Journal of the Japanese Physical Therapy Association

Effects of Massage Therapy and Occlusal Splint Usage on Quality of Life and Pain in Individuals with Sleep Bruxism: A Randomized Controlled Trial

Cid Andre Fidelis de Paula GOMES, Yasmin El-HAGE, Ana Paula AMARAL, Carolina Marciela HERPICH, Fabiano POLITTI, Sandra Kalil-BUSSADORI, Tabajara de Oliveira GONZALEZ, Daniela Aparecida Biasotto-GONZALEZ

Released: December 20, 2015

[Advance Publication] Released: February 24, 2015

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Purpose: The aim of the present study was to investigate the effects of massage therapy on the masticatory muscles and occlusal splint usage on quality of life and pain in individuals with sleep bruxism. Method: A randomized, controlled, blinded, clinical trial was conducted involving 78 volunteers aged 18 to 40 years with sleep bruxism. Quality of life and pain assessments were performed. Results: Significant differences (p < 0.05) were found on the physical functioning, general health state, vitality, role emotional and mental health subscales. A large effect size was found for all treatment protocols with regard to pain. The largest effect was found in the combined treatment group. Conclusions: The findings of the present study reveal that the occlusal splint usage alone led to improvements in components of quality of life among individuals with sleep bruxism. Moreover, both treatments (occlusal splint usage and massage therapy on the masticatory muscles) led to a reduction in pain.

Sit-to-walk Task in Hemiplegic Stroke Patients: Relationship between Movement Fluidity and the Motor Strategy in Initial Contact

Yuji OSADA, Sumiko YAMAMOTO, Masako FUCHI, Setsuro IBAYASHI

Released: December 20, 2015

[Advance Publication] Released: March 03, 2015

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Purpose: Generally, stroke patients can walk and stand up fluidly but fulfill the sit-to-walk (STW) task with difficulty. The purpose of this study was to investigate the relationship between movement fluidity and motor strategy in the initial contact of the STW task. Method: Thirty stroke patients and ten healthy subjects performed the STW task from a sitting position, and their movement was measured by a motion analysis system. The differences in data between patients and healthy subjects were analyzed using the Mann-Whitney U test. The relationship between fluidity index (FI) and other indices (kinetic and kinematic data in STW, functional independence measure [FIM], and Fugl-Meyer Assessment [FMA]) were analyzed using Spearman’s rank correlation coefficient. Results: The stroke patients had lower FI values than the healthy subjects and exhibited shortened step length and prolonged duration from onset to the first stance leg off. FI values correlated with trunk flexure angle at initial contact, first step length, and maximum vertical floor reaction force. The independent level of the FIM of stair climbing and walking ability and the FMA of balance also correlated with FI. Conclusion: There is a possibility that poor balance is one of the reasons why stroke patients are unable to start walking fluently from the sitting position. To perform the STW fluidly, patients must start walking before the trunk extension is fully completed. The relationship between FI and indices of physical ability, namely stair climbing and balance, may have therapeutic benefits for coaching the STW task to stroke patients.

Joint Function and Arthropathy Severity in Patients with Hemophilia

Miwa GOTO, Hideyuki TAKEDANI, Osamu NITTA, Kennosuke KAWAMA

Released: December 20, 2015

[Advance Publication] Released: September 18, 2015

p.15-22

Background: The Arnold-Hilgartner classification is one of the most popular evaluation systems for the progression hemophilic arthropathy. A previous study reported an association between arthropathy severity and arc range of motion (ROM). However, associations between arthropathy severity and angular ROM and muscle strength remain unclear. AIM: The purpose of this study was to clarify the association between joint function and arthropathy severity in hemophilia. Methods: We studied the knee, ankle, and elbow joints of 31 patients with hemophilia (PWH). The condition of the affected joints was evaluated on the basis of the interview data, joint function measurements, and roentgenography of the affected joints. In assessment of joint function, we evaluated knee strength (flexor, extensor) and grip strength as well as the passive ROM of the elbow, knee, and ankle. During the interview, all patients were asked about the history of intra-articular bleeding over the past year and pain. Results: As arthropathy severity worsened, knee flexor strength, knee extensor strength, grip strength, and ROM (elbow flexion, elbow extension, knee flexion, knee extension, and ankle extension) significantly decreased. Even patients with mild arthropathies experienced knee extensor weakness and extension limitation. In addition, joint function of severe ankle arthropathy was significantly related to the history of intra-articular bleeding and pain. Conclusion: Our results suggest that physical therapy is necessary to improve joint function in PWH and mild or no arthropathy. Pain control and prophylactic hematological management are necessary for patients with severe arthropathy because intra-articular bleeding and pain significantly decrease joint function.

Evaluation of Physical Activities Using the 30-s Chair Stand Test in Male Patients with Chronic Respiratory Diseases

Koji IWAI, Tetsuya OGUMA

Released: December 20, 2015

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Purpose: The 30-s chair-stand (CS-30) test is a useful methods to evaluate exercise capacity. The study aimed to investigate whether standing frequency during the CS-30 test could evaluate physical activities (PA) in patients with chronic respiratory diseases.
Methods: The study population consisted of 33 patients with chronic respiratory diseases. During hospital stay, CS-30 test, knee extension strength assessment, and spirometry were performed. One week after discharge, PA was assessed again. The results were analyzed using correlation and multiple regression analyses.
Result: Multiple regression analysis, showed that the modified medical research council (mMRC) scale (β = –0.55), and standing frequency during the CS-30 test (β = 0.34) significantly(R = 0.83, R² = 0.67, p < 0.05) associated with PA, as derived using a moderately accurate multiple regression equation. However, knee extension strength and pulmonary function did not significantly associate with PA.
Conclusion: Our results have indicated that the standing frequency during the CS-30 test is feasible to evaluate PA in patients with chronic respiratory diseases.

The Effect of Physical Therapy Intervention on Cerebral Palsy Patients with Windswept Deformity and Hip Dislocation

Katsumi SHIMIZU, Takaharu KONDOU, Tomoyoshi OOTSUKA, Michiyuki KAWAKAMI

Released: December 20, 2015

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Objective: Windswept Deformity (hereinafter WD) develops with the growth of patients and in many cases involves hip dislocation. This study aims to reveal influences of hip dislocation on the effect of physical exercise.
Subjects and Method: The subjects were 17 patients with WD (7 men and 10 women, and class V of GMFCS, whose average age was 24.75 years). The patients performed lateral position exercise for half an hour and ROM exercise on the hip joint for five minutes in each direction once a week for half a year, before going through a three-month observation period. Before and after intervention, and after the observation period, Goldsmith Index (hereinafter GI) and ROM of the hip joint were measured to compare the effects of physical intervention.
Results: 1.GI measurements
GI measurements significantly decreased in both the hip joint dislocation and control groups after intervention. However, after the observation period, no significant changes were seen in the hip dislocation group.
2.ROM measurements
ROM measurements significantly increased in windward extension and abduction in the hip dislocation group, and in windward abduction in the control group. After the observation period, no significant changes were seen in either group.
Conclusion: Physical intervention can improve WD regardless of hip dislocation, and continuation of exercise is more important for patients with hip dislocation. The result also implies the importance of physical intervention as a preventive measure against hip dislocation.

Immediate Effects of Functional Electrical Stimulation on Kinematic and Kinetic Variables and Oxygenation in Medial Sensorimotor Cortices during Gait in Patients with Acute Cerebral Infarction

Masafumi KUBOTA, Chiaki IGARASHI, Hideaki MATSUO, Hiroaki NARUSE, Seiichiro SHIMADA, Osamu YAMAMURA, Tomoko KAMISAWA, Ryu KATO, Hiroshi YOKOI, Kenzo UCHIDA, Hisatoshi BABA

Released: December 20, 2015

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Purpose: The aim of this study was to determine the immediate effects of functional electrical stimulation (FES) on kinematic and kinetic gait variables and oxygenation in medial sensorimotor cortices (mSMC).
Methods: We performed gait analysis using Vicon motion capture system and brain oxygenation in mSMC using near-infrared spectroscopy (NIRS) in eight subjects with acute cerebral infarction. FES was performed during walking on the tibialis anterior muscles and gastrocnemius of the paretic limb during the swing and terminal stance phases, respectively.
Results: Gait velocity, paretic hip flexion, knee extension, and ankle plantar flexion moments in the stance phase significantly increased when FES was performed during walking compared with those with walking before FES. Moreover, these improvements of gait quality were carried over after performing FES. Oxygenated hemoglobin levels in unaffected mSMC were significantly lower during walking with FES than that during walking without FES.
Conclusion: FES can improve weight shifting to the paretic limb during the stance phase and improve propulsion as a roll-off function in the late stance. Furthermore, FES may inhibit cortical excitability in unaffected mSMC.

Association between Very Early Initiation of Rehabilitation and Rehabilitation Provision System for Stroke Patients: Analysis According to Day of Admission

Daisuke MATSUMOTO, Katsunori KONDO, Nariaki SHIRAISHI, Motoya SUGIYAMA, Seungwon JEONG

Released: December 20, 2015

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Purpose: To investigate the association between very early initiation of rehabilitation (VEI) and a rehabilitation provision system for acute stroke patients by performing an analysis according to the day of admission.
Methods: Data of stroke patients (n = 2,307; 8 hospitals) from the Japan Rehabilitation Patients Database in Japan were examined. The patients were divided into the following five groups according to the day of admission: (1) weekday with no holidays (Monday to Thursday), (2) weekday with a holiday, (3) Friday, (4) Saturday and Sunday, and (5) holiday. We defined VEI as rehabilitation commencing within 3 days of stroke admission. Multiple logistic regression analysis was used to evaluate VEI, involvement of rehabilitation specialists as an attending doctor, and the ratio of rehabilitation staff members to beds.
Results: We found that VEI for acute stroke patients was significantly associated with involvement of a rehabilitation specialist and a high ratio of rehabilitation staff members to beds (p < 0.05).
Conclusion: Our results suggest that when providing VEI for acute stroke patients, it may be effective to promote the involvement of a rehabilitation specialist as an attending doctor, and increase the number of rehabilitation staff members.

EEG Analyses of Source Localization and Functional Connectivity of Kinesthetic Illusion Elicited by Tendon Vibration

Takayuki KODAMA, Hironori OSUGI, Teppei ABIKO, Hideki NAKANO, Michihiro OSUMI, Shu MORIOKA

Released: December 20, 2015

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Purpose: The purpose of this study was to examine the influence of vibratory stimulation-induced kinesthetic illusion on brain function, which compared it with brain function during actual muscle contractile movement by using the EEG analysis.
Subjects: Twenty healthy people aged 21.5 ± 1.5 years were recruited. No subjects were observed to exhibit motor and sensory paralysis.
Methods: Brain waves in vibratory stimulation were measured in the resting condition and presence of vibratory stimulation, active muscle contraction (active movement), and sensory stimulation without vibratory stimulation to tendon or movement. For the neurophysiological index to evaluate brain function, the μ rhythm (10-13 Hz high α cortical Oscillations), which is expressed mainly in the kinesthetic cortex and attenuates with movement, was employed. Calculated data were compared employing analyses of Source Localization and Functional Connectivity by eLORETA method.
Results: In vibratory stimulation condition, compared to brain waves in the resting condition or sensory stimulation condition, the kinesthetic cortical μ rhythm decreased under the other conditions. Furthermore, intra- and inter-hemispheric brain functional connectivity in sensorimotor cortex were significantly stronger than it under the other conditions. When brain waves were compared between those in the presence of vibratory stimulation and active movement, no significant difference was noted in both the kinesthetic cortical μ rhythm and functional connectivity in sensorimotor cortex.
Conclusions: These findings suggested that sensorimotor information processing induced by vibratory stimulation is based on neural functional networks in sensorimotor cortex.

A Study of the Exercise Effect and Exercise Load Determined Using Perceived Exertion in Patients with the Subacute Phase of Inflammatory Myopathy

Shinya YAMAUCHI, Shinichiro MORISHITA, Satoshi MABUCHI, Norihiko KODAMA, Kazuhisa DOMEN

Released: December 20, 2015

p.28

Purpose: The purpose of this study was to examine the exercise effect and exercise load in patients with the subacute phase of inflammatory myopathy.
Methods: We set exercise loads according to the modified Borg scale (BS). Thirteen patients performed exercises that mainly comprised muscle strength and endurance training after 1–6 weeks following the onset of inflammatory myopathy. Muscle training exercises included straight leg raise, hip raise, squat, and calf raise, with the exercise load resulting in muscle fatigue of 2–4 on the BS. Endurance training involved walking or ergometer cycling, with the exercise load resulting in dyspnea of 2–4 on the BS. Subsequently, we investigated the trainable exercise load continuously. Furthermore, we compared muscle strength on knee extension, 6-min walking distance, and creatine kinase (CK) levels before and after exercises.
Result: Of the 13 patients, 10 completed the exercises. Three patients could not complete the exercise because of deterioration of their general condition, increase in CK levels, and muscle pain. Of the 10 patients who completed the exercises, 9 performed moderate load exercises (BS, 4) and 1 patient performed low load exercises (BS, 2) because of arrhythmia and muscle pain. No increase in CK levels were observed in these 10 patients. Further, no significant improvements were observed in kneeextension strength, but the 6-min walk distance significantly improved after exercises compared to that before the exercises (p ＜ 0.05)．
Conclusion: Our results indicate that patients with subacute inflammatory myopathy should initially perform low load exercises, and subsequently, the load should be set depending on individual conditions while simultaneously checking for myalgia and CK levels, and improvement in strength. The careful monitoring of load during muscle training is important. In contrast, endurance levels improve after training with moderate load if patients have a stable condition.

Effects of Hip Angles in Sagittal Plane on the Hip Rotator Force in Normal Subjects

Yuji KODAMA, Eiki TSUSHIMA

Released: December 20, 2015

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Purpose: The purpose of this study was examine the effects of hip joint angles in sagittal plane on the hip external and internal rotator force.
Methods: Thirty-two healthy volunteers (male: sixteen people, female: sixteen people, mean age: 21.9 ± 3.8years, range: 18-33 years) participated in this study. There were 4 condition that measured the hip joint angles in that plane extension 10 degree, flexion 0 degree, flexion 45 degree and flexion 90 degree. The maximum isometric external and internal rotational force were measured with hip joint abduction 0 degree, rotation 0 degree and knee joint flexion 90 degree.
Results: External rotator force at extension 10 degree was significantly lower than at flexion 45 degree in female, in addition to Flexion 0 degree was significantly lower than flexion 45 degree and 90 degree in both male and female. Those two sex have internal rotation force at extension 10 degree and flexion 0 degree were significantly lower than at flexion 45 degree and 90 degree in common.
Conclusion: The effects of hip joint angles in sagittal plane on the hip external rotator force was small, on the other hand internal rotation force increased as hip joint angle of flexion.

Relation between Fatty Infiltration of Cervical Extensor Muscles and Postural Stability in Patients with Cervical Spondylotic Radiculopathy

Tsubasa MITSUTAKE, Yuji CHUDA, Tsuyoshi OISHI, Etsuo HORIKAWA

Released: December 20, 2015

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Purpose: This study aimed to clarify the association of muscle fat infiltration with cervical extensor muscle laterality and postural stability in patients with cervical spondylotic radiculopathy.
Methods: We evaluated 20 patients with cervical spondylotic radiculopathy. The measure of the amount of fat within the muscles was obtained by the ratio of the pixel intensities of the upper trapezius and cervical multifidus muscles to the pixel intensity of a standardized region of intermuscular fat using magnetic resonance imaging. In the stabilometer test, postural sway determined by a shift in the center of pressure was measured in the upright position on a platform with the subject’s eyes closed for 60 s. We used two parameters for evaluation: locus length (LNG) and environmental area (EA). Spearman’s rank and partial correlation test was used to analyze the association between fat indices in the upper trapezius and multifidus muscles and the results of the LNG. To determine whether any factor could the LNG, a step-wise multiple regression analysis was performed with LNG as the dependent variable and age, gender, body mass index, neck disability index and muscle fat infiltration with cervical extensor muscle laterality as independent variable.
Results: Impaired cervical multifidus muscle had a significant correlation with LNG. The multiple regression analysis demonstrated that muscle fat infiltration with impaired cervical multifidus muscle was significant contributors to LNG, accounting for 62％ of the variability.
Conclusion: In the patients with cervical spondylotic radiculopathy, muscle fat infiltration with impaired cervical multifidus muscle possibly affected postural control.

Associations of Walking Function and Physical Activity with Community Ambulation in People with Chronic Stroke

Hideyuki TASHIRO, Takuya ISHO, Fumihiko HOSHI

Released: December 20, 2015

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Purpose: The purpose of this study was to examine the association of walking function and physical activity with community ambulation in people with chronic stroke, and to investigate whether walking function is a predictor of community ambulation.
Methods: The study included 54 subjects with chronic stroke who were living at home. The subjects were classified according to the level of ambulation using the Functional Ambulation Classification of the Hospital at Sagunto (FACHS). Comfortable walking speed (CWS), maximal walking speed (MWS), and 6-minute walking distance (6MWD) were used to determine walking function, and the life space assessment (LSA) was used to determine physical activity. Linear correlations were calculated between clinical measurements, and a multiple comparison procedure was used to compare the means of each outcome variables between the three groups classified using the FACHS. Furthermore, receiver operating characteristic curve analysis was performed to obtain cut-off points of the walking tests for discriminating between community ambulators and non-community ambulators.
Results: There were moderate correlations between the FACHS and CWS, MWS, and 6MWD. Additionally, a significant strong correlation was found between the FACHS and the LSA score. CWS, MWS, and 6MWD were significantly higher for community ambulators compared with neighborhood and household ambulators. Moreover, the LSA score was significantly different between the groups. The optimal cut-off values for community ambulators were 0.61 m/s for CWS, 0.71 m/s for MWS, and 213 m for 6MWD.
Conclusion: Community ambulation was associated with walking function, and was related to physical activity. Walking speed and distance could predict independent community ambulation in people with chronic stroke.

Factors Influencing the Life Space in Patients with Severe Knee Osteoarthritis

Yoshinori HIYAMA, Daiki KAWAZOE, Tatsuya UCHIYAMA, Takeru YAGIHASHI, Satoshi NAKAKITA, Osamu WADA

Released: December 20, 2015

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Purpose: This study examined the factors influencing the life space in patients with severe knee osteoarthritis.
Methods: One hundred six patients with severe knee osteoarthritis participated in this study. Life space assessment (LSA), International Physical Activity Questionnaire Environmental Module (IPAQ-E), and visual analog scale measurement of confidence about going out were measured. In addition, range of motion of the knee, quadriceps strength, 10-m walking time, walking pain, and the Timed Up & Go test (TUG) were measured. To determine whether any of those factors could affect the life space, a step-wise regression analysis was performed with LSA as the dependent variable and age, confidence about going out, IPAQ-E, quadriceps strength, 10-m walking time, walking pain, TUG, gender, and employment status as independent variables.
Results: The multiple regression analysis demonstrated that TUG, confidence about going out, and “The sidewalks in my neighborhood are well maintained (paved, with few cracks) and not obstructed” were significant contributors to LSA.
Conclusions: The mobility capacity, confidence about going out, and condition of the sidewalks in the neighborhood affected LSA in patients with severe knee osteoarthritis. It is important to improve these factors to improve life space in patients with severe knee osteoarthritis.

Effects of Preoperative or Postoperative Exercise Interventions on Physical Function and Activity in Patients with Hip Osteoarthritis Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Takuya UMEHARA, Ryo TANAKA, Akinori KANEGUCHI

Released: December 20, 2015

p.33

Purpose: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of preoperative or postoperative exercise interventions on physical function and activity in patients with hip osteoarthritis (OA) undergoing total hip arthroplasty (THA).
Subjects and Methods: This search was applied to Medline, Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, and the Cumulative Index to Nursing and Allied Health Literature. We generated data comparing the effect of exercise intervention on physical function or activity in the experimental group and control group through this search. The Grading of Recommendations Assessment, Development, and Evaluation system was used to determine the quality of the evidence.
Results: Thirteen RCTs were identified. Meta-analysis indicated that preoperative exercises were effective for improving physical function, as assessed by the Harris Hip score (HHS) and the first days of re-starting activities (walking, walking up and down stairs, using the toilet, sitting on the chair). Furthermore, the effect of postoperative exercises, especially that of exercises performed in addition to the standard rehabilitation program, on hip abductor muscle strength, maximal oxygen uptake, and cadence was also observed. The quality of evidence for most outcomes was moderate, except that for the outcome assessed by the HHS (high) and the first days of re-starting walking (low).
Conclusion: We confirmed that physical function and activity improved in patients with hip OA undergoing THA by preoperative or post-operative exercise interventions.

Range of Motion Exercises based on Ultrasonographic Assessment of Heterotopic Ossification after Supracondylar Fracture of the Femur

Yoshikazu HIRASAWA, Hiroshi YAMAMOTO, Takahiro FUJIMORI, Yutaka KATAOKA

Released: December 20, 2015

p.34

Purpose: To report the performance of range of motion exercises based on ultrasonographic assessment of heterotopic ossification after supracondylar fracture of the femur.
Methods: The subject was a woman in her sixties with a supracondylar fracture of the femur. We performed ultrasonography to investigate a mass that developed medial to the patella postoperatively.
Results: No ossification was detected by radiographic examination at 1 month postoperatively. Ultrasonography showed that the mass was a hematoma with hyperechoic and hypoechoic regions. The hyperechoic regions seemed to be callus. The hematoma was located in the pre-femoral fat pad between the femur and the vastus medialis muscle, and was adherent to vastus medialis. Ossification was detected by radiography at 2 months postoperatively. Ultrasonography showed that the ossification was continuous with the femur and there was breakdown of the adhesions with vastus medialis. Range of motion exercises were continued until knee flexion of 155 degrees were achieved.
Conclusions: We could assess the progression and extent of heterotopic ossification and could judge the performance of range of motion exercises by ultrasonography.

In-hospital Phase of Postoperative Cardiac Rehabilitation in Elderly Patients with Aortic Stenosis

Masakazu SAITOH, Yohei SHIOTANI, Shogo NAKASHIMA, Reina UEWAKI, Kentaro HORI, Tetsuya OZAWA, Kana KAWAI, Yuichi ADACHI, Yuko IWASA, Aika KOZONO, Nobuo MOROTOMI, Masatoshi NAGAYAMA, Morimasa TAKAYAMA

Released: December 20, 2015

p.35

Purpose: The aim of this study was to evaluate the progress of postoperative cardiac rehabilitation and physical function in elderly patients after transcatheter aortic valve replacement (TAVR).
Methods: One hundred thirty-nine patients aged over 65 years with severe aortic stenosis (54 males and 85 females, aged 77 ± 7 years) who underwent elective conventional open heart AVR or TAVR were selected and divided into 3 groups; group A (AVR, < 80 years), group B (AVR ≥ 80 years), group C (TAVR). We evaluated the progress of postoperative cardiac rehabilitation and physical function at discharge. We assessed the ability of 100-m unassisted walk as a progress criterion of cardiac rehabilitation, and the short physical performance battery (SPPB) as an indicator of physical function before cardiac surgery and at discharge.
Results: Preoperative and postoperative SPPB score in group C were significantly lower than that in groups A and B (p < 0.05). Additionally, achievement of 100-m unassisted walk was significantly delayed in group C compared with groups A and B, although postoperative hospital stay was not significantly different among 3 groups.
Conclusion: Physical function of patients who underwent TAVR was considerably lower than elderly patients who had conventional open heart AVR. Similarly, progress of postoperative cardiac rehabilitation was delayed in patients who underwent TAVR compared with those who underwent conventional open heart AVR.

Effects of Movement Velocity and Contraction Pattern of Resistance Training on Muscle Damage

Takuya KOBAYASHI, Masatoshi NAKAMURA, Hiroki UMEGAKI, Tome IKEZOE

Released: December 20, 2015

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Purpose: This study investigated the effects of movement velocity and contraction pattern on muscle damage during a single bout of resistance training.
Methods: Forty healthy young men were randomly assigned to four groups: the Normal Slow group (NS; 5 seconds for concentric and eccentric phases), Concentric Slow group (CS; 7 seconds for concentric phase, 3 seconds for eccentric phase), Eccentric Slow group (ES; 3 seconds for concentric phase, 7 seconds for eccentric phase), and Normal Speed group (N; 1 second for concentric and eccentric phases). The total resistance training time for elbow flexor muscles was standardized to 300 seconds. Maximal isometric strength (MS), muscle thickness (MT), muscle echo-intensity (EI), and muscle hardness (MH) were measured before, immediately after, 1 day after, and 2 days after training.
Results: There were no differences in the muscle activity during resistance training between the groups. All groups showed significant decreases in MS and increases in MT and EI immediately after training. There were no significant differences in the rate of change of these muscle properties between groups.
Conclusion: These results suggest that there is less influence of movement velocity and contraction pattern during a single bout of resistance training standardized total training time or muscle activity on damage of skeletal muscle.

Quantitative Analysis of Rolling Over Movement in Normal Adults: Classification of Patterns by Cluster Analysis

Hiroshi MIKI, Osamu NITTA

Released: December 20, 2015

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Purpose: Rolling over movement is an important part of bed mobility skills and in rehabilitation is often done in evaluating physical therapy and teaching. However, it is different from other basic motions like sit-to-stand and gait; the kinematic characteristics of normal rolling over movement based on quantitative data are not well understood. Thus, the purpose of this study was to classify the patterns of rolling over movement of healthy individuals and to clarify its kinematic characteristics of each movement pattern.
Methods: Thirty healthy male subjects were measured in three trials of rolling over by using three dimensional motion analysis systems. After analyzing the joints angle of trunk in using one trial data of three trials, the movement patterns were classified by means of cluster analysis; in addition, the characteristics of each movement pattern were clarified by statistical analysis.
Results: The findings showed that rolling over movement in healthy individuals could be classified into three movement patterns, and the characteristics of each movement pattern were clarified.
Conclusion: In rolling over movement, which was difficult to do major classification based on quantitative data, by analyzing the trunk motion, in particular trunk rotation and flexion-extension, it is possible to determine major classification of patterns. And, we were able to show the normal movement of rolling over movement by the kinematic characteristics of three movement patterns.

Analysis of the Factors Influencing the Hopping Height During Two-legged Hopping in the Place in Healthy Subjects: With Special Reference to the Posture and Movement of the Trunk and Lower Limb

Osamu NAKAMATA, Osamu NITTA, Yorimitsu FURUKAWA

Released: December 20, 2015

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Purpose: The purpose of this study was to reveal correlations between the posture and movement of the trunk and lower limbs and the hopping height in the ground contact phase of two-legged hopping in the place and to clarify factors influencing the hopping height.
Methods: The subjects were 19 healthy males. The hopping at 130 of motion pitch per minute was measured by using a three-dimensional motion analysis system and a force plate. The ground contact phase was divided into the first-half and latter-half phases on the basis of a point of the time when the hip reached its lowest level in a vertical direction (point of lowest hip joint level), then correlations between the following parameters and the hopping height were analyzed: Postures at the ground contact point, point of lowest hip joint level, and takeoff point; motion range in the first-half and latterhalf phases; and timing of motion direction change-over (motion change-over time).
Results: There were correlations of the hopping height with the heights of the hip at point of lowest hip joint level, the motion range of the thorax and hip joint in the first-half phase, the moving range of the hip joint in the first-half and latter-half phases, and with motion change-over time for the thorax and the knee joint. Two parameters, i.e., motion change-over times for the knee joint and the moving range of the hip joint in the latter-half phase, were extracted as predictive factors for the hopping height.
Conclusion: The factors of determination of the hopping height were revealed to be only the parameters involved with lower limb, though movement of the thorax and lower limb was correlated with the hopping height.

Study on the Gender Difference of Lumbar Multifidus Cross-sectional Area Using Ultrasound System

Hitomi UBUKATA, Hitoshi MARUYAMA, Ming HUO, Qiuchen HUANG

Released: December 20, 2015

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Purpose: In this study, we measured the multifidus muscle cross-sectional area in normal adults using an ultrasound imaging device, to clarify factors influencing the difference in this cross-sectional area between males and females and to develop method to correct for this difference.
Methods: Subjects comprised 63 normal adults (30 males and 33 females) with no anamnestic history of lumbar pain. We measured the cross-sectional area of their lumbar multifidus muscles using an ultrasound imaging device.
Results: Regarding multifidus muscle cross-sectional area measurement, data from 25 males indicated a larger difference compared with data from females, indicating significance. However, a significant difference was not observed between males and females in multifidus muscle cross-sectional area measurement when divided by height and weight. The cross-sectional area showed a significant relationship with height, weight and BMI; however, only weight was adopted in stepwise multiple regression analysis.
Conclusions: To obtain accurate multifidus muscle cross-sectional area measurement that did not relate to the body, we suggest that this should be divided by weight. In addition, it was suggested the ratio of weight to the multifidus muscle cross-sectional area can be applied as unified basis between males and females for clinical application.

Influence of Subliminal Rhythm Shift with a Lengthened Interval on Reactive Periodic Movement

Yuki TAKAHASHI, Satoshi FUJIWARA, Masanori ITO, Naoki KADO, Toshiaki SUZUKI

Released: December 20, 2015

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Purpose: This study aimed to investigate the influence of interonset interval (IOI) shift below the threshold of conscious recognition on the control of reactive movements.
Methods: Thirteen healthy individuals (10 males, 3 females; mean age, 27.4 ± 3.9 years) were included in this study. All subjects performed reaction time tasks, wherein they were instructed to raise their right ankle in response to each auditory stimulus. There were three test conditions as follows: periodic auditory stimuli at an IOI of 1,500 ms and a shift in the last stimulus interval to 1,575 ms and 1,800 ms, respectively, during successive stimuli sequences at an IOI of 1,500 ms. Electromyographic reaction time (EMG-RT) for the last stimulus was compared among the three conditions.
Result: The EMG-RT was significantly delayed under condition 3 compared with that under conditions 1 and 2. A comparison of conditions 1 and 2 revealed no significant differences.
Conclusion: Periodic rhythmic stimulation is predicted to comprise some time width, and reactive movements can be performed without delay under conditions with an IOI shift below the threshold of conscious recognition.

A New Device for Measuring Spinal Kyphosis: Validity and Reproducibility of Measurements Obtained Using a Small Gyro-embedded Device

Takuya UEDA, Yoshitaka SHIBA, Shuichiro WATANABE, Haruhiko SATO, Kosuke MIZUNO

Released: December 20, 2015

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Purpose: This study aimed to examine the reproducibility and validity of a new quantitative method for measuring spinal kyphosis using a small gyro sensor．
Method: Subjects were 96 community-dwelling middle-aged and elderly (mean age, 72.7 ± 6.2 years) people who performed a gymnastic exercise. We measured spinal kyphosis using 2 methods: (1) the kyphosis angle (KA) using a small gyro-embedded posture-measuring device and (2) the kyphosis index using a flexible ruler. We examined the reproducibility of the new method by obtaining 2–3 consecutive measurements and adequate number of measurements for KA. We also assessed the validity of KA measurement using the device. Statistical analysis: We used interclass correlation coefficients (ICCs) of KA reproducibility and a Pearson’s product-moment correlation coefficient between KA and kyphosis index for determining the validity of KA measurement.
Results: ICC (1,1): the reproducibility of repeated measurements was 0.967 (95％ confidence interval [95% CI]， 0.951–0.978) for 2 measurements and 0.956 (95％ CI, 0.941–0.970) for 3 measurements, suggesting a high reproducibility for KA measurement using this method. The result of more than 0.95 for ICC (1,1) suggests that a single measurement of KA is sufficient. For the validity of KA measurement, a statistically significant correlation was shown between KA and kyphosis index.
Conclusion: Thus, KA measurement using a small gyro-embedded posture-measuring device is highly reproducible in consecutive measurements as well as highly valid; this may be a useful quantitative method for measuring spinal kyphosis in the research or clinical environment.

Development of a Home-Exercise Barrier Self-Efficacy Scale for Elderly People Requiring Support and Care

Naoki ARITA, Koji TAKENAKA, Takashi SHIMAZAKI

Released: December 20, 2015

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Purpose: This study was undertaken to develop a Home-Exercise Barrier Self-Efficacy Scale (HEBS) for elderly people, to evaluate the reliability and validity of HEBS, and to clarify the relation between HEBS and obtained data.
Methods: Study participants were 114 elderly people (mean 80.0 ± 9.2 years) requiring support and care. This study assessed their gender, age, primary disease, level of long-term care need, stage of change for home exercise modification, 8-Item Short-Form Health Survey (SF-8) responses, and HEBS.
Results: A HEBS with six items was created with one factor structure. Cronbach’s alpha for this subscale in this study was 0.86. The HEBS score showed excellent test-retest reliability (r = 0.94). We conducted an analysis of variance with independent variables of construct validity and stage of change for home exercise modification. The dependent variable was the HEBS score. Results clarified that the HEBS score increased significantly as the stage progressed. Scores shown by people under age of 75 were significantly higher than those of people 75 or older. No significant difference was found between gender, primary disease, level of long-term care needed, or HEBS score.
Conclusion: The HEBS was confirmed to be reliable and valid for measuring confidence in performing Home Exercise for elderly people requiring support and care.

Investigation of Factors Affecting the Ability for Gait Using a Cane and Walking Speed in Patients with Hip Fractures: Factors Determining the Ability for Gait Using a Cane are Different from those Determining Walking Speed

Yuji KAWABATA, Yasuhiro SUMIKAWA, Mami HAYASHI, Satoshi TAKECHI, Keita GOTO, Satomi FUJIMORI, Narumi KOHARA

Released: December 20, 2015

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Purpose: The purpose of this study was to clarify factors affecting the ability for gait using a cane and walking speed in patients with hip fractures.
Methods: The subjects were 104 patients with unilateral hip fractures. These included 61 patients who were able to independently walk using a cane and 43 patients who were unable to walk without any assistance. We investigated age, gender, standing height, fracture type, postoperative day, fractured and non-fractured isometric hip abductor strength, fractured and non-fractured isometric knee extensor strength, pain, leg length discrepancy, and 10-m walking speed.
Results: A multiple logistic regression analysis and a multiple regression analysis revealed that fractured isometric hip abductor strength and pain were significantly related to the ability for gait using a cane (corrected discriminate rate, 74.0% ). In addition, fractured isometric knee extensor strength and age were significantly related to 10-m walking speed (coefficient of determination, 0.48).
Conclusion: The results suggest that factors determining the ability for gait using a cane are different from those determining 10-m walking speed. Improving fractured hip abductor strength and pain relief were important for the ability for gait using a cane. Our results suggest that improvement of fractured knee extensor strength is important for increasing 10-m walking speed.

Effects of a Trunk Brace with Joints that Provides a Resistive Force to Modify Pelvic Alignment During Level Walking in the Elderly

Shinno IIJIMA, Akihiro ITO, Junji KATSUHIRA, Takahiro NOMURA, Hitoshi MARUYAMA

Released: December 20, 2015

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Objective: The purpose of the present study was to examine the kinetic and kinematic effects of wearing a trunk brace with joints that provides a resistive force to modify pelvic alignment during level walking in the elderly.
Methods: Twenty-seven healthy elderly people participated in the study. The study compared kinetic and kinematic variables among three different conditions of level walking: (1) with no orthosis, (2) with a trunk brace with joints, and (3) with a lumbosacral corset. Statistical analysis was performed using repeated measures ANOVA. Variables showing a significant difference were analyzed further with multiple comparisons using the Bonferroni correction. The significance level was set at 0.05.
Results: Use of the trunk brace with joints and lumbosacral corset increased the walking speed compared to the no orthosis condition. Furthermore, use of the trunk brace with joints significantly increased the pelvic anterior tilt angle, trunk extension angle, and hip abductor moment in the early stance phase of one gait cycle compared to the other two conditions.
Conclusions: Wearing the trunk brace with joints provided a resistive force that effectively modified pelvic alignment in the elderly and increased their walking speed and hip abductor moment during level walking.

Muscular Characteristics of Back Muscles at Different Pelvic Angle and Different Voluntary Contraction Strength

Teppei ABIKO, Ryota SHIMAMURA, Daisuke OGAWA, Hitoshi TAKEI, Junichiro YAMAMOTO, Takayuki SAKASAI, Yoko ABIKO, Masayuki SOMA, Yoko NAKAO

Released: December 20, 2015

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Purpose: The purpose of this study was to analyze the effect of different pelvic alignment and voluntary contraction strength on electromyographic activity of the lumbar multifidus (LM) and erector spinae muscles (ES). In addition, we examined the activity of the LM in the absence of overactive ES.
Methods: Ten healthy men participated in this study. We studied the back muscles at 3 pelvic positions (moderate anterior tilt, neutral, and moderate posterior tilt) and 6 different voluntary contraction strengths (0％， 10％， 25％， 50％， 75％， and 100％ maximum voluntary contraction: MVC). The participants performed a task that involved isometric contraction of the back muscles during pelvic anterior tilt in a prone position at the edge of the bed with the legs hanging. The main outcome measure was the normalized LM/ES ratio assessed by using surface electromyography for the right ES and right LM.
Results: The LM/ES ratio was more activated in the neutral position than in the moderate anterior and moderate posterior pelvic tilt position at 10％MVC. In neutral position, it was more activated at 10％MVC than 100％MVC.
Conclusions: The present findings suggest that the neutral pelvic positions with mild resistance facilitated lumbar multifidus activity in the absence of overactive ES.

Factors Influencing Lower Extremity Muscle Strength in Interstitial Pneumonia Patients: The Association of Isometric Knee Extension Strength with Respiratory Function, Dyspnea and Exercise Capacity

Rie TAKEICHI, Hitoshi YOKOYAMA, Yosuke WATANABE, Yuri YOKOYAMA, Yusuke KASAHARA, Yoshitsugu OMORI, Yuko KOMASE

Released: December 20, 2015

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Purpose: The aim of this study was to clarify factors that can affect lower extremity muscle strength in stable interstitial pneumonia (IP).
Methods: We examined the relationship between lower extremity muscle strength and respiratory function, dyspnea, and exercise tolerance in 107 patients with stable IP.
Result: Isometric knee extension strength was associated with % DLco, the modified Medical Research Council (mMRC) dyspnea scale, and the 6-minute walk test. Moreover, logistic regression analysis to determine an dependent variable for whether a value of 0.50 kgf/kg of isometric knee extension strength caused movement impairment revealed the mMRC dyspnea scale grade as a factor that affected isometric knee extension strength (odds ratio 0.480, 95% CI 0.242–0.953). In addition, when the mMRC scale was Grade 1 or more, the results indicated that more than one half of the IP patients had a level of lower extremity muscle strength that fell below the level at which movement impairment begins.
Conclusion: Lower limb muscle strength in IP patients was related to the level of respiratory failure, exercise tolerance, and dyspnea. Especially, it was revealed that when dyspnea is exacerbated in daily life, it can lead to a reduction in lower extremity muscle strength that may impair mobility.

Skin Extensibility around Surgical Wounds after Total Knee Arthroplasty

Takeshi ARAKAWA, Katsuhiro ITO, Shintaro UEHARA, Tomofumi YAMAGUCHI

Released: December 20, 2015

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Purpose: We investigated skin extensibility around surgical wounds in patients after total knee arthroplasty (TKA) to determine the relationship between skin extensibility and knee range of motion.
Methods: Twenty patients treated with TKA (mean age: 78.1 ± 7.4 years) and ten age-matched healthy subjects (mean age, 71.8 ± 8.7 years) participated in this study. To evaluate skin extensibility, we marked the surface of the skin over the knee and measured changes in the location of these marks using vertical and horizontal reference points as the knee was positioned in various degrees of flexion (60°, 90°， and full flexion). We further divided TKA patients into two groups based on a knee flexion angle of 120°（above or below 120° knee flexion), and compared skin extensibility among TKA patients and healthy subjects.
Results: In TKA patients, skin extensibility was significantly lower than that in healthy subjects, as determined using the vertical line reference around the suprapatellar region. There was no significant difference between the two groups of TKA patients.
Conclusion: Our results reveal that skin extensibility around surgical wounds in TKA patients is lower than that in healthy subjects. However, skin extensibility is not a limiting factor for knee flexion after TKA.

Kinetic and Kinematic Features of Failed Sit-to-stand Trials in Stroke Patients: Analysis Using a Dynamic Balance Index

Yuji OSADA, Masako FUCHI

Released: December 20, 2015

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Purpose: The purpose of this study was to investigate the features of failed sit-to-stand by analyzing the differences between accomplished and failed task in stroke patients.
Methods: From 136 stroke patients in whom sit-to-stand was measured using a threedimensional motion analysis system and force plates, 7 who failed in one sit-to-stand trial but succeeded in another trial were extracted for comparative analysis. Differences in the following kinetic and kinematic data were compared between the failed and accomplished trials by the nonparametric Wilcoxon signedrank test: displacement of the center of mass (COM), center of pressure, extrapolated center of mass (Xcom), and peak joint moments.
Results: In the accomplished trials, Xcom moved significantly further forward over the ankle compared with the failed trials at lift off. The peak hip extension moments was increased in accomplished trials while transitioning from sitting to standing.
Conclusions: Because Xcom could not move forward sufficiently, COM was forced backward to compensate in failed sit-to-stand. Thus, to accomplish sit-to-stand, it is important for stroke patients to relearn the hip flex direction that increases COM forward velocity and to activate the hip extension muscles.

Benefits of Standing Up on the Same Day after Primary Total Knee Arthroplasty: A Randomized Clinical Trial

Yoshinori HIYAMA, Osamu WADA, Daiki KAWAZOE, Satoshi NAKAKITA, Yumi MATSUOKA, Shingo NITTA, Hideto MARUNO, Kiyonori MIZUNO, Yasunobu IWASAKI

Released: December 20, 2015

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Purpose: This study aimed to investigate the effect of standing up on the same day after primary total knee arthroplasty (TKA)．
Methods: Seventy-five patients with knee osteoarthritis participated in this study. They were randomized to one of three groups: standing, sitting, or bed rest. Three hours after surgery, patients in the standing group stood up, those in the sitting group sat up, and those in the bed rest group only performed calf pumps. Outcome measures included range of motion, quadriceps strength, 10-m walking test, Timed Up and Go test score, and D-dimer levels, both one month before and on the fourth day after surgery. In addition, we measured C-reactive protein (CRP) levels and performed ultrasonographic examination for deep vein thrombosis (DVT) on postoperative day 4.
Results: There were no differences in baseline variables and postoperative motor function and CRP among the three groups. The standing group showed a significantly lower incidence of DVT than the other two groups. In addition, the bed rest group showed higher D-dimer levels than the other two groups.
Conclusions: Standing up on the same day after primary TKA shows potential as a treatment for preventing DVT.

Reliability, Validity, and Responsiveness of the Japanese Version of the Lower Extremity Functional Scale in Outpatients with Lower Extremity Musculoskeletal Dysfunction

Koji NAKAMARU, Osamu NITTA, Junya AIZAWA, Takayuki KOYAMA

Released: December 20, 2015

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Purpose: The purpose of this study was to assess the reliability, validity, and responsiveness of the Japanese version of the Lower Extremity Functional Scale (LEFS-J)．
Methods: A total of 112 outpatients with lower-extremity musculoskeletal dysfunction participated in the study. Psychometric testing include reliability by internal consistency (Cronbach α) and test-retest reliability (intraclass correlation coefficient), convergent validity by comparing the LEFS-J with the short-form health survey, version 36 (Pearson correlation) and responsiveness (unpaired t tests and minimal detectable change)．
Results: The Cronbach α of the LEFS-J was 0.96 and intraclass correlation coefficient for test-retest reliability was 0.92. The correlation between the LEFS and the short-form health survey physical function subscale was excellent (r = 0.75). The analysis of responsiveness was calculated with an unpaired t test after 4 weeks of treatment demonstrating a statistically significant difference between the stable and improved patients (p = 0.02). The minimal detectable change was calculated 8.14.
Conclusion: The LEFS-J is a valid, reliable, and responsive tool that can be used assess Japanese outpatients with lower-extremity musculoskeletal dysfunction.

Traits of Motor Functions of Obstructive Sleep Apnea Syndrome Patients Who Have Experienced a Fall

Hiroaki KATAOKA, Satoshi TANAKA, Kazuhiko OKITA, Koichi YAMAMOTO, Yukako ARAKAWA, Yoshihiro MORI

Released: December 20, 2015

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Purpose: This study examines the factors leading to falling incidents in obstructive sleep apnea syndrome (OSAS) patients from the perspective of a motor function.
Methods: Subjects were 47 male OSAS patients (mean age: 55.2 ± 12.1 years, mean duration of therapy: 30.3±18.5 months) undergoing nasal continuous positive airway pressure treatment. Subjects were checked for a falling incident in the past years, and the relationship between extraneous factors and motor functions was examined using binomial logistic regression analysis.
Results: The experience of a fall was found to have a significant relationship with knee extension strength (odds ratio: 0.862, 95％ confidence interval: 0.775–0.958) and toe muscle strength (odds ratio: 0.164, 95％ confidence interval: 0.164–0.896).
Conclusions: A decrease in knee extension strength and toe muscle strength was revealed to be responsible for falls in OSAS patients, indicating the importance of exercise-therapy interventions that aim at fall prevention.

The Effect of Exercise Therapy Combined with Environmental Manipulation on the Walking Function of Patients with Chronic Schizophrenia and Drug-induced Extrapyramidal Symptoms: A Randomized Crossover Comparative Study

Kimiyasu SHIKATA, Sinya OKAZAKI, Ryuichi YAMAMOTO, Tamotsu KIMURA

Released: December 20, 2015

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Purpose: This study was designed to investigate the effects of exercise therapy combined with environmental manipulation on walking function in patients with chronic schizophrenia and druginduced extrapyramidal symptoms.
Subjects: Eighteen patients with chronic schizophrenia complicated by drug-induced extrapyramidal symptoms who were hospitalized in the locked ward of psychiatric hospital C were investigated in this study.
Methods: This was a randomized crossover comparative study. Patients were randomly divided into group A (n = 10) and group B (n = 8). Both groups underwent the same exercise therapy for 4 weeks, following which the presence or absence of significant differences in walking function were determined. Subsequently, without a rest period, group A and group B began exercise therapy with and without environmental manipulation, respectively. Each group switched the exercise regimen after 4 weeks.
Results: Significant changes in walking function were observed after the environmental manipulation. In addition, the creation of a performance checklist was the most effective aspect of environmental manipulation.
Conclusion: The results of this study suggest that exercise therapy combined with environmental manipulation may be effective in improving the walking function of patients with chronic schizophrenia and drug-induced extrapyramidal symptoms.

The Relationship of the Optimal Gait Pattern with Energy Cost upon Ankle Immobilization

Kazuki TAKAHASHI, Toru NISHIYAMA, Jun ONOBE, Hiroto SUZUKI, Hiroyuki FUJISAWA

Released: December 20, 2015

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Purpose: The purposes of this study were to compare cardiopulmonary responses among four gait patterns and investigate the relationship between the optimal gait pattern and energy cost upon ankle immobilization.
Method: Thirty-seven healthy men participated in the study. Subjects were randomly assigned to one of four groups and instructed to walk using the specific gait pattern with or without (control) immobilization of the right ankle. The gait patterns were as follows: (1) external rotation gait (external rotation of the right hip and a toe-out gait; (2) circumduction; (3) toe gait (foot flat in initial contact and forefoot in contact from midstance to pre-swing; and (4) behind step gait (step at the back of the immobilized foot). Subjects walked on a treadmill at an incremental speeds (1.0, 2.0, 3.0, 4.0 and 5.0 km･h^–1). In addition, for each speed, eight subjects walked on a treadmill in free gait (no intentional dictation of gait pattern) with an ankle immobilized, and their observed walking patterns were categorized.
Result: Cardiopulmonary responses and energy cost per meter varied according to the gait pattern. Among the subjects who were allowed to choose their own gait patterns, none selected a gait pattern that required high energy cost and/or energy cost per meter.
Conclusion: Each gait pattern had unique characteristics. It is considered that individuals select optimal gait patterns to minimize energy costs.

Quantitative Analysis and Recovery Process of a Patient with Ataxic Upper Limb Using a Robotic Device

Toshiyuki AOYAMA, Fuminari KANEKO, Nobuhiro AOKI, Tatsunori SAWADA, Tatsuya HAYAMI

Released: December 20, 2015

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Purpose: The purpose of the present study is to investigate the kinematic change in a patient with upper limb ataxia, quantitatively using a robotic device.
Methods: One septuagenarian man with upper limb ataxia due to midbrain infarction participated in this study. The kinematic assessment was performed at baseline (BL) and 2 and 4 weeks after baseline (2W, 4W) during his rehabilitation at the hospital. The subject made use of visually guided tracking movement in the horizontal plane with his affected arm using a robotic device. The six kinematic parameters (coordinate error, velocity error, moving range of the X-axis and Y-axis, total length of trajectory, and Jerk Index) were calculated. Clinical findings such as the finger-nose test and the hand pronation supination test were also obtained.
Results: Coordinate error gradually decreased, but the other 5 parameters increased at 2W and decreased at 4W. The finger-nose test and the hand pronation supination test were positive at both BL and 4W.
Conclusion: The kinematic change of the upper limb tracking movement may not simply reflect the change of ataxic symptom but also an adaptive motor strategy. The present results indicate that the kinematic assessment using this robotic device is useful for detecting chronological change of the ataxic arm movement quantitatively.

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Released: December 20, 2015

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Journal of the Japanese Physical Therapy Association Vol. 18(2015) No. 1

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