9 th September 2021

JAOT response to COVID-19
Japanese Association of Occupational Therapists(JAOT)
Vise President
Shinichi Yamamoto

Changes in the numbers ofqualified OTs and JAOT members
10000090000
80000

Welfare

Other

4%

6%

Nursing Care
17%

Medicine

70000

73%

60000
50000
40000
30000
20000
10000

As of 1st March 2021※
Qualified OTs：99,788
JAOT members：63,474
FY2021(April 2021~）
Qualified OTs：104,298

Proportion of JAOT members
by working areas
In 1966
Qualified OTs：22
JAOT members：180

有資格者③
Qualified OTs

協会員数（事務局資料による）JAOT members

Contents
1. Emergency Survey of JAOT members on COVID-19（27 th April ~ 1st May 2020, 15,292 members）（5 th ~ 12 th October 2020, 8,215 members）

2. Public Information pamphlets, etc
3. COVID-19 countermeasures／Occupational Therapy services（Ver.1.2.3）
4. Letter of request to the Medical Economics Division, Health
Insurance Bureau, Ministry of Health, Labour and Welfare（27 th May 2020）
5. Creation of a video for the promotion of infection prevention
6. COVID-19 practice cases by occupational therapists
7. Conclusion

1st and 2nd Emergency Surveys of JAOTmembers on COVID-19
Summary of Results 【Latest Report/Extract】

Survey Period：【1st survey】27th April ~ 1st May 2020
【2nd survey】5th ~ 12th October 2020
Method：JAOT members whose e-mail addresses areregistered in JAOT. Online survey.

Response：【 1st survey 】15,292【 2nd survey 】8,215

Respondent Attributes
１．Affiliations
0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

第1回
1st9587

1645

1858

606 799 423
179
195

第2回
2nd5280

856

939

321

551 63
135

68■Medical Institution■ Facilities Covered by Long-Term Care Insurance ■Long-Term Care Insurance Office■ Services and Supports for Persons with Disabilities Act ・ Child Welfare Act related facilities■Public facilities including public health centers■OT Schools■Non-practice・No affiliation■Other２．Main Client Group
0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

第1回
1st7765

1721

3754

824 679 227

第2回
2nd4211

910

1987

420

■Physical Disability■Mental Disorder■Older People■Children■Students (OT Schools)

494 133■OtherRespondent Situation

50%

1%1%
0%

23%21%
30%

10%

Other
Finding someone to talkSelf-managing to reduce stress andanxiety
Taking measures when oneself orfamily members suspected infected
Checking contact details whensuspected infection

Gathering scientifically accurate
information
Measuring temperature
Showering when coming home
Washing and disinfecting
hands with alcohol frequently
Wearing a mask when goingoutsideCs

Having good sleep and diet to makebody more resistant

Avoiding

Avoiding going to places whereclusters occurred or there is a risk of★
a cluster3

Avoiding going out unlessnecessary
0%

26%
21%

36% 36%
31%
37%
35%
40%

第1回
1st85%
84%
81%

46%
51%
47%
59%
60%

第2回
2nd73%
80%

96% 94% 94%
93%
94%91%
95%
100%

84%
90%

％: percentage when total number of respondents counted as 100★: new question added in 2nd survey

Things to take in mind

70%

20%

Facility Response to COVID-19
70%

40%

14%
16%
18%
20%

49%

3%

1%
10%

Other
Mental health measures for staff are in★
place
Usage instructions and usage standardsof PPE are known to all
Organizational management measures
are well known and shared withstakeholders
Enough masks and sanitizers available☆

Having a grasp of infection informationof the entire facility
Rehabilitation/OT intervention
standards are established when
infected cases are observed
Measures are in place when clusters
occur
Measures are in place when clients or
staff are suspected infected
Measures are in place when clients or
staff are suspected infected19

isPerson in charge of control measures
is assigned in each department

Department in charge of COVIDavailable
0%

27%
25%
30%

41%
38%
37%
40%

第2回
2nd
44%
38%

1st
第1回
61%

63%
59%
60%

72%
74%
67%

80%

49%
45%
50%

＊1st n=13,696 2nd n=7,396 (facilities are limited to medical, nursing,disability welfare and child welfare)☆: only asked in the 1st survey★: newly added in the 2nd survey

Organizational management measures

2：Public Information Phamphlets
We support
your health

How to prevent disuse
syndrome at home

Japanese Association ofOccupational Therapists

To stay healthy while staying home!
Osaka Association of Occupational Therapists

Due to the coronavirus pandemic people don't go out as much as they used toand they have less opportunities to be physically active. It results in reduced
muscle strengths which eventually lead to an increase risk of falls.
If you cannot stay motivated doing exercise by yourself, you cantry ADLs (house chores etc) with slight changes in order to prevent reduced
muscle strength and risk of falls.

Introducing activities you can do at home
★Household chores are very good physical activities!
Let’s look back your day. Check with exercise chart★Find things “you might be able to do”
Introducing familiar activities (exercise, cleaning etc) you can do right now

Tokyo Association of Occupational Therapists

Tips fromoccupational
therapists~Summer~3： COVID-19 Countermeasures／
Occupational Therapy services （Ver.3）
1. About COVID-19 Infection
2. Basic infection countermeasures
3. Organization or department response interms of COVID-19 infection
countermeasures
4. Specific COVID-19 infection
countermeasures in Occupational Therapy
5. Cooperation with stakeholders

COVID-19 Control Measures／
Occupational Therapy services（Ver.3）

Japanese Association ofOccupational Therapists

4：Petition to Medical Economics Division, Health Insurance
Bureau, Ministry of Health, Labour and Welfare（27 th May 2020）
In consideration of various opinions expressed by members in “1st and 2nd JAOT
Members Emergency Surveys on COVID-19 “,
27 th May 2020：
JAOT submitted a letter of request “Response to the suspension of outpatient rehabilitation due to the effects of COVID-19” to Medical Economics Division, Health Insurance Bureau, Ministry of Health, Labour and Welfare
21st July 2020：

To respond to the above request, Ministry of Health, Labour and Welfare iss
ued “Temporary measures of medical fees in relation to COVID-19（No.24）”(Q) From the perspective of preventing COVID-19, is it possible to continue calculating
disease-specific rehabilitation fees for patients who have exceeded the standard days
for calculation because they had to temporarily stop the disease-specific rehabilitation?
(A) The gratitude is for the patients listed in Appendix 9-8 Daiichi, such as the medical
standards of the specially listed clinical departments (2008 Ministry of Health, Labourand Welfare Notification No. 63). If it is medically determined that the patient's
condition may improve by continuing treatment, the prescribed score can be calculated
in excess of the standard calculation days in accordance with the proviso of Note 1 of
the rehabilitation fee for each disease.

５： Creation of a video for the promotion ofCOVID-19 infection prevention
Lecture① Basic infection prevention measures
Lecture② Knowledge needed to understand COVID-19
Standard prevention① Hand Wash
Standard prevention ② Mask
Standard prevention ③ Gloves
Standard prevention ④ Gown
Points in OT service provision
Points in administrative services
Ideas in home-visit OT
Ideas in care offices

6：COVID-19 practice cases by occupational therapists
JAOT received a number of comments and enquires from JAOT members that
how OT services are provided in response to COVID-19.
Some occupational therapists involved in COVID-19 clients kindly reported theirOT practice cases and these cases were published on JAOT homepage.

Case1．Prevention of mental deterioration complication
Case 2．Intervention choices of clients with functional and motivation dissociation
Case 3．A case of COVID-19 with stroke immediately after ventilator extubation
Case 4．A successful case promoting of getting out of bed and expanding activities asa result of assessment based on pathological condition
Case 5．COVID-19 and remote intervention
Case 6．A case of smooth discharge as a result of early direct intervention
Case 7．A case of occupational therapy in COVID-19 ward
Case 8． A case of occupational therapy for client who experienced a decline incognitive functioning and peripheral symptoms in COVID-19 ward
Case 9．A case of occupational therapy for clients with severe COVID-19 symptoms

７：Conclusion
Based on the survey results and opinions from therapists, JAOT
kept in mind to provide continuous education and evidence-based
information with regards to COVID-19 to our members, promoted
public awareness, presented recommendations to the social
security system.
We believe that JAOT should continue to take the followingmeasures;•••

All therapists implement the basic infection control measures
regardless the area of specialty they work
Mental health care and stress coping of therapists themselves
Providing learning opportunities by each organization, society,and association to ensure the quality of occupational therapy

We believe Occupational therapists can savepeople's lives and contribute to their health.

Clinical response to COVID-19
in Japan-Efforts at our hospital ,department and case studies
2021/Sep/9
2021 Asian Occupational Therapy Associations Exchange Meeting
National Center for Global Health and Medicine（ NCGM）
Department of physical medicine and rehabilitation
Atsuko Nishimoto
Hiroko MIzuguchiToday’s contents

1. COVID-19 situation in Japan and the world
2. Efforts at our hospital in COVID-19
3. Efforts at our department of PM &R in COVID-19
4.Case studies
5. Summary

１.Situation in Japan and the world in COVID-19

Changes in the new number of people infected with COVID-19 in Japan
5th wave
15,00010,000

3rd wave
4th wave

5,000
1st wave

2nd wave

3/1

7/1

5/1

9/1

11/11/1

3/1

5/1

7/1

8/16

（From the Ministry of Health, Labor and Welfare website）

 The number of newly infected people in Japan is limited to the metropolitan
area in the first and second waves, spreads nationwide in the third wave,
spreads mainly in mutant strains in the fourth wave, and is currently spreading
due to the fifth wave.
 The number of inpatients is also increasing and medical tightness becomes anational problem.

１.Situation in Japan and the world in COVID-19

Number of COVID-19 deaths in Japanpeoples

200
150
100
500

3/1peoples

5/1

7/1

9/1

11/1

1/1

3/1

5/1

7/1

8/16

（From the Ministry of Health, Labor and Welfare website）

Deaths Per Million People Worldwide (July 2021)

3,000
2,500
2,000
1,500
1,0005000USA

BRASILUKFRANCE

 There are several waves in thetransition of the number of daily
deaths in Japan.
 Compared to the number ofdeaths in the world (July 2021),
the numbers of Japan is less thanthe United States, Brazil , theUnited Kingdom, and France.
JAPAN（JHU CSSE COVID-19 Data）

１.Situation in Japan and the world in COVID-19

Domestic COVID-19 cluster occurrence%

Number of outbreaks (officially announced, as of February 2021): 5,104
2520151050
Medical Facilities for Restaurants
institutions the elderlySchools

Childwelfare
facilities

Companies（Japan Association of Medical and Care Facilities ） The number of clusters at medical institutions and facilities for theelderly is as high as at restaurants.

thorough infection control!

 Many people infected with COVID-19 in facilities and medical
institutions are subjects to rehabilitation or caring.

2. Efforts at our hospital in COVID-19

National Center for Global Health and Medicine（ NCGM）
Our mission
Advanced medical care
International coorperation
Research
Infectious diseases(designated infectious diseases medicalinstitution )Shinjyuku,TOKYO749 beds
45 clinical departments
 Designated infectious diseases medical institution
・Only 4 facilities nationwide
・Institutions can accommodate patients with infectious diseases based on theJapanese infectious Disease Law(EX: SARS, Ebola,tuberculosis, New influenza)2. Efforts at our hospital in COVID-19

January 2020, We accepts people from Wuhan, China(return charter flights)
January 27, 2020, the first case of COVID-19 was
hospitalizedNCGM accepts severe patients ( Ex: in ICU , with medical
ventilater, ECMO,NPPV, HFNC and PMX therapy)
NCGM also accepts patients in COVID-19 widely incollaboration with other hospitals in Tokyo (Ex: From
home care or nearby hospital in a cluster)2. Efforts at our hospital in COVID-19

Zoning in the moderate patient ward
Timing of PPE attachment / detachmentnursestation

Clean area

semiclean area

The dedicatedspacefor PPE
contaminatedarea
NCGM COVID-19 Infection Manual

The space for removing
PPE other than N95mask

When examining multiple patients in the same room, change new PPE
each time one patient is examined2. Efforts at our hospital in COVID-19

Thorough installation of PPE
How to wear of PPE

Double gloves

Careful point
1. Does not pollute theclean environment withcontaminated PPE
2. Change new PPE eachtime one patient

Apron withsleeves
N95 mask Shield mask NCGM COVID-19 Infection Manual

2. Efforts at our hospital in COVID-19

Staff education
 Hand hygiene

 Mask fit check(3) Efforts at our PM & Rin COVID-19

NCGM Rehabilitation for COVID-19• COVID therapist teamMember PT 5

OT 2ST3COVID(+)

After COVID(-)

During isolated
Only one’s room or ICU

Can also use theRehabilitation center

Rehabilitation in the ICU

Post-COVID patients can only use rehab center for the permitted
place and time

One year COVID-19 OT Cases(N=31) May 2020-March 2021
All COVID inpatients（N≒650)

All rehab patients（N=110)

17%
72%

83%
rehab +

rehab －OT +28%

OT（N＝31）

OT －(PT and/or ST)

Rehabilitation in the ICU

2 OT patterns for COVID-19 (N=31)
ADL(before COVID-19):independent 23 and non- independent 8
ADL independent
Non – independent(23)(8)
Age(ave)69.1（±15.1）
Younger87.4（±6.0）
older

Sex(M/F)

16/7

0/8COVID-19 mild

Medical ventilator

Have job
14(60.9%)But
COVID-19 severe
16(69.6%)

dispositionHome9(39.1%）

2（25%）

Rehab hospital6（26%）

Other hospital1（4.3%）

0

Referral source
facility or hospital

05（62.5%）

death

7（30.4%）1（12.5%）56.7（±36.6）

29.6（±28.0）

workerLength of stay

65%

But
Need nursing care1(12.5%)00Case1 37yrs male～remarkable upper limb disorder caused by medical devise

Before COVID
ADL full, depression+, lives with parents,
welfare employment
Acute phase of COVID
whole body management in ICU 40days
medical ventilator 38days
ECMO 11days

chest drain 15days

PT start
hematoma
ICU rehabilitation Dr+Nrs

Oral ingestion
OT start

Case1 37yrs maleOT assessment at the begining (day46)① Desaturation:３-4L /min. of oxygen from nasal canula② Upper arm circumference difference： 2.5cm③ Left shoulder joint limitation ： Active ROM 45°④ Grip power： Rt.10Kg 、Lt.8Kg

difficulty inchanging cloths orwashing face etc

OT approach（for 26 days)
Upper limb functional training(ROM ex. Muscle ex.) ADLtraining
OT assessment at the time of transfer（day72)① improving desaturation but also needed 2-3/min. of oxygen② no difference③ No limitation(up to 180°)④ Rt. 18.5Kg、Lt.16Kg
Day72 He was discharged to rehab hospital, and then day99 He got back home
To date, he needs the Home oxygen therapyCase268yrs female

hemiplegia due to a history of Stroke
Before COVIDLt. hemiplegia due to a history of stroke
ADL full, outside gait with T-cane. lives with her husband
Acute phase of COVID

difficultywalking dueto weakness

ICU 10days
medical ventilator 11days.

PT start

PMX3days

ST start
ICU rehab Dr+Nrs

rehab DrOT startCase268yrs female

OT assessment at the begining (day31)➀no desaturation: no need oxygen②muscle weakness③moderate left hemiplegia（Br.stageⅡ-Ⅲ-Ⅲ）④ could not walktachypnea andtachycardia
with doing ADL

OT approach (for 8days)
training for hemiplegia, muscle strength , ADL and introducing self help tools
OT assessment at discharge(day42)②Muscle strength improvement③ improvement of hemiplegia(Br.stageⅢ-Ⅲ-Ⅳ）by improving muscle output④could walk indoors
When taking shower , she was at risk of falling down, tachypnea andtachycardia→Provided nformation of shower chair for her and her family

Day42, she was discharged from hospital
shower chairPurpose of OT training n=31
OT training

Purpose of OT

ROM
muscle training
upper limb function
improved durability
get out of bedrelaxation
saturation evaliation
respiratory rehabilitation
mental activation
communication
ADL
housework
reworkhemiplegia
radial nerve palsy
self- help tool
environmental arrangement

physical function(ROM, muscle powerdurability）
respiratory function
Mental and communication
ADL/ I-ADL
For underlying disease/disability
Approach to the environment
02

4

6

8

10

12

1416

number（４）Summary

Patients for whom OT was indicatedwere divided into 2 Patterns(1) COVID-19 Severe and need respirator• Sedation disuse-syndrome 、myopathy, Atelecrasis• medical device rerated upper limb disfunction• Higher goal(rework or house keeping)(2)COVID-19 mild but needed nursing care prior to hospitalization• Underlying paralysis: need maintenance rehab• frailty ： the risk of frailty, difficult to walk , disuse syndrome• Dementia :getting worse by isolation

The important things are Proper precautions andproviding OT to the patients who need OT!!

Someday welcome to Tokyo!!