It is important for therapists to observe patients’ motion and make the sotry of the motion. A patient’s motions reflects the characteristics of the disease and the results of tests for physical therapy evaluation.
Bipedal standing and bipedal walking are the most characteristic posture and movement of humans. The human obtained current cultures and civilizations by evolving into bipedal standing. The central nervous system evolved to adapt to bipedal standing too. One of the characteristics of the standing position is the narrow base of support and high COM. Therefore, the maintenance of the stability of the standing position requires the activity of the central nervous system. This paper describes the components of bipedal standing and how to observe the standing position.
Therapists observe movement, objectively analyze it, and explain it to other professions and patients. Movement is often recorded as time series. However, it may be difficult to express movement with the objective notation used for abnormal movement, when describing sports performance, and movement calling for artistry. Therefore, the interpretation of the movement that can be shared as an image has become clinically important. “Daruma otoshi” is an easy way of imaging human trunk motion. Thus, we think that it is clinically helpful to know this expression method. We also introduce a case who had difficulty in ballet performance and wanted to make use of understanding of the movement interpretation of the arms. This can teach the importance of movement interpretation, assisting the learning of movement interpretation for competition and the aspiration to artistry.
The patients often ask us to improve daily movements involving the upper limbs in shoulder rehabilitation. Daily movements using the upper limbs are done with many variations, even by healthy people, and we have to understand these variations. In the rehabilitation of daily movements, we need to set a goal about how the patient will perform. In addition, daily movements using the upper limbs constitute multiple joint movements, not only shoulder joint movement, so there are mutual relationships with multiple joint movements. Therefore, we have to make a hypothesis while thinking about the relationships among the multiple joint movements.
The head and neck have a very important function in the control of posture. The head and neck often unconsciously compensate if there is an abnormality in posture. However, that compensation movement becomes a habit for the patients who have an abnormality in posture, and when the compensatory movement of the head and neck is large it may become a problem. Here, we report the results of dorsal electromyography of what kind of compensation actually occurs by when changing the position of the head and neck in sitting, and in rising from sitting. We also describe an approach that paid attention to excessive compensation of the head and neck. It is difficult to define the right alignment of the head and neck. It is important in alignment of the head and neck that the head and neck do not cause a problem for posture, or movement. In other words, it is important that the head and neck should be in the right alignment which over muscle activities are not required. If the head and neck are in the right alignment, it is easy to get up or look around naturally.
Behavior requires coordinating activities of many muscles. Neural mechanisms exist in the background of such movements. Walking is the main means of locomotion. The knowledge of joint motion and muscle activity is important for the interpretation of walking. In this manuscript, the joint motion and muscle activities of walking are outlined. The relation between spinal reflexes and muscular activity during walking is also described.
Motor imagery is considered to have potential as a tool for the improvement of motor function in physical therapy. Numerous studies have demonstrated that motor imagery can facilitate the excitability of the central nervous system. However, previous research has not established the changes in the excitability of spinal motor neurons during motor imagery. In this study, we investigated the changes in the excitability of spinal motor neurons during motor imagery under various imagined muscle contraction strengths using the F-wave. Our results suggest that motor imagery can facilitate the excitability of spinal motor neurons; however, this excitability does not vary with the imagined muscle contraction strengths. In addition, we also investigated the autonomic nervous system during motor imagery under different imagined muscle contraction strengths. Motor imagery increased cardiac sympathetic nerve activity, but the difference in the imagined muscle contraction strengths did not influence the changes in cardiac sympathetic nerve activity.
Lateral movement in the sitting position is a task which is used in evaluation and treatment in clinical practice. Also lateral movement in the sitting position can be seen in many activities of daily living. However, patients with dysfunction of the hip muscles have more difficulty performing lateral movement in the sitting position than healthy person, because, they cannot raise the opposite side buttock from the weight-bearing surface. To do lateral movement in the sitting position is reported to require lateral tilt of the pelvis. The trunk is displaced to the moving side by this lateral tilt of the pelvis. Furthermore, lateral movement in the sitting position requires muscle activity of the hip muscles that hold the lateral tilt position of the pelvis. Lateral tilt of the pelvis in lateral movement in the sitting position is a movement of the hip joint. TO promote smooth lateral movement in the sitting position, it is necessary to know the kinematics of the hip joint. However, the kinematics of the hip joint are different between sitting and standing postures. For this reason, interpretation of the kinematics of the hip joint is difficult in lateral movement in the sitting position. In this paper, we measured COP, and surface EMG of the hip girdle muscles during lateral movement in the sitting position following the procedures of a previous study, and carried out a video analysis of the displacement of the pelvis. We also examined the factors involved in successful lateral tilt of the pelvis in lateral movement in the sitting position.
The purpose of this study was to illustrate the actions of the gluteus maximus (GM), medial hamstrings (MH), and lateral hamstrings (LH) during forward-reaching in a sitting position using electromyography (EMG). We found that as the distance of forward-reaching increased, EMG activity of the GM, MH, and LH muscles increased to maintain forward-bending of the trunk. In addition, lower GM activation increased at a shorter reaching distance than the upper GM. From the analysis of posture during this task, we also found that the distance covered during forward-reaching was increased by up to 15 cm mainly through flexion of the thoracic spine. This mechanism enhances the distance of forward-reaching achieved by flexion of the hip joint, but extension of the lumbar spine. From these results, we suggest that forward reaching is not simply caused by flexion of the hip joint and that each fiber of GM, MH, and LH muscles has a different function in the sequence of activities that leads to a change in posture.
In the present study, the effect of motor imagery of 30% maximum voluntary contraction (MVC) of thumb opposition movement on the accuracy of movement and excitability of the spinal nerve function was examined. The subjects were 11 healthy adult patients (6 males, 5 females, 24.1 ± 3.5 years of age). The excitability of the spinal nerve function was examined using the F-wave, and the F wave induced by left median nerve stimulation of the left thenar eminence muscle. The F wave was measured while subjects rested supine, and while they held the sensor of a pinch meter. Thumb opposition movement of 30% MVC was practiced with the visual feedback, and subsequently without visual feedback to reproduce 30%MVC of thumb opposition movement. Next, the F wave measured at 30%MVC of motor imagery, and finally, the subjects generated 30% MVC with no visual feedback. Accuracy of movement with 30%MVC ± 5% within the correct time were compared before and after motor imagery. In the motor imagery attempts, there was a significant increase in the F-wave frequency of appearance compared to the sensor holding trials. The accuracy of the movement did not significantly change after motor imagery. Although the excitability of the spinal nerve function in the motor imagery was increased by thumb opposition movement of 30%MVC, the accuracy of the movement was no different from before motor imagery, suggesting the importance of pre-motor imagery learning.
This study aimed to quantify the trunk movement angle when rising from the bed using a calculated local coordinate reference system. A total of 11 healthy male subjects participated. Subjects were assigned to 2 types of motion, free (n=6) and slow (n=5), when rising from the bed using the rolling motion previously described by Sarnacki. Motions of rising from the bed were recorded using four video cameras. The trunk angles of the local coordinate reference system were calculated using 3-dimensional analysis. The peak trunk angle, at both the free and slow speeds when rising from the bed, was obtained. The unpaired t-test was used for the statistical analysis. The trunk rotation angle was significantly greater for the slow speed motion than for the free speed motion (p>0.05). The trunk lateral flexion tended to be higher in the slow speed motion than in the free speed motion (p=0.07). Rising from the bed with a slow speed of motion decreased the contribution of momentum compared to when the subject rose from the bed with the free speed motion. A significant increase in the trunk angle for the slow speed motion assisted displacement of the center of mass of the upper body within the base of support formed by the upper extremities.
In this study, F-wave analysis was used to examine whether differences in the reaction times of mental rotation (MR) of the hands affects the excitability of spinal neurons during MR of hands. The subjects were eleven healthy people in their 20s. They were divided into fast and slow groups according to the reaction times of MR of their hands. The subjects sat on a chair, and F waves of the right thenar eminence were recorded after stimulation of the right median nerve during MR of letters and during MR of hands. In the slow group, the amplitude ratio of F/M and the persistence were significantly higher during MR of hands than during MR of letters; however, the fast group, they showed no significant changes. The results seem to indicate that individual differences in motor imagery ability can affect the excitability of spinal neurons during motor imagery.
The F-wave is characterized by different waveforms after each stimulation. We observed that the numbers and types of F-wave waveform during resting by healthy subjects were the same in number. From this result, we presumed that various F-wave waveforms indicate therapeutic effects in the progress of physical therapy. In addition, we considered that analysis of the type of F-wave waveform would provide an index for assessing the improvement of neurological function. In this study, we analyzed the type of F-wave waveforms elicited in healthy subjects by isometric contraction of pinch movements of the thumb and index finger. F-wave waveforms of the subjects were recorded during rest, pinching of a pressure sensor by the thumb and index finger, and pinching at 25% and 50% maximum voluntary contraction. In addition, we recorded the F-wave occurrence and calculated the F/M amplitude ratios of the recorded F-wave waveforms, and carried out F-wave waveform analysis. The F-wave occurrence and the F/M amplitude ratio increased with the isometric contraction intensity in comparison with the rest phase. Further, the F-wave waveforms were different in each trial. Consequently, this result suggests the excitability of the spinal motor neurons and the type of F-wave waveform generated by the anterior horn cell increase in tandem with the isometric contraction intensity.
We performed physical therapy for a patient who presented with right hemiplegia after cerebral infarction. The patient was a Japanese dancer, and she fell forward toward the right side during a right lower limb backward step movement in a dance. The basic stance of the dance is an upright trunk position with slight flexion of both the hip and knee joints. Furthermore, the right lower limb backward step movement produces right pelvic elevation by slightly lowering lumbar flexion on the right side. The patient had difficulty holding the trunk in the upright position with tilting of the trunk to the right due to the depressed right pelvic position. Moreover, when the patient pulled the right lower limb backward, the trunk tilted to the right due to the persistent depression of the pelvis on the right, with insufficient left lower limb weight shift. Therefore, it was difficult for the patient to maintain an even position during right pelvic elevation due to slight flexion of the lumbar spine to the right side. As a result, the patient tended to fall forward toward the paralyzed right side. Therefore, in physical therapy, we trained the patient to step the right lower limb posteriorly during smooth weight shift to the left side, after gaining an upright trunk position. As a result, the patient showed improved safety and stability during the right lower limb backward step movement. Throughout the course of this case, it was important to understand the performance characteristics of the Japanese dance to understand the right lower limb backward step movement. Evaluation of the problems before and after the onset of cerebral infarction confirmed the need to expand the physical therapy.
The IZARI exercise involves using the buttocks to improve sitting movements during activities of daily living. In this study involving a patient with spinal cord disease, we focused on the patient’s bilateral trunk muscle actions when performing the bathtub straddle movement. Following IZARI exercise, the trunk stability during the bathtub straddle movement improved, allowing the patient to bathe on her own. Initially, the patient could turn 90 degrees to the right in a sitting position, and lift the lower limbs beginning with the right limb. However, it was time consuming, and the patient needed to separately hold each of the lower limbs. After the initial evaluation, physical therapy was performed to improve the function of the right internal and left external oblique muscles, but no improvement in the bathtub straddle movement was observed. Therefore, the IZARI exercise was prescribed to improve the coordinated action of the bilateral internal and external oblique muscles. Following this, improvement in the bilateral internal and external oblique muscle functions was observed, allowing the patient to perform the bathtub straddle movement from the sitting position. The IZARI exercise, which mimics the required trunk muscle activity, can be effective training for the performance of the bathtub straddle movement.
We conducted physical therapy for a patient who had cervical spondylosis myelopathy with the complication of degenerative spondylosis. The patient was observed to have backward instability in the standing posture while placing a tray on the table in front of her. When she stood, we observed bilateral knee joint flexion and ankle joint dorsiflexion, compensating for excessive thoracic spine flexion. We considered that hypotonia of the longissimus muscles of both sides was the major cause of these problems of trunk extension. We conducted physical therapy for the patient to improve hypotonia of the longissimus muscles. Physical therapy improved in the stability of her standing posture and her movement when placing a tray on the table in front of her.
In this report, we describe the physical therapy prescribed for a patient with right hemiplegia following cerebral hemorrhage. The patient had difficulty in swinging off the toes because of right hip flexion during walking. This posture did not allow sufficient right hip joint extension from the right loading response to mid stance. In the left swing phase, right hip joint medial rotation from the flexion position caused her trunk to lean forward. She recovered to the right rear direction by right lateral bending and extension of the thoracic and lumbar spine, and right shoulder extension. Even in the terminal stance, right hip joint flexion persisted. The patient increased her right hip joint flexion in the right swing phase. Her walk weight movement was insufficient because right hip joint flexure was increased in the right terminal stance. As a result, the right foot caught on the floor during the right swing. We regarded gluteus maximus weakness to be the chief issue causing right hip joint flexion in the stance phase and conducted physiotherapy accordingly. We report the progress in gait improvement as a result of the prescribed physiotherapy.
Here we report the physical therapy administered to a patient with fracture of the proximal left tibia and fibula and instability during the left stance phase of walking. In postural standing, i.e., at the start position of walking, there was flexion of the upper thoracic vertebrae, mild flexion and adduction of the left hip, slight flexion of both knees in the valgus position, external rotation of the left lower leg to the thigh, inclination of the inside lower leg, and supination of the left rear foot. During the left stance phase of walking, at the initial ground contact of the left knee joint in the valgus position, partial supination of the left rear foot together with left lateral pelvic migration due to left hip adduction in the left-loading response, increased the left knee joint valgus position with poor outer inclination of the left lower leg and insufficient shifting of weight to the left. The valgus positioning of the left knee increased during the left mid-stance phase of walking, with inadequate left foot dorsiflexion in the terminal stance phase, left knee flexion, and inadequate rapid grounding of the bottom of the right foot due to the increase in the left knee valgus position and outer positioning of the lower leg, causing instability during walking. Therefore, impairments of the left knee and left foot were considered to be the cause of the instability in the left stance phase of walking as well as being responsible for increasing the left knee valgus position, which required improvement. The braking action of the left knee valgus position was chosen for physical therapy, which resulted in reduction of the left knee valgus position in the left loading response period, improvement in rapid grounding of the bottom of the right foot in the left terminal stance phase, and improvement in walking stability. In this case, detailed evaluation of the relationship between the knee joint and foot at the time of lateral weight transfer to the affected lower limb during walking highlighted the importance of physical therapy.
We report the case of a patient with a massive rotator cuff tear (all of the supraspinatus, upper subscapularis, and upper infraspinatus muscle fibers), which rendered raising the upper extremity impossible. The patient experienced pain when moving the clavicular portion of the pectoralis major and all of the deltoid muscle fibers. Therapeutic exercises resulted in inadequate effects. In order to reduce pain when moving the clavicular portion of the pectoralis major muscle and all of the deltoid muscle fibers, and to examine compensatory mechanisms for failure in rotator cuff function, we evaluated two-dimensional scapular motion using X-ray and surface EMG. During scapular motion, there was excessive outer displacement on the abnormal side compared with the normal side and the clavicular portion of the pectoralis major and all the deltoid muscle fibers exhibited excess muscle activity, while the middle trapezius muscle fibers exhibited low activity. Therefore, the therapeutic program was re-examined. Therapeutic exercises were developed to improve the excessive outer displacement of the scapula through its muscle function and those of the middle trapezius muscle fibers, and to control the clavicular portion of the pectoralis major and all of the deltoid muscle fibers. Through these exercises, the patient was able to raise the upper extremity. Therefore, in cases of massive rotator cuff tear, it is necessary to consider dynamic scapular motion and control muscle pain during movement due to excessive muscle activity through therapeutic exercises.
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