[Purpose] We aimed to clarify the effects of different baggage carrying methods on the movement of the trunk and pelvis while walking with an arm sling in simulated hemiplegic stroke patients. [Participants and Methods] The participants were 14 healthy young adults. Measurements were obtained using a three-dimensional motion analysis device in the following order: normal walking, walking with an arm sling on the upper left limb, walking with baggage on the right side, vertical walking, and diagonal walking. The range of motion of the trunk and pelvis during one walking cycle was analyzed. [Results] The range of motion of the lateral tilt of the pelvis significantly differed between normal and vertical walking, as well as between normal walking and diagonal walking. A significant difference was observed in the range of movement in pelvic rotation during the three walking cycles—walking with baggage, vertical walking, and diagonal walking. The range of movement in pelvic rotation was seemingly smaller under other conditions compared to that in normal walking. [Conclusion] It was shown that walking with restrictions on the upper limbs, such as wearing an arm sling or carrying baggage, may impose slight restrictions on the lateral tilt as well as on the rotation of the pelvis.

[Purpose] The purpose of this study was to identify the roles of caregivers in preventing patients with severe Alzheimer’s disease with loss of language skills from becoming distracted while eating their meals. [Participants and Methods] The study was conducted on two residents of a nursing home with severe Alzheimer’s disease who had lost their language skills. In this study, by comparing the scenes in which the two participants were distracted and not distracted from eating, we analyzed the factors associated with patients with severe Alzheimer’s disease who had lost their language skills becoming distracted and factors that prevented them from becoming distracted from eating at mealtimes and considered the roles of caregivers. [Results] The participants became distracted from eating where they were in a lively environment. On the other hand, they were not distracted when they were made to sit and eat in quiet environments. [Conclusion] Patients with severe Alzheimer’s disease who have lost their language skills cannot filter out a range of other information around them and focus on the information necessary to oneself. The role of caregivers is to serve as filters for patients with severe Alzheimer’s disease who have lost their language skills and whose selective attention abilities have become impaired.

[Purpose] Blood lactate reduction helps in understanding muscle recovery. Although light exercise and stretching are known interventions to reduce its concentration, the impact of skeletal muscle mass on blood lactate clearance is unknown. This study aimed to determine the relationships between blood lactate reduction and skeletal muscle mass following exercise. [Participants and Methods] Healthy non-athletic males performed squat jumps for 1 minute and 30 seconds. Blood lactate level was measured before and immediately after the exercise and then every 2 minutes for a period of 20 minutes. The decrease in blood lactate level was estimated as the difference between the minimum and maximum values. The rate of decrease was calculated by dividing the decrease in blood lactate level by time. Blood lactate level was measured using Lactate Pro^TM 2, while skeletal muscle mass was assessed using InBody 430. [Results] There was a significant positive correlation between skeletal muscle mass, the amount of blood lactate level reduction, and the rate of reduction of blood lactate level. [Conclusion] Our results demonstrated that greater skeletal muscle mass enabled a greater decrease in blood lactate level, suggesting that skeletal muscle mass may be involved in the reduction of blood lactate level after a squat jump. Interventions to increase skeletal muscle mass may promote more efficient lactate metabolism and muscle fatigue recovery.

[Purpose] This study aimed to clarify the influence of the isometric contraction of the quadriceps (ICQ) with low intensity on the circulation in the infrapatellar fat pad (IFP). [Participants and Methods] The participants were 7 males and 5 females, with an average age of 21.5 ± 1.4 years. IFP hardness was measured using shear wave ultrasound elastography and Biodex. Tissue oxygenation was measured via near-infrared spectroscopy using oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and total hemoglobin (cHb) as indices. The mean values were calculated for three periods: 1 min of rest immediately before the exercise task (before ICQ), the lower limit of the 10 sets during the exercise task (during ICQ), and 3–4 min after the exercise task (after ICQ). IFP hardness was compared between resting conditions and ICQ, and tissue oxygenation was compared before, during, and after ICQ. [Results] ICQ significantly increased IFP hardness. Tissue hemoglobin, O2Hb, and cHb decreased significantly during ICQ and increased after ICQ compared to that before ICQ. HHb decreased during ICQ and recovered significantly after ICQ. [Conclusion] In healthy participants, low-intensity ICQ increases the hardness and oxygenation of the IFP. This study may partly explain the unknown pain relief mechanism of exercise therapy.

[Purpose] The purpose of this study was to investigate the factors of ankle instability by using Cumberland ankle instability tool (CAIT), which have been frequently used as ankle instability tools. The participants were divided into the normal ankle group and the instability ankle group. Maximum strength, proprioception, dynamic balance and maximum rage of joint motion were compared in order to find out factors of instability in the questionnaires. [Participants and Methods] A total of 44 participants were classified into the control (CON) group and the chronic ankle instability (CAI) group according to questionnaire types. Muscle strength, proprioception, dynamic balance and maximum joint angle were measured. The independent t-test was used. [Results] In the case of maximum ankle strength, it showed significance in CON group and CAI group ankle dorsiflexion and plantarflexion. In proprioception, it showed significance in CON group and CAI group. In dynamic balance, it showed significance in anterior (ANT) direction of the CON group and CAI group. Maximum joint angle produced significance in dorsiflexion of CON group and CAI group. [Conclusion] Information on maximum strength, proprioception, dynamic balance of anterior direction, and maximum joint angle of dorsiflexion is available through questionnaire CAIT.

[Purpose] This study aimed to compare the results of two questionnaires administered in 2013 and 2020, on the level of awareness and understanding of trunk muscle training. [Participants and Methods] In total, 238 soccer club members in high schools responded to our questionnaire regarding trunk muscle training. Two teams were recruited from the top (top 4), middle (top 16), and bottom levels (first-round losers), according to the prefectural tournament’s results in 2019. This questionnaire comprised questions divided into four parts: 1. Prevalence of trunk muscle training; 2. Knowledge of the classification of trunk muscles (local and global); 3. Consciousness of local and global muscles during trunk muscle training; and 4. Knowledge of the role of each muscle. These results were compared to those obtained from the survey in 2013. [Results] A significant difference was observed only in the responses to question 2. Regarding question 2 in 2020, several student-athletes in the top-level teams were aware of muscle classification compared to those in the middle- and lower-level teams. [Conclusion] The number of athletes who understood the classification of trunk muscles increased significantly in 2020. Therefore, in the future, we would need to better educate young athletes concerning the purpose of trunk muscle training and the role of each muscle.

[Purpose] To determine if runners with patellofemoral pain (PFP) exhibit higher patellofemoral joint (PFJ) stress and trunk extension compared to pain-free runners during treadmill running. [Participants and Methods] Twelve runners (7 with PFP and 5 pain-free) participated in this study. Participants ran at 3 different running conditions: self-selected, fast (120% of self-selected), and slow (80% of self-selected) speeds. Kinematics and kinetics of trunk and lower extremities were obtained. PFJ stress, PFJ reaction force, and PFJ contact area were determined using a biomechanical model. Two-factor ANOVAs with repeated measures were used to compare outcome variables between 3 speeds and between 2 groups. [Results] There was no significant difference in peak PFJ stress between groups across the 3 speeds. Peak PFJ stress was lowest during slow running compared to fast and self-selected running speed conditions across both groups. No significant difference was found in trunk flexion angle, PFJ reaction force, or PFJ contact area between groups across the 3 speeds. [Conclusion] Runners with and without PFP exhibited similar peak PFJ stress and trunk flexion angle during treadmill running. This preliminary work does not support the theory that reduced trunk flexion during running contributes to increased PFJ stress in runners with PFP.

[Purpose] Muscle weakness in patients with chronic kidney disease is associated with several disease-related factors, and this study aimed to examine whether hemodialysis is one of risk factors for muscle weakness in patients with chronic kidney disease. [Participants and Methods] We conducted a cross-sectional study with 74 non-dialysis and 84 hemodialysis patients. Muscle strength evaluations were performed by measuring isometric knee extensor muscle strength and grip strength. Each evaluation item was compared between the hemodialysis and non-dialysis groups, and multiple regression analysis was performed to determine the factors associated with muscle strength. In addition, the correlation between lower-extremity muscle strength and grip strength was examined in each group. [Results] Isometric knee extensor muscle strength was significantly lower in the hemodialysis group than in the non-dialysis group. Grip strength was also significantly lower in the hemodialysis group than in the non-dialysis group. Hemodialysis was determined to be an independent risk factor associated with lower limb muscle strength as well as grip strength. The positive correlation between isometric knee extensor muscle strength and grip strength was almost the same in the groups. [Conclusion] Hemodialysis treatment was an independent risk factor for muscle weakness. Regular monitoring of grip strength may facilitate better management with physical therapy in hemodialysis patients.

[Purpose] This study investigated the effects of co-contraction resistance exercises of the transverse abdominal and pelvic floor muscles in middle-aged females with stress urinary incontinence. [Participants and Methods] We included 32 females with stress urinary incontinence and divided them into two groups: the inner muscle training group and the pelvic floor muscle group. The thickness of the transverse abdominal muscle was measured during four tasks: (1) rest, (2) maximum contraction of the transverse abdominal muscle, (3) maximum contraction of the pelvic floor muscle, and (4) maximum co-contraction of the transverse abdominal and pelvic floor muscles. In the latter three tasks, measurements were obtained while the participants performed resistance movements using a Thera-band^®. A home program was conducted in both groups, and the intervention lasted for 8 weeks. [Results] The cure rates for SUI were 87.5% and 68.8% in the inner muscle training and pelvic floor muscle groups, respectively. After the intervention, the thickness of the transverse abdominal muscle significantly increased in the inner muscle training groups performing maximum co-contraction of the transverse abdominal and pelvic floor muscles and maximum contraction of the transverse abdominal muscle. [Conclusion] Inner muscle training exercises are more effective than pelvic floor muscle exercises in improving inner muscle function and urinary incontinence in middle-aged females.

[Purpose] We aimed to investigate the changes in the swallowing sounds of healthy adults during neuromuscular joint facilitation treatment using neck patterns. [Participants and Methods] A total of 20 healthy adults (10 males and 10 females; mean age, 29.2 ± 6.3 years) swallowed 10 mL of water four times under three conditions (after the neuromuscular joint facilitation neck-flexion resistance pattern, after the Shaker-type exercise, and during relaxed sitting without prior exercise [control]), randomly ordered with an interval greater than 3 days. Swallowing sounds for each water swallow were recorded using cervical auscultation. [Results] The mean amplitude of swallowing sound intensity and the mean spectral frequency were significantly higher after the neuromuscular joint facilitation neck-flexion resistance pattern and the Shaker-type exercise, in comparison with those in the control group. [Conclusion] Neuromuscular joint facilitation training with the neck-flexion resistance pattern influenced swallowing sounds to the same degree as the Shaker-type exercise, implying that this resistance pattern may enhance suprahyoid muscle contraction.

[Purpose] To develop assessment/rehabilitation indices for prevention of chronic and recurrent shin splint injuries among sport athletes, we analyzed the plantar center of pressure trajectories after drop-jump landing on one leg, and compared the foot function on the injured and healthy sides. [Participants and Methods] The participants were 10 female athletes who received consultation at our facility due to shin splints of the lower leg. The exercise task was the “single-leg drop jump landing test”, in which the participants maintained a static posture on one leg for 8 s after landing. Using the collected data, the peak value of the vertical component of the floor-reaction force at the landing and the rectangular areas at 20–200 ms and 1–5 s after landing were calculated and compared between the healthy and affected sides. [Results] The peak value of the vertical component and the rectangular area at 20–200-ms were significantly larger on the affected side. However, the value for the 1–5-s rectangular area was significantly larger on the healthy side. [Conclusion] The feedforward function may have been reduced on the affected side in comparison with that on the healthy side, and the reduction in dynamic balance early after landing may have increased the influence of the non-vertical component. The 1–5-s rectangular area was smaller on the affected side than that on the healthy side, suggesting that the feedback function excessively worked on the affected side and caused immobility by excessively locking the joint in single-leg balance and reducing body sway.

[Purpose] This study aimed to establish unique criteria for hematologic patients with low blood counts in the borderline region of or below the threshold for discontinuing cancer rehabilitation without meeting the criteria for blood transfusion, and to investigate the physical symptoms and activities of daily living. [Participants and Methods] Among the 251 participants, 128 had blood test results below the discontinuation criteria. They were permitted to engage in rehabilitation interventions by a hematologist based on the new criteria. The remaining 123 patients were classified under the discontinuation group. The Barthel Index scores during admission and discharge were compared between the two groups, in terms of chemotherapy, physical symptoms of nausea, petechial hemorrhage, pyrexia, and diarrhea. [Results] There was no significant difference between the two groups in terms of the Barthel Index score during admission or discharge. Pyrexia occurred more frequently in patients managed under the new criteria. [Conclusion] Patients with low blood counts that fall between the criteria for discontinuing rehabilitation and receiving blood transfusions can continue undergoing rehabilitation interventions with the permission of their doctors, provided that measures are taken to manage adverse events. This strategy prevents activities of daily living reduction.

[Purpose] This study examined the measurement reliability and cooperative movement of the pelvic floor and transverse abdominal muscles. [Participants and Methods] The participants were seven healthy adult females. Transverse abdominal muscle thickness and bladder floor elevation were measured under the following conditions during active exercise and during resistance exercise: the resting state, maximum contraction of the transverse abdominal muscle, maximum contraction of the pelvic floor muscle, and maximum co-contraction of the transverse abdominal and pelvic floor muscles. Measurements were taken at rest and under each exercise condition. [Results] The intraclass correlation coefficients of transverse abdominal muscle thickness and bladder floor elevation showed high reproducibility under all conditions. The maximum contraction of the pelvic floor muscle showed a high correlation with the maximum co-contraction of the transverse abdominal muscle and pelvic floor muscle during resistance exercise. A significant regression line was found between transverse abdominal muscle thickness and bladder floor elevation under all conditions. The regression equation was as follows: transverse abdominal muscle thickness=0.113 bladder floor elevation+0.377 (r²=0.21). [Conclusion] This study demonstrated that the measurement reliability of the transverse abdominal and pelvic floor muscles is high, and that both muscles exhibit cooperative movement.

[Purpose] Surface electromyography (SEMG) topography is used to objectively assess patients with low back pain (LBP). This study aimed to investigate the correlation between SEMG topographic variables, pain, and disability in patients with chronic LBP (CLBP) after interferential current (IFC) treatment, and to evaluate IFC treatment efficacy using SEMG topography. [Participants and Methods] Twenty nine patients with CLBP were recruited for a 6-week IFC treatment. Pain and disability scores, and the root-mean-square difference (RMSD) of SEMG topographic variables (relative areas [RAs] at flexion and extension) were compared before and after the intervention by repeated measures ANOVA; the correlation between variables was also explored and p-value was set at 0.001. [Results] Significant positive correlations between changes in pain score and the RMSD of RA at flexion (r(29)=0.593), and between changes in pain and disability scores (r(29)=0.426) were observed. All participants showed statistically significant improvements in the RMSD of RA at flexion, pain score, and disability score after IFC treatment. [Conclusion] SEMG topographic variables are closely associated with changes in pain score in patients with CLBP after IFC treatment. The RMSD of RA at flexion can be used as an objective marker in IFC treatment efficacy evaluation.

[Purpose] We aimed to analyze parameters of pulmonary function and physiological, psychological, and physical factors in patients with chronic obstructive pulmonary disease (COPD) receiving pulmonary rehabilitation (PR) and music therapy (MT). [Participants and Methods] This randomized crossover comparative study included in-patients diagnosed with COPD and a ratio of forced expiratory volume measured at the first second and forced vital capacity (FEV1/FVC) of <70% after administration of a bronchodilator. Patients were randomly divided into two groups that received either PR only or MT and PR (n=13 each). The PR program included conditioning, respiratory muscle training, and endurance training, whereas the MT program included vocal, singing, and breathing exercises using a keyboard harmonica. The programs lasted 8 weeks, in which pre- and post-intervention data were compared every 4 weeks. [Results] The FEV1/FVC in the MT group improved after the intervention. Expiratory volume control was obtained better with feedback by sound than with expiration practice. In the MT and PR program, it was easier to adjust the timing and volume of breathing, obtain expiratory volume control, and, thus, improve FEV1/FVC than in conventional practice. [Conclusion] Combining MT with PR improves parameters of pulmonary function in patients with COPD. Music therapy is a novel approach that, in combination with PR, may be used in COPD management.

[Purpose] To systematically review the literature on the use of cervical extension traction methods for increasing cervical lordosis in those with hypolordosis and cervical spine disorders. [Methods] Literature searches for controlled clinical trials were performed in Pubmed, PEDro, Cochrane, and ICL databases. Search terms included iterations related to the cervical spine, neck pain and disorders, and extension traction rehabilitation. [Results] Of 1,001 initially located articles, 9 met the inclusion/exclusion criteria. The trials demonstrated increases in radiographically measured lordosis of 12–18°, over 5–15 weeks, after 15–60 treatment sessions. Untreated controls/comparison groups not receiving extension traction showed no increase in cervical lordosis. Several trials demonstrated that both traction and comparison treatment groups experienced immediate pain relief. Traction treatment groups maintained their pain and disability improvements up to 1.5 years later. Comparative groups not receiving lordosis improvement experienced regression of symptoms towards pre-treatment values by 1 years’ follow-up. [Conclusion] There are several high-quality controlled clinical trials substantiating that increasing cervical lordosis by extension traction as part of a spinal rehabilitation program reduces pain and disability and improves functional measures, and that these improvements are maintained long-term. Comparative groups who receive multimodal rehabilitation but not extension traction experience temporary relief that regresses after treatment cessation.

[Purpose] Physical therapy for patients with multiple myeloma requires appropriate exercise intensity and risk management due to osteolytic lesions. However, the optimal strategy for setting exercise intensity remains unclear. We report cases in which physical therapy was performed using the Borg scale and the Common Terminology Criteria for Adverse Events v4.0 as indicators of improvement in the performance of activities of daily living without causing adverse events. [Participants and Methods] Two patients with multiple myeloma, whose performance status was 4, underwent resistance training of the upper and lower limbs and activities of daily living practice in stages according to their functional status. Each exercise was performed for 20 to 40 minutes twice a day for 6 days a week. The exercise intensity was set to 13 on the Borg scale as a guide, and the allowable bone pain was up to Grade 1 according to Common Terminology Criteria for Adverse Events v4.0. [Results] No adverse events occurred in either patient, and the performance status improved to 1 or 2. Subsequently, autologous peripheral hematopoietic stem cell transplantation was performed. [Conclusion] Physical therapy with exercise intensity set to 13 on the Borg scale and Grade 1 per Common Terminology Criteria for Adverse Events v4.0 may safely improve the performance of activities of daily living of patients with multiple myeloma.