The care of the limb deficient child in Japan.

The incidence as well as the current state of the management of the limb deficient child in Japan is described. General medical and welfare services in Japan The medical service system in Japan is well organized and includes the diagnosis, treatment and follow-up care of limb deficient children. Once the child has been diagnosed as physically disabled due to limb deficiencies and/or congenital malformations, he or she has the right to receive welfare assistance under the Law for the Welfare of Physically Disabled Children. They are registered and issued with a handbook for identification and access to services. The welfare offices are in charge of the manufacture and distribution, as well as the repair, of the prosthetic appliances. Unfortunately, electric arm prostheses are not included in the inventory at the present time. Those children for whom surgical conversion seems appropriate are evaluated for short-term hospitalization at the medical agencies designated by the Ministry of Health and Welfare. However, not every facility is experienced in the management of such children, as will be shown later in the results of a questionnaire survey. Incidence of limb deficiencies present at birth and activities of parents organizations in Japan Thalidomide embryopathies were prevalent during the early 1960's in Japan and 306 patients (171 males and 135 females) were registered (Kida, 1987). A survey has been conducted by the Japan Physician's Association for Maternal Welfare (JAMW) for monitoring birth defect babies since 1982. Approximately 120,000 new-born babies have been examined annually at 250 gynaecological hospitals and facilities throughout the country and the results registered with the International Clearing House for Birth Defects. Monitoring System (ICBDMS). According to the statistical study of Kida (1989), new-born children with limbreduction deformity are born at a rate of 7 per 10,000 births; therefore, approximately 1,000 affected infants are bora annually. Table 1 shows the frequency of limb-reduction deformities recorded by the JAMW between 1978 and 1986. The Association of Parents of Children with Congenital Malformation of the Limbs (APCCML) was organized in 1979 and more than 1,000 families are joint members. Since the establishment of the association one of the authors has been engaged in 66 screening surveys throughout the country and has examined a total of 1,441 cases (Kida, 1989). Table 2 shows a comparison of results of limb deficiencies present at birth registered by the JAMW and screening surveys done at the APCCML. The APCCML have many activities for the psychological support of its members and also to encourage the development of social understanding. Apart from this study, the authors wanted to investigate the situation of congenital limb deficient children who had been hospitalized in facilities for crippled children and at children's hospitals throughout the country. Some 79 questionnaires were sent and 49 answers received (62% response ratio); 23 facilities had never experienced such cases during the past All correspondence to be addressed to S. Kakurai, Department Physical Medicine and Rehabilitation, Teikyo University Ichihara Hospital, 3426-3, Anegasaki, Ichihara City 299-01 , Japan.