Self-training must be carried out for the purpose of deriving the correct problem by physical therapy evaluation and solving the problem. As, the physical therapist must be able to properly provide the necessary self-training for the patient himself. The physical therapist must also check whether the patient is properly performing self-training. We believe that proper self-training will help restore motor function.
Self-training can be both effective and harmful. It is also necessary to consider safety. Proposing self-training is one of the important jobs of a therapist. This paper introduces self-training for orthopedic diseases of the spine and lower limbs that the author is prescribing. However, among the many self-training methods for the spine and lower limbs, this content is specialized for the prevention of disability.
Arm elevation movement is used in daily living. We have performed physical therapy for patients with arm elevation difficulty due to problems with the shoulder joint and trunk function. We think self-exercise is important for effective rehabilitation. Therefore, we examined the concepts behind self-exercise for patient with arm elevation difficulty and describe them in this report.
Sensory information is required to perform appropriate movements. Not all sensory information is input during movements, and only necessary sensory information is extracted by the nervous system. When promoting sensory input for cases with sensory disorder, it is important to conduct exercises with low frequency and pay attention to the joint movements while the subject consciously performs the exercise. In this paper, we describe the relationship between sensory function and motor function, and present self-training for cases with sensory disorder.
Therapists can clarify the major functional impairments of patients having difficulty maintaining a sitting position or performing a standing up motion based on postural and motion observations. Through physical therapy, exercises for sitting and standing up are given alongside approaches for addressing patients’ functional impairments. Furthermore, voluntary training of patients outside the physical therapy setting is important for improving posture and movement. Thus, this study  introduces the elements necessary for maintaining a sitting position and performing standing up, and  provides an example of voluntary training for cases having difficulty maintaining sitting positions or performing standing up.
The Trendelenburg sign can occur due to various factors, and it is necessary to evaluate the factors in detail and then perform treatment to lead to voluntary training. In this paper, we consider the factors and movement patterns of the Trendelenburg sign appearing in electromyogram data, and explain voluntary training for those factors.
In this paper, we explain the evaluation and treatment strategies of lifting motion with reference to our previous studies. Our previous studies have revealed that the pelvic position of the lifting motion is related to the postures of the knee and ankle joints. Based on the results of these previous studies, we consider that evaluation focusing on the ankle joint is useful for the evaluation of cases that complain of low back pain in a lifting motion. When the object is light, the activity of the tibialis anterior muscle tends to increase, and when the object is heavy, the activity of soleus muscle tends to increase.
We investigated the relationship between changes in motor cortex and corticospinal tract excitability and different characteristics of isotonic contraction. The characteristics included contraction intensity (strong and weak), frequency (high and low), and periodicity (periodic and discrete). Excitability of the motor cortex and corticospinal tract was higher during periodic isotonic contraction than during discrete isotonic contraction. The effects of contraction intensity and frequency remain controversial.
This study investigated the effects of superficial sensory stimulation on the excitability of the spinal motor nerve function using F-waves recorded for 10 healthy subjects. The F-wave was elicited from the right thenar eminence by stimulating the right median nerve. In the protocol, the F-wave was recorded for 1 minute at rest with the eyes closed, and recorded for one minute while subjects carried out tasks after a four-minute rest period. Three types of tasks were performed at the same time as the F-wave measurement: stimulation of superficial sensation of the right thumb (Task A), stimulation of superficial sensation of the right thumb with execution of calculation tasks (Task B), and execution of calculation tasks only (Task C). The results revealed that the amplitude of the F/M ratio in task A was higher than at rest during stimulation of superficial sensation (p<0.05), while in tasks B and C no change was observed. These results suggest that the excitability of the spinal motor nerve function, corresponding to the muscle on the right thenar eminence, was increased by superficial sensory stimulation triggering consciousness of the right thumb.
This study examined the effects of a task of modulating different voluntary contraction strengths on somatosensory evoked potentials (SEP). The subjects were seven healthy adults (age 24.0 ± 3.0 years). SEPs were recorded at rest and during three motor tasks. The motor tasks consisted of palmar abduction of the right thumb in the palmar abduction position, which was adjusted to 5%, 10% and 20% of the maximum voluntary contraction strength using visual feedback. The results showed that there was no difference in SEP amplitude between resting and each task. The task of self-regulating contraction intensity may not decrease the amount of sensory input regardless of the contraction intensity.
This study examined and compared the pelvic tilt angle and movement characteristics of a forward-reaching task at different speeds in the sitting position. Seven healthy males each performed a forward-reaching movement toward a target 20 cm ahead within periods of 2 seconds, 1 second, and 0.5 second. It was found that the thoracic vertebra tended to bend immediately after the initiation of movement in all the tasks. Additionally, in the 2-second and 1-second tasks, the pelvis showed a change in angle, tilting forward at initiation of the movement. In the 0.5-second task, however, the pelvis exhibited a slight change in angle, tilting backward to maintain posture at the initiation of movement.
We examined the joint angles of the trunk, hips, and feet of 16 healthy adult male subjects while they performed downward reach position from the standing position while holding one arm along the side of the body. The postural change at the time of reach was recorded from the rear with a digital video camera. ImageJ was then used to process the captured images. The thoracic spine lateral flexion angle, thoracolumbar transitional lateral flexion angle, lumbar spine lateral flexion angle, hip adduction/abduction angle, foot pronation/supination angle, pelvic lateral tilt angle, crus tilt angle, and calcaneal tilt angle were used to determine the change in posture. In the downward reach, lateral flexion mainly occurred on the reach side of the trunk. The images revealed that hip abduction on the reach side and reach inclination of the pelvis occurred at the beginning and at the end of the movement. Therefore, downward reach mainly involves lateral flexion of the trunk. Furthermore, the reach-side inclination of the trunk due to the lateral flexion of the trunk and hip abduction on the reach side is a movement in which the center of gravity of the body tends to deviate to the reach side. Therefore, we consider that the center of gravity of the body is kept on the base of support by the non-reach side movement of the pelvis and the non-reach side inclination of the lower limbs using hip abduction on the reach side and hip adduction on the non-reach side.
As a pre-step to using motor imagery for functional training of patients with an increased likelihood of falling due to deterioration in toe grip function, the effect of motor imagery using still images was evaluated by F-waves, an index of the excitability of the spinal nerve function. The subjects were 15 healthy individuals (9 men, 6 women, average age 20.4 ± 1.5 years). The F-wave of the flexor muscle of the left great toe was measured in the resting state and, after learning the left toe flexion movement, the F-wave was measured again during the motor imagery task. The motor imagery task was an imagery trial performed with and without still images. The resting F-wave was recorded immediately after and 5, 10, and 15 minutes after both imagery trials. The amplitude of the F/M ratio of the imagery trial without still images was significantly increased compared with that of rest. In addition, there was no significant change in the amplitude of the F/M ratio of the image when using still images. When images are used for motor imagery, the excitability of the anterior horn cells of the spinal cord does not increase significantly. This is because the motor imagery execution reminds us of the sensation of motor execution, thereby prompting a clearer and more realistic motor image. Therefore, the influence of the images may be reduced.
This study aimed to clarify the change of the spinal motor neural function effected by ASPT (acupoint stimulation physical therapy) of Ximen. ASPT is physical therapy using acupuncture stimulation. This study enrolled twenty healthy subjects and examined the change of the spinal motor neural function in them. First, the F-wave of resting was measured. Next, we performed ASPT of Ximen and measured the F-wave during ASPT, and at 0, 5, 10, and 15 minutes after ASPT. F-wave persistence was significantly decreased at 0, 5, 10, and 15 minutes after ASPT compared with that during ASPT. The F/M amplitude ratio did not significantly decrease at any time. Therefore, no significant difference was observed between rest and any of the other times. Based on these results, we consider that pain stimulation of Ximen does not affect spinal motor nerve function.
The internal oblique muscle (IO) shows different muscle fiber orientations. Therefore, the purpose of this study was to examine the muscle fiber orientations of the IO and the external oblique muscle (EO) using ultrasound imaging. The subjects were 12 healthy males (mean age, 24.3 years). Initially, five points were determined. For the five points, the inferior margin of the eighth rib was defined as point A and the point below, 2 cm from the anterior superior iliac spine (ASIS), was defined as point E. Then, the point one-fourth of the head side of line AE was defined as point B, the midpoint of the line, as point C, and the point one-fourth of the caudal side of line AE, as point D. Next, a line parallel to the line AE was drawn 1 cm on the outside, and 1 and 2 cm on the inside of the line AE. Finally, ultrasound imaging was performed along each of these four lines. In all subjects, EO was present at point A regardless of the distance from ASIS, and IO was absent. At points B and C, IO and EO were present in all subjects regardless of the distance from ASIS. At point D, IO was present in all subjects regardless of the distance from ASIS, and the number of subjects with EO decreased as the distance from ASIS increased. At point E, the number of subjects with IO increased as the distance from ASIS increased, and EO was absent in all subjects regardless of the distance from ASIS. The results of this study suggest that the electrode position for the oblique fibers of IO should be 2 cm above and 2 cm inside ASIS. In addition, they also suggest that the electrode position for the transverse fibers of IO should be 2 cm below and 4 cm inside ASIS.
Physiotherapy was performed in a patient with frozen shoulder who suffered from pain of the entire upper limb whenever he moved the limb in the forward and upwards direction. In an extended position, supination movements of the forearm caused excessive muscle activity in the upper limb. This resulted in pain due to the dysfunction of the oblique fibers of the infraspinatus muscle. Maintaining the upper limb in the extended (forward and upward) position required that the shoulder joint be kept in a neutral position (for internal and external rotation) because the oblique fibers of the infraspinatus muscle were damaged. Therefore, dynamic evaluation of each of the fibers of the infraspinatus muscle is important for determining appropriate physical therapy targeting the movement of the upper limb in the forward and upward direction.
We performed physical therapy for a patient with left hemiparesis due to stroke who had food leftovers on the left side of the mouth during eating. In the sitting position, the patient’s pelvis was tilted backward and rotated left, and there was a left depression, which was restrained owing to hypotonia of the left gluteus maximus muscle. The patient’s body was bent toward the right, which made turning the face to the left side difficult during mealtimes. After physiotherapy for lowering the muscle tone of the left gluteus maximus and restricting the range of motion of the thoracolumbar right-side flexion, the pelvic back tilt, left rotation, lower left restraint, and left trunk flexion were reduced in the sitting position. The patient could now turn the face to the left side, and the amount of food leftovers on the left side of the mouth during mealtimes decreased.
In fishing, the act of moving the rod while winding in the line is called the rattling operation. Here we present a case of shoulder stiffness that occurred during rattling in a patient who earlier had had a rotator cuff repair by arthroscopy. The rattling movement is performed by mild external rotation of the shoulder joint. Our case had difficulty performing the movement due to a decrease in the function of the supraspinatus muscle, and stiffness was occurring on the upper surface of the left shoulder. This also negatively influenced our case’s fishing results. Physical therapy involving stimulation of the supraspinatus muscle was performed, paying attention not to over exercise the upper trapezius muscle fibers. With improvement in the function of the supraspinatus muscle, the rattling movement became possible, the stiffness disappeared, and our case’s fishing results improved. The rattling movement is highly dependent on rotator cuff function.
We performed physical therapy focused on the shoulder girdle and scapula for a patient with a right elbow fracture who had been experiencing difficulty in accessing the area behind the right shoulder joint while bathing. Right shoulder girdle extension was considered to be an issue based on the impairment predicted in motion observation. Increased muscle tone in the right pectoralis minor muscle was a factor affecting the poor extension of the right scapular girdle, suggesting that this muscle was involved when the towel was moved behind the right shoulder. Administration of treatment of the right pectoralis minor muscle led to increased right shoulder girdle extension, and the patient could access the area behind the right shoulder joint with a towel.
The patient, a man in his late 70s diagnosed with spinal cord infarction, showed a tendency to fall backward while standing up from the squatting position. Among the motion patterns, the standing-up pattern via the squatting position is the most efficient; hence, acquisition of the standing-up motion from the squatting position was the aim of therapy. Initial assessments indicated that anterior weight shift owing to dorsiflexion of both ankle joints was insufficient. In addition, during upward movement, a tendency to fall backward due to early weight shift occurring upward and backward was observed. Based on motor observations, the dorsiflexors and plantarflexors of both ankles were weak and the muscle tones of both hamstrings were high. In physical therapy, the patient performed strength training for the dorsiflexors and plantarflexors of both ankles, and the muscle tone of both hamstrings was reduced. In the final evaluation, the anterior weight shift owing to the dorsiflexion of both ankle joints was found to have increased. Furthermore, during upward movements, both knee joints extended when the pelvis was directed forward, and the tendency to fall backward was improved along with the patient’s safety and stability.
We performed physiotherapy that focused on the function of the supraspinatus muscle during upper limb elevation for patients with left humeral shaft fracture who had difficulty in washing their own hair. Supraspinatus muscle weakness was recognized by observing the difference between motions in the sitting and side-lying positions. The onset of activation of the supraspinatus muscle during upper limb elevation was earlier in patients with left humeral shaft fracture than in healthy people. The exercises for the supraspinatus muscle were effective at improving the self-care activity of washing hair.
We performed physical therapy for a patient with spinal cord metastasis after malignant lymphoma one year ago. Posterior instability was observed in the buttocks while standing up; therefore, the patient lacked safety and stability during this action. The motions of the flexion phase in standing up were as follows: (1) spatial anterior and lateral tilting of the leg, and (2) pelvic anterior tilting with flexion of the hip. These abnormal motions were considered to have been caused by high muscle tones in the right ankle and foot muscles. Therefore, we considered that it might be difficult for the patient to perform pelvic anterior tilting with hip flexion; and this would have made standing up difficult as well. We prescribed direct stretching and strength training for the right ankle and foot muscles. However, the pelvic anterior tilting with hip flexion showed no improvement. Therefore, pelvic anterior tilting with hip flexion was not solely caused by the ankle and foot. On re-examination, abnormal motion with left hip flexion muscle weakness was observed. Physical therapy was performed to treat these hip, ankle, and foot conditions. Consequently, the patient showed improvement in spatial anterior and lateral tilting of the leg, and pelvic anterior tilting with the flexion of the hip during the flexion phase. The patient also improved with respect to safety and stability while standing up.
We present a case of backward walking in which adduction of the left hip joint was not possible in the left stance phase due to muscle weakness in left hip joint abduction. In addition, the left knee joint was bent because of the decreased muscle strength in left knee joint extension, and the thigh was tilted backward and became unstable during movement toward the right. Physiotherapy was performed for 40 minutes per session twice a week to improve the muscle strengths of left knee joint extension and left hip joint abduction. Following improvement in the muscle strength of left hip joint abduction in the left stance phase, the weight shift to the left increased. In addition, the safety and stability of backward walking were improved by prevention of the backward inclination of the thigh, caused by bending of the left knee joint, by an increase in the muscle strength of left knee joint extension.
We performed physical therapy for a patient with a right trochanteric fracture who complained of staggering while walking. From the right initial stance to the right mid-stance phases, the right hip joint abducted and the trunk tilted towards the right. The patient presented with poor extension of the right knee joint due to knee osteoarthritis. Thus, we focused on the hip joint adductor muscles. We performed physical therapy and observed improvement in the patient’s gait as the strength of her hip joint adductor muscles increased.