[in Japanese]

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Continuous infusion of intrathecal baclofen (ITB) is a powerful tool for management of spasticity and can greatly improve walking ability and activities of daily living (ADL). Starting after ITB therapy, appropriate gait training and usage of lower limb orthosis is important. However, optimal rehabilitation after ITB therapy has not yet established. In this review, we demonstrated that spasticity, gait speed, cadence and distribution of foot pressure are useful markers to evaluate the effect of ITB therapy. In addition, we pointed out that suitable lower limb orthosis is a key factor for gait training after ITB therapy.

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The clinical practice for rheumatoid arthritis has dramatically changed during the recent couple of decades. The immuno-pathological mechanisms of autoimmune chronic arthritis have elucidated. Immune complexes consisting of citrullinated proteins and anti-citrullinated protein antibodies play a major role in the synovial inflammatory process, and inflammatory cytokines such as TNF-α, IL-1, IL-6 derived from granulocytes, monocytes and macrophages play a major role in the destructive process of cartilage and bone tissue. Development of anti-cytokine molecular target drugs, i.e. biological DMARDs, has changed treatment strategies for rheumatoid arthritis. In accordance with this therapeutic innovation, diagnostic classification criteria were also revised in 2010 for the first time since 1986. Consequently, the treat to target (T2T) concept was introduced. These revolutionary changes have been called a paradigm shift in rheumatoid arthritis treatment. Medical rehabilitation has to change in concert with this revolution in medical practice concerning rheumatoid arthritis. Orthoses and assistive technologies help rheumatoid arthritis patients to prevent impairment and to restore body function and to maintain activities and participation. Detachable bandages and shoe inserts are useful for impairment prevention. For restoration of disability, foot orthoses, and ankle and knee orthoses are effective. Carefully selected and properly adjusted canes and walkers restore ambulation. Many kinds of assistive technical devices are utilized for regaining activities in patients with rheumatoid arthritis.

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[in Japanese]

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[in Japanese]

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Musculoskeletal tumors are defined as neoplasms arising from bone and soft tissue. In the treatment of malignant musculoskeletal tumors, resection of bone, muscles, nerves, and joints involved in the tumor are necessary. As a result, almost all surgically treated cases require prosthetics or orthotics. For osteosarcoma, the major disease of malignant bone tumor, amputation was replaced with limb salvage surgery in the second half of the 1980s. Limbs are reconstructed with prosthesis, bone graft, and bone transport. Until the limb condition becomes stable after the operation, braces are necessary to get better limb function and to avoid complications such as dislocation. In this paper, we described recent treatment strategy for malignant bone tumors and the use of orthotics and prosthetics according to the sites of the surgery.

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A TF (transfemoral) prosthesis with MR-SPCOM (MR (Magneto-Rheological) fluid brake-Stance Phase Controlled by Optional Motion) knee joint has been designed and developed, which mainly consists of a variable resistance knee joint with a developed MR fluid brake and a developed load cell detecting the wearer’s optional motions. The optional motions mean that the wearers slightly push their stump ends back and forward voluntarily. As the resistance torque of the knee joint can be voluntarily controlled by using a computer based on signals from sensors such as a load cell, an encoder detecting knee angle and other touch sensors, it was possible to smoothly ascend and descend stairs reciprocally and to voluntarily lock and yield the knee joint during sitting down on a chair. The results were accomplished by the improvements of the load cell, several other sensors and the control scheme. In this paper, the design concept, theoretical approaches and structure of the improved TF prosthesis with the MR-SPCOM knee joint are described, and the results of the gait and motion analyses are discussed.

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We used a double upright ankle foot orthosis with an adjustable ankle joint that can change braking force. We examined this orthosis with a hemiplegic patient and focused on the difference in distance-time-parameters and activity of muscles by adding a dorsiflexional braking function to the lower limb of the paralyzed side during the stance phase. As a result, the support to the paralyzed limb rose and the distance-time-parameters improved because the plantar flexion muscles of the ankle and the extension muscles of the knee has been assisted. From the present experiment, the addition of a dorsiflexional braking function to the ankle is effective in the case of sudden knee flexion caused by lower muscle tonus or uneasiness of weighting on an affected limb in the stance phase by increasing the flexion joint moment of the knee.

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We developed an upper-limb motion-assist device for high cervical spinal cord injury, which makes it possible for a patient to move a paralyzed arm in the intended way by using residual functions of the neck and head. This device consists of an upper-limb motion-assist mechanism, a control system, and a sensor that measures the motion of the head. The upper limb is always supported in various postures by the same force as gravity exerts, due to the elastic force of the spring, and this device can be adjusted for upper limbs of different weights. The three-dimensional position of the wrist and the pronosupination motion are assisted by 4 DC motors controlled by a PC. For self-motion control, an acceleration sensor and switches are applied to detect head motion. This device can assist with upper-limb motions, such as are required to eat independently, in response to the head movements of the users.

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For a severely physically and mentally disabled child with marked dysphagia, in whom aspiration pneumonia recurred frequently due to saliva aspiration, we constructed a wheelchair with a sitting posture-maintaining device that has the following features : maintaining appropriate forward leaning posture, head support to prevent over-extension of the neck, and a cut-out table and chest pad to stabilize the mandibular position. By assuming a forward leaning posture, saliva can be directed outside the oral cavity. By preventing over-extension of the neck, excessive tension of the anterior neck region is prevented. By supporting the whole mandible, airway can be secured more easily. Through these measures, laryngeal elevation was facilitated, inflow of secretions in the oral cavity into the airway was reduced, and airway obstruction was improved. As a result, aspiration and the number of sputum suctions were reduced, and the physical and mental burden of the child and family while moving were reduced.

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We studied the effect of creation time for ankle-foot orthotics on FIM in stroke patients in convalescent hospitalization. Subjects were 36 hemiplegic patients who had an AFO prescription because of stroke. The subjects were divided into 2 groups and compared : Group A comprised 20 persons with less than a three-week wait. Group B comprised 16 persons with a wait of over three weeks. (The early AFO order takes about 3 weeks. This time frame includes the medical check, brace clinic, casting and completion.) As a result, in three factors (movement, motor, and general condition) there were significant differences between A and B. The moving FIM increased in inverse correlation with hospitalization term. Our results showed the creation time for an AFO order had an effect on ADL. The movement factor for the AFO is increased by short-term hospitalization.

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Currently, no fewer than 310,000 patients with end-stage renal failure require maintenance dialysis therapy in Japan. Although a worldwide survey showed that Japanese dialysis patients had the best prognosis and lowest prevalence of peripheral arterial disease and amputation, therapeutic limb amputations often have to be performed on Japanese dialysis patients. Sufficient care of arteriovenous fistula, which is required for efficient dialysis therapy, should be ensured for the prevention and early detection of complications such as occlusion and bleeding. Chronic kidney disease-mineral and bone disorders are unavoidable among dialysis patients. These disorders may lead to fall-related fractures and arthrosclerosis due to ectopic calcification. Physiotherapists should consider blood pressure fluctuations arising from dynamic changes in the plasma volume when designing therapeutic approaches for patients undergoing dialysis.

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