disability evaluation typically requires an assessment of the activities of daily life ( adl ) and instrumental adl ( i - adl ) . in japan
, a physical disability certificate is based on the patient 's adl and i - adl grades .
the independent adl scale , which is widely considered within the field of rehabilitation medicine to be a particularly important component in the evaluation ( 1 , 2 ) , considers both individual and universal factors ( fig .
assessment is performed by analyzing the results of test activities relating the patient 's personal life .
for example , adult independence refers to a person who does not require external care in daily life , whereas child independence includes care within the family and school life .
such personal factors have been nurtured through development in the community and belong to the community 's values and customs .
the universal factors , on the other hand , are measured against the common rule of humanbeings .
furthermore , disability evaluation should also include assessment for the supporting system in the community - based rehabilitation ( cbr ) and other problems .
these other problems , which relate to objective signs , the timing of evaluation and multiple impairments , are still under fierce debate .
, japan officially recognizes three forms of the identification booklet for the disabled , one for physical disability , one for mental disability , and another for psychological disability .
during the course of this investigation , several reports issued by the ministry of health , labor and welfare of japan , including the outline of the systems and basic statistics in annual reports on health and welfare 1998 - 1999 social security and national life from white paper and reports were reviewed ( 3 ) .
data concerning the annual change in the number of people with physical disabilities by type and age per 1,000 people were used to analyze total disability evaluation , while the annual change in the number of children with physical disabilities by type and age was used to analyze child disability evaluation .
the number of people with physical and mental disabilities was used to determine the relationship between welfare facilities and the home in the community .
finally , several data related to the elderly were used to anticipate bigger problems in future .
the results of this study , as provided in detail in the appendices to this report , are summarized as follows .
recent trends in the last 10 yr suggest a sharp rise in physical disabilities and internal disorders among the elderly ( table 1 , 2 ) .
data on children by type ( table 3 ) and age ( table 4 ) shows an increase in the rate of internal disorders and young children with physical disabilities .
data on the overall number of people with disabilities ( table 5 ) reveals that 28.5% of patients in health care facilities have mental retardation , whereas only 5% have physical disabilities .
data suggesting bigger future problems for the elderly are also presented in fig . 2 and table 6 and 7 .
in japan , disability is categorized under three identification booklets : 1 ) physical disability , which is classified by four subgroups , 2 ) mental disability , and 3 ) psychological disability .
the classification of the physically disabled subgroups ( table 1 - 4 ) was very useful for determining the problems for government policy on welfare and public health .
the increasing rate of internal disorders within the physically disabled has become a major theme for following global welfare services in the future .
a multi - system for evaluating disabilities has resulted in many welfare services , depending on the various kinds of disabilities .
however , the achievements of the welfare system , based on different types of disabilities , have led to a complex or confused service system .
the system has also been affected yearly by the changing social community around persons with disabilities .
accordingly , the increasing ratio of the elderly population has prompted the development of a new disability evaluation related to practical adl . to cite another example ,
mental disability has been evaluated from infancy because of a lack of social response . as such
, most people with mental disability usually tend to receive the identification booklet up to the age of 18 yr .
however , table 5 shows that , in japan , adults with mental disability tend to be less adaptive to the community than those with physical disability .
therefore , the ministry of health , labor and welfare of japanese government has started to rearrange many welfare services to be more suitable to a small community around persons with disabilities . moreover ,
the concept of preventing disabilities is emphasized not only in rehabilitation medicine , but also in cbr , indicating that disability evaluation needs another factor of support system based on their community .
thus , it is important to think about the disability evaluation according to the characteristics of age , impairment and assistive environment . in the field of cbr ,
disability evaluation has recently become important for measuring the effects of rehabilitation treatment in medical insurance and decision of the grade of welfare service volume in japan .
while the first and second groups have been historically well - established without any disagreement on the classifications of disability type , the third group concerning psychological disability has recently been questioned with respect to the visibly less apparent disabilities relating to cognition , memory , attention , emotion , and social behavior after traumatic head injury .
although the new system to evaluate and support such a disability group is under development throughout the country , problems with classification continue to be debated .
 to examine the current state and social ramifications of disability evaluation in japan , public data from annual reports on health and welfare 1998 - 1999 were investigated . 
 all data were analyzed based on the classification of disabilities and the effects of age - appropriate welfare services , which have been developed through a half - century of legislative efforts to support disability evaluation . 
 these data suggest that disability evaluation , while essentially affected by age and impairment factors at a minimum , was impacted more by the assistive environment for disabilities . 
 the assistive environment was found to be closely linked with the welfare support system related to a global assessment in the field of community - based rehabilitation . 
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION