Mirror therapy can be used to promote recovery from paralysis in patients with post-stroke hemiplegia, There are a lot of reports that mirror-image observation of the unilateral moving hand enhanced the excitability of the primary motor area (M1) ipsilateral to the moving hand in healthy subjects. but the neural mechanisms underlying its therapeutic effects are currently unclear. To investigate this issue, we used functional magnetic resonance imaging to measure activity in brain regions related to visual information processing during mirror image movement observation. Thirteen healthy subjects performed a finger-thumb opposition task with the left and right hands separately, with or without access to mirror observation. In the mirror condition, one hand was reflected in a mirror placed above the abdomen in the MRI scanner. In the masked mirror condition, subjects performed the same task but with the mirror obscured. In both conditions, the other hand was held at rest behind the mirror. A betweentask comparison (mirror versus masked mirror) revealed significant activation in the ipsilateral hemisphere in the anterior intraparietal sulcus (aIP) while performing all tasks, regardless of which hand was used. The right aIP was significantly activated while moving the right hand. In contrast, in the left aIP, a small number of voxels showed a tendency toward activation during both left and right hand movement. The enhancement of ipsilateral aIP activity by the mirror image observation of finger action suggests that bimodal aIP neurons can be activated by visual information. We propose that activation in the M1 ipsilateral to the moving hand can be induced by information passing through the ventral premotor area from the aIP.

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Purpose: To investigate improvement in various impairments by exercise interventions in patients with knee osteoarthritis (OA). Methods: We collected data on randomized controlled trials (RCTs) comparing the effects of exercise intervention with those of either nonintervention or psychoeducational intervention in patients with knee OA. Data on pain, stiffness, muscle strength, range of motion, flexibility, maximal oxygen uptake, and position sense were synthesized. The Grading of Recommendations Assessment, Development, and Evaluation system was used to determine the quality of the evidence. Results: Thirty-three RCTs involving 3,192 participants were identified. Meta-analysis provided highquality evidence that exercise intervention improves maximal oxygen uptake, and moderate-quality evidence that exercise intervention also improves pain, stiffness, knee extensor and flexor muscle strength, and position sense. The evidence that exercise intervention improves knee extension and flexion range of motion was deemed as undetermined-quality. Conclusion: In patients with knee OA, improvement in pain, stiffness, muscle strength, maximal oxygen uptake, and position sense with the use of exercise intervention can be expected. Although the quality of evidence of the effect of exercise intervention on range of motion was inconclusive, exercise intervention should be recommended for patients with knee OA to improve various impairments.

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Objective: To investigate changes in hip and knee muscle strength in patients before and after total hip arthroplasty (THA) in comparison with that in healthy adults. Methods: The study included 21 women who underwent unilateral THA (THA group) and 21 age-matched healthy women (healthy group). Maximal isometric strengths of hip flexors, extensors, and abductors, and knee extensors and flexors were measured before surgery and at 4 weeks and 6 months after surgery. Results: Before surgery, muscle strength on both sides, except for hip flexors on the uninvolved side, was significantly lower in the THA group than the corresponding muscle strength in the healthy group. Up to 6 months after THA, strength of all muscle groups on both sides was significantly improved compared with their preoperative status, although the knee extensor strength on the involved side temporarily worsened at 4 weeks. However, the strength of hip extensors and knee extensors on the involved side, and hip abductors on both sides in the THA group remained below that in the healthy group. Conclusions: Our results suggest that rehabilitation specialists should consider increasing the focus on the uninvolved side and encourage patients to continue strength training beyond 6 months after surgery.

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Objective: To compare the effect of body-weight-supported treadmill training (BWSTT) and full-body-weight treadmill training (FBWTT) on patients with knee osteoarthritis (OA). Methods: Design was Randomized controlled trial. Patients with knee osteoarthritis (n = 30; mean age, 76.0±7.5 y) were randomly assigned to BWSTT or FBWTT group. All patients performed 20 min walking exercise twice a week for 6 weeks under the supervision of the therapist. Main measures were 10-meter walking test (10MWT), functional reach test (FRT), timed get up and go test (TUG), one-leg standing test, 6-minute walking test (6MWT), the parameters set on the treadmill, MOS Short-Form 36-Item Health Survey (SF36), Japanese Knee Osteoarthritis Measure (JKOM). Results: Twenty-five patients (10 men, 15 women; mean age, 76.5 ± 8.0 y) completed the experiment. Exercise capacity, indicated by the heart rate, was similar in both groups. After 3 weeks of BWSTT, the patients performed significantly better in the 10-m and 6-min walking tests. This was not the case with FBWTT even after 6 weeks training. Pain levels assessed were significantly improved after 3 weeks of BWSTT and 6 weeks of FBWTT. There were no significant improvements in either group assessed by the FRT, one-leg standing time test, TUG, or SF -36 questionnaire. Conclusions: BWSTT enhanced exercise capacity in terms of walking speed and pain reduction after 3 weeks; however, there was no significant improvement in patients’ functional abilities or quality of life.

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Objective: The present retrospective study aimed to clarify the involvement of knee extensor strength and autonomic indices （ΔHR) in the improvement of exercise capacity (peak VO₂) in acute myocardial infarction (AMI) patients with type 2 diabetes mellitus (DM) undergoing cardiac rehabilitation (CR) -related exercise training. Methods: A total of 41 consecutive male AMI patients with type 2 DM were divided into the supervised outpatient CR group (n = 24) and the non-CR group (control, n = 17). Physical training was prescribed for 8 weeks in the CR group. Cardiopulmonary exercise testing (peak VO₂, ΔHR) and isokinetic knee extension strength measurements were performed on all subjects at 1 (T1) and 3 (T2) months after AMI onset. Results: Significantly greater improvements in peak VO₂ (26.1→29.4 vs 23.5→24.4 ml/kg/min, F = 7.5， p ＜0.01), knee extension strength (1.7 →1.9 vs 1.7 →1.7 Nm/kg，F=5.1，p = 0.02), and ΔHR (71.3 →77.2 vs 63.5 →62.5 bpm, F = 5.5, p = 0.02) were measured from T1 to T2 in the CR group versus the nonCR group. Conclusions: In patients with AMI complicated by DM, only the exercise group showed significant improvements in knee extensor strength and ΔHR. Therefore, improvement in exercise capacity in such patients was considered to be related to improvements in knee extensor strength and ΔHR.

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Purpose: We aimed to clarify the factors associated with transfer of cerebral infarction patients in the acute stage to rehabilitation hospitals. Subjects: From 277 consecutive patients admitted with cerebral infarction to the Stroke Center of our hospital, we chose 215 patients discharged to home (home-discharged group, n = 121) or to rehabilitation hospitals (rehabilitation hospital group, n = 94). We designed this study as a retrospective observational study and investigated various factors including social factors obtained from medical records. Results: Compared with the home-discharged group, the rehabilitation hospital group did not show differences in patient background, such as presence of housemates and numbers of persons per household but did show greater dysfunction and disability. Factors associated with discharge destination by multiple logistic regression analysis included the National Institute of Health Stroke Scale (NIHSS), when the illness is serious; the Ability for Basic Movement Scale II (ABMS II), when a wheelchair is first used; higher brain dysfunction; and the Barthel Index at the start of rehabilitation. From the results of ROC curves, cutoff values for determining discharge direction were 3.5 points by the NIHSS and 21.5 points by the ABMS II. Conclusion: It is suggested that both the NIHSS and the ABMS II, which is an objective index for evaluating basic mobility, might be factors for early prediction of discharge to rehabilitation hospitals.

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Purpose: The purpose of this study was to clarify whether stroke patients with different stepping patterns had the ability to ascend and descend stairs, based on their basic attributes and physical functions. Methods: Subjects were 64 persons with stroke in whom age, time since stroke, knee extension on non-paretic and paretic sides, leg weight bearing rate (WBR) on non-paretic and paretic sides, leg Brunnstrome recovery stage (Br-stage), presence or absence of disturbance of deep sensibility, and severity of spasms were surveyed or measured. Results: Subjects were divided into 3 groups for stair ascending and descending: 1 leg-1 step; 2 legs-1 step; and unable to use stairs. Significant differences were seen in leg strength on non-paretic side, leg strength on paretic side, WBR on non-paretic side, WBR on paretic side, leg Br-stage, and presence or absence of disturbance of deep sensibility. In a comparison of consecutive data, values for paretic side muscle strength and paretic side WBR were significantly higher in the 1 leg-1 step group than in the 2 legs-1 step group for both ascending and descending. Moreover, values for paretic side muscle strength were significantly higher in the 2 leg-1 step group than in the unable group for both ascending and descending. Conclusion: In stroke patients, various physical functions contribute in ascending and descending stairs with different ascent/descent patterns. The results suggest that muscle strength and WBR on the paretic side is particularly important when using stairs.

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Purpose: We examined our hypothesis that a 7-week program of plantar flexor training improves gait function, by using spatiotemporal and Center of pressure （COP） parameters. Subject: Three subjects with cerebral palsy (13.7 ± 5.4 years old), who are possible to serial walk 10 m or more, and understand oral instructions, were included in the study. Methods: We employed a single-subject ABA´ design consisting of a 7-week baseline phase, a 7-week intervention phase, and a 7-week post intervention phase. The subjects were given training 3 times a week during the intervention phase. Result: Two cases showed a significant improvement in the walking ability and the walking efficiency, one case showed a significant improvement in the walking efficiency. These results support our hypothesis. Conclusion: It is not easy to improve gait function by increasing the amount of the activity of the muscle for people with cerebral palsy who have not haven a normal movement pattern since their birth. However, the approach of the amount which has been a contraindication, is one of the important approaches for it to improve and maintain gait function.

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Purpose: When exercise by post-stroke hemiplegic patients is guided, there is often a lack of specific guidance regarding how much walking the patient should do. The purpose of this study was to examine exercise guidance for hemiplegic patients based on an analysis of energy consumption while walking. The assumption is that an energy consumption of about 300 kcal through daily exercise (equivalent to walking about 10,000 steps) is effective for health maintenance in an able-bodied person. Methods: Seventy-one hemiplegic patients were included in this study; the number of steps, walking distance, and energy consumption were measured while the subjects walked for 12 minutes. Next, the number of steps, walking distance, and walking time equivalent to the target energy consumption (300 kcal/60 kg) were calculated. Results: The number of steps and walking distance equivalent to the target energy consumption were reduced in subjects whose walking speed was slower. Conclusion: We must consider motor functions, such as walking speed, when prescribing the number of steps and walking distance because energy consumption per step and distance is influenced by motor paralysis in hemiplegic patients.

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Purpose: Shoulder injuries to wheelchair tennis players are often linked to the serve. This study aims to investigate the characteristics of serve motion in wheelchair tennis players. We compared the shoulder angle and muscle activations during serve motion of wheelchair and non-wheelchair tennis players. Subjects: Eight wheelchair tennis players participated in this study. Methods: A six-camera 250 Hz Vicon motion analysis system and surface electromyography were employed to record the serve of eight wheelchair tennis players. Student’s t-test was used to determine statistically significant differences between the serve motions of wheelchair and non wheelchair tennis players. Results: At maximum external rotation of the racket arm, wheelchair tennis players had a significantly lower shoulder external rotation angle and a larger abduction and horizontal adduction than non-wheelchair tennis players. At ball–racket impact, wheelchair tennis players had a significantly lower shoulder abduction angle and a larger horizontal adduction than non-wheelchair tennis players. In addition, in the forward-swing phase, the anterior deltoid was more active and the posterior deltoid was less active than that in non-wheelchair tennis players. Furthermore, the pectoralis major was not significant. Conclusion: These results indicate that wheelchair tennis players serve in an unstable shoulder position compared to non-wheelchair tennis players. This suggests that wheelchair tennis players are more prone to shoulder injury than non-wheelchair tennis player. In addition, a wheelchair tennis player may biomechanically suffer shoulder injuries during the serve motion.

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Purpose: The aim of this study was to determine the possible existence of locomotor respiratory coupling (LRC) and examine the effect of imposing LRC on ventilation and gas exchange responses during arm ergometry exercise. Methods: Ten healthy subjects performed incremental exercise testing to determine exercise intensity. Arm ergometry exercise with constant work loads was then carried out either under spontaneous breathing or with different entrainment breathings in which respiration/cranking frequency (f_r/f_c ratio) were fixed at 1/1, 2/3, 1/2, 2/5 and 1/3. Results: During spontaneous breathing, all the subjects exhibited the various f_r/f_c, the most commonly observed f_r/f_c was 2/5 under spontaneous breathing. The imposed LRC patterns did not significantly affect the actual LRC rate. Still, dead space ventilation ratio was significantly reduced at ratio of 2/5 and 1/3, respectively. Conclusions: These results suggest that the entrainment patterns during arm ergometry exercise was similar to that seen in studies of pedaling exercise, but to a much less extent. In addition, the ventilatory efficiency was affected by f_r/f_c independent of actual LRC apparent rate.

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Purpose: The purpose of this study was to identify major risk factors of the falls of the patients with stroke whom live at home by analyzing patients’ information and functional evaluation tools data such as FIM (Functional Independence Measure) instrument and SIAS (Stroke Impairment Assessment Set). Methods: Sixty-four stroke outpatients who had earlier discharged from Fujita Health University Nanakuri Sanatorium were participated in our study. We evaluated the following baseline characteristics for all patients: age, sex, stroke type, affected side of the body, number of stroke suffered, maximum walking speed, use of ankle foot orthosis, use of cane, use of medicine that may increase the risk of falling, and frequency of the falls of the patient during their rehabilitation period in the hospital, FIM, SIAS, and Mini-Mental State Examination scoring were also done before their discharge from the hospital. We first carried out bivariate analysis to determine which variables differed significantly between the non-fallers and fallers. Those variables of significant statistical values were then included in a multivariate logistic regression analysis. The model was simplified in a Forward Selection Method (Likelihood Ratio) by removing variables. Results: Those patients with a falling experience comprised 25 patients out of the total 64 patients (39.1% ). The logistic model was refined until it excluded all the predictors except two. These two predictors were maximum walking speed, and use of ankle foot orthosis. Conclusions: Those patients with a slow speed of walking and/or the patients who required the use of ankle foot orthosis were at a higher risk of falling.

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Purpose: The purpose of this study was to test whether the plasticity changes of the primary motor cortex (M1), which has been proposed as a neural basis of motor learning, was induced by mirror therapy. Methods: We investigated by using transcranial magnetic stimulation (TMS) in 12 neurologically healthy subjects. Each subject was asked to rotate two cork-balls in a counter-clockwise direction with non-dominant hand as fast and accuracy as possible and the number of ball-rotation was counted for 30 seconds. After measuring the motor behavior and TMS (Pre), subjects practiced Motor-training intervention of the right hand with mirror visual feedback (MVF) superimposed on the left hand using a mirror box (Post1). Furthermore, the beneficial effects of MVF were disrupted by the continuous theta burst stimulation (cTBS), which is a procedure to suppress local cortical function, over M1 and the occipital cortex (OC) (Post2). Subjects were randomly assigned with the M1 (n=8) and OC group (n=8) by the site where cTBS was applied. Finally, both groups performed another set of mirror therapy intervention (Post3). Results: Mirror therapy significantly improved the motor behavior and increased the excitability in M1. In addition, the motor behavior and cortical excitability were transiently suppressed by cTBS in M1 group but not in OC group. However, subsequent mirror therapy following cTBS could improve the motor behavior and cortical excitability, again. Conclusion: These results have suggested that the cause-effect link between the M1 activity and behavioral improvement in MVF-induced motor learning.

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Purpose: This is an expanded version of the study “Selecting Technical Vocabulary in the Field of Physical Therapy and Determining its Characteristics”, which previously appeared in this journal. The aim of this study is to identify the features of English in the field of physical therapy from the viewpoint of collocational patterns. Method: We examined collocational patterns in the two corpora created for the previous study (RA corpus: 397,874 words, PT text corpus: 546,666 words). The heads of collocation for analysis were combinations of adverb+verb, verb+noun, and adjective+noun. In each head, two-word units which co-occur three times or more were extracted from the two corpora. A mutual information score of the units was calculated to identify whether there are unique collocational patterns which have stronger connections in texts in the physical therapy field. Mutual information shows the expected probability of co-occurrence. The higher score tell us the stronger attraction between the words. Results: In all heads, there are combinations of two words showing high scores in common across the two corpora. Conclusion: Knowledge of collocation is vital to improve reading ability. Learning collocational patterns observed in the two corpora will be an effective strategy to increase the speed of understanding physical therapy texts.

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Purpose: The purpose of this study was to examine the influence of the different joint angles and traction forces, especially to indicate the maximally loose-packed position by analyzing the change of joint space width (separation distance) that accompanies the traction of knee joint. Method: The subjects were 18 healthy adult subjects (9 male and female, average age of 25.1 years old). The method was to tug their right knees toward long axis direction of the right lower leg with 7 levels of joint angle (completely extended position, 25, 35, 45, 55, 70, 90 degrees) and 2 levels of traction force (100・200 N), and analyzed the separation distance by examining the ultrasound images of the joint spaces. Result: With 100 N, 55 degrees flexion angle showed greater separation distance than completely extended position. With 200 N, the distance are larger with 25, 35, 45, and 55 degrees than completely extended position, and 45 and 55 degrees showed greater separation distance than 90 degrees. Based on the regression formula of the relationship between the joint angle and separation distance with 200 N, the knee angle that shows the maximum separation was estimated as 51 degrees. Conclusion: The study showed that separation distance is larger with 200 N than 100 N. It also suggested that maximally loose-packed position of a normal knee joint is about 51 degrees.

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Purpose: The purpose of this study was to extract the kinetic and kinematic factors of the sit-to-stand (STS) movement of stroke patients. To determine these factors, we analyzed the relationship between patient kinetic and kinematic data and indices of physical ability. Methods: Thirty four subjects who had experienced stroke performed the STS movement from a stool, and their movement was measured by a motion analysis system (VICON). The relationship between kinetic and kinematic data and indices of physical ability (gait speed, the functional independence measure, and the Fugl-Meyer Assessment) was analyzed using the Spearman rank correlation coefficient. Result: The execution time of STS and the ratio of the load on the affected side at seat-off correlated with many physical ability indices. The anteroposterior movement range of the center of pressure during STS correlated with the following kinetic and kinematic factors. The duration of momentum phase, which began with initiation of movement and ended just before the buttocks were lifted from the chair (Phase 1) correlated with the lower limb functions of the affected side as well as with the balance function. The duration of extension phase, which began with maximal ankle dorsiflexion and ended with hip extension (Phase 3) correlated with the balance function. Conclusions: The following kinetic and kinematic factors were determined to be useful as indices for the mechanical evaluation of STS movement in stroke patients: execution time of STS, ratio of the load in the affected side at seat-off, and the anteroposterior movement range of the center of pressure during STS. Results revealed that the lower limb functions of the affected side are important to Phase 1 while the balance function is important to both Phase 1 and Phase 3.

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Purpose: The purpose of this study was to assess the difference of between the effect of muscle strengthening and combined functional training with muscle strengthening on everyday function in community-dwelling elderly individuals who had risks for functional decline. Subjects: Sixty eight specified elderly subjects using adult day-care service were participated in the study, and were assigned to muscle strength group and functional training group. Methods: The muscle strength group (n = 40) performed resistance training with leg press machine which intensity was 60% maximum voluntary contraction, and conducted strength training with weight in lower extremity muscles. The functional training group (n = 28) were executed balance and gait exercise consisted of standing balance exercise on form mat and tandem walking, and walking exercise with weight and long distance walking, in addition to muscle strength training. The subjects were measured 1 repetition maximum of leg press machine (1RM), one leg standing time (OLS), functional reach test (FR), timed “Up & Go” test (TUG), maximum walking speed (MWS), Tokyo Metropolitan Institute of Gerontology index, the basic checklist and self-perceived health in before and after the training. The exercise intervention was performed for 3 months, 1 time weekly. Results: The functional training group showed significant improvements in TUG, MWS and self-perceived health than the muscle strength group after exercise intervention. There were main effects in 1RM, OLS, FR, however, no interactions were found. Conclusion: The results suggested that the combination of functional training and muscle strength training was useful to maintain/improve gait performances and self-perceived health than muscle strength training only in the specified elderly individuals.

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Purpose: The purpose of this study was to develop a new scale, the Stroke Physical Performance Scale (SPPS), based on the Rasch model. The SPPS evaluates physical performance in a standing position and during ambulation related to the activities of daily living (ADL) of stroke patients. Methods: A preliminary scale was developed that consisted of 25 items representing physical performance selected by observation of the ADL. This scale was tested for stroke patients (N = 102) in 2 rehabilitation hospitals using 5-level rating categories. Their responses were analyzed using the Rasch model to select rating categories and items. After the development of the SPPS, we investigated its unidimensionality and reliability. Results: The rating category analysis integrated the category of “supervision” into “light assistance”, so that rating involved 4-level categories. The item selection analysis excluded 9 items, the SPPS therefore became a 16-item scale, which fitted the Rasch model. The SPPS demonstrated good unidimensionality and reliability. Conclusion: The SPPS was constructed as a scale to evaluate physical performance in a standing position and during ambulation related to the ADL of stroke patients. It may be valuable to evaluate changes in physical performance using an interval scale both in a clinical setting and for clinical research.

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Purpose: We aimed to evaluate whether synchronization between cardiac and locomotor rhythms during walk results from an entrainment or occurs just by chance. Method: Nine healthy men participated in this study. Each subject walked at the frequency of his heart rate on a treadmill. Synchrogram and histogram data during the walk were generated based on the electrocardiogram and foot switch signals. We also generated surrogate data by randomly sorting the original data of the locomotor rhythm, and then compared the two data. Result: The cardiac-locomotor synchronization was observed in 7 of the 9 subjects. There was a significant difference between the original and the surrogate data. This result may indicate that the observed synchronization between the cardiac and locomotor rhythms represented entrainment. Conclusion: Walking at the frequency of heart rate would induce the cardiac-locomotor synchro nization by entrainment.

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Purpose: We aimed to return using the toilet of a patient with distal myopathy by using exercise therapy. Methods: The patient was a 65-year-old woman who had developed depression and had therefore experienced long-term immobility. She had developed deteriorating the muscular strength and was restricted to diaper use. On alleviation of the depression, the patient wanted to use the toilet by herself. We used PNF muscle strengthening exercises to help the patient regain continence, while taking care to prevent overuse syndrome. This therapy was performed in 7 stages and we assessed the results in each stage. We also assessed the patient’s muscular strength by using a handheld dynamometer and measured muscle thickness by ultra sonography. Results: After 4 weeks, the patient’s muscular strength improved. After 8 weeks, she could operate the toilet without wearing her under-pants and pants. Conclusions: The muscular strength of a distal myopathy patient who has experienced long-term immobility can be improved by exercise, while taking care to prevent overuse syndrome.

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Purpose: The purpose of this study is to clarify the process of regaining the activities of daily living (ADL) of stroke patients and femoral neck fracture patients. Method: From the data registered in the rehabilitation patient database produced by the Japanese Association of Rehabilitation Medicine, 1,820 cases of stroke and 247 cases of femoral neck fracture were extracted and studied. With the Rasch analysis, difficulty and fit index were obtained for each of 13 items related to movement in the functional independence measure (FIM). Result: In the case of stroke, there existed the ADL group with intermediate difficulty. In the case of femoral neck fracture, the difficulty of changing dressing-upper body was lower than that in the case of stroke, but the order of ADL difficulty was not so different between the two cases. Conclusion: Based on analysis of this database the study found that there are differences in the ADL structures between the stroke patients and the patients with femoral neck fracture. The difference occurs from the different functional disorder levels: the stroke patients have the unilateral paralysis of upper and lower extremities, while the patients with femoral neck fracture have injury of a single extremity. It is considered that understanding the ADL structures of both diseases provides useful knowledge for the advancement of the ADL assessment and physical therapy.

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Purpose: The purpose of this study was to investigate the immediate effect of low-intensity pulsed ultrasound (LIPUS) used at several intensities on chondrocyte metabolism by gene expression analysis. Methods: Chondrocytes were isolated from the knee joint of 12-week-old Wistar rat. In order to induce osteoarthritis (OA) -like condition experimentally, interleukin-1β (IL-1β) of 0 pg/ml, 100 pg/ml and 1000 pg/ml concentration was added to the isolated chondrocytes. Then the chondrocytes were stimulated for 20 min by LIPUS of 0, 7.5, 30 and 120 mW/cm² intensity. After stimulation, gene expression analysis was conducted. Results: Matrix metalloproteinase (MMP) -13 mRNA expression, articular cartilage degeneration factor, induced by IL-1β at a concentration of 100 pg/ml was inhibited in an LIPUS intensity-dependent manner. Type 2 collagen and aggrecan mRNA expression, main articular cartilage matrix component, showed the inhibiting tendency by LIPUS stimuli. Conclusions: Our results suggest that LIPUS may potentially protect articular cartilage by inhibiting MMP13 mRNA expression in an intensity-dependent manner.

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Purpose: The purpose of this study was to examine the effect of supported and unsupported arm exercise on the 2 dyspnea indexes, namely, airway occlusion pressure (P_0.1) and the ratio of the change in ventilation to the change in P_0.1 (ΔVE/ΔP_0.1), by using symptom-limited exercise stress testing. Methods: Twenty-one healthy male volunteers performed both these exercises with 3 increments(stage 1 to 3) in oxygen consumption, defined as exercise intensity. Each stage was performed at the same intensity between the 2 exercises, to aid in the comparison. The P_0.1, VE, carbon dioxide production (VCO₂), respiratory frequency (f), ventilatory equivalent of carbon dioxide (VE/VCO₂) and the Borg scale rating of perceived dyspnea and arm muscle exertion was obtained at each stage. Results: The P_0.1 was significantly greater in the unsupported arm exercise than in the supported arm exercise (P ＜0.001); however, there was no difference in ΔVE/ΔP_0.1 between the 2 exercises. With higher load, the corresponding VE, VCO₂, f, VE/VCO₂ and the Borg scale rating of perceived dyspnea were significantly greater in the unsupported arm exercise than in the supported arm exercise. Conclusions: The results of this study indicate that there is a greater possibility of developing dyspnea during an unsupported arm exercise than during a supported arm exercise, possibly because of the greater ventilatory demand in the former.

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Purpose: The purpose of this study was to clarify the effective motor control to trunk muscles by quantitatively analyze the lumbar movement during active leg raise under different strategies for lumbar stabilization in healthy subjects. Methods: Twenty-three healthy male (mean age 22.8 ± 5.4 years) subjects participated in this study. Firstly, subjects were instructed to perform three different types of contraction of trunk muscles in the supine position as follows: 1) control condition: involuntary, 2) hollowing condition: draw-in the abdominal wall at 20％ maximum voluntary contraction (MVC) using a modified Richardson’s method, 3) bracing condition: brace the abdominal wall at 20％ MVC without change of abdominal girth using a modified McGill’s method. Secondly, the amount, timing and sharpness of lumbar movement during the leg raise from crook lying position under each conditions were recorded with a custom-made back pressure recording device placed beneath the back and a foot switch placed beneath the heel. Data analysis was performed using a bio-signal analyzing software (BIMUTAS version 2.0E, Kissei Comtec, Japan). Results: 20 subjects (87% ) demonstrated the lumbar moves in the direction of the lordosis preceding leg raise. The amount and sharpness of this movement in bracing exercise were significantly lower than the hollowing and control exercise conditions (p < 0.05)． Conclusions: This study suggested that motor control in trunk muscles during bracing condition was more effective for lumbar stability compared with hollowing and control conditions in healthy subjects.

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Purpose: To evaluate the effects of mirror therapy on finger motor dysfunction after stroke. Methods: Fourteen convalescent stroke patients were randomly assigned to the mirror therapy group trained thirty minutes of mirror therapy in addition to conventional rehabilitation program or control group trained conventional therapy only, and then conducted each 4-week training program. The primary outcome measure was the Brunnstrom recovery stage (Brs), Fugl-Meyer assessment (FMA) sub-scores for the upper extremity, Wolf motor function test (WMFT) and the self-care items of the Functional independence measure. Results: The scores of the Brs for the hand, FMA for the wrist and hand, and the WMFT improved more in the mirror therapy group than in the control group (all p < 0.05). Furthermore, these outcome change scores between pretreatment and posttreatment on mirror therapy group reached the distribution based minimal clinically important difference. Conclusions: These results suggested that mirror therapy in addition to a conventional rehabilitation program can be effectiveness for finger motor dysfunction after stroke.

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Purpose: The purpose of this study was to clarify the influence of age-related differences on attentional focus effects in the reaction time and the movement pattern of the involuntary front single step. Methods: Eight healthy elderly women and eight healthy young men were released from a forward-leaning position and instructed to regain standing balance by taking a single step forward. The involuntary step was induced while carrying out three cognitive tasks: 1) simple front-fixed gaze as control condition; 2) Color word reading as displayed every one sec; and 3) Color word reading as a word is displayed in a color different from the color it actually names. This task is called stroop task. Lower extremity spatiotemporal parameters, foot-floor reaction time, and thigh muscle activity were measured during the step responses. Results: The delay of foot-floor reaction time and the increase of knee extension muscle activity after the step landing were found only in the elderly stroop task compared with control task. The step length and step velocity were significantly decreased in the elderly in comparison with the young subjects, but there was no difference among the cognitive tasks. Conclusion: In the elderly, a delay in the fall prevention step reaction after tripping is predicted when the elderly is distracted by attention-demanding tasks. This study also shows that there is no change in step movement velocity for a step delay.

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Purpose: The purpose of the present study was to examine the effects of smoking on muscle oxygenation during localized muscular exercise. Methods: The subjects included 9 young smokers and 9 nonsmokers. Near-infrared spectroscopy (NIRS) was used to assess muscle oxygenation in the right vastus lateralis muscle during 30 repeated maximal isokinetic knee extensions at high angular velocity (300 degrees per sec) and 5 repeated extensions at low angular velocity (60 degrees per sec). Results: During the high angular velocity extensions, the time course of the NIRS parameters were not significantly different between two groups. In contrast, during the low angular velocity extensions, time-related changes in Oxy-Hb･Mb and Total-Hb･Mb were significantly different in the two groups. We also showed that Oxy-Hb･Mb was significantly lower in smokers than in nonsmokers during the latter period of the exercise. Conclusion: These results indicate that the ability to deliver oxygen to active muscles to satisfy oxygen demand in young smokers is limited compared to nonsmokers during isokinetic knee extension at higher torque and low angular velocity.

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Introduction: The purpose of this study was to examine the compensatory mechanism in rats, underwent left decortication at postnatal day 7 by using retrograde tracing method. Methods: Retrograde tracers, FITC-conjugated CTB and FastBlue were injected into the right and the left sides of upper cervical segments of spinal cord, respectively, at postoperative weeks 2, 3, 4, and 5. The number of retrogradely labeled descending projective neurons was compared to the number of the same neurons in normally developed rats. Results: Significantly more ipsilateral corticospinal neurons were labeled with FITC-CTB in the experimental rats compared to normal rats at all cases. There were also some FITC-CTB and FB double-labeled corticospinal neurons in both experimental and normal rats. In decorticated rats the number of doubly labeled neurons increased sequentially, and was significantly greater than in normal rats at postoperative weeks 4 and 5. However, only few percent of all neurons were double labeled in the treated animals. Significantly more neurons were also labeled with FITC-CTB in the medullary ventral reticulospinal area and in the medullary raphe-spinal area in the experimental rats compared to control animals at postoperative weeks 4 and 5. Conclusion: The present results suggest that main compensatory response after unilateral neonatal decortication was formed by unlesioned ipsilateral corticospinal neurons, which were not selective in development. Furthermore, the collaterals of the corticospinal tracts originate from the cerebral cortex on the unlesioned side and descending spinal projections from brainstem are also related to compensatory response.

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Purpose: This study aimed to assess the inter-rater reliability of a modified version of the gait abnormality rating scale (GARS-M)． Methods: The GARS-M was thoroughly translated into Japanese. Outpatients aged ≥ 65 years were included. The subjects were made to walk for a short distance (7.6 m), and the entire walk was videotaped. Three physical therapists retrospectively viewed these recordings and rated the gait of each subject according to the GARS-M. The intraclass correlation coefficient (ICC) for the obtained scores was calculated to evaluate inter-rater reliability. Results: A total of 26 elderly individuals Twenty-six older persons (17 men, 73.9 ± 5.8 years) participated were rated. ， and the calculated The ICC was 0.83. Conclusion: The Japanese version of the GARS-M has an acceptable inter-rater reliability and can prove beneficial for evaluating the gait of elderly individuals in Japan.

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Purpose: The objective of this study was to determine whether psychological stress is associated with changes in subjective pain intensity and changes in excitability of the somatosensory cortex. Methods: Twenty healthy volunteers participated in this study. Of these, 10 took the Uchida-Kraeplin psychodiagnostic test as a mental stress task, whereas the remaining 10 (control group) were seated comfortably for approximately 35 minutes. Painful electrical stimuli were applied to the right median nerve of participants in both groups. We compared pain-related somatosensory evoked potentials after painful electrical stimulation between the test and control groups and pain intensity was rated according to the visual analog scale (VAS) during electrical stimulation before and after the mental stress task in the test group. Results: VAS scores for pain intensity and the peak-to-peak amplitude of N20/P25 were found to be significantly increased after the mental stress task. Conclusion: We concluded that mental stress increased subjective pain intensity and excitability in the primary somatosensory cortex.

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Purpose: To assess the impact of preoperative kidney function and postoperative acute kidney injury (AKI) on the perioperative catecholamine therapy and early phase of postoperative cardiac rehabilitation (EPPCR)． Methods: Eight hundreds seventy three consecutive patients (572 male, 301 female, 68 ± 11yo) who underwent elective cardiac surgery were selected and divided into 3 groups depending on preoperative kidney function; non chronic kidney disease (CKD) group, CKD group and hemodialysis (HD) group. Moreover these patients were classified into 2 groups according to the presence of postoperative AKI. We evaluated the effects of preoperative kidney function and postoperative AKI on perioperative catecholamine therapy and EPPCR. Results: In non CKD and CKD group among AKI group, catecholamine index (CI) at initiation of sitting exercise and standing exercise were significantly delayed compared with those in postoperative non AKI group. In non AKI group, progression of postoperative EPPCR were significantly delayed according to the severity of preoperative kidney function (p < 0.05). In non CKD and CKD group among AKI group, sitting, standing, walking exercise and 100 m unassisted walk were significantly delayed compared with those among non AKI group (p < 0.05) ． Conclusion: EPPCR was delayed according to the severity of preoperative renal function in non AKI group. However, CI at initiation of EPPCR was higher, and progression of EPPCR was more delayed in AKI group than those in non AKI group.

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Purpose: The purpose of this study was to determine the effect of exercise with dual-task training (DTT) on the Dynamic gait index (DGI) score among patients with stroke. Methods: We recruited 14 patients who were capable of walking unassisted and scored 24 points or higher on the mini-mental examination state. Subjects were randomly assigned to the experimental or the control group. The experimental group received conventional individualized exercise with DTT. The control group received it without DTT. The DGI scores were collected at baseline and after training for evaluating walking ability and compared between the two groups. Results: Both groups showed significant improvements of the DGI score after training. In addition, there was a significant time by group interaction, the experimental group showed significant higher change scores of the DGI compared with the control group. Conclusion: These findings suggest that the exercise with DTT among patients with stroke who were capable of walking unassisted can be an effective training improving the DGI score.

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Mirror Observation of Finger Action Enhances Activity in Anterior Intraparietal Sulcus: A Functional Magnetic Resonance Imaging Study
J Jpn Phys Ther Assoc Vol. 16: 1-6, 2013
There was an error in reference number on page 6 line 23.
Original text
This finding suggests that the left aIP is dominant for visual information, because the right aIP responds to only one of the hands, but the left aIP responds to both hands^18,26).
Corrected text
This finding suggests that the left aIP is dominant for visual information, because the right aIP responds to only one of the hands, but the left aIP responds to both hands¹⁸⁾.

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