Self care and Activities Parallel to Daily Living (APDL) are composed of basic movements; sitting, standing, gait and so on. For example, basic movements of toilet activity ae sitting, sit-to-stand motion, standing and gait. To improve problems of self care and Activities Parallel to Daily Living (APDL), we apply 2 methods: 1) If patients have difficulty of self care and APDL, we evaluate the basic movement related to that difficulty. We treat the problems of the basic movement to solve the problem of self care and APDL. 2) If the problem of the basic movement is obvious, improving the basic movement connected with the problem solves the problems self care and APDL. We need the ability to analyze motion because it is important to find the problems in basic movement in both method. Furthermore, a new theory for basic movement is introduced in this paper.

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Toilet activity, which is done every day attended with the physiological phenomenon of "excretion", has high necessity in the activities of daily living (ADL). We analyzed it in terms of "sense", and describe how to guide a person who has difficulty in this activity, with some specific approaches. It is important to carry out all of the activities of daily living not only in the rehabilitation room but also in a practical environment, and we need to take it into consideration in the physical therapy.

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The activity of bathing involves multiple motions that consist of basic abilities and functions of the upper limbs. This paper aims to describe "the motion of stepping over the bathtub" that is a necessary activity of bathing. We describe these motions, and simulate the motion which can reproduced in the rehabilitation room, from sitting to long sitting on a platform. We divided these motions into three phases and explain the movement of normal adults and adults with hemiplegia, as well as the points of treatment about each phase.

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The daily routine of changing clothes and underclothes for patients undergoing physical therapy can sometimes be a problem. Clothes of the patients need to be changed several times a day, for example, when going outdoors and for other functional and social purposes. Changing clothes can be a problem for patients, depending on the kind of clothing, the patients' posture, and the method for changing clothes. Detaching, removing, or raising and lowering of clothes can also be a problem for patients, depending on whether the patient is lying down, sitting, or standing. This poses the question: How do physical therapists guide patients regarding changing clothes and underclothes? This study examined the operations of detaching, removing of clothes, and raising and lowering of underclothes. The study observed the normal operation of changing underclothes, using healthy people as subjects. The participants were videotaped. Additionally, the participants' centers of pressure (COP) were determined using a stabilimeter, and electrical muscle activity of the supporting leg was monitored by surface electromyography.

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In patients with disorder of the shoulder joint, the the activities of daily Living (ADL), "reach a shelf over the head", "move to a medially rotated position" and "open and shut a sliding door", often become difficult. ADL of reach a shelf over the head needs the function of flexion and abduction of the shoulder joint. ADL of open and shut a sliding door needs the function of horizontal abduction and adduction with the same flexion angle of the shoulder joint. To understand the movement function of the shoulder joint, it is necessary to distinguish to it from the function of the shoulder girdle and the function of the gleno-humeral joint. We think that it helps the physical therapy approach (the evaluation, the cure) to shoulder joint disease to pay attention to movement while sitting or supine in order to understand the function of the shoulder girdle. Evaluating the function of the gleno-humeral joint and the rotator cuff function corresponding to the direction of the movement and the angle change must also be considered.

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Patients with cerebrovascular disease are often drive a car. It is necessary for these patients to assess driving a car as Activities Parallel to Daily Living (APDL). The driver is affected by inertial forces of acceleration, deceleration, taking a curve and others. Especially, it is impossible for the trunk to resist the inertial forces. Accordingly, it is indispensable to assess the function of the trunk for a patient with cerebrovascular disease who drives a car. The analysis of the driving motion and the assessment of the physical function on the driving are difficult in a clinical setting. Moreover, there has been little research in the field of rehabilitation related to driving a car. To contribute to therapy of patients who drive a car, the function of the trunk of a driver were investigated in this report. The subject of this research was a healthy person. Electromyography (EMG) of the trunk muscles of the driver was recorded, and digital video tape recordings were synchronized with the EMG. The characteristic results were: 1) When the car cornered sharply, the muscle activity of the trunk muscles on the side contralateral to turning increased. 2) When the driver braked hard, the muscle activity of the internal oblique abdominus on the brake side increased. The results suggest that the trunk muscles and the internal oblique abdominus resist the centrifugal force and the shear force on the sacro-iliac joint.

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Introduce treatment for speech and swallowing by acupuncture or acupoint pressure for rehabilitation in this article. For both speech and swallowing, the aim of the treatment is not only improvement of oral function but also improvement of posture. It is necessary to pay attention to the neck and trunk posture for treating speech and swallowing. If we find shortening of the skin or muscles on the neck and the trunk, the first treatment is to stretch shortening skin and shortening muscles. To treat abnormal muscle tonus, I choose acupoint treatment by the meridian method. The acupoint treatment is decided by the relationship of the affected muscle and the meridian. I treat patients' acupoint by acupuncture, but if you cannot use acupuncture, apply pressure to the acupoint using your fingers. This method is named "acupoint stimulation physical therapy (ASPT)", and is advocated by Toshiaki Suzuki. The acupoints that we use for neck and trunk posture are as follows: to control neck flexor muscles, Hegu(LI4) for the sternocleidmastoid muscle, and Chongyang(ST42) for scalenus muscles; and to control for neck extensor muscles, Waiguan(TE5) for the trapezius muscle; (upper part), Houxi(SI3) or Waiguan(TE5) for the splenius, and Kunlun(BL60) for elevator scapula. If the abnormal posture appears at the trunk, hypotonus of the abdomen muscles and hypertonus of the back muscles occur simultaneously. To control these muscles, we use acupoints of Chongyang(ST42) for abdomen muscles and Kunlun(BL60) for back muscles. Some kinds of dysarthria and dysphagia are too difficult for conventional rehabilitation, but I think that ASPT, an alternative treatment approach, may raise the possibility of favorable outcomes for dysarthria and dysphagia.

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It is important to understand about the mechanism of motor learning. Moreover, it is necessary to guide automated behavior by intervening according to each stage of motor learning. In this paper, we summarize the neural mechanism and strategy of motor learning.

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It is important to achieve effectual body manipulation by therapists in the transfer of the center of gravity of patients. To get the effectual body manipulation we need to know "fulcrum shift" which is the movement between center of the gravity and the supported line in the standing position. We also need effective communication between therapists and patients.

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In this article, an outline of the International Classification of Functioning, Disability and Health (ICF) is described, and, rehabilitation which is based on the ICF concept is proposed. Because the ICIDH model consists of impairments, disabilities and handicap from the "flow" of thinking originating from diseases, it could a only be constructed by professionals like a doctor or a therapist. However, because ICF is a classification of daily life function, its construction is possible by various disciplines, not just a doctor or a therapist. It is desirable that a therapist understands the ICF concept to maintain cooperation and a common language with other disciplines. To keep therapist's identity as "we can cure", it is therapists who have to recognize the concept of ICF with the new three dimensional paradigm described in this article. To establish the three dimensional paradigm of ICF, the therapist has to understand the "Wellness", which arises from the client's desire and needs, instead of "Health condition" in ICF. In other words, construct the three dimensional paradigm of ICF, to offer rehabilitation service, and the subject is lead to higher "Wellness", and as a results of this process, whole human rehabilitation is facilitated better than the rehabilitation which is done under the ICIDH model.

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A difference of alignment of rear foot between lying down and standing in patients who have sports disorders is often observed. The purpose of this study was to clarify the relationship between the alignment of the rear foot and activities of ankle flexor muscles during the calf-raise. We identified an alteration of the alignment of the rear foot between the prone position to standing by measuring leg heel angle under each condition, and classified subjects into three groups (varus, neutral, valgus) according to angle alteration. In addition, we measured activities of the tibialis posterior muscle, soleus muscle, medial head of the gastrocnemius muscle and lateral head of the gastrocnemius muscle during the calf-raise with surface electromyography. The varus group showed significantly greater activation of the tibialis posterior muscle than the valgus group. Activation of the medial head of the gastrocnemius muscle displayed similar findings with an increase from the valgus group to the neutral and varus groups. These results suggest that if alignment of the rear foot in standing is more varus than in lying prone, sports disorders are potentially more likely in therapeutic calf-raise exercises and in running during training.

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We have experimented with physical therapy for patients with difficulty of body weight transfer due to hyperactivity of the latissimus dorsi and muscular contractions. For lateral body weight transfer, training changed the distance of lateral transfer in the sitting position. Recent electromyographic (EMG) studies on the latissimus dorsi reported activities in its upper and lower fibers in the scapular brachial joint during trunk exercise. However, the activities of this muscle on lateral transfer in the sitting position have not been analyzed. In this study, we examined the influence of changes in the distance of lateral transfer in the sitting position using the EMG of the upper and lower fibers of the latissimus dorsi. Initially, in the end-sitting position (starting limb position), in which the bilateral arms were folded, we measured integrated EMG (iEMG) for the upper and lower fibers of the bilateral latissimus dorsi. Subsequently, the shoulder girdle was transferred in the lateral direction at distances of 5, 10, 15, and 20 cm without inclining or rotating the line between the bilateral acromions, while maintaining the head in the vertical position, with both feet placed on the ground from the starting limb position. We determined the respective iEMGs. There were no significant lateral transfer distance-related changes in the relative iEMG for the upper and lower fibers of the mobile side latissimus dorsi. Furthermore, the value for the upper fibers of the non-mobile side increased with the distance of lateral transfer. In addition, the value for the lower fibers of the non-mobile side also elevated with the lateral transfer distance; at a distance of 20 cm, the value was significantly higher than those at distances of 5 and 10 cm. Based on the results of this study, it may be important to evaluate the abdominal oblique muscles, dorsolumbar muscles, and latissimus dorsi in performing lateral body weight transfer. Training chang the distance of lateral transfer in the sitting position of patients with difficulty of lateral transfer . In addition, the actions of the upper fibers of the latissimus dorsi differed from those of the lower fibers, suggesting the necessity of assessing these fibers individually.

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We performed physical therapy for a patient with post-stroke hemiplegia. She had maintained her posture using her skin turgor, and her skin's stretch ability between the neck and scapular arch had decreased. Therapists scrubbed her back with towels, and her upper trunk has extended, her abdominal muscle tone was promoted and her trunk and pelvis supported each other well. As a result, she could put on her clothes by herself, a segment of her left arm could move and the load of her right arm was reduced. In the stance phase of gait, the patient's upper trunk could keep the extended position, the load on her right arm was reduced and the associated reaction of her left arm decreased. We also found that the trunk of healthy persons' could be extended autonomously and his abdominal muscle tone could be promoted by the scrubbing of his back with towels, as in the above case. We rediscovered the fact that it is necessary to evaluate and approach the relationship between the patient's activity of daily living and basic motion sufficiently.

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The purpose of this study was to investigate the effect of differences of the foot center of pressure in standing on postural control of stand-to sit movement. It was thought that the reverse reaction phenomenon of standing posture in normal subjects at the fist of the sitting movement start by reduction of the muscle activity of the lumbar back muscles. Stable stand-to-sit movement was able to be performed when COP was located forward. From this, the position of foot COP in standing before stand-to-sit movement influences the difficulty of adjustment of COP and COG. Therefore, we suggest that in order to improve stand-to-sit movement, it is important to evaluate foot COP in the standing posture and muscle activity of the lumbar back muscles.

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We provided physical therapy for a patient with tendinitis of the Achilles tendon. She had pain with plantar flexion on standing. The characteristic finding of plantar flexion on standing in this case was varus instability in the foot from the early stage of movement, and the foot varus angle became largest in plantar flexion. Because the difference of muscle strength between the digitus primus side and the digitus minimus side was thought to be the cause of instability of the foot, we measured it using a hand-held dynamometer. From this measurement, weakness of output of muscle strength on the digitus minimus side was clear, and the following two problems were apparent: shift of the joint motion axis during ankle dorsal flexion, and decline of the muscle strength of the peroneus brevis, gastrocnemius and soleus. Instability in plantar flexion was improved by physical therapy paying attention to the joint motion shift and improvement of the pain was achieved.

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I report acupuncture treatment for abnormal neck posture and deviation of trunk in a patient with drug induced dystonia.The patient was a 60-year-old female. In the last 3 years, her neck and mouth had showen involuntary movement when she received medical treatment for her bipolar disorder, and she was diagnosed as having drug induced dystonia. Her symptoms were slightly improved by botulinum therapy (BTX) and transcranial magnetic stimulation (TMS), but she wanted to receive acupuncture treatment, so she came to our clinic. At the first consultation at our clinic, her neck posture in a sitting position showed left lateral bending, left rotation, flexion, and extension, and her trunk posture showed left lateral bending. Her neck presented with intermittent involuntary movement of left rotation and extension. The problems of her abnormal posture were some muscle tones and shortening of skin and muscles. Abnormal muscle tones were hypertonus of the trapezius muscle and erector spinae, and hypotonus of the abdomen muscles. Skin and muscle shortening presented on the posterior region of her neck (trapezius and splenius capitis muscle), the occipital region of the head, and the interscapulum, lumbar and dorsal. Her neck also showed intermittent involuntary movement. The acupuncture treatment was as follows: multiple epidermis penetrating needles were used to treat skin and muscle shortening on the posterior region of her neck (trapezius and splenius capitis muscle), occipital region of head, and interscapulum. Lumbar and dorsal retaining needles were used for Waiguan(TE5) for hypertonus of trapezius muscle, Chongyang(ST42) to increase abdomen muscles, Kunlun(BL60) for hypertonus erector spinae, and Baihui(GV20) to decrease the involuntary movement. After acupuncture treatment, the patient's involuntary movement of the neck was reduced, and flexion of trunk and extension of neck were improved. Currently there is no definitive treatment method for drug induced dystonia. This case suggests that abnormal neck posture and deviation of trunk in a patient with drug induced dystonia can be improved by acupuncture treatment.

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We encountered a patient, who underwent therapeutic exercise following surgery for spondylolisthesis, showing a hunchback with pain in the gluteus maximus and rectus femoris muscles on standing. Pain was caused by the hunchback posture and we suggested the necessity of its correction for pain reduction. However, active therapeutic exercise for the trunk was contraindicated because the patient was still under observation for postoperative bone union. During investigating the cause of the hunched back, we assumed that it was due to functional disorder of the lower limbs. Aiming at pain reduction with improvement of the hunched back, we performed 3 types of therapeutic exercise focusing on the lower limbs and pelvis on different days. When theraputic exercise for lower limb dysfunction (Therapeutic exercise A) was performed, the standing posture remained unchanged. After analyzing the results, adjustment of the standing posture by guiding the pelvis (Therapeutic exercise B) was performed in the week following Therapeutic exercise A, again with no change. After re-analyzing the results, Therapeutic exercise B was performed immediately after Therapeutic exercise A starting the following week (Therapeutic exercise C), and a satisfactory outcome was achieved after Therapeutic exercise C. Based on this experience, we concluede it is necessary to sufficiently investigate and improve the influence of the lower limbs and pelvis, not only the trunk, in patients showing a hunched back posture.

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We performed physical therapy a softball player with a medial meniscus injury. She had difficulty in the movement of knee bending due to pain at the anteromedial part of the right knee. We observed the following mal-alignment in her movement with knee bending: pelvic inclination, valgus of the knee, external rotation of the tibia and eversion of the foot. The main problem in this case was the weakness of vastus medialis and abdominis muscles in movement with knee bending and deficiency of improvement in dynamic alignment. In physical therapy, we prescribed the practice of movement paying attention to the mal-alignment and muscle contraction. As a result of physical therapy, dynamic alignment of pelvic inclination, valgus of the knee, external rotation of the tibia and eversion of the foot were reduced, and muscle strength in the movement of knee bending and pain at the anteromedial part of right knee were relieved. The patient was able to resume the movement of knee bending during softball.

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We performed physical therapy for a patient with left hemiparesis due to cerebral hemorrhage. This patient had instability to the rear in standing up. The patient's standing up motion was evaluated by digital video camera and a weighing machine. This case's problems with standing up were as follows: a tendency to one side weight bearing, and difficulty with bearing forward on the affected side. The common factor was low abdominal muscles tonus in standing up. We instructed the patient to bend forward when standing up, and to distribute weight bearing equally on both sides, and encouraged the movement participation of the affected side. The amount of weight bearing on both the affected side and to the front increased, because the muscular tonus of the abdominal muscles had improved one week later. It was thought that this promoted stability in the standing up and improved the instability to the rear in standing up. However, in standing up the lateral bend of the trunk remained. It was thought that an approach to the trunk including the arm necessary in this case.

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