Regional demographics of spinal cord injuries (SCIs) are fundamental to identifying and implementing appropriate preventive measures. The current study was conducted as a longitudinal analysis of all patients with SCIs admitted to the Hyogo Rehabilitation Center over a 19-year period. The sex and age of the patient, time and nature of injury (i.e., cause, level, and extent), and period from injury to admission were evaluated retrospectively. Pertinent tests, including Poisson regression analysis, and the Cochran–Armitage, Kruskal–Wallis, and chi-square tests, were applied to assess demographic variables, with statistical significance set at p < 0.05. Between 1995 and 2013, a total of 632 patients with SCIs (predominantly male and largely < 60 years old) were admitted to our center for rehabilitation. Although the male: female ratio remained unchanged throughout the study period, the ratio of older adults increased over time. In assessing the cause of injury, the majority of the patients involved in road traffic accidents were aged ≤ 44 years, whereas patients aged ≥ 45 years accounted for the majority of low-distance falls and disease-related SCIs, the proportions of which gradually increased. Complete paralysis and paraplegia primarily occurred in patients aged ≤ 44 years, whereas the majority of incomplete injuries and tetraplegia were limited to those aged ≥ 45 years. The patient age at the time of SCI and the nature of the injury sustained were interrelated. Age-specific strategies thus offered the best means of preventing/reducing the incidence of SCIs in Hyogo prefecture.

Study Design: Prospective cohort study.Purpose: This study aims to examine changes in spinopelvic alignment, sagittal global balance, and low back pain (LBP) following the removal of knee flexion contracture by total knee arthroplasty (TKA).Overview of Literature: The limitation of the knee extension was correlated with the decrease in lumbar lordosis (LL). Currently, there are no studies evaluating the spinopelvic alignment and LBP before and after TKAs.Methods: Sagittal spinopelvic alignment was evaluated in 110 subjects using radiographs of the whole spine. Parameters measured in this study included sagittal vertical axis (SVA), LL, sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). The distribution of sagittal plane modifier grade was evaluated according to the Scoliosis Research Society-Schwab classification of adult spinal deformity (ASD). Consequently, personal history related to LBP was obtained, and the association of pre- and postoperative LBP and spinopelvic alignment was investigated.Results: Preoperatively, 66% of all subjects showed LBP and mostly exhibited anteriorly shifted global imbalance associated with a decrease in LL and knee flexion contractures, and the subject who had severe flexion contracture of the knee joint showed more forwardly shifted global balance with backward PT and decrease in LL. After TKAs, the knee flexion contractures were eliminated in most cases, and one-third of subjects experienced decrease in LBP. However, SVA increased more and associated with slight decrease of PT and increase of SS. No significant differences were confirmed between pre- and postoperative values of LL and PI. In addition, there were no significant differences in postoperative values of spinopelvic parameters between subjects with and without relieved LBP.Conclusions: Although one-third of subjects experienced decrease of LBP after TKAs, the sagittal global imbalance was not restored through the removal of knee flexion contracture.

BackgroundThere has been no research investigating the use of powered prosthetic for children in Japan.ObjectiveTo gain better insight into the state of powered prosthesis usage and identify a ratio of rejection among children.MethodsSubjects were 37 unilateral below elbow amputees between the ages of 0 and 16 at the time of their first experienced fitting with a powered prosthesis at our Center. The information was collected from medical records and through face-to-face interviews, and we examined rejection rate and the factors affecting the use of powered prosthesis.ResultsThe rate of discontinuation was 21.6% as 8 of the 37 children stopped using powered prosthesis. All of them were fitted their prosthesis after 2 years of age, and they rejected prosthesis between 5 to 19 years. We found that the level of amputation had no influence on the use of a powered prosthesis.ConclusionsChildren fitted before 2 years of age tend to accept their powered prosthesis than those fitted after 2 years. Multidisciprinary team approach, adequate rehabilitation, detailed follow-up and involvement of parents are quite important for introducing powered prosthesis for children.

ObjectiveTo investigate the effect of a standardized silicone liner programme on the duration of prosthetic rehabilitation in patients who underwent transtibial amputation as a result of peripheral arterial disease.MethodsThis retrospective study enrolled patients who underwent transtibial amputation followed by one of two stump management programmes at the same rehabilitation centre over a period of 14 years. The study compared the duration of rehabilitation following a standardized silicone liner programme compared with that following a conventional soft dressing programme.ResultsThis study included 16 patients who underwent the silicone liner programme and 11 patients who underwent the soft dressing programme. There were no significant differences between the two groups in age, sex, interval between amputation and admission to the rehabilitation centre and stump length. The duration required for the completion of the rehabilitation programme was significantly shorter for the silicone liner programme compared with the soft dressing programme (mean ± SD: 77.3 days ± 13.4 versus 125.4 days ± 66.4 days, respectively).ConclusionA standardized silicone liner programme reduced the duration of rehabilitation and could be a valuable replacement for soft dressing-based stump management.

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