[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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The daycare service system, a daycare program for patients with severe motor and intellectual disabilities (SMID), was established in Japan over 20 years ago. There are more than 300 daycare service institutions, and about 6,000 patients with SMID now use this system. However, it is uncertain whether there are an adequate number of institutions in Japan. This study examined the distribution of institutions in Hyogo Prefecture, as an investigation on a nationwide scale was unfeasible. There are six institutions in the capital city of Kobe and six institutions elsewhere in the prefecture. There is no accepted standard for the proper distribution of institutions in a city. In Kobe, the number of institutions has increased according to demand. Using the situation in Kobe as a benchmark, this research concluded that eight additional institutions are needed in Hyogo Prefecture outside the city of Kobe to enable all individuals with SMID to use the daycare service system with ease and safety.

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The present study aimed to examine toileting and eating in activities of daily living of patients admitted to Japanese public and private institutions for children with severe motor and intellectual disabilities (SMID) from 1988 to 2009. A survey of 12 items of body functions, activities and environmental factors associated with toileting and eating was conducted. The proportion of patients with severe impairments of urination and defecation and that of patients with the unspecified impairment were 30% and 50%, respectively. Approximately 80% of the patients had complete difficulty in understanding urination and defecation issues. This appeared to be caused by impairments of urination and defecation functions, as well as by limitations of communication-producing. Therefore, most of the patients needed intensive support for toileting. Ingestion functions, such as sucking, chewing and swallowing were impaired in 50%, 75% and 60% of the patients, respectively. The proportion of the patients who could not eat by themselves was approximately 70%, and 25% were able to ingest a meal with a spoon. Some extent of support for eating was provided to most of the patients, including full support to 75% of the patients. Different types of meals, such as liquid, hashed, gruel and usual meals were appropriately served according to the patient's ingestion impairments. These results indicate the presence of severe impairments and activity limitations of toileting and eating in these patients, as well as severe motor and intellectual disabilities.

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The aim of this study was to determine how mothers who decided to have their homebound patients with severe motor and intellectual disability (SMID) undergo a medical procedure (i.e., creation of a tracheostomy or gastrostomy and starting of mechanical ventilation) evaluated their decision. A qualitative and inductive analysis was conducted by interviewing 12 mothers whose child with SMID was visiting a facility for disabled patients or a home nursing station and had undergone a medical procedure at least one year prior to the study. It was found that although mothers interpreted their decision to have their child undergo a medical procedure as “good,” their confidence in their decision was shaken when they were confronted with their children's reaction and changes to their condition after the medical procedure. In addition, some mothers interpreted their decision positively because they were able to experience their child persevering. The above results suggest that when evaluating their decision to have their child undergo a medical procedure, mothers need the assistance of a health care provider who has a constant understanding of their children's progress.

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The aim of this study was to determine what kind of assistance mothers would like from health care professionals when deciding to have their homebound patients with severe motor and intellectual disability (SMID) undergo a medical procedure (i.e., creation of a tracheostomy or gastrostomy and starting of mechanical ventilation). A focus group interview was conducted with six mothers of patients with SMID who had previously decided to have their child undergo a medical procedure or were currently planning for their child to have such a procedure. It was found that when making their decision, mothers needed “to be provided with a person they could consult or a place to go for consultation.” They suggested a home health nurse, a peer supporter, or a doctor with a second opinion as people who could support their decision, and want their health care providers to assist them in this effort. They also wanted a study session about the medical procedure to be held for them and the rest of their family.

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Herein, we describe a patient with severe motor and intellectual disabilities (SMID) having ceftriaxone-induced biliary pseudolithiasis. In the gallbladder, ceftriaxone is known to induce the production of precipitates that mimic a gallstone on sonograms. The term “pseudolithiasis” is used to denote a reversible condition that takes several days to disappear. Ceftriaxone-associated pseudolithiasis is a benign condition usually without clinical signs. However, we report a patient with SMID who showed gallstone attack-like symptoms and pseudolithiasis that lasted for 4 months after the last administration of ceftriaxone. To our knowledge, no previous report has described a patient with SMID having ceftriaxone-induced pseudolithiasis. In the present patient, the insufficient secretion of gastrointestinal hormones and impaired sensitivity of the gallbladder to gastrointestinal hormones and neuronal systems probably caused the failure of gallbladder contractions. Although pseudolithiasis rarely causes clinical symptoms, the administration of ceftriaxone should be carefully monitored in patients with SMID.

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Foreign bodies in the airways can cause recurrent pneumonia or atelectasis and may even be fatal. Early diagnosis and removal is thus preferable. We hereby report on two cases of foreign bodies in the airways. In the first case, pneumonia led to the discovery of dental calculus aspiration in the left main bronchus. Removal by bronchoscope was attempted, but the dental calculus could not be removed as it crumbled during the procedure and moved into the peripheral bronchus. Further pneumonia recurrence was prevented by administration of antibiotics. To our knowledge, there has been only one report of dental calculus aspiration to date. Insufficient oral care can degrade oral flora and consequently increase the risk of aspiration pneumonia. As seen in the present case, it can also raise the risk of dental calculus aspiration. In the second case, a tracheal tube used in a permanent tracheostoma fell out in the trachea. It was expelled about 4 months later by coughing, but presented no symptoms while displaced. The reason for the lack of symptoms may be that the lumen structure of the tracheal tube did not obstruct the airways.

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An upper gastrointestinal (GI) endoscopy was performed on three mobile patients with severe motor and intellectual disabilities (SMID) long thought to have rumination syndrome. A 36-year-old woman presented with upper GI tract bleeding symptoms. Reflux laryngitis, esophageal hiatus hernia, and reflux esophagitis were confirmed, and proton pump inhibitors (PPIs) were administered. A 43-year-old man showed symptoms of upper GI tract bleeding. Reflux esophagitis was confirmed and PPIs were administered. A 26-year-old man showed only rumination symptoms, but was suspected of having an esophageal hiatus hernia. Although these three patients were long thought to have rumination syndrome, endoscopy revealed mechanical problems, likely resulting from gastroesophageal reflux. As about 6-10% of patients with SMID have rumination syndrome, it is certainly a problem behavior that is not infrequent. However, such patients may have latent mechanical problems that are the actual cause of the symptoms, and should be actively given GI endoscopy or other tests to confirm the cause of the symptoms and enable appropriate response.

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Chronic pancreatitis is a progressive inflammatory disorder in which the pancreatic secretory parenchyma is destroyed and replaced by fibrous tissue, which eventually leads to malnutrition, and pancreatic exocrine and endocrine dysfunction. On the other hand, patients with severe motor and intellectual disabilities (SMID) have the complication of a high incidence of epilepsy, most of them having intractable epilepsy. We have reported chronic pancreatitis with the complication of marked pancreatic calcification in an epileptic patient with SMID, who had exhibited cerebral palsy and undergone gastrostomy feeding due to difficulty in swallowing. Clinically, he had no remarkable digestive symptoms and the laboratory findings indicated maintenance of pancreatic functions in the normal ranges. The two main types of chronic pancreatitis are basically regarded as being alcoholic and non-alcoholic. Furthermore, as causative factors of drug-induced pancreatitis, valproic acid, phenacitin, thiazide, oestrogen, and azathioprine are known. In the present case, the treatment with multidrug therapy, including valproic acid for intractable epilepsy was performed, and the causative factor for the chronic pancreatitis was strongly suggested to be drugs. Therefore, in intractable epileptic patients with SMID, great care should be taken regarding chronic pancreatitis such as in this case.

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A gaze input communication device was used to observe the gaze movements of patients with severe motor and intellectual disabilities (SMID), and the usefulness of the device for assessing vision was examined. While each patient exhibited distinctive gaze movements, the gaze movements of all subjects could be observed on the device screen. This suggests that gaze input communication devices may be useful for assessing the visual perception of patients with SMID.

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A patient with MD-SMID (medically dependent-SMID) and weak movement attending a school for special needs education ( “A,” 6 years and 10 months old) was given communication support consisting of measures (1) and (2) below. (1) Make efforts to center class activities around activities thought to be preferred by A and develop activities according to A's intentions. (2) Carefully repeat a sequence of actions referred to as the PICDC cycle (1. Pick up a physical movement exhibited by A (pick up); 2. Interpret the meaning of that movement (interpret); 3. Taking A's visual impairment into account, confirm by touching the area of the body picked up (confirm); 4. Develop activities that fit the interpretation (develop); and 5. Check the appropriateness of the interpretation from A's reaction to the activity development (check)). As a result, A's physical movement became more active and expression of intentions was enhanced, leading to the start of communication. Based on these results, we offer a discussion of the ideal form of classes aimed at supporting communication in patients with MD-SMID.

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[in Japanese]

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