Inaugural Address of President

President, Japanese Association of Rehabilitation Medicine
Professor, Kyoto Prefectural University of Medicine
Toshikazu Kubo

I was selected as the new President of the Japanese Association of Rehabilitation Medicine (JARM) at the JARM board meeting on June 8, 2016.

The Ministry of Health, Labour and Welfare published a White Paper in 1960 that proposed the necessity of rehabilitation medicine. Based on this proposal, the JARM was established in 1963 as a joint venture between the orthopedic and internal medicine fields. After starting as a private organization, the JARM was approved as an incorporated association in 1989 and as a public interest incorporated association in 2012. The JARM marked its 50th anniversary in 2013, and currently has more than a half-century of history.

Dr. Kenji Takagi, who became Professor of Orthopedics at the University of Tokyo in 1924, proposed the philosophy of “Ryoiku” (the word was a neologism combining the characters for "treatment" and "education"). This is the origin of rehabilitation medicine in Japan. The main patients in the early days of rehabilitation medicine were those with pediatric diseases, including polio and cerebral palsy. Later, patients with extremity amputation due to war, occupational accidents, and fracture and spinal cord injury due to traffic accidents required rehabilitation medicine. The rapid aging of society has added cerebral infarction and osteoarthritis to the field. Thus, patients who have benefitted from rehabilitation medicine have included children to the elderly as the times have changed.

Aging of society combined with fewer children has complicated disease structures. Diseases and disorders that are currently treated by rehabilitation medicine are diverse, and include motor disorder, cerebrovascular disorder, cardiovascular and respiratory disorder, eating/swallowing disorder, pediatric disease, and cancer. Furthermore, the unhealthy lifespan has increased and quality rehabilitation is also needed at home, as well as in hospitals and care facilities. The public now expects effective rehabilitation medicine.

Prosthesis fitting, pharmacotherapy, physical stimulation therapy and nutritional control are important in rehabilitation medicine, in addition to training. Rehabilitation doctors treat patients with a combination of these therapies, and support patients to make a positive effort to perform movements for improvement of activities of daily living (ADL). Successful treatment requires rehabilitation team, in which physical therapists, occupational therapists, speech-language-hearing therapists, nurses, orthopedists, pharmacists, registered dietitians, and clinical social workers all play important roles. Rehabilitation doctors have a great responsibility as the team leader. Many elderly patients have diseases and disorders of multiple organs, and rehabilitation doctors must understand the pathology of these diseases and disorders in order to provide safe and effective rehabilitation medicine. Therefore, interprofessional liaison with specialists in other fields is an important role of rehabilitation doctors.

Internationalization is also necessary for improvement of rehabilitation medicine. The JARM has started publication of a journal in English (Progress in Rehabilitation Medicine) this year, and the 2019 World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM) will be held in Japan. The 2019 congress will increase international contribution in academic and clinical fields. Support of contribution for young physicians is also important, since this activity provides the latest information from other countries and allows successful outcomes in Japan to be presented globally.

Therapy providing optimal outcomes is required as rehabilitation medicine becomes more important. There is a need for accumulation of evidence to validate the usefulness of therapies, including conventional approaches. Robots, electric and magnetic biophysical stimulation, and state-of-the-art devices including brain-machine interface (BMI) systems are also being studied, indicating the importance of coordination with the medical engineering field and industry-university collaboration. The JARM has the responsibility of validating conventional therapies and promoting development of state-of-the-art devices to improve patient QOL.

Human resource development is the highest priority of the JARM. There are an insufficient number of rehabilitation doctors in Japan, and an increased demand for rehabilitation medicine. In a survey by the Ministry of Health, Labour and Welfare in 2010, the required number of rehabilitation doctors was higher than the current number, which is a greater shortage than that for doctors in other fields. For development of rehabilitation doctors, it is important to enhance medical education and establish courses in rehabilitation medicine in medical schools across the country. There is also a need to train highly qualified rehabilitation doctors through development of systematic educational programs. In this context, a greater educational role for Rehabilitation Medicine, the 53-volume JARM journal, is important.

Diversity management, a process to activate systems with diversity, is currently of interest. Rehabilitation medicine includes diversity management because it deals with various diseases and disorders, and requires cooperation among many departments and doctors. These characteristics provide energy, and diversity enables pleiotropic social contributions. These include promotion of sports for the disabled and establishment of an inclusive society in which people have a fulfilling life regardless of disability.

The JARM has many issues to resolve, given the current focus on rehabilitation medicine. I will do my best to address these issues, and I will depend on the support and advice of JARM members and all other people involved. This support and advice will be greatly appreciated.

June 2016