A multidisciplinary team approach to prosthetic rehabilitation offers a holistic method of assessing and providing a comprehensive treatment plan for clients. It is important to involve the client/family throughout the rehabilitation process, including goal setting, prosthetic education and device selection, and implementation of skills to enhance performance in daily activities. Treatment plans are modified over the course of the client’s lifespan as activity needs and interests change over time. Community partners are encouraged to participate and help foster a supportive environment for clients to implement adaptive skills.

Clinical experience shows the benefits of starting prosthetic rehabilitation early in the child’s life, using a multidisciplinary approach, and placing emphasis on the client/family goals. Training and education is an important tool for teaching clients how to use their prosthesis optimally. Some children benefit from more than one type of prosthesis or terminal device to enable them to participate in daily activities and sports/recreational activities. Play is an important part of child development and is encouraged in the clinic, home and community settings using adaptive techniques and/or prostheses to enhance the child’s performance.

We provided training on the operation of transradial body-powered prostheses to four occupational therapy students. The training involved continually moving a cube once a week for 5 minutes. We attempted to evaluate motor learning through mechanomyographic (MMG) measurements of the anterior part of the deltoid muscle and anterior serratus muscles. We also took simultaneous measurements using conventional electromyography (EMG). This analysis showed that the four participants discovered how to perform each movement efficiently by trial and error, with findings suggesting that the muscles were being controlled in anticipation of fatigue. Moreover, MMG measurement results indicated that muscle load was a moderate percentage of maximum voluntary contraction. As the performance improved, a decrease in EMG median power frequency (MDF) slowed and muscle fatigue increased during learning. The activity ratio of the anterior fibers of the deltoid muscle to the anterior serratus muscle differed between subjects.

We examined the influence of the balans chair on neck muscle activity during Visual Display Terminal (VDT) work. Nine healthy adults (age 27.8±5.2 years) were included. The participants performed a typing task on a personal computer ; spinal curvature angle at rest and neck muscle activity during the typing task were measured with slump sitting on the standard and balans chairs. Lumbar curvature showed significantly decreased kyphosis during use of the balans chair and neck muscle activity was significantly decreased. This result suggested that sitting on a balans chair improved posture and reduced neck muscle activity during VDT work.

The Gait Exercise Assist Robot (GEAR) is a robot assisting gait exercise for reconstruction of gait in a hemiplegic stroke patient. In this study, we investigated the adaptation of GEAR based on the attributes and gait ability of subacute hemiplegic stroke patients who underwent gait exercise using GEAR (GEAR exercise). The subjects were 21 patients and we divided them into 2 groups according to gait ability at the end of the GEAR exercise : attainment group (independence or supervision, n=15) and non-attainment group (assistance, n=6). In comparison of the attributes between the two groups, days after onset, SIAS abdominal muscles and FIM memory showed significant differences (p=0.03 to 0.04). In addition, for the attributes showing significant differences, as a result of discriminant analysis conducted using gait ability at the end of the GEAR exercise as the dependent variable, SIAS abdominal had the most influence. Investigation of the adaptation of GEAR is considered to be useful for the prediction of gait ability in subacute hemiplegic stroke patients.

Because athletes with upper limb deficiency have difficulties using training equipment for non-disabled persons which require left-right symmetrical movements, it is currently difficult to increase the muscular strength of the affected side and improve the left-right balance ability of these athletes. In the Paralympic swimming competition, athletes compete for time without wearing prosthetic limbs. Therefore, very few athletes train while wearing prostheses. In the present study, we developed a training trans-radial prosthesis for a Paralympic swimmer with congenital trans-radial deficiency, aiming at strengthening the muscles of the affected side and improving the balance ability, and observed good results both in the recorded time and physical findings. We report this case with discussion.

To help improve the daily life and social life of persons with physical disabilities and patients with intractable/rare diseases, the “devices expense subsidy system” has been implemented under the Act on Comprehensive Support for Persons with Disabilities. In this system, part of the expenses for the purchase or repair of devices (such as prosthetics, orthotics, wheelchairs, white canes, and hearing aids.) that support or replace body functions is subsidized. The municipal governments examine the individual applications and subsidize the expense of valid devices to the applicants. Through the process, the applicant submits the application form and a letter of reference from a medical doctor. Once the designated professional organization verifies the application, the device will be made and checked that the size, shape, function and all aspects of it are matched to the user. This article explains the definition of such devices, the outline of this subsidy system, and the points to be noted in its implementation.