Balanced Forearm Orthoses are a solution to assist eating movements in people with amyotrophic lateral sclerosis. We introduced the Portable Spring Balancer (PSB) (Honey International Co.) for 13 cases subsidized by the rental system for elderly care from June 2018 to October 2022. We analyzed the recipients based on their type of disabilities, utilized services, and period of use, and concluded that their family members and caregivers were not informed sufficiently how to use PSBs and that the trial use of PSBs was not going smoothly. A case was chosen to study from the introduction of the PSB to the follow-ups and clarified the importance of frequent adjustment of the PSB and the wearer’s postures. It is also effective to use other assistive devices (self-help equipment) together such as customized cutlery.

To improve push-off for patients after stroke, we developed a sole that can reproduce the dorsiflexion motion of the metatarsophalangeal joint. This study aimed to investigate whether this novel sole improved push-off movement in patients after stroke. Ten patients with hemiplegia who were able to walk independently participated. Two gait tasks were performed using an ankle-foot orthosis with oil damper (AFO-OD) with versus without the novel sole. Compared to the conventional AFO-OD, that with the novel sole significantly increased plantar flexion resistive torque at the ankle joint during the pre-swing phase (p＜0.01). Moreover, the high peak electromyography amplitude of the lateral gastrocnemius muscle activity during the single-stance phase significantly increased (p＜0.01). These findings suggest that the novel sole promoted suitable ankle plantar flexion and push-off movement in patients after stroke.

With the view to implement early rehabilitation for persons post-stroke, orthoses manufacturers are required to deliver double upright knee-ankle-foot orthoses as early as possible. The measurement/casting process and manufacturing process are performed at different departments in our company. Therefore, orthotists transfer the measurement data to the manufacturing department to order orthoses. One of the factors to hinder the shortening of delivery time of orthoses is that written paper documents are used to transfer information between these departments. In order to solve this problem, we have developed a system of creating parts layout drawings for paperless communication, using Photo Trace, a software program that we developed and launched. In this paper, we report how this system works and its prospects in the future.

We developed a knee-ankle-foot orthosis with a multi-axis mobility knee joint (CB-KAFO) for hemiplegic stroke patients with hyperextension of the knee joint during the stance phase of walking (extension thrust pattern; ETP) by combining a multi-axial knee joint, Sakima CB03A-01 (manufactured by Sakima Prosthetics & Orthotics Co., Ltd.), and an ankle-foot orthosis. The CB-KAFO was applied for two hemiplegic stroke patients with ETP while walking and the effects on gait velocity and gait verified. We administered the 10-meter walking test before and after CB-KAFO and 3 years later, and calculated the knee joint flexion angle in the stance phase using ImageJ, an image processing and analysis software program, and compared the results. The results showed that CB-KAFO improved the gait velocity and knee joint flexion angle of the stance phase both immediately and in the long term, suggesting that CB-KAFO may provide significant improvement in these areas.

In orthotic therapy for strokes, the shoehorn brace (SHB) is the most frequently prescribed orthosis in Japan. However, in the case of severe varus of the ankle joint, SHB does not provide sufficient corrective force. Therefore, a T-strap is used with an ankle-foot orthosis with metal support. According to the results of a questionnaire survey of users of ankle-foot orthosis for stroke, users had lower satisfaction with the appearance of ankle-foot orthosis with metal support compared to SHB. This study aimed to expand the range of indications of SHB widely used for stroke therapy now, by fabricating and evaluating a prototype of a T-strap for SHB that can be used even by users with severe ankle varus. A conventionally fabricated SHB or an SHB with T-strap was worn on a healthy subject, and the ankle joint angle was measured while the ankle joint was supinated. The results showed a decrease in the supination angle of the ankle joint when the SHB with T-strap was worn compared to the conventional SHB.

This study investigated the effects of repeated reclining movement, such as inclining and raising the back support, on pelvic tilt angle and respiratory function. The subjects were 21 healthy adults (20.6±0.6 years old). We measured pelvic tilt angle and forced vital capacity (FVC) before and after reclining movement in two experimental conditions: one condition with one reclining movement and the other condition with three reclining movements. In both conditions, the pelvis tilted significantly backward (p＜0.01) and FVC significantly decreased (p＜0.05) after the reclining compared with before the reclining. In the three-time condition, the pelvis tilted significantly backward compared to the one-time condition (p＜0.01), but there was no significant difference in FVC in comparison with the one-time condition. The results suggest that repetition of reclining movement increases posterior pelvic tilt, but the decrease in FVC may be caused by effects other than increase of posterior pelvic tilt.

A questionnaire survey was conducted to clarify the relationship of physiotherapists to follow-up after the prescription of lower-limb orthosis, as well as to the current status of cooperation with other occupations. An online questionnaire created by the author was distributed to physiotherapists recruited by snowball sampling. The results were simply aggregated. Responses were received from 224 physiotherapists. Of the total, 16％ were involved in the production of lower-limb orthosis by using an identification booklet for the physically disabled, and 90％ had fewer than 5 opportunities per year. To enhance the follow-up management of lower-limb orthotic users, physiotherapists need to create small local communities of individuals engaged in related occupations. They also need support to make a second lower-limb orthosis covered by an identification booklet for the physically disabled.

A questionnaire survey was conducted with the purpose to clarify the current status of follow-up of users of lower-limb orthoses by prosthetists and orthotists, and the collaboration with other professions related to lower-limb orthosis. The authors created an online questionnaire survey and distributed 913 invitations to participate in the survey to potential participants including 237 manufacturers nationwide, and analyzed the results obtained by simple tabulation. Responses were obtained from 173 participants. Sixty-six percent of the respondents answered that they lacked opportunities to visit the homes of orthosis users to check the state of usage. Ninety-two percent responded that they were unable to provide information regarding the lower-limb orthoses to care managers on a routine basis. The involvement of prosthetists and orthotists in the follow-up of lower-limb orthosis users was insufficient, suggesting a state of poor collaboration with other professionals such as care managers.

To address the issues of ankle-foot orthosis wearing in stroke patients, this study was conducted to clarify the difference in weight bearing on the heels during walking when the orthosis is put on by the wearer (self-wearing) and when the orthosis is put on by a physiotherapist (physiotherapist-wearing). Thirty healthy subjects and 17 stroke patients were studied. Using a simple gait analysis system (the Gait Judge System) and a weight-bearing measurement system, the weight bearing during a 10-meter walk when wearing an ankle-foot orthosis and the gait function obtained from the 10-meter walk were evaluated. The weight bearing was significantly lower in stroke patients than in healthy subjects both for self-wearing and physiotherapist-wearing. In addition, in stroke patients, the number of steps was significantly reduced, although slightly, in physiotherapist-wearing situation compared to self-wearing.