Research questions may be resolved through research, and research results may benefit clinical work. This interaction improves the quality of therapists and can lead to cures for patients.

In rehabilitation, movement observation is applied to improve motor functions. We investigated the effects of movement observation by assessing the excitability changes in the spinal anterior horn cells using the F-wave. In healthy subjects, we found that movement observation accompanying target muscle contraction increased the excitability of the spinal anterior horn cells corresponding to the target muscle. This observation suggests that the use of movement observation may be efficacious for patients with reduced excitability and function of the spinal anterior horn cells. In clinical applications of movement observation, it is important to match the patient’s posture with the observation object, and to present movement of the same side as the treated region.

In rehabilitation, progress in the order of passive, automatic assistance, automatic, and resistance exercises is common. Automatic assistance exercise occupies an important position as preparation for automatic exercise acquisition, but it is easily influenced by the experience and skill of the therapist. Therefore, in this study, we focused on the automatic assistance movement necessary for the handling technique of the upper extremity. The relationship between the amount of upper limb assistance and shoulder muscle activity and the muscle activity pattern between automatic and automatic assistance exercises were examined. The points in the handling technique of the upper limb are described.

Scapular movements and activation should be assessed in patients with shoulder disorders. In the evaluation and treatment of scapular motion, the focus must be on scapular muscle activity and scapulothoracic, sternoclavicular, and acromioclavicular joint movements. Evaluation of the relationships between the scapula and other adjacent joints such as the glenohumeral joint and trunk will also be helpful for shoulder rehabilitation. This paper presents an assessment of scapular function based on electromyographic data and a case report.

In the physical therapy field, physicians encounter some patients who cannot maintain their posture in the standing position because of decreased activity of the lumbar spine. In such cases, forward weight shifting in the standing position may be performed. The purpose of this study was to examine postural changes and muscle activity during forward weight shifting while standing. We observed that during forward weight shifting, the activity of the multifidus muscle (L4/S1) increased from the initial stage, with the anteversion of the lower legs and pelvis. To maintain the posture of the lower lumbar spine, the muscle activity of multifidus (S1) must start prior to that of multifidus (L4).

In patients with musculoskeletal and central nervous system diseases, even if the sitting and standing postures can be maintained to some extent, the instability of the hip joint and pelvic area may limit the muscle activity when the lower limbs are raised. By presenting electromyographic studies and images of the hip joint and pelvis during the above-mentioned movements, this study introduces points of clinical evaluation and treatment.

In daily life and sport situations, external stimuli can be used to control exercise. In physical therapy, periodic auditory stimulation is said to be effective at improving patients' walking ability (walking speed, stride length, and cadence). A metronome, hand clapping, and vocalization are used by therapists to deliver periodic auditory stimuli. Prediction of the rhythm is necessary to perform efficient exercise based on auditory stimuli. Reaction time and synchronization tapping tasks are used to examine the ability to perform exercise according to rhythm prediction. The mechanisms of motor control in the central nervous system are different for periodic and non-periodic movements. This study describes the results of research on motion control according to rhythm prediction based on reaction time and synchronization tapping tasks, the ability to reproduce rhythmic movements with hand clapping and foot stepping, and rhythm tasks and sensory function, and discusses clinical applications of rhythm tasks.

In clinical practice, lateral weight shift to one leg in the standing position and trunk anterior tilt movement in the standing position are sometimes recommended for patients for whom movement in the standing position is difficult. It was found that postural changes of the lower limbs affect the activities of lower limb muscles. Because of this finding, it has become necessary to clarify the influence of postural changes on hip muscles. In this paper, we determined the activities of hip extensor muscles when lateral weight shift to one leg in the standing position and trunk anterior tilt movement in the standing position are recommended.

This study examined the motor imagery effect using F-waves in order to verify a report that performance and body function were improved by motor imagery. To improve motor accuracy, motor practice for 30 seconds or 1 minutes before motor imagery was important. For the assumed scenarios in activities of daily living, motor imagery of compound movements must include the shoulder, elbow, wrist, and finger. Under these circumstances, it is desirable to set the task difficulty according to individual motor imagery ability. In the future, thorough investigation of F-wave forms will be necessary for the interpretation of the excitability of the spinal neural function during motor imagery.

In this study, we assessed changes in trunk, pelvic, and hip-joint alignment during downward reach from a standing position. Eight healthy adult men participated in this study. First, the subjects looked at their feet in a standing position and pointed their fingertips toward their toes. From this position, they were instructed to reach for their toes in random 2-cm increments up to 16 cm. They were instructed to maintain each position for 5 seconds. Postural images were taken with a digital camera of the sagittal plane during the task. From these images, the angles of thoracic vertebrae flexion, thoracolumbar vertebrae flexion, lumbar vertebrae flexion, forward pelvic flexion, and hip flexion were calculated, using ImageJ. No statistically significant difference in the thoracic vertebrae flexion angle was observed. There was a statistically significant increase in the thoracolumbar vertebrae flexion angle at more than 10 cm, forward pelvic flexion angle at more than 12 cm, and hip flexion angle at more than 6 cm. The results suggest that these angles have certain effects as task components. In addition, the flexion angle of the lumbar vertebrae tended to increase gradually with an increase in the reach distance and showed a statistically significant increase at more than 8 cm. This result suggests that this angle also has an important effect as a task component. The results of the angle changes of thoracic vertebrae flexion and thoracolumbar vertebrae flexion are considered to reflect the flexural mobility of those joints. Moreover, the results of the angle changes of lumbar vertebrae flexion and forward pelvic flexion are thought to reflect the movement of those joints, namely, the lumbar-pelvic rhythm as reported by previous studies.

The purpose of this study was to investigate changes in the excitability of the contralateral upper limb spinal nerve function during movements of the fingers of different difficulties using F-waves. The F-waves of twelve healthy subjects were measured at rest and during two motor tasks: Task 1 involved flexion and extension of the left fingers at a frequency of 1 Hz, and Task 2 involved two-ball clockwise rotation using the left fingers, which is a difficult movement. The amplitude F/M ratio, appearance frequency, and latency of the F wave were analyzed. The appearance frequency was found to be significantly increased in Task 2 compared to at rest and in Task 1. There was no significant difference in the amplitude F/M ratio between the two tasks. The latency of the two tasks was also the same. The promotion effect on the contralateral spinal nerve function accompanying movement of the finger in one direction may increase in a difficult exercise task.

To provide more effective instructions for walking exercise in physical therapy, this study reviewed the biomechanics of turning during walking. Forty-one studies were found in PubMed using search terms related to “turning” and “biomechanics:” Twenty analyses of kinematics, eight analyses of kinetics, nine analyses of kinematics and kinetics, one analysis of kinematics and electrophysiology, and three analyses of kinematics, kinetics, and electrophysiology. The points where a unified view was found are as follows: 1) Performing turning required exertion of ankle plantarflexion torque and activation of hip abductor muscles; 2) The ground reaction force waveform and muscle activation of turning were similar to gait termination; 3) The turning angle was related to the variation of step length and rotation of the torso and pelvis. However, the joint torque and muscle activation of the torso were not analyzed. To perform physical therapy for turning, we suggest that strengthening ankle plantarflexion torque and activation of hip abductor muscles are necessary.

This study examined the effect of performing motor imagery (MI) simultaneously with movement on the excitability of the spinal nerve function and its impact on movement accuracy. Twelve healthy subjects (mean age, 20.9 years) who completed Scale 4 of the Kinesthetic and Visual Imagery Questionnaire participated in this study. After resting (rest), the subjects practiced adjusting pinch forces at 20% maximum voluntary contraction (MVC) using visual feedback (motor practice [MP]). Next, the subjects adjusted for 20% MVC without visual feedback (pinch task 1) and performed MI. Then they performed pinch task 1 again (pinch task 2), MI simultaneous with the actual movement using visual feedback (MP+MI), and pinch task 1 again (pinch task 3). Finally, they rested again (rest 2). F-waves were recorded at rest, MP, MI, MP+MI, and rest 2. Movement accuracy was assessed during pinch tasks 1–3. Spinal nerve function excitability was significantly increased in MP, MI, and MP+MI compared with rest and rest 2. Movement accuracy was increased in pinch task 3 compared with pinch task 1. High MI ability and MI simultaneous with movement increased spinal nerve function excitability and improved movement accuracy.

In this study, we investigated the changes in the excitability of the spinal motor nerve function after motor imagery of the box and block test (BBT) by conducting an F-wave study. The study included 20 healthy participants. BBT motor imagery was performed by dividing the box into two sections, one filled with blocks and the other empty. BBT motor imagery was performed of the index finger and the thumb of the right hand moving the blocks one by one to the empty section of the box at the fastest speed. The F-waves were measured of six tasks: rest 1, rest 2, motor imagery 1, motor imagery 2, after motor imagery 1, and after motor imagery 2. Each task was performed continuously for 30 seconds. The relative values of the amplitude F/M ratio and persistence were calculated. The amplitude F/M ratio and persistence of motor imageries 1 and 2 were higher than rests 1 and 2, and after motor imagery 2. In addition, the amplitude F/M ratio after motor imagery 1 was higher than that of rests 1 and 2. Our results suggest that the excitability of the spinal motor function was increased after motor imagery of BBT compared with that of rest for 30 seconds.

Rising from supine (RS) is an important functional movement that should be analyzed by physical therapists to improve functional ability. However, no previous study has reported kinetic data on RS. To quantitatively evaluate the contribution of the lower extremities to the center of mass (CM) location during RS. Five healthy men (average age: 23.6 ± 3.8 years) performed unrestricted rising toward the right from supine. Their average execution time in the usual speed task was 2.40 ± 0.24 seconds. The motions of RS were recorded using four video cameras. The three orthogonal components of angular momentum, X, Y, and Z, of 15 body segments, composed of a transfer term and a local term, were computed. The body’s CM location and whole-body angular momentum were estimated using a human model and joint position data of the motion capture measurements. The RS period was divided into first and second halves. Relative contributions of the angular impulse of each segment to the whole-body angular impulse were compared between the first and second halves of RS. In the first half of RS, downward movement of the right lower extremity and head flexion contributed to the rising of the upper body (45% and 23%, respectively). In the second half of RS, downward movement of the right and left lower extremities contributed to the rising of the upper body (34% and 30%, respectively). The findings suggest that the movement of the lower extremities is important in RS.

We performed physical therapy focused for the forward-upward reach motion of a patient with cervical spinal cord disease who had difficulty hanging clothes on a pole. The range of motion of the left ankle dorsiflexion was determined as a problem point on the basis of the functional disorder predicted by movement observation. The extensibility of the left long hallux valgus flexor/left posterior tibial muscle, which is a factor in the range of motion of the left ankle dorsiflexion, was suggested to be involved in the forward movement of the center-of-foot pressure. As a result of the treatment of the foot to improve the forward-upward reach operation, the limitation of the range of motion of the left ankle in dorsiflexion and the execution of the motion were improved.

The patient was a woman in her 80s who had decreased trunk function due to compressive myelopathy of the sixth and seventh cervical spinal cord segments. In the Zancolli classification, the right upper limb was C6A and the left upper limb was C6BIII. As the main complaint was “I want to eat rice by myself,” the need was considered to be “performing a meal action.” When the patient ate meals in the erect sitting position, the trunk bent leftward upon reaching the left upper limb, making it difficult to perform the motion. An attempt to compensate for this was made with the remaining function of the right upper limb, but abduction of the right shoulder joint and bending of the right shoulder band occurred, and the patient couldn't maintain the posture. Therefore, the main problem was considered to be muscle weakness of the right shoulder joint horizontal inversion and right shoulder blade extension. Thus, physical therapy was carried out. As a result, the patient could maintain posture using the right upper limb for meal action, and the meal action itself was possible. Although trunk function was difficult to recover because of the influence of the injured spinal cord, the right upper limb function, which remained, could be properly used compensatorily and led to good results.

We performed physical therapy for a patient with right hemiparesis who complained of staggering while walking. His right hip and knee joints flexed in response to right side loading during walking, and he had backward instability because he had no control of the extension of either hip joint. His trunk tilted backward due to left hip joint extension in the double stance phase. He had hypotonia of the right iliac muscle and had no control of the right hip joint extension in the right stance. Thus, we thought that the impairment was hypotonia of the right iliac muscle during right hip joint extension in the right stance. We performed physical therapy and observed improvement in his gait.

Walking speed is expressed as distance per unit time and calculated as the product of step length and walking rate. It is important to increase the position of the lower limb by extension of the hip joint and knee joint in order to improve walking speed. We started physical therapy for a patient with disuse syndrome after aspiration pneumonia who complained of not reaching the toilet in time because of a reduction in walking speed caused by poor extension of the left hip joint from the left mid stance to the left terminal stance. The patient’s walking speed was improved by increasing the extension of the left hip joint from the left mid stance to the left terminal stance.

We performed physical therapy for a patient after bilateral Achilles tendon extension and left anterior tibial muscle tendon transition for bilateral pes equinovarus. The patient’s walking speed needed to improve for the patient to return to work. The walking speed was reduced because of failure to kick-off on the digitus primus side during the late stance phase. During walking, supination of the right foot increased because of poor anterior tilting of the right lower leg with right knee joint extension and right ankle joint dorsiflexion from the right mid stance phase to the late stance phase. In physical therapy, the right ankle joint plantarflexion was poor. In addition, we observed no increase in the muscle activity of the gastrocnemius with anterior tilting of the right lower leg in the electromyographic evaluation of forward lunge. As described earlier, the anterior tilting of the right lower leg was difficult to stop from the right mid stance phase to the late stance phase because of right ankle joint plantarflexion muscle weakness. Accordingly, the foot varus muscle group, such as the toe flexion muscle group, was thought to be compensating, stopping the anterior tilting of the right lower leg. During treatment, we tried to improve the right ankle joint plantarflexion strength with heel raises. After the treatment, prevention of the anterior tilting of the right lower leg was possible because the strength of the right ankle joint plantarflexion muscle had improved. Furthermore, the anterior tilting of the right lower leg also involved right knee joint extension and right ankle joint dorsiflexion. Thus, by reducing the compensation activity of the foot varus muscle group at the time of anterior tilting of the lower leg, the loads on the forefoot and digitus primus side were improved. As a result, the patient’s walking speed improved until kick-off on the digitus primus side during the right late stance phase, and the patient could return to work 6 months after the operation.