"Problems of the Aged" are nothing but problems of ourselves, constituent members of the society. What was the power of continuous change in the society? By the analysis of the relation between human controls and money, in addition to the introduction of messages from prominent superiors, a strategy for living through our old age is elaborated in this article.

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After the enforcement of the long-term care insurance system in 2000, substantial service of home-based rehabilitation has been being needed. Regrettably, it cannot be said that physical therapists perform their duties in home-visit activities. A series of rehabilitation flow from the acute phase to the recovery or preservation (chronic) phases is imperative in the rehabilitation medicine. Especially in the preservation phase at home, care management which works in cooperation with various home services plays an important role. It is also important to regard the subjects as people who lead ordinary lives, and to make life-linked approaches. The present study introduces the actual activity of home-visit rehabilitation from the viewpoint of a medical office or a home-visit nursing station, and examines the roles of physical therapists in home-based rehabilitation.

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In the thought of physical therapy for elderly people, this article analyzed the function of the facilities with beds for medical treatment where physical therapy is actually performed. First, the change in medical system including rehabilitation was described, and a process of rehabilitation as well as appropriate rehabilitation for each recovery phase was then introduced. Especially about the rehabilitation ward at recovery phase, which plays an intermediary role between medical service and home care, and has been recently being provided with necessaries, its actual management was introduced. Secondly, it was considered what we should do for inpatients of the ward. Finally, making effective use of my experience, future roles of the ward and a physical therapist were discussed.

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The purposes of this study were to compare muscle strength during closed kinetic chain (CKC) exercise of upper extremity in different abduction angle directions of shoulder joint, and to clarify the relationship between the muscle strength and locomotion activities. Sixteen healthy women aged 19.0 ± 1.2 years (mean ± SD) participated in this study. The extensor muscle strength during CKC exercise of upper extremity was measured under nine conditions, which combined each shoulder abduction angle of 0, 15 and 30 degree with each velocity of 60, 180 and 300 degree/sec. Ability of three locomotion activities, the wheelchair driving time on a 10 m path, the number of repeatable push-ups in 30 second and the ratio of weight bearing relieved by loading on T-cane to body weight, was measured under subject's maximum effort. Muscle strength during CKC exercise of upper extremity became significantly smaller with an increase in shoulder abduction angle at all exercise velocities. The muscle strength did not correlate with the wheelchair driving time and the number of repeatable push-ups. But, it significantly correlated with the ratio of weight bearing relieved by loading on T-cane to body weight under 60, 180 degree/sec at all angle directions and under 300 degree/sec at 0° abduction. With an increase in shoulder abduction angle, muscle strength during CKC exercise of upper extremity became significantly smaller at every velocity. This suggests that humeral adduction action of latissimus dorsi muscle may contribute mostly. As for the relationship between muscle strength and locomotion activities, it was found that the ability to load weight on T-cane correlated with muscle strength at 60, 180 degree/sec. This may be because this task does not require high skill, whereas wheelchair driving and push-up require performance skill and muscle endurance in addition to muscle strength. In conclusion, the direction specificity of muscle strength during CKC exercise of upper extremity was shown, but the influence of the direction specificity on locomotion activities was not clarified.

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We evaluated the activity of the elector muscle of the spine with bipolar lead using electromyography during lifting of heavy loads in 11 healthy males. The weights of the load were 5%, 15%, and 30% of the body weight of each subject. The load was lifted from the floor to a table of half height of the subject. In both Preparation-Period and Carrying-Period, the %MVC was large when the weight of the load was unknown. As a result, when the weight of the load was unknown, the muscles appeared to react excessively, inducing fatigue, probably because of overestimation of the weight by the subjects. These results suggested the usefulness of the indication of the weight in handling work of heavy loads.

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Interviews of 39 home-care patients (mean age: 76.9 years) were conducted to investigate current conditions regarding interaction with others and going out. As controls, 31 users of a public community center for the elderly (mean age: 75.5 years) were interviewed. The results revealed that the patients had less frequent interactions with friends and acquaintances and more frequent interactions with health professionals such as home helpers, compared with controls. Based on the frequency of going out, patients were categorized as either homebound or non-homebound patients. Comparison of these two groups demonstrated no differences in the basic attributes of patients. However, non-homebound patients tended to use day care/day services more as opportunities to go out, compared with homebound patients. The results suggest that day care/day services may represent an important measure for preventing home-care patients from being homebound.

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The reproducibility of the measurement values was examined in our newly developed apparatus for measuring the foot grasp power. The present study was also aimed at the elucidation of relationship between foot grasp power and body sway or running velocity. Foot grasp power was measured three times in 55 healthy male subjects (average age: 22.1 ± 3.2 years) and 60 healthy female subjects (average age: 21.2 ± 2.2 years). Body sway was measured by GS3000 and running velocity for 30-m distance was recorded. The reproducibility of measurement values of foot grasp power was high, showing intraclass correlation coefficient of 0.973. Foot grasp power was significantly greater in male subjects than in female subjects, which suggests a difference between the sexes. Female subjects exerted a significantly negative correlation, and male subjects tended to show a negative correlation between foot grasp power and body sway. Subjects of both sexes indicated a significantly positive correlation between foot grasp power and running velocity. These results suggest that foot grasp power may play a role in postural stability, and may work for forward movement during running. The results also suggest the clinical applicability of our new apparatus.

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The purpose of this study was to examine the effect of a difference in body weight between a wheelchair user and an assistant of wheelchair propulsion on oxygen intake, heart rate and rate of perceived exertion (RPE) of an assistant. Assistants of wheelchair propulsion were 17 healthy adults aged 21 years in average, and were asked to push a wheelchair at the velocity of 1-4 km/h on a treadmill without inclination. Relative weight was obtained by the following formula: (body weight of a wheelchair user) / (body weight of an assistant) × 100 (%). A significant positive correlation was observed between the relative weight and oxygen intake at the velocity of more than 2 km/h, and between the relative weight and heart rate at the velocity of more than 3 km/h. At the velocity of more than 3 km/h, metabolic energy cost was increased with an increment of body weight of a wheelchair user. RPE showed no correlation with a difference in body weight. The results of the present study, analyzed by physiological indices, may be applicable to the health improvement and the lightening of care burden of an assistant.

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There is little research evidence concerning the dynamic function of the foot arch. We described the characteristics of the medial longitudinal arch (MLA) in 34 healthy subjects using a six-camera Vicon motion analysis system while they were sitting, supported and non-supported single-limb standing, and during walking. We also measured the length of the MLA in nine men using an electro arch gauge (EAG) during walking. The results showed that the maximum increase of the MLA during the stance of walking was influenced by the vertical components of ground reaction force. We confirmed the MLA as a dynamic structure, which provides the capacity to absorb some of the increased shock and propulsive balance during walking.

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Leg muscle strength of both the operated and unoperated sides was measured before and after total knee arthroplasty (TKA) by the SLR test and gait ability was evaluated by the timed up & go test (up & go test). The results were compared between 16 patients with rheumatoid arthritis (RA) and 12 patients with knee osteoarthritis (OA). Patients were all female and their average age was 67.2 ± 9.0 years in RA patients and 70.8 ± 4.6 years in OA patients. Muscle strength was measured before operation, in full weight bearing (16.9 ± 2.6 days after operation), and at discharge (26.0 ± 2.9 days after operation) by a newly developed manual dynamometer. The degree of pain was also evaluated by Visual Analogue Scale (VAS). In RA patients, leg muscle strength of SLR test in full weight bearing reached almost the same value as that before operation, and was increased significantly at discharge. In OA patients, leg muscle strength of SLR test was decreased significantly in full weight bearing, and reached the same value as that before operation at discharge. Leg muscle strength of SLR test of OA patients correlated negatively with VAS. Compared with before operation, muscle strength of unoperated side in SLR test was increased both in full weight bearing and at discharge in RA patients, but was not significantly increased in full weight bearing and increased at discharge in OA patients. In up & go test, RA patients showed no difference in gait velocity between before operation and at discharge, but OA patients showed lower gait velocity at discharge than before operation. Depending on basic diseases, patients indicate different physical conditions before operation, and exhibit different recovery process even though the same operation and physical therapy are conducted. It is therefore necessary to prepare goal-setting and to proceed programs, which are suited for each disease.

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Measurement of respiratory muscle strength is one of the examinations of respiratory function, and is useful to the diagnosis of respiratory insufficiency and neuromuscular disease, and to the evaluation of clinical features. The present article described the measurement methods of respiratory muscle strength.

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