Understanding the spinal neural function is important in physical therapy for patients with neurological disease, especially the control of spasticity. We introduce our research and that of others about the spinal neural function for motor control using evoked EMG. The excitability of the spinal neural function, especially that of the spinal reflex is influenced by central and peripheral nerve function due to muscle contraction and muscle stretching at different parts. In this report, we introduce researches into the spinal reflex rearding: 1) Presynaptic inhibition in healthy and neurological diseases; 2) Excitability of the spinal neural function of an affected arm with muscle contraction of the leg in patients with cerebrovascular diseases (CVD); 3) Excitability of the spinal neural function of an affected arm at the distal part with muscle stretching of the affected arm at proximal parts in patients with CVD; and 4) Excitability of the spinal neural function of an affected arm with direct muscle stretching in patients with CVD. From these reports, it is suggested that the excitability of the spinal neural function is changed by several factors: muscle contraction, muscle stretching and others of the affected muscle and different parts.
In this chapter, we describe the kind of senses and the central nervous system from the viewpoint of sensory inputs. There is a close relation between the sense and movement, and the memory of movement is very important in activating movement. We should use sensory evaluation as accurate proof of the problems that we expect from postural-movement analysis. We memorize the sense of movement appropriately on moving, and we can create new movement smoothly on the basis of this information. If a patient can cause each movement consciously, it means that he can memorize the sense of movement and that we can treat him appropriately.
There are a lot of motor related areas in cerebral cortex. This paper describes the premotor area (PM) and supplementary motor area (SMA). These areas belong in area 6 of Brodmann's areas and they are very important for preparation and planning of movement, although each of them has an independent function. We hope this article will help you to understand those functions and your clinical treatment.
This article describes mechanical stress and functional kinetics in the upper limbs as biomechanics related to bone and joint disorders in the upper extremity. Mechanical stresses to the human body are classified as traction, compression and shearing. The therapist has to identify the location, timing and reason for mechanical stress. For the functional kinetics of the upper limbs, a typical kinetic chain, the setting phase in shoulder flexion, anterior displacement of the humeral head, winging scapula, elbow valgus, motion axis of forearm, and grasping, are presented. For management of musculoskeletal disorders, it is important to understand the mechanical stress on the human body and the functional kinetics of body being subjected to mechanical stress.
It is important to understand the functional anatomy for motion analysis in the field of sport biomechanics and/or physical therapy. This article describes the functional anatomy of the muscles and joint movements in the lower extremity. The contents of this article are as follows: flexor hallucis, digitorum longus and ankle dorsiflexion; gastrocnemius medial head and tibial rotation; and hip external-rotators and hip flexion. As mentioned above, consideration of the relationship between the functional anatomy and impairments is important for physical therapy evaluation in the lower extremity.
It is difficult to understand the biomechanics of the control and stability of the spine and pelvis. The factors for this are that the orientation of the muscle fibers in the abdominal muscles are diverse and the abdominal muscles are composed of layers. Therapeutic approaches for impairment of the abdomen need the theory of the biomechanics of the spine and pelvis. This paper proposes several theories of the biomechanics of the spine and pelvis. These theories are called: soil function, double ladder structure, air bag function and sacroiliac joint stability. These functions are expained in this paper.
This report introduces how to choose acupoints in acupuncture and moxibustion therapy, from the basic theory of oriental medicine and from research reports on acupuncture and moxibustion that provide evidence for the choice of acupoints. In the future, researching the effects of acupuncture and moxibustion therapy using acupoints chosen using the basic theory of oriental medicine and connecting it with the diagnosis outline of western medicine, will give more effective acupuncture and moxibustion treatments for many patients.
The basal ganglia is a group of neural cells in the subcortical structure region. It is important in the control of the movement and motor learning. The function of the basal ganglia is described in this text based on a reference documents.
The therapist's attitude and touch are important in the field of physical therapy. To master the handling skills, we must study and understand rational attitude and touch. If therapists do not have rational attitude and touch, they can not control movement for patients. The important points in handling of patients are follows: 1) Therapists must study and understand rational attitude and touch. 2) Therapists need to gain information by touching the patient's body. 3) To feel the joint in a patient's body, therapists must feel the joint themselves.
The purpose of this study was to investigate the trunk muscles causing associated reactions in a hemiplegia patient with cerebrovascular disoders. Clinical evaluation and surface electromyographic based motion analysis were performed to confirm impairment problems in the patient. He showed associated reaction of left elbow flexion and left forearm supination caused by left anterior tilt to right posterior tilt of the trunk in the stance phase shift to the swing phase in gait. Surface electromyographic evaluation was performed while practing a similar gait task. The results indicated that high muscle activity of the affected side biceps brachii muscle was caused by high muscle activity of the unaffected side low back muscles. These finding suggest that not causing hypertonia of unaffected side low back muscles in normal movement of gait is very important.
Lateral shift using one hand while sitting on a seat is an important ability in sitting up, for locomotion, to reach the other side. We sometimes control muscle tone of the trunk to change lateral weight bearing on one hand in hemiplegia caused by cerebrovascular diseases in which movements are difficult to perform because of trunk collapse. In this study, we analyzed the activity of the trunk muscles (obliquus abdominis, obliquus externus abdominis, obliquus internus abdominis and lumbar back) with EMG in changing the weight bearing in lateral shift with one hand while sitting on a seat. The results show that the supporting hand is necessary in sitting on the seat. The supported obliquus abdominis muscles, obliquus externus abdominis muscles and lumbar back muscles acted to maintain and fix the trunk as the weight increased. The supported obliquus external abdominis muscles acted to stabilize the upper trunk and rib cage, and the unsupported obliquus abdominis muscles, obliquus internus abdominis muscles and lumbar back muscles elevated pelvis as the weight decreased. Therefore, it is suggested that in the change of weight bearing in lateral shift the supporting hand serves an important purpose in maintaining trunk stability.
The purpose of this study was to investigate electromyographic reaction time (EMG-RT) in auditory stimulus of movements of the non-dominant hand. The comparative items were unilateral auditory stimulus and bilateral auditory stimulus, and alteration of stimulus number. We experimented with 11 right-handed healthy subjects. The subjects extended quickly the left index finger on the non-dominant hand, in response to an auditory stimulus signal. The conditions of auditory stimulus were: stimulus frequency of 0.5 Hz, stimulus intensity of 90 dB, auditory frequency of 1 KHz and nine stimuli per trial. We experimented using an eye mask, in order to remove visual effects. There was no significant difference in the EMG-RT between unilateral auditory stimulus and bilateral auditory stimulus. In the alteration of stimulus number, the EMG-RT from second to ninth auditory stimulus were shorter than the first stimulus; and the EMG-RT from third to ninth auditory stimulus were shorter than the second stimulus. From these results, it was suggested that there was no significant difference between unilateral auditory stimulus and bilateral auditory stimulus, because the experimental task was too easy. With regard to alteration of stimulus number, in the generation of movement up to the second auditory stimulus, stimulus information was propagated to the cerebral cortex through the cerebellum, which converted it to movement. In the generation of movement from the third auditory stimulus onwards, the motivation to movement increased the activity of the circuits linking the basal ganglia to the cortex, suggesting that efficient processing by motor learning took place.
The foot region plays an important role in postural control. It is often observed that improvement of foot and foot joint functions leads to improvement of movements of the lower limbs, pelvis, trunk, and eventually the entire body. We generally use the position of plantar pressure as a parameter for the evaluation of the foot region and foot joints, because the center of plantar pressure (COP) provides important information. In patients with dysfunction in the foot region, COP is often deviated to the big or little toe side during movements, or induction of COP from the little toe side to the big toe side is often difficult. In therapeutic exercise for control of COP in such patients, closed kinetic chain exercise is considered effective. In such exercises, monitoring of the necessary activities of the peripedal muscles caused by changes in COP is important. In this study, we examined the electromyographic integral of the peripedal muscles caused by changes in COP using a ground reaction force plate and electromyography. In the measurement, a surface electromyograph, Mlyosystem 1200 (NORAXON Co.), was used for recording electromyography. For electromyography analysis, MyoResearch (NORAXON Co.) software was used for calculation of the integrated values of the electromyography. A force plate (Anima Co.) was synchronized with the surface electromyograph. Weight loading on the forefoot and hind foot induced characteristic muscular activity patterns of muscles around the foot. For changing COP, muscular activity of muscles around the foot is necessary, and it is important to know that the muscular activity pattern varies depending on the position of COP.
We report the case of a cerebral vascular accident patient whose gait was affected by dysfunction of the trunk accompanying a poor mobility of the upper trunk. This patient was a 65-year-old male. He had suffered cerebral infarction in 1972, and was afflicted with paralysis of the left side. He said that his left leg stumbled in walking, and he wanted to walk without stumbling. His posture was retraction of scapula girdle, thorax flat, refloat of the inferior edge of ribs, and thoracic kyphosis, and motions of thorax and thoracic spine were not seen. We thought that the motion of his chief complaint was prevented by dysfunction of abdominal muscles due to poor mobility of the thorax and thoracic spine. We carried out evaluation of surface electromyography to certify trunk muscle activation of the left swing phase in the patient's gait. He carried out step motion of the left leg with a similar motion to the left swing phase. Although a healthy person shows an increase of muscle activation of the abdominal muscles and decrease of muscle activation of the low back muscles, our case had an inadequate muscle activity pattern compared with the healthy person. We perform therapy to increase mobility of the upper trunk to facilitate normalization of abdominal muscles activity. As a result, the mobility of his upper trunk increased, and his motion improved in gait. A similar muscle activity compared to healthy subjects was also shown with surface electromyography. It is suggested that in order to increase the mobility of the upper trunk, it is important to improve the function of trunk muscles, and the mobility of the upper trunk by maintaining normal muscle tone of the abdominal muscles.
In this study, we reported the physical therapy in a subject who had difficulty with walking after viral encephalitis. In this case, we found that muscle tone in the right lower back was increased compensating for lowered muscle tone of the left obliquus internus abdominis and right gluteus medius. In gait, the subject showed a tendency to fall forward to the left in the early left stance phase and to fall backwards to the right in the early right stance phase resulting in an unsafe, unstable and unsustainable gait. In physical therapy, treatment for the lowered muscle tone was verified using electromyography, and the tendency to fall in gait was improved. The results suggest that normal muscle tone in the back, obliquus internus abdominis and gluteus medius is related to the stability of the pelvic girdle and hip joint.
We report the rehabilitation of a patient with chronic left side paralysis caused by SAH. When walking, from the time the heel of the patient's paralyzed side contacted the ground to the time of mid stance, the patient's pelvis tilted anteriorly, rotated to the left, and lumbar vertebrae bent backwards and the paralyzed side of the shoulder girdle eleveated, extended, and paralyzed and collapsed forward. We examined the relationship between the paralyzed lower trunk and the paralyzed shoulder girdle. We performed three different patterns of physical therapy a total of twelve times over three months. Pattern A: physical therapy for the paralyzed lower trunk; Pattern B: physical therapy for the paralyzed shoulder girdle; Pattern C: both. After physical therapy of patterns A and B we observed no noticeable effect, but after the treatment of pattern C the patient's sitting, walking and weight shift to the paralyzed side when standing improved. In this case, it was not enough to treat only one side to improve the unusual muscle tone of the paralyzed lower trunk and the shoulder girdle, so we also considered the relationship between the primary problem of unusual muscle tone of the paralyzed lower trunk, and then considered the problem of unusual muscle tone of the paralyzed lower trunk, including the shoulder girdle, and treated both at the same time. Through this experience, we again confirmed the importance of understanding each part of a patient's problems and the relationship between them.
We gave treatment involving an arch-support to a patient with osteoarthritis of the knee. The arch-support used in this treatment was the functional orthotics insole (FOI) designed by Kawano. The purpose of FOI was to prevent pelmatic arch dysfunction and to improve the pelmatic arch function. By the use of the arch-support, which was designed based on motion analyses, the abnormal motion of this case was improved but a problem with moton also remained. Physical therapy for the remaining problem of the motion after FOI use improved the motion. From this case, it seems it is important to perform appropriate physical therapy for a dysfunction which was not improved by treatment with orthotic equipment.
We performed physical therapy after fixation of the anterior cruciate ligament (ACL) using fibrin adhesive (Tisseel). It was considered that the tension strength of the reconstructed ligament using Tisseel was weak in the restoration process. Therefore, we thought that prevention of repeat injury to the reconstructed ligament was important. However, the protocol for physical therapy after ligament reconstruction using Tisseel has not been established. Therefore, the mechanical stress on the ligament was forecast from a dynamic alignment in the squatting position. In physical therapy, we gave particular priority to muscle strengthening exercises to stabilize the unstable joint. As a result, the functional disorder safely improved without further injury to the unstable joint, and the subject successfully returned to sports activities.