Because multiple causing factors exist for pressure ulcers, it is not so uncommon for wound healing to be delayed when they occur. Therefore, it is necessary that the pressure ulcer control team in association with other specialists evaluate the systemic condition of every patient undergoing pressure ulcer prevention and treatment and support nutrition management. The pressure ulcer control team in Osaka Medical College Hospital, by going on rounds or holding a seminal on pressure ulcers has performed data collection and analysis of the actual situation regarding the care for the high-risk patients and the status of use of body pressure dispersing mattresses. In addition, holding an in-hospital meeting, we make efforts to educate the staff on control of pressure ulcers. Through these activities, we aim to reduce the incidence of pressure ulcers in this hospital and promote their healing.

Skin problems are one of the serious factors that restrict the use of a prosthesis or orthosis. The cause of the skin problems includes two factors. One factor is a mechanical force, which means pressure and shear force. Efficient distribution of the force to the skin is required when using a prosthesis or orthosis. Although silicone liners are effective for skin protection, poor socket-fit results in the skin problems of the stump even while wearing a liner. Another factor is a biological factor, which means infection. Because warm and moist conditions inside of a prosthesis or orthosis increase the risk of infection, hygiene control is extremely important. To prevent skin problems, patients in hospital should learn self-management skills for skin care. A care system for early detection and treatment of the skin problems is also required for patients discharged from hospital.

The purpose of this study was to examine the stress of a silicone liner (liner) to the skin in patients with transtibial amputation. Subjects included 7 transtibial amputees. Interface pressure and shear force in the thigh area were measured by using a small instrument for measuring pressure and shear force. Interface pressure and shear force fluctuated with a change in knee movement for all subjects. With an increase in knee angle, there was an increase in shearing stress and pressure. A liner has a particular elastic property, but it’s different from that of the skin. In addition, it closely contacts the skin through its viscidity. The difference in the strain on the liner and the skin causes stress to the stump surface. It is indicated that this mechanism causes the skin disorder.

The purpose of this study was to investigate the effects of the height of an ankle-foot orthosis (AFO) on standing activities and walking in healthy adult females (mean age 26.9±6.4 years). Performances in standing activities and walking were compared across three conditions of the height of the AFO : normal height (3cm below the fibula head), 3/4 of the normal height (3/4AFO) and 1/2 of the normal height (1/2AFO). The range of the center of pressure (COP) and the angle of the ankle joint were measured during standing activities. The temporal and distance factors, the angle of the ankle joint and the pain in the lower limbs were evaluated during normal walking. The results showed that both the range of the COP during standing activities and the walking ability were reduced more when wearing a taller AFO, indicating the standing activities and walking are restricted more when wearing a taller AFO.

Upper limb amputees could experience the withdrawal or the decrease of the use of their prostheses for a while after they first got them. We investigated the use of the upper limb prostheses. We enrolled twenty-one adult unilateral upper limb amputees who had body-powered or myoelectric prostheses made in our hospital between 2009 and 2015. The users with the transhumeral myoelectric prostheses, transhumeral body-powered prostheses, and transradial body-powered prostheses showed a withdrawal or decrease of the use of their prostheses. The main reasons were the weight of the prostheses, the neck and shoulder pain caused by the weight, and the troublesome procedure of putting them on. Based on these results, we have to make a new effort to provide better upper limb prostheses for the users.

The portable spring balancer (PSB) is a common assistive device used by patients with high cervical spinal cord injuries during tabletop activities. The control of forearm pronosupination is extremely important to perform certain activities of daily living in these patients ; however, the function of the control system is not mounted on the current PSB. The orthosis-controlled forearm pronosupination in a suitable positon was developed, and the orthotic therapy was performed for two patients (C4 and C5 functional level) who required total assistance with each activity of daily living. As a result of the therapy, the two patients were individually able to eat and brush their teeth. Moreover, the C5 patient was able to operate a smartphone. We believe that patients with high cervical spinal cord injuries, who currently are unable to do table top activities, will be able to do them with the aid of this orthosis.

We evaluated the combined effects of gait training with an ankle foot orthosis and functional electrical stimulation of the gastrocnemius muscle for a chronic stroke patient. This study adopted a single-case design (ABA’B’) : gait training with the ankle foot orthosis during the A and A’ phase, and gait training with the ankle foot orthosis and functional electrical stimulation during the B and B’ phase. In our results, maximum gait speed and step length increased during the B and B’phase. Cadence didn’t change in any phase. Combined ankle foot orthosis and functional electrical stimulation of the gastrocnemius muscle produced effective gait ability for this patient.

Upper limb amputees have experienced the rejection or decrease in the usage of the prostheses a while after they first got them. The main reasons were the uncomfortableness of wearing the prostheses, the weight of them, and the neck and shoulder pain. We experienced three cases, a trans-radial amputee and two trans-humeral amputees. They use body-powered, cosmetic, myoelectric upper limb prostheses which adopted the silicone inner socket containing the shuttle-lock system or the seal-in suction socket with the silicone liner. Consequently, the users who put on the new socket felt more comfortable, and recovered from the neck and shoulder pain because of the good suspension. The silicone liners are useful for the upper limb prostheses as well as the lower limb prostheses.