The Journal BIOPHILIA 2016 (2)

The Proceedings of IBRC 2016 July 18-19, 2016 in Geneva, Swiss

"Revolution of Hope on Re-acquirement of Ability by Rehabilitation Medicine Innovation"

Hosted by; International Biophilia Rehabilitation Academy

Co-Hosted by; Biophilia Rehabilitation Academy of Japan
Supported by:
Embassy of Japan in Switzerland
Japanese Society for Rehabilitation of Persons with Disabilities
Japanese National Foundation, Association for Technical Aids

Conference Chair; Prof. Toshiyuki Tanaka
Department of Applied Physics and Physico-Informatics, Faculty of Science and Technology Keio University

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It is a great pleasure and an honor to host the 13th International Biophilia Rehabilitation Conference (13th IBRC) in Geneva, Swiss, on July 18-19, 2016. I am Toshiyuki Tanaka, chairperson of the 13th IBRC. I am part of the Faculty of Science and Technology at Keio University, which is a long-established private institution founded in Japan in 1858 by Yukichi Fukuzawa. Keio University is well known to researchers worldwide for the students and professors who produce high-quality research.
My research field is pattern measurement, including medical image processing and computer-aided diagnosis. In recent years, hospitals have seen increases in the number of patients, in step with the aging of the population. Following advances in medical devices using techniques such as fMRI, fNIRS, and X-ray CT to support the work of doctors, the precision of diagnosis has risen markedly. However, it seems that the burdens on doctors have not lessened. To reduce these burdens, we are developing a diagnosis support system using medical image processing.
The number of older patients, especially stroke patients, is increasing in the rehabilitation field as well. The current system in Japan is limited in that each patient requires individual attention from a physical therapist. Therefore, we have proposed a new rehabilitation system that allows a physical therapist to use devices to respond to several patients simultaneously. However, the new system will not catch on quickly, because the business-model mindset present in medical services is not shared by doctors in Japan. At present, only big and wealthy hospitals can keep physical therapists on staff, because the one-to-one rehabilitation system is not an efficient business model. The one-to-many system is more realistic for a successful model, and would allow many small hospitals to hire physical therapists, thereby improving employment among physical therapists.
Through a workshop and research exchange, we hope that the 13th IBRC will provide the opportunity to introduce important innovations in the field of the rehabilitation.

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国際バイオフィリアリハビリテーション学会を代表してIBRC2016 開催に当たり、一言ご挨拶申し上げます。
今回の大会はジュネーブで開催されます。開催の目的は次の2 つです。1.ジュネーブに本部のあるWorld Health Organization（WHO）へ障害の克服が可能であり、その手法の研究がすすんでいる事実を知らせること、2.今後「経験から科学へ」より一層その内容を高めるにあたり、WHO と共同して研究活動ができるように協調を働きかけることです。
我々は日頃ご指導、ご協力いただいている厚生労働省と同省関連法人のご期待にお応えできるよう、日々力を尽くしております。そして今回は厚生労働省のご支援を得て、WHO から講演者をお迎えすることになりました。第一の目的は達成できたものと思われます。

我々はリハ医学の再構築が必要との立場で、多年研究を続けてきました。歩行の再獲得や生活自立の再獲得事実を明らかにし、可能な限り機序の仮説とその証明を明らかにしています。 7 月のジュネーブ開催は、当初大会長を予定していたISPRM 女性健康委員長・タイ王国テラコンロン大学アリラット教授の希望でした。私たちは若く有能で、野心にあふれた彼女に期待していました。結果として何か事情があったようで大会長を務めきることができませんでした。しかしその間に、ISPRM へ対して、多年リハ医学の再構築を実現する研究を推進する団体があることを知らせ得たのは一面では大きな成果でした。

今後ますます高齢者が増えます。人類史上初めて人口ピラミッドが逆転する時代になるのです。どのように扶養するか、高齢者が充実した生活をするためにはどうすべきか。社会保障における諸課題や、生命の自己実現の視点における課題も山積しています。
私たちは高齢者がいつまでも自立生活ができるようにリハ医学改革するべく研究を続けております。冒頭に述べた第2 の課題として、研究は新たな次元へ進もうとしています。
この学会の最初の大会は2002 年開催で、北マリアナ諸島連邦政府との共同開催でした。そこでの私の基調講演は、「高齢者の増加を負の要因としない新たな文明の構築」が題名でした。慶應義塾大学理工学部田中敏幸教授を大会長にお迎えした今回の大会が真の意味で、この表題を可能にする大会になることでしょう。

そして参加者にとり有意義であり、さらに人類に大きな貢献ができることを期待しています。 この開催を皆さんと共に心から祝いたいと存じます。

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The International Biophilia Rehabilitation Academy (IBRA) is an independent scientific organization devoted to creating and nurturing novel ideas on medical rehabilitation, in particluar focusing attention on innovative methods of rehabilitation in the elderly. IBRA, since its inception, delivers supports and services to education and research in all over the world. To this end, IBRA has set up annual international conferences organized in various regions of the world to disseminate the updated knowledge on rehabilitation. The IBRA2016 conference is scheduled to take place in Geneva on July 18-19. It will be a perfect opportunity to meet world-renowned scientists and scholars to disseminate and gain the current knowledge in the field of rehabilitation. The main theme of the conference is “Rehabilitation to the Brain to Enable Functional Recovery”. This theme has to do with the development of self-motivation on the part of patients to conduct active rehabilitative exercise and training by themselves, to a possible extent, instead of passive exercise by a physical therapist. The enticement of patients to get involved in the process of physical rehabilitation requires a turnaround in the hitherto practice of rehabilitation. The nurturing of proper mental attitude and mind-to-body connection is essential. We expect to have a selection of the most innovative and state-of-the art invited lectures on rehabilitation. The topics will cover a wide range of critically important scientific sessions from basic research to innovations. Available data suggest that motivative exercise by oneself can reduce morbidity and hospital stay when compared to equipollent procedures performed by a therapist. An additional critically important bonus is to take off the burden from the steadily dwindling number of therapist, in proportion to growing number of the elderly worldwide, and to lower the social and fiscal costs of health care in light of the ‘aging crisis’. IBRA is warmly welcome you to join us at the event.

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The experience matured during the collaboration with IBRA (International Biophilia Rehabilitation Academy) every year enables us to deepening the area of neurological disorders in the advanced rehabilitative contexts related to it.
This partnership allows all the participants to discuss in the light of the inherent international literature and of every own experience matured during time and also to speak in a context debated at international level but also in scientific literature.

We can implement, enhance and potentiate the particular fields of Physical And Rehabilitative Medicine which is actually projected to the recovery of illnesses related to the psyco-bio-socio aspects of the person only through the collaboration and the exchange of knowledge.
The Man, considered as a complex biomotor biosystem, needs, when afflicted by a neurological illness, to recover his residual potential so he can adapt the corporeal system to the different condition to which it is subjected: that is how he can realize a continuous dynamic interaction in and with the environment around, even if afflicted by the supervening disability.
A multidisciplinary and multispecialistic medical equipe that is able to act on every aspect of the body system, in a coordinated and synergc way it is necessary In order to obtain those rehabilitative outcome.

This important scientific appointment, IBRC 2016 will allow us to focalize and discuss on the state of art of these problems, in a view of multispecialistic international collaboration pointing on the innovation in the rehabilitative field, inspired by the principles of the evidence based medicine.
I wish for every organizer, participants and for everyone of us that this will be a productive conference in every aspect: the result of this cultural exchange will be just the apex of all the positive predictions announced.

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It is my pleasure to join my esteemed colleagues in welcoming you to the 13th INTERNATIONAL BIOPHILIA REHABILITATION CONFERENCE (IBRC) in Geneva, Switzerland on July 18th -19th, 2016. The IBRC is a leading international forum for advancing research and restructuring brain injury rehabilitation medicine to obtain functional recovery and reintegration into society. Brain injury affects cognitive, motor, behavioural and social functions and we must restructure neurorehabilitation treatment to address these specific problems. This change requires new programs and techniques which have been proven to benefit patients of all ages. The ultimate goal of the IBRC is to contribute to the welfare of human beings and the sustainability of societies with aging populations. The conference theme is the "Revolution of Hope of Re-acquirement of Ability by Rehabilitation Medicine Innovation" chaired by Professor Areerat Suputtitada, M.D. (Chairperson, Neurorehabilitation Research Unit, Chulalongkorn University and Chairperson of ISPRM Women and Health Task Force), Professor Toshiyuki Tanaka (Faculty of Science and Technology, Keio University) and Professor Takizawa Shiego (President, International Biophilia Rehabilitation Academy and Professor, Biophilia Institute of the Japanese Ministry of Education, Culture, Sports, Science and Technology). The scientific program will include lectures and hands-on workshops on the latest in physical and rehabilitation medicine, exercise, gait and balance, and cutting-edge technology. The International Biophilia Rehabilitation Academy (IBRA) is increasingly endorsed each year, with international conferences hosted in Japan, Havana, Cuba and Seville, Spain. This year, conference will be held in Geneva, an historic city which will provide a stimulating backdrop for this exchange of ideas, developments and breakthroughs in rehabilitation strategies.

We look forward to welcoming you in Geneva.

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The International Biophilia Academy Rehabilitation Conference - IBR(A)C - has now reached to its 13th Edition, that will be held on 19-18 July, 2016, in Geneva/ Switzerland.
Since the beginning of my actual Greetings I want to emphasize that IBRA and its annual related Workshop - to be held on 27-28 April, in Japan - and respectively, above mentioned Conference, has advanced to a new level regarding one of the major goals of this Academy: to give a welcome supplementary input - aiming at a positively somehow ”restructuring” of (Neuro)”Rehab. Medicine” - for bettering the currently obtained outcomes in the, especially sorely, chronic neurological conditions’ approach. This is because the respective results, unfortunately, do not yet fully match the expectations of very numerous (and growing in number - including within a continuous and accelerated demographic aging population, i.e. with more elderly, that are prone to multi-morbidity, among which neural-motor/sensorial-/psycho-cognitive/communicational, disorders, are some of the most severe impairments, but/and at the same time, being targets for rehabilitative/assistive endeavors) severely disabled persons and therefore, in need including for (Neuro)Rehabilitation (and/or - encompassing - assistive facilities/devices and afferent technologies, to be used and improved, too).
Accordingly, as an academic physician of Physical and Rehabilitation Medicine (with special focus on NeuroRehabilitation and President/ Co-Founder, including of the Romanian Society for NeuroRehabilitation - RoSNeRa - affiliated to the World Federation for NeuroRehabilitation ? WFNR) and respectively, of Gerontology and Geriatrics, I salute the focus of both, the Workshop and the Conference, this year, on the brain impairments’ recovery through a patented, newer rehabilitative technique and specifically, by standing on the ”Preparation for the Randomized control trial of the passive exercise vs. the Motivative exercise”

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The goal of Biophilia Rehabilitation Academy (BRA) is to clarify the relation between a brain function and a paralysis, and to perform the therapy of stroke patients using the knowledge of the previous researches. Before now, I have proposed that doctors diagnose the recovery level of paralysis by measuring brain function at rehabilitation as well as by rehabilitation scores, and give the adequate medical treatment to the patients. In the 12th International Biophilia Rehabilitation Conference at Keio university, the research group of BRA started with endeavor that our contribution reaches in one of the medical science. I show in this report about the previous, current and future researches by the international Biophilia Rehabilitation Academy. Although many researchers have made effective devices for rehabilitation in some countries, most of the devices are expensive and requires some infrastructures. Our investigative group has tried to make a system of rehabilitation with cheap and effective devices, which we call it “Takizawa method”. The exercises in Takizawa method is motivative exercise, and the traditional method in rehabilitation is passive exercise. We think that Takizawa method will be a standard rehabilitation system in the future in many countries.

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As the world ages, and as global health priorities focus on reducing mortality, the world is experiencing a growing demand for rehabilitation services that can help optimise people’s functioning and keep them healthy, productive and engaged in meaningful activities for longer¹². Currently, however, rehabilitation services, particularly in low- and middle-income countries, do not have the capacity to adequately address the needs of the population¹. The WHO global disability action plan 2014-2021³ includes the strengthening of rehabilitation services as a key objective and presents actions towards this end for WHO, member states and national and international partners. Today this action plan sits in a broader context of the Sustainable Development Goals (SDGs)⁴, which sets an exciting and ambitious agenda for global health. Goal 3, “Ensure healthy lives and promote well-being for all at all ages” cannot be achieved without quality rehabilitation services, and the mantra of the SDGs to “leave no one behind” compels us to ensure that these services reach all those that need them. It is therefore imperative that rehabilitation be included in efforts towards Target 3.8, achieving universal health coverage.
The objective of the presentation is to show how WHO’s agenda on disability and rehabilitation has evolved over the years. Furthermore, the impact of the SDGs and WHO’s conceptualization of disability on the objectives of the action plan and their corresponding activities will be discussed, including how this will guide the strategic direction of rehabilitation in the next 15 years.

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This presentation by the video broadcasting is a disclosure of the research record of the rehabilitation training with devices. To establish this training program, we needed to acquire much information from Mrs.Takizawa, PT who developed the Motivative training and many devices. But she had always advocated “I can treat them. Only I can do and I use 10,000 kinds of rehabilitation intervention techniques “and had the profits by herself all alone. Now we knew that the co-author analyzed the situation of the rehabilitation training by carrying out identification of multiple accounts under the same name as a single entity with 10,000 kinds of rehabilitation intervention techniques to 10000 numbers ²⁾ . I mention specially that there had been the big sacrifice of the co-author who hadn’t fear losing all, especially in his political possibilities, in order to obtain information disclosure.
We had already a chance to prove the effectiveness of developed walker by the co-author by the grant of the Japanese National Foundation, Association for Technical Aids in 2000 ¹⁾ , illustrated the revelation to Fig. 1 Raku walker. This rehabilitation training with devices was happened to project to join the prior study. Some of the devices in this training are shown here, Fig.2 Pata (ankle dorsi-plantar Flexion exercise device) and Fig.3 Quadriceps training with weights.
We summarized those to the video film from the analysis, which I will show you from now on. The scene of evaluation is shown in Fig. 4. Moreover, I display the written directive for enforcement on Fig. 5. Participation of the Commonwealth of the Northern Mariana Islands (CNMI) official who was invited to Japan in order to participate in this research became the foundation of the first international biophilia rehabilitation conference with the government of the CNMI of the next year, 2001. The author had confirmed the good effect in our qualitative analysis to walk acquisition ²⁾ . I required statistical analysis to Prof. Ushizawa, the top medical statistician. He could prove by FIM evaluation results that the adoption of training showed significantly effective results. In table 1 we realize the facts ⁴⁾ . The significant differences were shown in gray.
Meantime my research presentation became the foundation of the patent³⁾ .
We recognized the necessity to record what we saw actually by this rehabilitation training. And we obtained the KAKEN grant and recorded it in 2001. Then, we arranged and published as a video book from the Civil publication. Although it is recognized as the fact which is not accepted except Japan and though very regrettable, in Japan after the Long-term Care Insurance Law enforcement in 2000, re-acquirement of walking ability meant the financial loss due to improvement. This economic loss is a large sum, 880 USD per month per person. It means a monthly decrease in income of 88000 dollars with 100 persons' facilities. Therefore re-acquirement of walking ability was not desired at all. The diffusion of our study results has not been realized until today by focusing on such a situation.
Then I expect that its diffusion of all over the world and scientific analysis of the Motivative exercise, which is a core intervention of the Takizawa’s rehabilitation method will be performed by watching the training situation at the video session this time.

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We studied the new Rehabilitation intervention technique (Takizawa method), which realized re-acquirement of walking from bedridden of 30% or more of the bedr₁₎ idden elderly by the grant of Japanese National Foundation, Association for Technical Aids in 2000 . An increase in the elderly population, including the disabled, demands the expansion of social security-related expenditures, which confers an unbearable burden to the following generation. These “Aging Crises” would give rise to the collapse of the social system.
The social security-related expenditures are enabled to reduce by getting knowledge of the way for disabled persons to live independently from to live with depending on caregivers. That elderly people live independently means the reduction of social security costs. It leads to preventing the collapse of the social system. Then, we studied “the formulation study of the community rehabilitation network by the advanced age disabled person oneself”. by the grant of the Incorporated Administrative Agency(IAA), Welfare And Medical Service Agency（WAM）.
The purpose for us was to make everyday life of as much as disabled elderly become independent possible but care reliance₂₎ . We clarified the significant difference on improvement in a degree of independent living degree .
At this time, my facility was only one which has already introduced the Takizawa method from starting time but the facility in Fujisawa. Therefore, we made a video of our reality of rehabilitation enforcement and contributed it to the test implementation facility. We used it simultaneously as a report to the WAM of the research grant offer IAA.
This video is created with two of information. One shows the everyday training situation of this institution and the other does it at home. All of the people who appears in the video are users of members in this facility and one is a patient of the Fujisawa one. All of them agreed with photography and televising.
Please look at the video as an example of Takizawa method rehabilitation enforcement.

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Surely in this period Europe, and some other regions in the world, has many deep economical and social criticisms, but Health Services, as built in the past century in our Countries must be defended and maintained, especially now in relation to the economical and demographical changes to support the most and enlarging frails people groups.
Rehabilitation has a specific role in maintaining Health for All : In our medical field mainly than others scientific knowledges are strongly connected with etical mission. PRM Ph. has a leading responsibility, together with other professionals and bio-engineer in all fields in rehabilitation, with the aim to better define all the features of clinical and research pathways, appropriateness and efficacy/effectiveness, and finally outcomes measures and concrete advantages in quality of Health for patients.
So we must face in time these critical points to find a good and sustainable solution, finding alliances, promoting attention and awareness at any level. Researches and Technologies in one hand, changes in demography and epidemiology in another hand, in the same time the efficacy/effectiveness of health interventions (from ICU up to rehabilitation and long term cares) are creating a so rapid increase of numbers and duration for rehabilitation treatments.
This Landscape opens many risks for any National Health Service, regarding globality, sustainability, accessibility needed to be guaranteed to any patient in relation to their health right .
For example the field of new technologies have high costs itself, and open some different sources for other costs if well applied :
- time for Specialists and other Professionals to know, to apply, to make very often a personalized setting for any care programs, to verify and collect results,
- rapid innovation asking change of apparatus ( change education and so on ),
- enlarging duration, number, types of treatments and follow-up for in-patients and for out-patients too (tele-rehabilitation could be not a simplifier but probably a multiplayer of needs ?).
Probably it is totally not possible to hope to follow and apply (neither in richest countries ) these developments only by methodologies/technologies/professionals working “around” (in- or out- ) patients, and in the same time it is surely not suitable to the true value of “recovery” in the people life.
On the contrary Rehabilitation Medicine must be the vay to re-acquire the people's body function, by latent powers which we have in any part of the body and mainly in the brain. Working actively ( motivation ) to reach the best personal activity and participation must occupy a big portion of the Rehabilitation Medicine, and the process of activating the work of brain by the latent powers ( hope, whish, joy, fear, emulation ….).
As a matter of fact these are the main contents in Community Rehabilitation too, as United Nations defined in their guidelines for less developed Countries to face many aspects of disability.

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Aging is usually defined as the progressive loss of function accompanied by increasing morbidity with advancing age. The process of aging is multifactorial and depends on intrinsic (genetic) and extrinsic (environmental) factors. Aging concerns both physical and cognitive spheres of an individual. Detriments in functional reserve predominate in such body systems as the cardiovascular, the muscle-skeletal, the osteo-arthritic, the immuno-humoral, and brain systems. Physical exercise, adequate to the metabolic capability of an individual at a given stage of life, has been proposed as remedy to counteract aging. One of the most common exercise techniques is stretch. The unresolved issue with stretch is what kind of it should be applied in the setting of health care practitioners, particularly those engaged in sports training or in rehabilitation of the elderly. There are basically three types of stretch exercise: static stretching, dynamic stretching, and proprioceptive neuromuscular facilitation (PNF). The static paradigm consists of holding muscles in an elongated position for an extended period, the dynamic consists of moving joints through their range of motion, and the PNF combines static stretching with isometric contractions in a cyclic manner. While the static stretching may lead to muscle weakness which hampers subsequent physical performance, the dynamic stretching gives proneness to injuries, although it may be argued that range of motion is important to activities of daily living and declines with age. On the plus side, dynamic stretching increases the speed of neural signals running down from the brain to muscles, quickness of motion, and the velocity of enzymes. Studies demonstrate that both PNF and static stretching appear to substantially reduce the number of physical activity-related injuries. Ultimately, the mix of stretch modes, with static stretch followed by dynamic stretch, may be optimal to mitigate the risk of muscle impairment and to counteract injuries. To this end, meditation techniques containing a mixed physical motion ingredient, such as Tai Chi, deserve attention and imitation as an example exercise, with the additional benefit of improvement in mood, emotional stability, and cognition.
Human functionality has an outstanding plasticity and is capable of compensating for the structural insufficiency due to the age-related hampering of cellular metabolism. That may be exemplified by the maintenance of adaptive hyperventilatory responses to strenuous stimuli, such as exercise, in old age despite severe structural deterioration of the lungs and airways, limiting the alveolar gas exchange area and thus oxygen delivery.
Exercise is an antiaging strategy linked to physical and cognitive rehabilitation, a process aimed at combating the effects of a disease. This process also entails a large psychological component that is closely linked to behavior, personality traits, and other factors. The mind-to-body connection is indispensable for a motivative engagement in antiaging behaviors, such as exercise or rehabilitation in case of a physical handicap due to a disease. Exercise has a protective effect on cognitive functions and helps combat the deleterious effects of stress and aging. The practice of exercise improves physiological and functional responses and thus the physical health and quality of life of the elderly.

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Multiple Sclerosis (MS) is a chronic immune-mediated disease of the central nervous system, most often diagnosed in young and middle-aged subjects (two-third of which are women). Walking disturbances and fatigue are key symptoms in patients with MS, and major causes of discomfort, even in patients with mild disability since the early stages of the disease. Controversy exists about the association between fatigue and physical disability, between elevated fatigue, impaired balance and a higher risk of falls, between perceived fatigue and gait performance.
We enrolled 16 patients with relapsing-remitting MS at early stage and low or mild disability, 11 females and 5 males, aged 27.1 (range 23-34 years), randomly divided into two groups: patients in group A underwent a robotic gait rehabilitation treatment which involved the use of SPAD^® (Sistema Posturale Antigravitario Dinamico, Dynamic Antigravity Postural System), patients in group B underwent a cycle of sensory-motor physical activity in our laboratory of performance enhancement; patients in both groups were subjected to neuromuscular manual therapy. All treatment were provided with 3 sessions per week for 6 weeks (for a total of 18 sessions). Patients were evaluated by administration of the Functional Independence Measure (FIM^®), Expanded Disability Status Scale (EDSS), the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS), and gait analysis with MTX7^® (Diagnostic Support, Rome, Italy).
Results show statistically significant improvement of the FIM^® average score in all patients, reduction of the EDSS average score in all patients (but in a statistically significant manner only in group A), reduction in average scores obtained in both evaluation questionnaires of fatigue (non-significant improvement of the FSS average score in the overall sample and in both groups, statistically significant reduction of the MFIS average scores), improvement in temporal (but not spatial) gait parameters. So body weight supported gait training is feasible and could be safely used as additional therapeutic option in MS patients with mild walking disability.

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Near-infrared spectroscopy (NIRS) can easily measure brain activation during rehabilitation exercises. However, irrelevant signals mainly from scalp blood flow change are often observed in NIRS measurements. In this study, we simulate optical diffusion approximation in a four-layered tissue head model and focus on the association of the optical attenuation changes by the scalp blood flow in each probe distance, and propose an algorithm to extract signals derived from the brain activities with a pair of probe distance. We show that the proposed method is effective in removing artifacts by applying the method to the simulation data and the measured data of NIRS.

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Recently, technology of brain activity measurement has developed, and many researchers have tried to elucidate the human brain function. In those technology, Near Infrared Spectroscopy (NIRS) enables us to measure brain activity safely and easily. That is the reason that NIRS is expected to apply variable study field. Since the spatial resolution of NIRS is not sufficient for further measurement of brain function, which is the disadvantage of NIRS and prevent development of applied research. In some previous researches, the spatial resolution improvement of NIRS have been performed by the minimum norm method and so on. The approaches can three-dimensionally estimate activation site in brain. However, the activation site estimated by the minimum norm method widely spreads, and it is difficult to perform the activity estimation in deep area. Therefore, the purpose of our study is to improve the measurement of activation site in deep position in brain by the modified minimum norm method. In this study, an experimental model based on the head structure is used, and the sensitivity distribution in the model is calculated by Monte Carlo simulation. We focus on the sensitivity distribution, and voxels in the model are classified by some levels depending on intensity of the sensitivity distribution. By comparing estimation value in each level, inactive voxels were determined and estimated active position was able to be narrowed down. As a result, estimation of brain activity in local position is improved compared with the conventional minimum norm method especially in estimation of small active position.

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Since we gained a new research grant by the Ministry of Internal Affairs and Communications, we report its outline. The name is as the notation and the purpose of research and development is systems development which is based on the local ICT organization in Kanagawa prefecture. We research and develop the system which can manage autonomous rehabilitation in the whole region and in an institution at remoteness by information and communications technology (ICT) due to the device development for leg motivative exercise that is included in the ICT network.

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In the field of medical rehabilitation, our patients are often in a vulnerable state and are unable to process the real dimension of their illness, so the way that disability is discussed with the patient and his/her family is crucial in the process of understanding their condition and the realistic rehabilitation outcomes. In Romania, these aspects developed later after the ending of the communist period, after we became part of different groupings such as EU and we started to establish good social networks. After a traumatic condition that changes the patient’s and his family’s life the medical decision concerns not only the short-term outcome, but also long-term disability management for daily-life activities.

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Introduction: cerebral palsy (CP) is a condition determined by a damage occurred in the developing brain of children during the first year of life, resulting in cognitive alterations and motor disorders like spasticity. It is known in Literature the efficacy of integrated rehabilitative treatment for CP. The aim of this study, conducted in the Chair of Physical Medicine and Rehabilitation at Univeristy “G. D’Annunzio” of Chieti - Pescara, was to demonstrate the importance of an early integrated rehabilitative treatment as affirmed in Literature for patients affected by CP.

Materials and methods: 20 patients with CP were recruited, aged between 2 and 7 years old, of both sexes. Datas were collected at the beginning of the treatment (T0), at 3 months (T1), at 6 months (T2) and at 12 months (T3) using the Gross Motor Function Measure, the WeeFIM and the Barthel Index. Patients performed 3 weekly therapeutic sessions, each one lasting 1 hour, for a total of 6 months and 1 weekly session for the remaining 6 months. Each session consisted in a set of proprioceptive and stretching exercises.

Conclusions: at time T2, patients showed an increase in their motor and cognitive abilities. All patients maintained their improvements at the end of the follow up (T3). These improvements resulted in a greater independence of patients from caregivers and in an overall better quality of life.

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Introduction: Life satisfaction is a notion often combined with mental wellbeing, happiness, and contentment. This type of satisfaction directly influences the quality of life. It is believed that physical activity not only increases a functional efficiency level of people with high spinal cord trauma, but also affects their life satisfaction. The aim of the study was to assess life satisfaction of men with the spinal cord injury in the cervical, wheelchair rugby players (WR) against a control group.
Material and methods: The study was conducted among 36 men after spinal cord injury in the cervical (SCI-C) - 25 active athletes of Polish Wheelchair Rugby League ranked as “high score" players and "low score" players and 12 men’s named “inactive”, who after the injury do not undertake any physical activity. The research tool was a questionnaire of life satisfaction LiSat-9 evaluator life as a whole and some of its components,
Results: Statistical analysis showed significant differences between selected components of life satisfaction and temporal variables, ie. age of participants, time since injury, age at injury. Significantly higher average life satisfaction component was identified among “high score” players (4.7) compare to the value of the average of result among "low score" players (3.9) and among inactive in sports (4,0).
Conclusions: The level of the life satisfaction wheelchair rugby players is varied due to their age, time since injury and age at injury. Successes in sport significantly affect the level of their life satisfaction.

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IntroductionAccording to scientific reports cardiovascular complications are the leading cause of death in people with diabetes (Stirban and Tschoepe 2008). It has been shown that chronically elevated blood glucose concentration is mainly responsible for the development of micro- and/or macroangiopathy (American Diabetes Association 2009). Angiogenesis is mainly stimulated by hypoxia, and more specifically by hypoxia inducible factor-1 alpha (HIF-1α) the main proangiogenic factor – vascular-endothelial growth factor (VEGF). In diabetes chronic exposure to hyperglycemia modifies the function these main angiogenic factors (Simons et al. 2005). Studies suggest that combining physical activity with hypoxia improves glycaemic control (D'hooge et al. 2011; Mackenzie et al. 2012) and to have beneficial effect on vascular function (Fuchsjäger-Mayrl et al. 2002,). Therefore, the aim of the study was to assess the effect of moderate intensity continuous exercise in normobaric hypoxia on glycaemic control and concentration of proangiogenic factors in patients with Type 1 diabetes.
Methods: Twelve patients (age: 29.2±9.5 years) suffering from Type 1 diabetes (T1D) for 12.1±6.0 years, with HbA1c at approximately 56.3mmol/mol, free of diabetic complications, and twelve randomly chosen adults (GC) without diabetes performed the 40 min continuous exercise (ExC) of moderate intensity (50% of lactate threshold load). The exercise tests were performed in normoxia and normobaric hypoxia, which simulated the altitude of 2500 m a.s.l. Serum glucose, proangiogenic factors, and brain-derived neurotrophic factor (BDNF) concentrations were measured at rest, immediately and up to 24 h after exercise.
Results: A significant decrease in serum glucose concentration was observed immediately after ExC in hypoxia (p<0.001) and normoxia (p<0.05). Continuous exercise in hypoxia caused the greatest decline in blood glucose (mean Δ glucose: 83.6±13.3 mg/dl) and had the most beneficial effect on moderate-term (up to 24 h) glucose control. A significantly higher baseline serum concentrations of HIF-1α were showed in the group of individuals with T1D in comparison with healthy subjects (p<0.05). ExC in normoxia (p<0.001) and hypoxia (p<0.05) significantly increased the level of BDNF in T1D. A tendency TNF-α level reduction was observed in T1D in response to Ex. No significant modifications in concentrations of other proangiogenic factors were stated in response to exercise tests.
Conclusions: The significant glycaemia reduction induced by continuous exercise in hypoxia with a tendency to reduction of pro-inflammatory cytokine level suggest that physical exertions of different intensity combined with exposure to hypoxia may improve metabolic control and stabilize the process of angiogenesis decreasing the risk of severe vascular complications in patients with Type 1 diabetes.

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Chronic pain is a main cause of disability in female adults and in the elderly population. The World Report on Disability estimates that over one billion people Contemporary pain management shifted from symptom control to management based on pathophysiological mechanisms. The clear understanding of the mechanisms involved in pain generation, modulation, amplification and perpetuation plays a potential role in patient profiling to recognize indicators of these complex processes.
Serum levels of pro-inflammatory cytokines, for example, may differentiate people with chronic pain compared with healthy controls. Recently, it has been recognized that constant and intense nociceptive sensory information generated by painful, inflamed deep somatic structures produce significant neurochemical and metabolic changes and reorganizations within corresponding spinal cord segments. Increased excitability of dorsal horn neurons producing pain hypersensitivity in a segmental distribution negatively impacts functional capacity and most aspects of quality of life. Hyperalgesia of central nervous origin that can be detected by combined pressure pain thresholds measured by a pressure algometer over the patellar tendon, at S2 subcutaneous dermatome and at the adductor longus muscle are the best predictors for pain scores rated at a visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index, accounting for 61% of those scores in patients with chronic pain and knee osteoarthritis. Pain related changes in activation of brain circuits such as the limbic and the somatosensory cortex can be identified using functional neuroimaging techniques.
Patient profiling including functional neuroimaging, algometric measurements and biochemical profiling of circulating cytokines, chemokines and growth factors may detect functional, morphometric and chemical changes that serve as translational mechanistic pain biomarkers.

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Osteoporosis is one of the most common metabolic disorders and the most common metabolic bone disease. Weight bearing exercises, good nutrition and adequate amounts of vitamin D are important in attaining and maintaining bone mass. The incidence of osteoporosis is increasing worldwide, especially in Asia, but osteoporotic patients can benefit from individually programmed exercises that help minimize fractures.

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Introduction. The present study – endorsed by the Committee Permanent/ Standing Committee of the European Doctors (CPME) – generated data for the first time on the levels of health literacy on functional decline and frailty, related to ageing, for doctors and older patients (60+ years old) in Romania and Latvia. This trial tackles not only the lack of data on the topic but it provides insight from two EU member states: a Central-South/Eastern and respectively a Baltic – Central-North/Eastern – ones, that (also) struggle with the fall in fertility, coupled with high percentage of outward migration predominantly within the early working age population.
Materials and methods. 300 doctors responded to the questionnaire: 148 doctors practicing in Romania and 150 in Latvia. 1 doctor indicated Andorra was his main place of practice and another Romanian doctor indicated Nigeria as his main country of practice. 301 responses were received from 60+ older patients living in Romania and Latvia. Most respondents were aged between 65 and 74 years (38.2%),
Conclusions. The self-declared awareness on functional decline and frailty, related to ageing, is high for both patients and doctors in Romania and Latvia (over 70%) but overall levels of health literacy on both these items are determined also by degrees of access, understanding, appraisal and application which reduce them. All these health literacy components are much lower for patients, with over 20% of respondents finding it difficult to access information, understand it and/or demonstrating knowledge about functional decline and/or frailty, whereas for the doctors there is a discrepancy between claiming no problematic awareness, access and understanding and the appraise and apply related components, as defined in the common background of this study.

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You can get the answers for all the correspondences following when you watch the Video session; The previous correspondences are listed.


Note:
We decided the name of the committee by the founder members on the conference day, 18 July 2016. If you would like to join the study, please contact the administrator at takizawa (at) biophilia.biz.

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