Japan has an area of 380,000 km2. Comparatively it is about half as much again as the United Kingdom, but with a population is 130 million (i. e., twice that of the UK). Japan is divided into 46 prefectures. One big national rehabilitation center is situated in Tokyo and each prefecture has several rehabilitation centers. Also, each district has smaller rehabilitation facilities.
Japan has a national medical insurance system that everybody has to enter and most rehabilitation is covered by the national insurance system. Almost all rehabilitation is defined by the insurance system. This includes pediatric rehabilitation.
With respect to pediatric rehabilitation, the main targets are developmental disabilities. Hospitals and rehabilitation facilities are connected and children with disabilities go to special kindergartens for under 6-year-old children. After school age, there are special schools. Special education programs for developmental disabilities are almost complete, but there is no program for acquired brain injury (ABI).
We do not have a systematized rehabilitation program for children with ABI in Japan at the moment. For adults, the national model system for higher brain dysfunction began in 12 model centers from 2001. Because of this system, a rehabilitation program for ABI only for adults has been put in place. Two of these 12 centers began to provide rehabilitation programs for children in parallel with the adult model system. My role in one of these two centers is as a pediatric neurologist and also a pediatric rehabilitation doctor. Our center has two hospitals with 700 beds and four social welfare facilities, which are equipped with the latest innovations in science and technology. We also have a rehabilitation research and training institute, and a nursing school. The center, therefore, plays a leading role in offering advanced medical and welfare services to the handicapped population in Kanagawa prefecture.
We have 15 beds for ABI children in our in-patient ward. Most children are transferred from acute hospitals and are rehabilitated through our clinical-pass program for three months. We use the team approach method. Teachers play an important part in re-entrance to schools. During the third month in hospital the children were rehabilitated through a transitional program, in which they visit schools several times. They come to be checked up every 2 to 3 months after discharge. I am looking after about 80 ABI children (i. e., 50 TBI ones, 20 cerebro-vascular accident ones and others), in my follow up clinic.
There are good special education programs for mental retardation, physical disabilities, pervasive developmental disabilities, attention deficit hyperactivity disorders, and severe motor and intellectual disabilities. But we do not have special programs for ABI. ABI is not categorized as a special disability in Japan.
The traumatic brain injury data bank was put into operation in 1998, although the data are corrected after the age of 4 years old. This means we do not have statistical data for infants. One of the reasons why we do not have statistical data or a rehabilitation system for ABI is that the numbers are not so high, for example fatalities from traffic accidents, which is most common etiology of traumatic brain injury (TBI) in Japan, number under 6000 every year.
The etiology of ABI during childhood in Japan might be slightly different from that in Europe and North America. The most frequent etiology is acute encephalitis/encephalopathy, such as influenza encephalopathy, which is specific to east Asia. The next most common etiology is TBI.
The main differences between ABI and developmental disabilities as to rehabilitation seem to be the "process to accept the disabilities" and the "approach to higher brain dysfunction". Regarding former, we have started a family support center with the parties concerned in our hospital, which has become important for the families. As to the latter, we began to research how to evaluate, and how to make/carry out/continue the program for re-entrance to schools. We began a special project "to make an ABI program for Japanese children". I visited nine rehabilitation centers/hospitals/schools and attended an ABI conference in North America last year. I think the rehabilitation system for ABI children in our center is very similar to that in North America. One marked difference is that we have only two such centers in Japan. Fortunately we have many rehabilitation facilities for developmentally disabled children. So I am trying to spread our program to every such center.