There are no well-defined or documented boundaries for either the vastus medialis oblique or for the vastus medialis longus. The purpose of this study was to examine anatomically the boundaries of the vastus medialis longus and the vastus medialis oblique. In an embalmed adult cadaver, two vastus medialis muscles were examined by direct visual observation. Our observations indicate that the boundary of the vastus medialis oblique and the vastus medialis longus appears to be the line from the adductor hiatus to the medial rim of the patella. This finding indicates that the vastus medialis oblique and vastus medialis longus may have different functions in the vastus medialis.

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A 32-year-old female was referred to our hospital for physiotherapy. This woman had severe pain in the right thigh and weakness in the iliopsoas muscle. She had difficulty in walking. According to her history, the pain started in the 28th week of pregnancy and continued to deteriorate progressively in the following weeks. The gynecologist did not want to subject the woman to any examinations and prescribed bed rest until delivery. Ten days after delivery the symptoms had not subsided, and the woman sought the help of an orthopedist. X- rays revealed an increase in lumbrosacral angle, while tomography and magnetic resonance imaging revealed no disc herniation. Electromyogram was negative. The physician referred her for physiotherapy that included transcutaneous electrical nerve stimulation, short wave diathermy and strengthening exercises. The woman after fifteen treatments was absolutely free of symptoms and could use the lower extremity in most of her daily activities. This case report shows the significant role of physiotherapy in the rehabilitation of iliopsoas weakness in a rare incident.

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OBJECTIVE: To investigate how senior high school students' knowledge of physiotherapy is acquired and their possible view of physiotherapy as a career. DESIGN: Cross-sectional survey. SETTING: Two non-vocational senior high schools in Japan. PARTICIPANTS: Six hundred and twenty-three students with a scholastic deviation value of more than 60. METHODOLOGY: A questionnaire in a closed-question format was used to survey the students' accuracy of knowledge and sources of information about physiotherapy. MAIN RESULTS: The science students and healthcare-aspiring students were more knowledgeable about physiotherapy compared to the literary and non-healthcare aspiring students with a mean score of 4.3, ranging from 0 to 11. Instruction in exercises (51%) was shown to be the most accurate, and intensive therapy (6%) was the least accurate. Television, one's own experience as a client, and career literature or pamphlets were the most cited sources of information. DISCUSSION AND CONCLUSION: Only half of the 619 students were aware of physiotherapy. This is partly due to the fact that the profession of physiotherapy has become commonly regarded as medical rehabilitation instead of one of the branches of therapeutics. Eighty-five per cent of the respondents indicated their aspiration to have a career, so acquisition of appropriate information on careers during high school days is important. Therefore, knowledge of physiotherapy conveyed by physiotherapists and the mass media to senior high school students should be improved in its accuracy of content.

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The present investigation aimed to clarify the physical functional abilities involved in the disturbance of smooth rising from a supine position in hemiplegic patients. The study compared task performance time and functional abilities between patients rising from a supine position with or without gripping the edge of the bed. Subjects comprising 21 hemiplegic patients were divided into 2 groups: those who needed to grip the edge of the bed to rise from a supine position (Group G, n=7); and those who did not (Group NG, n=14). The 2 groups displayed no significant differences in background characteristics other than age, with mean age for Group G significantly higher than that for Group NG. Rising performance time and 11 items for physical functional abilities were measured in all subjects. Rising performance time was significantly higher in Group G than in Group NG (p<0.05). Neck-trunk-pelvis motor function was lower (p<0.01), muscle tone was abnormal in more subjects (p<0.05) and strength of trunk rotation to the unaffected side was weak in more subjects (p<0.05) in Group G than in Group NG. No other physical functional abilities differed significantly between groups. These results suggest that patients rising from a supine position by gripping the edge of the bed display restricted task performance, and the main factors leading to a requirement for grip assistance seem to be abnormality and disability of trunk functions.

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The purpose of this study was to investigate the effect of ageing on body sway during sit-to-stand movement from a chair and on quadriceps muscle strength in the elderly population. A total of 275 community dwellers volunteered to participate in this study. All subjects signed an informed consent statement prior to participating in this study. They were required to be able to perform a sit-to-stand movement from a chair independently. The postural sway for the subjects during the sit-to-stand movement from the chair was measured using a stabilometer. The analog signals of the subjects' center of pressure in the anterior-posterior direction (%Y-axis) derived from the stabilometer were recorded. The maximum isometric muscle strength of knee extension was measured using an isometric dynamometer at 90 degrees flexion of the knee joint. Our results demonstrate that as age increased, lower extremity muscle strength decreased, and forward shift of the center of pressure also decreased. It is possible that the elderly subjects could not use their propelling power because of decreased lower extremity muscle strength. Therefore, the forward shift of the center of pressure of elderly subjects also decreased causing them difficulty in standing up from a chair. Therefore, we believe that we there is a need to educate elderly people about accurate sit-to-stand movement and the importance of lower extremity muscle strength exercise.

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In rehabilitation medicine, it is important to understand the hierarchical structure of patients' disturbances as well as causal relations within the structure. This study developed hierarchical structural disturbance models based on patients' function, ability and health-related QOL (HR-QOL) for coxarthrosis treated by total hip replacement (THR). Whether or not the structural equation modeling (SEM) analysis could depict the disturbances structure clearly and predict the prognosis properly was investigated. We used a set of longitudinal data for 92 patients who received THR for coxarthrosis from 1995 to the end of 2000 and who had no missing data of the Japanese Orthopaedic Association's Hip Score (Hip Score) as well as Manual Muscle Testing (MMT) conducted before and 3, 6, 12 and 24 months after the surgery. Subsequently we obtained a set of cross-sectional data for 283 patients who received THR in 2001 or later, including results of the SF-36 test that rated HR-QOL, and used it to determine the relational structure among patients' function, ability and HR-QOL. SEM analysis with stepwise modification of disturbance models resulted in a model in which a patient's function explained about 70% of a patient's ability and a patient's ability explained 60% of HR-QOL. The SEM analysis used in this study made it possible to understand the disturbances structure hierarchically. An SEM analysis that allows disturbances to be understood structurally might be useful in considering patient care after THR and could be applicable to cases with other diseases. It will be necessary to consider how to represent categorical data numerically for model fit improvement. Better graphic representation should also be considered.

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The left side neglect tendency was examined by the ability to draw self-portraits in six unilateral spatial neglect (USN) patients with the patients' eyes open and closed. With the eyes open, all the six patients were able to draw their self-portraits. All of those self-portraits were their own visual images, in which clear defects were observed on the left side of the body. With their eyes closed, however, three of them managed to draw their self-portraits but the other three failed to do so. The self-portraits drawn by the three patients with eyes closed had more defective parts than those drawn with eyes open. These results indicate that USN patients have difficulty not only in memorizing the visual scene but also in recalling their body image. Furthermore, it is also interesting to observe the left-right inversion in the self-portrait drawing.

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The effects of a low intensity training programme for 12 months on motor functions and mobility of institutionalized elderly women were investigated. The subjects comprised 28 elderly women aged 80.4 ± 5.4 years, who were assigned to either the control group (CG) (n=15) or the training group (TG) (n=13). Training 4 to 6 days a week with each session for about 20 minutes a day was performed. After training, a significant increase in quadriceps strength was observed in TG (P<0.05), but not in CG (mean ± S.D.% = 22.2 ± 14.1 v.s. -9.8 ± 19.4). Ability of balance tested by functional reach was decreased in CG (P<0.05), whereas there was no change in TG (mean ± S.D.% = -15.3 ± 23.4 v.s. -2.1 ± 15.3). Ambulatory status was reduced in CG, whereas there was no change in TG. These results suggest that low intensity training is effective for increasing strength and maintaining balance and mobility in frail elderly persons.

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The relationship between muscle stress (MS) or exercise stress (ES) was examined in 20 healthy young volunteers (all male, 22.9 ± 4.8 years old, mean ± SD) through cardiopulmonary exercise testing and coronary flow velocity (CFV). A heart lung function measuring system was used to conduct expiration gas analysis through isokinetic testing, a training system for MS and a treadmill for ES. CFV was measured using an ultrasound diagnostic device before and after MS and ES loadings. CFV showed a significant increase for both MS and ES (p<.01 for both), and rate pressure product (RPP) similarly showed a significant increase (p<.001 for both). The relationship between CFV and expiration gas analysis etc., showed weak correlation only between CFV after loading MS and knee extension muscle strength (r=.56, p<.01). This indicates that CFV increases with ES and MS. Nonetheless, since no correlation was observed between CFV and RPP, further examinations are required with an increased number of volunteers.

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