In order to improve functional impairment, it is necessary to clarify the problem of impairment, and it is important to first address the major problem of impairment when conducting physical therapy. In addition, physical therapy for the improvement of impairment should be performed in a posture close to the basic movement that is the problematic disability.

Central nervous system disease is a disease that occurs in the central nervous system from the brain to the spinal cord due to various reasons. The pathology is diverse, and the symptoms are different even for the same disease. In order to develop physical therapy, it is important to evaluate the posture and movements of actual subjects. Physical therapy technique is considered to be whether the therapist can respond well to changes in the subject in a clinical setting. Here, we describe our own approaches for physical therapy for central nervous system diseases from the viewpoint of imitation, guidance, and voluntary movements.

It is necessary to interpret the behavior in order to improve the behavior of a paralyzed upper limb in patients with cerebrovascular disorders. If the motor analysis is incorrect, the behavior will not be improved by physical therapy. Therefore, motion analysis is an important first step in physical therapy. In addition, muscle tone can be adjusted by stimulating the skin and muscles in physical therapy. This paper outlines the content of physical therapy based on kinematic and physiological interpretations of the characteristic movements of paralyzed upper limbs of patients with cerebrovascular disorders.

Physiotherapists often have opportunities to perform physical therapy for patients with hemiplegia due to cerebrovascular disorders (among patients with central nervous system diseases), during the acute, recovery and chronic phases of the condition. Physical therapy is performed for patients who have difficulties in maintaining a sitting posture or performing activities while sitting, or who have walking difficulties or difficulties in performing activities while standing, due to trunk or pelvic dysfunctions. The authors consider that physical therapy, focusing on the major causative dysfunction, should be performed for patients at any phase of the disease, and that this requires a proper knowledge of kinesiology and anatomy. In this special topic, we will discuss the main measures for reducing the trunk dysfunction of patients with hemiplegia due to cerebrovascular disorders.

In physical therapy for patients with central nervous system disorders, the goal is often the acquisition of walking movement. Physical therapy is required to always consider the risk of falls in hospitalized life and to judge the degree of independence for each individual. The authors believe that it is necessary not only to rely solely on the determination of gait independence, but also to supplement it by observing movement, which is a necessary clinical ability required of a physical therapist. In this paper, we focus on the movement of initiating gait and present approaches for improving lower limb dysfunction while deepening the understanding of normal movement.

The important points for improvement of functional impairment of the upper limb are clarification of the impairment level and identification of the tissue related to the impairment. Also, we have to estimate the impairment not only from the perspective of the upper limb, but also from a whole-body viewpoint including the trunk and lower limbs. This paper presents the author's approaches for improving functional impairment.

We recommend performing a top-down physiotherapy evaluation rather than a bottom-up evaluation. During an assessment, it is desirable to detect problems at the impairment level and narrow them down to one problem in terms of order and relevance. By intervention for narrowed-down problems and re-evaluation of changes, a clearer physical therapy can be developed. In this study, we introduce abnormal postures and movements that are characteristics of patients with musculoskeletal diseases involving lumbar and hip joint impairment. Furthermore, we present one problem focusing on muscle weakness and decreased muscle tone as the possible underlying cause of impairment. We explain intervention methods for this impairment using kinematic and anatomical viewpoints and electromyography.

An overview of meridians and acupuncture points and some acupuncture points that can be used in exercise therapy is introduced. Pressure stimulation, using the theory of acupuncture and moxibustion, can be applied to selected acupuncture points and meridians to improve functional disorders. The actual conditions for stimulation of acupuncture points have not been anatomically confirmed. Therefore, from the standpoint of acupuncture and moxibustion practitioners, it is important to continue to research and demonstrate the functional effects of acupuncture point stimulation from various perspectives. In physiotherapy clinical practice, we hope that the theory of stimulation of meridian and acupuncture points can be used to improve functional disability. We believe that an accurate evaluation of functional disability will lead to greater effectiveness in acupuncture point stimulation.

Conventional evaluation methods are not sufficient for finding sports dysfunction. The reason for this is that athletes have exceptional muscle strength and range of motion as a result of adaptation to sports. In anticipation of these characteristics, we need to be creative in our evaluation methods and treatment. In this paper, I would like to discuss the evaluation of upper limb and trunk dysfunction based on the characteristics of motor function of athletes, and how we can try to improve them.

Evaluation is a very important part of the process of providing physical therapy. After selecting movements based on the patient’s daily activities and narrowing down the problematic joint movements based on movement observation, it is necessary to evaluate the patient and to establish the functional impairment. Sometimes there are cases where problematic joint range of motion can be deduced from the movement, but no range-of-motion measurement method exists. The patient may be diagnosed with joint range of motion limitation based on movement observation, and treatment may be developed, but no change in movement is observed. In this section, we introduce methods for evaluating joint range of motion with awareness of the axis of motion, and explain how to evaluate external rotation of the lower leg together with an explanation of the correct interpretation of the motion.

In clinical practice, muscle weakness is often considered a functional disability similar to limitation of range of motion. We physical therapists use manual muscle testing (MMT) described by Daniels et al. for the general assessment of 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. In other words, it is difficult to narrow down the individual muscles and muscle fibers that are weak using MMT results. In this paper, we examine the possibility of evaluating muscle weakness using MMT for knee extension, and hip abduction by changing some of the test positions and the direction of manual resistance based on kinematics. Each of these proposed test positions is presented based on electromyogram data.

In this study, the area where the iliac muscle and psoas major muscle are visualized on the surface was examined using ultrasound imaging system. The site where the iliac muscle was visualized on the surface was 0–1 cm lateral at 1 cm below the anterior superior iliac spine (ASIS), 0–2 cm lateral at 2 cm below the ASIS, 1–2 cm lateral at 3 cm below the ASIS, 2–3 cm lateral at 4 cm below the ASIS, 2–4 cm lateral at 5 cm below the ASIS, 3–4 cm lateral at 6 cm below the ASIS, 3–4 cm lateral at 7 cm below the ASIS. The psoas major muscle was not visualized on the surface. This result suggests that the activity of the iliac muscle can be examined using surface electromyography.

This study examined the effects of motor imagery and real movement on the excitability of spinal nerve function and its impact on movement accuracy, for a specific image. Fifteen healthy adults (mean age, 25.9 years) participated in this study. They practiced adjusting their pinch force (motor practice) to 20% maximum voluntary contraction (MVC). Initially, the MVC of the participants was adjusted to 20% without visual feedback. Then, they performed three types of motor imagery tasks simultaneously with the real movement. After the motor practice and each imagery task, the subjects’ adjusted 20% MVC pinch forces were compared, and the rate of absolute error was calculated. The three tasks were: a free image task (Task 1), a force image task (Task 2), and a hand image task (Task 3). F-waves were recorded during the motor practice and Tasks 1–3. The F-waves and the rate of absolute error were significantly lower in Task 2 than in the motor practice. Concentrating on muscular sensory information promotes motor learning, while decreasing the rate of absolute error and suppressing F-waves.

This study investigated the effects of numerical imagery alone on spinal motor nerve function and motor skills. The motor imagery of a force regulation task with pinch movements of the thumb and index finger can be divided into three types of imagery: numeric imagery, which is the image of digital numbers displayed in the pinch force value; muscle contraction imagery, which is the image of muscle contraction; and sensory imagery, which is the image of the sensation of pressing on the sensor. A questionnaire was administered as a pretest to nine healthy participants (mean age: 20.8 years) who had not previously used numeric imagery. During a resting trial, F waves were elicited from the abductor pollicis brevis muscle by stimulation of the median nerve on the non-dominant hand side. The F-wave was subsequently elicited during an imagery trial in which a numerical image was provided. The task of reaching 50% contraction strength was performed before and after the imagery task. Spinal motor nerve function did not differ between the resting and imagery tasks. Moreover, a difference in absolute error between the pinch task before and after the imagery task was absent. However, the participants with decreased motor accuracy were characterized by increased excitability of the spinal motor nerve function compared to those with improved motor accuracy.

We report a case of postoperative fracture of the right femoral tuberosity with a resultant pain in the lateral part of the right hip experienced at the start of walking. During steady-state gait, right pelvic rotation with medial rotation of the right hip occurred in the right stance phase of the patient. However, at gait initiation, medial rotation of the right hip was limited. We focused on and treated the anterior fibers of the right gluteus medius muscles, which are responsible for internal hip rotation. Post treatment, the patient reported an improvement in the pain felt at gait initiation, an improvement in the medial rotation of the right hip during the right stance phase, and an improvement in walking stability.

We report the case of a man in his 50s with decreased endurance in gait after brain tumor resection. His main complaints were that he felt pain on the right side of his waist and that he could not walk for long periods. We observed that during the left loading-response phase, he could not adduct his left hip joint, nor could he move his pelvis to the left. Therefore, during the initial swing phase, he put his right plantar foot down quickly and his trunk tilted forward. This resulted in flexion of the thoracolumbar transition during the right loading-response phase and extension of the thoracolumbar transition during the right mid-stance phase. The patient repeated this gait pattern, and after about 3,000 steps, he developed pain in the right lumbar region. We considered the main problem to be weakness of the left hip adductor muscle, and treated the patient with physical therapy. As a result, left hip adduction became possible during the left loading-response phase, and the pain in the patient’s right lumbar region improved, resulting in improved endurance of walking. In this case, physical therapy with a focus on the left adductor magnus muscle was effective at improving the pain in the patient’s right lumbar back and the functioning of the hip adductor muscles required during the left loading-response phase.

We present the case of a man in his 40s who sustained a left femoral intertrochanteric fracture following surgery. The patient’s occupation was to inspect items while moving his body to the left side in a crouching position. He exhibited decreased safety and stability posteriorly when shifting to the left during this action. Abnormalities during movement included a constant posterior pelvic tilt and difficulties with left rotation. Physical therapy evaluation revealed weakness of the left hip flexor. The patient’s lateral motions in a crouching posture improved, despite continued instability in his left posterior and backward movements. Physical therapy evaluation revealed improved strength in the left hip flexor. The hip flexors are involved in both pelvic and femoral motion. The patient was, therefore, able to maintain anterior pelvic tilt during the required movement as a result of the improved strength of his left hip flexor muscles. Able to move laterally from a stable crouching posture, he managed to resume work.

We report the case of a patient with spinal osteoarthritis, who had difficulty reaching down to perform weeding movements. The patient had a history of degenerative scoliosis and had undergone a posterior corrective fusion surgery. Therefore, it was difficult for her to recover spinal mobility. After her discharge following surgery, the patient could perform weeding (perform a downward reaching movement) while kneeling on one knee, but gradually lost this ability. To regain this movement, the patient was enrolled into a rehabilitation program where she performed weeding while kneeling on one knee with the right lower leg extended forward. Because the patient had difficulties with mobility of the spine, we focused on the range of motion of the right hip flexor and backward rotation of the right iliac bone relative to the sacrum to help evaluate the results of the therapeutic intervention.

We present the case of a patient with a frozen shoulder, which made it difficult for him to wash the back of his right hip using his right upper limb. His range of motion was restricted, with muscle weakness exacerbating his difficulties with performing a body wash. Therefore we evaluated the potential efficacy of physical therapy for the right upper limb and concluded that the compensation that occurred in the lower back of his right upper limb resulted in a lack of abduction and extension of the right shoulder joint occurring in the early stages of the required movements. Exercise therapy was accordingly administered in which the compensation was suppressed, and good results were obtained.