Folia Psychiatrica et Neurologica Japonica, Vol. 33, No. 3, 1979
On Rehabilitation in Epilepsy Yutaka Fukushima, M.D. Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki
Since the last century, welfare work for people with epilepsy has been developing in European countries and America and, nowadays, there is a number of epilepsy centers to promote activity in the fight against epilepsy not only nationally but also internationally. Of course, comprehensive care is necessary for the patients; namely, they must be helped medically, psychologically and socially. Accordingly, the necessity of rehabilitation (in other words, socialization) of epileptic patients is being stressed. However, we have as yet no special facilities for rehabilitation of epilepsy at this point in Japan, although a national epilepsy center was established in Shizuoka several years ago. The present situation does not mean that there is no need for rehabilitation in Japan, and many people have asked for the establishment of facilities for rehabilitation of the patients, as seen in the monthly “Nami”issued by the Japanese Bureau for Epilepsy. The author reported on occupational problems in epilepsy at the 11th annual meeting of the Japanese League against Epilepsy (1977); of 136 male outpatients aged from 18 to 65, 65% (88 cases) had regular occupations, but the others were either unemployed or not regularly employed. Their occupational conditions were poor, particularly among the so-called multiply handicapped patients who suffered mental and/or physical disorders, as well as epilepsy. It was also emphasized in this Received for publication June 25, 1979.
report that a close relationship existed between education and occupation: the patients with only compulsory education tended to work under worse conditions and to change their work more often than those with higher education. The results of the study distinctly indicate that some social measures must be urgently taken for the welfare of epileptic patients in Japan. The patients who request rehabilitative aid may be divided generally into two groups: 1) patients so handicapped that they are not able to manage their life by themselves, 2) patients who have capability more or less to work in their community but cannot well adjust themselves to it. Correspondingly, at least, two types of rehabilitative facilities are required for them; 1) long-stay institution, in which the patients live and make their own community and, besides, in which conveniences are prepared, to activate them physically and mentally: workshops, gymnasiums, gardens and so on, 2) rehabilitation workshops, to socialize and to return them to society. This workshop will be utilized by the patients from a short-stay hospital, from hostels or from their homes. Of course, special facilities for rehabilitation are not necessary for all of people with epilepsy. Because, as seen in the author’s report, many of the patients are able to keep their occupation, even if they have attacks and/or other handicaps, some trouble may sometimes occur. Rehabilitation is necessary only for disabled patients who have difficulty in adapting
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themselves to their community. I would like to report here on two different types of the rehabilitation facilities in Europe, which I recently visited: “Instituut voor Epilepsiebestrijding” in Holland and “Seaborn industries” in Scotland. The famous epilepsy center “Instituut voor bpilepsiebestrijding (institute fot the fight against epilepsy)” consists of two institutions, “Meer en Bosch” and “De Cruquiushoeve.” The former is a short-stay hospital in which observation, treatment and rehabilitation are performed for “fresh” patients, and the latter is a long-stay institution or colony where long-term care and treatment are provided for the severely handicapped. At both facilities of the “Instituut,” a team of experts plan the treatment, as a whole. As to their rehabilitation activities, the sheltered workshop at “Meer en Bosch” has advanced equipment .in a modern building and provides a variety of work for the patients such as assembly work, machine-operating, packing, storehouse keeping, clerical work, and so on. The workshop can accommodate 160 patients and about a half of them are outpatients. In the workshop, occupational therapists work in close cooperation with other specialists: doctors, psychologists, social workers. The main objective is to enable the patients to take their place again in their community-asbsom as pnerible. _,_. At ’‘De Cruquiushoeve,” where about 550 patients live separately in a number of pavilions, a large sheltered workshop is provided .mainly for occupational therapy of multiply handicapped patients. Of course, 8 c
experts of each department keep in contact with the workshop. At “De Cruquiushoeve,” children with epilepsy also live and are treated and, besides, are educated at a school located close to their wards. As the author has already suggested, education is particularly important for the future of’these children. In Scotland, there is a unique sheltered workshop for epileptic patients in Glasgow, which was provided by the Scottish Epilepsy Association; it is called “Sea (an acronym of the association)-born industries.” The industries have no spcial contact with any clinics or hospitals and are managed by personnel, including social workers, of the association, .On the other hand, they maintain close cooperation with the official Department of Employment. The purpose of the industries is to assist the patients in obtaining regular employment. According to the report from the Department of Community Medicine of Glasgow University (1978), from 1957 to 1977, 325 male and female patients were received by the industries. Their ages ranged between 17 and 57 years old. All of the patients had seizures and most of them had no career of employment. Surprisingly, out of them, 3 10 obtained regular employment in open industries, after the training at Seaborn. The report emphasized that the aims of the workshop are not only to obtain regular employment for the patients but also to improve their health; physically and mentally, to give them selfconfidence, to socialize them and to reduce the number of seizures.
On Rehabilitation in Epilepsy Yutaka Fukushima, M.D. Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki
Since the last century, welfare work for people with epilepsy has been developing in European countries and America and, nowadays, there is a number of epilepsy centers to promote activity in the fight against epilepsy not only nationally but also internationally. Of course, comprehensive care is necessary for the patients; namely, they must be helped medically, psychologically and socially. Accordingly, the necessity of rehabilitation (in other words, socialization) of epileptic patients is being stressed. However, we have as yet no special facilities for rehabilitation of epilepsy at this point in Japan, although a national epilepsy center was established in Shizuoka several years ago. The present situation does not mean that there is no need for rehabilitation in Japan, and many people have asked for the establishment of facilities for rehabilitation of the patients, as seen in the monthly “Nami”issued by the Japanese Bureau for Epilepsy. The author reported on occupational problems in epilepsy at the 11th annual meeting of the Japanese League against Epilepsy (1977); of 136 male outpatients aged from 18 to 65, 65% (88 cases) had regular occupations, but the others were either unemployed or not regularly employed. Their occupational conditions were poor, particularly among the so-called multiply handicapped patients who suffered mental and/or physical disorders, as well as epilepsy. It was also emphasized in this Received for publication June 25, 1979.
report that a close relationship existed between education and occupation: the patients with only compulsory education tended to work under worse conditions and to change their work more often than those with higher education. The results of the study distinctly indicate that some social measures must be urgently taken for the welfare of epileptic patients in Japan. The patients who request rehabilitative aid may be divided generally into two groups: 1) patients so handicapped that they are not able to manage their life by themselves, 2) patients who have capability more or less to work in their community but cannot well adjust themselves to it. Correspondingly, at least, two types of rehabilitative facilities are required for them; 1) long-stay institution, in which the patients live and make their own community and, besides, in which conveniences are prepared, to activate them physically and mentally: workshops, gymnasiums, gardens and so on, 2) rehabilitation workshops, to socialize and to return them to society. This workshop will be utilized by the patients from a short-stay hospital, from hostels or from their homes. Of course, special facilities for rehabilitation are not necessary for all of people with epilepsy. Because, as seen in the author’s report, many of the patients are able to keep their occupation, even if they have attacks and/or other handicaps, some trouble may sometimes occur. Rehabilitation is necessary only for disabled patients who have difficulty in adapting
422
Y . Fukushlma
themselves to their community. I would like to report here on two different types of the rehabilitation facilities in Europe, which I recently visited: “Instituut voor Epilepsiebestrijding” in Holland and “Seaborn industries” in Scotland. The famous epilepsy center “Instituut voor bpilepsiebestrijding (institute fot the fight against epilepsy)” consists of two institutions, “Meer en Bosch” and “De Cruquiushoeve.” The former is a short-stay hospital in which observation, treatment and rehabilitation are performed for “fresh” patients, and the latter is a long-stay institution or colony where long-term care and treatment are provided for the severely handicapped. At both facilities of the “Instituut,” a team of experts plan the treatment, as a whole. As to their rehabilitation activities, the sheltered workshop at “Meer en Bosch” has advanced equipment .in a modern building and provides a variety of work for the patients such as assembly work, machine-operating, packing, storehouse keeping, clerical work, and so on. The workshop can accommodate 160 patients and about a half of them are outpatients. In the workshop, occupational therapists work in close cooperation with other specialists: doctors, psychologists, social workers. The main objective is to enable the patients to take their place again in their community-asbsom as pnerible. _,_. At ’‘De Cruquiushoeve,” where about 550 patients live separately in a number of pavilions, a large sheltered workshop is provided .mainly for occupational therapy of multiply handicapped patients. Of course, 8 c
experts of each department keep in contact with the workshop. At “De Cruquiushoeve,” children with epilepsy also live and are treated and, besides, are educated at a school located close to their wards. As the author has already suggested, education is particularly important for the future of’these children. In Scotland, there is a unique sheltered workshop for epileptic patients in Glasgow, which was provided by the Scottish Epilepsy Association; it is called “Sea (an acronym of the association)-born industries.” The industries have no spcial contact with any clinics or hospitals and are managed by personnel, including social workers, of the association, .On the other hand, they maintain close cooperation with the official Department of Employment. The purpose of the industries is to assist the patients in obtaining regular employment. According to the report from the Department of Community Medicine of Glasgow University (1978), from 1957 to 1977, 325 male and female patients were received by the industries. Their ages ranged between 17 and 57 years old. All of the patients had seizures and most of them had no career of employment. Surprisingly, out of them, 3 10 obtained regular employment in open industries, after the training at Seaborn. The report emphasized that the aims of the workshop are not only to obtain regular employment for the patients but also to improve their health; physically and mentally, to give them selfconfidence, to socialize them and to reduce the number of seizures.
