[Purpose] For people with disabilities, public funding is the principal means by which assistive devices, such as wheelchairs and seating equipment, may be acquired. In the future, to make the system easier for beneficiaries, it is necessary to determine the actual utilization level in the current system. In this study, using statistical data provided by the Japanese government, we investigated the level of public expenditure on wheelchairs and postural support devices. [Methods] The number of devices (Wheelchairs, Powered Wheelchairs, Postural Support Devices, and Seating Furniture) provided each year from 1997 to 2016 was extracted and the annual trends were analyzed. [Results] In the last 20 years, the number of grants provided for wheelchairs has decreased, while the number of grants provided for seating equipment has increased. These changes may be due to the enactment of new legislation. [Conclusion] Based on the anticipated service life of various types of equipment, it is believed that approximately 970,000 assistive devices in the four categories are provided with public funding alone. As the number of people with disabilities increases, the use and importance of assistive devices is also expected to increase.

[Purpose] The purpose of this study was to evaluate the early effects of a knee-ankle-foot orthosis on static standing balance in people with subacute stroke. [Participants and Methods] Timed static standing balance in four standing conditions (feet apart with eyes open, feet apart with eyes closed, feet together with eyes open, and tandem stance with eyes open) was assessed in 29 inpatients (mean age: 67.3 ± 13.3 years) with subacute stroke with and without a knee-ankle-foot orthosis on the paretic lower limb. [Results] In the group of participants who were unable to stand without a knee-ankle-foot orthosis, the proportion of participants who were able to stand with a knee-ankle-foot orthosis was significantly increased in the following conditions: feet apart with eyes open and feet apart with eyes closed. In the group of participants who were able to stand without a knee-ankle-foot orthosis, the mean duration of time for which the participants with a knee-ankle-foot orthosis were able to stand was significantly longer than that for those without a knee-ankle-foot orthosis for all standing conditions. [Conclusion] A knee-ankle-foot orthosis may be a useful assistive device to support static standing balance for people with subacute stroke.

[Purpose] The purpose of this study was to examine the effects of Taekkyon training on balance control during stair descent in community-dwelling older adults. [Participants and Methods] Participants were randomly assigned to either the Taekkyon group or wellness education group. The participants in the Taekkyon group received Taekkyon training 2 times a week for 12 weeks. The participants in the wellness education group participated in a health education program 1 hour weekly for 12 weeks. Subjects stood in a predetermined position on the top of the custom-built 3-step staircase and then descended the stairs at a self-paced speed. The changes in the translation of the center of pressure before and after Taekkyon training were measured. [Results] The Taekkyon group showed a greater increase in the displacement of the center of pressure in the anteroposterior and mediolateral directions as well as the average velocity of the center of pressure in posttesting than the wellness education group. The Taekkyon group also showed a significant increase in all measures after Taekkyon training. However, little change was found in all measures in the wellness education group. [Conclusion] These findings support the use of Taekkyon training as an effective fall-preventive rehabilitation program to reduce falling in older adults.

[Purpose] The objective of this study is to identify the influence of ocarina practices on the lung function of a group of healthy female ocarina players aged 40 and above in comparison to an age-matched group of females with no experience with ocarina playing. [Participants and Methods] Spirometry measurement has been conducted on both groups of 35 healthy females aged 40 and above, one with regular participation in ocarina practices (experimental group) and the other without (control group). [Results] FEV₁ and FEV₁/FVC values of those in the experiment group who practiced ocarina on a regular basis turned out to be significantly higher than the control group, and there was no significant difference on FVC. [Conclusion] This study indicates that ocarina practices on a regular basis helps middle-aged females improve their lung functions particularly in FEV₁ and FEV₁/FVC.

[Purpose] Ineffective and prolonged treatment of low back pain is a major social problem resulting in a huge economic burden. The effectiveness of back pain and/or leg pain treatment using active soft tissue release alone or in combination with a trigger point block was examined. [Participants and Methods] Among 115 patients who underwent medical examination at Senshunkai Hospital during the study period, information on treatment outcomes using active soft tissue release alone or in combination with a trigger point block, location of myofascial trigger points, and duration of treatment were extracted for patients with low back pain, leg pain, or low back pain with leg pain. [Results] Myofascial pain syndrome was diagnosed in 73.4% (36/49) in the low back pain group, 50% (16/32) in the leg pain group, and 85.3% (29/34) in the low back pain with leg pain group. Symptom improvement was noted in all three groups with active soft tissue release alone (90.9%, 20/22; 90.0%, 9/10; and 100%, 14/14, respectively) and active soft tissue release + a trigger point block (90.9%, 10/11; 100%, 1/1; and 92.9%, 13/14, respectively). The gluteus medius was the major myofascial trigger point in all groups. [Conclusion] Manual therapy with active soft tissue release and a trigger point block constitutes an effective treatment combination for low back pain and leg pain, but prolonged treatment is required in chronic cases.

[Purpose] The purpose of this study is to examine the sleep quality, pain, and instrumental activities of daily living (IADL) of outpatients with chronic stroke, and to examine their correlation. [Participants and Methods] This study was conducted on 42 outpatients with chronic stroke, and data on their sleep quality, pain, and instrumental activities of daily living were collected and analyzed using the survey measurement tools. [Results] The analysis shows significant correlations among the sleep quality, pain, and instrumental activities of daily living of the outpatients with chronic stroke. [Conclusion] The findings of this study confirmed that the sleep quality and pain of outpatients with chronic stroke was related with their capacities of instrumental activities of daily living.

[Purpose] To demonstrate the reduction of symptoms related to Parkinson’s disease by improvement in posture. [Participant and Methods] A 59-year-old male patient presented with a prior diagnosis of Parkinson’s. Symptoms included a resting right hand tremor, intermittent ‘freezing episodes’ with gait, mild ataxia with shuffling on toes and bradykinesia assisted with a cane, as well as low back pain and right knee pain. Radiography revealed gross postural and spine deformity. The patient received Chiropractic BioPhysics care including mirror image exercises, spinal traction, spinal adjustments as well as gait rehabilitation. [Results] After 38 treatments over 5 months, the patient had significant improvements in posture alignment as well as gait, balance, hand tremors, low back and knee pains and SF-36 values. A 21 month follow-up revealed the patient had remained essentially well and the initial postural improvements were maintained. [Conclusion] This case demonstrates improvement of various symptoms in a patient with Parkinson’s disease. Since poor posture is a long known clinical manifestation of this disorder, it is proposed that the improvement of posture in these patients may lead to improved outcomes. X-ray use in the diagnosis and management in those with spine deformity is safe and not carcinogenic.

[Purpose] There is a paucity of high-quality data pertaining to the conservative management of adult spinal deformity, particularly Scheuermann’s kyphosis. Long-term follow-up data for both treated and untreated Scheuermann’s patients is also lacking. Given that changes in sagittal balance are associated with increased morbidity, and that these changes are increasingly prevalent in the spines of ageing populations, it is imperative that potential strategies aimed at reversing or minimizing this type of deformity are explored. As the number of elderly patients in developed countries increases, so does the need for a safe and effective non-surgical management option for patients with spinal deformity/sagittal imbalance. This case study details the influence of ScoliBrace rigid TSLO bracing in combination with a specific rehabilitation program in an adult patient with Kypho-scoliosis. [Participant and Methods] The authors describe a case involving the treatment of a 26-year-old male with Scheuermann’s kyphosis and a lumbar scoliosis. The patient received 12 months of bracing with a supplemental exercise program. The patient was followed for a period of approximately 12 months. Patient progress was assessed using ODI, SRS-22r, NPRS, and radiographic Cobb angle measurements throughout treatment. [Results] The patient presented with an initial ODI score of 18/100, a SRS-22r score of 3.0, and an average NPRS score of 4/10. Initial Cobb angle measurements demonstrated a 79° thoracic kyphosis and a 30° (coronal plane) lumbar scoliosis. At the final assessment, the patient reported an ODI score of 6/100, an SRS-22r score of 3.91, and an average NPRS score of 0/10. The coronal plane Cobb angle measured 63°, and the thoracolumbar scoliosis had reduced to 25°. [Conclusion] The findings from this case study highlight that this type of brace in combination with exercise rehabilitation may be useful for reducing the magnitude of curves and reducing symptoms in patients presenting with adult kypho-scoliosis. Further investigation of this style of treatment is warranted in patients with sagittal plane imbalance.

[Purpose] There have been many study ipsilateral erector spinae in regard of prone hip extension (PHE). However, mediating methods have been focusing on the reinforcement of gluteus. Hereupon, this study is intended to identify how an increase of gluteus maximus influences on posterior oblique sling (POS) and suggest a mediating method to effectively reinforce them. This study shows the seclective POS strength exercise. [Participants and Methods] This study has been conducted on normal male (13) and female (13), and participants were asked to proceed PHE exercise and prone hip extension with hip abduction with knee flexion (PHEAKF). Surface electromyography (EMG) was recorded from the contralateral latissimus dorsi, contralateral erector spinae, ipsilateral erector spinae, ipsilateral gluteus maximus, and ipsilateral biceps femoris. A paried t-test was used to compare muscle activity POS. [Results] EMG activity of the contralateral latissimus dorsi, ipsilateral erector spinae, and ipsilateral gluteus maximus was significantly greater performed PHEAKF than PHE. As for ipsilateral biceps femoris, muscle activation was lower in PHEAKF than PHE. [Conclusions] According to the results of this study, increase in muscular activation from the direction of muscular fiber and posterior oblique sling seems to be an important factor that influencontralateral crector spinae on muscular activation of POS.

[Purpose] Although much researches have been conducted on the hippotherapy, the intervention methods of the previous studies focus on the pelvis posture. Thus, this study analyzed the electromyogram (EMG) of trunk muscle and lower limb muscle to analyze the kinetic factors. Based on the analysis, this study aims to compare the muscle load and suggest effective exercise method. [Participants and Methods] This study checked the muscle activity of Rectus abdominis (RA), Erector spinae (ES), Rectus femoris (RF), Adductor magnus (AM) during the exercise using horse riding machine in dorsiflexion position by bending 20 degrees and in neutral position. Each position was performed for 5 minutes and the speed of the horse riding machine was set to medium speed. [Results] Rectus abdominis showed higher muscle activity in dorsiflexion position and the groups had significant differences. Elector spinae showed higher muscle activity in dorsiflexion position and the groups had significant differences. Rectus femoris showed higher muscle activity in dorsiflexion position and the groups had significant differences. Adductor magnus also showed higher muscle activity in dorsiflexion position and the groups had significant differences. [Conclusions] The study result showed that exercise with horse riding machine in dorsiflexion position activates trunk muscle and thigh muscle effectively. Thus, the study suggests more effective posture for the modern people who exercise with horse riding machine for strengthening physical health.

[Purpose] The purpose of this study was to identify which physical attribute could influence each outcome in the Stand-up test and the Two-step test and the degree of their involvement. [Participants and Methods] The participants were 2,476 people (1,674 males and 802 females), who underwent a two-day health checkup and were requested to take the Locomotive Syndrome Risk Test (Locomo Test). Participants were divided into groups under the Locomo level based on the result of Locomo Test by gender. Furthermore, the relationship between each physical attributes (quartile) based on the result of Locomo Test and the Locomo level was evaluated. [Results] According to the relationship between each physical attributes and Locomo level 1 in the Stand-up test, height showed a positive relationship and the multivariable adjusted odds ratio significantly increased with taller height in both genders. Body weight and BMI showed a negative relationship, although rather weak positive relationship, it was identified in waist circumference. On the other hand, there was no clear correlation between each physical attribute and Locomo level 1 in the Two-step test. [Conclusion] The findings indicate The Stand-up test would overestimate the decline of locomotor function in taller people and would underestimate it in shorter individuals.

[Purpose] To clarify the sitting postural control, the influences of several reference sitting positions on the perception of the trunk position while sitting with the feet in contact with the floor and keeping the eyes closed were investigated. [Participants and Methods] Fifteen young healthy volunteers participated in the present study. The perception of the trunk position was evaluated by calculating the absolute error (error magnitude) and constant error (error direction) between the reference trunk position (which the subjects memorized; the reference position) and the position that they adopted when reproducing the reference position (the reproduced position). Eight reference positions were set at 5° increments (from 15° backward inclination [−] to 20° forward inclination [+]). [Results] The reference positions had a significant effect on the absolute error, and the absolute error values at −15° and −10° were significantly smaller than at 20°. However, the reference positions had no effect on the constant error. [Conclusion] The present study revealed that the perception of the trunk position while sitting with the feet in contact with the floor is better when inclining backward than when inclining forward. The perception of the trunk position may be higher in a low-stability position and lower in a high-stability position.

[Purpose] This study aimed to investigate the association between two skeletal muscle mass indices and insulin resistance, and to determine the skeletal muscle mass index that is beneficial in evaluating insulin resistance in patients with type 2 diabetes mellitus. [Participants and Methods] This study evaluated 136 male and 100 female patients with type 2 diabetes mellitus. The skeletal muscle mass was evaluated by bioelectrical impedance analysis. Two skeletal muscle mass indices were investigated as the appendicular skeletal muscle mass index (appendicular skeletal muscle mass divided by the square of height) and relative total skeletal muscle mass (total skeletal muscle mass as a percent of body weight). The homeostasis model assessment of insulin resistance was used as a marker of insulin resistance. Associations were investigated by grouping the participants according to gender and age (<60 or ≥60 years). [Results] The appendicular skeletal muscle mass index was positively associated with the homeostasis model assessment of insulin resistance, except in male patients aged ≥60 years, whereas the relative total skeletal muscle mass was significantly inversely associated with the homeostasis model assessment of insulin resistance, in all patient groups. The cutoff values of the relative total skeletal muscle mass for the presence of insulin resistance were 37.9% and 32.5% in male and female patients, respectively. [Conclusion] This finding suggests that relative total skeletal muscle mass may be a better indicator of insulin resistance than appendicular skeletal muscle mass index is, in patients with type 2 diabetes mellitus.

[Purpose] To determine the short-term effects of thoracic manipulation, used alone or in conjunction with the Rungthip massage technique, on pain and neural extensibility in patients with chronic mechanical neck pain. [Participants and Methods] Thirty participants were randomly allocated to the aforementioned two groups. Outcome measures were neck pain at rest assessed using the Visual Analog Scale, and elbow extension range of motion evaluated using Upper Limb Neurodynamic Test 1 prior to treatment and three weeks after it. [Results] A statistically significant reduction in resting neck pain, and an improvement in elbow extension range of motion was reported by both groups shortly after the moment when the pain was first felt (threshold level). However, an improvement in elbow extension range of motion was not observed in either group at the maximum level of pain (tolerance level). A significant reduction in resting neck pain was seen in the thoracic manipulation plus Rungthip massage group, compared to that achieved using thoracic manipulation alone. [Conclusion] The use of thoracic manipulation and Rungthip massage is recommended to reduce resting neck pain and increase pain-free neural tissue extensibility.

[Purpose] Hallux valgus occurs in the forefoot where the transverse arch is located and may be a factor involved in forefoot pain. The relationship between forefoot pain and forefoot structure is unknown. This study aimed to analyze the relationship between forefoot pain and the transverse arch in patients with hallux valgus. [Participants and Methods] In this study, 122 (197 feet) adult females (46 to 86 years old) with hallux valgus were studied. By using questionnaires, the females were divided into two groups depending on whether or not they had forefoot pain (a group with forefoot pain [P group] and a group without forefoot pain [NP group]). The hallux valgus angle was measured using a goniometer, and the transverse arch was measured using a weight-bearing plantar ultrasonography imaging device. The transverse arch measurements included the transverse arch height and length. [Results] Only the transverse arch length, even after adjustment, was significantly greater in the P group. No significant difference was found between the hallux valgus angle and the transverse arch height. [Conclusion] The greater transverse arch length in the P group was possibly due to the collapsing transverse arch support muscles. Increased width probably caused inadequate impact absorption which in turn led to forefoot pain.

[Purpose] Obstetric brachial plexus injuries are accompanied by co-contractions due to misdirection of regenerated nerve fibers. The result is inhibition of arm movement necessary for activities of daily living. Rehabilitation is important to prevent joint contracture and muscle atrophy in such cases. A single-joint hybrid assistive limb is a new wearable robot that can assist in elbow joint motion by detecting muscle action potentials on the upper limb surface. Inhibiting co-contractions due to obstetric brachial plexus injuries with this device may help with performance of activities of daily living. This study aimed to evaluate the safety and efficacy of using a single-joint hybrid assistive limb combined with conventional rehabilitation in a patient with obstetric brachial plexus injuries. [Participant and Methods] A 40-year-old male with bilateral obstetric brachial plexus injuries and co-contractions of the biceps and deltoid underwent rehabilitation training using the single-joint hybrid assistive limb 3 times a week for 12 sessions (4 weeks) in both upper limbs. [Results] The patient completed all 12 sessions of training using the single-joint hybrid assistive limb with no adverse events. Improvements in flexion strength in the left elbow, active flexion range of motion in both elbows, and functional tests in the right arm were observed. [Conclusion] Elbow training using the newly developed single-joint hybrid assistive limb combined with conventional rehabilitation can be performed without severe adverse events and may improve muscle strength, range of motion, and arm functions in adults with obstetric brachial plexus injuries and bilateral co-contractions of the deltoid and biceps muscles.