Improvements in the basic techniques of physical therapy involve not only training in special techniques but also training in basic skills with accurate physical therapy evaluations. The first step is accurate physical therapy evaluations in order to determine an impairment using motion analysis in a top-down evaluation. The second step is to perform physical therapy for this impairment. The basic methods of physical therapy are ROM training, sensory education training, muscle strengthening, and muscle tone training. Physical therapists need to undergo basic training in anatomical, physiological, and kinesiological knowledge. The third step is to maintain the therapeutic effects of basic motion and self care with improvement of the impairment. The clinical motion facilitation method, which is a facilitation method for normal motion, is a powerful method for maintaining the effect of physical therapy. In the final step, physical therapists undergo training in the technical skills of physical therapy in order to perform accurate evaluation.

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Generally, activities of daily living are performed smoothly at a subconscious level. However, in order to perform these activities smoothly, input and integration of information from each sensory stimulus and checking of the information with motion memory is necessary. In this paper, we discuss the role of sensory inputs, such as visual, somatic, and vestibular stimuli, in maintaining postural control. We also present information regarding postural changes that occur as a result of receiving somatic stimuli.

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Currently, the importance of muscle tone (postural tone) is not widely considered in rehabilitation-related occupations. In this paper, we discuss the importance of the control of postural tone and explain how to measure it, particularly with regard to the front of the trunk muscles. It is important to improve palpation techniques and closely observe patients in order to measure postural tone of the trunk muscles.

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We recommend the use of resistance training for patients who present with postoperative muscle weakness. The purpose of this training is to improve and prevent muscle weakness. The drawback of resistance training exercises is that the patient needs to understand the training and its effects; if executed incorrectly, resistance training is ineffective. Furthermore, if an incorrect exercise program is followed, trauma may occur. Therefore, physical therapists should inform the patients of the relationship between the necessity of resistance training and the ability to perform activities of daily living. Furthermore, the physical therapist should have personally experienced resistance training to understand its effects. This study provides important information for patients undergoing resistance training. In this paper, I would like to report the effective method of resistance training.

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The lower limb comprises the hip joint, knee joint, and ankle joint. These joints are connected to each other and provide overall support to the lower limb. Knee-in and knee-out that occur while ascending and descending the stairs or when standing up produce tensile and compressive stresses inside or outside the knee joint, which in turn cause pain. This paper introduces a method for determining the lower limb joint which is chiefly responsible for knee-in and knee-out. It also discusses how to implement range of motion exercises in patients with joint dysfunction. The trunk comprises the pelvis, spine, and thorax. The spine consists of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae. Although these bones generate only small movements individually, these bones function together to provide a wide range of body motion. This paper introduces a method for qualitatively evaluating body motion, in addition to conventional quantitative methods such as the range of motion test.

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We think that joint range of motion exercises, muscular power reinforcement practice, control of the senses, and motor learning are important as basic techniques of therapeutic exercise, and we endeavour to ensure that patients acquire accuracy in these areas. It is especially necessary to improve the joint range of motion at the earliest opportunity. In this report, we look at the shoulder joint and the elbow joint in range of motion exercises of the upper limbs, and report on two themes. One theme is the relation between the peel back mechanism in the shoulder joint and shortening of the ligament, and we explain the mechanism and the treatment method for joint range of motion limitation of the shoulder due to shortening of the inferior glenohumeral ligament. The second theme is the evaluation of elbow joint axis and exercises for elbow joint range of motion, and we explain the relation between abnormal elbow joint axis and range of motion limitation.

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Therapists are required to maintain subjects' posture and move their center of gravity in body manipulation. Therefore, it is important to educate "the center" as the most important body sense for skillful body manipulation. The educated center dominates the support of bones, and enables the subject to maintain posture and move without excessive muscle activity. Moreover it is possible for a therapist to connect to the center of the subject through the contact plane for the educated center of gravity line as the subject's middle of the body in body manipulation, and then enable the manipulation of the body without excessive muscle activity.

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Patients with lumbar vertebral disease inevitably have an orthosis applied to the trunk after surgery until the treated region is stabilized. During this phase, flexion, lateral flexion, and rotation of the trunk are limited, and patients have difficulty putting on and taking off shoes and socks. When sitting straight at a distance from the edge of the bed, these motions cause excess unilateral elevation of the femur, posterior tilt of the pelvis, and bending of the trunk, which may increase the load on the treated region. Lower leg flexion exercises may make it easier to sit straight with the ischium positioned near the edge of the bed. We investigated a method that reduces the load on the lower back caused by the postural strategies adopted when putting on and taking off socks and shoes while sitting straight. Patients elevated each leg individually and touched the ankle of the elevated leg with the ipsilateral index finger. The elevation angle of the femur, flexion angles of the hip and knee joints and trunk, and tilt angle of the pelvis in the sagittal plane were measured. The sitting distance from the edge of the bed was changed and the patients repeated the task. The hip flexion angle did not change with an increase in the distance from the bed's edge. However, the angles of femoral elevation, pelvic inclination, and trunk flexion increased whereas the knee flexion angle decreased. This suggests that an increase in the femoral elevation angle coupled with an increase in the distance from the bed's edge produces a pelvic-femoral rhythm and increases pelvic tilt and trunk flexion angles. The reduction of the knee flexion angle with an increase in the distance from the bed's edge suggests that the space between the bed's edge and lower leg cannot be maintained by backward movement, making knee flexion difficult. The load on the treated region may have been increased by posterior pelvic tilt, which is induced by femoral elevation, and trunk flexion during these motions while sitting straight when the ischium is positioned at a distance from the bed's edge. The results of this study suggest that as a part of early guidance after surgery, it is necessary to instruct postoperative patients with lumbar disease to position the ischium close to the edge of the bed while sitting straight during the activities discussed.

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The efficacy of physical therapy for a patient with impaired hair-washing motion due to dysfunction of the inferior fibers of the trapezius was assessed. Surface electromyography was performed to investigate the clinical implications, and to elucidate the relationship between changes in the speed of elbow joint flexion-extension during simulated hair-washing motion and the corresponding activities of the superior, intermediate, and inferior fibers of the trapezius and of the caput longum of triceps brachii. In a sitting position, the subject moved the shoulder joint approximately 110 degrees in flexion and the elbow joint approximately 45 degrees horizontally on the measured side, and performed flexion-extension of the elbow joint in which the middle finger on the measured side reciprocated between the torus occipitalis and vertex in a hair-washing motion-simulating task. The motion speed was set at 40, 80, 120, and 160 motions per minute using a metronome and electromyograms of the superior, intermediate, and inferior fibers of the trapezius and the caput longum of triceps brachii were measured for 10 seconds 3 times during each task. Electromyogram waveforms of these fibers at each speed and the influence of changes in the elbow joint flexion-extension speed on the relative integrated electromyogram value were investigated. In the caput longum of triceps brachii, the amplitude of the electromyogram waveform in a single elbow joint flexion-extension motion was compared among the tasks at different speeds. The waveform amplitude increased and the relative integral value tended to increase as the elbow joint flexion-extension speed increased only in the inferior fibers of the trapezius. These findings suggest that to evaluate and improve hair-washing motion in patients with impairment of the scapulothoracic joint, the arm should be maintained in an elevated position during this motion. Furthermore, attention should be paid to the activity of the inferior fibers of the trapezius, which are assumed to be involved in stabilization of the scapula during the elbow joint flexion-extension motion, in this posture.

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We were involved in the physiotherapy of a patient with cerebrovascular disorder. The patient had repeated aspiration pneumonia. The trunk takes a bent position in a patient with repeated aspiration pneumonia, and the neck leans back. We performed physiotherapy for the facial expression and mastication muscles. As a result, the position of the patient's neck and trunk improved. Furthermore, the muscle tone of the trunk muscles was promoted by our treatment of the facial expression and mastication muscles, allowing the cervical vertebrae to rotate. In this article, we report the influence of the trunk on induction of the facial expression and mastication muscles and lordosis of the cervical vertebrae.

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The purpose of this study was to investigate the influence of varying interstimulus intervals on electromyographic reaction time (EMG-RT) during exercise using a rhythmic auditory stimulus. In addition, we investigated the alteration of EMG-RTs accompanying the auditory stimulus of the 6^th, 12^th, 18^th, and 24^th stimuli. The subjects were 17 healthy subjects (12 males, 5 females; mean age: 24.1 ± 3.8 years). The auditory stimulus had a stimulus intensity that was easy to hear during experiments, an auditory frequency of 900 Hz, and 25 stimuli were delivered per trial. The subjects were requested to quickly raise their right ankle in response to each auditory stimulus. The stimulus conditions 1 to 4 were as follows; 1) interstimulus intervals were a constant 1,000 ms, 2) interstimulus intervals between the 5^th and 6^th, 11^th and 12^th, 17^th and 18^th, and 23^rd and 24^th stimuli were 1,200 ms, 3) interstimulus intervals between the 5^th and 6^th, 11^th and 12^th, 17^th and 18^th, and 23^rd and 24^th stimuli were 2,400 ms, 4) interstimulus intervals between the 5^th and 6^th, 11^th and 12^th, 17^th and 18^th, and 23^rd and 24^th were 4,800 ms. We investigated the following; 1) how EMG-RTs changed when there was an increase in the stimulus number, 2) how the difference in the interstimulus interval influenced the EMG-RTs corresponding to the 1^st, 6^th, 12^th, 18^th, and 24^th stimuli. The results suggest that the EMG-RTs corresponding to the 6^th, 12^th, 18^th, and 24^th stimuli were shorter than the 1^st in condition 1; those corresponding to the 18^th and 24^th stimuli were shorter than the 1^st in condition 2; and those corresponding to the 1^st, 6^th, 12^th, 18^th, and 24^th stimuli did not differ in conditions 3 and 4. EMG-RTs did not differ in the first condition. The EMG-RT corresponding to the 24^th signal in condition 4 was longer than that in condition 2. These results suggest that the rhythm of the interstimulus interval was important for guiding exercise internally compared to that employing external stimulation. In addition, these results suggest that the difference in the interstimulus intervals influenced exercise when an auditory stimulus was applied regularly.

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Exercise therapy was ordered for a patient with Guillain-Barré syndrome who had difficulty typing on a computer keyboard with the left little finger. No abduction or flexion of the left little finger was observed during typing, while marked compensatory supination of the forearm was observed. Occupational therapy and electromyography findings suggested that weakness of the left ulnar carpal flexor and extensor muscles reduced the stability of the attachment sites of these muscles, which are the pisiform, hamate, and 5th metacarpal bones. The reduced stability of these bones inhibited efficient muscle activity of the abductor and flexor muscles in the little finger. In exercise therapy, the left ulnar carpal flexor and extensor muscles were simultaneously strengthened to increase the stability of the pisiform, hamate, and 5th metacarpal bones, with the goal of increasing the muscle activity of not only the left little finger abductor and flexor muscles but also those of the muscles around this finger. The patient was able to type by abduction and flexion of the left little finger 2 months after initiation of the exercise therapy, and this improvement was also observed on electromyography. It is important to perform an occupational therapeutic evaluation with exercise therapy, focusing not only on the activity of the muscles around the left little finger but also on the carpal and metacarpal stability due to activity of the left ulnar flexor muscles.

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We conducted physical therapy for a patient who experienced pain in the right gluteal and lateral femoral regions during walking following right hip replacement. Pain appeared due to flexion, adduction, and internal rotation of the right hip joint accompanied by exaggerated anterior inclination and right rotation of the pelvis on right heel contact through to right mid-stance. Physical therapy was conducted for the limited range of right hip joint motion and muscle weakness around this joint, which was assumed to be the cause of the abnormal gait and pain. Following this, standing step practice (Physical Therapy A) was conduced. After 6 weeks of Physical Therapy A, the limited range of right hip joint motion and muscle weakness around the joint had improved; however, the gait and pain had not improved. Thus, the therapy was re-evaluated, and bridge exercise was added to Physical Therapy A (Physical Therapy B). Physical Therapy B enabled induction of muscle activity and contractile patterns similar to those occurring during walking with respect to the muscle activity around the right hip joint that is necessary for right heel contact through to right mid-stance. A single session of Physical Therapy B improved the gait and reduced pain. Therefore, we concluded that the promotion of complex muscle activity, not in a single direction, and improvement of the muscle strength and contractile pattern are necessary in physical therapy for problematic muscle weakness.

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We performed physical therapy for a patient with left hemiplegia following cerebral hemorrhage. We noted dystonia on the affected side of the trunk and muscles around the hip. A short apparatus with a metallic support worn on the affected lower limb made it difficult for the patient to step into a bathtub. Another hospital had instructed the patient to wear the short lower-limb apparatus with a metallic support to facilitate gait early after cerebral hemorrhage. When gait had improved, on using a 4-point stick, the patient was discharged. The patient usually walked with the aid of the 4-point stick at home following discharge but tended to fall backward toward the unaffected side. The patient was often unable to step into the bathtub using the affected lower limb and would fall down backward on the unaffected side. We reviewed factors influencing falling down in walking and bathing. When the patient walked or moved wearing the short lower-limb apparatus, posterior rotation and elevation of the affected side of the pelvis with respect to hypermyotonia of the dorsolumbar muscles on the affected side was observed in the swing phase of the affected lower limb. Furthermore, increase in the affected lower-limb weight due to the apparatus worn on the ipsilateral side enhanced hypermyotonia of the dorsolumbar muscles on the affected side during locomotion, including stepping into the bathtub. As part of physical therapy, the patient was instructed to improve the gait and transfer-movement patterns, which are frequently necessary in activities of daily living, and continue home training. In addition, the patient practiced stepping into the bathtub, and improvement was observed in this activity.

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We performed physical therapy for a patient who developed disuse syndrome after surgery for distal aortic arch replacement. The patient was unstable and tended to sway backward when lifting the buttocks off a chair, and this also interfered with independence in toileting. The patient's pelvis inclined backward and thoracic kyphosis increased in the sitting position. During flexion in standing, the patient was unable to bend the pelvis forward properly, and had difficulty transferring weight forward while maintaining the center of gravity. We believed that the defective alignment in the sitting position was due to limited extension of the spine and the shoulder girdle, weak hip flexors, and decreased tone of abdominal muscles. We surmised that the inadequate forward bending of the trunk might be due to weak knee extensors, making it difficult for the patient to actively bend the trunk forward. The problem with the patient's standing was thought to be caused by post-operative disuse syndrome. To treat the disuse syndrome, we first trained the patient to assume a proper sitting position through physical therapy, and subsequently observed an improvement in pelvic retroversion and thoracic kyphosis. Second, we had the patient practice trunk anteversion, during which the buttocks were lifted off the chair. This resulted in an improvement in the instability the patient experienced while standing. Using a three-dimensional motion analysis system, we measured the angle at which the trunk bent forward when the buttocks lifted off the chair, and observed that this angle had increased after two weeks of therapy compared with the original evaluation. In the present case, physical therapy was required to counter the combined effects of surgery and disuse syndrome, and consequently, to improve stability.

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