Kayo Terada
Ishikawa Prefecture Rehabilitation Center

1. Overview of the Center

The Ishikawa Prefecture Rehabilitation Center (henceforth referred to as the Center) was established in 1994. In 1996, the Center, in collaboration with the Prefecture Industrial Testing Center and the Prefecture Civil Engineering and Architecture/Housing Division, established the Barrier-Free Promotion Workshop, an interdisciplinary organization for medical and engineering cooperation. The Center supports independence for individuals with disabilities by adapting and improving welfare equipment and environments while providing research and development support for welfare equipment and universal design products to companies. They also provide technical support for making public facilities barrier-free. In addition, in 2003, they initiated the Prefecture Rehabilitation Support Project, followed by the Intractable Disease Consultation and Support Center Project in 2006, and the Higher Brain Dysfunction Consultation and Support Center Project in 2007. As a specialized consultation and support organization in the prefecture, the Center provides services such as assistance with the daily life, education, and employment of individuals with disabilities and intractable diseases.

2. Life Support Using Assistive Technology (AT Support: Assistive Technology)

Assistive technology tailored to individual physical capabilities and living environments is indispensable for people with disabilities. To effectively utilize these tools, it is essential to provide support that respects the lifestyle desired by the individuals, promotes safety, and encourages independent living and social participation. Support should consider the individual’s abilities, living environment, family composition, and economic situation while proposing a clear plan that allows them to envision the lifestyle they desire and make choices for their future. Especially for individuals with disabilities or intractable diseases who have communication difficulties and need ICT, exploring specific communication methods can help them realize their capabilities, leading to an improvement in their quality of life. The Center aims to make such support available in all regions of the prefecture by collaborating with municipal councils for self-support and raising awareness among consultation support specialists for individuals with disabilities and care support specialists. Additionally, they offer training programs for professionals in rehabilitation (referred to as rehab specialists), welfare equipment consultation experts, and assistive device businesses, with the goal of cultivating a skilled workforce that can provide accurate AT support.

As a core institution for providing AT support in the prefecture, the Center receives requests for assistance from municipalities, consultation support organizations, medical institutions, educational institutions, and others. The number of support requests in the past three years by the source of the request is shown in Table 1. Furthermore, the Center has observed an increasing trend in consultation support, particularly for individuals with severe disabilities and high medical dependency in municipalities, and for individuals with progressive conditions such as neuromuscular diseases. Many of these individuals have communication disabilities, and the support for ICT, as indicated in Table 2, has also been on the rise.

Table 1: Performance of the Rehabilitation Regional Activity Support Project (Last 3 years)

Requesting Organization	R2	R3	R4
Medical Institutions	326	131	214
Facilities Related to the Comprehensive Support Act for Persons with Disabilities (Disability Facilities, etc.)	227	102	127
Educational Institutions (Special Needs Schools, Special Needs Classes, etc.)	155	160	169
Long-Term Care Insurance Act Related Facilities	49	140	100
Home-Visit Rehabilitation Service Providers	202	252	298
Health and Welfare Centers	13	4	14
Disability Consultation and Support Service Providers	277	183	143
Cities and Towns	56	11	3
Prefectural Intractable Disease Consultation and Support Centers	116	105	94
Prefectural Higher Brain Dysfunction Disease Consultation and Support Centers	146	196	198
Occupational Facilities	1	6	1
Other (Individuals, Families, Businesses, etc.)	153	85	123
Total	1721	1375	1484

Table 2: Assistive Devices Support Cases for last 3 years

						R2	R3	R4
	Total Consultation and Support Cases					1721	1375	1484
		Welfare Equipment and Assistive Devices Support Cases				1078	870	913
					Assistive Device Consultation Support Cases	906	682	739
					Prosthetic Devices	44	32	20
					Seating Support Devices	145	85	84
					Wheelchairs	329	177	152
					Electric Wheelchairs	294	252	251
					Severe Communication Assistive Devices (ICT)	94	136	232

3. Processes and Initiatives Required for ICT Support

Against this backdrop, starting from the fiscal year 2021, the Center has been expanding communication support within the prefecture. To achieve this, the Center is working on enhancing its equipment with the latest devices, various input devices, and fixtures, and has even created a list for loaning equipment for training purposes. The Center is also working towards expanding the number of hospitals and rehabilitation facilities capable of providing support. The flow of support for individuals with communication impairments involves the following steps: a request for consultation is received (awareness), ① evaluation of the individual’s physical characteristics and environment, ② clarification of the intended activities (organizing needs), ③ consideration of trial usage, ④ equipment training, ⑤ in cases where a prosthetic device application is required, an assessment by a rehabilitation counseling office is conducted, and ⑥ follow-ups, etc.. Initially, when individuals in need of support are identified by their close associates, it leads to consultations, and steps ① to ③ are carried out at the Center. Steps ④ to ⑥ are connected to regional rehabilitation professionals, welfare equipment consultants, and so on. In cases where individuals in need of support have close support personnel such as rehabilitation professionals, only the lending of trial equipment is sometimes necessary. Furthermore, in recent years, due to the advancements in ICT, various devices with multiple functionalities have emerged. Thus, it has become essential to provide information dissemination and skill improvement for support personnel. In addition, this field is challenging in terms of compatibility with main devices, input devices, fixtures, and more. Many people have reservations, however, so efforts are being made to establish networks to ensure that as many rehabilitation professionals and welfare equipment consultants as possible can provide support in each region.

In the fiscal year 2022, the Center provided ICT support for 226 cases to 35 individuals. The 35 patients included 14 with Amyotrophic Lateral Sclerosis (ALS), 6 with cerebrovascular diseases, 5 with cerebral palsy, 3 with multisystem atrophy, 2 with spinal muscular atrophy, and 5 with other impairments. The ICT ultimately used by the individuals included Severe Disability Communication Devices as assistive devices, with 7 individuals using auto-scan and eye-tracking input methods. Two individuals used biological phenomenon methods. Additionally, 11 individuals acquired communication using other ICT, 6 are still under consideration, and 8 individuals used alternative means such as dial pads or call bells as ICT usage was difficult despite progressing with trial usage. Unfortunately, there was also one person with ALS whose disease progressed quickly and died during the support process. Among the challenges encountered in these initiatives are ① the time required for analyzing the communication methods needed by the individuals, ② the time needed for selecting ICT based on the individual’s goals and physical characteristics, ③ the need for cooperative organizations in the individuals’ local areas, ④ the need for engineering professionals and cooperative companies capable of configuring, adjusting, and maintaining the equipment to facilitate the introduction and ongoing use of ICT, ⑤ the need for greater awareness of ICT support for individuals in need, and ⑥ the need for measures to ensure that ICT introduced for home use can also be used in respite care and short-term stay facilities.

4. Conclusion

In order to provide ICT from the perspective of fostering communication independence in the lives of the target individuals, it is crucial to understand and apply the necessary communication within the context of overall life management. The goal should not be merely introducing devices but rather taking an approach that supports the individual’s communication disabilities. Furthermore, as there are often cases where the usage, operation guidance, and device adjustments for ICT are not in place, it is essential to conduct trial evaluations and device training to connect these experiences to effective support for independence rather than leaving the individuals with negative experiences. To address these issues, we believe that the enhancement of social rehabilitation within the community is vital.

Edited and pablished by the Japanese Society for Rehabilitation of Persons with Disabilities. Published on June 25th, 2023.