Congenital limb deficiencies are rare genetic conditions and treatment options vary according to their phenotypes. In longitudinal deficiencies of lower limbs, limb-sparing surgery or prosthetic fitting following amputation is selected. In upper-limb deficiencies, amputation is rarely indicated ; reconstruction for radial deficiency and prosthetic fitting for transverse deficiency proximal to the carpus are commonly-used treatment options. Treatment for acquired pediatric amputations follows that for congenital transverse deficiencies and indications for prosthetic fitting are common. In both congenital and acquired conditions, multidisciplinary collaboration by medical doctors, prosthetists-orthotists, physiotherapists, occupational therapists, and other professionals is necessary. Sharing information and unifying recognition on treatment options through medical conferences are important.

Myoelectric prosthesis is a useful tool for children with congenital upper limb deficiency in terms of expanding their daily activity and participation. The rehabilitation approach for children with upper limb deficiency should be performed according to their physical and mental development. In addition, these rehabilitation and supportive care programmes should be provided continuously for the long term. Facilitation of myoelectric prosthetic hands in their home, kindergarten, nursery school, and elementary school has a big influence on their permanent use of prostheses. Here, we describe rehabilitation our approach to support the independence of children with upper limb deficiency in preschool and elementary school. We also introduce our initiative ‘meet-and-greet of kids with upper limb deficiency and their families’ as a peer support and information exchange.

Myoelectric prosthesis is a useful tool for children with congenital upper limb deficiency in terms of expanding their daily life. However, very few children use myoelectric prosthesis in Japan. Hyogo Rehabilitation Center have introduced a framework in 2002 to allow children to train and fit a myoelectric prosthesis at any time. We have trained more than 70 children with upper limb deficiency. Here, we summarize the history of myoelectric upper limb prosthesis for children and report our experience and credential in Hyogo Rehabilitation Center. Also we would like to mention about the impact on rehabilitation service by COVID-19, and future perspective.

Pressure dispersion is known as an important function for insoles. However it cannot be evaluated effectively with the conventional parameters. Therefore, we developed a new insole evaluation method based on pressure dispersion. We verified the pressure dispersion effects of the newly developed evaluation parameters. The subjects were healthy adults, 8 male and 3 female. Sample conditions were 5 types of different foam resin. We calculated three parameters based on foot pressure distribution during standing. The calculated parameters were conventional (Peak-pressure and Contact-area) and a new parameter (Pressure Dispersion Parameter; PDP). Each parameter was compared with the dispersion degree of sensory evaluation. The result of this study was that our new evaluation parameter (PDP) has a higher correlation with subjectivity than conventional parameters. It’s hoped that these results will establish sufficient evidence for the efficacy of our new insole.

We have developed a new orthosis strap, the Calcaneus Stabilization Strap, for the purpose of correcting equinovarus in combination with the Ankle-Foot Orthosis. For the purpose of verifying the effectiveness of this product, a standing test and plantar pressure measurement during walking were performed in 15 patients with chronic stroke hemiplegia. Under the conditions of using this product, the standing sway area of the center of pressure was reduced and the cross test result was improved. These results suggest that standing balance was improved. From the result of a gait test, the improvement of the equinovarus was suggested by the segmented foot pressure value. And the improvement in the lateral stability during the stance phase was suggested by the trajectory of the center of foot pressure. In the future, we plan to put this product into practical use after studying its durability during long-term use.

We prescribed a myoelectric prosthetic hand for an adolescent boy with congenital upper extremity deficiency who was a school refuser and trained him in its use. As a result, the boy’s school refusal was improved. When the boy trained and started using the myoelectric prosthetic hand, he began going to school. After lending myoelectric prosthetic hand to the boy, he began to use it at school. We exchanged opinions with school teachers about the use of the myoelectric prosthetic hand. After that, the boy gradually increased the frequency of myoelectric prosthetic hand use at school. The boy also began to use the myoelectric prosthetic hand at home. Therefore, the boy was allowed to purchase myoelectric prosthetic hand at public expense. Children with congenital upper extremity deficiencies may experience disabilities and frustration as they grow up due to deficiencies. The myoelectric prosthetic hand was effective not only in the physical side such as two-handed movement but also in the mental side. Therefore, in order to use a myoelectric prosthetic hand effectively at school, it is useful to exchange opinions between medical staff and school teachers. In the future, it is necessary to explain to many school educators about the effect of myoelectric prosthetic hands.

Toilet movement in stroke patients is one of the most difficult activities of daily living, and patients with motor paralysis or higher brain dysfunction in the early stages of stroke require assistance. A higher severity of disease is associated with a greater amount of assistance. In addition, it has been reported that the frequency of an overactive bladder is approximately 36% within 3 months of stroke onset and that the psychological burden of the urge to urinate and frequency of urination may interfere with improvement in walking ability. We report a case in which a young male patient with cerebral hemorrhage and severe motor paralysis and higher brain dysfunction was able to acquire urination in the standing position, and was able to practice walking sufficiently, with less assistance to frequent urination during physical therapy and occupational therapy by using a knee-ankle-foot orthosis device.

The purpose of this study was to clarify the current state of ankle foot orthosis (AFO) in re-prescription in chronic stroke patients. In Yokohama City 319 stroke patients were re-prescribed AFO under the Comprehensive Service and Supports for Persons with Disabilities Act between October, 2017 and September, 2018. We retrospectively investigated the period to re-prescription and changes in the type of AFO. Fifty-seven (17.2%) changed the type of AFO, the median period to re-prescribing was 49 months (range 15-300), and 33 (17.2%) AFOs had been prescribed more than 10 years earlier. These results suggested that the types of AFO were changed at a relatively high rate even in the chronic stroke patients, and that the follow-up of the orthosis may not be sufficiently performed.