There are several key points for performing pediatric rehabilitation such as favorable effect of brain plasticity, adverse effect of vulnerability in young brain, effect of growth and development, and necessity of family support. In the execution of pediatric rehabilitation, it is most important for a patient to be evaluated accurately. The rehabilitation program should be made based on a detailed evaluation. Rehabilitation should be carried out in a program with such elements as sufficient whole body management, functional training, regional cooperation, support for returning to school, and family support. A team approach is very effective because staff members can provide support from wide-ranging aspects. The main disabilities for pediatric rehabilitation are of congenital or perinatal etiology such as cerebral palsy or bone disorders. At the same time, though the incidence rate is somewhat low, rehabilitation for acquired brain injury such as traumatic brain injury, acute encephalopathy, hypoxic encephalopathy, and cerebrovascular disorders is also important.

When rehabilitation for cerebral palsy is undertaken, orthosis is indispensable. Since the easy-to-use appliances are going to vary depending on the progress of the rehabilitation, it is necessary to select an appropriate brace in each of its stages. It is becoming increasingly common in practice to combine orthosis with botulinum toxin type A. After the muscle tone is relaxed with botulinum toxin type A, treatment strategies include a nighttime orthodontic appliance intended to achieve a stretch effect. This paper will outline treatment combinations such as brace treatment and botulinum toxin type A in the rehabilitation of cerebral palsy.

Orthosis and physical therapy are often used to treat pediatric bone and joint disease. This section will focus on Perthes disease, osteogenesis imperfecta, congenital arthrogryposis and hemophilia. The treatment strategy for these diseases calls for concern about the state of treatment and the patients’ growth and activity from birth to adulthood. We will introduce the current state of treatment strategy and management using orthosis and physical therapy for such patients.

The experiences of rehabilitation by using orthosis for children with neuromuscular disorders are discussed in this article. For appropriate orthosis prescription, estimating the details of gait abnormalities using the PDCA (Plan-Do-Check-Act) cycle was helpful for untrained therapists. The most important tips were stabilization of the subtalar joint, normalization of the tibiotalar joint, and normalization of the forefoot alignment. Although when to start the treatment with orthosis is controversial, we suggest early intervention in the post-neonatal infantile term before the patient starts walking, to get the effective work of polyarticular muscles around the ankle stabilizing the bony alignment of the foot, in order to prevent dilation to bony deformation or increment of gait disturbance induced by congenital muscle tone abnormality, so that the patient will have a better gait than without orthosis.

Occupational Therapists at the National Rehabilitation Center for Children with Disabilities in Tokyo fabricate specialized adaptive equipment for disabled children to maintain functional positions to support daily living and leisure activities as well as to prevent contractures and deformities. Equipment must support each child’s special visual motor coordination needs. Wheelchair adaptations, special seating systems, prone and side-lying positioners, trunk stabilizers, and elbow, wrist, and finger splints are all fabricated by occupational therapists. The adaptive equipment must support each child’s special positioning needs as well as assist families with providing care. The cost, materials used, weight, and fit must be considered. After initial equipment delivery, the occupational therapist must recheck the fit and the child’s function using the equipment and adapt it as the child grows. The overall result is to help parents to better care for their child and to achieve each child’s improved functional abilities.

In recent years, many positioning system products have been developed, so that technical expertise and a high level of practical ability are required to select and provide appropriate products for each user. To select appropriate elements of head support, back support and seat in accordance with patients’ seating ability and physical state improve users’ QOL. It’s important to find a stable sitting position and to make a good fit between the supporting device and the user’s body.

This study investigated therapeutic effects of rehabilitation with Knee Ankle Foot Orthoses (KAFO) and Ankle Foot Orthoses (AFO) in acute stroke patients who can switch over from KAFO to AFO. Fourteen acute stroke patients who can walk with AFO participated in this study. Subjects were divided into the AFO group and KAFO group. Maximum weight bearing rate on the non-affected and affected side, step length, walking speed, and cadence were compared by means of before and after exercises. As a result, the KAFO group significantly increased the maximum weight bearing rate on the affected side, gait speed and step length after the exercises. Standing and walking exercises with KAFO suggested immediately improved walking ability and affected side lower limb support in stroke patients who can switch over from KAFO to AFO.

The present study aimed to find an effective driving method for the adaptive handbike and to examine the effect of dominant and non-dominant hands on the driving motion of the handbike. Using commonly used strain gauges attached directly to the left and right cranks of the handbike, the driving torque in the tangential direction necessary for crank propulsion, and the non-driving torque in the lateral directions (inside and outside) were measured. At the same time, the joint angles of the shoulder and elbow joints during the arm-crank motion were measured using a three-dimensional motion analysis device. The driving motion was performed with the synchronous motion pattern of the crank while maintaining the crank rotation at 30 rpm. The test was conducted in 12 healthy subjects under three exercise load conditions. The results showed that under high exercise load condition, the non-driving torque increased immediately after the maximum extension of the elbow joint in the push down phase. In addition, the greatest difference between the dominant and non-dominant hands was observed during the push down phase ; especially, under high exercise load condition, the dominant hand yielded superior driving torque. Since activity of the triceps brachii muscle is required in the push down phase, this probably accounts for the difference between the dominant and non-dominant hands in this phase.

It is well known that the elderly and patients after total knee arthroplasty (TKA) present with postural change caused by aging, namely lumbar kyphosis and pelvic backward tilt. These postural changes have the potential to decrease balance and gait ability and therefore to increase the risk of falling. To resolve this problem, we developed a newly designed spinal orthosis, Trunk Solution (TS), with joints providing resistive force ; the orthosis has functions to increase pelvic forward tilt and to increase the activity of abdominal muscles. The purpose of this study is to show the effect of TS on gait and balance ability of the elderly and patients after TKA by a performance test. As the results, 5m walking time of both the elderly and patients after TKA significantly decreased and one leg standing time of some elderly subjects significantly increased in after TS removal compared to before wearing TS. Use of TS can enhance gait and balance ability of the elderly and patients after TKA and therefore the orthosis might be useful for fall prevention.

Shoehorn ankle foot orthosis (AFO) is one of the AFOs frequently used after stroke events. Because of the high prescription rate, there is a possibility that designs may vary among hospitals. Differences in design would impact the functionality. We considered that it is meaningful to know the design and functionality as well as the trend of the views on indications and the reasons of selection of shoehorn AFO, and therefore conducted a nationwide survey. We targeted hospitals in Japan possessing recovery rehabilitation wards that have greater opportunities in prescribing the initial orthosis after the occurrence of stroke. A questionnaire was sent to 341 facilities, 110 of which responded. Statistical calculations and analyses were conducted on the data collected, with the following results. Other than typical shoehorn AFO, short type shoehorn AFO and articulated plastic AFO are also being used. In addition, 32 facilities reported that they were not using shoehorn AFO at the time of survey. Concerning design and functionality, many variations were found. Regarding the rationale of prescription and the reasons for selection, many cited that they selected the optimal shoehorn AFOs for the patients by considering various factors including the disease pathology, selection of indication, timing of prescription, and initial dorsiflexion angle.

Early prescription of a brace to do rehabilitation is important. However, because of the lack of knowledge about braces, I thought that the early prescription is not provided. Therefore, a study of the appliances from diverse multidisciplinary perspectives seemed to be necessary. Seventy stroke paralysis patients who participated in the brace fittings in our hospital convalescent ward between December 1, 2012 and March 31, 2014, were investigated until their brace completion date. As a result, our hospital admission date averaged 33.9 days from the date of onset, first fitting for braces after the hospital admission date was 11.6 days, and brace completion date was 9.5 days after first fitting. In other words, it was considered necessary to perform the brace fitting in order to perform the early formulation of the brace.

Acute lower limb ischemia requires as prompt revascularization as possible. If an irreversible change to the tissue is confirmed, a judgment concerning amputation is required. Most cases of chronic lower limbs ischemia are arteriosclerosis obliterans. The disease structure becomes complicated, and diabetes and dialysis cases increase the possibility of complications. Chronic lower limb ischemia is divided into intermittent claudication and critical limb ischemia, and timings of the revascularization intervention are totally different. Intermittent claudication is given conservative treatment, and revascularization is considered when a symptom remains. Revascularization at the earliest possible moment is necessary for critical limb ischemia. Even if an abnormality is pointed out with a CT imaging and a ABI test value, we revascularize it but do not intervene in cases without a symptom.