Twister orthoses are used to correct in-toeing and out-toeing, and consist of a pelvic band, a twister cable, and an ankle-foot orthosis (AFO). The twister cable is made of spiral coiled springs and connects the pelvic band with the AFO. Twister orthoses are used for children with lower limb paralysis who in many cases present with a rotation deformity of the hip joint ; however, their use in adults has not yet been reported. We report our experience treating two cases of adult poststroke hemiplegic patients whose gate ability was improved by using twister orthoses.

Botulinum toxin type A (BTXA) has been shown to be an effective treatment in reducing muscle tone and managing spasticity in poststroke patients. However, its effectiveness in improving function in lower limb spasticity has been more controversial. In this report, we present our findings in three cases of chronic stroke patients with lower limb spasticity wherein we examine the effectiveness of a 4-week intensive rehabilitation program following BTXA treatment. For each patient, BTXA was injected into spastic muscles of the affected lower limb and a rehabilitation program was provided for the patient in-hospital for 4 weeks. Before BTXA treatment (baseline) and at 2 and 4 week follow-ups after each treatment, the Stroke Impairment Assessment Set (SIAS), the Modified Ashworth Scale (MAS) and the Range of Motion (ROM) of the ankle, the 10 Meter Walking Test (10MWT), the 6 minutes walking distance (6MD), the Timed Up and Go Test (TUG), the Berg Balance Scale (BBS), and the Functional Independence Measure (FIM) were all assessed. In each patient, ankle MAS and ROM, 10MWT, 6MD, TUG, and BBS after 4 weeks improved from the baseline. Furthermore, the ankle MAS and ROM improved significantly within 2 weeks, as did the 10MWT and 6MD over the total 4 weeks. In conclusion, it is suggested that a better improvement of ambulation and balance, as well as spasticity, would be found with intensive rehabilitation following BTXA treatment for lower limb spasticity.

Constraint-induced aphasia therapy (CIAT) is becoming increasingly popular worldwide. It is based on the theory of CI therapy, which is supported by considerable evidence as being useful for rehabilitation after stroke. The CIAT-II protocol (Johnson et al., 2015) was modified to a Japanese version, consisting of intensive training using five expressive language exercises, with shaping and a transfer package for 3 hr/day for 15 consecutive weekdays. We assessed outcomes using the Standard Language Test of Aphasia (SLTA) and Verbal Activity Log (VAL) before and after therapy. We confirmed some improvements in language function using the SLTA and remarkable improvement in VAL amount-of-use scores. Language function and communication skills can be improved using CIAT in patients with chronic aphasia, based on their language function evaluation. The present findings suggest that CIAT might be effective as speech therapy for Japanese patients with chronic aphasia.

Constraint-induced aphasia therapy (CIAT) is becoming increasingly popular worldwide. It is based on the theory of CI therapy, which is supported by considerable evidence as being useful for rehabilitation after stroke. The CIAT-II protocol (Johnson et al., 2015) was modified to a Japanese version, consisting of intensive training using five expressive language exercises, with shaping and a transfer package for 3 hr/day for 15 consecutive weekdays. We assessed outcomes using the Standard Language Test of Aphasia (SLTA) and Verbal Activity Log (VAL) before and after therapy. We confirmed some improvements in language function using the SLTA and remarkable improvement in VAL amount-of-use scores. Language function and communication skills can be improved using CIAT in patients with chronic aphasia, based on their language function evaluation. The present findings suggest that CIAT might be effective as speech therapy for Japanese patients with chronic aphasia.