We investigated the effect of motor imagery on the excitability of the spinal neural function in healthy subjects using the F-wave, which is considered to be an index of motor neuron excitability. Previous research has shown that motor imagery with isometric contraction may increase the excitability of spinal neuronal function. Our study results show that during motor imagery tasks, the excitability of the spinal neural function was facilitated much more with movement preparation than without movement preparation. No significant difference was found between the motor imagery tasks performed with and without vision, as indicated by the excitability of the spinal neural function. In addition, subjective evaluation indicated that vision did not influence the excitability of the spinal neural function during the motor imagery task. From these findings, we conclude the following two important points for motor imagery use in the field of rehabilitation: 1) a motor imagery task with movement preparation is more effective at facilitating the spinal neural function, and 2) an easier method of performing motor imagery, such as one with vision, does not necessarily facilitate the excitability of the spinal neural function.

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In a clinical setup, difficulty in maintaining posture and controlling movements while bending, lateral bending, or performing rotation of the thoracic and lumbar region due to reduced activities of the abdominal oblique, multifidus, longissimus, and iliocostalis muscles, when in the seated and standing positions, and during walking, is often encountered. We trained patients with postural and control difficulties to shift their body weight laterally from one limb to the other while standing to increase the activities of the trunk muscles and improve the seated, standing, and gait postures. The activities of the trunk muscles, that serve as clinical indicators, were evaluated using electromyography and measurement of tissue stiffness. In the present study, we present the results of our research on the activities of the trunk muscles in the sitting and standing positions, and during sustained lateral shifting of body weight from one limb to the other while standing, and discuss their clinical implications.

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To evaluate the scapulo-humeral rhythm of patients with a clinical condition, not only a quantitative evaluation (range of motion) but also a qualitative evaluation (a structural method that measures scapular upward rotation) is required. This study investigated the effectiveness of an analysis that assessed the scapular-girdle dynamics, in which the direction and translation of the coordinates were analyzed using electromyograms of the scapular muscle activities of the elevated upper limb. Scapula upward rotation did not show a difference during shoulder flexion and abduction. The difference between shoulder flexion and abduction was more prominent when we used a structural method that measured scapular upward rotation including clavicle movement. When considering a structural method that measures scapular upward rotation during shoulder flexion and abduction, the function of the scapular muscle must be taken into account, since it may worsen and develop into a clinical condition. The direction of gravity that acts on the shoulder joint changes when the shoulder position changes during exercise. Therefore, a change is observed in the mechanical energy of the shoulder. It should be possible to design a therapeutic-exercise program that includes exercise positions that improve the function of the scapular and shoulder muscles to treat shoulder disorders.

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Motor adaptation and learning are processes in which the efficiency of movement is improved with regular practice. In these processes, changes in neuromuscular function are observed. In this report, we review a previous study of changes in neuromuscular function in a motor learning process, and assess the physical therapy.

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Healthy subjects were given somatosensory stimulation and were observed for movements such as rising-up, standing-up, and the standing position. As a result of the stimulation, changes in movement were observed. Hence, such somatosensory stimulation may be lead to smooth movement. It is also said that the gentle touch of the therapist may also have a major influence on treatment.

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Healthy subjects were given visual, somatosensory, and hearing stimulation and were observed for changes in movement, such as reaching, standing-to-sitting, and weight shifting during sitting. In addition, in patients with cerebrovascular disorders and right hemiplegia who were similarly stimulated, we observed a change in the stretching of the arm upwards while in the sitting position for approximately 2 min during a weight- shifting exercise. It was confirmed that this change in movement was the result of slight differences in the testing conditions between the control and experimental groups. In this study, we noticed slight changes in movement in patients with hemiplegia. Hence, an approach based on such changes in movements could be used to treat patients with hemiplegia.

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We analyzed F-waves of healthy subjects, obtained during passive tactile discrimination and at rest, to investigate changes in upper extremity spinal motor neuron excitability. Twenty healthy subjects (average age 25.2 ± 5.2 years, average height 172.1 ± 5.1 cm, average upper limb length 88.8 ± 3.5 cm) were evaluated during passive tactile discrimination and at rest. We recorded F-waves from the abductor pollicis brevis muscle of the upper extremity during passive tactile discrimination and at rest. The average values of F-wave persistence were 65.8 ± 22.2% at rest, and 74.6 ± 21.4% during passive tactile discrimination. The persistence of F-wave significantly increased during passive tactile discrimination compared to at rest (paired t-test, p<0.01). The average values of the F/M amplitude ratio were 4.61 ± 5.8% at rest, and 4.58 ± 5.8% during passive tactile discrimination. There was no significant change in F/M amplitude ratio between rest and passive tactile discrimination. The average values of latency were 28.2 ± 2.2 ms at rest, and 28.0 ± 2.3 ms during passive tactile discrimination. There was no significant change in latency between rest and passive tactile discrimination. These findings indicate that the firing frequency of the upper extremity motor unit increased during passive tactile discrimination, but that the excitability of each motor unit and the conduction velocity of the motor units of the upper extremity did not increase. Our findings suggest that passive tactile discrimination is modulated by descending commands from upper motor neurons in healthy subjects.

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Weakness of the trapezius lower muscle fibers is one of the problems of patients with shoulder joint disease. Therefore, we attempted to train the muscle activity of these muscle fibers by providing movements to the upper limbs. Stimulating these movements is often difficult for various reasons such as limited range of motion. Therefore, we attempted to increase the muscle activity of the opposite side lower trapezius muscle fibers by hip joint abduction in the prone position. In this study, we compared the muscle activities of the lower trapezius muscle fibers during two tasks. First, the upper limbs were placed with the shoulder joint abducted at 145 degrees in the prone position. Then, hip joint abduction was performed in the prone position. A significant difference was not observed between the integrated electromyogram values of the lower trapezius muscle fibers of the tow tasks. In particular, the muscle activity of trapezius lower fibers was approximately the same in shoulder joint abduction of 145 degrees in the prone position as in hip joint abduction, suggesting that hip joint abduction in the prone position is an effective method of training the lower trapezius muscle fibers that does not require upper limb movement.

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The purpose of this study was to examine the influence of a knee and ankle foot orthosis (KAFO) on normal gait. The subjects were 9 healthy males with a mean age of 23.2 ± 1.1 (range 20-31) years. Alterations in the angles of the trunk, hip, knee, and ankle were examined during walking with and without a KAFO using a three-dimensional motion analysis system (UM-CAT II). From the results, three patterns were defined, all of which could be considered types of compensation for the limitation of motion caused by KAFO.

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In this study, we examined the patterns of activity of the trunk muscles during weight shifting to one side of the lower limbs in the standing position in five patients with Parkinson’s disease and trunk malalignment. In the movement task, the patients first shifted their weight to one side of the lower limbs and attempted to move the maximum distance in which they could shift their weight to the moving limb in 1 s. Then, the patients held the posture with the maximum weight shift for 1 s and returned to the starting position in the next 1 s. The patterns of activity of the bilateral multifidus, iliocostalis, and longissimus muscles as well as that of the internal oblique and gluteus medius muscles on the weight-bearing side were analyzed. Compared with that of the starting position, we observed an increase in thoracic kyphosis during the movement task, and this was common to all of the patients. In addition, although we observed coronal plane inclination of the pelvis associated with hip joint movement during the movement task, 4 of the 5 patients did not show any change in trunk alignment compared with that in the starting position. The patterns of activation had the following characteristic tendencies: activation of the bilateral longissimus muscles was observed in the starting position in all patients, activation of the longissimus and iliocostalis muscles on the nonweight-bearing side was increased in 4 of the 5 patients, and activation was weak in the internal oblique and gluteus medius muscles on the weight-bearing side in 4 of the 5 patients. We observed a significant difference between the muscle activation patterns reported by previous studies of healthy subjects and those of our present study. When using weight shifting to one side of the lower limbs in the standing position as an exercise therapy for patients with Parkinson’s disease, activation of the internal oblique, gluteus medius, and multifidus muscles on the weight-bearing side increases. Therefore, it is necessary to implement exercises with the intention of performing the movements, with the pelvis in a horizontal position and the trunk in a vertical position. Moreover, it is necessary to ensure that activation of the bilateral longissimus muscles or that of the iliocostal muscle on the nonweight-bearing side does not differ from the activation of the starting position.

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We initiated physical therapy for a female patient with Alzheimer’s disease who suffered a left trochanteric fracture that caused a short and unstable left stance phase in gait. Initially, we performed muscle stretching and strengthening, and weight-bearing exercises in the sitting and standing positions, but the patient could not follow the therapy and did not achieve the target strength because of attention deficit due to Alzheimer’s disease. However, the patient was capable of independent activities of daily living (ADLs) such as dressing and grooming. Therefore, we initiated an exercise therapy which involved putting on and taking off a sock. After the therapy was started, the strength of the patient’s left gluteus maximus and external and internal oblique muscles improved and the instability in her gait stance decreased. This experience shows the necessity of selecting a therapy focused not only on the impairments but also on the patient’s abilities to perform ADL.

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A patient with left hemiplegia following cerebral infarction could not maintain a sitting position. Treatment in this position was difficult for the patient because of a tendency to fall toward the paralyzed side (left side) when sitting, and associated anxiety. Therefore, with the aim of maintaining the sitting position, physiotherapy was started in this position for a week to treat hypotonia of the internal and external oblique muscles of the abdomen, longissimus muscle, and multifidus muscle, which was the primary condition. However, it was difficult to maintain a sitting position. Thus, we considered that it was necessary to treat hypotonia by placing the patient in a supine position to improve the ability to maintain the sitting position. After 3 days of practicing to turn to the non-paralyzed side (right side), and sitting-up exercises to increase the activity of the internal and external oblique muscles of the abdomen, longissimus muscle, and multifidus muscle, the patient was able to sit independently without support. To treat the condition and help maintain a sitting position, as well as to reduce the anxiety of falling, it is necessary to initially treat the patient in a supine position.

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A patient presented with difficulty with turning the steering wheel to the left when driving an automobile due to a right distal clavicle fracture. Minimally invasive osteosynthesis was performed 9 days after the injury. Physiotherapy was indicated fROM the 23rd postoperative day. At this time, the initial evaluation was performed, and the patient was prohibited fROM performing motions that involved the movement of the clavicle. This movement prohibition was lifted 40 days after the injury. In the initial evaluation, inward rotation of the right shoulder joint was observed during the operation of a steering wheel; however, flexion was poor and the patient was unable to turn the wheel to the left. Therefore, the limited range of flexion of the right shoulder joint was considered to be the cause of the impairment. A test determined that the following factors contributed to the impairment: the range of flexion of the right shoulder joint was limited to 40°, forward and downward inclination of the glenoid during abduction, forward inclination and downward rotation of the right scapula, and restricted intra-articular movement due to anterior displacement of the right humeral head. The right glenohumeral joint was treated (physiotherapy A), following which the range of flexion of the right shoulder joint increased to 65°. However, the patient was still unable to turn the wheel to the left. On the 40th postoperative day, treatment of the clavicle was permitted and a re-evaluation was performed. During right shoulder joint flexion, backward rotation of the clavicle in the sternoclavicular joint was not observed, and backward inclination and upward rotation of the scapula was insufficient. The sternoclavicular joint was treated (physiotherapy B) to improve the backward rotation of the clavicle. After the treatment, improvement was observed in upward rotation and backward inclination of the scapula. As a result, the range of the flexion of the right shoulder joint increased to 110°, and the patient was eventually able to turn the steering wheel to the left. In this case, the achievement of backward rotation of the clavicle in shoulder joint flexion was considered to be useful.

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We provided physical therapy for a patient with inability to hang up laundry due to pain involving the anterior aspect of right shoulder after fracture of the proximal section of the right humerus. We observed the patient performing a sham laundry-hanging task and noted the flexion and elevation of the right scapular arch in the early phase of anterior elevation of both arms, and the adduction and introversion associated with flexion of the right shoulder. Flexion of the patient’s right shoulder was restricted to about 60°, and the patient reported pain around the right coracoid process. The shoulder movements suggested impingement between the coracoid process and the lesser tubercle of the humerus. Considering the problems of restricted range of motion of the right scapular arch and shoulder, and weakness of the muscles around the right shoulder, corrective therapy was performed for about one month. Improvements were observed in the impaired functions that were suggested as major problems; however, the sham laundry-hanging task in the standing position was still difficult to perform due to the pain in the anterior aspect of right shoulder. Therefore, the patient’s movements were more closely examined, especially in the standing posture, and mild extension, abduction and extroversion of the left hip and mild flexion/adduction/introversion of the right hip during anterior elevation of both the arms in the standing position, which caused characteristic left anterior rotation of the pelvis, were observed. This movement forced the patient to perform the task with the body turned to the right and horizontal adduction of the right shoulder. Moreover, flexion of the right scapular arch and adduction and introversion of the right shoulder appeared to be intensified in an effort to hold a bath towel at the height of the laundry pole due to the posteriorly displaced position of the right shoulder. Evaluation of the causes of these findings revealed weakness and reduced tone of the left gluteus maximus muscle; therefore, training with the primary aim of strengthening this muscle was performed. As a result, anterior elevation of both arms in a symmetric standing posture became possible with improvements in the strength and tone of the left gluteus maximus muscle, and the pain in the anterior aspect of the right shoulder disappeared. For restoration of the patient’s ability to hang up laundry, improvements in the strength and tone of the left gluteus maximus muscle were necessary, as indicated by the evaluation of the standing posture during the laundry-hanging task, in addition to the correction of the functional impairment of the right shoulder.

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In this study, we report the results of physiotherapy for a patient with right hemiplegia after cerebral infarction, who complained of difficulty in using a kitchen knife with his right hand. This was because of the occurrence of pathological synkinesis involving left trunk lateroflexion and right shoulder elevation, shoulder joint flexion, adduction, and internal rotation; elbow joint internal rotation; and forearm pronation. While isolated movements on the right side became possible one month after the onset of cerebral infarction, a decrease in performance due to involuntary movements, causing the knife to move left and forward, was continuously observed. Hypotonia in the bilateral internal and external oblique muscles and hypertonia in the left iliocostalis muscle were suspected as the primary causes of these abnormal movements. Pathological synkinesis in the right upper limb leading to left trunk lateroflexion and simultaneous right shoulder girdle elevation, may have occurred when using a kitchen knife, because of abnormal tone of the trunk muscles. Based on this hypothesis and focusing on the problem with the trunk, physiotherapy was performed to improve the tone of the trunk muscles by practicing lateral weight shifts to the left in the standing position. It became possible for the patient to handle a kitchen knife, while maintaining the trunk in a neutral position without left trunk lateroflexion. This led to the disappearance of pathological synkinesis on the right side when performing cutting activities, improving the patient’s handling of the kitchen knife. These results highlight the importance of maintaining symmetrical postures for the improvement of upper limb functions on the affected side in patients with post-stroke hemiplegia.

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We report the case of a patient who, after posterior lumbar fixation for lumbar spinal canal stenosis, presented with difficulty in reaching the gluteal cleft with the right upper limb from the dorsal side while wiping after excretion and inevitably used the left upper limb. Through observation of a simulated wiping motion with the right upper limb, a decrease in the ability to perform the following movements was suspected: moving the pelvis from a posterior to an anterior inclination with flexion, internally rotating the left hip joint, extending the trunk, elevating the right pelvis and flexing the trunk to the right side, and rotating the trunk to the right. Examination based on these observations identified decreased tonus of the bilateral internal oblique muscles of the abdomen and multifidus and longissimus muscles, and increased tonus of the bilateral iliocostal muscles to be the primary causes. Therefore, surface electromyography was performed, and electromyographic waveform patterns of the aforementioned trunk muscles during simulated wiping motion with the right upper limb were compared with those of healthy subjects. No activity was detected in the bilateral internal oblique muscles of the abdomen. The patterns of the other muscles were similar, albeit with decreased activity. During physical therapy, the patient retained the physiological curvature of the spine, with the pelvis in the center of the anterior and posterior inclinations and the trunk extended in a sitting position. Furthermore, right pelvic elevation and right rotation of the trunk accompanied by right-sided flexion were promoted while shifting the body weight in the left anterior direction. Satisfactory wiping motion with the right upper limb was acquired through this therapy. This case report suggests that when examining the wiping motion after excretion, it is necessary to evaluate the ability to elevate the pelvis and flex and rotate the trunk to the required side while retaining the physiological curvature of the spine.

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