Objective：The Nagasaki Prefectural Centre of Medicine and Welfare for Children was established in 1954 as a center for children with physical disabilities in Nagasaki prefecture. Medical education consultation in the local area of Nagasaki prefecture was started in the following year.

Methods：We examined the number of patients and the area selected for this project over the recent 36 years. Documents from the center's library were examined, and orthopedic physicians who had previously participated in the project were interviewed.

Results：The number of patients and visiting areas in the project continuously decreased. This patient tendency was caused by the declining birth rate in Japan and the satisfaction from human services in local areas. The decrease in the number of local areas visited was affected by the financial administration of our center and the development of a traffic network in the mainland of Nagasaki prefecture. Health visitors now working in the island continue to require visits to pediatric specialists from the mainland twice a year. The number of visits to four selected isolated islands has been maintained till date.

Conclusion：Medical support from the mainland is necessary for isolated islands because of the absence of physicians, especially those for children with physical disabilities, and visiting the hospital in the mainland by airplane is difficult for these children.

Introduction：Respiratory failures are categorized into types I and II. To our knowledge, we report the first case of pulmonary rehabilitation in a patient with systemic sclerosis/polymyositis overlap syndrome who developed type II respiratory failure.

Methods：The patient was a 77-year-old woman who had received treatment for systemic sclerosis and polymyositis at another hospital. When she visited our hospital to obtain a second opinion, she suddenly lost consciousness and underwent trachea intubation because of typeⅡrespiratory failure. She received physical therapy on the third day of hospitalization and underwent a tracheotomy on the 16th day. As her thoracic movement was markedly restricted, we started physical training. After she was weaned off from the ventilator on the 43rd day, we performed muscular strength training and aerobic exercise. No exacerbation of CO₂ storage was observed even if chest motion training was performed. She was discharged on the 72nd day and advised to wear retina^®．Administration of therapeutic drugs such as steroids was maintained at the same dose.

Conclusion：Physical therapy, such as chest mobilization, was effective for marked restriction of chest movement in a patient who had both polymyositis and systemic sclerosis.