The important points of motion analysis in basic movements are as follows. The movements of simple joints should not be observed alone, but together with the movements of several joints that participate in the basic movement. Next, basic movements should be expressed as anatomical and kinematic data. Furthermore, to clarify problems such as impairment disorders, whether characteristic movements are needed for performance of basic movements needs to be determined. If these goals are definitively accomplished, then the appropriate timing of physical therapy can be accurately determined. In this report, the importance of motor analysis in the field of physical therapy is reconfirmed.
Visual observation and electromyographic evaluation of the movement from the sitting position to the supine position were performed. In the movement from the sitting position to the side-lying position, the forearm of the upper limb supports the lateral bending of the trunk after elevation of the pelvis. The pelvis is elevated by the muscle activity of the oblique muscle on the opposite side, which is important.
Table manners are as important as just eating a meal. With the spread of food culture, Japanese culture has been influenced by overseas eating habits. The upper limb is moved into a certain position to have a meal. When performing functional therapy, a knowledge of these movement chains is important because the shoulder, elbow, forearm, wrist, and finger joints are mutually related. In clinical practice, the relationship between the joints is immediately noticeable by movement compensation that is generally recognized and helpful to gauge the effects of physical therapy. However, the exercise chain of the forearm, elbow, and shoulder joints may not display obvious movement compensation, thereby making it difficult to detect functional decline. The movement used to pick up food with chopsticks, a fork, or a hand during meals is known as the reach movement. There are two types of reach movement: of a range that is smaller than the length of the arms, or beyond the length of the arms. Generally, the movement used during meals is mainly of the former type, but the latter type may also be used in some food cultures. This report describes the exercise chain of the forearm, elbow, and shoulder joints, and the movement chain involving the trunk and the shoulder girdle, in consideration of these factors.
Sitting down is one of the items of activities of daily living, and it involves movement from a standing to a sitting position. This paper outlines the components of this sitting-down movement. Sitting down and standing up are inverse motions. The electromyography pattern of the sitting-down movement was analyzed and is discussed with reference to physical therapy. An improved understanding of the components of this movement is desirable.
Single-leg standing is performed in various daily activities such as wearing and removing trousers, stepping into and out of a bathtub, and ascending and descending stairs. Therefore the acquisition of stable and safe single-leg standing is crucial for independent living. Watanabe et al. (Journal of Kansai Physical Therapy, Vol. 9) have reported the importance of the trunk and hip muscle activities of the legs both on and off the ground in the single-leg standing position. Single-leg standing also requires maintenance of the center of pressure (COP) by the foot on the ground. To achieve this condition, the functions of the trunk and hip as well as the functional activity of the foot on the ground have important roles, including the ability to keep COP in the same place, and the ability to flexibly shift COP with the foot on the ground. In addition to the trunk and hip muscle activities, these abilities are attained when the functional muscle activity of the foot activates the medial and lateral longitudinal and transverse arches. This paper describes the assessment methods of the lateral longitudinal arch and the function of the abductor digiti minimi muscle of the foot in supporting the lateral longitudinal arch.
While walking, we often change our direction and speed as necessary. The movement made to change the direction is divided into two types: the spin turn and the step turn. The axis of the lower extremity in the spin turn is on the same side as the direction in which the turn is made, whereas in the step turn, it is on the opposite side. In this study, with respect to the spin turn and step turn, the center of pressure trajectories and the electromyography patterns of the lower extremity were measured. Based on these results, the function of the lower extremity required for the spin turn and step turn is explained and discussed.
Walking is the main means of locomotion. Locomotion is performed not only forward but also backward in daily life. However, there are few explanations of backward walking, compared to forward walking, in textbooks of motion analysis. In this study, previous studies of backward walking are reviewed, and the trajectories of center of pressure and electromyogram patterns assessed. The functions of the lower leg and the trunk in backward walking are discussed with reference to the results.
We previously examined the order of the activity of scapular muscles during trials against an external load and during trials of isometric contractions in healthy participants. From these studies, we learned that scapular muscles can be divided into agonists and antagonists. An agonist muscle at the scapulothoracic joint (STJ) generates resistance against an external load just like the agonist at the glenohumeral joint (GHJ). In the present study, we investigated muscle activity during maximum isometric contraction in subjects with muscle weakness at the GHJ or STJ and analyzed the characteristics of the muscle activity. Two patients participated in this study. One patient (subject A) had muscle weakness at the GHJ, and the other patient (subject B) had muscle weakness at the STJ. We used electromyography to measure muscle activity during maximum isometric contractions of shoulder flexion, external rotation, and internal rotation and analyzed the changes in muscle activity as these muscles applied resistance against an external load. Subject A demonstrated lower muscle activity at both the GHJ and STJ than in the healthy shoulder and Subject B. The lower muscle activity observed at the STJ of subject A was possibly due to the absence of the transfer of energy to the STJ by the external load because of muscle weakness at the GHJ. This suggests that the normal STJ function depends on maintaining muscle strength at the GHJ at a constant level in isometric contraction.
The purpose of this study was to clarify the activities of the longissimus, multifidus, and iliocostalis muscles at different angles of shoulder joint flexion. The subjects were 14 healthy males (mean age, 23.7 ± 1.9 years). Electromyograms of the longissimus, multifidus, and iliocostalis muscles were recorded at shoulder flexion angles of 0, 30, 60, 90, 120, and 150 degrees in a seated position. The relative values of the integrated electromyograms (iEMG) of the longissimus muscle on the side of shoulder joint flexion gradually increased up to the flexion angle of 90 degrees and gradually decreased thereafter. The longissimus iEMG value was significantly higher at 90 degrees than at 150 degrees. There were no changes in the relative values of the other muscles. We conclude that the longissimus muscle on the side of shoulder joint flexion contributes to the maintenance of posture.
The aim of this study was to clarify the influence of changes in the angle of horizontal shoulder flexion on the muscle activities of the clavicular and sternal parts of the pectoralis major. Surface electromyography (EMG) was performed on the clavicular and sternal parts of the pectoralis major of 10 healthy male subjects (mean age: 24.2 ± 2.5 years). Recordings were taken with the shoulder maintained in horizontal flexion on the side being measured. The angles of horizontal shoulder flexion were 0°, 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, and 90°, and each position was maintained for 5 s. The EMG activity of the clavicular portion of the pectoralis major significantly increased during horizontal shoulder flexion of 70°, 80°, and 90° (p < 0.05). However, the EMG activity of the sternal part of the pectoralis major demonstrated no significant change at any angle of horizontal shoulder flexion. These results suggest that the clavicular part of the pectoralis major is involved in pulling the humerus to the clavicle between 70° and 90° of horizontal shoulder flexion, and the sternal part of the pectoralis major does not participate in maintaining the angle of horizontal shoulder flexion.
To analyze walking turns, the influence the hip joint external rotation angle of the stepping limb in the standing position has on electromyographic activities of the upper and lower gluteus maximus muscle fibers was examined. The subjects were 10 healthy males with a mean age of 24.2. The standing position was defined as the position in which subjects stepped forward from a standing position. The hip joint external rotation angle of the starting position was changed, and the electromyographic activities of the upper and lower gluteus maximus muscle fibers were measured at each angle. The integrated electromyographic relative value of the upper gluteus maximus fiber significantly increased with the increase of the hip joint external rotation angle. The integrated electromyographic relative value of the lower gluteus maximus fiber also showed a tendency to increase. It is our opinion that the upper and lower gluteus maximus muscle fibers participate in the maintenance of the extension and external rotation of the support side hip through the actions of hip extension and external rotation. In addition, the support side hip performs adduction with increase in the angle of hip external rotation, indicating that the upper gluteus maximus fiber increases hip abduction to brake it.
The tissue hardness of the internal oblique muscle lateral fibers in the abdomen and pelvis of 13 healthy male subjects was measured using a tissue hardness gauge while lying in a supine position and then in an upright position. This study investigated the changes in tissue hardness between the two positions. The results show that compared with the supine position, the upright position displayed increased tissue hardness in the abdomen and pelvis. This increased tissue hardness in the upright position appears to be related to the effect of the internal oblique muscle lateral fibers in stabilizing both sacroiliac joints, and is also considered to be related to maintaining control against the forward and downward dropping action of the intra-abdominal organs in the upright position. Additionally, it is considered that when the abdomen wall bulges in relation to the forward and downward dropping action of the intra-abdominal organs in the upright position, the skin and subcutaneous tissue in the abdomen and pelvis are stretched, and thus, tissue hardness increases.
This study evaluated the effects of voluntary arm movements performed during difficult movements on the excitability of spinal motor neurons in the contralateral arm after motor learning, using F-wave analysis. Sixteen healthy volunteers participated in this study after giving their written informed consent (average age, 26.3 ± 4.7 years). They were assigned at random to two groups of eight: a simple task practice group, and a difficult task practice group. They were asked to sit on a chair, and F-waves were elicited from the right abductor pollicis brevis during the movement task before and after each of three practice tasks performed by the left arm. The movement task and practice tasks were repetitive movements between two targets placed 200 mm apart on a desk. The subjects were instructed to accurately touch the targets with the tip of a pen. The size of the targets was 5 mm × 150 mm (width × length) for the movement task. In order to adjust the difficulty level of the practice tasks, the target size was changed as follows: 50 mm × 150 mm for task 1 and 5 mm × 150 mm for task 2. We found that the F/M amplitude ratio was significantly reduced after the difficult practice task compared with the pre-practice ratio. The results suggest that, following motor learning, the facilitation effects on spinal motor nerves in the contralateral arm were attenuated by localization of cortical regions or by the attenuation of sensory input.
Lateral weight shift to one side in the standing position is performed to facilitate the initiation and change of direction in patients with trunk muscle instability. In this study, the muscle activity patterns of the multifidus, iliocostalis, and longissimus during lateral weight shift in the standing position were analyzed. The subjects were 10 healthy males who consented to participation. The subjects initiated lateral weight shift in 2 s in the standing position, and maintained the lateral weight-shift posture for a maximum of 2 s. Rotation of the trunk and pelvis did not occur, and both the acromion processes were held horizontal. Lateral movement distance is the distance that a subject can move within the specified time, while the toes of the limb on the side opposite the weight shift direction remain touching the ground lightly. The items measured were the center of pressure (COP), the electromyographic activities of the multifidus, iliocostalis, and longissimus of both the sides, and a video image taken from the front. The muscle activity on the non-moving side multifidus tended to increase with the displacement of the COP of the moving side. In addition, muscle activities of the iliocostalis and longissimus of the non-moving side tended to increase. Furthermore, elevation of the pelvis and flexion of the trunk on the non-moving side were observed with the displacement of the COP to the moving side. The multifidus of the non-moving side appears to contribute to the movement, because of the physiological lordosis of the lumbar spine, and both the acromion processes are held horizontal for elevation of the pelvis on the non-moving side, which is the result of lumbar extension and flexion on the non-moving side. In addition, the iliocostalis and longissimus of the non-moving side also appear to contribute to the movement, because of the curvature of the thoracolumbar segments, and both the acromion processes are held horizontal for the elevation of the pelvis on the non-moving side, which is the result of thoracolumbar extension and flexion on the non-moving side. In physical therapy, it has been suggested that the lateral weight shift that occurs because of the elevation of pelvis on the non-moving side is important, and that thoracolumbar flexion on the non-movable side is generated by the posterior trunk muscles (multifidus, iliocostalis, and longissimus) on the non-moving side.
To provide more effective instructions for walking exercise in physical therapy, this study investigated lower extremity joint torque during a change in direction while walking. The subjects were 9 healthy males who performed walking and direction changes by side stepping (SS) and crossover stepping (CS). SS was performed in a new direction by planting the right foot in the opposite direction. CS was performed in a new direction by planting the right foot on the same side and then crossing the left leg in front of the right leg. These movements were recorded using 4 infrared cameras. During each movement, the ground reaction force of the right lower extremity was measured using a force platform. Right lower extremity joint torque was computed using the results of a three-dimensional motion analysis system for these movements and the ground reaction force data. The results indicate that hip extension and external and internal rotation torques during CS were significantly greater than those during walking and SS. Hip abduction torque during CS was significantly greater than that during SS. In addition, knee flexion torque during CS was significantly greater than that during walking. In conclusion, the kinetic properties during CS are very different from those during walking and SS according to the joint torque data. Thus, it is important to consider the functions of hip extension and external and internal rotators in order to perform CS smoothly.
This study examined the effect on spinal nerve function of differences in the motor imagery method. A total of 20 healthy volunteers (11 males and 9 females; mean age, 24 years) participated in the study. We recorded the F-wave of three different methods of motor imagery described in previous research: two single images of vision image and muscle image, and one composite image. Vision imagery is the method in which subjects image the digital digits to display pinch force. Muscle imagery is the method in which subjects image the muscle contraction during pinching. Composite imagery is the method in which subjects simultaneously image the vision image and muscle image. F-wave analysis items were the F/M amplitude ratio, persistence and latency. F/M amplitude ratios of motor imagery under composite imagery were significantly higher than that observed at rest. A significant difference was noted in the relative data of the amplitude ratio of F/M between the muscle image and the composite image. Motor imagery under composite imagery was significantly higher than those of the two single images of vision image and muscle image.
In this study, we examined the effect of motor imagery on the accuracy of motion and excitement of the spinal nerve function. The subjects were 20 healthy volunteers (10 males, 10 females; mean age, 22.6 ± 3.9 years). F waves of the left thenar eminence were recorded following stimulation of the left median nerve during supine rest. Subsequently, subjects practiced the pinch movement at 50% maximum voluntary contraction (MVC), as measured by visual feedback using a pinch force view display. The pinching operation was then performed at 50% MVC visually without feedback and the motor output of the 50% MVC was calculated to measure the accuracy of the movement. F waves were then measured using motor imagery of the pinch movement. Repeat measurements were made at 50% MVC with no visual feedback.The F wave persistence during motor imagery was significantly increased compared with that of rest. However, in the period of 50% MVC ± 5%, there was no difference between the before and after motor imagery. In conclusion, motor imagery increases the excitability of the spinal nerve function, suggesting that it does not affect the accuracy of the movement.
In this study, the influence of acupuncture at SP3 on the quadriceps femoris muscle during extension movement of the knee joint using the meridian concept was investigated in patients with musculoskeletal diseases. Sixty healthy individuals (mean age, 23.7 years) provided their informed consent to participation during extension movement of the knee joint. The subjects received different types of acupuncture stimulation at SP3: (1) the retaining needle method, (2) the single needle method, and (3) no stimulation. The subjects performed isometric contraction with 40% of the maximum voluntary contraction and 60° knee flexion while receiving the different acupuncture stimulations. Surface electromyography (EMG) of the vastus medialis obliquus, vastus medialis longus, rectus femoris, and four sites within the vastus lateralis was performed before, during, and 15 min after the start of the acupuncture stimulations during extension movement of the knee joint. The relative integrated EMG (IEMG) recorded during and 15 min after acupuncture stimulation was compared with the value recorded before acupuncture which was used as the reference value. The Tukey method was used for statistical analyses (significance, p<0.05). The relative IEMG of the vastus medialis obliquus after 15 min of the retaining needle method was significantly more than that observed without stimulation. After 15 min of the retaining needle method, the relative IEMG of the vastus medialis obliquus exhibited suppressed muscle function.
In this report, we describe the physical therapy performed for a patient with left hemiplegia following cerebral infarction. The patient had a limited ability to grip a bowl with the paralyzed hand while eating. The bowl-gripping action is performed with the thoracic vertebrae in a flexed position while sitting. This action also causes right lateral bending of the thoracolumbar spine, and left trunk rotation, resulting in pelvic tilting by left hip extension. Physical therapy was performed to improve the coordination between the thoracolumbar spine, pelvis, hip joint, and upper paralyzed limb. As a result of the therapy, the patient’s ability to perform the bowl-gripping action with the paralyzed hand improved. The reaching action described here requires the coordination of the upper paralyzed limb, thoracolumbar spine, and pelvis. Therefore, the result of this case suggests the importance of physical therapy that takes into consideration the position of the limb with respect to the pelvis.
A stroke patient with left hemiplegia was at risk of falling to the right side when turning left, due to, lack of displacement to the left side of the center of gravity which resulted in instability to the right side when turning. Therapy was administered for the left hip joint abductor muscle, left obliquus internus abdominis muscle, and obliquus externus abdominis muscle, but this did not improve turning movements. Therefore, therapy then focused on the alignment of the upper trunk, right shoulder joint, and the right latissimus dorsi muscle. As a result of the new therapy, the center of gravity shifted to the left side thereby reducing the risk of fall. It is our opinion that the right lateral bending of the upper trunk was caused by hypertonia of the right latissimus dorsi muscle, and that hypertonia of the right latissimus dorsi muscle had prevented the patient from shifting her center of gravity to the left side.
A patient with right hemiplegia after cerebral infarction had difficulty washing his face with both hands. In the face-washing movement, the inability of the hands to touch the face and spillage of water from the hands were the problem. When the patient was observed in the standing posture, his weight was predominately on the left, non-paralyzed side. When the patient began washing his face, the pelvis moved to the left, non-paralyzed side with right, paralyzed side rotation. At this time, the patient’s right, paralyzed side elbow flexion was poor. Furthermore, water fell from between both hands because of the inward rotation of the paralyzed right forearm. Measurements based on the observation of the face-washing movement revealed hypertonia and muscle shortening of the multifidus muscle on both sides. In addition, the abdominal oblique muscle, gluteus maximus and biceps brachii on the right, paralyzed side displayed hypotonia. Physical therapy performed for these problems led to the acquisition of the face-washing movement.
We report on the use of physical therapy for a patient with right hemiplegia experiencing difficulty with getting up from a bed after cerebral infarction. Based on a previous study, the aim was for the patient to get up by rolling over to the non-paralyzed side to attain the sitting position. Observation of the getting up action of the patient revealed that the trunk flexion and rotation of the non-paralyzed side were insufficient. Therefore, the patient tried to lift the upper body by pushing with the non-paralyzed side elbow on the bed. However, the patient had difficulty performing the getting up action, because the upper body fell down to the rear due to paralysis on the side of rotation of the trunk. Our assessment showed hypotonia in both parts of the rectus abdominis, and in the external oblique muscle and serratus anterior muscle of the paralyzed side. Hypertonia was also found in the posterior fibers of the deltoid muscle and upper fibers of the latissimus dorsi muscle on the non-paralyzed side. After 1 week of physical therapy, the impairments improved and the patient was able to perform the getting up movement.
The serratus anterior muscle is an important muscle for scapular joint function. It is innervated by the long thoracic nerve, and its function is to stabilize the medial border and inferior angle of the scapula. Generally, exercises that emphasize the protraction and upward rotation of the scapula (wall push-up plus, dynamic hag, push-up plus) have been recommended for strengthening the serratus anterior. However, because greater activation of the pectoral muscles is likely to occur during these exercises, there is a possibility that efficient serratus anterior muscle activity will not be obtained. In this study, a patient was subjected to physical therapy after right long thoracic nerve paralysis resulted in fatigue during shoulder flexion at 120° or higher. General strengthening exercises for the serratus anterior muscle were incorporated, but sufficient effects were not achieved. Therefore, our training focused on improving serratus anterior contraction patterns through facilitation, while reducing the activation of the pectoralis major. These exercises improved shoulder joint motor function and reduced fatigue during flexion better than general strengthening exercises. We consider that it is necessary to focus on facilitation and contraction patterns to improve serratus anterior activation after long thoracic nerve injury.
A patient with left hemiplegia after right thalamic hemorrhage had a tendency to fall backwards while in a standing posture for toilet activities, and he was referred to us for physical therapy. In the standing posture, load bearing by the lower limb was difficult because of the following problems: left-side rotation and posterior displacement of the pelvis caused by flexion, adduction, and internal rotation of the left hip joint; backward tilt of the lower leg; plantar flexion of the left ankle; flexion, left paralyzed side flexion, and non-paralyzed side rotation of the trunk. The patient was asked to stand and hold the railing with the right non-paralyzed hand. Hypotonia was found in the longissimus, internal oblique, and external oblique muscles of both sides. Also, the tone of left-side muscles was lower than that of the corresponding right-side muscles. In addition, we found: hypotonia in the lower gluteus maximus fibers, gluteus medius, and iliac muscle of the left side; hypertonia in the rectus abdominis muscle of both sides; and range of motion restriction during trunk extension. Therefore, physical therapy was directed primarily at these impairments. After physical therapy, immediately after the patient stood, improvement was observed in rotation of the left pelvis due to improvements in flexion, adduction, and internal rotation of the left hip joint; however, a few seconds later, the tendency to fall backwards reappeared, as before the initiation of physical therapy. Therefore, a thorough re-evaluation was performed which found that improvement of hypertonia in the left adductor longus muscle was insufficient. Accordingly, a stand-up exercise was added to improve the hypotonia of the lower gluteus maximus fibers and gluteus medius, keeping in mind the hypertonia of the adductor longus. Eventually, the stability of the standing posture improved, leading to improvements in toilet activities. The present case demonstrates that during physical therapy, when attempting to improve the hypotonia of muscles with primary problems, it is also necessary to consider problems in antagonistic muscles.