Many neuromuscular diseases are rare and so little known that it might be confusing to introduce some orthosis to neuromuscular disease patients. This paper will be an introductory remark explaining the procedure of representative diseases and a confirmation of the general principles. It is necessary to consider the terms of the usual selection and adaptation of orthosis, like preventing changes in shape, supplying function, the distribution of motor disturbance and muscle strength, the degree of muscular tone, the age of users, the situation of activity and the quantity of exercise. It is also important to consider the patients’ mental conditions by accepting such things as the speed of disease progression and its severity. In order to proceed smoothly with little experience of orthosis, maintenance and change for neuromuscular disease, it is best for patients to try some manufactured orthotics and customize them. This will allow them to realize the effectiveness. I introduce some practical examples in our hospital. I introduce neck and trunk orthotics, which are used for the spinal curvature of Parkinson’s disease, and an ankle-foot orthotic, which is for distal dominant muscle weakness.

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[in Japanese]

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The usage of lower limb and cervical orthosis is indispensable for maintaining ambulation and ADL in ALS patients. However, orthotic therapy for ALS patients has been underestimated for improving their QOL. We consider rationalization of medical support system to develop orthotic therapy in the early disease stage to be a key for the rehabilitation of progressive neurological disease including ALS.

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A majority of patients with muscular dystrophy (MD) develop a gradual loss of functional muscle and a progressive contracture. Orthotic interventions for the limb and the spine may be able to improve their quality of life if they are applied in the appropriate region and with the proper timing. The authors use orthotic management and devices for patients with MD; medical devices discussed in this paper are knee-ankle-foot orthoses (KAFOs) for assisted ambulation, ankle-foot orthoses (AFO) for preventing the progression of equinovarus deformities in wheelchairs, thoraco-lumbo-sacral orthoses before a formation of scoliosis and later in the clinical course, the seating systems. Any kind of orthotic management requires the provision of detailed information to the patients and their parents. Both risk and limitations of orthotic treatment have to be mentioned. Careful consideration of the environment and the mental condition of the patient and the caregiver, as well as the motor function, is important in the orthotic treatment of patients with MD.

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[in Japanese]

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The purpose of this study was to clarify the change in lower extremity orthosis and mobility in stroke patients after discharge from the hospital. Subjects were 30 hemiplegic patients who had a stroke for the first time and were discharged from the convalescence rehabilitation ward of our hospital. They were prescribed the lower extremity orthosis (mean age : 59.7±11.9 years). The subjects were divided into 2 groups : the using orthosis group, comprising subjects who always used lower extremity orthosis both in their house and outside, and the not using orthosis group, comprising those who did not always use it in their house or outside. Various factors such as clinical features, physical function, mobility and ADL were compared between the 2 groups. In addition, we investigated their awareness of using lower extremity orthosis after discharge. A difference in the presence of family education was observed between the 2 groups. No differences were observed in the physical function, mobility or ADL at discharge and after discharge. The purpose and reason for using orthosis after discharge were also different between the 2 groups. However, their satisfaction and sense of dissatisfaction with the use of lower extremity orthosis were similar in both the groups. We conclude that hemiplegic patient in need of lower extremity orthosis after discharge and the family need instruction through family guidance in a convalescence rehabilitation ward. In addition, it is necessary to continued evaluation for the patients and family after discharge.

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Reports have suggested that in gait training for stroke patients with hemiplegia, increasing the walking speed is a more effective therapeutic approach. With the purpose to improve the walking speed during gait training using a knee-ankle-foot orthosis, we have constructed a band for assisting the flexion movement of the hip joint. To examine the effect of this band on walking motion, we investigated the changes in gait parameters with and without the band in 6 patients undergoing gait training using a knee-ankle-foot orthosis. Our results showed an increase in stride length and an improvement in walking speed, suggesting the effectiveness of using the band during gait training using a knee-ankle-foot orthosis.

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The prosthetic and orthotics service in Japan has been improved greatly by the team of committees on prosthetics and orthotics of the Japanese Association of Rehabilitation Medicine and Japanese Orthopedic Association in the past 50 years. In 1984, the Japanese Association of Prosthetics and Orthotics was founded under a multi-professional team approach. The educational and accreditation program for prosthetists and orthotists, a standardization system for prosthetic orthotic components and JIS PO terminology were developed. Internationally, Japan ISPO (International Society on Prosthetics and Orthotics) has performed in many aspects, such as hosting the 6th World Congress KOBE in 1989, starting the Asian Prosthetic Orthotic Congress in 1997, and helping a school for prosthetists and orthotists in Thailand in 2002. The first Global Educators Meeting will be held in Kobe, in June 2014.

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