Normal movement was defined as automatic exercise of skill and motion with low attention. A characteristic of normal movement is typical rules of motion. Normal movement is a normative state with sensory functions, motor functions, and spinal and brain functions that control sensory and motor functions. Especially functions of the basal ganglia are affected by internal stimulation, intention and mind, and the cerebellum is affected by external stimulation; rhythmical sound and vision and so on; important controlling normal movement. And sensory functions during motion, for example plantar sensory functions during gait are also important in normal movement. We might improve movement pattern by using the characteristic of the normative neurological mechanism in all patients with abnormal movement.

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In the field of physical therapy, observational motion analysis is important to predict the impairment and/or to judge the effect of physical therapy. Many kinds of knowledge are needed to observe a human movement and to integrate its phenomena and impairment. It is very important to have a knowledge of mechanics, because human motion is governed by the laws of mechanics. In this paper, especially, I would like to mention both mechanical stress and various forces in a knowledge of mechanics. Mechanical stresses include the following: load, tension, compression, bending, shear and torsion. Various forces are displayed in this article, including gravity, inertial force and reaction force. I think that to understand these stresses and forces related to human movement may be useful for the prediction of impairment.

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This article emphasizes the importance of the ‘motion mechanism’ in comprehending human movement and motional impairment. ‘Motion mechanism’ was operationally defined as ‘an effective function against the force of gravity acting on the human body’. To understand human movement, it was necessary to know all the anatomy and human structures, muscle functions and dynamic alignment. As to anatomy and human structure, especially, the axes of human joints had to be clearly understood. And the axes of human joints, there were both physiological and functional axes. In muscle function, muscle physiology, muscle kinetics and the kinetic chain are involved. Dynamic alignment was important in comprehending impairment of the musculoskeletal system. The more severe dynamic malalignment was, the more remarkable the disturbance of movement was. To reduce motor disturbance, re-alignment of dynamic malalignment was effective. One of the methods for re-alignment of the leg during walking and stair-up/down was Knee Bent Walking (KBW). It was used as a conscious method for re-alignment in cases of dynamic malalignment. In the field of physical therapy, as an effective approach for aged, disabled and injured people, it was very important that we understood the motion mechanism and human body functions, and it will offer unlimited possibilities to all aged, disabled and injured people.

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There are various movements in our daily life. In this chapter, we considered standing-up from the following viewpoints: 1) Consideration of the literature: We consider normal "standing-up" from the kinematical viewpoint as mentioned in the each literature. 2) Consider the analysis of "standing-up" with the emphasizes on movement (the accent): We understand the influence of the other parts on the body with the emphasis on "standing-up", and we understand the difference between the normal "standing-up" and emphasized "standing-up". 3) Consideration from the "standing-up" analysis of each disease: After analyzing "standing-up" ralated to each disease, we compared it with emphasized movements and considered each relationship (similarity, common points, points of difference). There are various movements in our daily life. If we can understand "standing-up" which is common in our daily life. we can predict the other normal movements and the movements of patients with various diseases, and we can treat diseases early. Although "standing-up" is the basic movement in locomotion, we must not limit understanding to this. Because we can understand whole movements in more detail by considering the abovementioned viwepoints.

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The important role of the Central Nervous System (CNS) in walking creates a walking pattern. In other words, that system invents appropriate motive power, it controls the center of gravity, it integrates afferent information from sight, hearing, the vestibular organ and the peripheral systems and muscular elasticity must be controlled. In a moment human CNS does it, almost automatically. In this automatic system, spinal cord functions (central pattern generators: CPGs) are remarkable. CPGs is the neuron circuit network which plays a central role in forming such a pattern when a lot of movement cell groups are active in the pattern having to do with a fixed form as to time and sapce. In treatment, in which the principal objective is the reaquirement of walking in a CVA patient, it is necessary to consider activating the functions (CPGs) of the spinal cord. It it is important to facilitate equilibrium reactions, righting reactions and step balances to do it.

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This article describes the characteristics of running and sprinting from the viewpoint of kinematics and mechanical energy. Mechanical stress on the body induced by running does not always increase at faster running speed. Mechanical stress on the body when running is affected by the conversion of mechanical energy and momentum. In instruction on running in the field of physical therapy, it is not necessary to decide the grade of running as to speed. It is necessary to prescribe running while predicting mechanical stress on the body, and thinking about the conversion of mechanical energy and momentum.

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Due to the revision of Japanese medical fee payment in 2002, most of hospitals and clinic will be faced to a decrease in income. For prevention the decrease in income, they are needed to both understand its revision accurately and device a special technique for increase in income. In this article, it was accounted that a characteristics of this revision and a notification related to this revision from Ministry of Health, Labour and Welfare. The special features in this revision were as follows: an introduction of `a unit', a reorganization of standard of facilities and an emphasis of among EBM, ADL, Informed-consent, a record and/or report and a risk management. And as another features, they were emphasized that prevention of diseases and health promotion. From this revision, we have had to catch this concept seriously, and must keep the quality of rehabilitation service with consciousness of cost performance.

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Medical fields are not exempted from the effects of waves of deregulation and structural changes. The minus revision of medical fees has been implemented from this April, and all hospitals, public and private, are facing the need to search for significant management strategies to survive. But quite a few hospitals depend on administrative organizations for their management practice, and to meet the needs of the age, a change to independent hospital management is expected. It is necessary to recognize highly precise management analyses and diagnoses of hospital management as the means of providing better, appropriate medical services to the patients, and that securing a stable medical business profit is not the prime purpose. When hospital management analysis is carried out, lowering personnel expenses, which is the core of total cost, is an important point. It is necessary to reconsider wages based on seniority, and to adopt a system based on ability and further to introduce meritocracy in the future. In this paper the author speculates upon various problems arising from recent medical fee revision, focusing particularly on the personnel wage system from the hospital management viewpoint.

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The environment of hospital management has been greatly changing due to implementation of the Care Insurance, the quaternary revison of Medical Laws, control of medical fees, and reform of the medical system. It is very doubtful that the present hospital care system would be appropriate as it is to provide medical services because of the decreasing number of the young and the aging society. In order to meet the various needs of the people in local community, it is a must to maintain the quality of the individual hospital, and to provide new services and systems to respond to the needs of age. The purpose of this paper is to establish a new medical system to explore ways to provide hospital management and rehabilitation care that respond to the external environmental changes.

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Due to revision of the Japanese medical fee payment system in 2002, it is estimated that most privately owned hospitals will suffer a loss of income of about 10%. In this serious situation, it is necessary to make a change in our understanding of the system and to obtain the best results with minimal cost. To deal with the serious situation, the following four items were important: emphasis on rehabilitation in the early phase, propaganda and marketing, close communication and a team approach among medical staff (i.e. physical therapist, nurse, medical social worker and so on) and the use of a critical path. And also, the following four concepts were thought to become problems in the future: the importance of informed consent by patients, carrying out evidence-based medicine, reconstruction of the payment system an assessment method for rehabilitation staff, and the introduction of a continuous internship for a career in rehabilitation staff. Indeed in this serious situation, rehabilitation staff with good skills and a warm heart will be needed in the future in Japanese society.

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As the result of the medical treatment revision at this time hospital income for treatment will be reduced substantially to 0.51–0.77. On the clinical scene, problems are (1) What do we ought to pay attention to when we carry out individual therapy? (2) What are it the merits and demerits when we carry out group therapy? (3) How do we discriminate between individual therapy and group therapy? (4) How is it able to compensate for the decrease in income? Therefore, we want to talk about countermeasures and direction in the clinical scene.

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The big change in the rehabilitation system was seen as a result of the recent revision of medical treatment fees, but there was no special change in the long-term care insurance. Nevertheless, we can expect a turning point, even in long-term care insurance. Also it is likely that our income will be decreased by the long-term care insurance revision in the next fiscal year. As a developmental change in long-term care insurance after this medical treatment fee revision, we predict quantitative/qualitative change (impairment, need of user) for a day care/entry users in geriatric health services facilities and there is additional also the possibility that many workers in rehabilitation are rapidly joining long-term care insurance institutions. Hereafter, qualitative improvement of geriatric health services facilities and the sorts of occupations related to rehabilitation will be important for our occupational survival.

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This article introduces both the Outpatient Rehabilitation Centers (ORC) and Medical Training Therapy (MTT) in Germany and Power Rehabilitation in Japan to consider in relation to the future Japanese medical situation. ORC is the framework of physical medicine in Germany, which standardizes staff, area, equipment and programs. ORC has attracted attention in Germany as to both rapidity of patientsi recovery and cost performance. In 1999, about three hundred and eighty institutions were standardized asORC as follows: three hundred Orthopedics and Traumatology, twenty Neurology, thirty Cardiology and thirty Geriatrics. MTT is for training and exercise under medical control, and includes medical management, diagnosis and evaluation, and it has been introduced as the means for an early recovery from diseases in ORC. Power Rehabilitation in Japan established in 2002 is an exercise program and methods for the evaluation of physical and mental fitness and quality of life (QOL) to improve activity fitness, and prevent falling and disuse. Power Rehabilitation is one of the methods and concepts for rehabilitation of the elderly, and consists of the following elements: stretching, physical exercises, training exercise with a machine, recreation activity, and so on. In the present social situation as it affeccts medicine, it is important to change the viewpoint of the medical marketing system. And ORC and/or Power Rehabilitation are significant directions for new age medicine to take.

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This article refers to the future of physical therapy as related to the revision of medical fee payment in Japan in terms of physical therapy education. From the viewpoint of physical therapy education, since the revision of medical fee payment in Japan, it is necessary to have more highly trained physical therapists. It is important to have cooperation between before graduate education and post diploma education to enhance the quality of physical therapists. Before graduation, students should recognize the possibilities of their career, their identity as physical therapists, and the importance of evidence based on physical therapy, and so on. On the other hand, in post diploma education, it is important to extend knowledge and techniques and to study hard.

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We have reported acupuncture therapy for shoulder pain and low back pain. The trigger point, the origin of pain was located on certain muscles in a patient with shoulder pain and low back pain. It is important to remove the origin of pain in treating these patients. Acupuncture stimulates trigger points with muscle twitch of the affected muscle and associated parts. In rehabilitation staff, not acupuncturists, finding and using the trigger points is not so difficult. They can reduce the pain with massage, mobilization and so on for trigger points to apply the trigger point acupuncture therapy. It is helpful to know the trigger points and treatment for shoulder pain and low back pain.

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We reported factors and their treatment for health care of low back pain from the viewpoint of oriental medicine. Factors in low back pain due to the kidney and spleen vacuity in medical and welfare workers, and helpers were thought to be due to "overfatigue (hard work)" which are non-endon-exopathogenic factors from the standpoint of oriental medicine. Treatment of low back pain in oriental medicine was as follows: The most important point in health care to avoid low back pain is to avoid fatigue. In the type of low back pain due to spleen vacuity, it is important not to be indifferent to health, over-drinking and over-eating, as endogenous dampness because there is a close relationship between spleen vacuity and "wet". It is important in preventing "wet", to try to not engage in bathing or hydrotherapy for a long time and after work, and to dry the body sufficiently. If we keep the spleen in good condition, we can avoid changing from "wet" to "phlegm (tan)" and avoid a out or decrease in "stasis blood (oketsu)". In the type of low back pain due to kidney vacuity, it is important to not become "cold" and if we do, to take care to warm our body soon.

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The purpose of this study was to investigate whether ROM on pronation of the transverse tarsal joint affected both pelvic movement and EMG activity of gluteus medius muscle on hemi-standing. We researched two experiments about ROM limitation on pronation of the transverse tarsal joint. One was the inherent limitation: it was classified as the hypo-mobility side (ROM on pronation of the transverse tarsal joint <10°) or normal-mobility side (ROM on pronation of the transverse tarsal joint ≥10). Another was artificial limitation by meanes of taping. It discriminated between the non-taping group and the taping group (ROM on pronation of the transverse tarsal joint=0°). In each experiment, subjects were instructed to maintain hemi-standing with 90 degree hip flexion on the unsupported side. We compared the degree of eversion of the subtalar joint, pelvic movement and EMG activity of the gluteus medius muscle on the supported side on hemi-standing on both the hypo-mobility side and the normal-mobility side; and taping group and non-taping group in two experiments, respectively. In both of the two experiments on ROM limitation on pronation ofthe transverse tarsal joint, pelvic movement tended to increase pelvic elevating to the opposite side on hemi-standing or the degree of eversion of the subtalar joint on the supported side significantly increased on hemi-standing, and EMG activity of the gluteus medius muscle significantly increased on hemi-standing. We would like to emphasize that pelvic movement was altered by ROM limitation on pronation of the transverse tarsal joint. The main reason was that ROM limitation on pronation of the transverse tarsal joint on the supported side caused excessive eversion of the subtalar joint on hemi-standing. And excessive eversion of the subtalar joint caused the obstruction to shift the pelvis in the direction of the supported side for hemi-standing. We suggest that the pelvic elevation to the opposite side was caused to compensate for obstruction when shifting the pelvis in the direction of the supported side.

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To evaluate of sustained elevation of a paralyzed superior limb, we performed physical therapy for the limb in a patient with postapoplectic hemiplegia. During the physical therapy, sustained elevation of the paralyzed superior limb was achieved by activating muscle groups in the lower trunk and gluteal region controlled by the corticoreticular spinal tract, and by accelerating continuation of associated righting reflex. These findings suggest that postural adjustment of the body center and proximal extremities is required in hemiplegic patients to achieve functional improvement of a paralyzed superior limb.

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The purpose of this study was to examine the influence of physical therapy for trunk muscles on the function of the affected arm muscles in a patient with cerebrovascular disease (CVD). Evaluation of trunk muscle function and function of the affected arm was done with surface electromyography and evoked electromyography. I compared the amplitude ratio of H/M and muscle action potential in the sitting position after physical therapy with that in the sitting position before physical therapy. The H-reflex was recorded from the abductor pollicis brevis after stimulating the median nerve at the wrist with evoked electromyography. The H-reflex was analyzed and the amplitude ratio of H/M was determined. And muscle action potential was recorded from both the obliquus abdominis and low back muscles with surface electromyography. The amplitude H/M after physical therapy was lower than that before physical therapy in this patient. In surface electromyography, the obliquus abdominis on the affected side and both of the low back muscles after physical therapy was lower than that before physical therapy in this patient. As a result of this study, excitability of spinal neural function in the affected arm might be decreased after physical therapy for function of the trunk and lower extremity muscles in patients with CVD. The result suggested that physical therapy of affected arm in patients with CVD needed to consider the influence of contraction of the trunk muscles and the low back muscles.

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As the reason for a post-stroke patients difficulty in walking, the imbalance in the actions of his trunk muscles was found based on motion analysis in the first therapeutic evaluation. Furthermore, the problems were confirmed by electromyography (EMG). Physical therapy was started and the course was followed by the first therapeutic evaluation and EMG. The therapy focused on normal action in sitting and standing in accordance with the function of attitude control and walk control of the central nervous system. The 60 minute exercise program was performed once a week for 15 weeks. As a result, the trunk muscles had actions equivalent to those of a person who is not physically handicapped, and difficulty in walking was reduced. The results suggested that physical therapy based on motion analysis is effective even in post-stroke patients.

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We encountered a patient with hemiplegia caused by a cerebrovascular disorder. The chief symptom was gait disturbance due to insufficient lifting of the toe from the ground on the affected side caused by leaning of the trunk forward and toward the affected side when toe on the affected side was lifted from the ground. Hypotonus of the abdominal muscles on the affected side was involved in the leaning of the trunk forward and toward the affected side. Hypertonus of the hamstring muscles on the unaffected side caused by compensation for the instability was observed. In the patient, treatment of hypotonus of the abdominal muscles was performed, but the effects reached a plateau. While re-examining the condition, we noticed shortening of the pectoralis major muscle on the affected side. The shortening of the pectoralis major muscle on the affected side, which had been caused by compensation of the instability induced by long-term hypotonus of the abdominal muscle tonus, limited the mobility of the shoulder girdle and trunk, and further reduced the tonus of the abdominal muscles, creating a vicious circle. We performed stretching exercises of the shortened pectoralis major muscle on the affected side, and examined the effects by EMG. The hypotonus of the abdominal muscles was improved by stretching exercises, and the hypertonus of the hamstring muscles on the unaffected side was also improved. And also the gait disturbance was improved by the combination of treatment of the abdominal muscles and stretching exercises of the shortened pectoralis major muscle on the affected side. Our experience indicated the importance of treatment of the shortened pectoralis major muscle on the affected side caused secondarily in the long term in addition to treatment of hypotonus of the abdominal muscles caused primarily by a cerebrovascular disease.

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Cervical dystonia appeared in March 1998, and it seemed that no treatment was effective. Treatment by means of acupuncture started in March at Kansai College of Oriental Medicine. In the patient with cervical dystonia, EMG at the initial treatment showed only left splenius (SPL). Also shortening of the neck in the left frontal side was found, to treat these symptoms multiple epidermis needles was used. The retaining needles were GV20 for involuntary movement and SI3 for SPL. After 2 months from the start of treatment there was improvement of the neck posture in the sitting position, and smooth neck movement. This case also proves that EMG analysis and correct treatment by means of acupuncture improves the symptoms.

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The patient was a 61-year-old female. Abnormal neck posture first appeared in July 2001.We started acupuncture treatment once a week at our clinic in November 2001. We evaluated the patient clinically with electromyography (EMG). At the time of the first medical examination, neck posture in the sitting position showed right rotation due to hypertonus of the right splenius (SPL) and left trapezius on EMG finding. The retaining needle on the meridian points and the multiple epidermis penetrating needle on a tender spot were used every week as acupuncture treatment. The point of the retaining needle was both ways SI3 in the affected SPL and TE5 in trapezius. As regards right scalenus and right levatorscapulae inserted directly. Multiple epidermis penetrating needles were used to treat skin and muscle shortening in the right lateral portion of the neck. Nevertheless, after acupuncture therapy, the neck posture in the sitting position was not improved, so we again studied acupuncture therapy and paid attention to the scalenus. The point of the retaining needle was ST42 in the affected scalenus, LI4 in the sternocleidomastoid (SCM), SI3 in the SPL, and GV20 due to involuntary movement. Multiple epidermis penetrating needles were used to treat skin and muscle shortening of the right scalenus, around the left SCM from the left trapezius. As a consequence of modifying the acupuncture therapy again, the neck posture in the sitting position and the EMG result also improved. The results suggested that the acupuncture therapy with the retaining needle and Multiple epidermis penetrating needles are beneficial for cervical dystonia.

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