Management related to personal occupational skills are described in this article. For the improvement of individual skills, individual behavior pattern and the method of raising skills are important. Individual behavior pattern is influenced by both a desire with in the individual person and purpose as a professional. A human has desires from needs of the body to self-efficacy. When desire reaches self-efficacy, an individual keeps improving his career. The purpose of an individual professional is regulated by the philosophy of the profession's organization and/or company. One method of skill improvement is represented by a functioning memory and/or a sense or an intuition.

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Clinical research is important to establish a scientific basis for physical therapy and other rehabilitation therapies. To increase the level of clinical research three things are needed: 1) motivation for research; 2) good research conditions; and 3) definition of the aims of research. I hope that many therapists start clinical research for patients.

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With regard to rehabilitation techniques, the therapeutic effect depends on the ability of the therapist. Especially, in the area of central nervous diseases, it is felt that differences in therapists skills are greatly reflected in therapeutic outcomes. An appropriate environment setting is necessary to cure central nervous diseases. The environment setting has many items, but the following are especially important: 1) integration of the cure policy; 2) appropriate imitation technology; 3) reduction of surplus compensation; 4) construction of the central axis; and 5) offer of the appropriate search activity.

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This paper describes skill improvement in the treatment of cerebrovascular diseases. In the physical therapy for cerebrovascular diseases, I describe the necessary abilities to achieve skill improvements efficiently. The abilities are: 1) observation of posture and movement, 2) examination and measurement, and 3) problem solving. Then, I give hints on how to improve the abilities.

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It is important to understand the mechanism of the healthy person in order to develop therapeutic exercises for orthopedic diseases. If we can understand the mechanism of the healthy person, we can devise mechanisms of compensation movements and abnormal movements for the patients. Consequently, the method of the evaluation and the therapeutic technique will considerably develop. Here, I explain in detail, the motor function of the hamstrings that are evaluated and therapeutic techniques in "knee-in" and "knee-out".

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In this paper, we describe the management of musculoskeletal disorders following acute trauma, as seen in ankle joint sprain, and during chronic trauma, as seen in knee joint osteoarthritis. Treatment management of acute trauma is especially important in ankle joint sprain, where the length of the physical therapy period affects the time until full patient recovery and return to normal activities. For knee joint osteoarthristis, the three essential goals of treatment management are improvement of symptoms, prevention of recurrence and protection of the affected body area. In both acute and chronic treatment, the physical therapist should evaluate symptoms and organize therapy by adjusting those tasks to be carried out by the therapist and those by the patient.

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I think that interview skills and palpation are important for management of the acupuncturist. The interview from the viewpoint of Oriental medicine, Qi and Blood, is very important for the acupuncturist. Progress in the skill of palpation is utilized not only for evaluation of acupuncture but also for acupuncture treatment and its effects.

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When we do physical therapy, motion analysis is an important tool. We think that considering "the meaning of the joint movement under motion" in the motion analysis is necessary. We performed physical therapy for underhand pitchers. In this paper, we introduce the physiotherapy evaluation that we did for the underhand pitchers. It was especially important to consider "the meaning of the joint movement under motion" in the evaluations. Moreover, when thinking about "the meaning of the joint movement under motion", it was necessary to understand the purpose of the underhand pitch. We also report the purpose and the history of the underhand pitch, because it was necessary to investigate them to understand underhand pitchers' needs.

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Our bones and joints are a functional structure. Especially, the ossa cranji and neck alignment are important, because their alignment change influences the whole body alignment.

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The treatment of patients with cerebrovascular disease/hemiplegia is described briefly, including clinical scenes, particularly concerning reaching movement. · Problems with the upper extremity markedly affect the posture and movements. · Since reaching movement is a motivated action with a specific intention, it is important to guide the patients toward having such an intention. · When posture control of the pelvis and trunk is adequate, the stability of the periscapular region is maintained, and smooth reaching action becomes possible. · In the treatment, the action must be re-learned by comparing the actions with input from other senses such as vision and hearing, as well as past experiences and memories, and through feeding them back. · Finger sensibility is important for manipulation, dexterity movements, and holding.

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It is difficult for cerebrovascular disease patients to maintain the standing position while holding the shoulder in the flexed position and flexing the shoulder. It is thought that center-of-gravity line deviates from the base of support because holding the shoulder in the flexed position or flexing the shoulder influence the body alignment and generate addtional forces. The center of plantar pressure moves toward the center of gravity line to avoid leaving the base of support. Therefore, clarifying the movement pattern of the center of plantar pressure while holding the shoulder in the flexed position and flexing the shoulder is important when we perform a physical therapy evaluation for patients with instability in standing. In this study, trace of the center of plantar pressure movement during holding the shoulder in the flexed position and flexing the shoulder in standing was investigated to evaluate postural control in healthy subjects. We analyzed the trace of the center of plantar pressure in standing as follows: 1) The center of plantar pressure average displacement with change of the shoulder flexion angle (0°, 30°, 60°, 90°, 120°, 150° and 180°); 2) The trace pattern of the center of plantar pressure in flexing the shoulder. We found trace patterns of center of plantar pressure which are common to subjects holding the shoulder flexed at 30°, 60° and 90°. Also, in the pattern classification of trace patterns of the center of plantar pressure during flexing the shoulder, we identified 5 patterns as follows: front S pattern, front reverse S pattern, rear S pattern, front C pattern and front reverse C pattern. We think that a force was generated by holding the shoulder in the flexed position and that flexing the shoulder was related to some of the patterns produced. It is important that the trace pattern of center of plantar pressure is ealuated while holding the shoulder in the flexed position and flexing the shoulder.

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It is quite common for patients with hemiplegia caused by cerebrovascular diseases, diseases of the spine or the lower extremities to have an unstable pelvis when walking or using stairs. We frequently assess such patients and initiate exercise therapy for the gluteus maximus focused on lateral shifts of weight while standing before undertaking walking exercise. The muscle fibers of the gluteus maximus have been reported to have various actions: the upper and lower gluteus maximus both abduct the hip joint. Therefore, we used electromyography to investigate the action of the upper and lower gluteus maximus during lateral shifts of weight while standing for 7 healthy male subjects (14 lower extremities). We measured integrated electromyograms (IEMGs) of the upper and lower gluteus maximus of the shifted side as subjects shifted to a horizontal laterally changed quantity of shift 60%, 70%, 80%, 90% and 95% of the weight without tilting or rotating the trunk and pelvis while standing. IEMGs of the lower gluteus maximus of the shifted side tended to decrease as the lateral shift decreased, and it was significantly higher in the 60% shift than in the 95% shift. The lower gluteus maximus of the shifted side was considered to have been activated to provide anteroposterior stability for the pelvis for action in extending the hip joint in the 95% shift. IEMGs of the upper gluteus maximus of the shifted side was significantly increased as the lateral shift increased. The upper gluteus maximus was found to be activated to provide lateral stability for the pelvis to allow for the abduction of the hip joint in more than 80% shift. Moreover, the upper gluteus maximus was also found to have been activated to provide anteroposterior stability for the pelvis for action extending the hip joint in the 95% shift. We suggest that because of the various actions, as described above, that it is necessary to estimate the separate actions of the upper and lower gluteus maximus for exercises involving lateral weight shifts while standing.

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Foot function deteriorates after varus sprain of the ankle joint, and impairs smooth body movement in some cases. Dysfunction of the peroneal muscles, such as muscle weakness and delayed reaction time, occurs after varus sprain, and great importance has been attached to strengthening of the peroneal muscles in exercise therapy. Our exercise therapy targets stable posture control in weight-bearing on the little toe side, and we consider that not only the peroneal muscles but also varus muscles of the foot are important with regard to muscle activity in this position. In this study, we investigated muscle activity of the varus muscles of the foot and plantar pressure distribution on the supporting side in inward step positions as an exercise menu. Compared to the baseline position regarded as 0 cm, muscle activity increased at an inward step distance of 10 and 20 cm, and significantly increased at 30 and 40 cm (p<0.01). It is suggested that the inward steps induced weight-bearing on the little toe side, and forced tilting of the lower leg outward, during which the varus muscles may have acted to brake the outward tilting of the lower leg. This suggests that the varus muscles of the foot are important for posture control in weight-bearing on the little toe side.

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We experienced cases that can elevate the humerus but can't maintain the position in shoulder flexion. It is generally thought that the inner muscles stabilize the humeral head in the glenoid, and the deltoid, which is one of the outer muscles, elevates the humerus during shoulder flexion. Kido et al. recently reported that all portions including the anterior, middle and posterior deltoid muscles have functions in stabilizing the shoulder. In this study, in order to evaluate the activity of the deltoid muscle, not only the anterior portion but the middle and posterior portions were analyzed at several positions of flexion by surface electromyography (EMG). Our results show that the deltoid muscle activity of the anterior portion increased with flexion, and especially the activity at over 90°C flexion was significantly increased over that at 30°C flexion. The activity of the middle and posterior portions over 120°C flexion were significantly increased over those at 30°C and 60°C flexion. In addition, at 150°C flexion, the activities of the middle and posterior deltoid muscles were significantly increased over that at 90°C flexion. This study demonstrates that the anterior portion of the deltoid muscle, mainly has the function of active flexion, and the middle and posterior portions as well as the inner muscles have functions which stabilize the glenohumeral joint during shoulder flexion.

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The muscle activity of the internal oblique muscle (IO) increases with an increase in load bearing on the standing side leg. However, we often observe a contraction of the IO in a forward step and a back step in cerebrovascular disease patients. If the muscle activity of the swing side IO increases in a forward step and a back step, the dynamic stability of pelvis in the swing phase in walking would improve in cerebrovascular disease patients. Accordingly, the purpose of this research was to elucidate of the muscle activity of the swing side IO in the first stage of a rear step. The subjects of the research were 10 healthy persons in this study. For the measurement method, we measured the surface electromyography of the trunk muscles and recorded the motion with cameras two video during one step forward and one step backward with the right leg by the subjects. In the first stage of the rear step, the group muscle activity of the swing side IO was not seen and the movement was carried out with a hip joint strategy. On the right side, the group muscle activity of the swing side IO was seen and the movement was carried out with an upright body. As mention above, we think that a step taking heed of the motor strategy is valuable for the rehabilitation of cerebrovascular disease patients.

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We gave acupuncture treatment to a patient with cervical dystonia caused by typical neck movement and a psychological problem. We investigated the effect of acupuncture treatment on the psychological problem using the Tsui modified score and five psychological tests at the first session of acupuncture treatment and after six months acupuncture treatment. The problems revealed by the psychological tests in the first session of acupuncture treatment were as follows: 1) the patient had difficulty to recognize her psychological problem, and 2) she had few psychological complaints but many physical complaints such as abnormal neck posture. We think that she represented the psychological complaint as physical complaints. The acupuncture treatment improved the physical factors, such as the neck posture, and the psychological factors, such as as reduction of excessive effort and substantial judgement. The results suggest that our acupuncture treatment improved not only the physical problem of cervical dystonia, but also the psychological problem caused by cervical dystonia.

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We report the effect of acupuncture based on the meridian concept by the writing evaluation test and writing pressure in a patient with writer's cramp. The case was a 32-year-old male, who was right-handed. The patient reported feeling a sense of incongruity while playing slot machine, and also in handwriting in X+6 years. When the department of nerve internal medicine at a local hospital was consulted, the problem was diagnosed as dystonic writer's cramp. We started acupuncture treatment in our clinic from X year. Acupuncture was performed once a week. Multiple epidermis penetrating needles were used to treat skin and muscle shortening on the palm and forearm. Retaining needles were used for scalp acupuncture in the upper limb zone, LI4 and ST11. Consequently, although some involuntary movement persisted 10 weeks after the start of treatment, control of handwriting became possible. Moreover, agitation during the application of writing pressure before acupuncture therapy was improved after acupuncture therapy. The results suggest that acupuncture therapy with the retaining needles and multiple epidermis penetrating needles is beneficial for dystonic writer's cramp.

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For mobility training of the shoulder joint in cases presenting restricted movement, it is important to understand the pattern of movement and the angles of all the joints forming the shoulder complex, including changes in the sternoclavicular, acromioclavicular, scapulohumeral, and scapulothoracic joints. In this research, differences in the starting and finishing distance of muscles surrounding the shoulder girdle during shoulder joint flexion and abduction were surveyed using a skeletal model. X-ray images were obtained at intervals of 30° between 0° and 180° during shoulder joint flexion and abduction of the right upper arms of seven healthy male subjects. At each angle, the shoulder blade rotation angle, the degree of slant of the collar bone, and the location of the scapular spine medial extremity were measured. These results were recreated on a skeletal model, and the distances between the muscles surrounding the shoulder joint (trapezius muscle superior fiber, mid fiber and inferior fiber, levator scapulae, serratus anterior upper fiber, serratus anterior lower fiber, and rhomboid minor and major muscles) before and after the joint flexion and abduction were measured. The characteristics of two-dimensional analysis of flexion (bone index coordinates movement analysis) comprise the separation of the scapular spine medial extremity from the spine and the movement in a caudal direction. The characteristics of two-dimensional analysis of abduction comprise approach of the scapular spine medial extremity to the spine and movement in a caudal direction. The trapezius muscle superior fiber located on the inner side of the shoulder blade, levator scapulae, trapezius muscle inferior fiber, and rhomboid minor and major muscles exhibited a complex pattern of extension and contraction corresponding to changes in the angle, unlike in flexion. We consider that, in a clinical situation, during shoulder joint movement range training, the muscle group on the medial edge of the scapula can easily become a limiting factor in joint movement range control. Moreover, in subduction, where the muscle group cannot automatically respond to changes in the angle by extension and contraction, treatment is needed on the assumption that it is a ROM control factor.

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We provided physical therapy for a patient with anterior cruciate ligament (ACL) injury, who had difficulty descending stairs due to patellofemoral pain. This case had the following clinical findings: instability of the knee, disorder of the ankle motion axis, external rotation of the knee, and patellofemoral pain. This patient had gait ability but could not descend stairs. The problem was re-assessed using surface electromyograms. It was thought that external rotation of the knee with knee flexion when descending stairs was causing the patellofemoral pain. Physical therapy to control external rotation of the knee resulted in the pain in the patellofemoral joint being reduced. The movement of the knee improved during descending stairs as captured by digital video camera, and quadriceps muscles activity continued on the surface electromyogram, after the single physical therapy session. As a result, descending stairs became possible for this patient.

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We report a case of right hemiparesis after cerebral infarction, who was not able to walk without both lateral bending of trunk and elevation of pelvis on the unaffected side. In the evaluation, hypotonia of the paralyzed side obliquus abdominis muscles and gluteus muscles was confirmed, clearly indicating hypertonia of the paralyzed lumbar muscles. We approached the paralyzed side obliquus abdominis muscles group and gluteus muscles group, with the objective of suppressing paralysis of the lumbar muscles. After 2 weeks of physical therapy, the elevation of the pelvis on the unaffected side was decreased and the side movement of pelvis increased. We suggest physical therapy of CVA patients who have compensatory hypertonia should approach hypotonia of muscles, with the object of suppressing hypertonia.

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In this study, we conducted physical therapy for a patient with sitting position-related abnormalities of the right anterolateral femur, such as pain and numbness. In this patient, sitting postures consisted of posterior pelvic tilting, right rotation, right elevation of the pelvis, lumbar vertebral bending, and right lateral bending; left ischial weight-bearing was predominant. In the sitting position, abnormalities of the right anterolateral femur appeared. These symptoms were localized to the lateral femoral cutaneous nerve region. Therefore, assuming impairment of the lateral femoral cutaneous nerves, we evaluated the greater psoas muscle, which has been reported as an etiological factor of these disorders. We performed two therapies (Therapies A and B), in consideration of the association between sitting posture and the greater psoas muscle. In Therapy A, improvement of the sitting posture was promoted via regulation of trunk muscle activities. This therapy improved the sitting posture, and reduced tension of the trunk muscle. However, there were no changes in abnormalities of the right anterolateral femur. In Therapy B, the sitting posture was adjusted after greater psoas muscle stretching. This therapy relieved the abnormalities. In this patient, it was important to administer 2 therapies: treatment of the greater psoas muscle and postural correction via adjustment of the abdominal muscles

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We conducted physical therapy for a patient with mild bilateral hemiplegia who had instability to the rear because of hyper tonus of the lower back muscles in standing up and putting on and taking off the pants. We conducted therapeutic exercises of setting of posture in sitting and standing up exercises. The patient improved instability to the rear in lifting the buttocks off a seat while standing up immediately after the therapeutic exercises. However, the effect of the therapeutic exercises wasn't maintained on the following day. Therefore, we provided guidance on standing up in the ward in addition to the therapeutic exercises after the assessment of standing up. The effect of the therapeutic exercises was maintained and the patient's progress in a daily living activities was good.

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We experienced a case diagnozed as lumbar spinal canal stenosis who had difficulty with walking because of pains in the left low back. A characteristic of this case was dysfunction of left abdominal internal oblique muscle causing a lack of the stability in the pelvis and trunk in the phase of left heel strike shift to mid-stance. In compensation, high muscle activity was caused in the lumbar back muscles in the stance phase. The pain occurred because the blood flow volume of the muscles decreased due to the continuous high muscle activity of the left lumbar back muscles. We performed body weight shift training and stepping training to improve activity of the left abdominal internal oblique muscle in the stance phase. As a result, walking improved and the pain decreased. From this case, we suggest that it is important to consider the role of the trunk muscles while actually exercising, in order to reduce low back pain.

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