Japanese Journal of Severe Motor and Intellectual Disabilities

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The present study examined the interannual trend in the sex and age of patients admitted to Japanese public and private institutions for patients with severe motor and intellectual disabilities (SMID) from 1979 to 2013. The patients were categorized into three groups: newly admitted, retired, and all residing patients (including newly admitted and existing patients). The proportion of male and female patients among both newly admitted and retired patients remained almost constant throughout the 35 years of the survey (approximately 55% and 45%, respectively). The gender proportion among all residing patients was equivalent in 1979 (i.e., 50%), and this was followed by a progressive increase in the proportion of male patients to 54% throughout the 35 years. The sex trend seemed to be influenced by the proportion of males and female patients among newly admitted patients. The median of age of all residing patients gradually increased from 16 years in 1979 to 38 years in 2013 with a 6.5-year increase per decade. The retired patients demonstrated an age trend similar to that demonstrated by all residing patients. The age of newly admitted patients increased from 12 years in 1979 to 25 years in 2013, with a 3.8-year increase per decade. This age trend is considered to have occurred because of the aging of the existing patients (excluding newly admitted and retired patients) at a rate of 10 years per decade, as well as the new admission of younger patients.

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We conducted a survey of doctors in 64 national hospital organizations with wards for patients with severe motor and intellectual disabilities (SMID). There were 301 attending physicians for patients with SMID and 211 dedicated doctors, of which 155 (73.5%) were pediatricians. There were 0 to 10 dedicated doctors (mean: one) per institution, and four institutions did not have a dedicated doctor. There were 0 to 9 dedicated pediatricians (mean: two) per institution, and four institutions did not have a pediatrician. Breaking institutions into rural and urban location for analysis revealed that 43 of the 64 institutions were in rural areas, and all institutions without a dedicated doctor and all except one without a pediatrician were in rural areas. While the doctor shortage problem was more prominent in rural institutions, disparities existed among institutions in both rural and urban areas. As symptoms become more severe among both long-term and short-term residents, procurement of doctors is becoming an even more critical challenge for ensuring medical care safety and quality.

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We investigated the impact of morning activities conducted at our institution on the alertness of subjects who had been sleeping throughout the morning and examined the relationship between changes in alertness and subject characteristics. Subjects were individuals with low levels of morning alertness who tended to be in lower stages of motor function and psychological development. Subjects included those who became alert while changing postural position before starting morning activities and those who were encouraged to become alert by performing morning activities. This difference appeared to be related to differences in such factors as severity of epileptic seizures and acceptance of sensory stimulation.

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