To perform patient treatment in physical therapy, it is necessary to identify the problems correctly. The problems must be narrowed down to the impairments that can be understood from the physical therapy evaluation. To determine the impairment level, it is important that motion observation and motion analysis of the patient’s problems are performed correctly.

It is known that the patients with shoulder disorder have scapular dyskinesia in shoulder motion, and there are many variations in scapular dyskinesia. Scapular movement is a consequence of the movements in the sternoclavicular and acromioclavicular joints. Therefore, we have to assess and focus on the functional impairment instead of the phenomenon. In this article, the perspectives of determining a functional impairment from the patient’s motion are presented.

There are two types of assessments in physical therapy: top-down and bottom-up. Top-down evaluations, which we recommend, focus on movement observation and analysis. In this article, we introduce some points for analyzing ankle joint problems. When observing movements, determining the details of the movements according to the type of movement is sometimes difficult. In such cases, dynamic alignment evaluation is occasionally performed, an example of which is presented in this article. In addition, patients with ankle joint diseases often have limited range of motion of ankle dorsiflexion. Multiple factors contribute to ankle dorsiflexion limitation, such as flexor hallucis longus and Kager’s fat pad, which we describe in this study using an ultrasound imaging system.

The authors use top-down evaluation to determine impairments and perform physical therapy regardless of musculoskeletal or central nervous system disorders. One of the abnormal postures in patients with musculoskeletal disorders is a hunched posture with trunk flexion. In addition to the influence of the trunk, hunched posture tends to become more prominent with the influence of the lower limbs, lifestyle, and aging,. In this paper, we explain how to weigh the relevance of the problems considering the effects of not only the trunk but also the lower limbs, when considering the problems of trunk flexion posture in musculoskeletal disorders. In addition, we also explain the main points for performing examinations and physical therapy for problems of the trunk, while presenting posture and motion analysis of cases and electromyogram data of healthy subjects.

Screening tests are useful for determining the functional impairments of disorders and diseases in sports activities. In this paper, a case study is presented and the original Hara test (EPT, EET) and lateral reach movements test were used for screening. In order to use these as screening tests, the myofunction of the triceps and serratus anterior muscles of each movement was examined using surface electromyography. It is often difficult to determine the functional impairment of disorders and diseases in sports activities. A deeper understanding of the significance of screening tests and their use in clinical practice can help the elucidation of the causal relationship between disease and functional impairment.

Central nervous system diseases are often associated with somatosensory dysfunction. Somatosensory deficits affect postural and motor control. However, postural and motor control can be improved by using visual and vestibular sensory information, and by emphasizing somatosensory information. An understanding of somatosensory function should distinguish it from other dysfunctions.

The upper limbs play an important role in holding an object in the hand and moving that hand to the required position. Notably, upper limb motor paralysis and spasticity are observed in patients with cerebrovascular disorders, resulting in restricted upper limb movement. Moreover, the interpretation of upper limb movement disorders requires knowledge on kinematics and physiology. This paper outlines the kinematic and physiological interpretations of the characteristic movements of paralyzed upper limbs.

We believe that it is important to determine impairments from motion observation in the process of pursuing the ADL problems of patients. Physical therapists are involved in a wide variety of illnesses, and there are many opportunities to confront the impairments caused by falls. Most of the injuries caused by falls are due to stumbling. Regarding motion observation, it is necessary to focus on pelvic tilt at the time just before toe-off on the swing leg side, and carefully examine which factor corresponds to it, and to look at the joint movement in detail. We think that it is important to consider this. Here, we look at the factors that cause stumbling from an examination of cases.

Physical therapists have opportunities to perform physical therapy for patients with cerebrovascular disorder-associated hemiplegia during the acute, convalescent, and chronic phases. However, functional impairment of the trunk and/or pelvic region may cause difficulties for patients with acute hemiplegia to maintain a sitting position or may cause difficulties in standing up or walking for patients with convalescent hemiplegia. Physical therapists also encounter patients with chronic hemiplegia who can walk but have decreased gait performance due to functionally impaired trunk performance. The authors consider that physical therapy must be performed based on a knowledge of kinematics and anatomy to target the primary problem of functional impairment. This article features trunk impairment assessment and physical therapy practice for patients with cerebrovascular disorder-associated hemiplegia.

An appropriate physical therapy assessment is important for acquiring basic physical therapy skills. Each therapist needs to fully understand the purpose and limitations of the physical therapy assessment. Seeking the detailed method of a test in physical therapy assessment is important for all therapists, and it is possible with an understanding of kinematics and anatomy. In this paper, we focus on the movement of the pelvis, trunk, and foot, and introduce clinical assessments that determine an impairment through corresponding joint movements.

In clinical practice, muscle weakness is often considered a functional disability similar to limitation of range of motion. Physical therapists use manual muscle testing (MMT) as described by Daniels et al. for the general assessment for muscle weakness. This test quantitatively assesses muscle strength by the amount of joint movement, muscle contraction, and the effect of gravity and resistance. However, it is not possible to evaluate the strength of individual muscles involved in a single joint movement, or to separate a single muscle into fibers with different actions when using this method. It is also difficult to assess qualitatively whether muscle activity is assessed at a specific time during movement. In this paper, we examine the possibility of evaluating muscle weakness using MMT for knee extension, hip extension, and hip abduction by changing some of the test positions and the direction of manual resistance based on kinematics. For knee extension, we describe how to check the alignment of the patella and how to vary the movement speed to check for muscle activity at a given time. Each of these approaches are presented based on electromyogram data.

This study investigated the effect of increased periodic counts of auditory stimuli on the changes in electromyographic reaction time (EMG-RT) and the effect of different stimulation frequencies on the changes in the EMG-RT. Twenty-one healthy subjects (16 males and 5 females; average age, 25.5 ± 5.2 years) were enrolled and provided informed consent. The conditions for auditory stimulation were as follows: 1 Hz stimulation frequency, 70 dB stimulation intensity, 1 kHz auditory frequency, and 15 stimulations per trial. The auditory stimulus was delivered via headphones. The subjects were required to raise their right wrist quickly in response to each auditory stimulus signal. The results suggest that the EMG-RT of the 2nd to 15th auditory stimuli were shorter than the EMG-RT of the first stimulus as the stimulation frequency changed. Similarly, the EMG-RT of the 3rd to 15th stimuli were shorter than that of the 2nd. There was no significant difference between the 3rd and 15th auditory stimuli EMG-RT. From these results, it can be hypothesized that the first stimulation acted as a warning signal and increased attention to the task. We think that EMG-RT was shortened compared to the stimulation frequency. This difference might be due to both the difference in histology and repetition of tasks, and the function of the central nervous system was streamlined.

In the hand mental rotation (MR) task, an image of the hand is presented, and the subject judges whether the hand shown is the right or left by mentally rotating and converting the image. The reaction time and correct answer rate are then measured. This study aimed to determine the effect of the difference in viewpoints of the hand MR task on the excitability of the spinal anterior horn cells of the abductor digiti minimi muscle using F-wave measurements. The subjects were 12 healthy adults (age [mean ± standard deviation]: 23.8 ± 4.2 years). We used the task of viewing the thumb and the little finger. The F-waves were measured at rest and during the tasks of viewing the thumb and the little finger. The changes in F-wave persistence and F/M amplitude ratio between rest and during each task were compared. F-wave persistence and the F/M amplitude ratio were higher during the respective tasks of viewing the thumb and the little finger than at rest, and the F-wave persistence and F/M amplitude ratio were higher during the task of viewing the little finger than during the task of viewing the thumb. These findings suggest that viewing at the corresponding point (the little finger) may further increase the excitability of the spinal anterior horn cells of the abductor digiti minimi muscle.

This study examined the effect of pressure stimulation of acupuncture point “Chize (LU5)” during pinch action of 50% maximal voluntary contraction on the excitability of the spinal motor neuron function using F-waves. Fourteen healthy subjects (average age 25.5 ± 2.3 years) were recruited. The subjects were requested to perform a pinch action of 50% maximal voluntary contraction for 1 min (Task 1), and then the same task with an examiner simultaneously performing pressure stimulation to Chize (LU5) for 1 min (Task 2). F-waves were recorded at rest and after the tasks. After Task 1, the F-wave persistence and F/M amplitude ratio increased compared to at rest. After Task 2, the F-wave persistence and F/M amplitude ratio showed no significant difference from at rest. Additionally, the relative values of F-wave persistence and F/M amplitude ratio were significantly higher after Task 1 than after Task 2. These results suggest that pressure stimulation of Chize (LU5) may suppress the excitability of the spinal motor neuron function.

This study investigated the effects of different methods of motor imagery on spinal motor nerve function. The motor imagery strategy was determined by a preliminary questionnaire on the strategy of free imagery. Based on the preliminary questionnaire results, the F-wave of the unselected imagery strategy was compared with those of free imagery. Nine healthy individuals (mean age, 21.7 years) participated in this study. We investigated the excitability of spinal motor nerve function during a motor imagery task. The motor imagery adjusted the pinch motion using the non-dominant thumb and index finger to 50% maximal voluntary contraction. The F/M amplitude ratio observed during free imagery was significantly higher than that observed during rest imagery, but there were no significant differences between the other conations. This suggests that the excitability of spinal motor nerve function changes with the content of the imagery during motor imagery or the number of contents of motor imagery. Moreover, motor imagery combined with muscle contraction and sensory imageries increased the excitability of spinal motor nerve function.

This study aimed to determine the effect of acupoint stimulation physical therapy (ASPT) of the acupuncture point Quze (PC3) on spinal motor neural function. We examined the F-wave excitability of the spinal neural function of 10 healthy participants following ASPT of Quze (PC3). We performed ASPT using two methods: applying pressure on Quze (PC3) vertically, and applying pressure obliquely toward the radius. The first method significantly decreased the F-wave persistence and the F/M amplitude ratio at 10 and 15 minutes after ASPT. The second method significantly decreased the F-wave persistence at 5 minutes and the F/M amplitude ratio at 5 and 10 minutes after ASPT. Therefore, we consider that ASPT of Quze (PC3) influences spinal motor neural function.

We carried out rehabilitation therapy for a post-stroke patient. The patient could not turn over sufficiently because he could not swing his left lower leg to the right and did not rotate his pelvis to the right enough. We tested the muscle tone and found decreased muscle tone in the right iliopsoas muscle and the oblique fibers of the left internal oblique abdominal muscle. From the results of the test, we thought that the decreased muscle tone of the right psoas major muscle was preventing the right swing of the left lower limb, and the reduced tonus of the left internal oblique muscle prevented the pelvis from rotating to the right. Therefore, we conducted a therapeutic approach for these muscles. As a result, the patient was able to perform a complete turning movement.

We report a case of cervical disc hernia who found it difficult to scratch the back with the right hand due to pain. With a supinated forearm, although it was difficult to perform the tying movement with the right palm facing the back, this could be performed without pain. A difference was found in the shoulder extension movement when comparing the tying movements of the medial and supinated positions of the forearm. As a result of treatment focusing on the range of motion of right shoulder joint extension, the practical use of the tying movement in the supinated position of the forearm increased.

We report a case of pain in the radial side of the right wrist joint when operating the accelerator of a motorcycle. The subject was a woman in her 60s with a fracture of the distal end of the right radius. As the pain was caused by abnormal alignment of the handlebar grip, which is a preliminary step in accelerator operation, her evaluation mainly involved postural observation and assessment of the handlebar grip. From the range of motion (ROM) measurement and the results of the alignment abnormality analysis, we deduced that the ROM limitations of forearm pronation and wrist dorsiflexion were causes of the pain. Therefore, physical therapy was performed for extending right forearm pronation and wrist dorsiflexion ROM. The ROM of the pronation angle of the forearm and dorsiflexion angle of the wrist joint improved, the alignment when the handle was gripped improved, and the pain experienced when operating the accelerator disappeared. Regarding pain, it is necessary to take an approach based on the potential influence of other parts as assessed via motion observation and motion analysis, in addition to the influence of the injured site.

The patient was an 80-year-old male who had right hemiplegia secondary to cerebral infarction and whose safety and stability of transfer to the left side had decreased. He came in with the chief complaint of, “I feel like I might fall backwards when transferring to a wheelchair”. Thus, the treatment goal was to improve the safety and stability of transfer movements. Specifically, when the patient stood up to transfer to the left side, pelvic left rotation did not occur with left hip joint internal rotation, putting the pelvis in a right rotated position instead. Moreover, when stepping on the left lower limb, the patient’s right thigh and lower leg tilted backwards and the right ankle joint was bottomed out, making it difficult for him to shift his weight to the right front. We considered the main problem to be a decrease in the muscle tone of the anterior fibers of the left mid-density muscle on the non-paralyzed side, and we conducted physical therapy to address this. As a result, the patient became able to shift his weight to the right front, when transferring to the left side, before stepping on the left lower limb, improving the safety and stability of the transfer movement. For this patient, it was necessary to improve not only the functional impairment on the paralyzed side, but also the functional impairment on the non-paralyzed side to improve the safety and stability of the transfer motion.

The present case, a woman in her 70s, slipped while pruning a tree branch and fell 3 meters. She was unable to move due to neck pain and was taken to an emergency room, where she was diagnosed with a central cervical spinous cord injury, a 4th cervical spinous process fracture, and a 5th cervical spinous process fracture. Later, when the patient was hanging laundry, she found it difficult to lift a hanger with clothes with one hand and to hang three or more clothes at a time. In an examination of the movement of hanging the laundry with shoulder flexion, upward rotation of the scapula at the acromioclavicular joint was found to occur as the right shoulder joint flexion angle increased. Shoulder flexion by the patient was difficult due to weakness of the right shoulder flexor muscle and supraspinatus muscle. In addition, due to weakness of the right scapular abduction and upper rotator muscles, the patient could not reach forward when raising her upper limbs. Therefore, although the movement was performed utilizing the trunk and shoulder girdle, only three clothes could be hung at a time, and the time required for hanging the laundry increased. We prescribed exercises for strengthening the right shoulder flexor and supraspinatus muscles, and right scapula abduction and upper rotator muscles. Subsequently, no compensatory movements of the trunk and shoulder girdle were observed. Moreover, the right shoulder joint flexed and the acromioclavicular joint rotated upward, and 80 pieces of laundry could be dried on the laundry pole.

The present case had right putamen hemorrhage 5 years ago and presented with left hemiplegia. The patient had used a left lower limb orthosis for 5 years. The long-duration usage of the orthosis reduced the chance of muscle activity in the left lower limb, promoted hypotonia in the left triceps surae and left quadriceps muscles, and additionally promoted hypotonia in the left lower limb. These were assumed to be causative factors of the swing habit. Additionally, the habitual swing pattern of the left lower extremity resulted in secondary dysfunctions such as hypotonia of the anterior and posterior gluteus medius muscles and hypertonia of the left iliocostalis and quadratus lumborum. It was assumed that it also affected the decrease in stability of barefoot walking. Therefore, to improve the stability of barefoot walking, it was important to improve not only the dysfunction of the left lower limb but also the habitual swing mode of the left lower limb.

We report a case of left-side hemiplegia due to subarachnoid hemorrhage. When our patient walked with a T-shaped cane, almost no extension and adduction of the left hip joint from the left loading response to the left mid-stance, poor weight transfer to the left lower limb, and instability from the right mid-stance to the right terminal stance due to hyperabduction of the right hip joint were noted. The patient's right hip joint was externally rotated, and the pelvis was left rotated throughout both standing and walking due to internal rotation weakness of the right hip joint. The left hip joint was poorly flexed in the left swing phase due to hypotonia of the left iliacus muscle, and the left lower leg had been swinging out for many years due to left pelvic elevation along with left lumbar flexion. It was necessary to first address the problems of the right lower limb. Left hip extension, adduction, and internal rotation, left ankle dorsiflexion, and left foot supination were absent. In addition, horizontal movement of the pelvis was difficult. An approach improving the left rotation of the pelvis and external rotation of the left lower leg via external rotation of the right hip joint, resulted in extension and adduction of the left hip joint occurring in the middle stage of the left stance, enabling the patient to transfer weight onto the left lower limb.

We administered physical therapy for a patient with knee osteoarthritis who had an increased risk of falling backward while standing up or standing. The patient experienced poor hip flexion during sitting and the flexion phase of standing up, causing the pelvis to tilt backward. Moreover, the extension of both hip joints was poor in standing and the flexion phase of standing up, which compromised the support of the upper limbs. Improved muscle tone in the iliacus muscle and gluteus maximus increased the flexion of both hip joints during sitting and the flexion phase of standing up. Additionally, the extension of both hip joints increased in standing. Consequently, the risk of falling backward was reduced in standing up and standing, which improved the patient's safety and standing ability.

We performed physical therapy for a patient with Parkinson’s disease to improve posture and movement. The patient showed flexion of the thoracolumbar transition and lateral flexion while sitting, which continued even when standing, and also demonstrated pelvic posterior tilting due to poor flexion of both hip joints. In the standing position, the patient showed instability to the left and a tendency to fall because of left tilting of the trunk due to abduction of the left hip joint. These characteristics continued even during gait motion. During gait motion, left hip flexion and lateral flexion of the thoracolumbar transition caused instability to the left anterior and a tendency to fall from initial contact of the left foot to the mid-stance. The common problems of the sitting, standing, and gait motions were determined by top-down assessment, and improvement of posture and motion were achieved by intervention.