The purpose of this study was to investigate the usefulness of the double-layered ankle-foot orthosis (AFO), which has foot inner made of elastic hard thermoplastic material. The subjects were seventeen cases who had complained of the difficulty of wearing the usual AFO. The most common disease was cerebral palsy : there were thirteen cases that were spastic type. There were seven cases that could walk alone or assisted, and ten cases that could not walk. The age at the time of the first double-layered AFO was three to twenty-four years old. With the double-layered AFO, all cases experienced good wearing conditions and fifteen cases could wear the brace for a short term. The double-layered AFO, which can be easily put on by an inexperienced caregiver in a good alignment, seems to be useful, especially in cases with severe spasticity.

A joint study by industry-academia collaboration was planned to develop a wearable robot that can freely change the braking force applied to the knee joint during gait training for patients with severe hemiplegia due to stroke. Robotic MR-KAFO prototypes were completed based on the idea that both the magneto-rheological (MR) fluid brake developed for the ankle joint of an ankle-foot-orthosis and a spring to assist knee extension would be equipped on the knee joint. The eight levels of knee joint braking force can be changed instantaneously in each phase of the gait cycle, and a gait analysis system was incorporated into the robot in order to measure angle changes in the knee and ankle simultaneously. The braking force setting and the gait analysis system were designed to communicate between the prototypes and a tablet PC using Bluetooth. In trial walking performed by a healthy subject, excessive flexion of the knee joint was prevented during the standing phase by applying strong braking force. Additionally, the knee joint could be bent up to about 20 degrees at the toe-off phase by removing the braking force only between the heel-off and the toe-off phases. In the future, it is necessary to verify whether the Robotic MR-KAFO is useful for stroke patients with hemiplegia.

Although ankle foot orthosis (AFO) with heel height has been used to improve the walking ability of post-stroke patients with hemiplegia accompanied by equinus foot contracture, there is no long-term report regarding their walking ability. In this report, we present the one-year clinical course and the outcome of a chronic stroke patient with equinus foot contracture who used an AFO with heal height and underwent physiotherapy. A man in his 60s had cardiogenic cerebral embolism 9 years ago. He had left hemiplegia combined with equinus foot contracture, and required supervision while walking without use of orthosis. An AFO with heal height and physiotherapy were prescribed with the purpose to improve walking ability. The equinus foot improved slightly, heel contact became possible by using the AFO with heel height. He acquired walking independence both indoors and outdoors, which was maintained for one year. Short-term intensive physiotherapy was conducted three times. Although improvement in walking speed was observed each time, therapy was not continued. Use of an AFO with heel height was effective in improving gait and walking independence in a chronic stroke patient with hemiplegia combined with equinus foot contracture.

An ischial weight-bearing brace is prescribed when a patient with femoral fracture needs a weight-bearing restriction, as an ischial weight-bearing brace allows gait training from the early stage of recovery. However, when using the ischial weight-bearing brace, relatively high body function is required. In this case report, a man was injured with a femoral supracondylar fracture, and the affected side showed lower leg muscle strength, deformity, and leg length differences due to poliovirus infection during childhood. In the affected lower limb, gluteus maximus muscle was normal, quadriceps muscle was completely paralyzed and other muscles also indicated paresis. We fit the ischial weight-bearing brace for gait training at an early stage of rehabilitation after surgery and prescribed a Lofstrand crutch. He gained practical walking ability early and was able to return to work early. The activity level after bracing upon discharge, during the first and second month, recovered to about 70% and 90%, respectively, as compared with the activity level before the injury. Therefore, when the strength of the gluteus maximus muscle is maintained, the patient can be expected to obtain a practical activity level earlier by using an ischial weight-bearing brace, even for cases with paralysis.

It is known that children with upper limb deficiencies sometimes reject their prosthetic hands, especially at over the age of two. However, a way to prevent the rejection is unknown. We retrospectively surveyed 22 children with congenital unilateral transradial or transcarpal transverse deficiencies who were prescribed prosthetic hands at our hospital from 2013 to 2017. The overall rate of continuous use of the prostheses was 86%. Moreover, the rate of continuous use in the patients who were prescribed prostheses at 2 years or older was 90%. Our continuous interprofessional support and peer support contributed to the high rate of continuous use. In detail, the interprofessional support included early initiation of occupational therapy for the patients, multidisciplinary assessment of the body and development of the patients, appropriate prescription of prostheses coincident with the children’s demands, and proper training at occupational therapy. On the other hand, financial burden, and the difficulty in commuting to our hospital were associated with discontinuation of the prostheses, meaning that they were obstacles we should tackle in the future.