Purpose: The assessment of rehabilitation by the Takizawa Method in which one physical therapist rehabilitates many patients by individual contact at a time. In a facility, although there were many person of a remarkable decline in the body function and/or person with severe dementia, the evaluation has been described individually. Because one therapist rehabilitated a lot of patients at a time, she had a big burden to report the evaluation. Since Takizawa Method rehabilitation will be carried out in multiple facilities and it was necessary to reduce the burden of a physical therapist, a common functional evaluation chart that could be used by all institution involved is needed. Method: We conducted the analysis of available data, taking into account the real situation, in a standardized manner in order to find out what kind of training was used, the number of training times, etc. Result: The functional evaluation chart named the Motivative Report was created, which enabled to standardize the records and which could be verified by a developed formula. We divided items of the functional evaluation chart into the head, trunk, lower limbs, and transfer and movement, in order to evaluate them and illustrate in the chart. We were able to demonstrate contracture, having or not agnosia, the ability to keep the standing position, walking as well as the number of times of training. Conclusion:The chart made it possible for a physical therapist to resolve the problem of patient's evaluation and to introduce short-and long-term markers of rehabilitation progress. The chart saves time and labor for the physical therapist and may be used in many facilities for the evaluation purpose.
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