Since the Japanese act against cancer was executed in 2007, attention has become focused on cancer rehabilitation. However, orthotic and prosthetic management and assistive technologies are not recognized as one of the cancer rehabilitation measures. We reviewed our clinical results regarding orthotic services for cancer patients at Kanagawa Cancer Center, in Kanagawa Prefecture, Japan. For forty-two cancer patients, forty-nine orthoses, prostheses, and assistive technologies were prescribed from April 2016 to March 2017. For various impairments of various cancer patients, four lower extremity prostheses and 19 spinal orthoses, 15 lower extremity orthoses and 9 upper extremity orthoses and one walking aid and wheel chair were prescribed and utilized effectively. Prosthetists and orthotists will play an active role in cancer rehabilitation to regain human functioning of cancer survivors.
Prostheses and orthoses of the upper limb and pectoral girdle related to cancer treatment are not adequately practiced even in education for occupational therapists. Since treatment methods and disability symptoms vary depending on the cancer type, the involvements of occupational therapists and prosthetists corresponding to the characteristics of the cases vary greatly among hospitals. In our hospital, the majority of the cases are functional disability after surgery for bone and soft tissue tumors. These cases are broadly divided into limb salvage surgery and amputative surgery. Even in patients who undergo limb salvage surgery, since there is no standard surgery and wide resection is basically practiced, post-surgical symptoms are diverse. The characteristics of upper limb amputation for tumors are high-level amputation and use of cosmetic upper limb prothesis in the majority of the cases. From now on, transmission of information from us is urgently needed, in order that our expert skills can reach cancer patients with indications for prostheses and orthoses related to other carcinomas, including outpatient service.
The purpose of this study was to investigate the physical function factor related to femoral prosthetic running ability. Evaluation items were 20m running time as running ability, the Timed Up and Go test (TUG) as balance ability, prosthetic leg landing position time, and isometric muscle strength using a handheld dynamometer as muscular strength. For each evaluation, the comparison was made between the running group and the non-running group. For the items with significant difference, a receiver operating characteristic curve was drawn and a cut-off value was set, and its diagnostic performance was considered based on area under the curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value, and correct diagnosis rate. As a result, in the running group and the non-running group, a significant difference was seen in the prosthetic side hip extension muscle strength. Furthermore, it was confirmed that the diagnostic ability of the cut-off value that separates the two groups is high, and that cut-off value was 0.14kgf/kg. In addition, by the evaluation with the combination of prosthetic side hip abductor muscle strength, it was possible to evaluate those that can run more limitedly.
Bilateral transfemoral amputees have a high probability of having to live in a wheelchair. We report a bilateral transfemoral amputee with finger dysfunction who acquired independence in prosthesis wearing and prosthetic gait as a result of modifying the lower limb prostheses. To overcome finger dysfunction, a circular handle was attached to the locking part, which allowed the patent to don the lower limb prostheses independently. For prosthetic gait, a site on the lateral surface of the socket was prepared for hanging the release cord of the prosthetic knee joint, thus allowing the patient to switch between knee-free and knee-locked positions. As a result, the patient was able to acquire prosthetic gait appropriate to the environment, and became independent in prosthetic walking both indoors and outdoors. This case suggests that even under the condition of bilateral transfemoral amputation with finger dysfunction, modifications of the lower limb prostheses would allow acquisition of independence in prosthesis wearing and prosthetic gait.
The number of elderly amputees has increased recently, and they often experience complicated cerebrovascular disease. Among them, only a small number of cases have acquired ‘functional walking ability’, which represents the difficulty of obtaining it. This is a report of a case that attempted to acquire ‘functional walking ability’ by using prosthetic limbs after cerebrovascular disease and femoral amputation on the paralyzed side by lower extremity arterial embolism. As a result, ‘functional walking ability’ could not be acquired, but applied activities such as ascending and descending stairs and narrow street passage could be acquire. Prosthesis attachment can contribute not only to gait acquisition but also to reduction of the burden of assistance in the Japanese home environment.