Abstract: [Purpose] To examine the clinical significance of the values obtained using a system to measure the lower-limb and gluteal loading forces in a sitting position. [Subjects] Twenty-three females elderly requiring care or support (Long-Term Care Insurance Grade: Care 1 to Support 1;mean age:83.8±8.5;and mean weight:44.0±8.6 kg) were studied. [Methods] The correlation between the lower-limb and gluteal loading forces and physical functions (the ability to maintain an upright sitting posture, walking, and lower limb muscle strength) was examined by calculating Pearson's correlation coefficient. [Results] A significant positive correlation was observed between the lower-limb and gluteal loading forces and each physical function. The lower-limb loading force was also shown to be significantly correlated with the gluteal loading force. <Conclusion> This system may be useful not only for the evaluation of lower-limb function, but also for comprehensive physical assessment covering trunk function.

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[Purpose]We evaluated factors affecting the regaining of gait ability and their cut-off values in stroke patients. [Subjects]The subjects consisted of 35 hemiparetic stroke patients(22 males and 13 females) including those with cognitive impairment. [Method] As candidate factors,the age,Brunnstrom stage, standing balance, upper limb muscle strength, abdominal muscle strength,lower limb muscle strength, plantar sensation, and cognitive impairment, and their associations with gait ability were evaluated. The factors affecting gait ability were analyzed by logistic regression,and their cut-off values for regaining the ability to gait unassisted were evaluated based on the ROC curve. [Results] The factors affecting the regaining of gait ability were identified as the muscle strength of the paretic lower limb and HDS-R score, and their cut-off values were a muscle strength/ body weight ratio of 24% and a score of 25, respectively. [Conclusion]Our study suggested that hemiparetic stroke patients who can regain the ability to gait unassisted can be discriminated based on the muscle strength of the paretic lower limb and HDS-R score.

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Abstract: The purpose of this study was to evaluate the patterns of standing-up movement from the floor and characteristics of physical functions in male senior citizens. Subjects were 49 males (average age 74.8±5.7 years), aged over 60 years old. Patterns of standing-up movement from a supine position were classified, and the age, body mass index, time to stand up from the supine position, upper and lower limb muscles of the trunk, flexibility, standing balance ability, gait ability were compared between the classified groups with one-way ANOVA. The association between the time to stand up from the floor and each physical function was assessed. As a result, patterns of standing-up movement from a supine position were classified into three categories(1:standing up from a position in which both hands and feet are on the floor and both legs are straight, 2:standing up from a position in which one knee is on the floor, and 3:standing up from a squatting position),and there were significant differences in the BMI and time to stand up from the floor between groups. A multiple comparison test revealed that the BMI was significantly higher, and time to stand up from the floor was significantly longer in Group 1 than 3. On the other hand, the time to stand up from the floor was significantly correlated with all items, excluding physical flexibility. Based on these findings, it was suggested that patterns of standing-up movement from the floor in male senior citizens are influenced by their body types, and measurement of the time to stand up from the floor can possibly become a screening test to determine whether further testing of the physical strength is necessary.

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Abstract: This study aimed to develop guidelines for supporting main caregivers who care for dependent elderly using ambulatory rehabilitation facilities, and was designed to extract factors that affect depression. Forty-three dependent elderly and 43 main caregivers were enrolled. We examined depression, care burden feeling, sleeping hours, caregiving period, and age of the caregivers, as well as the ADL, level of care burden feeling, grade of care need, and age of the dependent elderly in order to determine the relationships with depression. Multiple regression analyses revealed that two items have an effect on depression: the age of the dependent elderly and the level of care burden feeling of caregivers. It was confirmed that depression of caregivers became higher as the age of the dependent elderly decreased and/or the level of care burden feeling of caregivers increased. The results suggest that rehabilitation for function lost with age and support for caregivers with strong care burden feelings are important to reduce depression in main caregivers for dependent elderly.

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The purpose of this study was to investigate the difference of gait adjustment between with and without fall experience elderly when stepping over an obstacle on a dual-task condition. The subjects were 30 community-dwelling elderly women. In addition, 30 community-dwelling elderly women were divided 7 people who had a history of falls and 23 people who had no history of falls in the past year by based on interview results. We measured stepping over parameter the single and dual tasks. The single task was a solitary motor task. The dual task consisted of a motor task and a concurrent cognitive task. The motor task was stepping over a 2cm high wooden obstacle that was 80 cm wide, and 15 cm deep, which was set up in the middle of a 9m walkway during comfortable gait, and the cognitive task was the serial subtraction of seven from 100. We measured gait speeds, step length and step width in steady state condition and adjustment of stepping over obstacles. Two-way ANOVA showed that significant differences were found in step length and step width. These results suggest that non-fallers and fallers may have different strategies for stepping over an obstacle.

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[Purpose] The study examined the association between pelvic tilt and basic movements in the sitting position in hemiplegic stroke patients. [Subjects] The subjects consisted of 28 hemiplegic stroke patients (17 males and 11 females). [Methods] As measurement items, anterior and posterior pelvic tilt, pelvic range of motion, basic movements (standing up, sitting down, standing,standing on one leg, walking), Brunnstrom stages, and lower limb muscle strength in the sitting po sition during active exercise were evaluated, and factors associated with the capacity for basic movements were analyzed. [Results] There was a significant correlation between basic movements other than standing on one leg and anterior pelvic tilt, whereas, no significant correlation was observed among each measurement item, the posterior pelvic tilt, and pelvic range of motion. [Conclusion] The results suggest that the ability to anteriorly tilt the pelvis during active exercise may be associated with basic movements in hemiplegic stroke patients.

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The purpose of this study was to investigate the influence of a combination of physical and exercise therapies on the knee joint in patients with osteoarthritis of the knee. Subjects: We evaluated 14 female patients (21 knees) with osteoarthritis of the knee, who did not have a history of undergoing surgery for the disease. Methods: The bending and extending ranges of motion (ROM) of the knee, quadriceps femoris strength, and walking function (walking rate, walking velocity,stride length, step length, step width, as well as stance and swing times) were measured before and after thermal as well as exercise therapies. Results: The ROM of the knee joint, walking rate, and walking velocity significantly improved along with a significantly shortened stance time after each of thermal and exercise therapies. No significant differences in any measurement items were seen between the therapies. Conclusion: Thermal and exercise therapies each showed immediate effects for the limited ROM and walking function in patients with osteoarthritis of the knee, but the effects of exercise therapy were not greater than those of thermal therapy.

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This study evaluated effects of shoulder stiffness caused by a massage chair, based on the muscle stiffness of the trapezius, involving 30 limbs of 15 healthy adult females. We conducted a 15-minute massage program (the shoulder, lower back, and lower limbs) for subjects, and kept them in the same posture at rest in a sitting position for 15 minutes as a control. The trapezius muscle stiffness was measured and compared before starting the massage, after keeping a sitting position at rest, and after the massage. As a result, no significant changes in stiffness were noted after the 15-minute sitting position at rest (12.6±7.8), compared with that before starting the massage (12.8±6.2), but the muscle stiffness was significantly reduced after the 15-minute massage (8.7± 4.8). However, regarding three subjects without complaints of shoulder stiffness, the muscle stiffness increased after the massage. These findings demonstrated that mechanical stimulation by a massage chair significantly reduces muscle stiffness. However, it was not appropriate for all subjects; therefore, the necessity to establish criteria was suggested.

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This study aimed to determine the validity of measurement of the weight-bearing capacity of the lower limbs after orthopedic lower-limb surgery in terms of the evaluation of physical functions, involving 19 elderly patients (mean age: 75.8±7.6) who underwent orthopedic lowerlimb surgery. The weight-bearing capacity of the lower limbs and strength of the quadriceps muscle in a sitting position were examined by calculating Spearman's rank correlation coefficient between the diameter of the femur, thickness of the quadriceps muscle, and FIM motor sub-scores (FIM-M).As a result, both the weight-bearing capacity of the lower limbs and strength of the quadriceps muscle were shown to be significantly correlated with ADL levels; the weight-bearing capacity of the lower limbs exhibited higher correlation coefficients with all sub-items. These results suggest that measurement of the weight-bearing capacity of the lower limbs in a sitting position is more appropriate to evaluate ADL levels of elderly patients after orthopedic lower-limb surgery than that of the strength of the quadriceps muscle.

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Purpose: The purpose of this study was to examine voluntary training guidance by physical therapists for the musculoskeletal ambulation disability symptom complex (MADS) patients with pain and investigated the influences of gender, age and changes in functional measurements. Method: Thirty-one subjects diagnosed as MADS practiced voluntary training guidance by physical therapists once a month for six months. Functional performance measures such as range of motion (ROM), pain, strength, balance functions, walking ability and Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence. We evaluated changes in functional measurements and the associations between physical measurements and changes in functional measurements. Results: ROM of the hip abduction, pain and balance functions were significantly improved after six month. Regardless of gender, subjects aged below 75 significantly improved physical measurements. The changes in ROM of the hip abduction, pain and balance functions showed significant negative correlations with the initial physical performance measurements. Conclusion: It seems to be effective for the MADS patients aged blow 75 and lower physical performance with pain to voluntary training guidance by physical therapy.

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