[Purpose] Flatfoot often presents in patients with Down syndrome, and it can be diagnosed using a simple radiograph. Consequently, due to radiograph limitations, alternative non-invasive testing must be determined. Conventionally, arch height ratio can be used for evaluation of the medial longitudinal arch, where the foot is evaluated by detecting the navicular bone on the foot surface. However, detection of the navicular tuberosity is difficult and even though the detection is relatively straightforward for patients without intellectual disability, measuring navicular bone is more difficult in patients with intellectual disability, such as those who have Down syndrome and are uncooperative with a tester. Therefore, we evaluated arch height ratio using the malleoli instead of the navicular bone to determine whether malleoli testing was appropriate for patients with Down syndrome that have an intellectual disability. [Participants and Methods] We conducted a retrospective study of 16 pairs of feet in 16 patients with Down syndrome, diagnosed with flatfoot. The height to the centre of the talo-navicular joint and that of the malleoli from the sole were measured on radiographs using weight-bearing conditions. [Results] The age range was 5.2 to 25.3 years. There was a correlation between the height of the navicular bone and that of the medial and lateral malleoli. [Conclusion] We conclude that the medial and lateral malleoli can substitute navicular bone as a landmark diagnosis test for flatfoot. Considering the close physical distance between the medial malleolus and navicular bone, and the association between the tibia and medial longitudinal arch, the medial malleolus may provide a better landmark in patients with Down syndrome with it being potentially less invasive for uncooperative patients.

[Purpose] The purpose of this study was to examine the effect of nutritional status on the prognosis of patients with severe hemiplegia who were recently admitted to a convalescent rehabilitation hospital. [Participants and Methods] Eighty patients with stroke and severe hemiplegia were divided into two groups based on their serum albumin levels: normal (serum albumin 3.5 g/dL or more) and undernourished group (serum albumin 3.4 g/dL or less). Background characteristics, cognitive function, neurological symptoms, physical function at admission, and outcome were compared between groups. [Results] There were no differences found between groups in terms of cognitive function, neurological symptoms, physical function at admission, destination, and length of stay at the hospital. In contrast, age and duration from onset to admission were significantly lower in the normal group than in the undernourished group. The ability to walk and perform activities of daily living (ADL) at discharge was significantly higher in the normal group than in the undernourished group. [Conclusion] As a result, the findings of the present study suggest that in patients with severe hemiplegia, nutritional status at the time of admission determines the improved walking and ADL ability at the time of discharge.

[Purpose] To explore the views of clients referred for physical therapy in a tertiary care setting regarding the integration of physical therapy service at primary health care centers. [Participants and Methods] A self-administered questionnaire was distributed to eligible Saudi clients. The questionnaire consisted of three sections including demographic information section; closed-ended section with 6 Likert scale items on the perceptions of potential advantages of physical therapy service at the primary health care level; and open-ended section on potential disadvantages and barriers of implementing physical therapy service. The surveys were described and analyzed quantitatively and qualitatively. [Results] A total of 412 participants were included in the analysis (56.8% females). Participants’ mean age was 35.7 ± 21.9 years; 67.2% were Riyadh city residents; and 38.1% had musculoskeletal conditions. Seventy-five percent responded in support for the availability of physical therapy service at the primary health care level. Demographic characteristics had no effect on the level of support to the service availability. [Conclusion] The results of this survey demonstrated high positive support for the integration of physical therapy service at primary health care centers in Saudi Arabia. However, challenges and barriers identified by the study results require attention when physical therapy services are to be established.

[Purpose] In this study, we aimed to determine which typical postures or an arm-supported posture were more comfortable and conducive to respiratory function, during seated defecation. [Participants and Methods] In 73 healthy adults, we measured and compared respiratory function and subjective contentment associated with 3 sitting defecation postures: upright, forward-leaning, and arm-supported forward-leaning. [Results] Vital capacity (VC), forced vital capacity (FVC), maximal expiratory pressure (MEP), and subjective comfort were significantly greater in the arm-supported forward-leaning position than in the other 2 positions. [Conclusion] The arm-supported forward-leaning position for defection increased the VC and was subjectively comfortable. Moreover, the high MEP in this position, compared with the other 2 positions, may have facilitated strain. A detailed examination of the cause for the observed increase in comfort was beyond the scope of this study; therefore, this effect requires further investigation.

[Purpose] We aimed to detect muscle activity during a forearm pronation exercise using a 0.2 T MRI system. [Participants and Methods] We recruited healthy adult volunteers (7 males, 4 females). Transverse relaxation time (T₂) values for 10 forearm muscles were obtained from transverse multiple-spin-echo MR images of one-third of the ulna, lengthwise from the olecranon, in the resting state and after isotonic forearm pronation exercise at three strength levels (5, 15, and 25% of the maximum voluntary contraction). Z values were calculated as (T_2e − T_2r)/SD_r, where T_2e, T_2r and SD_r were T₂ after exercise, 34 ms, and 3 ms, respectively. A Z value of 2.56 was used as the threshold for defining muscle activation. [Results] T₂ values increased significantly in the pronator teres muscle (agonist), while those in the supinator muscle (antagonist) showed no change. The sensitivity and specificity values obtained were high and low, respectively, for all of the three exercise strength levels employed. In some of the participants, activity was detected in the flexor carpi radialis, extensor carpi ulnaris, and extensor digitorum. [Conclusion] Using T₂-map MRI, we detected activity in primary and secondary mover muscles. We also found individual variations in the use of forearm muscles during pronation.

[Purpose] We aimed to determine the cause of floating toe syndrome, along with methods for correction and prevention. [Participants and Methods] We recruited 93 Japanese male students. Participants were grouped, according to primary sport, as Sprinters (SPR), Swimmers (SWM), Gymnasts (GYM), Kendoists (KND) and Controls (CON). Degree of floating toe syndrome was measured according to whether any toe was not in full contact with the ground in a static standing posture—the Floating Toe Point (FTP). Two points were given for each toe that was not at the FTP. The sum of the FTP was defined as the Floating Toes Score (FTS), and was classified as follows: Normalcy (over 18 points), Incomplete Contact (between 10 and 17 points), and Floating Toes (Under 9 points). [Results] The mean FTS for all participants (10.40 ± 5.803) met the criteria for Floating Toes. Scores were highest for SWMs (13.46 ± 5.710), followed by GYMs (13.26 ± 4.505), and SPRs (12.00 ± 4.870), who all met the criteria for Incomplete Contact. Both KNDs (6.55 ± 5.409) and CONs (9.45 ± 4.824) met the criteria for Floating Toes. [Conclusion] SWMs had the highest FTSs, followed by GYMs, and SPRs. KNDs had the lowest FTS. However, no group was classified as Normal. We suggest that athletes who practice or train with bare feet do not necessarily have higher FTSs, if evaluated in the standing posture.

[Purpose] We aimed to examine the relationship between gross motor function, selective motor control (SMC), range of motion (ROM), and spasticity in the lower extremities of adults with cerebral palsy (CP), as well as the proximal to distal distribution of SMC impairment in lower extremity joints. [Participants and Methods] We recruited 11 adults with bilateral spastic CP, ranging from levels I to III according to the Gross Motor Function Classification System (GMFCS). We evaluated participants according to the Selective Control Assessment of the Lower Extremity (SCALE), ROM, and the Modified Ashworth Scale (MAS). We conducted the Friedman test to assess differences among the SCALE scores of each joint. The relationship between GMFCS level, SCALE scores, ROM, and MAS scores was assessed. [Results] The mean SCALE scores were lower for distal than for proximal joints. The SCALE scores of each leg showed significant inverse correlations with the GMFCS level. [Conclusion] SMC in adults with CP strongly influences gross motor function. SMC did not have a significant relationship with spasticity or ROM. SMC, ROM, and spasticity independently influenced gross motor function in adults with CP. SMC impairment in adults with CP was higher in distal than in proximal joints.

[Purpose] Children with autism spectrum disorder (ASD) exhibit many problematic mealtime behaviours. Currently, there is no process for measuring the mealtime behaviours of children with ASD in Japan. Therefore, we developed the ASD-Mealtime Behaviour Questionnaire (ASD-MBQ) using the results of surveys measuring problematic mealtime behaviours in Japanese children with ASD aged 3–18 years. The objective of this study was to analyse the structural validity of the ASD-MBQ in Japan. [Participants and Methods] We recruited 378 children with ASD aged 3–18 years and performed a confirmatory factor analysis on the ASD-MBQ by using a five-factor structure. [Results] The confirmatory factor analysis demonstrated structural validity (χ²=796.5, degrees of freedom=265, comparative fit index=0.901, root mean square error of approximation [90% confidence interval]=0.073 [0.067–0.079]). [Conclusion] We have demonstrated the structural validity of the ASD-MBQ, which provided useful information for planning interventions and evaluations for children with ASD. Further studies need to consider cut-off score by age and inter-rater reliability.