[Purpose] This study sought to determine an exercise regimen that can effectively improve degenerative osteoarthritis patients' muscle strength, proprioception, and functional performance. The regimen consisted of resistive exercises (RT) or manual therapy and resistive exercises (MT). [Subjects] The subjects were 35 elderly women who trained three times a week for eight weeks. [Methods] The 35 subjects were divided at random into RT and MT groups, according to the treatment method. [Results] Quadriceps strength significantly improved in both the RT and MT groups. Muscle strength increased to 4.35 N on the right side and to 3.55 N on the left side in the RT group, and to 10.59 N and 9.02 N, respectively, in the MT group. Only in the MT group did proprioception change significantly. The MT group showed a decrease in error from the target angle by -0.83° on the right side and -0.5° on the left side. Additionally, only in the MT group did functional performance change significantly; with the elapsed time in functional performance testing decreasing by 10.29 s. [Conclusion] According to the results, a regimen consisting of manual therapy together with resistive exercise appears to be more effective at improving muscle strength, proprioception, and functional performance than resistive exercise alone.
[Purpose] The purpose of this study was to evaluate the benefit of 8-week home-based lower extremity strength training combined with whole body endurance training on peripheral muscle oxygenation in outpatients with chronic obstructive pulmonary disease (COPD). [Subjects] The 8 subjects were COPD patients (6 males, 2 females). [Methods] Using near infrared spectroscopy (NIRS), muscle oxygenation in the right vastus lateralis muscle at rest and during isometric contraction of 30% maximal voluntary contraction (MVC) were assessed before and after intervention. Also, MVC of the right quadriceps muscles, the muscle endurance time (TLIM), defined as the time from the onset of the isometric contraction of 30% MVC until termination of the test, and the distance covered in the incremental shuttle walking test (ISWD) were measured. [Results] Although there were improvements, no significant changes were seen in MVC, TLIM, and ISWD between before and after the 8-week intervention. Also, no changes were seen in NIRS parameters at rest and during muscle endurance exercise between before and after intervention. [Conclusion] Our results identify no statistically significant improvements in MVC and walking ability which could be acknowledged as an effect of pulmonary rehabilitation. Further investigation is needed to clarify the effect of pulmonary rehabilitation on muscle oxygenation.
[Purpose] The purpose of this study was to evaluate job satisfaction and the role of the department of rehabilitation at a hospital as perceived by nurses who were actually working in the department. [Methods] Questionnaires were distributed to 92 nurses in the departments of orthopedics, cardiovascular surgery, neurosurgery, and internal. The questionnaires included questions on the responsibilities of the rehabilitation department, and the necessity of the rehabilitation department. The results were compared with the questionnaires completed in 2000. [Results] Sixty-six questionnaires were returned. In terms of job satisfaction, 42 were satisfied, and 15 were dissatisfied. In 2000, only 15 were satisfied. In terms of the necessity of the rehabilitation department, 64 felt it is necessary, and none felt it unnecessary. [Conclusion] The reason for the increase in the degree of job satisfaction is probably due to factors such as the initiation of heart rehabilitation, the increase of bedside physiotherapy, the increase in the number of staff members, and providing information on a Local Area Network at the hospital. Many nurses think that the rehabilitation department is necessary. They apparently recognize the importance of rehabilitation carried out by professionals to support patients' recovery.
[Purpose] This study examined physical and cognitive factors associated with falls by the elderly. The authors hypothesized that, elderly people who experienced at least one fall in the past 12 months would show delayed probe reaction time (P-RT) during walking compared with elderly people with no history of falls. [Subjects] The subjects were 101 elderly people (27 males, 74 females), and the subjects were divided into two groups: a Fall group and a No-fall group. [Methods] We evaluated the probe reaction time, Trail Marking Test Part-A (TMT-A), Timed Up and Go Test (TUG), walking speeds at a self- determined pace, and the gait cycle time. [Results] The Fall group showed longer P-RT, TMT-A, TUG times and slower walking speeds than the No-fall group and its coefficient of variation (CV) of the time for a gait cycle was increased. In logistic regression analysis with fall as the dependent variable, the probe reaction time was identified as an significant factor, and the cut-off value of the probe reaction time was 406 ms as evaluated by the Receiver-Operating-Characteristic (ROC) curve. [Conclusion] It was found that probe reaction time is both reliable and useful for the evaluation of the fall risk for the elderly.
[Purpose] The purpose of this study was to investigate the effectiveness of community-based Tai Chi (TC) training on balance control during stair descent by older adults. [Subjects] Participants were randomly assigned to either the TC group or the wellness education (WE) group. The participants in the TC group received TC training three times a week for 12 weeks. The participants in the WE group participated in a health education program for one hour weekly. [Methods] Subjects stood in a predetermined position at the top of a custom-built 3-step staircase and then negotiated the stairs at a self-paced speed. Participants were asked to place only one foot on each step (foot-over-foot). The changes in the translation of the center of pressure (COP) before and after TC training were measured. [Results] Subjects in the TC group showed a significant increase in the displacement of COP in the anteroposterior (A-P) and mediolateral (M-L) directions as well as average velocity of the COP displacement after Tai Chi training (p<0.01). There was little change in the COP displacement for subjects in the WE group. [Conclusion] These findings support the use of TC training as an effective fall prevention program to reduce the incidence of falls among the elderly.
[Purpose] The purpose of this study was to determine whether gender differences exist in the activity and ratio of the vastus medialis oblique and vastus lateralis muscles when performing a vertical drop landing. [Subjects] Thirty participants (15 males, 15 females) dropped from the height of their lower leg. [Methods] The EMG activities of the vastus medialis oblique and vastus lateralis muscles were recorded during vertical drop landing using surface electrodes. [Results] The muscle activities and the ratio of both muscles were significantly higher for males than for females. The muscle activity of the vastus medialis oblique muscle was 36.3% for males and 20.2% for females, and that of the lateralis muscle was 34.2% for males and 26.1% for females. The mean ratio of the vastus medialis oblique muscle : vastus lateralis muscle was 1.07 for males and 0.78 for females. [Conclusion] For females, drop landing in females may increase the likelihood of patellofemoral pain syndrome.
[Purpose] The aim of this study was to compare the effectiveness of pulsed and continuous diclofenac gel phonophoresis with topical diclofenac gel treatment. [Methods] Eighty patients with knee osteoarthritis were randomly assigned to 4 groups. The first group received continuous diclofenac gel phonophoresis, the second group received pulsed diclofenac gel phonophoresis, the third group received diclofenac gel with sham ultrasound, and the fourth group received acoustic gel applied with sham ultrasound. Range of knee motion, VAS pain at rest and in activity, the WOMAC Index and 20 m walking time were evaluated before the treatment, at the end of treatment and 1 month after the treatment. [Results] Improvements were found in VAS pain at rest, VAS pain in activity, WOMAC pain and physical function scores in all of the groups up to 1 month after the therapy. Both modalities of phonophoresis were shown to improve VAS pain at rest, VAS pain in activity, WOMAC pain and physical function scores compared to the other treatments. There was no significant difference in the improvements between the pulsed phonophoresis group and the continuous phonophoresis group. [Conclusion] We showed that both continuous and pulsed ultrasound diclofenac gel phonophoresis is more effective for pain and functional status of patients with knee osteoarthritis than topical application of diclofenac gel, and that the effectiveness of pulsed phonophoresis and continuous phonophoresis is similar.
[Purpose] The purpose of this study was to find out the characteristics of large and small arterial compliance and regional body composition in middle-aged and elderly adults. [Subjects] The subjects were 103 middle-aged and elderly adults (33 men and 70 women; mean age, 53.7 ± 8.4 years; range, 34-69 years). [Methods] Large and small arterial compliances were measured as indices of arterial wall elasticity. Waist circumference, hip circumference and the waist-to-hip ratio were anthropometrically determined. As an index of regional body composition, peripheral and central lean and fat mass were measured by a dual energy X-ray absorptiometry method. [Results] Large arterial compliance was negatively correlated with the waist-to-hip ratio. Small arterial compliance was positively correlated with peripheral and central lean mass. [Conclusion] We conclude that stiffness of large arteries is positively associated with increased abdominal fat mass relative to fat and lean mass of the hip and lower extremities in middle-aged and elderly adults, whereas stiffness of small arteries is inversely associated with muscle volume of the whole body.
[Purpose] The purpose of this study was to verify of the effect of continued home-visit rehabilitation on the functioning of frail elderly who had been discharged from acute beds. [Methods] Subjects were 31 frail elderly (27 women) aged 67-97 years old who had been discharged from acute beds. Home-visit rehabilitation was provided for them immediately after discharge. Body functions (20 items), activities (24 items), participation (2 items), and health status (2 items) were evaluated at the start of home-visit rehabilitation (baseline) and 3 months later by physiotherapists (PT). [Results] Compared to the functioning at baseline, 3 months later we found that 1) independence level of standing, walking, moving around inside and outside the home, going up and down of the stairs, 2) activity situation during daytime and frequency of going out, 3) mental functions and depression tendency, and 4) anxiety of falling had improved significantly. [Conclusion] The results show that home-visit rehabilitation provided continuously to the discharged elderly brought an excellent effect not only on improvement of activities of daily living (ADL) and amount of activity but also on mental function and depression tendency.
[Purpose] In this paper, we examined factors of physical function, reaction time and attention ability associated with falls. [Subjects] Twenty-seven young patients with post-stroke hemiplegia (males mean age 43.3±10.3 years), who had been receiving treatment at the China Rehabilitation Research Center, were divided into two groups: the Fall group and the No-fall group. [Methods] We evaluated the probe reaction time during walking, Trail Marking Test Part-A, Timed Up and Go Test, 10 m maximum walking speed, and the time of the walking cycle. [Results] The results show that the probe reaction time of the Fall group was slower, and the dispersion of the rhythm during walking was bigger than the No-fall group. In logistic regression analysis with fall as the dependent variable, the probe reaction time was identified as significant, and the cut-off value of the probe reaction time was 626 msec according to the ROC curve. [Conclusion] We consider that the probe reaction time is useful for the evaluation of falls risk in the patients with post-stroke hemiplegia.
[Purpose] This study investigated whether instability during standing occurs just after transcutaneous xenon light irradiation around the stellate ganglion. [Subjects] Thirty healthy volunteers were the subjects. [Methods] The subjects underwent two experimental sessions: 1) 10-minute xenon light irradiation around the bilateral stellate ganglions in a comfortable supine position (Xe-LISG); and 2) 10-minute rest in the same position as Xe-LISG (control). After Xe-LISG and the control, they stood up immediately and maintained quiet standing for 1 minute. The low frequency power (LF) and ratio of LF to the high frequency power (LF/HF) based on R-R intervals, and the total length (LNG) and rectangular area (REC) of the excursion of the center of foot pressure during quiet standing were examined. [Results] Although no significant changes of HF and LF/HF were observed before and after the control, HF after Xe-LISG was significantly greater than that before Xe-LISG, and LF/HF after Xe-LISG was significantly lower than that before Xe-LISG. Additionally, although no significant difference was observed between REC after Xe-LISG and that after the control, LNG after Xe-LISG was significantly longer than that after the control. [Conclusion] These results suggest that Xe-LISG causes not only parasympathetic predominance and sympathetic suppression but also instability during standing just after Xe-LISG.
[Purpose] The purpose of this study was to investigate the mechanism of muscular force improvement after low-intensity exercise with transient restriction of blood flow using compound muscle action potential (CMAP) analysis. [Subjects] Thirty healthy subjects in their 20s (mean age=21.73 years) were randomly assigned to an experimental group (EG) and a placebo control group (PG); each group had 15 subjects. [Methods] CMAP was analyzed by measuring terminal latency and amplitude using a motor nerve conduction velocity test. For Baseline 1, supramaximal electrical stimulation was applied to the median nerves of the EG and PG to obtain CMAP at the abductor pollicis brevis. For Baseline 2, the intensity of the electrical stimulation was decreased to a level at which the CMAP amplitude was about a third (1/3) of the CMAP amplitude obtained by supramaximal electrical stimulation. In the first test, CMAP was obtained under the same conditions as Baseline 2 after low-intensity thumb abduction exercises were performed at subjects' own pace for one minute. EG had blood flow restricted by a sphygmomanometer cuff, but PG did not. In the retest, CMAP was obtained under the same conditions as Baseline 2, one minute after the removal of the sphygmomanometer cuff immediately after the first test. [Results] PG did not show significant changes in CMAP, whereas EG showed a significant increase in CMAP amplitude, signifying that more muscle fibers were recruited. [Conclusion] This study found that low-intensity exercise with transient restriction of blood flow recruited more muscle fibers than low-intensity exercise without transient restriction of blood flow.
[Purpose] The purpose of this preliminary investigation was to obtain a professional consensus regarding current high-priority research questions (RQs) in the field of physical therapy. [Subjects and Methods] The Delphi method was utilized for 46 physical therapists (39 male, 7 female) who had obtained a master's degree in rehabilitation science from the University of Tsukuba. Subjects were asked to quickly list up to three current high-priority RQs in the field of physical therapy. [Results] A total of 20 questionnaires were returned, and 53 RQs were obtained in total for the study. The highest-ranking RQ was, "Is the difference between natural recovery and the effect of the treatment intervention clear?" [Conclusion] High-ranking RQs were influenced by the background of the promotion of Evidence-Based Medicine in recent years.
[Purpose] The timed up and go test (TUGT) requires no special equipment or training, and it is a simple clinical assessment tool. The aim of this study was to investigate the relationship between a quantitative ultrasound (QUS) parameter of bone strength and TUGT in Japanese community-dwelling elderly women. [Methods] Ninety-nine community-dwelling elderly women participated (mean age, 74.4 ± 5.7 years) in the present study. The speed of sound (SOS) in the right calcaneus was measured using a QUS device to assess bone strength. Physical function examinations included grip strength, single leg stance time, TUGT, and gait speed. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to assess each subject's functioning, and each subject's age, height, and weight were also collected. [Results] In multiple linear regression analysis controlling for age, of the physical function parameters, only TUGT was significantly related to SOS in all subjects. Furthermore, the relationship between SOS and TUGT was significant for those with high TMIG-IC scores, but SOS was not associated with any physical function parameters (including TUGT) for those with low TMIG-IC scores. [Conclusion] TUGT may contribute to the development of a simple clinical assessment tool that could be used to screen for hip fracture risk.
[Purpose] We examined the time course of changes in the activation of muscle satellite cells and muscle protein synthesis after a single session of low-intensity treadmill exercise. [Subjects] A total of 25 male Wistar rats aged 11 weeks were used. [Methods] Rats were run on a treadmill with a 16° decline for 30 min at 24 m/min, except for the control group (CON). Blood was collected to measure creatine phosphokinase (CPK) and both soleus muscles were removed to analyze histological and muscle gene expression at 24, 48, 72 and 96 h post-exercise. [Results] CPK levels in exercised rats at 24 and 96 h were significantly higher than in CON, and CPK levels at 96 h were higher than those at 48 h. Infiltration of macrophages and gathering of small myofibers were detected in the exercise group, but there were no significant differences in MyoD, myogenin, myosin heavy chain (MHC) -1 and MHC-2a mRNA levels. [Conclusion] These results suggest that muscle satellite cells and muscle protein synthesis are not significantly activated, despite the occurrence of myotrauma, in the acute phase (24 h to 96 h) after a single session of low-intensity exercise.
[Purpose] The purpose of this study was to investigate changes of gait strategy, by measurement of gait parameters and kinematic data of the lower limbs during walking on slopes with four different incline angles. [Subjects] A total of 23 healthy adults were recruited for the study. [Methods] Three-dimensional kinematic data were measured with a camera-based system, while subjects walked on an upslope at four different inclinations (0°, 8°, 16°, 24°). Data analyses were conducted using ANOVA with repeated measurements to determine the difference of gait parameters according to the slope inclinations.[Results] The kinematics during ascent of the slopes could be clearly distinguished from the kinematics of level walking. Spatio-temporal parameters were significantly affected by slope inclinations. The joint angle of the lower extremities in the sagittal plane was increased at slope inclinations greater than 16°. Ankle and knee joint angles in the frontal plane increased on the 16° and 24° slopes, and the hip joint angle increased on the 24° slope. The knee joint angle only increased on the 24° slope in the horizontal plane. [Conclusion] Alterations of the lower extremities in the sagittal plane were greater than in the other planes and the joint angles of the lower extremities were generally changed on slope of 16° or greater inclination. These results indicate the optimal inclination for slope climbing and may provide therapists with valuable therapeutic strategies for gait training on an inclined slope for patients with locomotion dysfunction.
[Purpose] This study was performed to clarify the relationship between respiratory muscle strength and exercise tolerance. [Subjects and Methods] Nine healthy adult male subjects (mean age 20.9 ± 0.3 years) were instructed to perform a ramp load exercise using a cycle ergometer. As measures of inspiratory muscle strength, maximal expiratory mouth pressure (PEmax) and maximal inspiratory mouth pressure (PImax) were measured before exercise and immediately, 15 minutes and 30 minutes after exercise. As measures of respiratory response, minute ventilation, respiratory frequency, tidal volume and oxygen uptake were measured using an exhaled gas analyzer. Heart rate was calculated from R-R intervals on an electrocardiogram as a measure of heart rate response. [Results] The results revealed significant correlations between PEmax and maximal exercise load, PImax and maximal exercise load, PEmax and peak VO2 and PImax and peak VO2. PEmax measured immediately after exercise was lower than that measured immediately before exercise. [Conclusion] These findings suggest a correlation between respiratory muscle strength, especially expiratory muscle strength, and exercise performance.
[Purpose] This review aimed: (1) to obtain all the facts regarding existing goal-setting methods in physical therapy; (2) to clarify the application status of the methods for stroke patients; and (3) to put forth a suggestion for the development of a format prepared by collaboration between stroke patients and physical therapists. [Methods] A systematic search was performed to identify the existing goal-setting methods and to obtain the relevant literature. We reviewed a total of 165 reports. [Results] We identified 8 types of goal-setting methods: Goal Attainment Scaling (GAS), the Canadian Occupational Performance Measure (COPM), goal forum intervention, and others. GAS was evaluated for its validity, reliability, and sensitivity for physically disabled children and the elderly, but there were no reports on the applicability of GAS to stroke patients. The COPM, which is a subjective measurement method using self-reporting, was evaluated for validity, reliability, and sensitivity for occupational therapy patients and physically disabled children. The goal forum intervention is a goal-setting method involving the collaboration of patients and physical therapists with the use of a check-list, but this method was developed for rheumatoid arthritis patients. [Conclusion] We recommend further studies on the development of a goal-setting method using a checklist for stroke patients and the evaluation of the validity and reliability of GAS for stroke patients.