In the field of rehabilitation of patients with Parkinson's disease, external cues (visual or auditory information) are important in execution of activities of daily living, which is called "paradoxical movement". However, the neural mechanism of paradoxical movement is unclear. In order to clarify the influence of external cues (paced sound) on the activation of the cerebellum, we scanned 9 right-handed healthy subjects by functional MRI while they performed (1) self-initiated finger-to-thumb opposition movements once every second, and (2) the same movements externally triggered by a metronome's sound. During self-initiated movements with the right hand, the cerebellum was activated in all subjects. During externally triggered movements, the activation was decreased in 7 of 9 subjects, and vanished in 1 of 9 subjects. During self-initiated movements with the left hand, the cerebellum was activated in 8 of 9 subjects. During externally triggered movements, the activation was decreased in 6 of 8 and vanished in 1 of 8 subjects. These results suggest the cerebellum's role is feed-forward control during self-initiated movements, but external cues take the place of feed-forward control during externally triggered movemesinnnts.

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To develop a simple test of endurance capacity, we evaluated the usefulness of 15 m Shuttle Walk & Run Test (15 mSWRT). We found that each level in 15 mSWRT was correlated with average oxygen intake (r=0.948), and the average oxygen intake of level 12 in 15 mSWRT was 51.18 ± 8.28 ml/kg/min. There was a significant correlation between average oxygen intake and the walking distance. In addition, 15 mSWRT had a higher maximum work rate than the 10 m Shuttle Walking Test (10 mSWT). These results suggest that 15 mSWRT has usefulness as a simple test of endurance capacity that can be performed safely over a wide range of ages, from middle-aged to elderly people.

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There is a real danger that an inadequate movement strategy invites the prospect of falling in elderly people lacking proper physical strength awareness. In this report we examined the factors regarding falling related to physical strength awareness in the elderly using the recognized `functional reach test', in the clinic. This was done with the objective of constructing an index for predicting falls with high accuracy. We used 88 healthy elderly people that were able to perform the trial and who had no impediments whatsoever in daily life. After subjects declared their estimate values for the `functional reach test' actual measurements were carried out. Errors were shown in individual physical strength awareness arising from differences in predicted and actual measurement values. Three months later, subjects participated in a survey regarding whether or not falls had taken place and were examined for physical strength awareness. As a result of multiple logistic regression analysis, the usual functional reach test result (p<0.05) and physical strength awareness error (p<0.01) were both chosen as influences and factors in falling within the 3 month period. The recurrence adoption when the two factors were included was best. Furthermore, discriminant characteristic analysis indicated the possibility of distinguishing falls by errors in physical strength awareness at 6.5 cm (discriminant rate 91.7%, sensitivity 80.9%). It is thought that this test of physical strength awareness is useful information for predicting falling.

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The purpose of study was to examine the changes of center of pressure (COP) and onset latency of electromyograms of the supporting leg in a motion consisting of elevation of the leg from standing to hemi-standing (raising one leg to 90° of hip flexion) with limitation of the transverse tarsal joint on the supported side. Six healthy subjects, with a mean age of 23.2 years, participated in this study. We limited range of motion (ROM) in the transverse tarsal joint on the supported side in hemi-standing by using taping. Subjects were instructed to perform a motion consisting of elevation of the leg from standing to hemi-standing. Subjects were prompted with a signal for the motion, and performed the motion as quickly as possible. A three-dimensional analysis system was used to compare both the initiation time and end time about the degree of hip flexion. A force platform was used to record the trajectory of COP during the motion. Electromyograms (EMG) were recorded from the tibialis anterior, gastrocnemius, peroneus longus, semitendinosus, rectus femoris and gluteus medius on the supported side. We also calculated the onset latency of muscle activities. We examined the trajectory of COP and the onset latency of electromyograms in the case of limitation and compared them with those in the case of no limitation. The maximum amplitude of the trajectory of COP toward the unsupported side decreased in the case of limitation compared with that in the case of no limitation. The latency at the time of maximum amplitudes of the trajectory of COP did not alter between the cases of limitation and no limitation. The onset latency of only the gluteus medius muscle was prolonged in the case of limitation compared with that in the case of no limitation. The COP primary moves to the unsupported side in gait initiation. It is generally thought that body shifts passively to the supported side due to the movement of COP from the center of the base of support to the unsupported side. From the results of this study, the decrease of maximum amplitude of the trajectory of COP toward the unsupported side shows that the whole body passively shifts to the supported side. We consider that the elongation of the onset latency in the gluteus medius muscle is related to the decrease of the maximum amplitude of trajectory of COP toward the unsupported side. This study provides evidence that limitation of the transverse tarsal joint causes compensatory movement of the pelvis in motion consisting of elevation of the leg from standing to hemi-standing.

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The purpose of this study was to clarify the influence of difference in the angle of forward trunk inclination (AFI) on the activity of the erector spinae (ES) muscles, in the plantigrade (PG) posture, which is observed while standing up from the floor in a PG pattern. Thirty healthy subjects (20 males and 10 females, 20.0 ± 2.1 years old) participated in this study. AFI was analyzed using a two-dimensional movement analysis system. Electromyograms (EMG) was measured when AFI while standing up from the floor was 30°, 60°, and 90°, with knee joints both flexed (KF) and extended (KE). Integrated EMG was normalized relative to values obtained during maximum voluntary contractions (%MVC). The results show that AFI became a maximum (109.9 ± 5.9°) at PG posture. The %MVC when AFI was 30° was significantly larger than that at 90° with both KE and KF. The %MVC of the ES at 60° with KE was significantly larger than that with KF. The results suggested that ES activity by AFI in the PG posture shows a characteristic change similar to flexion-relaxation phenomenon.

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The gait performance and energy consumption of patients with cerebrovascular disorder (CVD) is an important factor in rehabilitation, and ankle-foot orthosis (AFO) is often used to stabilize gait performance in these patients. The purpose of this study was to evaluate the effects of AFO on functional exercise performance and oxygen uptake (VO₂) kinetics in an exercise test using a bicycle ergometer in CVD patients. Twenty-five ambulatory post-stroke hemiplegia patients (20 male and 5 female; 56 ± 11 years old) admitted to Hyogo Rehabilitation Center Hospital participated in this study. To evaluate the effects of AFO on exercise capacity, a graded cycling exercise test was performed, monitoring gas exchange, and data were obtained with and without AFO. To investigate the physical strength, maximal oxygen uptake (VO₂ max, in ml/min/kg), maximal work rate (max WR, in watts) and ΔVO₂/ΔWR (in ml/watt) were continuously monitored while the subjects rotated a bicycle ergometer (the Load-type). VO₂ was measured using the breath-by-breath method. The data are presented as the mean ± SD. Student's t test for unpaired data was used to determine statistical significance at p<0.05. When wearing AFO, (1) max WR was significantly elevated (82.6 ± 26.3 vs 71.9 ± 23.7 watt, p<0.001), although VO₂ max did not change (18.7 ± 4.3 vs 19.8 ± 4.3 ml/min/kg); (2)ΔVO₂/ΔWR was significantly decreased (14.2 ± 3.6 vs 15.6 ± 2.5 ml/ watt, p<0.05). There was an increase of physical work capacity and an improvement of movement efficacy in the exercise test using a bicycle ergometer in CVD patients equipped with AFO. These results suggest that it is important to equip CVD patients with AFO to improve exercise performance in hemiplegia.

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For 21 hemiplegia patients we measured the rising up maneuver time and the center of pressure (COP) in the single elbow support position to find out which physical functions influence it and prevent the rising up maneuver, for treatment strategies. The rising up maneuver time and COP in the single elbow support position using a force plate under the static and dynamic conditions were measured. For the physical function, we measured the range of motion of trunk rotation, hemiplegia motor function, flaccidity of the shoulder girdle on the hemiplegic paralysis side, trunk rotation muscle strength, motor functions of the neck, trunk and pelvis, COP of the muscle strength of upper limb in the single elbow support position and in sitting on the edge of a bed position under static and dynamic conditions. The rising up maneuver time had a significant negative correlation with COP Y axis maximal movement distance (YD) in the single elbow support position under the dynamic condition. For stepwise multiple linear regression analysis, range of motion of trunk rotation, hemiplegia motor function, flaccidity of the shoulder girdle on the hemiplegic paralysis side, COP of the muscle strength of upper limb in the single elbow support position and sitting on the edge of a bed position under static and dynamic condition were adopted for YD interpretation. The analysis suggests dynamic stability in hemiplegia patients is a factor in performing a rising up maneuver smoothly. Furthermore, performing a rising up maneuver smoothly needs complex physical functions requiring multi-faceted approaches to each individual case.

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In the orthopedics field, gonarthrosis (OA) and rheumatoid arthritis (RA) are often seen as typical pain disorders. Exercises for muscle reinforcement of the lower limbs are often performed as general rehabilitation for patients with knee joint disorder; joint proprioception function (sensation of movements and joint angle) is also important for improving ADL. In this study, we focused on the knee joint in order to reveal the relationship between knee joint proprioception (threshold value and position sensation of the knee joint) and muscle strength around the knee joint (extension and flexion torque of the knee). Considering the actual cases in clinical context, we independently made "a relationship model of muscle deterioration and joint proprioception decline" for considering the effect of muscle deterioration on joint proprioception. The knee joint threshold value and position sensation of 20 limbs of 10 healthy women (average age 19.5 ± 0.5) were measured. Also the muscle force of quadriceps femoris and biceps femoris were measured. We used a machine which was designed and built by ourselves for measurement of the knee joint threshold value and position sensation. The measurement of knee joint proprioception gave a correlation coefficient, r=0.89 (p<0.01), in the relationship between the threshold value and position sensation, and the knee joint torque gave a correlation coefficient, r=0.81 (p<0.01), in the relationship between the extension and flexion torque, revealing strong respective correlations. Also the relationship between knee joint proprioception (the threshold value and position sensation) and knee joint muscle strength (the extension and flexion torque) showed a general negative correlation revealing the possibility that knee joint muscle strength is associated with the knee joint proprioception.

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We can experience a large difference in the value of first and second measurements in clinical measurements when evaluating joint position sense. This can bring about a misinterpretation of the true value of joint position sense and it is often thought that reliability of the measurement value is low. This study was designed to examine the number of measurements that are necessary to guarantee a high reliability for measuring joint position sense. Using Barrett's method, we measured the joint position sense at three different set angles for each knee of 32 healthy elderly subjects (i.e. 64 knees). The set angles were set at 10°, 40° and 70°, and measurements were taken as part of our objective at two angle speeds approximately set at 10°/sec and 70°/sec. First, the coefficient of reliability at each set angle was obtained from the measurement values gained through a number of measurements undertaken. Second, we set the coefficient of reliability at 0.81 according to our objectives and we substituted the Spearman-Brown formula for the smallest value of coefficient of reliability that was obtained. We measured the number of times the values that were given due to application of the substitution to obtain the reliability temporarily and subsequently confirmed the angle measurements. As a result, it was understood that in order to guarantee high reliability, it is necessary to use the average values of 3 separate measurements. From this we can assume that it is unreliable to make judgments whether abnormalities exist on just one measurement value and it is therefore necessary to use the average value of three measurements in order to guarantee high reliability for measurements of joint position sense. We consider that it will be necessary to adopt these numbers of measurements for the elderly and for the handicapped in general.

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Vital signs are basic signs of life such as pulse rate, respiration rate, body temperature and blood pressure, and in this study, the definition, outline, method of measurement and interpretation of the results are described. Particular note is made of: pulse relationship with heart rate, pulse palpation and disorders; respiratory disorders and breath sounds; fever and body temperature; and hypertension and blood pressure.

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In the risk management of physiotherapy, electrocardiograms provide a lot of information. An irregular pulse is especially problematic in the clinical setting. The most important point physiotherapists must consider is when they should stop the therapeutic exercise or continue the exercise. In this report, we explain the basic criteria for understanding an irregular pulse, and explain the mechanism with an electrocardiogram.

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We report the blood clinical data and drug side-effects that require attention during physical therapy. The points requiring attention at the time of physical therapy are described for cell contents including red blood cell count, hematocrit, hemoglobin, white blood cell count and platelet count, and blood plasma and serum including uric acid, blood urea nitrogen, creatinine, total protein, albumin globlin ratio, total cholesterol, free fatty acid, triglyceride, blood sugar, serum enzyme, electrolyte, antigen and antibody. For medicines causing side effects, we mention each symptom with relation to physical therapy, for example, anticancer drugs, adrenal cortex steroid, diabetes, cardiotonic drugs, beta-blockers, antiarrhythmic drugs, anti-hypertensive drugs, hydragogue, bronchodilator, sleeping pills, anti-anxiety agents, anesthetics and analgesics. The action time of medical therapy may make the evaluation of physical therapy inaccurate, or cause interactions with therapeutic exercise inducing side effects, to which it is important to pay attention.

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It is important to avoid risks to perform physiotherapy effectively and safely. Risk management means not only knowing the criteria of discontinuance but also predicting various risks and continuing intervention while carefully avoiding these risks. Therefore, therapists should keep in mind to try to check the general condition of patients in order to prevent unexpected accidents. This report mentions some points that therapists should know about reducing risks on introduction of physiotherapy for various acute neurological disorders.

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This report surveys the risks of internal disability for the purpose of achieving the aim of risk management ability. In the case of intervention of physical therapy, it is important to follow the changes of vital signs not only during rest but also during exercise. It is important to consider the patients' daily living activities and quantity of activity, while analyzing and interpreting properly collected data. Too much anxiety with regard to risks promotes the disuse syndrome, therefore, this should be avoided.

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The number of physical therapists working in the health care facilities for the elderly and in the community is increasing. Physical therapists encounter patients who have medical problems that they cannot directly. In foreign countries, independent practice by physical therapists (direct access) has already undergone. In such a situation, the ability to differentiate between musculoskeletal problems and other diseases which show the same symptoms is needed in order to avoid risk. Differential diagnosis is the ability to confirm problems not related to the musculoskeletal system and find the needs of medical intervention from the patients' medical history, subjective complaints and objective findings. Physical therapists need to understand patients' complaints comprehensively. In cases whose condition demands that they should not receive physical therapy, or the condition is beyond the knowledge of physical therapist, the physical therapist should report to the doctor. This article describes differential diagnoses in orthopedic physical therapy.

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