Some clinical studies have been conducted to apply HAL (Hybrid Assistive Limb), invented at Tsukuba University, in the rehabilitation field. In particular, the application of HAL to stroke patients, which have a large number of target patients, is a field that is attracting attention, and it is also a field that can greatly contribute to clinical medicine. These stroke-related applications have a path to future clinical trials, and it is necessary to build evidence, including the clinical position of HAL treatment. I am thinking about the potential of applying HAL to stroke rehabilitation based on the data of clinical research at the University of Tsukuba.

RE-Gait^®, a close-fitting assistive walking robot specialized for the ankle joint, has the feature that the amount and timing of ankle support can be changed according to the subjects’ gait pattern and enables dynamic control in accordance with the rocker function. Previous studies have revealed that 1) ankle control in response to the heel and ankle rocker function was effective for preventing knee hyperextension and buckling during the stance phase, and 2) assists for forefoot rocker function and subsequent dorsiflexion led to increase stride length and intramuscular coherence of the lower flexor muscles. It was also reported that the utilization of RE-Gait^® increased spinal cord reciprocal inhibition in the lower leg. Dynamic approaches to the ankle joint throughout the gait cycle are expected to improve gait in post-stroke hemiplegic patients.

Pressure ulcers in the sacrum due to pelvic tilting become a problem when elderly people sit on a wheelchair. Though there are a lot of elderly people who spend time sitting on a wheel chair on a daily basis, there are few reports of pressure ulcer prevention in the sacrum that can be applied to ordinary wheelchairs. Therefore, we examined the effect of reducing the sitting pressure of the sacrum when wearing a shape memory alloy corset with a mechanism that can be expected to have a pelvic forward tilting effect while on an ordinary wheelchair. The subjects were 16 elderly inpatients (age: 83±8 years old). As a result of comparison between the conditions with and without corset, the sacrum sitting pressure was shown to be significantly lower with this corset. Therefore, this corset is considered one of the preventions of pressure ulcers in the sacrum which can be applied to ordinary wheelchairs.

The purpose of this study is to investigate the response methods and consultation channels of physical/occupational therapists, care managers, and care workers, and to identify the issues related to the re-prescription and repair of ankle foot orthosis. The purpose of this study was to determine the factors related to the understanding of the orthotic supply system among physical/occupational therapists. The results of the questionnaire survey showed that physical/occupational therapists and care workers detected problems with ankle foot orthosis, but the consultation route was complicated, as physical/occupational therapists and care managers had different understandings in proposing the fabrication of ankle foot orthosis. It was found that physical/occupational therapists who understood the orthotic supply system were influenced more by being in charge of orthotic users and exchanging information over the phone than by years of experience or work environment. In the future, it is necessary to unify and publicize the consultation channels for the re-prescription and repair.

Recently, ankle foot orthosis (AFS: Agilium Freestep) has been used for treatment in patients with osteoarthritis of the knee. However, there is a relative lack of research describing the mechanism of its effects. The purpose of this study was to examine the clinical aspects and to verify kinetics and kinematics effects in healthy subjects and patients with knee osteoarthritis. For the kinetics and kinematics analysis, we measured the lower limb joint angle and the knee joint moment of frontal plane using a three-dimensional motion analysis system. The results showed AFS generated resistance moment during the loading response. In addition, AFS could induce a normal coupling motion of foot pronation and tibial internal rotation, if the flexion motion of the knee and the retention of dorsiflexion at the time of initial contact of the ankle accompanied it during the loading response. This study also found that the first peak of the bimodal knee joint moment was decreased by AFS effects during the stance phase. Finally, motor learning of the normal kinematic chain could be promoted and also knee pain and difficulty of daily living would be improved by using AFS over a long-term period.

We investigated the influence of wearing pressure from flexible knee orthosis on the sit-to-stand motion of patients with knee osteoarthritis. The subjects were seven patients with osteoarthritis of the knee. Knee joint flexion angle was analyzed when the sit-to-stand motion was performed by the subject wearing flexible knee orthosis with three different wearing pressures. High wearing pressure caused a significantly larger knee flexion angle compared to that when wearing no orthosis. The knee joint flexion angle increased with increasing wearing pressure. The knee joint flexion angle at the time of sit-to-stand motion increased with the increased wearing pressure of the flexible knee orthosis.

The sole plate corrects the alignment of the foot, and through the kinetic chain, its effect spills over to the knee joint, hip joint, pelvis, and trunk. In previous studies, it has been reported that correcting foot alignment has a ripple effect on the scapula. However, there are no reports regarding the effect on the elbow flexor muscles. This study aimed to determine if plantar insert therapy, which corrects foot alignment, has an immediate effect on improving elbow flexor strength in patients with external flat feet. Subjects were 10 men diagnosed with bilateral flat foot. The sole plate was evaluated by visual inspection and palpation of the subtalar joint, It was made to guide the subtalar joint in the neutral direction. In this study, it is speculated that the reason for the improvement of elbow flexor muscle strength from wearing the sole plate for patients with external flat foot was stabilizing the foot and eliciting floor reaction forces through the use of the sole plate. Secondarily, the alignment of the scapula was changed by wearing the sole plate, and posture was corrected, making it easier to perform the scapula was induced to rotate the scapula upward.

Recently, several multi-grip myoelectric prosthetic hands have become available in clinical practice in Japan. However, the indications for these novel myoelectric hands are still unclear. Here we report the experience of training and evaluation of two types of myoelectric prostheses, a traditional myoelectric hand (Ottobock Healthcare Products GmbH, myobock system) and a multi-grip myoelectric prosthetic hand, for a male with unilateral transradial amputation. Both prosthetic trainings have been completed successfully, and the multi-grip myoelectric prosthetic hand has been superior to the traditional myoelectric hand in various activities of daily living (ADLs) and vocational evaluations. Work efficiency was much better in the multi-grip myoelectric prosthetic hand than in traditional myoelectric hand in his workplace. As a result, the multi-grip myoelectric prosthetic hand was prescribed, and he reintegrated into a full-time job as a salesperson. For appropriate prescription of upper limb prosthesis, it is important to evaluate the need of each case in ADL and vocational activities, and to provide appropriate prosthetic training. The multi-grip myoelectric prosthetic hand could be a solution to improve work-related bimanual activities that are difficult to perform with the traditional myoelectric hand.

The secondary disability of lower limb amputees is thought to be related to the gait pattern of prosthesis users. In this study, we performed walking exercise and home exercise for 2 months for a unilateral trans-femoral amputee whose limb was amputated 17 years ago, and tried to improve her abnormal gait pattern. The use of vaulting on the intact limb improved, but subsequent recurrence was observed. Pelvic anterior tilt and lumbar lordosis during static and walking decreased after the intervention. Although it is possible to improve the use of vaulting itself, it was considered that the recurrence occurred because some use of vaulting was required in daily walking. Improvement in the pelvis and lumbar spine is thought to have been caused by re-education of the psoas major muscle.

Although some reports have indicated the regional differences in the payment of the installation costs of wheelchairs and seating support devices by the public system, the specific situation has been unclear. In this study, the number of new grant decisions for wheelchairs, seating support devices, and other related prosthetic devices for each prefecture was counted for the 2005-2019 Report on Social Welfare Administration and Services. Then, the above number was divided by the number of people with physical disabilities who meet the provision requirements, getting a “provision ratio” in order to compare the difference among regions. The findings include the provision ratio of each prefecture varying annually, the comparison of difference among prefectures showing up to ten times or more, and the national provision rate fluctuating from year to year. Though the inability to ascertain the exact number of people who need these prosthetic devices is an issue, this result can be expected to serve as reference material for future efforts to eliminate such regional differences.