中国の地域基盤リハビリテーション

(1)

Japanese Physical Therapy Association

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JapanesePhysicalTherapy Association

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Community-BasedRehabilitation

in

China*

GuoZhiqiang'*

Preface

The

problems on

handicapped

_peopleand the eld-erly _people have been becoming complicated inthe society, while the mean lifeexpectancy of the pop-ulation has

been

extending. Because the ratio of

ha.ndicapped _people and people with senile

func-tional

disorder

who should receive rehabilitation

treatment to _thewhole population isquitehigh,the developrnent of rehabilitatien rnedicine and

rehabili-tationservice forthose _people marks the

civiliza-tion

degree

of one country or region.

Since

1976,

the project of

Community-Based

Rehabilitation

_(CBR)

driven

by

WHO

(World

Health

Organization)

has

been

carried out

in

many

coun-triesin the world. CBR _plays irnportantand eM-cient roles indevelopjng the modern rehabilitation medicine and

in

rnaking

the

handicapped

_people

re-join

thesociety as well as _possible.

CBR

is

a _projectwhich would make handicapped people incertain region be recovered inall aspects

including

the

recovery in education, career and social activity, Thus, CBR would _provide various regional services ior the

handicapped

people.

Therefore,

the

implement

of

CBR

in

different

coun-try depends on the manpower, material resources,

financial

capacity and the need of

handicapped

peopre.

Since

1986,

the

CBR

has

been

carried out with certain scepes

in

many _provinces and cities

in

China.

In

the aspects of spreading the

knowledge

of rehabilitation medicine, establishing the

organi-' _cppa_a)betmgma

v

_.N _v _v_f- _ti

. v *'

_{tiltmg,K\memfipEvewa#st}

zation of modern rehabilitation medicine, and train-ing the professionals, we have got many experi-ences.

A

fundamental

network of

CBR

with

Chi-nese characteristics

has

been

built.

General

Data

According

to the sampling survey

in

1987

in

China,

the population of whole country

is

1.1

bil-lion,inwhich

handicapped

_people are more than 50 million and the elderly _people

(elder

than 60) are nearly 100 million.

Inthe sampling investigationinRoad 3 of North

Districtof

Qindao

cityi),seven neighborhood com-rnittees which include

3281

families,

10241

resi-dents

_(males

5135,females 5206) were

investigated,

The number of handicapped _people reached

702 (6.79%),

which was

higher

than theaverage

level

of

whole country

(4.9%).

The

handicapped

types

in-volved are summarized inTable 1.

Among

the

702 handicapped

people there were

635 _people

(91.46%)

who should receive rehabili-tationtreatment.

Jiang

Meiling et al. 2) investigated a community with 6000 families

(20935

residents) ina factoryof

Wuhan city, and reported thattherewere 1491 eld-erly _people

(older

than 60). Among 1301 elderly

people surveyed

(672

males, 51.65%;

629

femaies,

48.34%: mean age 67.54 _years),1092 suffered from chronic diseases.

The investigationsclearly

present

an irnportant social significance of CBR to

be

carried out.

CBR

The network of

CBR

in

cities of

China

is

(2)

JapanesePhysicalTherapyAssociation

Table 1.

Community-Based

Rehabilitation

in

China

Type

of

handicapped

_peopleand ratio of

Nerth

district,

Qindao

cityi)

455

type number of people ratio

(%)

Cardiovascular

disease

Pulmonary Arthritis Paralysis

Mental

disorder

Diabetes TumorMental Retardation and Deafness Others

299103

76

66

21 20 17 28 72 42,5914,6710.83

9.40

2.99 2.85

2.42

3.99 1026

ly

composed of threegrades.

Under

the

leadership

of the central

government

and the association of

the

_{(organization}

of) handicapped people, the

proc-ess of three-grade CBR activity

is

aroused and or-ganized by localgovernment,

joined

by the

func-tionaldepartment

_(civil

administration, health, edu-cation and labor bureaus, etc.), and associated

by

enterprises, institutions

(social

welfare organ),

grass-roots unit of city

(sub-district

oMce and

neighborhood committee) and thefamiliesof

hand-icapped

peoplei)3)

(Table

2).

The

sub-district oMce

is

a nucleus of

CBR

activi-ty, on which the

leading

group of

CBR

is

built.

The

group

is

also

joined

by

the

doctors

from

Prov-ince

Rehabilitation

Center

or

Rehabilitation

Depart-ment of

Medical

University

(Table

3).

CBR

network

in

China

has a close relationship with the

first-grade

health

network. This means

that the network

has

multi-function, which is con-sistent with the spirit of "everybody

will hold the

first-grade

health service

in

2000" _put

forward

world-wide by WHO, Inaspect of organization, the

CBR network isled

by

the district_government and carried out

by

the

civil administration

bureau;

in

aspect of rehabilitation medicine, itismanaged

by

the

health

bureau,

supervised

by

the

rehabilitation

Table

2.System

of _grass-rootsCBR

grade reglon organ organlzatlon

12 3 Neighborhood committee

Sub-district

office

District

Health center

CBR

leading

_group of sub-district office

Districthealthbureau

Health

center and

family

Rehabilitation

station

(Mini

rehabilitation center)

District

hospital

Province rehabilitation center RehabilitationDept,of

Medical

University

Table

3.CQrnposition

of leading_group of CBR

Group

leader Group member

Sub-district

office

Sub-district

office

Sub-districtoffice District

health

bureau

Province rehabilitation center

Rehabilitationstation

Representatives

of

handicapped

people

Vice chairman

Vice section chief

Section

staff

Medical administration chief

(3)

JapanesePhysicalTherapy Association

456

ve*tsza\

experts of_province rehabilitation center or rehabili-tation

department

of medical university, and

based

on the sub-district rehabilitation center and

home

rehabilitationl

in

aspect of

finance,

the

budget

mainly comes from the sub-district welfare factory; the

job

arrangement istaken upon

by

laborbureau.

CBR

trainingiscarried out under theprinciple of

the combination of station and home rehabilitation.

Based on the need of handicapped _people, home rehabilitation ismainly _performed for improving

the ability of

daily

life

and for recovery of muscle system and

joint

function under the _guidance of

the

doctors

of rehabilitation station. The home rehabilitation takesthe

following

advantages;

1)

no

time

limit,

thus with the

help

of

family

member the trainingcan

be

taken at any time,

2)

practical

fer

handicapped

people,

3)

psychologically

beneficial

with the

feeling

communication with

family

mem-bers.

However,

home

rehabilitation islimitedby a lack of training

facilities,

skills and knowlediges of

reha-bilitation.Insome regions with betterfinancial

ca-pacityand material resources, the sub-district

reha-bilitationstation has advanced facilitiesfor

reha-bilitation,forexample, bicycleergometer, upper

ex-Table

4. ag

2o

_igee

7

_e

tremity trainer,pulley,and so on, similar to the

mini-rehabilitation center.

U$ing

those

training

facilities,

it

is

possible and effective to perform rehabilitation which cannot

be

carried out

in

the home.

Meanwhile, the combination of traditional

treat-ments of chinese medicine likeacupuncture, mas-sage, qigong hot packs, and modern rnedical treat-ments

(therapeutic

exercise, occupational therapy,

speech therapy) constitutes a CBR with chinese

characteristics.

The difficultiesand complicated _problems for

re-habilitationmay ask _the help of high-Ievel organi-zation

(Table

4).

The experts

in

province rehabilitation center or professors of university

have

responsibilities

for

carrying out

CBR

(Table

5).

The

CBR

in

China

focuses

on the

following

fields

depending

on the characteristics of the community:

1) chronic neuropathy4}, 2) infantile paralysis,

3)

mental retardation3), and 4)senility2).

CBR involves not enly medieal rehabilitatjon but also rehabilitation foreducational, social and career recovery. Some favorable_policieshave been made

for the recruit of handicapped _people,and more

Case

transformation system of

CBR

grass-rootsCBRmember

---,rehabilitationdoctor

---;rehabilitation

expert

'

ln unlverslty

health

worker

in

health station, family trainer and teacher inspecial school

doctors

inrehabilitation station and _province rehabilitation center

expert in_province rehabilitation center or

professorof university

Table

5.The

task of province rehabilitation center inCBR

L2,

3.4.5.6.

7.

Contrel

and management of

the

qualityof CBR

Sending

the

people tomake the sample survey

for

handicapped people, supporting tomanage thehealtharchives of thecommunity

･

Training the rehabilitation worker, providing thetechnicalconsultation and guidance

Constituting

the rehabilitation projects,checking and evaluating the _processing of the _projects

Making

the

propaganda materials and carrying out the

handicapped

_peoplesurvey

Accepting the handicapped people who need special

training

transferred

from

the _grass-roots organization

(4)

Japanese _Physioal _Therapy _Assooiation

COmmUnity

−

BaSed　

RehabilitatiOn

in

China

457

and 　more 　handicapped 　people　work 　

for

　the　welfare

factories　and 　get　the　good 　payment

．

　For　exa 皿 ple

，

　there　are 　639　welfare 　enterprises 　

in

Jinhua

　 city　 of　Zhejiang　Province

，

in

　which 　 the

number 　of　

the

handicapped

　people　is　3365

，40．

76％

of　_total　_workers5 ｝

．

Some

　_sub

−

district　o 伍 ces 　hold

the　sports 　meeting 　

for

handicapped

　people　

to

　make

then　

join

　the　social　activities　as　more 　as　possible

　improves 　the　social 　_position 　of　handicapP

−

ed　people　both　in　society 　and 　in　family

．

Thirdly，

CBR

　enableS 　

the

　handicapped 　people　to　spend 　more

time　on 　rehabilitation 　and 　to　receive 　early　treat

一

ment

，

　which 　results 　in　effective 　and 　economical

treatment．

Fourth

，　

it

　is　a　way 　

to

　realize 　

the

　goal　of

“

_everybody

　will　hold　

the

　fist

−

grade　health　service

in

2000 ”

put　

fQrward

by

WHO ．

Fifth，

by

　carrying

Qut

　the　

CBR ，

　the　

degree

　of　re

−

join

to

　society 　of　hand

−

icapped

　_people 　will 　

be

　_greatly　

increased

，

　and 　

hand−

icapped

　people　wm 　

be

　more 　active

，