IBRC 2019

Preparation of the International Standardization on MOTIVATIVE Exercise Enforcement and Journal 2019

Chairperson of IBRC 2019

Dr. Yoshiko Morita (Japan) Okayama rehabilitation Hospital

Hosted by; International Biophilia Rehabilitation Academy

Biophilia Rehabilitation Academy of Japan

Supported by; Association for Technical Aids

Japanese Society for Rehabilitation of Persons with Disabilities

ORGANIZING COMMITTEE and SCIENTIFIC COMMITTEE of IBRC 2019

Yoshiko Morita

Takizawa Shigeo

Toshiyuki Tanaka

Rika Wada

Mieczyslaw Pokorski

GELU ONOSE

Jose Leon-Carrion

The Biophilia Editorial Board

Takizawa Shigeo

Mieczyslaw Pokorski

GELU ONOSE

Yoshiyasu Takefuji

Hajime Takada

Toshiyuki Tanaka

Hiroshi Nagasawa

Camillo Di Giulio

Raoul Saggini

Jose Leon-Carrion

Yoshiko Morita

Aleksandra Zebrowska

Dariusz Jastrzebski

Gunta Ancane

Signe Tomsone

Anda Nulle

Alessandro Giustini

Jana Migliniece

Since 2000, we Biophilia members have payed attention to the Motivative Exercise program fit to group training in long term nursing home or community field for coming aging crisis.

So we’ve spent over twenty years to certify this training program beneficial to get independent living longer. By many applications to national research funds, we’ve got adequate funds to carry out several studies compared favorably Motivative Exercise with conventional passive exercise by clinical ADL estimation and picture data by using high-grade test machines, fMRI or fNIRS during training these program.

We’ve tried to get successfully many expected data and results from several trials to prove Motivative Exercise the useful and practical technique to senior frail or disabled person. In Rehabilitation field, Robots-machine or AI devices are studied enthusiastically now.

But our recommended and reasonable these tools also save our coming baby-boomers’ crisis still.

It is my pleasure to welcome you to our IBRC2019. The author aspired for the restructuring of rehabilitation medical treatment, and organized the study group which re-organized as International Biophilia Rehabilitation Academy later, took the hand with medical experts, such as many doctors, physiotherapists, etc., the engineering researcher, and the sociology researcher, and have advanced research with together. When Looking back, there was an evaluation of "one point" to the application of the Ministry of Health, Labour and Welfare research grant which specified the contents of restructuring of rehabilitation medical treatment. It was said by my acquaintance officer of there that he had never seen "one point" for the grant evaluation. It seemed to show that the difficulty of the social reformation which the author aspired after to overcome the disabilities and to realizes life reconstruction for independent living by the restructuring of rehabilitation medicine.

Once, the Soviet Union collapsed, and the communism of the firm social system was reformed. The author showed those at the IBRC 2018 and that even the firm social system would be restructured when the illogicality is included.

It is a pleasure from the depth of my heart that the workshop, which can show our current research at the ISPRM 2019 in Kobe, will be held. And in IBRC2019, “Preparation of the International Standardization on MOTIVATIVE Exercise Enforcement” became a subject for discussion. Moreover, “Preparation of the International Standardization on MOTIVATIVE Exercise Enforcement to diversify of the Rehabilitation medicine intervention technique“ became a subject of debate in a panel discussion in which the author serves as the chairman.

It is a great pleasure to held the 16th International Biophilia Rehabilitation Conference on 14 June, 2019. I am Toshiyuki Tanaka, chairperson of Biophilia Rehabilitation Academy in Japan. 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 image analysis and machine learning, 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. Modern medical devices such as fMRI, fNIRS, and X-ray CT support the work of doctors, and the precision of diagnosis has risen markedly. However, it seems that the burdens on doctors have remained as big issue. We are developing a diagnosis support system using medical image processing in order to reduce their burdens.

We have promoted the construction of new rehabilitation system that one physical therapist treats several patients with easy devices, which was called “Takizawa method”. The international Biophilia Rehabilitation Academy (IBRA), which is a sisterhood institute of BRA in Japan, has worldwide revolved the promotion of new rehabilitation system. In this year, we have the 16th International Biophilia Rehabilitation Conference (16th IBRC) held in Okayama, Japan. The BRA in Japan shall be glad to serve the 16th IBRC in any way in our power.

Through a workshop and research exchange, we hope that the workshop will provide the opportunity to introduce important innovations in the field of the rehabilitation.

I am privileged to invite you to the annual IBRC conference, which will take place in Okayama on June 14. This will be the 16^th annual meeting of the International Biophilia Rehabilitation Academy; an organization that has been undertaking undaunting efforts for more than two decades to reshape the rehabilitation paradigm in the super-aging society of the contemporary world. The IBRA has been one of the first to introduce the concept of motivated exercise into the modern physiotherapeutic work, particularly in neurological physical distress, in order to streamline the process of physical rehabilitation and to make the most of it from the standpoint of ever increasing medical, economical, and organizational needs. The innate part of this concept is to enhance the patient’s motivation and self-esteem to minimize mental resistance to physical motion, and to enhance the patient’s desire to overcome the handicap through active participation in the rehabilitation process. Motivated exercise may actually be considered a part of the modern bioprogressive philosophy, which combines holistic aspects of biology and function into the realm of rehabilitation and antiaging strategies to counteract the age-related ailments.

The main feature of this year’s conference will be the elaboration on the International Standardization of the motivated rehabilitation paradigm in an effort to unify various physiotherapeutic interventions. Standardization would make it easier to implement an integrative approach to improve the performance of corrective exercises and function recovery and to compare among various medical and, in particular, community-based rehabilitative settings.

We are obliged to invite Eminent Scientists, Academicians, and Researchers to the conference to share innovative thoughts and demonstrations on motivated rehabilitation therapy and its effects on health and movement patterns. The conference will feature internationally renowned keynote speakers in the area of rehabilitation and physiotherapy management. In addition to keynotes and workshops we are calling for abstracts of presentations and invite you to submit full articles related to your participation in the conference to the Biophilia Journal. We really value your outstanding contribution toward the advances in rehabilitation strategies and the scientific community.

Dear fellows and friends,

The International Biophilia Academy Rehabilitation Conference – IBR(A)C – has now reached to its 16th Edition, that will be held on the 14th of June, 2019, in Okayama, Japan.

In my professional and academic positions (PRM, with special focus on NeuroRehabilitation, and repetively, Gerontology & Geriatrics – including: Honorary Executive President/ Co-Founder of the Romanian Society of Physical and Rehabilitation Medicine & Balneoclimatology; President/ Co-Founder of the Romanian Society for NeuroRehabilitation), I herein warmly welcome this Conference and its very actual topics, i.e. ”Preparation of the International Standardization on Motivative Exercise Enforcement” and as well, the comprehensive, multimodal (bio-/medical and socio-economic – including at community-primary level) approach of a subject matter that becomes more and more important as the accelerated demographic aging process continues: the appearance, in different parts of the world, of a ”super-Aged Society”, resulting in a growing proportion of the elderly – prone to multi-morbidity, among which neural-motor/ sensorial-/ psycho-cognitive/ communicational, disorders, are some of the most severe impairments and diabilities, but/and, at the same time, being targets for (neuro-) rehabilitative/ assistive/ cares, endeavors.

Thereby, I wish great success to the 16th IBRC !

It is my pleasure to join my esteemed colleagues in welcoming you to the 16th INTERNATIONAL BIOPHILIA REHABILITATION CONFERENCE (IBRC) in Okayama, Japan on June 14th, 2019. This theme for this year’s conference is “Preparation of the International Standardization of MOTIVATIVE Exercise Enforcement”, chaired by Dr. Yoshiko Morita M.D., Director of the Department of Rehabilitation Medicine at Okayama Rehabilitation Hospital in Okayama City, Japan, and organizing the panel discussion with Professor Takizawa Shigeo (President, International Biophilia Rehabilitation Academy and Professor, Biophilia Institute of the Japanese Ministry of Education, Culture, Sports, Science and Technology) as the panel chair, and Professor Toshiyuki Tanaka (Faculty of Science and Technology, Keio University, Yokohama, Japan) and Director Rika Wada (Tachibana Rehabilitation Service Center, Kobe, Japan) as the panellist.

The IBRC is a leading international forum which has worked for almost 20 years to advance research and diversify techniques for effective rehabilitation programs, with special emphasis on functional recovery in aging populations and reintegration into society. This year’s theme for the panel discussion is “The MOTIVATIVE Exercise Program” and its success over conventional passive exercise for improving functional recovery in elderly and disabled persons.

The International Biophilia Rehabilitation Academy (IBRA) is increasingly endorsed each year, with international conferences hosted in Japan, Cuba, Philippines, Spain and Switzerland. Do not miss this exchange of ideas, developments and breakthroughs in rehabilitation strategies.

We look forward to welcoming you in Okayama.

本日ここに、多くの関係者の皆様のご参加を得て、「第１６回国際バイオフィリア リハビリテーション学会大会」が盛大に開催されますことを心からお祝いを申し上げます。

また、本学会の開催にあたりご尽力されましたバイオフィリアリハビリテーション学会並びに高齢市民が活躍するための社会技術研究会の皆様に深く敬意を表します。

貴学会は、医学、工学、社会科学等の関連する分野の研究を通じて、持続可能な超高齢社会を築くための多面の課題を解決する努力を続けており、特に「障害の受容」から「障害の克服」を実現するため「リハビリ医学再構築」に焦点を合わせ、患者が身体機能を再獲得し、機能障害を克服できるよう研究を進めておられます。

福祉用具の開発の推進と普及促進及び福祉用具関係技能者・認定補聴器技能者の養成・研修に努めている当協会は、貴学会に対し平成１２年度「高齢下肢骨折患者のＡＤＬ向上と自立のための調査研究」、平成１５年度「福祉用具による大腿骨頸部骨折患者のＡＤＬ向上と自立のための調査研究」、平成１８年度～１９年度「褥瘡予防における福祉用具の役割とその利用の実際の研究」にそれぞれ助成し、福祉用具の利用効果について研究成果を取り纏めていただいているところです。

この大会で高齢障害者が障害を受けた身体機能を改善し解剖学的機能障害（インペアメント）を克服し、寝たきりになることなく自立生活を送るための新たなリハビリテーション手法を研究し普及するためにリハ医学・工学（ＩＴを含む）、社会科学、在宅・施設における介護・看護・医療、地域リハ、体育といった学問領域の融合の下で、研究成果が広く人類の生活向上と社会発展に寄与できるよう期待しております。

結びとして、バイオフィリアリハビリテーション学会の益々のご発展並びに関係の皆様方のご健勝、ご多幸を祈念申し上げます。

第16回国際バイオフィリアリハビリテーション学会IBRC2019の開催を心からお慶び申し上げます。

これから日本だけでなく世界各国で高齢化が進んでいく中で、誰でも日常的に行うことのできるリハビリテーションシステムの構築は不可欠であります。

貴学会を中心に産官学そして医工の連携を密にして、また世界各国の関係者が力を合わせリハビリテーション医学がますます発展することを期待いたします。

貴学会のますますのご発展と、本日ご臨席の皆様のご健勝を心から祈念いたし、私からのメッセージといたします。

I have worked as a specialist of Rehabilitation Medicine since graduation of Okayama University medical course. So I‘ve been working for 45years long in clinical fields. Many environments have been changed almost in this half century.

The biggest change is the shape of distribution map of population.　It means that the lesser young aged versus the more senior aged people have made both the social economy and system unstable. The reason of instability is that social workers continue to decrease definitely from now on in this century long. The recipient will exceed the provider of medical and care insurances.

In Japanese honorable health care system covering whole nation, we worry about the medical and welfare funds exhausted near future. We can’t rely on the public medical or care insurance and put ourselves at ease within our days. We baby boomers must decide to stop our children assume too much burden to take care of us. We must decide to devise to delay inactivity by ourselves reasonably. The expensive tools must not save all the people rather than the convenient ones. The devices we use in Motivative Exercise just answer these conditions. Many senior frail persons in a local region will be able to continue Motivative Exercise to keep the independent life anyway.

We succeeded to have chances to certify activated brain while exercising Motivative Exercise,by fNIRS and fMRI. The result from analyzing data getting by these examinations were not so easy to explain. But I strongly declare the group exercise will adapt much better than elderly health training better than personal training.

We provide our coming elderly to keep our ADL well by ourselves using Motivative Exercise.

Moreover, a lot of papers of the motivative exercise and Takizawa method were published.

It was checked what kind of and how many words were used in these texts by text mining using KH Coder.

The author checked the words with Japanese and English contrasted and the frequency of appearance of them for the language used in carrying out international standardization.

The author advances preparation to show each meaning of the words as an international standardization proposal at the panel discussion to a word shown with high frequency, to consider the use situation in the actual rehabilitation service in Japanese and English, and to collect participants’ opinion.

The motivative exercise was performed 20 to 50 times enforcement, and the implementation for 5 minutes, and shows the result respectively good for re-acquirement of functional activities.

The international standards will be shown with two important viewpoints as following; to earn an income with considering the Japanese present nursing care insurance and earn the re-acquirement of functional activities.

The author expects that we can carry out the supplementary examination according to this presentation, especially on the re-acquirement of functional activities on a worldwide scale.

For Example;

One baby-boomer asked, “what is it called in English to move an arm with disability by the unaffected one to the president of the Hospital of National Rehabilitation Center for Persons with Disabilities, Dr. Tetsuhiko Kimura.” He answered, “it is called the self-training.”

And the baby-boomer asked, “what is it called in English to move a leg with disability by the unaffected one to him.” The president told him, "there is no word of the meaning. It is unable to do such a thing.

Therefore, a physiotherapist is in it who serves passive exercise to them for it.” The baby-boomer said that then it is necessary to make a new word since our proposal can move an impaired leg by the unaffected leg with using the developed device.

Then the baby-boomer made the word "MOTIVATIVE" and registered it with the U.S. Patent Office.

We are preparing to standardize this motivative exercise. The reason the word "MOTIVATIVE" will be explained in the IBRC 2019 Panel discussion.

Recently, the brain function has been measured by some imaging systems. The imaging systems diagnose several kind of diseases, and also check the recovery level of rehabilitation. The following systems are well known worldwide as the imaging systems.

(1) EEG (Electroencephalogram)

(2) MEG (Magnetic encephalogram)

(3) SPECT (Single photon emission computed tomography)

(4) PET (Positron emission tomography)

(5) fMRI (functional magnetic resonance imaging)

(6) fNIRS (functional near-infrared spectroscopy)

The above systems measure the different biological reaction. EEG and MEG measure the neural activity in the brain, and others (SPECT, PET, fMRI and fNIRS) measure the change of regional cerebral blood volume. The fNIRS has been frequently used in the brain function measurement at the rehabilitation, for the reason that the system can be used with metal-containing devices.

We have shown successful results by the fNIRS and fMRI in some conferences. Although the EEG and MEG have been not frequently used for the brain function analysis, because the analysis is complicate and the computer-based implementation is difficult and does not have sufficient results. We think that the EEG and MEG are more suitable for brain function measurement, since the systems directly measure the neural activity in the brain. Professor Takaaki Nara with University of Tokyo has proposed the mathematical researches of activation site in brain using MEG and EEG, and the study receives attention from the brain function researchers. We think that the brain function is analyzed by using computer, based on our research achievement. The diagnosis by EEG shows the recovery condition of brain function from the view of neural activity.

My facilities provide the rehabilitation service with a Takizawa Method and the functional training which the physiotherapist is usually performing. Furthermore, I am enforcing the exercise which the author concerts the Towel Sanding and a guide training by the physiotherapist lead with an autonomous one by the patient.

Although I thought that such contents didn’t especially change to the others, I present a subject for discussion in order to compensate for the international standardization of the motivative exercise for the decision of those names and clarification of a practice standard.

Next, I present a subject for discussion with an examination of the enforcement time of the motivative exercise for the international standardization. I am carrying out for 5 minutes training each for Pata and Koro at my facilities. Please check the reference ^1)-13) below for the effect and situation. I will show you the enforcement situation in my presentation.

We know that we need time for the international standardization of our study, but I am looking forward to getting the participants' opinion to overcome the difficulties.

Introduction: Stroke is a leading cause of disability and causes severe neurological dysfunction. The consequences of stroke impact the quality of life of the patient through the different degrees of disabilitation, social, and economic conditions that make it difficult to live independently. Therefore, we consider that there is a need for a simple and effective device to aid the patients in the rehabilitation process.

Material and Methods: The study took place in the medical-social center Bacesti (Ro/Eu), and it included 21 patients (11 women and 10 men) all with a history of stroke aged 59 to 96 years. We used the PataKoro (Japanese device for rehabilitation) devices to perform the exercise that has bilateral movement of the legs so that the affected leg becomes active by the unaffected leg. We measured the knee flexion/extension, thigh perimeter, and ankle flexion, extension.

Results: At the end of the first two weeks of treatment the knee flection improved with approximately 21 degrees, the extension had a 7 degrees improvement in one patient, thigh perimeter had, and an average of 1.7 cm increase, ankle flexion had an average of 2.8 degrees increase, the extension did not change. Using these types of devices is simple, low-cost, and easy to use in stroke rehabilitation, has a good psychological impact and is increasing the patients quality of life.

Conclusions: These results are showing that the motivative exercise using PataKoro in the dorsiflexion and plantar flexion exercise of the ankle joint have an effect on the range of motion of the knee/ankle and the thigh perimeter. One of the goals in rehabilitation is to achieve mobility, improving physical and psychological status. These devices enhance functional independence in the hospital and at home.

We developed the A.I. Artificial Intelligence-IoT device in which real use is possible based on the developed device with the Scope.

The judgment of the present degree of care is based on the argumentation of specialists. If there is a system which can judge it automatically, laborsaving and much more objectification will be attained. According to previous research, it was clarified that the correlation in the movement speed of pumping legs in the same direction and the degree [1]. However, in order to judge it correctly from the rate, a good deal of various measurement data of many people is required.

Therefore, the evaluation device which measures the speed by wireless communications was manufactured [2], [3]. In order to judge it, in addition to the collection of the measurement as mentioned above data, it is necessary to accumulate it.

Moreover, the system which visualizes the stored data and to analyze it is also required. In order to satisfy these requirements, it is effective to compose the method with which we can search easily to manage the measurement data in a unified manner by Cloud and/or the stored data.

Fall fractures in the elderly are a big social problem. It is important to evaluate lower-limb muscular strength, walking function, balance function, and appearance of the foot for fall prevention. However, the measurement method has not been established.

In this study, we are developing a measurement system that can contribute to falling prevention.

Purpose: The present study aimed to compare the tidal volume and the peak inspiratory flow during manual breathing assist and rib springing in the lower chest. Method: Twenty-three healthy adult men were included. The manual breathing assist and rib springing procedures were performed by a physical therapist familiar with respiratory physical therapy. Measurement conditions were as follows: the maximum tidal volume was measured during quiet breathing, and while using manual breathing assist, and during rib springing. The peak inspiratory flow was measured 3 times each during manual breathing assist and rib springing, and the maximum value was used. Results: The tidal volume increased significantly during manual breathing assist and rib springing in comparison to quiet breathing. There was no significant difference in the tidal volume in manual breathing assist and rib springing. The peak inspiratory flow during rib springing was significantly higher compared to that during manual breathing assist. Conclusion: Our results suggest that the rib springing was able to increase the peak inspiratory flow by about 1.6 times in comparison to the manual breathing assist.