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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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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Visiting education is provided for students with severe disabilities who are unable to commute to school. However, it is restricted to one-on-one interaction between student and teacher. This investigation was aimed at developing an information and communication technology (ICT) visiting education system where in-home students study together with in-school students and participate in schoolwide events as well as regional school interaction, and at clarifying the effectiveness of the ICT system and identifying problems for practical use. An elementary school child with severe motor and intellectual disabilities was recruited for this study. The ICT education system brought one-on-one visiting education closer to the one-to-many school education, extended the social participation environment for the in-home student, and contributed to his communication abilities. The in-home student also attended schoolwide events such as the closing exercise and graduation ceremony through the ICT system, and had opportunities to meet all students and teachers in the school while they were aware of him as one of their schoolmates. In addition, interaction with the special needs class in the regional primary school could play a useful role in promoting social participation in the community. The findings suggest that the ICT-based education system enhances the current visiting education and promotes participation in school and community.

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In this study, we aimed to confirm clinical effectiveness and safety of oral bisphosphonate (alendronate) for patients with severe motor and intellectual disabilities (SMID) associated with bone fragility. We treated five patients with SMID who had a past history of bone fracture with oral alendronate for 72 months. We reviewed the incidence of bone fracture during 72 months before and after starting oral alendronate treatment on each patient. Cross-linked N-telopeptide of type I collagen in urine (urinary NTX), bone specific alkaline phosphatase in serum (serum BAP), and bone mineral density (BMD) of lumbar vertebrae (L2-L4) as well as the left femoral neck were monitored as indicators to evaluate the effects for bone metabolism. The incidence of bone fracture decreased in some patients after starting oral alendronate treatment compared to before the treatment. We found no improvement on BMD of lumbar vertebrae and left femoral neck. However, urinary NTX was relatively decreased in 6 months after starting the treatment. We detected improvement of urinary NTX in all patients with the minimum significant change exceeding 27.3 %, while serum BAP did not change in the observation period. The treatment was discontinued in one patient because of adverse effect of renal dysfunction. Esophageal ulcer was successfully avoided by keeping the head elevated for a while after taking the drug in all patients over the period. In conclusion, we suggest that oral alendronate treatment could be effective for preventing bone fractures in patients with SMID.

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We examined the electrolyte data of 11 patients with severe motor and intellectual disabilities (SMID) in our hospital after their intake of ISOCAL® 1.0 Junior, which is a carnitine-supplemented, enteral-nutrition formula. All 11 cases developed decreased serum potassium levels (cases 1 to 5: 1.9 to 3.1 mmol/l; cases 6 to 11: 3.5 to 4.3 mmol/l) and decreased serum chloride levels (all cases: 90 to 103 mmol/l). None of the 11 cases had diarrhea or vomiting. Cases 1 to 3 were managed on a respirator. We found a significant difference in the height and body weight between cases 1 to 5 and cases 6 to 11. The potassium and chloride content of ISOCAL® 1.0 Junior is lower than that of other enteral-nutrition formulas. One week after we switched the enteral-nutrition formula to Mei Balance® 1.0, the serum potassium and chloride levels have been increased. Since patients with SMID easily develop metabolic alkalosis, we speculate that the intake of an enteral-nutrition formula with low levels of potassium and chloride might have caused the electrolyte abnormalities in our patients.

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The leading cause of death in patients with severe motor and intellectual disabilities (SMID) is respiratory infection. In particular, aspiration pneumonia, which is considered to develop due to oral bacteria, requires significant attention in patients with SMID who are likely to have difficulties in food-intake/swallowing. In this study, we investigated the method of nutrition intake and risk of aspiration pneumonia in these patients, according to the number of oral bacteria. The subjects included 47 patients with SMID and 30 healthy individuals (the control group : C). The patients with SMID were further divided into two groups according to the method of food-intake: 20 patients in the non-oral intake (NOI) group and 27 in the oral-intake (OI) group; the number of oral bacteria were compared between them according to presence/absence of past medical history of aspiration pneumonia. We also evaluated patients using the dysphagia severity scale (DSS). The results revealed that the number of bacteria was significantly larger in NOI group compared to OI group and C group, and the number of patients who had developed aspiration pneumonia in the past was largest in NOI group. Moreover, saliva aspiration occurred in 65% of the patients in the NOI group, presenting severe food-intake/swallowing difficulties according to DSS. Hence, it was suggested that the risk of aspiration pneumonia is high in patients with SMID who take nutrition via non-oral routes.

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In patients with cerebral palsy of perinatal onset admitted to a ward designated for long-term care after 18 years of age, we made retrospective comparisons on following two aspects, (1) passive range of motion (abduction, adduction and flexion) and (2) acetabular head index (AHI), for their hip joints at two particular assessment points. The subjects included 4 inpatients and one outpatient at level 5 in the gross motor function classification system (GMFCS), aged between 20 and 24 years old. In order to equalize the degree of symptoms, we selected patients with normal/subluxated hip or mild hip dislocation on X-ray. Abduction was within a normal range at the first assessment point in one patient, while in others it had been restricted. Of these, one of the patients showed improvement in the angle of restriction in one hip joint at the second assessment point. The angle had been increased in two joints with flexion, suggesting improvement, and in 6 joints with adduction. The increase in the angle of adduction can cause restriction in abduction. Hence, we regarded this as a sign of aggravation. For AHI, we observed 10 hip joints of 5 patients. It was within the normal range at the first assessment point in 6 joints, and subluxation was detected in 4 joints. The values increased in 8 joints in patients who received the second assessment, and AHI was considered improved in one joint. A t-test was performed for the difference in mean values obtained at two assessment points, and no significant difference was observed. For AHI, normal value was obtained in 6 out of 8 joints (75%) at the second assessment, while for the angle of abduction, only 2 out of 10 joints (20%) were normal, showing that there was a remarkable difference. These findings suggest that, although disability had been almost fixed before puberty in cerebral palsy patients, their conditions can be either progressed or improved in adolescence; the symptoms are not fixed but rather unstable. We confirmed that we could prevent progression of symptoms and maintain the patients’ QOL by trying available approaches and continuing long-term care including physiotherapy even after adolescence.

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ADL is generally low in children with severe motor and intellectual disabilities (SMID), and gastrointestinal problems such as constipation due to bedridden are likely to occur. There are also chronic breathing problems and the potential risk of gastroesophageal reflux is high. There is also a high risk of diarrhea due to the use of laxative for the purpose of improving constipation. In this issue, we also introduced a bag type semi-solidified nutrient and a variable viscosity type liquid meal (hereinafter referred to as “H. E”) introduction of products considering hygiene and work reduction. Two types of bag-type semi-solidified nutrient nutrients (E and M) and one type of “HE” products “H.E” were added to six patients with SMID (four men and two women, 28 to 49 years old) was introduced. Although E and M could not be successfully injected with a narrow diameter of 8 to 10 Fr, when “H.E” was introduced, no exacerbation of the symptoms accompanying gastroesophageal reflux was observed and 5 patients used a medicine such as laxative etc. The amount also improved. Introduction of “H.E” was beneficial for improving digestive symptoms of patients under tube and nutrition management as well as hygiene.

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