We apply the following 3 methods to establish the basic movements used in self-care and activities connected daily living (APDL).
1) We defined basic movements as those involved in self-care and APDL.
2) We analyzed the basic movements and found the problems in the basic movements.
3) We considered the relationship between difficult basic movement and other movements involved in self-care and APDL.

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Washing the hands is an operation done as maintenance of cleanliness and for the prevention of infectious diseases. A healthy person's hand-washing is done cooperatively and automatically based on sensory information obtained from rubbing the hands together. However, patients with cerebrovascular disease wash their hands by strongly rubbing with the unaffected side hand, and the movement is done intentionally. In this study, we observed the hand-washing movement and noted the differences between healthy persons and patients with cerebrovascular diseases. We also report on developments in therapeutic intervention for hand-washing and other activities of daily living.

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Shoulder joint disease patients have difficulty with reaching a shelf above the head, an activity of daily living (ADL). In the functional movement of raising the upper limbs above the head, flexion and abduction of the shoulder joint is required. Using X-ray photography, we compared the movement of the clavicle and scapula, in shoulder joint flexion and abduction, between healthy persons and shoulder joint disease patients. We think that an objective understanding of the compensation mechanism can lead to extension of ADL in cases of shoulder paralysis due to organic denaturation of the peripheral nerves.

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The activity of bathing involves multiple motions that consist of basic movement of the upper limbs. We described these motions in the Journal of Kansai Physical Therapy, Vol. 8. This paper aims to describe the aspect of treatment for the motion of getting into/out of the bathtub. In this paper we explain the treatment of the motion of getting into/out of the bathtub as two postures. One treatment setting is the standing posture and the other is the sitting posture. Especially, we interpret the viewpoint of these treatments with respect to each other.

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Changing underclothes is an activity that everyone performs every day and there is a lack of objective information derived from observations of people performing this activity. Therefore, a physical therapist must rely on his or her own experience while guiding a person who is changing their underclothes. However, the physical therapist should observe and understand the movements involved. In this study we examined the activity of the abdominal muscle group in healthy persons during a change of underclothes. Observations on the angle of inclination of the pelvis in the long-sitting and chair-sitting positions were made. Integrated electromyographic values of the abdominal muscle group tended to decrease with increasing inclination angle of the pelvis. Our results suggest that the angle of the pelvis during a change of underclothes affects the activity of the abdominal muscle group.

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The act of driving a car is classified as an Activity Parallel to Daily Living (APDL) - a combination of many different basic movements. Therefore, physical therapy places an emphasis on the analyses of these basic movements to examine the activities of daily living. In the present study, we analyzed the activity of the trunk muscles when pushing down a pedal with the foot. The results demonstrated that the activity of the obliquus internus muscle was closely associated with the pedal-pressing motion. We also performed a simulation of the motion, examining the muscle activity, with the purpose of applying it to rehabilitation training. In this paper, we report the findings obtained from the study, which will facilitate the analyses of body movements while driving a car.

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The effects of posture during needle retention were examined in acupuncture treatments of patients with cervical dystonia. The neck posture of the patients was observed in the prone, supine, sitting, or standing positions or while walking, and the abnormal posture observed was selected as a treatment posture during needle retention. We hypothesized that in this posture the acupuncture treatment would be more effective. We conclude that selecting an acupuncture treatment method in this manner should be effective not only for dystonia but also movement disorders.

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The purpose of this research was to examine which is more useful in-phase or anti-phase movement, the execution of exact periodic movement paced by auditory stimulus. The experiment was conducted on 14 right-handed healthy subjects (nine males, five females, mean age 20.6 ± 2.6 years). Informed consent was obtained from all subjects. Each trial took place under four conditions: i) in-phase movement with a frequency of 1 Hz, ii) anti-phase movement with a frequency of 1 Hz, iii) in-phase movement with a frequency of 0.5 Hz, and iv) anti-phase movement with a frequency of 0.5 Hz. The conditions of auditory stimulus were: stimulus intensity of 60 dB, auditory frequency of 1 kHz, and sixty consecutive stimuli per trial. Auditory stimulus was delivered via headphones. The data measured during the experiment were stimulus onset and movement onset times. The time difference between the target time and the movement onset was defined as the synchronization error. The time difference between two successive movement onsets was defined as the inter- movement interval. For data analysis we used: i) root-mean-square (RMS) of synchronization error, ii) RMS of the difference between the inter-stimulus interval and the inter-movement interval, iii) coefficient of variation (CV) of the inter-movement interval, and iv) the autocorrelation function at lag1 of inter-movement interval. At each frequency, data were compared between the in-phase and anti-phase movement conditions, and the paired t-test was used for statistical analysis. At a frequency of 0.5 Hz, there was a significant difference in RMS of the difference between the inter-stimulus interval and the inter-movement interval and CV of inter-movement interval. At a frequency of 1 Hz, there was no significant difference between these two parameters. The results suggest that the periodic movement of one second interval was a habitual and simple movement, and tends to become a self-paced movement. On the other hand, the periodic movement of two-second interval was not so easily self-paced, because anticipation of the stimulus interfered with retention of the time interval, leading to movement dependent on auditory stimulation.

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We assessed the direction and grade of pelvic deviation using palpation and spinal malleolar distance (SMD) measurement in patients with pelvic deviation at the sacroiliac joint affecting daily living and sporting activities. In this article, we introduce the pelvic deviation-testing method with palpation that we developed, with regard to the pelvic deviation condition in which the unilateral coxal bone at the sacroiliac joint in the pelvic region shows anteroposterior inclination. We report the pattern of pelvic deviation classified based on clinical data, and introduce a simple, objective examination procedure using the SMD. In addition, we present patients with pelvic deviation as an etiological factor influencing basic/sporting activities, and review the evaluation and treatment of pelvic deviation in physical therapy.

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We experimented with physical therapy for a post-stroke patient, from the viewpoint of proprioceptive input for the hip joint. As a result, his gait posture improved. It is important to perform physical therapy with awareness of the various sensory inputs in the treatment.

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This study investigated the influence on alteration of electromyographic reaction time (EMG-RT) due to increase in the periodic count of auditory stimulus. In addition, we also investigated the influence of differences in stimulus frequency on alteration of EMG-RT. Experiments were conducted on six healthy subjects (2 males and 4 females, mean age 28.1 ± 3.4 years). Informed consent was obtained from all subjects. The conditions of auditory stimulus were as follows: stimulus frequencies of 1 Hz and 0.5 Hz, stimulus intensity of 70 dB, auditory frequency of 1 kHz and 15 stimuli per trial. Auditory stimulus was delivered via headphones. The subjects were requested to raise the right-ankle quickly, in response to each auditory stimulus signal. The results suggest that with the alteration of stimulus frequency, the EMG-RT of the second to fifteenth auditory stimuli were shorter than that of the first stimulus; and the EMG-RT of the third to fifteenth auditory stimuli were shorter than that of the second stimulus. EMG-RT of the third to fifteenth auditory stimuli did not differ. Using a stimulus frequency of 1 Hz, the average EMG-RT from the fourth to fifteenth stimulus was shorter after each auditory stimulus than that after stimulus at a frequency of 0.5 Hz. Based on these results, with regard to alteration of EMG-RT due to increase in stimulus frequency, we suggest that there was no significant difference between the stimulus frequencies of 1 Hz and 0.5 Hz, because the experimental task was too easy. We consider that EMG-RT after the second stimulus was shortened compared with that of the first, because the first stimulus played the role of a warning signal, resulting in the induction of a state of motor awareness. We consider that the differences were due not only to a difference in histology but also to long-term learning such as that related to walking and central pattern generators (CPG). EMG-RT of the fourth to fifteenth stimuli at a stimulus frequency of 1 Hz were shorter than those at a stimulus frequency of 0.5 Hz. We consider that this was due to an unconscious process, because 1 Hz has an interstimulus interval of 1,800 ms or less. However, we think that it was hard for the ankle movement to be an unconscious process at a stimulus frequency of 0.5 Hz, since it had an interstimulus interval of 1,800 ms or more.

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In the clinical field, we have provided physical therapy for cases presenting with Trendelenburg sign on walking caused by reduced muscle strength of the abductor muscle group of the hip joint on the weighted side. The Trendelenburg sign can occur in the early stage or after the middle stage of the stance phase, showing various patterns. In this study, we focused on the relationship between Trendelenburg sign occurring in the early stage or after the middle stage of the stance phase and the abductor muscle group of the hip joint on the weighted side. The subjects were asked to flex their hip joint and bend the body forward with 95% of the body weight loaded on one side of the body in an upright position, and remain in this position with the angle from the initial position at 5, 10, 15, 20, and 25 degrees. We evaluated the influence of changes in the angle of the hip joint on integration values of electromyograms of the abductor muscle group of the hip joint (the tensor fascia lata muscle, gluteus medius muscle, and superior part of the gluteus maximus muscle) on the weighted side, using surface electromyograms. As a result, the relative integration value of the electromyograms of the tensor fasciae lata muscle and gluteus medius muscle on the weighted side significantly decreased as the angle of the hip joint increased. On the other hand, the relative integration value of electromyograms of superior part of the gluteus maximus muscle on the weighted side significantly elevated as the angle of the hip joint increased. The hip joint on the weighted side underwent flexion, and was subjected to an abduction force, as the angle of hip joint changed when one of the lower extremities was loaded. It was considered that superior part of the gluteus maximus muscle, which also belongs to the extensor muscle group of the hip joint, was primarily involved as a braking force. The results of this study suggest that the evaluation and treatment of superior part of the gluteus maximus muscle is important in controlling the dropping of the pelvis toward the non-weighted side (adduction of the hip joint of the standing leg) and its anterior inclination (flexion of the hip joint of the standing leg) in cases presenting with Trendelenburg sign.

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The purpose of this study was to investigate the effects of various interventions on service quality improvement in a health promotion facility attached to a hospital. The change in service quality was measured to clarify the effects of the interventions. The investigation was conducted at a health promotion facility attached to a hospital, and an internal analysis and a service analysis of the facility were conducted. The first analysis was performed to understand the service quality before the intervention for the service quality improvement. The second analysis was conducted to confirm the effect of the intervention. A survey was conducted on facility users to measure their service quality. The service quality was measured using ten elements (20 items, two for each element): hospital and medicine, program, staff, cleanness and atmosphere, plant and equipment, social intercourse and exchange, physical effect, emotion, information, and user manners. The importance and the performance level were ranked using seven levels in the first analysis. Only performance was ranked using seven levels in the second analysis. We acted on the confirmation of the movement and checked the cleaning for two months, based on the results of the first analysis. In the analysis of the effect of intervention, we selected the responses of only those users who had provided answers in first analysis (N=68). Service quality was measured by comparing importance and performance levels obtained in the first and second analyses. Differences in mean values were analyzed using the t-test. An improvement in the performance level was observed in six of the ten service elements.

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When patients with cerebrovascular disorder-associated hemiplegia and orthopedic diseases walk using a cane made necessary by a functional disorder on the paralyzed side of the affected leg, they tend to load excessive weight on the cane. In such patients, the latissimus dorsi on the side using the cane is hyperactive, and this hyperactivity promotes a vicious cycle leading to dysfunction of the abdominal muscles. Aiming to clarify the association of weight loading on a cane by the upper limbs with activities of the latissimus dorsi and trunk muscles, we investigated the influence of changes in unilateral upper limb weight loading on a cane, by adopting a one-legged standing position, on electromyographic integrals of the upper and lower fibers of the bilateral latissimus dorsi, obliquus abdominis, and low back muscles. The subjects were 8 healthy males. While the subjects maintained a resting standing position on 2 scales, loading equivalent weights on the bilateral legs, electromyograms of the muscles were recorded, and the integrals were determined. The subjects then held a 4-point cane with their right hand in this position. The weight loaded on the cane was adjusted to 0% of the body weight, and each subject lifted the heel on the cane side to a level at which the anterior sole lightly touched the scale, maintained this position supported by the leg on the non-cane side, and electromyograms were recorded. The weight loaded on the cane was randomly changed to 5%, 10%, 15%, and 20% of the body weight, electromyograms were measured, and the integrals were determined. The load on the cane was then set to 0% of the body weight, the subject lifted the heel on the non-cane side to a level at which the anterior sole lightly touched the scale, maintained this position supported by the leg on the cane side, and electromyograms were recorded. The load on the cane was again randomly changed to 5%, 10%, 15%, and 20% of the body weight, electromyograms were recorded, and the integrals were determined. The relative electromyographic integrals of the upper and lower fibers of the latissimus dorsi on the cane side increased with an increase in the load (at 15% and 20% of the body weight) on the cane in both tasks, that of the obliquus abdominis on the cane side also increased, and that of the upper fibers of the latissimus dorsi on the non-cane side tended to increase. In contrast, no marked changes were noted in the low back muscles on the cane side, lower fibers of the latissimus dorsi, or obliquus abdominis and low back muscles on the non-cane side. These results suggest that long-term excess loading on the cane causes hypertonus and muscle shortening of the lower and upper fibers of the latissimus dorsi on the cane side, for which consideration of weight loading on the cane in necessary during clinical gait training.

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We experienced a patient with post-stroke left hemiplegia exhibiting Pusher's syndrome, who required assistance to maintain sitting and standing positions and to standing up. Hypotonia on the hemiplegic side and hypoesthesia were considered to be the basic problems with the posture and movement of this patient. Moreover, hypotonia of abdominal muscles on the non-hemiplegic side was assumed to be the main cause of Pusher's syndrome, a characteristic of this case. This condition may have induced excessive extension and abduction of upper and lower limbs on the nonhemiplegic side (Pusher's syndrome) in order to maintain posture and movement, leading to the requirement for excretory assistance. The hypotonic abdominal muscles on the non-hemiplegic side were trained through physical therapy, and Pusher's syndrome of upper and lower limbs on the non-hemiplegic side was improved. Following this, postures and movements were modified in consideration of bilateral symmetric sensory input, and movements necessary for toilet use were improved.

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We performed physical therapy for a patient with osteoarthritis of the knee accompanied by lumbar spondylosis. This patient had extension limitation of the knee joint and pain in the lower left back as well as in the inside of left knee joint while walking. The patient's problem while walking was caused by lateral thrust, which in turn was causing lateral bending of the trunk towards the stance side during the phase from left heel contact to mid-stance. Moreover, increasing the workload of the lower back muscles reduced the extension movement of the knee joint during the phase from left mid-stance to toe-off. Therefore, we considered that extension limitation of the knee joint has marked effects on trunk alignment while walking. The patient was asked to perform weight-shifting and stepping exercises because we believe that physical therapy brings about an improvement in the extension movement of the knee joint and alleviate the pain in the lower back and knee joint. After 2 weeks of physical therapy, this patient's lateral thrust improved during the phase from left heel contact to mid-stance. Furthermore, the extension movement of the knee joint improved, thereby reducing the work load of lower back muscles during the phase from left mid-stance to toe-off. The patient was able to walk without any pain in the lower back and knee joint because she was made to perform weight-shifting and stepping exercises in order to achieve trunk alignment as well as to correct the extension limitation of the knee joint and restore its function by facilitation of the quadriceps femoris. It is important to take into account the relationship between the knee joint and trunk alignment when attempting to correct the gait of a patient with osteoarthritis of the knee.

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We encountered a patient with post-stroke right hemiplegia in whom equinovarus foot developed with dragging of the toe in the swing phase on the hemiplegic side interfering with walking. The problems in this case were abdominal muscle hypotonia on the hemiplegic side, hypertonia of the bilateral back muscles and ankle joint muscles on the hemiplegic side, and superficial hypesthesia of the sole on the hemiplegic side. Based on these findings, we performed treatment to improve functions of the hemiplegic leg and trunk, focusing on the problem in the swing phase, which the patient most strongly showed. Functions of the hemiplegic leg and trunk were inproved, and the gait improved immediately after treatment, but returned to the previous condition at the following outpatient session, showing no persistent therapeutic effect. We re-investigated the gait, and found that the patient walked while being conscious of dorsal flexion of the ankle joint to avoid the hemiplegic leg being caught. Assuming that walking while being unconscious of ankle joint dorsal flexion is necessary, we performed treatment to promote walking without consciousness of the dorsal flexion. The patient's gait improved, and a persistent therapeutic effect and ability to walk a long distance were achieved. The acquisition of this unconscious gait may have involved central pattern generators (CPGs) and motor learning.

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We report the case of a patient with limited range of motion (ROM) of the left shoulder joint after radiation therapy for a lymph node on the left side of the neck. In this patient, ROM for shoulder elevation was improved by remote acupuncture therapy. At the start of the treatment, the patient's limited shoulder joint ROM was attributed to limited upward rotation of the scapula due to limited backward rotation of the clavicle due to skin contraction around the left sternoclavicular joint. Since the skin contraction could not be improved, we reassessed the case. We confirmed overactivity of the anterior fibers of the deltoid muscle and hypotonia of the supraspinatus muscle at the start of the shoulder joint elevation, and manual therapy was therefore initiated. However, the patient showed a defensive muscular contraction and compensatory movements, and the muscle activity did not improve. We therefore considered that improvement of the muscle activity by local treatment was difficult and remote acupuncture therapy, which was reported to be effective in a previous study, was administered. Acupuncture treatment was administered at the Wenliu (LI7) point leading to the anterior fibers of the deltoid muscle and at the Waiguan (TE5) point leading to the supraspinatus muscle. As a result, the activity of the supraspinatus muscle increased and the shoulder joint ROM elevation improved to 120 degrees.

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We recently encountered a patient with chronic obstructive pulmonary disease who showed postural instability in the left posterior direction and shortness of breath while walking, and thus, had difficulty carrying a portable oxygen cylinder. Shortness of breath seemed to be due to respiratory insufficiency that was caused because of reduced motility of the right lower part of the thorax. On analyzing the patient's posture while walking, trunk flexion, lateral bending to the right, posterior inclination of the pelvis, and unstable gait were noted when the left heel was off the ground. Because of this, the patient tended to raise the right shoulder girdle to shift the center of gravity in the right anterior direction. This motion intensified forced respiration. This tendency seemed to be attributable to shortening of right obliquus abdominis and right lumbar quadrate muscles, resulting in reduced activity of the right obliquus abdominis muscles. We attempted to control respiratory insufficiency by targeting the reduced activity of the right lower thoracic segment. The instability while walking was controlled by targeting the shortened right obliquus abdominis and right lumbar quadrate muscles as well as the reduced activity of the right obliquus abdominis muscles when the left heel was off the ground. In addition, the patient was advised to shift his center of gravity in the right anterior direction when the left heel was off the ground. With these approaches, the patient adopted a diaphragm-predominant respiration pattern, resulting in the alleviation of his shortness of breath while walking. The instability with the left heel remaining off the ground was reduced following alleviation of trunk flexion, lateral bending to the right, and posterior inclination of pelvis when the left heel was off the ground. Furthermore, stabilization of his walk allowed the patient to shift his center of gravity in the right anterior direction, resulting in a reduction of the tendency to raise the right shoulder girdle, which further alleviated his shortness of breath.

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We encountered a patient undergoing physical therapy for myofascial lumbago. The patient complained of pain in the right dorsolumbar muscles during walking. Anteversion and leftward inclination of the pelvis (Trendelenburg's sign-like findings) were noted in the early to mid-right stance phase of walking. It was assumed that the right dorsolumbar muscles had become hyperactive, acting as a brake for the accompanying left anterior inclination of the trunk, thus producing pain. In physical therapy to resolve the Trendelenburg's sign-like findings, the right hip joint was treated with right hip extension ROM exercise and muscle strengthening exercise. The therapeutic effect was insufficient, and muscle pain in the right dorsolumbar area persisted. To identify the mechanism behind the Trendelenburg's sign-like findings in this patient, we investigated the influence of lateral body weight shift to one leg in a standing position on the internal oblique, gluteus medius, and dorsolumbar muscles in healthy subjects. The investigations measured on electromyography and the center of pressure (COP). The internal oblique muscle on the shift-to side was active from the early phase of the COP shift toward the shifted side. This was immediately followed by gluteus medius muscle activity, suggesting that stabilization of the sacroiliac joint by internal oblique muscle activity was important for resolving Trendelenburg's sign-like findings. We applied this finding to physical therapy for the patient, in which body weight was shifted rightward in a standing position to correct the activity pattern of the right internal oblique muscle. After this intervention, the right internal oblique muscle activity pattern on lateral body weight shift in a standing position and the right early to mid-stance phase of walking were corrected. The patient was able to maintain the pelvis in a horizontal position, and the Trendelenburg's sign-like findings were resolved. The intervention may have reduced the hyperactivity of the right dorsolumbar muscles associated with the leftward inclination of the trunk, thus resolving the pain. Our experience with this case suggests the importance of evaluating and performing physical therapy on internal oblique muscle activity on the shift-to side in cases showing Trendelenburg's sign-like findings.

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We taught the motions of hand washing, a frequently repeated activity of daily life, to a hemiplegic patient with serious aphasia resulting from cerebral infarction. This enabled the patient to increase other voluntarily movements, and reduce the amount of help needed to stand up. Focusing treatment on an activity of daily living appeared to be effective because it reminded the patient of movements deeply engrained in past experiences and memories.

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We report of a patient who presented with axilla nerve paresis. At first, the function of the triangular muscle was decreased because of the axillary nerve palsy, and the shoulder joint range of motion was limited. Because the patient had been doing compensatory movement of scapula elevation, the muscle activity of the upper and lower fibers of the trapezius were disproportionate. As a result, the stability of the scapulothoracic joint was decreased, and the patient had difficulty with overhead work. For evaluation of the scapulothoracic joint, we evaluated the position of the scapula when the shoulder joint was at maximum flexion. When the shoulder joint was at maximum flexion, the scapula was located above the outside. Muscular depression due to excessive muscle contraction and the lower fibers of the trapezius of the scapula elevation muscle was thought to be the cause. We controlled the scapula elevation, and perfprmed physiotherapy to encourage/enlist the muscle activities of the lower fibers of the trapezius selectively. As a result, the position of the scapula when the shoulder joint maximum flexion became normal, and the stability of the scapulothoracic joint improved. Moreover, the patient could do overhead work without difficulty.

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