It is my great pleasure to held the 4th International Biophilia Rehabilitation Conference in Berlin on September 23rd, 2005. One of the objectives of the conference is to make a global network for researchers and people who work for the rehabilitation medicine not only in the practical fields, but also in the basic research laboratories.

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Let me express my warm welcome to everyone participating in the fourth international Biophilia Rehabilitation Conference! The German Rheumatism Research Center (DRFZ) is honoured to host this important conference. As the only national research institute devoted to rheumatology research in Germany our institute has two major aims: on the one hand to detect the causes of autoimmune rheumatic diseases and to develop curative, cell-based therapies through experimental research and, on the other hand, to improve knowledge about the epidemiology, burden of illness and health care impact of rheumatic diseases in Germany. We share this new building with the Max-Planck-Institute of Infection Biology and take advantage of a number of joint facilities. The building is located in the heart of Berlin on the traditional campus of the Charit? medical school which underlines the close links between experimental science, clinical research and patient care. Several of our group leaders are also professors at the Charit?, and many more are involved in teaching.

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I am overjoyed to be hosting the 2005 conference in Berlin. Dr. Shirasawa is the conference chair. He is a famous researcher on Molecular Gerontology and focusing on how rehabilitation medicine changes from "the rehabilitation which approved of the acceptance of disability" into "the rehabilitation which can get over a disability" during our conference.

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Respecting German people, I am one of those who feel great joy for the exchange of information between our two countries with a central focus on specialist personnel. The Biophilia Rehabilitation Academy is the academic meeting established in 1998, based from the society that started the study of the aging of the population with fewer children in the 21st century. They initiated the legislation of Care Insurance in the 21st century. Continued legislation has progressed, and it seems as if the world could be ready for a legal measure. The current structure is said to face failure in five years and will be a crisis for the social security of health and welfare.

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The 3rd Annual International Convention of the Biophilia Rehabilitation Academy which I co-chaired and was held in Manila, Philippines was a resounding success. The in-depth discussions and presentations of important and relevant topics gave full meaning to the objectives of the scientific program and has left with us a fervent wish to have the convention back in our turf in the near future.

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The remarkable potential of lower vertebrates to rebuild adult organs and tissues contrasts with relatively poor regenerative capacity in mammals, which respond by rapid fibrosis and scarring. To improve the mechanisms at work in the mammalian response to damage or disease, we used a local acting isoform of Insulin-like growth factor-I (IGF-1).

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Hemoglobin (Hb) is a tetrameric molecule made up of two alpha and beta globin subunits. It exists in erythrocytes in the blood stream of vertebrates, taking charge of gas exchanges between the lung and the peripheral blood tissues. Carrying and supplying oxygen to body tissues its the most important role of Hb, which is largely influenced by it oxygen affinity. Lowered oxygen affinity is reported to increase the release of oxygen from Hb molecules to peripheral tissues and to improve the tissue oxygenation. Over 1,000 kinds of Hb variants have been characterized clinically and some variants show lowered oxygen affinity, among which are two novel ones, Hb Titusville and Presbyterian.

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This study intends to tackle some of the aspects of aging of the respiratory system's components at both structural and functional levels. The respiratory system is directly exposed to the environmental air, pumping ca 20000 liters of air through the lungs daily, which poses a formidable functional challenge. No wonder that respiratory health is linked to the quality of life and longevity of the elderly. All components of the respiratory system, aside from being affected by individuals' clinical history and habits, for instance smoking, are subject to the aging process.

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The acceptance of disability was an aspect of the rehabilitation medicine until today. It is different from the other extensive medical sciences in that it enables the preventions, medical treatments and diagnosis of disease and/or injury, while the name of medical science is crowned for its achievements as a whole. Research from the multiple aspects related to rehabilitation medicine in our academy is being done in order to innovate enabling the disabled elderly to improve and restore their physical function even if their injured area of the brain makes it difficult to acquire complete recovery and to reconstruct it from the medical science that has tolerated the acceptance of their disabilities. Our research related to the development of devices, actual results evaluation and predictions will be continued in the future and also some of those are presented today.

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Our overall purposes are to develop new methodologies for the study of physical activity and to provide exercise prescription guidelines for the elderly. Since 2000, we have thus been conducting a longitudinal interdisciplinary study on physical activity and health of the elderly in the typical medium-sized residential town of Nakanojo, Gunma Prefecture, central Japan (the Nakanojo Study). Nakanojo is about 150 km northwest of Tokyo. In 2004, it had a population of 17,942 (8,706 men and 9,236 women), 28.6% of whom were aged >65 years (25.3% of men and 31.9% of women).

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This report will prove the effectiveness of the Takizawa program and emphasize the importance of exercise therapy for bedridden elderly people. This research was conducted with 145 female examinees from 3 GHFSs. The patients were categorized by the degree of care and randomly divided into two groups; Exercise group (Ex) and Control group (Co). The degree of ROM. increased after therapy showed a significant difference. Those were shoulder flexion, knee extension, and dorsi flexion.

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A bone fracture due to an elderly person's turning over is a big cause of the so-called bedridden state. The prevention of turning over is then an important subject for elderly people. In these days, a kinematical method has been introduced as a countermeasure to the act of turning over. Strengthening muscular groups of lower limbs, focusing on the quadriceps femoris has been done as a main kinematical method of preventing a fall. Recently, however, the relationship between psoas major muscle (a muscle connecting the thighbone with the backbone) and the act of turning over has attracted attention because it has become clear that the muscle greatly influences walking ability. This research aimed at explaining the characteristics of the change of the quantity of psoas major muscle due to aging by comparing changes of the cross-section of the muscle to that of quadriceps femoris muscle as a part of the research on the prevention of elderly people's turning over. Participants in this research included solely women because the danger of female bone fracture due to turning over is approximately 2.5 times greater than that of male one. A total of 210 women who lived in two neighboring cites in the same prefecture, from ages 20 to 79, were divided into 6 age-groups in 10-year increments.

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Fall accidents of rheumatoid arthritis (RA) will easily lead the bone fractures and disuse syndrome. To prevent the fall accidents, we analyzed the relationship of the factors of disease severity, disorders and fall accidents. They have multiple disorders in joints and muscle. In this study, we analyzed their gait performance by using force plate system and F-scan system in 19 RA patients and normal healthy volunteers. The pattern of force plate (X,Y,Z) and F-scan showed similar in normal control, but the patients' patterns showed various patterns. We showed that the impact power of heel of controls was higher than that of RA patients at heel contact. The plantar pressure of the forefoot of the controls was higher than that of RA patients at the toe-off timing. And RA patients showed the longer double stance phase and many disorders in foot plate pressure.

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It is our goal to decrease the number of people who need nursing to solve various problems in the elderly community. Therefore the increase of rehabilitation for people who are not able to walk is hoped for. It is a difficult problem because rehabilitation is done by a physical therapist's qualitative evaluation based on his/her own professional experience and educational training. So in our study, we quantified horizontal walking and analyzed the correlation between walking ability evaluations done by physical therapists and parameters of horizontal walking. Based on this data, we developed the system that classifies walking ability.

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It is important to evaluate walking ability quantitatively in order to solve the problem of extended nursing dependency in the elderly community. Efficient rehabilitation can be made possible and a care worker's burden can be reduced. In our study, we measure the movable range and speed of the legs in motivative exercise and extract parameters that are related to walking ability. Moreover, we measure muscle function of the leg with an electromyogram and consider a relationship between muscle function and walking ability.

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The Japanese population in the near future will show us serious fact which means less young aged adults but much more elderly patients. We medical staff have to face our urgent problem to reduce care-dependent disabled elderly patients. To solve the problem we've found the multi-effects exercise, Takizawa Physical exercise Program. I'd like to introduce this easy but practical program.

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In Japan with a growing number of senior citizens, our Okayama Saiseikai General Hospital playing a role as the key hospital of the community, has been promoting a regional network activities in the fields of medical care, welfare system and health maintenance. A comprehensive welfare facility, Okayama Saiseikai Life Care Center, has been established in the year 2000 just close to the main hospital. This center has special elderly nursing home, health service facility for the elderly, day care center, and day service center. This center also provides outpatient clinic, care support center, home visit nursing station, home help service station, and short-stay type of special nursing home. I belong to the clinic of this center. After introducing the outline of this center, I would like to focus on the activity of special elderly nursing home.

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The total population of Japan is 127 million, with 24.8 million elderly over 65 years old, rating 19.5% of the total population. Physically unimpaired elderly is 85% while the infirm, in need of continual medical support is 15%. Medical, nutritional and emotional support networks in the area provide alimentation to this section of the elderly community. For those who live alone there are generally no friends to eat meals or drink tea with, resulting in him/her eating and drinking self-indulgently. They also have no habit of measuring or controlling weight, exercising or practicing in daily dental hygiene. If we do not promote diet and lifestyle modifications, health threats are imminent in their future. The Society for the Study of At-home Medical Nutrition Management is providing nationally registered dietitians to several areas of the country and promoting diet and lifestyle modifications.

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I studied and taught nutrition management at Juntendo University and Teaching Hospital for 45 years until my retirement. I continue, on staff, overseeing the evaluation of medical practices and currently belong to the academy as an arbitrator determining the quality of the welfare facilities. The staff members working in the social welfare facilities are very gentle and arduous. In an effort to increase independence among the elderly, I hope to deepen the theory composition of the programs available to them and to continue to study for myself, in order to contribute to the improvement of these facilities and their programs.

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I am pleased to hear the presentation related to our study in the conference 2005, Berlin by my two students who are studying in the graduate school of the Yokohama National University. It is shown that the study of our academy becomes some of major subjects to the Japanese academic society. In the opportunity, I expect many students contending with the subject that the advance on science, technology and medicine in which we intend to clarify in this convention in the global scale from the heart.

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