In Korea, western medicine was introduced in 1885, when Dr. Horace Allen, an American missionary, established the first western medical hospital, ‘Kwanghye Won’, which was the original Severance Hospital, Yonsei University College of Medicine. Then, the hospital renamed as ‘Chechung Won’. In 1886, the first education of medical students was started in ‘Chechung Won’. Later, in 1958, an educational course on Rehabilitation Medicine was introduced at Yonsei University College of Medicine for the first time. Education of Rehabilitation Medicine is included in the syllabuses of 40 among total 41 medical schools. Resident training requires the completion of a six year course in medical school and a year of rotating internship. A physiatrist is also required to undergo a four year course of resident training in an approved program. The number of resident training hospitals for Rehabilitation Medicine has increased since 1971, and the proportion of resident training hospitals for Rehabilitation Medicine among the total resident training hospitals has steadily increased. In addition, the number of residents in Rehabilitation Medicine training has increased. At present, 328 residents are undergoing Rehabilitation Medicine training in 2001. In 1983, twenty-two physiatrists were board certified in Korea for the first time, and the number of board certified physiatrists has increased gradually. In 2001, there were 591 board certified physiatrists practicing in Korea. The requirements for the board certification examination include a four year resident training, experiences with more than 300 patients, 200 cases of electromyographic studies, 12 out-hospital seminar attendances, 200 in-hospital seminar attendances and the publication of more than 3 scientific articles. The criterion for a pass at the board certification examination is a score of more than 60 of total 100 (score 60). In Korea, modern Rehabilitation Medicine has grown rapidly. However, education of Rehabilitation Medicine in Korea should overcome many problems still faced. For example, we should calculate and make a plan for adequate numbers of board certified physiatrists and related medical personnels in the future, and we should have a national license system for related medical personnel such as speech therapists and clinical psychologists. In addition, we need to establish a more adequate educational system for physical therapy, occupational therapy, speech therapy and prosthetics and orthotics.
Training and education in Rehabilitation Medicine in Thailand was started at Siriraj Hospital for 6th year medical students in 1958. The Society for Thai Rehabilitation Medicine was founded in 1972, developed into the Thai Rehabilitation Medicine Association in 1988 and was established as the Royal College of Physiatrists of Thailand in 1998. A Board Certification system for Rehabilitation Medicine was initiated in 1985 and the present number of certified physiatrists is 211. Teaching and training in Rehabilitation Medicine in Thailand is divided into undergraduate and postgraduate programs. The objective of undergraduate education is to develop attitudes that will enable medical students to see the patients holistically and to teach basic diagnostic and therapeutic skills to 5th and 6th year medical students. At Siriraj Hospital, Mahidol University, rehabilitation medicine is included in the Orthopedic rotation which earns 6 credits and elective clinical experience in rehabilitation medicine earns another 2 credits out of a total of 263 credits towards a medical degree. The postgraduate program consists of a 3-year residency training program approved by the Thai Medical Council. There are 6 university hospitals responsible for training with a total of 10-14 residency positions available per year. The components of training include: basic science, clinical science, clinical evaluation and treatment, electrodiagnosis, orthotics and prosthetics. Subspecialty training in pain, pediatrics, orthopaedics, neurology, rheumatology, cardiopulmonary rehabilitation, etc. are included in this 3 year training course. Elective periods of 1-2 months in the Department of Medicine, Orthopedic surgery and Neurology are also provided. The trainees are required to work in the training center for not less than 36 months and must publish at least one acceptable research study within their 3 year course. Residents who have fullfilled all of the requirements will be eligible for the board examination which comprises 40% of written examination and 60% of oral and skill examination which includes 4 parts; oral (20%), OSCE (15%), electrodiagnosis (15%) and orthotics/prosthetic (10%). After passing the board examination the specialty diplomas will be conferred upon them by the Thai Medical Council.
A market of rehabilitation service is rapidly expanding in health care field, while the development of education and training system for its professionals may vary from country to country with its inherent socioeconomic and cultural background. This paper reports on education system of rehabilitation medicine with a brief review of current curriculums for undergraduate as well as postgraduate training in the medical schools and teaching hospitals in Japan.
The prognosis of patients with ALS depends on the existence of ventilatory failure. To manage this, invasive intermittent positive pressure ventilation (invasive IPPV) has been the only treatment. This type of treatment, however, may spoil the quality of life of the patients, and they and their families may not be willing to accept it. Recently, noninvasive intermittent positive pressure ventilation including bilevel positive airway pressure ventilator (BiPAP). which is less costly, has become widely used. In this study, we applied BiPAP to two patients (one bulbar type and the other non-bulbar type) and invasive IPPV to one patient (bulbar type). The patient with non-bulbar ALS treated with BiPAP seemed to be more comfortable in speech and feeding than the patient with invasive IPPV. However, this did not apply to the patient with bulbar ALS treated with BiPAP. Further investigations are needed to elucidate the criteria of introducing BiPAP to patients with ALS.
Post-gastrectomy aspiration pneumonia (PGAP) is one type of aspiration pneumonia. Gastroesophageal reflux (GER) is thought to play an important role in the development of PGAP. Here, we report a case in which development of PGAP was prevented by an accurate diagnosis of GER. An 82-year-old male who had been treated for Parkinson's syndrome since 1995 was admitted to Hokkaido University Medical Hospital in August 2000 for evaluation of repeated pneumonia. The patient had undergone gastrectomy for the treatment of gastric cancer in 1999 and had also undergone a gastrojejunal anastomosis to correct a food-passing disturbance. Aspiration signs were not severe in a videofluorographic study for swallowing, and no indications of GER were noticed. However, scintigraphy showed repeated GER to the esophagus that occurred 16min after administration of an imaging drug. Based on these findings, a diagnosis of PGAP was made. The development of pneumonia was prevented by (1) prevention of the reflux of stomach contents into the pharynx or larynx by adjusting meal times and sleeping positions, (2) prescription of drugs to promote the rapid transfer of contents in the stomach to the small intestine, and (3) eating and swallowing training and maintenance of oral cavity hygiene.
The patient, a 34-year-old male, was admitted to our hospital for comprehensive rehabilitation 18 months after traumatic spinal cord injury. He was a complete C5 tetraplegia. Although he could drive a wheel chair using his right shoulder, his activity of daily living was severely restricted due to loss of pinch function. He could not switch from a spoon to a fork properly by himself at a meal, nor could he pick up a cup to drink water. He always needed a caregiver nearby him to provide care. Because of these embarrassments, he eagerly wanted to restore his pinch function. In the past, several orthoses have been developed for restoring the pinch function in spinal cord injury. However, these have not been widely used because of high cost and heavy weight. To overcome these difficulties, we developed a new electric flexor hinge splint using a commercially available motor, which is low cost and lightweight. He could use this orthosis easily and safely after relatively short training, and his activity of daily living was markedly improved with this orthosis.