Gait disturbance is a serious problem in Parkinson's disease (PD). Exercise therapy is used to alleviate this complaint. We investigated the effects of a videotaped arm swinging-based home exercise program on gait in PD patients. The subjects included 25 outpatients aged between 55 and 77 years (average age 68.9 years) with PD in Hoehn and Yahr stages II-IV. We prepared a master video tape in which a trainer was shown to be performing an arm swinging exercise or steps in synchrony with a metronome. The exercise menu consisted of 4 parts : arm swinging in a seated position, arm swinging in an upright position without stepping, arm swinging with stepping, and walking on the floor or taking a walk. The patients performed the arm swinging exercise while watching a video tape everyday for a period of 3.4 weeks. Of the 25 patients, 22 completed the exercise program. Following the program, these patients showed significant improvements in their walking times for a 20m walk (10 m, return, 10 m) (before/after=29.6/24.3 sec, p=0.002) and in the step length (before/after=43.7/50.1 cm, p<0.001). Frozen gait was a negative factor to complete the programs. Improvement of gait speed after the exercise was related with less frequency of cadence. Loss of arm swinging in PD may be associated with a disturbance in the internal rhythm formation process. Arm swinging exercises are one of the exercise methods that use rhythmic cues. This study suggests that a videotaped arm swinging-based home exercise therapy is effective in such patients.

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The six major determinants of gait, as proposed by Saunders et al., were reviewed. The results showed that each of the first three determinants (pelvic rotation, pelvic list, and stance phase knee flexion) have only a minor effect on decreasing the vertical displacement of the center of gravity (COG). The major determinant of COG displacement is heel rise, and the second is the inclination of the lower extremity in the stance phase. In spite of the assumption that decreasing the COG displacement decreases gait energy consumption, the energy required for walking with a flat COG trajectory increased dramatically. Therefore, the major gait determinants as defined by Saunders et al. should be corrected in terms of both the COG displacement and energetics.

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Femoral neck and intertrochanteric fractures are common in the elderly. These types of fractures affect about 90,000 people each year in Japan. At present, most such fractures are operated on. Immediate unrestricted weight-bearing after surgery is usually allowed. Conservative treatment may be considered if a patient can bear long-term bed rest and accept the risk of having a less functional outcome. Isometric quadriceps muscles and ankle range of motion exercises are important therapies to use before surgery. The appropriate intensity for rehabilitation is still controversial. The majority of the functional recoveries occur within the first 6 months, but further outpatient rehabilitation is still effective in patients without severe physical or cognitive impairments. About half of all patients recover their prefracture activities of daily living. Patients who are older or who are disoriented after surgery recovered least in terms of instrumental activities of daily living. In this group, even patients with uneventful healing courses did not regain their prefracture health-related quality of life level. Deep vein thrombosis, pulmonary infarction, palsy of the common peroneal nerve, fall, avascular necrosis of the femoral head, screw dislodging and removal, dislocation and infection are all possible risks factors after femoral neck and intertrochanteric fractures.

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