Anatomical and kinesiological explanations are very important in the analysis of posture and motion, and the judgement of impairments in physical therapy evaluation. To improve posture and motion it is necessary to treat the higher priority impairment.
To deepen understanding of the normal for sitting from supine, 10 men and women were examined using motion analysis and electromyography. Motion was classified into three categories, namely sitting from supine with arm support on one side, sitting from supine with arm support on both sides, and sitting from supine with the sitting position with extended legs. The muscle activities of the right and left rectus abdominis muscles and right and left abdominal oblique muscle overlapping sites were examined using electromyography. A common feature of the three motions was the absence of rotation or side bending of the trunk. In addition, as segmental rotation and lateral bending of the trunk do not occur, the activities of the upper limbs are suggested to be important with regard to raising and rotating the body.
Therapists identify major dysfunction by analyzing seated posture and standing-up motion, with the aim of treating the dysfunction and implementing training for maintenance of seated posture and standing-up motion. Treatments to improve posture and motion will encourage exercise and can be based on kinesiology and anatomy. This article considers the following: 1) methods for assessment of seated posture based on kinesiology and anatomy; 2) standing-up motion; 3) handling skills of seated posture and standing-up motion; and 4) the relationships between a symptomatic area and seated posture/standing-up motion.
In physical therapy settings, lateral weight shift in the standing position is used in the evaluation and prescription of exercise therapy. Measurement of lateral weight shift in the standing position is needed to properly evaluate and treat patients receiving physical therapy. This study adds to previous research of posture change and muscle activity during lateral weight shift in the standing position. We discuss treatments in the context of lateral weight shift during backward movement.
This study examined the influence of posture change of hemiplegic stroke patients in their forward stepping motion. The results suggest that forward stepping motions differ in terms of joint motion, electromyogram pattern, and center of pressure owing to hip joint and tibial external rotation. This study introduces an intervention based on evaluation of the forward stepping motion.
Many studies have discussed the biomechanics of the shoulder joints. However, therapists rarely use this research in clinical practice. In general, evaluation is performed using visual and tactile skills. Visual assessment is suitable for observing static motion, but skill is necessary to evaluate rapid and complicated motion. Visual assessment skills are easily taught to others, but observations can be misinterpreted. Tactile assessment skills are difficult to teach, but improve with experience, and proficiency enables detailed evaluation. Use of these sensory skills in combination can aid the evaluation of patients with shoulder joint disease. This paper introduces an approach to assessment using tactile and visual skills for evaluation and treatment with upper limb exercise therapy.
The Academy for Kansai Physical Therapy aims to train therapists who can cure symptoms. Curing symptoms is achieved by understanding specific problems through a top-down evaluation requiring motion analysis based on anatomy and kinematics. The treatment strategy is based on determining the relationship between the physical problem and the loss of mobility using anatomical and kinematic terms. When we see a patient, we identify this relationship and narrow down the symptoms to one out of three possible causes, which leads to a rapid diagnosis and an accurate treatment. We present a case and explain our evaluation and treatment strategies.
Manual muscle testing is used to assess movement during arm elevation. Prior studies of movement during arm elevation have not assessed concurrent elbow joint motion. However, arm elevation in activities of daily living is performed not only with movement of the shoulder joint and shoulder blades, but also with elbow joint movement. Therefore, arm reach movement and arm elevation are different actions. This paper discusses research to date on arm reach movement and describes assessment and exercise therapy methods.
To study the effect of motor imagery by recording the F-wave, which indicates spinal excitability, in patients with a history of falls because of decreased toe flexor strength. Thirty healthy subjects (22 men and 8 women, mean age: 22.9 ± 6.4 years) participated in this study. The F-wave was recorded with all the subjects in a resting state. The subjects were subsequently instructed to contract the left flexor hallucis brevis with maximum effort. After a 5-min rest period, they were asked to imagine the muscle contraction. F-waves were recorded at 0, 5, 10, and 15 min after completion of the motor imagery exercise. An increasing trend was observed in the persistence of the F/M amplitude ratio during imagery. Although the F/M amplitude ratio was not significantly different between the motor imagery and rest conditions, it was 3.0 ± 1.3% in the rest condition and 3.3 ± 1.4% in the motor imagery condition. The rate of F-wave appearance was not significantly different between the two conditions but showed an increasing trend in both conditions (86.4 ± 16.1% and 87.7 ± 13.4%, respectively). Application of motor imagery to contract the flexor hallucis brevis with maximum effort has potential for fall prevention as part of fall avoidance therapy.
We studied the effects of change in position from the supine to the upright position on the distance between the two anterior superior iliac spines. Thirteen healthy men with an average age of 29.8 ± 8.7 years were the subjects. They were asked to maintain the supine and the upright positions, and a measuring tape was used to determine the distance between the anterior superior iliac spines, along the skin of the abdomen. The paired t-test was performed using the measurements of the supine and upright positions. A significant increase was found in the distance between the anterior superior iliac spines in the upright position compared with that in the supine position. This may be attributable to increased muscle thickness, reflecting activity of the transverse abdominal muscle and the internal oblique muscle transverse fibers, and also forward and downward bulging of the abdominal wall due to the weight of the intra-abdominal organs.
In this study, we examined the influence of differences in motor image ability on the spinal neural function in motor imagery tasks of oppositional movements between the thumb and the other four fingers. A total of 30 healthy volunteers (17 males and 13 females; mean age, 24 ± 5 years) participated in this study. The subjects’ motor image abilities were evaluated using the Movement Imagery Questionnaire Revised Japanese Version (JMIQ-R), and they were divided into high and low motor image ability groups using the median of their JMIQ-R scores. Motor imagery of the oppositional movement between the thumb and the index finger (task 1), the thumb and middle finger (task 2), the thumb and ring finger (task 3), and the thumb and little finger (task 4) was recorded. Each task was carried out at a frequency of 1 Hz for 1 minute. The relative value of the F / M amplitude ratio increased significantly in task 4 in the group with low motor image ability compared to tasks 1 and 2. This suggests that the excitability of the spinal neural function may have increased more in the group with low motor image ability when motor imagery of oppositional movement between the thumb and little finger was performed compared to that of the index and middle fingers.
This study aimed to clarify the effect of physical therapy using acupuncture stimulation at the Shangdu point on spinal neural function. This study examined the F-wave excitability of the spinal neural function in 15 healthy subjects using pressure stimulation at the Shangdu point. F-wave persistence significantly decreased at 5, 10, and 15 minutes after treatment, compared with the resting state. F-wave persistence significantly decreased at 0, 5, 10, and 15 minutes after treatment, compared with that during application of pressure. F-wave persistence significantly decreased at 5, 10, and 15 minutes after treatment, compared with that at the 0 time point. Pressure at the Shangdu point inhibits the excitability of the spinal neural function.
To investigate the effects on postural change and muscle activity in foot muscles during lateral weight shift while wearing an AFO. The subjects were 15 healthy men (average age 24.9 ± 2.5 years old). They performed a lateral weight shift in the standing position to the right lower limb while wearing an AFO on the right foot, then repeated the process without one. In each instance, postural change and electromyograms (EMG) of the peroneus, foot supinator muscles, and tibialis anterior were measured. When initiating the lateral weight shift while wearing the AFO, hip adduction on the moving side resulted in pelvic depression on the non-moving side. Continuation of the lateral weight shift also resulted in lateral flexion of the thoracolumbar area on the moving side, as well as outward inclination of the lower limb on the moving side. Compared to the barefoot lateral weight shift, there was a trend toward overall decrease in muscle activity in the peroneus, foot supinator muscles, and tibialis anterior. During a lateral weight shift while wearing an AFO, the AFO limits both foot pronation and supination. It can be surmised that this function of the AFO results in reduced muscle activity of the peroneus, used for grounding the foot, as well as in reduced muscle activity of the foot supinator muscles and tibialis anterior, which are used to restrict outward inclination of the lower limbs.
In this research, we evaluated the ability of an individual to reproduce motion while being conscious of a rhythm after a periodic auditory stimulus was presented, and examined the stimulation interval and number of stimuli suitable for rhythmic exercise. The subjects were 13 healthy volunteers (8 males and 5 females; mean age, 26.2 ± 6.2 years). After an auditory stimulus was presented, the subjects were asked to perform 30 consecutive foot stepping exercises while being conscious of the rhythm. The stimulation intervals of the auditory stimulus were 500, 1000, and 2000 ms. The stimulation frequencies were 2, 3, 5, and 10 times, and 12 kinds of stimulation series were randomly presented. The absolute error and coefficient of variation related to the foot stepping interval with respect to stimulation interval and frequency were compared. The absolute error and coefficient of variation were not significantly different across stimulation intervals and frequencies, and a significant difference was observed only between the stimulation intervals. The absolute error of 500 ms was significantly smaller than those of 1000 and 2000 ms, and that of 1000 ms was significantly smaller than that of 2000 ms (p<0.05). The coefficient of variation of 500 ms was significantly smaller than that of 2000 ms (p<0.05). The results of this study suggest that subjects can recognize rhythm and reproduce rhythmic motion after being exposed to several auditory stimuli.
One-sided lower limb raising motion during sitting is carried out in various daily living activities. In clinical practice, we often encounter patients experiencing instability during maintenance of the sitting posture. When such patients lift the lower limb of one side, the balance of the sitting posture is disturbed, leading to instability at the back and the side, necessitating assistance for basic daily chores in some cases. Physiotherapy training includes practice exercises for raising the legs to various heights for patients who find it difficult to raise the lower limb of one side in the sitting position. We hypothesized that movement of the spine, the pelvis, and a change in the pressure center of the seating surface accompany lifting of the lower limbs, and analyzed the spinal, pelvic, and limb positions using two-dimensional image analysis in physical movement, and the center of pressure displacement responses to changes in the height of unilateral lower limb elevation in the sitting position. The objective was to examine the characteristics of COP displacement. In the 30% elevation task, displacement of the right and left COP locus was observed in response to lower limb elevation, and with regard to the longitudinal COP locus, there was a tendency of the COP locus to displace backward after the COP shifted forward. In the 90% elevation task, COP displacement to the support side and the rear side was observed. Considering these facts, a pattern of characteristic COP displacement corresponding to the change in height of the leg lifting was seen. In healthy volunteers, it has been observed that the supporting side hip joint is always held in internal rotation, and that the load is applied at the sole so that efficient operation with less COP displacement occurs. In cases of instability in one side lower limb elevation, it has been suggested that evaluation of the alignment of the supporting side hip joint is as important as that of the elevated lower limb and the trunk.
A patient with cerebellar hemorrhage underwent physical therapy because of a decline in the ability to turn to the left using a spin turn. When the left leg was used as the pivot leg, the main complaint was difficulty in performing an effective and quick turn, which was necessary for returning to work. The ability to turn on the left using a spin turn was essential. In the initial evaluation, when performing a spin turn, outward inclination of the lower left leg was difficult due to left foot pronation and left ankle joint dorsiflexion, and anterior weight shift to the left leg was insufficient. Subsequent lower left leg anteversion, because of ankle dorisflexion, and left side pelvic rotation, because of internal rotation of the hip joint, were insufficient, leading to insufficient travel of the right foot, which grounded without passing the left foot. As a result, a turn in two phases was needed, resulting in a speed decline. Moreover, left lower leg supination was excessive, while left forefoot pronation was poor, causing the left toe to leave the floor, thereby reducing stability. Measurements based on the problems identified by movement observation indicated hypotonia of the left peroneus longus muscle, left tibialis posterior muscle, and left triceps surae muscle, and moderate impairment of left foot position sense. Physical therapy involving pronation and supination movements of the foot allowed elevation of the heel in the standing position. In the final evaluation, outward inclination of the front of the leg with the left foot in pronation and left ankle joint in dorsiflexion had become possible, and anterior weight shift to the left side had increased. As a result, the swing of the right leg to the left side increased allowing a spin turn in one phase, and the speed of the turn improved. In addition, the left leg was now supported by the whole foot grounded on the floor, improving the stability of the left stance phase.
This case report describes a patient with a left trochanteric femoral fracture with reduced walking ability. The patient's trunk tilted toward the left in the left-loading response phase during walking. The patient underwent physical therapy including exercises such as kicking a ball forward with the right foot from a walk-standing position, as well as range-of-motion and muscle-strengthening exercises. After 4 weeks of physical therapy, the patient was able to walk with stability at a moderate speed. As she also had senile depression, the recreational aspect of the exercises was effective for continuation of the therapy.
We performed physical therapy for a patient with right total hip arthroplasty whose stability was impaired by left forward inclination of the trunk when putting a flower pot on the ground with the afflicted right side leg forward. In the observation of the action of placing the flower pot on the ground, in weight transfer to the right lower limb, excessive hip adduction resulted in left forward inclination of the trunk, and the patient's stability was impaired by the center of gravity trying to deviate from the base plane. After that, weight transfer to the left lower limb was accompanied by a rearward inclination of the right lower limb due to right ankle plantar flexion and knee extension, and right hip and chest flexion occurred because weight transfer to the right lower limb was poor. The patient could not move a flower pot to the front of the right foot. We measured muscle activities by EMG during imitation of the movement of putting a flower pot on the ground, to clarify the muscle activities necessary for that task. The muscle activities of the posterior gluteus medius and upper gluteus maximus, which is are hip abductor muscles, increased. On the basis of behavior observation of the patient and the results of EMG, we thought that weakness in the posterior gluteus medius and upper gluteus maximus was a major problem. So, we performed physical therapy focussing on strengthening exercises. As a result, excessive hip adduction, resulting from the left forward inclination of the trunk decreased, and the patient was able to transfer weight to the right lower limb, accompanied by a forward tilting of the lower leg by right knee flexion and ankle extension, allowing the patient to put a flower pot on the ground.
We performed physical therapy for a patient with bilateral knee osteoarthritis and left knee pain when stepping to the right while cooking. When standing, the patient’s right lower limb became shorter due to flexion and the varus position of the right knee joint, resulting in right pelvic depression. When cooking, her left knee was painful because the left lower leg was in external rotation with the knee in the varus position, while right pelvic depression occurred when stepping to the right. Therefore, we considered the pain occurring with stepping to the right was associated with right knee flexion in the varus position, resulting in pelvic depression. With physical therapy for the right knee, the patient's standing posture improved and her left knee pain disappeared, and she became independent for cooking.
We performed physical therapy for a patient following right total knee arthroplasty. The patient was at risk of falling backward during the sitting motion because of insufficient right knee flexion. During examination of the sitting motion, cessation of flexion of the patient's right knee at about 90°, followed by a sudden drop of the buttocks with ankle flexion was observed. Further evaluation identified weakness in right knee extensor strength. Physical therapy focused on the knee bending angle. The method was as follows: the right lower limb was placed on a 20-cm-high platform set in front of a high-position chair, and the patient stepped onto the platform with the knee in 90° flexion. The aim was to improve right knee extensor strength. After treatment, the patient could maintain right knee flexion until the buttocks reached the seat surface. Thus, the risk of falling backward during the sitting motion was reduced, thereby improving safety.