “shutaisei (self-leadership)” or “improvement from disability.”
Answers: 6
Fourth request:
How do you determine that the patient has undergone a change of state from “desperation” to “having shutaisei(self-leadership)”? Your answers may include references to patients’ words, utterances, behavior, and attitude.
Answers: 6
Minutes were based on the written answers to theinterview questions and answers from the conference
recorded with a voice recorder. Cases that exemplified
the process of the recovery of self-leadership in people
with acquired disabilities were collected on theanalysis worksheet and defined, and the concepts werenamed. These generated concepts were organized inchronological order along the timeline of the process
and categorized by concept similarities; therelationships between the categories werestructuralized and made into a final schema.
Discussions were held on the model, which was peer
reviewed and checked by the conference members.
Furthermore, the accuracy and validity of theinterpretations were discussed.
Results
A total of 18 conferences were held between
February 2015 and September 2016.
1. Definition of “self-leadership” at the beginningof the study“Shutaisei (self-leadership)” is defined as theattitude or characteristic of acting according to one’s
intentions and judgment and taking responsibility forit [15]; however, this definition was considered
incomplete for the context of the debate on “selfleadership that links to the long-term recovery ofpeople with disabilities.” As long as the intention or
motivation is aimed strictly at recovering the“functions” or “basic activities of daily living(ADLs),” it is difficult to reconstruct the emotionally
meaningful aspects of daily life; thus, an amended
definition was agreed upon at the first conference. The
point of view of “living like oneself” was added in
response to the idea that looking at intention or
motivation was needed to redefine the term to “Attitude
or characteristic of acting or making decisions withresponsibility according to one’s own intentions andjudgment in order to live like oneself” for the purposesof the research.
2. Model of the recovery of self-leadership
2.1 Generating concepts and categories
Analysis worksheets and model-mapping began in
March 2015. Opinions were exchanged, and revisions
were made more than 30 times over the course of theconferences. Forty-five concepts were generated bymeans of the M-GTA analysis worksheets and theconcepts were categorized by process, resulting in 16
concepts on “interactions with surrounding people”
and 29 on “the patient’s progress.”
Concepts representing “the patient’s progress,”one of the analytical themes, were organized withsome consideration for chronological order, with
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Wada S et al.: Long-term recovery of self-leadership in brain injury patients“elucidating the process of recovery of self-leadershipthat affects the improvement of people with disabilities
due to acquired brain injury” in mind. The recovery
stages with actions as the keyword came in five stages.
Five axes of recovery emerged from the concepts, andthe model was based on them (Figure).
2.2 Stages of the recovery of self-leadershipConcepts describing “the patient’s progress” werecategorized into the following five consecutive stages:“Oblivion,” “Inertness,” “Preparation,” “Readiness,”and “Control” (Table 2) (Figure).
2.3 Five axes of recovery related to self-leadership
According to the subcategories generated from theconcepts organized in chronological order, we foundthat “Vague recognition of the disabled self” and“Ability to see oneself objectively” corresponded to
the recovery of “awareness;” “Apathy and sense ofpointlessness” and “Urge to do things by oneself”
corresponded to the recovery of “motivation(expectation of results);” “Reliance on others” and“Impression that results are determined by one’s
decisions and actions” corresponded to the recovery of“self-reliance (responsibility);” “Lack of confidence(‘I don’t think I can do it’)” and “Budding confidence(‘I feel like I can do it‘)” corresponded to therecovery of “confidence (self-efficacy);” and, finally,“Predominance of pre-disability values,” “Gradualacceptance of changes to pre-disability values,” and“Life under a new value system” corresponded to therecovery of “standards of values” [12]. That is, they
were summarized into five Axes of Recovery (Table 3)(Figure).

FigureDiscussion“Awareness” of the self or the environment that one
is placed in (axis of recovery 0) is the base that
supports the three elements of self-leadership linked to
improvement, i.e., motivation, self-reliance andconfidence (axes of recovery 1, 2 and 3). Once selfleadership begins to recover, feelings of self-respectalso begin to increase based on new “values” (axisof recovery 4) (Table 3) (Figure). Close observationof the progress shows that changes in axis 1“motivation” and axis 2 “self-reliance” seem to occur
relatively quickly and without much hesitation. In
contrast, axis 3 “confidence” is established gradually
and with vacillation in stage 2. Similarly, axis 4“values” also seems to waver with gradual changes
throughout stage 3.
After a brain injury that is severe enough to impair
ADLs, comprehensive recovery of the various facetsof life is complex; needless to say, there are numerous
factors that influence these in functional andenvironmental aspects. Here, we focused on thereacquisition of self-leadership because we believe it
to be associated with the long-term recovery of life inindividuals with acquired disabilities, with the premisethat acute disease symptoms are stabilized and there isrelative financial stability. In Maslow’s hierarchy offive basic needs [16], these corresponded to having
physiological and safety needs fulfilled while love andbelonging and esteem needs were not yet met, whichcorresponded to stages 0 and 1 in the present model.
Stage 1 of the present model is similar to Erikson’s
concept of “identity diffusion,” as articulated in his
life-stage theory [17, 18]. Identity diffusion is a statein which an individual lacks the ability to define

Model of recovery of self-leadership for people with disabilities.

Jpn J Compr Rehabil Sci Vol 10, 2019Wada S et al.: Long-term recovery of self-leadership in brain injury patients

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Table 2. Stages of recovery of self-leadership.
Stage 0: Oblivion, “Not recognizing what they can’t do”
In this stage, patients are unable to recognize the current situation and the disability that is expected to persist. Patients are either unawareof the disability or they expect to recover completely.
Although the patients may have vague concerns that they may no longer be able to fulfill their roles, they are positive in a sense, and feellittle anxiety about their disability. At this stage, the patients’ goal is to return to their previous state through rehabilitation.
This stage is mainly expected to take place while still hospitalized. However, it may last longer in patients with lower awareness of theirillness due to disorders of higher mental functions.
Stage 1: Inertness, “Having difficulty taking action”
Patients in this stage are filled with desperation, anxiety, and feelings of loss and isolation that impair the urge to take action. Taking action
is a great challenge due to a lack of confidence and feelings of helplessness.
This stage starts from the patients’ vaguely recognizing their profile as a disabled person and finding that they cannot live the same way
as before. In this stage, patients are passive: tasks, even those that can be done by the patients themselves, are led and carried out by people
around the newly disabled person, which can further disable the patients in a vicious circle of apathy, dependence, and lack of confidence.
Rehabilitation itself easily becomes the goal.
Primarily takes place at home or after returning to the patients’ social spheres, including work, roles in the community, hobby groups andvolunteering activities, but some patients may enter this stage during hospitalization.
Stage 2: Preparation, “Preparation to take action”
Patients believe that a certain behavior will render desirable results (expectation of results, increasing motivation) and feel that certain
results depend on their own actions (belief in self-reliance), which motivates the patients to take action. At this stage, patients break out ofthe passive attitude in which they are waiting for guidance. Patients in this stage are equipped with two of the three elements of selfleadership, but their confidence still fluctuates.
Patients also begin to gain the ability to compare their current self not to the pre-stroke self, but to a more recent post-stroke self. They
begin to have values that are different from those before the stroke, begin to accept themselves as they are, and start to explore what it now
means to “be themselves.”
Stage 3: Readiness, “Readiness to take action”
Patients are motivated and have confidence in addition to the “belief in self-reliance,” completing the three elements of self-leadership.
Patients set specific and achievable goals themselves and begin to take actions that allow them to be like themselves. Their vision oninterests also broadens at this stage.
The actual abilities or environment of the patients begin to match with their abilities and environment as the patients perceive them(metacognition), and they begin to make clear distinctions between the tasks that they can do on their own and those that require the help ofothers in order to live like themselves. Although their values gradually begin to shift to thinking that their self-assessment should be basedon their own standards regardless of their disability, their search for a “sense of being oneself” continues.
Compared to the spatial realm of activity in Stage 2, which consisted of “familiar places,” such as places the patients have been taken to,
the patients in Stage 3 begin to explore places that they have never been.
Stage 4: Control, “Control over life”
Patients begin to take actions now with all three elements of self-leadership. Through that process, they begin to accept the things within
and outside the reach of their capacity and begin to look around before planning their actions. These changes in their standards allow them
to become aware of “the current self as the true self,” “acceptance” and “sense of being oneself,” which boosts their self-esteem and senseof self-respect. At this stage, patients are finally able to construct their entire lifestyle (control) within the new value system. The patients
have become fully independent at Stage 4 and do not require further intervention.

Table 3. Axes of recovery around self-leadership.
Axis of recovery 0: Cognition
Patient transition from the state of “Inability to see the disabled self” to recognizing new things that they cannot do in their “vague
recognition of the disabled self.” The last step in this process, “Ability to see oneself objectively” (metacognition) is characterized bybecoming able to assess their abilities, including factors such as the people surrounding them and the circumstances in which they areplaced. This element establishes the underpinnings of self-leadership.
Axis of recovery 1: Motivation (expectation of results)
This axis is characterized by the shift from “Apathy and sense of pointlessness,” or a sense that a particular action will not lead to thedesired result, to the belief that a particular action does link to the desired result in “Urge to do things by oneself” (increased expectation of
results).
Axis of recovery 2: Self-reliance (Responsibility)
Transition from the reliance on others, i.e., the “impression that results are determined by others’ decisions and luck” to a belief centeredon self-reliance and self-decision to rely on others, i.e., the “impression that results are determined by one’s decisions and actions.” Patients
begin to believe that one is responsible for the results of one’s own decisions. This axis is analogous to the transition from having an“internal” to an “external” locus of control.
Axis of recovery 3: Confidence (Self-efficacy)
Patients go from a state in which they feel like they “cannot do” anything, to having the confidence that tasks can be accomplishedindependently, or by asking for and receiving help from others. This axis characterizes an increase in confidence (self-efficacy).
Axis of recovery 4: Standards of values
A process of change from “disappointment in the changed self” and “plummeted sense of self-worth” to the “acceptance of self as is” and“positive image of the new self” so that the sense of being oneself can be regained once again. A shift in values: changes in the internal
standards of values, increase in self-esteem and self-respect.



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Wada S et al.: Long-term recovery of self-leadership in brain injury patientsthemselves and may not know what to do. The task fora person in this state is to construct or reconstruct asatisfying life that facilitates self-definition.
The importance of the “shutaisei (self-leadership)”of persons with disabilities has been repeatedly
debated in the areas of health care, long-term care, andwelfare [1-7]. However, it remains unclear what “selfleadership associated with recovery” exactly is. As
described in 1. Definition of “self-leadership” in the
Results section, self-leadership related to activities
and participation “in order to live like oneself” isimportant if emphasis is placed on the recovery of life.
Even when self-directed and purposeful, excessive
fixation on the impairments is far from self-leadershipthat links to recovery [12]. Without clarifying thispoint, it is difficult to show this difference clearly insupport settings.
The present model broadly assessed the stages of“self-leadership that links to recovery” in people withdisabilities to understand their characteristics so thatthey can be communicated clearly. This can help leadto consistent approaches towards long-term recovery
of life by professionals and families who assist people
with disabilities.
Other models have been used to describe thecomplex process of identity shift related to physicalchanges. Okamoto [19] proposes a theory characterized
by subjective efforts to adjust one’s identity, i.e., thateven after one’s identity is established during middle
age, it is revised at turning points of life in accordancewith physical changes to more realistically reflect theperson’s abilities at that point in their life. She explains
the process in four stages (Table 4), which almost
correspond to the stages in the present model. In otherwords, the recovery of self-leadership may reconfirm
the identity.
The process of recovery from disability has been
debated with a focus on “acceptance of disability” and“life story” [20-24]. However, the broad interpretationand vague use of the term “acceptance of disability”
by rehabilitation professionals has been a problem.
For example, some interpretations, such as “disabled
people should achieve changes in values while
hospitalized” was criticized [25], giving rise to more
confusion in rehabilitation settings [26].
The “acceptance of disability” theory and “recoveryof self-leadership” model are similar in that both
follow the progress in time and assume the final stage
to consist of adaptation through a change of values.
However, while the “acceptance of disability” theory
divides stages 0 and 1 of the present model into more
specific classifications, it treats stages 2 and 3 of ourmodel only briefly, giving the impression that thecourse between the first and the fourth and final stage
is a sudden jump (Table 4). That is, in the “acceptanceof disability” theory, there is a wide gap and a lack ofcontinuity between the final stage of adaptation andthe steps preceding it. This can cause confusion andhesitation for the patient, medical personnel, andformal caregivers, which are likely to be the reasons
underlying the criticism of this theory. Furthermore,the “recovery of self-leadership” model roughly

Table 4. Stages in the self-leadership recovery model compared to other theories.
Self-leadership
recovery model(present study)

Cohn’s stage theory[20]

Fink’s stage theory[21]

Stage 0: Oblivion
Lack of awareness ofthe disability(1) Shock(2) Expectations ofrecovery(1) Shock(2) Defensive retreat(Retreat)(1) Shock(2) Denial

Stage 1: Inertness
Presence of obstacles
to taking action(3) Mourning(4) Defense(3) Acknowledgement(Renewed stress)(3) Confusion

I: Crisis associatedwith recognition ofphysical changes

Stage 2: Preparation
Preparing to takeaction(4) Defense(4) Efforts tofind a solution

II: Re-evaluation of
one’s life andexploration ofidentity(4) Efforts tofind a solution

III: Re-evaluationand modification of
one’s life-track(5) Acceptance

IV: Re-achievementof identity

Stage 3: Readiness
Ability to take action
Stage 4: Control
Ability to manage
actions and life ingeneral(5) Adaptation

Jpn J Compr Rehabil Sci Vol 10, 2019(4) Adaptation

Ueda’s stagesof acceptanceof isability[22]Okamoto’s lifelong
development ofidentity theory [19]Wada S et al.: Long-term recovery of self-leadership in brain injury patientsassumes stage 0 to correspond to onset andhospitalization and stage 1 to hospitalization and earlypost-discharge period, which makes it easier to avoid
the misunderstanding that the patient must arrive atstage 4 while still hospitalized. Another difference
between this model and the “acceptance of disability”
theory is that it assumes that the trajectory to thechanges in values associated with stage 4 is difficultand emphasizes the importance of “recovery of selfleadership” preceding the adaptation stage.
As such, this model does emphasize the “recoveryof self-leadership,” but it is important to note that
individuals with disabilities experiencing distressshould not be compelled to set stage 4 (changes instandards of values) as a goal. The path to changes invalues achieved at stage 4 is a difficult, long, andwinding road, and in some cases, that stage may neverbe achieved.
Even in a stage of increased self-esteem characterized
by “acceptance” under a new value system, it does notjustify the illness or disability itself. This model wasdevised with the purpose of providing adequate support
for people with disabilities; however, prompting achange of values in a coercive manner may hurt oroffend the person with disabilities so it should be usedwith caution.
In actual practice, after making an assessment, it isimportant to determine what to do next. This model
facilitates an understanding of “interactions withsurrounding people that promote recovery of selfleadership” by stages and summarizes specificmechanisms for coping. In the future, we hope todevelop an assessment scale for the self-leadershipstage with this model as a point of origin, conduct
quantitative studies, and investigate the effects of“self-leadership” on improving daily life.
Additional noteThis study was based on “The Shutaisei (SelfLeadership) Research Conference”. The members
who participated in the conference significantly are as
follows: Akira Ogawa (Nurse, Tokyo Metropolitan
Rehabilitation Hospital), Setsuko Ogawa (SpeechLanguage-Hearing Therapist, JR Tokyo General
Hospital), Daisuke Kawagoe (Occupational Therapist,
Moriyama Rehabilitation Clinic), Jun Kawanabe(Social Worker, Social Welfare Corporation Setagaya
Volunteer Association Care-Center Flat), Yoshikazu
Goto (Occupational Therapist, Iki-iki Welfare Network
Center), Ryuji Kobayashi (Registered Occupational
Therapist, PhD, Professor, Division of Occupational
Therapy, Faculty of Health Sciences, Tokyo
Metropolitan University), Yukiko Komai (Chief
Director, Iki-iki Welfare Network Center), Masahiro
Sakakibara (CEO, Mono Well-Being Co., Ltd.), Yumi
Tezuka(Representative
Director,
Kisuikai
Incorporated Association), Sosuke Nagao (Registered35

Occupational Therapist, Long-Term Care Facility,
Kunitachi Aoyagien), Suzumi Nakashima (Physical
Therapist, Sangenjaya Rehabilitation Clinic),
Masahiro Nochi (Professor, Graduate School of
Education, The University of Tokyo), Yoko Nonoyama(Social Worker, Iki-iki Welfare Network Center),
Sachiko Hasegawa (Former Vice Director of Nursing
Service Department, Nippon Medical School
Hospital), Hiroshi Hasegawa (Philosopher), Kayoko
Fujii (Facility Director, Day Service Yumeko),
Maki Fujita (Occupational Therapist, Sangenjaya
Rehabilitation Clinic), Miwako Hosoda (VicePresident, Seisa University), Kanchi Mishima(Standing
Director,
Kisuikai
Incorporated
Association), Takayuki Watabe (Occupational
Therapist, Rehabilitation Center, Showa University
Fujigaoka Rehabilitation Hospital), Toshiko Wada(Social Worker, Social Welfare Corporation Setagaya
Volunteer Association Care-Center Flat).

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