In the evaluation of physical therapy, we suppose problems of disability based on interviews and problems of impairment on motion observation to assess disabilities. To suppose problems exactly, it is important that we have to do the motion observation correctly and check characteristics of motion for patients from different points with normal movement. Thus, this process to suppose problems is characteristic in the top down evaluation.

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To predict impairment in the field of athletic rehabilitation, the importance of analyzing of the joint axis during the joint motion is emphasized in this article. Five kinds of joint motion are described in this article, and they are ankle plantar flexion and dorsal flexion, patella setting, trunk extension and rotation, and shoulder flexion. In all cases, it is pointed that abnormality in the joint axis, factors in axis abnormality and the method of alteration of an abnormal joint axis by a physical therapy technique are included.

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To predict problems in patients with Chronic Low Back Pain (CLBP), we must collect the adequate information by the following processes; 1) interview, 2) physical therapy evaluation, 3) manual therapy evaluation, and 4) electromyographical evaluation of individual movement. It is important that we examine not only the relationship among these informations but also the improvement in each one. In this paper, I would like to discuss important issues predicting problems in patients with CLBP.

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We describe the estimation of problems in ataxia, presenting the clinical view and the treatment of ataxia. It is possible to classify ataxia into cerebellar ataxia, labyrinthine ataxia, spinal ataxia, cerebral ataxia and others. Each type of ataxia has characteristic symptoms, but compensatory methods for ataxia have many common parts. To understand ataxia, it is necessary to understand the following items:
1:The characteristic symptoms of each type of ataxia
2:The site of ataxic symptoms and the compensatory methods for ataxia
i) The position of the head and neck
ii) Compensatory methods using the trunk movement
iii) The relationship between the distal and the proximal parts of the limbs
We can often observe compensation for ataxia by excessive fixation, especially excessive extension of the trunk. Generally, the treatment for ataxia tends to stabilize only the unstable parts only by actual training (sitting or standing or walking…). It is very important that physiotherapists understand the true problems of the patient by copying the patient's posture and movement, then estimating the patient's activities of daily living. Then their actions will be better coordinated with appropriate treatment (smooth operation).

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The following is a predictin of problemes in patients with cerebrovascular disease. For this we need to gather much information to predict problems associated with this disease. Before rehabilitation can commence, the following information is needed; 1) order form needs to be filled out for the rehabilitation, 2) clinical records checked, 3) remarks about X-rays, 4) a letter of introduction for rehabilitation is needed. Then, it is important to interview patients to observe activities of daily living to predict problems easier. Patient's activities could then be changed accordingly.

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To predict problems for cervical dystonia, it is necessary to make clear primary and secondary problems using motion analysis. Primary problems are on the affected muscles that the muscle condition shows hyper activity or hypo activity. Secondary problems are the shortening of skin or muscle. To understand the detailed factors of primary and secondary problems is important for treatment in patients with cervical dystonia.

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Interpretation and integration are defined as tying up a patient's capacity for action and measurement results. This paper explains the interpretation and integration divided into the following five. “Solving relativity of impairment and active limitation”. “Solving the cause of impairment”. “Solving the correlation of impairment”. “Solving the correlation of active limitation”. “Inferring a prognosis of impairment from references or improvement of clinical physical therapy”. Interpretation and integration are the most important parts of physiotherapy evaluation.

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We explain a new method for patient's ambulatory movement, the Clinical Motion Facilitation Method (CMFM). The important points in CMFM are as follows: 1) Therapists contact patients using a light touch while conducting the patient's body movement; 2) To conduct the patient's movement, we must understand normal movement. During CMFM for gait, establishing the stance phase with sufficient weight bearing is the most important issue. CMFM is expected to become an effective method for controlling a patient movement.

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D test is an evaluation maneuver to hypothesize problems related to activities in daily life when a patient cannot perform because of some functional disorders. The procedure in the D test consists of three phases. In the first phase, the therapist investigates the joint motion axis during the ankle dorsal flexion of a patient. Next, the normal axis of ankle dorsal flexion is compared to the patient's actual axis. Finally, the therapist considers about factors and effects due to ankle axis abnormality, and observes and analyzes the ‘chain’ action from foot to head. The D test is very useful in the field of physical therapy evaluation. And for its clinical applications, it is necessary to master human functional anatomy and kinesiology.

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For physical therapy for a cerebrovascular disease patient complicated by diabetes, we describe the curing method and cautions. To complicate diabetes, the following symptoms appear or become conspicuous.
i) edema
ii) decreasing sensation (Both sides)·appearance of extraordinary sensations
iii) extraordinary muscle tone of the trunk muscles
iv) ataxia caused by peripheral nerve disease
v) others
These symptoms promote poor movement contorol as well as poor blood sugar control. We must not only improve movement in cerebrovascular disease, but also get good control of blood sugar. It appears that these symptoms are factors which strongly influence on both, and we need to take measures against.

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We encountered 5 patients with cerebrovascular disease, who demonstrated shortening of the trunk muscle. We thought that the shortening was caused by primary low muscle tone. We investigated whether there was an effect on sitting and walking postures by stretching the shortening muscles. So we stretched these muscles at first. But we could not obtain good effect on either static sitting or walking postures. Then we selected one patient, and tried using weight shifting during sitting with sufficient muscle contraction. As a result, we could acquire improvement in both sitting and walking postures. From the above investigation, it was suggested that both stretching the shortened muscles and performing physical therapy based on normal movements were important therapeutic exercise for patients with cerebrovascular disease.

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We described all cross sectioned images of the cruris on 1 screen using a curved array type probe, and tried to measure the cruris muscle cross-sectional area. The usefulness of a ratio of a dorsi/plantar flexor, relation to ankle joint muscular power, and an evaluation index for a test of physical strength and fitness was examined using the cruris muscle cross section product obtained by this method. This made the control group five generally healthy men which amounted to ten legs made up of 26 high school male sport players (a total of 52 legs) that did not have an exercise habit. Depiction of cruris muscle by the ultrasonic wave was performed at 30% of distant position of tibia length from the tibia point in the posterior position (on gastrocnemius) using 2-5MHz extensive zone curved array type probe (HDI 5000 by the ATL company). Isokinetic muscular power was measured using Cybex350, the peak torque value of ankle joint dorsi flexion and plantar flexion power was also measured. The muscle cross-sectional area of a high school male sport player showed a higher value than that of a generally healthy persons. The ratio of the ankle joint dorsi/plantar flexor, it turns out in a muscle cross-sectional area that a dorsi flexor becomes about 30% of that in a plantar flexor. Isokinetic muscle power was about 40% at 180 deg/s and about 30% at 60 deg/s. It is thought that measurement of muscle cross-sectional area using the ultrasonic dislocation method is valid as an evaluation index in a test of physical strength and fitness since all cross section images could be described on 1 screen without damage and correlation with muscular power accepted. For comparison with CT or MRI, it is thought that using phsiological cross-sectional area with consideration of the device of the measurement position for obtaining the maximum of a plantar flexor group further from now on, or the direction of pennation angle and muscle fiber that it is necessary to reexamine.

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To establish the evaluation of motor skills, this study investigated the torque curves of target matching task during shoulder external rotation. In this study, subjects were seated on the seat of Biodex System3 with the shoulder abducted at 90 degrees on the scapular plane and the elbow flexed at 90 degrees. The torque curve was recorded during isometric voluntary contraction of the shoulder external rotation with repetitive electrical stimulation of the brachial plexus at the supraclavicular fossa (Erb's point). We analyzed torque curves as follows; 1) pattern classification of torque curves. 2) calculation of total deviate integration against the target torque integration. In the pattern classification of torque curves, we defined 6 patterns as follows; “Early flat”, “Late flat”, “Early peak”, “Late peak”, “N cave” and “M cave”. The evaluation index of pattern classification is useful for analyzing motor skills using feedback control during ramp movement. There were different results of the total deviate integration against the target torque integration in the same torque curve pattern. Therefore, it is also useful to evaluate the motor skill in the same torque curve pattern. We believe those indices of torque curve pattern and total integration against target torque integration will be useful for analyzing the process until the output of voluntary contraction corresponds to the target in motor skill using feedback control.

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This report described the effect of remote acupuncture therapy for a scoliosis patient with low back pain. It was considered that the cause of the low back pain was contraction of the erector spinae. Contraction pain of the erector spinae was induced by trunk malalignment due to reduced trunk stabilization. Trunk instability was induced by reduced activity of the obliquus abdominis. Therefore, in order to increase the activity of the obliquus abdominis, remote acupuncture therapy was performed on the GB41 (Ashirinkyu). GB41 was a reaction point on the Gallbladder Meridian through the obliquus abdominis. As a result of remote acupuncture therapy, low back pain and trunk instability were reduced because the activity of the obliquus abdominis was increased.

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To investigate the effect of acupuncture using neurological and electromyographic evaluations. We reported the effect of acupuncture based on the meridian concept by a writing evaluation test and writing pressure in a patient with writer's cramp. This case is a 67-years-old male, a right-handed retired office worker complained of writer's cramp causing involuntary movement only during handwriting. The patient reported feeling a sense of incongruity during handwriting in 1985. He began to feel increased difficulty during handwriting in 1993. When the department of nerve internal medicine providing at a local hospital was consulted on June in 2001, the problem was diagnosed as writer's cramp. We started acupuncture treatment at our clinic in May, 2003. Acupuncture was performed once a week. Retaining needles were used for scalp acupuncture in the upper limb zone, ST11 and GB20 to relieve dysgraphia. Consequently, although some involuntary movement persisted 10 weeks after the start of treatment, control of handwriting became possible. Moreover, agitation during application of writing pressure before acupuncture therapy was improved after acupuncture therapy. As acupuncture improved the writing motion by remote treatment, it was suggested that acupuncture is effective for writer's cramp patients.

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In this study, It was found that there was a relationship between poorcoordination of the limbs and trunk and instability of the lower trunk and pelvic girdle in a stroke patient. It was clarified that instability of the lower trunk and pelvic girdle caused by lower muscle activity of the obliquus internus abdominis made the backmuscles tone higher, and that this condition made the poorcoordination. The effect of treatment for lower muscle activity of the obliquus internus abdominis was verified using a force-measuring platform and surface electromyogram. As a result, the trunk muscle tone in this patient got closer to normal, and the poorcoordination was alleviated. It was suggested that the approach to improve the instability of the lower trunk and pelvic girdle was effective in controlling the poorcoordination.

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We saw physical therapy to a patient with thalamic hemorrhage, whose sitting function in body weight shifting training showed better improvement by passive treatment than by active repetition of body weight shifting. Then we examined the effects of physical therapy using the somatosensory evoked potential. It could be increased that the amplitude of somatosensory evoked potential, and could be increased the postural reflex and asymmetry of posture in body weight shifting training guided passive treatment which would be automatic movement, but the amplitude decreased under active movement, which could not induce improvement. This result suggested that automatic movement caused by passive treatment made sensory input, which may have affected thalamus, and the sensory information acquired in the motor output path. Therefore, body weight shifting training improved postural reflexes and asymmetry of posture.

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We performed physical therapy for a patient with chronic postapoplectic hemiparesis, who had difficulty in individual movement in the upper extremity. It was possible for the patient to flex the shoulder joint, but it was difficult to supinate the forearm and externally rotate the shoulder while keeping the shoulder flexed at 90 degrees. Therefore, we evaluated these movements using electromyography. As a result, the activity of the anterior fiber of the deltoid was low, while those of the pectoralis major, the biceps brachii, and external oblique abdominis were high. Based on the above findings, we tried to stretch the muscles with high activity. After stretching, we could reduce the activities of muscles with hyper tone and facilitate the deltoideus, making it easier for the patient to move independently.

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