There is a strong connection between humans and their environments, and it is accepted that humans and their environments influence each other. Prostheses and orthoses including assistive devices are an environment factor for disabled persons and aged persons ; these environments have a big impact on their activity, social participation, and even mind and body in a lot of ways. In recent years, stress and autonomic nerves have been evaluated using heart rate or amylase activity value. This paper describes the evaluation method of stress and autonomic nerves for simply and inexpensively evaluating a level of the stress.

The aim of this study was to clarify the effect of walking exercise using the non-powered gait assist suit device ACSIVE on the gait pattern of healthy subjects after 1 hour. Twenty-three healthy adult volunteers participated in this study. All subjects were fitted with ACSIVE and underwent walking exercise of 1,000 steps (500 steps for each leg) in a previous study. Measurements were made barefoot walking before walking exercise (before ex), walking immediately after walking exercise (after ex), and walking at 1 hour after walking exercise (1 hr). Gait was measured using a 3D motion analysis system and force plates. The joint movements of the hip, knee, and ankle were calculated using the inverse dynamic model. As a result, maximum hip joint extensor movement in the loading response showed significant (p<0.01) increase, maximum hip joint flexor movement in the terminal-stance phase and pre-swing phase showed significant (p<0.01) decrease when comparing the after ex and 1 hr to the before ex. The study showed that after-effects of walking exercise using ACSIVE were due to repetition and task-specific effects.

The authors developed an improved seat cover to mount on the back support of a wheelchair to decrease the shear force applied to the buttocks while reclining. The purpose of this study was to investigate the effect of the seat cover. The participants included 14 healthy persons. A force plate was used to measure the shear force. The experimental conditions were three ; the improved seat cover, original, and control conditions. The result of this study showed that the shear force for the improved seat cover condition was significantly lower than for the other two conditions during the return of a fully reclined back support position to the upright position (p<0.01). This result suggested that the improved seat cover could better decrease the shear force applied to the buttocks while the back support was reclined.

In this study, we examined the effect of one- and two-hand tasks on the manipulability of the myoelectric hand prosthesis using the simulated myoelectric prosthesis for myoelectric hand prosthesis training. The subjects were 20 healthy people. We divided them into one-hand and two hand task groups and had them carry out tasks for five days. The one-hand task was block/wood disk movement, and the two-hand task was Macramé production. The Box and Block Test and The Southampton Hand Assessment Procedure were used for myoelectric hand ability assessment, As a result, the two-hand task was shown to improve the object manipulation more than the one-hand task.

In recent years, electric upper limb prostheses have been included as one of the standard prescriptions of upper limb prostheses in Western countries, because of their cosmetic and functional benefits. In Japan also, the myoelectric controlled upper limb prostheses have been provided under the Comprehensive Services and Supports for Persons with Disabilities Act and the Industrial Accident Insurance Act. However, currently, provision of electric upper limb prosthesis as a special prosthetic device under the Comprehensive Services and Supports for Persons with Disabilities Act remains difficult. In this case study, the electric upper limb prostheses of amputees who have been using electric bilateral upper arm prostheses continuously for over 30 years have reached the limit of durability. In 2012, the amputees applied to the Tokushima City for the provision of electric upper limb prosthesis under the Comprehensive Services and Supports for Persons with Disabilities Act. In 2016, the Rehabilitation Counseling Center of Tokushima Prefecture received a decision of conformity, and approved the provision of new electric bilateral upper arm prostheses. This article describes the conditions of the damaged electric upper limb prosthesis that had been used for 30 years, the specifications of the new electric upper limb prosthesis, and the process from application for the special prosthetic device to provision of the device.

An endoskeletal functional upper arm prosthesis has been used in clinical practice to enable patients with shoulder disarticulation or high-level amputation such as forequarter amputation to regain the ability to grasp objects. We successfully built an endoskeletal functional upper arm prosthesis for a transhumeral amputee who wanted a functional upper arm prosthesis with an improved appearance. During the manufacturing process, we noted that ① the fingers of the hand would open when the elbow hinge was flexed over 90° while unlocking it. We addressed this issue by adjusting the spring tension in the body-powered hand. Related to this issue, ② the elbow hinge would sometimes not flex completely. We developed a cable that also functions as a spring to address this issue. The cable uses a spring to assist in elbow flexion, thus improving the angles of elbow flexion. These improvements enabled manufacture and use of an endoskeletal functional upper arm prosthesis with improved design that is also user-friendly.

Our daily medical practice saves persons in distress and offers hope, the results of which bring benefits that meet patients’ expectations in almost every case. At the same time, it is also a fact that we experience cases in which the provided medical care brings unintended harm to the patient, casting a shadow over the life of not only the patient but also the patient’s family and the practitioners involved. In order to deliver maximum benefit to patients in the complex and uncertain course of care, it is required that we understand the purpose of incident reports and ways of applying them in our daily practice, as well as the causes of human errors, thereby recognizing potential incidents and adopting appropriate prevention strategies based on the awareness that “malpractice is always possible.” Above all, we believe that what ensures patient safety in medical practice is an institution-wide patient safety effort that focuses on achieving “improvements.”