To analyze the relationship between the problems of impairment and disability is important for the selection of the best therapy. The approach to the problems of impairment and disability is not a special technique, and the basic technique is as follows: expansion of ROM, control of muscle strength and muscle tonus, and control of sensory and motion education. To succeed in this technique it is important that the therapeutic position, the position of the therapist's hand and the end point of each therapy, are appropriate. Recognizing the importance of these processes in providing therapy, should make us the best therapist for the patient.

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In this article, I describe therapeutic exercise for disorders of higher brain function from the following points of view: developmental process of brain, alteration of brain function after physical therapy and brain fuction related to human activity. From the above points of view, 1) reduction of the compensatory motion, 2) location of the body axis, and 3) application of the search movement for physical therapy are thought to be important. Especially, we have to pay attention to search activity by patient at the scene of physical therapy treatment.

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Generally diseases which cause disorder of coordinated movement are cerebrovascular diseases, brain tumors, multiple sclerosis, spinal cerebellar and degeneration. Especially, many patients with cerebellum disease have disorders of coordinated movement. This paper describes the function of the cerebellum and disorders of coordinated movement. For physical therapy of disorder of coordinated movement we define the part of instability and provide compensatory fixation. Then, it is important that we facilitate the stabilized movement of patients in a functional setting.

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This article describes the intervention for improvement of the limitation of range of ankle dorsal flexion. A limited range of ankle dorsal flexion is caused by shortening of antagonist musde or joint capsule, decrease of joint play and disorder of the axis of dorsal flexion. Especially, a disorder of the joint axis is the most important finding among all causes. Disorder of the joint axis has a close relation with shortening of the soft tissue around the ankle joint. Especially, there are some typical parts, in which shortening of the soft tissue is related to disorder of the ankle motion axis. These parts were identified as the D-point (Daikuya's normalizing point for ankle axis). Compression and stretching to the D-point normalized ankle axis disorder. Normalizing the ankle axis is an important strategy in physical therapy for the limitation of the range of ankle dorsal flexion, because normal soft tissue is loosened and shortened tissue is untouched in physical therapy for an abnormal ankle axis.

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This article describes physical therapy for patients with knee joint instability. Therapists have to adjust the motion axis of the joint in range of motion exercises. Also, it is important to train the "dynamic stabilizer" in muscle strengthening exercises. Therefore, therapists have to understand the knee structure and muscle function in order to improve knee joint stability.

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The trunk is composed of the pelvis, the vertebrae, the rib cage, the head and the scapula. The mechanics of the trunk are complicated. Exercises of the trunk generally include drawing the pelvis and thorax together, but the function of stability of the trunk is important during weight bearing of the lower extremity and arm elevation. This paper describes the theories about cooperative exercises in the trunk.

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We report on physical therapy and its evaluation in patients with impaired deep sensation. Evaluation in physical therapy should be performed not only in the static states but also in the situations and postures causing abnormal actions. In physical therapy, treatment with the patient being aware (use of feedback such as that by visual sensation) provides clues that improve problems. For improvement in impaired deep sensation and recovery of motor function, their association should be considered, and the induction of normal actions is important.

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In oriental medicine, meridians, which are often called channels, are the routes that carry the "qi" and blood. If the qi and blood flow through the meridians smoothly, our body is kept healthy. But, if some meridians are injured by any factor, impairment of the meridians occurs in our body and we get ill. For example, obstruction factors are the six excesses: wind, cold, heat, dampness, dryness and summer heat. These stagnate qi. When these factors attack our body, the meridians' flows are not smooth and symptoms appear. The seven emotions are obstruction factors, too. The seven emotions are happiness, anger, worry, pensiveness, sadness, fear and terror. When these emotions are sustained for a long time or occur very suddenly, some organs are injured and the meridians' flows are not smooth. When giving acupuncture treatment for impairment of a meridian, we always observe why the symptoms occurred, how the symptoms appeared in the body and which meridian is injured. Then, it is important to choose the acupoint of the injured meridian.

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The thalamus is the last relay site on the way to the cortex for almost all sensory information. In addition, it is connected with the beginning and adjustment of movement. The function of the thalamus is described in this text, and the application of physical therapy is considered.

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It is difficult to evaluate patients and body manipulation, because we need a standard to evaluate patients and body manipulation for both therapists and patients. Here, I report my ideas from my clinical experience by learning from my body.

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Triangular fibrocartilage complex (TFCC) injury is generated with high frequency in a sports activities requiring a grip. In this paper, we explain the function of TFCC, conditions of TFCC injury, features of the grip and physical therapy for stabilizing the wrist joint. TFCC has three functions. These functions are to maintain the stability of the distal radioulnar joint, to provide support at the ulnar side of the wrist joint, and the transmission of power through wrist joint. The features of TFCC injuries are swelling and pain in TFCC surroundings. Moreover, an instability of distal radioulnar joint was occured in TFCC injury. The wrist joint might become unstable because of this phenomenon. In the physical therapy for TFCC injury, the improvement of grip skill is important. It involves stretching for the palmar intercarpal ligaments, flexor retinaculum and adductor pollicis muscle and mobilization of the carpal joints as well as grip exercise.

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A declining birth rate and an aging population has become an issue in the Japanese medical industry. Because of this situation, a revision of the medical remuneration system was performed in April, 2006. It had a severe impact on rehabilitation. We tried to establish a system of treatment at patients' own expense in our hospital, an institution authorized under Article 42 of the medical law. Our new rehabilitation system was called a post-rehabilitation course (post-rehab course). We have prepared five post-rehab courses. They consist of a maintenance adjustment course, a function improvement course, a basic course, a general course and a special course. Users pay a fee to register on a post-rehab course. A user must take our counseling. If registration and counseling are complete, we perform rehabilitation. For 1.5 months until September 30, 45 and 117 persons registerd for rehabilitation and were treated. The burden of expense is big for a person on a low income. In medical facilities, it is important to create rehabilitation systems that are not influenced by a change in the insurance regime.

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Standing position postural control requires interaction with the physical environment. To understand postural control in the individual, we must understand the task of postural control and examine the effect of the environment on that task. We report the rehabilitation of a patient with cerebellum-related ataxia caused by an operation for trigeminal neuralgia. In this case, visual memory disorder was attributed to external pressure on the cerebellum and it caused difficulties for standing position postural control. In therapy, visual image and priming apply methods based on cognitive psychology were used to improve postural control. These therapies helped the patient become aware of his/her self-body interaction with the environment and solved the problem with minimum intervention by the therapist. As a result, standing LNG and other postural control is improving.

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Patients with osteoarthritis (OA) of the knee usually have a posteriorly, tilted pelvis and a bent knee with varus deformity. Such patients usually show an increase of muscle tone and pain due to pressure in the tensor fasciae latae muscle (TFL) and biceps femoris muscle (BFS) and further more, insufficient vastus medial muscle (VM). We perform therapy to stretch TFL and BFS in the supine and sitting positions and contract VM. We can't obtain enough effect of therapy because it gives rise to disorders again like the above in the closed kinetic chain (CKC) exercise while standing and walking, although these disorders improve in open kinetic chain (OKC) exercise. Thus, we perform posture control while standing or sitting to improve the pelvis tilt to add to the direct therapy of each muscle in OKC. In performing this therapy, we observed that such disorders were improved in CKC. Therefore, we experimented with electromyography (EMG) on healthy subjects to define the effects on TFL, BFS and VM of changing the angle of the pelvis tilted posteriorly together with varus deformity of the knee. TFL is involved in keeping the knee bent in middle position of pelvis, and keeping the knee bent and varus deformity of the knee in hip extension and internal rotation in posterior tilt of the pelvis. BF and BFL are involved in keeping the knee and hip bent in middle position of pelvis. When the pelvis is tilted posteriorly, BFL is involved in keeping the knee bent, BF (BFS) is involved in braking varus deformity of the knee as well as keeping the knee bent. VM is involved in keeping the knee bent in middle position of pelvis and when the pelvis is tilted posteriorly. VM is not involved in controlling varus deformity of the knee. From these result, we suggest that it's important when performing the therapy of posture control to consider the posture of the pelvis besides assessment and therapy of the knee for patients with OA of the knee showing increase of muscle tone and pain due to pressure of TFL and BFS.

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Lateral shift in sitting is indispensable in daily life, and it has a big influence on the activities of daily living (ADL) in standing-up and walking. The purpose of this study was to clarify the function of each fiber of the trapezius-muscle during lateral shift in sitting by normal subjects using surface electromyography. The integrated electromyogram (IEMG) of the trapezius muscle in the non-shift side, tended to increase. Specifically, in the lower part fiber trapezius muscle, IEMG at 20 cm distance was significantly greater than others. On the other hand, IEMG of the trapezius muscle in the shift side tended to increase with the lateral distance of movement. In the middle fiber of trapezius muscle, IEMG at 20 cm distance was significantly greater than others. It was thought that the activity of the fiber of the lower part of the trapezius muscle in the non-shift side participated in braking the upper part of the trunk inclination which accompanies the increase of the distance. It was thought that the activity of the fiber of the middle part of the trapezius muscle in shift side participated in preservation of the controlled scapula. To stabilize the upper part of trunk to improve sitting, it is necessary to aim at the function of the fiber of the lower part of the trapezius muscle in the non-shift side.

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Clinically, strengthening exercises for scapular abductor muscles such as serratus anterior is usually prescribed for patients with scapular winging. However, the effect of such exercises on shoulder function is still unclear. The purpose of this study was to examine the changes of muscle strength on the shoulder joint after exercise for scapular abductor muscles. Thirty-six healthy male subjects participated in this study. All subjects were randomly assigned to either the exercise group (EX group) or control group (CO group). Initially, the muscle strengths of scapular protraction (PR), shoulder flexion (FL), abduction (AB), external rotation (ER), and internal rotation (IR) were measured in both groups. The EX group was instructed to perform the modified "elbow push up plus". The CO group did not perform any exercise. The muscle strengths were measured again after the training period. The paired t-test was used to compare the muscle strengths between before and after the training period. The muscle strengths of scapular PR, shoulder FL, AB and IR were significantly increased in the EX group (p<0.05). On the other hand, no significant increase was found in the CO group. Since the movement of shoulder FL, AB and IR involve scapular posterior tilt, upward rotation, and protraction movement, respectively, the increase of scapular abduction strength might have caused the increase in muscle strengths of shoulder FL, AB and IR. The muscle strength of the shoulder complex may depend on the function of the scapulothoracic joint.

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In this research, the relation between the stability of the wind-up phase motion and ball control of a baseball player were examined. The subject was a pitcher of 32 years old who plays baseball several times a month. We recorded this pitcher's throwing motion with a digital video camera, and we analyzed the throwing motion using a 3D motion analysis system. In the analysis, the trunk tilt angle of the wind-up phase was calculated. Afterwards, we compared the sizes of the differences of the trunk tilt angle when ball was thrown over the same course with when the ball was thrown on other trajectories. The trunk tilt angle in the wind-up phase motion when the ball was thrown over the same course was reproduced well at each throw. It was thought acquisition of wind-up motion reproducibility was necessary for having good ball control.

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According to acupuncture therapy for dystonia patients practised at the Outpatient Clinic, Kansai College of Oriental Medicine, there is a report that remote acupuncture therapy by the meridian concept is effective. It was reported that dystonia is sensory defect rather than dyskinesia, and we report acupuncture therapy of soft stimulus to normalize the upper central nervous system for stimulated sensory nerve. Based on the meridian theory, we investigated the influence of acupuncture stimulus to the sternocleidomastoid muscle (L14) through which the large intestine meridian (L1) passes on the hand, on the central nervous system and muscles by comparison of surface EMGS among 3 groups: no stimulus, 5 min stimulus, 20 min stimulus. After 20 min stimulus, both PMT and MT were significantly shortened compared with before stimulus. However, in the no stimulus and 5 min stimulus groups there were no differences in PMT and MT compared with before stimulus. This suggests that to excite the central nervous system and muscle function via the sternocleidomastoid muscle, 20 min acupucture is needed.

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This study analyzed by electromyography, the effect of acupuncture therapy and exercise therapy for increasing the activity of the supraspinafus. The effect of acupuncture therapy and exercise therapy was analyzed in three sessions of acupuncture therapy, (performed on the SI3 (Koukei, Houxi)) supraspinatus exercise, and supraspinatus exercise during acupuncture therapy (performed on the SI3 (Koukei, Houxi)). The elctromyogram measurement muscles were supraspinatus, upper trapezius, middle trapezius and middle deltoideus. As a result, it was considered that a possibility of the acupuncture therapy (performed on the SI3 (Koukei, Houxi)) increased the activity of the supraspinatus. The activity of the middle deltoideus in supraspinatus exercise with the shoulder joint held in abduction 15° of decreased. The activities of the upper and middle trapezius in supraspinatus exercise during acupuncture therapy (performed on the SI3 (Koukei, Houxi)) in shoulder joint held in abduction 15° of decreased. Therefore, it was considered that supraspinatus exercise was an effective method for increasing the activity of the supraspinatus for hyper-activity of the middle deltoideus in early abduction of the shoulder joint. Also, supraspinatus exercise during acupuncture therapy was considered a useful method for increasing the activity of the supraspinafus for hyper-activity of the upper trapezius in early abduction of the shoulder joint.

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This report describes the effect of supraspinatus exercise during remote acupuncture therapy for a patient with periarthritis scapulohumeralis. It was considered that the cause of limitation of flexion in the shoulder joint was an abnormal flexion motion pattern due to lower activity of the supraspinatus muscle. The pattern of shoulder flexion was elevation and early upward rotation of the scapula caused by hyperactivity of the upper trapezius. Therefore, in order to increase the activity of the supraspinatus, remote acupuncture therapy was performed on the SI3 (Koukei) and to reduce the activity was performed on the TE5 (Gaikan). Exercise of the supraspinatus muscle was performed during remote acupuncture therapy. As a result of exercise during remote acupuncture therapy, the abnormal shoulder flexion pattern was improved and pain in the anterior part of the shoulder joint was reduced.

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We had a patient with a tear of rectus femoris during running. As a characteristic finding, a big hematoma was identified by ultrasonography. The patient wanted to return to sports activities as soon as possible, because she was a competitor in an important game in a pennant race. So, we selected acupuncture therapy for improvement of hematoma. Especially, we chose electro-acupuncture, which is thought to be effective for early healing. As a result of electro-acupuncture therapy for three weeks, the hematoma was decreased however muscle activity had declined as measured by surface electromyography. Therefore we gave intermittent continuous wave pulse stimulation of 30 Hz to the rectus femoris. After the stimulation, muscle contraction was improved. The patient had no physical findings and returned to sports activities.

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We gave physical therapy to a patient with total right knee arthroplasty. After a knee operation, in general, the muscular strength of the quadriceps femoris decreases rapidly, and it is difficult to recover well. In this case, we performed physical therapy for imperfect contraction of the quadriceps femoris in extension of the knee joint. For evaluation of the physical therapy effect, we measured the center of gravity in the standing posture before and after physical therapy and examined its characteristics. As a result of physical therapy, the contraction of the quadriceps femoris muscle in knee extension was improved, and the standing posture with knee extension became stable. Through this case, the following was clear, it is important to consider the alignment before the knee operation and we were able to measure the effect of physical therapy by using a gravicorder.

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In this article, we describe physical therapy for a case of decline in muscular strength caused by axillary nervous paralysis with a dislocation of the shoulder joint. This case was characterized by difficulty in flexional movement in the scapulothoracic joint in primary flexion of the shoulder joint because of the adduction and lift of the scapula. We defined the alignment on the several phases that the specific movement of scapula appears. We practiced scapula alignment and performed electromyographic assessment. In this case, in addition to a decline of muscular activity in the deltoid muscle, the upper, middle and lower fibers of the trapezius muscle started to move before the anterior fibers of the deltoid muscle. So, we supposed that this phenomenon caused the disorder, the specific movement of the scapula. We observed the start of activity of the deltoid and trapezius muscles and administered a pendular movement as a therapeutic exercise. Improvement in both excursion of flexion and in patterns of muscular activity in the deltoid and trapezius muscles were confirmed. Furthermore, with repetition of kinesiatrics in the sitting position on the edge of a bed following results was acquired; an increase in muscular activation in the anterior fibers of the deltoid muscle and a muscle activation with same order. This lead to improvement of stability of the scapula because of a decrease in adduction and lift of the scapula in the start position. From the above, we suggest that choice of the method of kinesic therapy, paying attention to the posture of patients and paying attention to the stability of scapulothoracic joint is important.

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We report a case in which significant edema was found in the paralyzed foot, which showed ankle plantar flexion, varus position and toe flexion in walking, disturbing the walking movement because of insufficient load to the forepart of the foot. In this case, the patient's foot grounded first with its post-outside when standing on the paralyzed foot due to abnormal alignment on the paralyzed side. Therefore the knee joint couldn't move forward, causing knee joint flexion and trunk anteversion and compensatory tone elevation of both back muscles. We performed therapy to correct the abnormal alignment of the paralyzed foot, which remedied the compensatory tone elevation of both back muscles due to loading of the paralyzed foot sufficiently. We conclude that it is necessary to ensure the foot is fully loaded when perfoming physical therapy for patients who have trouble with the trunk due to the foot during walking.

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In this study, we report on the physical therapy given to a patient with hemiplegia on the left side caused by a cerebrovascular event, whose posture and behavior were badly affected by her longtime use of an ankle foot orthosis (AFO). Attaching the AFO caused in the patient's pain paralyzed foot and lowered durability of gait, resulting in reduced ADL. We examined the connection between gait and AFO again, and for the purpose of defining the mutual problems, we compared and examined it in physical therapy evaluation of walking both barefoot and with AFO. In barefoot walking, the subject's thoracic and lumbar spine showed a tendency to fall down flexing and rotating in the early stance phase of the paralyzed side on account of the lowered muscle tone of her abdominal muscles. As a result of chain reaction of movement, the subject showed an unusual posture in which her pelvis rotated anti-clockwise, her hip joint bent and knee joint extended excessively and she had difficulty in loading the left leg. In additon, we speculated that by attaching AFO, the range of motion was limited, resulting in the restriction of movement in the patient's knee joint which caused her thoracic and lumbar spine to fall down. For physical therapy, for the purpose of heightening the patient's muscle tone of her abdominal muscle, we got her to balance herself in the standing and sitting positions and to practice walking. As a result, the alignment of her thoracic and lumbar spine was improved, the unusual alignment of her pelvis and left leg were reduced and an increase in the load on the left leg was recognized. After treatment, however, in walking with AFO the problem of the patient's thoracic and lumbar spine falling down recurred. Therefore, if she made continuous use of the same AFO, she would have collateral difficulty because of being forced to assume the unusual posture. We suggest that equipment should not be used without an objective. Regarding prescription of equipment to a subject with hemiplegia on the left side caused by a cerebrovascular event, we thought it was important to recognize the behavior of the subject with AFO and to examine its necessity, period of use and timetable for removal.

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