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Dedicated care for brain-injured traffic accident victims at Chiba clinic proving effective

Yumiko Yamaguchi, center, undergoes rehab with her husband Takashi, left, at NASVA's Chiba Ryogo Center in Chiba, as her nurse Keiko Ikeda looks on, on June 8, 2017. (Mainichi)

CHIBA -- A local clinic run by the government-affiliated National Agency for Automotive Safety and Victims' Aid (NASVA) has given the Mainichi Shimbun an inside look at its advanced treatment and rehabilitation of traffic accident victims with severe brain injuries.

    The Chiba Ryogo Center in Chiba's Mihama Ward, which was opened in 1984, is the oldest of all the eight hospitals operated by NASVA. The center has served as a pioneer in treating and rehabilitating patients with severe brain damage, and its expertise is shared with other specialized medical institutions.

    The center has adopted a so-called "primary nursing" system under which the same nurse cares for the same patient during his or her period of hospitalization, so that the nurse can notice the slightest change in the patient's condition. Those with the most severe brain injuries can be admitted to the facility after screening. Most inpatients are hospitalized for up to three years. All 80 beds at the center are situated on the first floor, facing windows. Nursing and other medical staff can easily glance over the entire room for patients, while patients can observe the four seasons through the windows.

    It had previously been believed that it was difficult for bedridden and unresponsive patients with severe brain injuries to recover once a certain amount of time had passed. However, 26 percent of patients admitted to NASVA's eight hospitals as of this past March had overcome a so-called persistent vegetative state (PVS) under the agency's own standards.

    Neurosurgeon Masaru Odaki, 68, director of the Chiba Ryogo Center, said, "Our achievements have proven that even patients with the severest conditions, such as PVS, can recover to a certain degree if they undergo rehabilitation corresponding to details of their conditions over a long period. Such rehab is important in terms of supporting victims of traffic accidents.

    Yumiko Yamaguchi, 63, who has been undergoing rehabilitation at the Chiba institution for more than 2 1/2 years after she was hit by a truck in an accident, has recovered to the level where she can engage in simple conversation with her husband, 72-year-old Takashi.

    "Yumi, show me your favorite sign," Takashi tells her. She flashes a victory sign in response. Yumiko is scheduled to leave the hospital this coming November. She can eat by herself by using her right hand, although she can hardly move her left arm and left leg. She now can sit in a wheelchair for a long time.

    "Considering her condition shortly after the accident, I'm glad she has made it this far," Takashi said.

    The accident occurred in July 2014. Yumiko was crossing an intersection with the light when a small truck turning right hit her, and she fell unconscious. She was taken to an emergency hospital and barely survived. However, she became bedridden with serious aftereffects on the left side of her body.

    Yumiko had belonged to a theater club when she was a high school student. She joined a theatrical troupe in Tokyo when she was in her 50s, having finished raising her children, and occasionally appeared in TV dramas as an extra. She was on her way to the troupe for rehearsal when she had the accident.

    Shortly before the accident, the couple had been considering changing their lifestyle centering on Takashi's work. Takashi had believed that Yumiko would care for him after he grew old. "However, the accident drastically changed my life," Takashi recalled.

    A consultant at the emergency hospital where Yumiko was initially admitted told Takashi about the Chiba Ryogo Center. Desperate for help, he took his wife to the institution, where he saw patients undergoing thorough rehab based on the assumption that even PVS patients could recover. Yumiko transferred to the institution in November the same year.

    The center's rehabilitation is not limited to treatment by physical therapists and other specialists, but incorporates dressing, having meals, brushing one's teeth and taking baths into the rehab program. The primary nursing system, which enables such thorough rehab, is supported by 91 full-time nurses who look after up to 80 inpatients.

    Keiko Ikeda, 40, a nurse assigned to Yumiko, pushes her wheelchair and takes her inside and outside the hospital ward as long as time permits. This is because riding in a wheelchair itself stimulates the patient's five senses.

    Initially, Yumiko was able to sit on her wheelchair for less than half an hour at a time, complaining that her seat was sore. She can now travel some 50 meters on her wheelchair by hitting the ground with her right leg after receiving assistance.

    When she was hospitalized, Yumiko was unable to have meals by herself, but Ikeda and doctors were successful in drastically improving her ability to feed herself. Initially, she was only able to have liquid food, but her diet was gradually changed to normal food. She can now eat her meal in about 30 minutes, using her right hand.

    Takashi starts work at 6 a.m., two hours earlier than before the accident, and visits his wife at the hospital in the evening. During his visits, Takashi massages her in hope that it will help improve her condition.

    As she is expected to be released from the institution in November, Takashi is worried about her bathroom visits. Yumiko is now undergoing training to go to the bathroom with Ikeda's help.

    "Her nurse takes care of our requests and is of great help," Takashi said.

    Takashi hopes to make Yumiko's dream of standing on stage once again come true.

    According to the Chiba Ryogo Center, over half of the center's past inpatients have showed some improvement, and the conditions of about 10 percent of the center's patients greatly improved, just like Yumiko. Thorough medical treatments provided at the institution are supported by a hospital operating cost subsidy system utilizing funds from the compulsory automobile liability insurance program.

    Odaki says it takes a long time for treatment of patients with severe conditions such as PVS to produce tangible results, adding that a mere six months or so of rehabilitation is unlikely to improve the patient's condition.

    If a medical institution has enough staff members and spends several years stimulating patients' brains in various ways, however, many of them become able to communicate with others and express their feelings.

    In the meantime, there are only eight specialized hospitals like this across the country, including the Chiba Ryogo Center, with a combined 290 beds.

    Yuji Kuwayama, 61, head of an organization representing patients with PVS and their families, has called for an increase in the number of specialized institutions. He says, "The number of those with severe aftereffects from traffic accidents hasn't decreased. I'd like the central government and NASVA to open at least one specialized institution in each prefecture."

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