[Purpose] This study aimed to determine the diagnostic utility of the sitting active and prone passive lag test in identifying terminal extension lag in unilaterally symptomatic knees. The lack of full extension at the knee leads to greater force of quadriceps activation, overloading of the weight bearing joints, abnormal gait mechanics, resulting in pain and dysfunction. [Participants and Methods] Participants were randomly assigned and evaluated by two blinded examiners, to determine the presence of extension lag at the knee. The reproducibility of test results between examiners was determined, for reliability. In addition, the ability of the test to identify the presence of extension lag in symptomatic knees and absence of extension lag in asymptomatic knees was assessed, for validity. [Results] The results revealed the test to possess an ‘almost perfect’ inter-rater reliability, high sensitivity, and moderate specificity. [Conclusion] The sitting active and prone passive lag test may be incorporated as a reliable and valid test to determine the presence of terminal knee extension lag in a unilaterally symptomatic knee population.

[Purpose] The weight-bearing ratio in sitting is a simple quantitative assessment using a body weight scale. Bilateral total weight bearing ratio in sitting is related to the ability to stand up, transfer, and walk; however, it has not been examined in the performance test on just one side. Therefore, this study aimed to investigate the relationship between weight bearing ratio in sitting and performance tests on one side. [Participants and Methods] Thirty-two healthy adults were recruited (27.47 ± 4.06 years). Weight-bearing ratio in sitting, knee extensor muscle strength, lateral reach test, and one-leg stand-up test were measured. Correlation analysis between the measurement results was performed on the pivot and non-pivot sides and the total. [Results] Correlation analysis of the weight-bearing ratio in sitting showed a significant positive correlation (pivot/non-pivot/total) with knee extensor muscle strength (r=0.54/0.44/0.50), lateral reach test (r=0.42/0.44/0.48), and one-leg stand up test (r=0.44/0.52/0.51). [Conclusion] Weight-bearing ratio in sitting, both pivot, non-pivot, and total, reflected results of the performance tests. Weight bearing ratio in sitting would be a highly useful quantitative assessment for a wide range of individuals, from those with unstable standing to those with relatively high function.

[Purpose] This study aimed to clarify whether collaborative learning could be promoted via information and communication technology education using tablets at college of physical therapy. [Participants and Methods] An online survey was conducted to evaluate collaborative learning among 81 first-year students at the Department of Physical Therapy actively using tablets in classes (six specific categories). [Results] The Friedman test had significant results, and a significant primary effect was observed between each questionnaire item. Following this, the Bonferroni test was performed for multiple comparisons, with significant differences were observed among certain items. [Conclusion] We reported employing tablets in the classroom positively impacted collaborative learning. Here, among the evaluations of collaborative learning, the items with the best results corresponded mainly to communication activation between students.

[Purpose] Herein, we aimed to investigate the effects of bathing in a sodium chloride spring and an artificially carbonated spring on core body temperature and electroencephalograms, to assess whether the springs facilitate sleep. [Participants and Methods] This randomized, controlled, crossover study evaluated the effects of a sodium chloride spring, an artificially carbonated spring, a plain hot bath, and no bath on sleep. The subjective evaluations and recording of temperature were performed before/after bathing at 40 °C for 15 min at 22:00 h, before nocturnal sleep (0:00–7:00 h), and after the participants (n=8) woke up in the morning. [Results] Bathing significantly increased the core body temperature, with significant subsequent declines observed until bedtime. Participants in the sodium chloride spring group had the highest average core body temperature, while participants in the no-bath group had the lowest average core body temperature before bedtime (23:00–0:00 h). During bedtime (1:00–2:00 h), the participants in the no bath group had the highest average core body temperature, while participants in the artificially carbonated spring group had the lowest average core body temperature. The amount of delta power/min in the first sleep cycle significantly increased in the bathing groups, with the highest value during bedtime being recorded in the artificially carbonated spring group, followed by the sodium chloride spring, plain hot bath, and no-bath groups. These sleep changes were associated with significant declines in the elevated core body temperature. Increased heat dissipation and decreased core body temperature were observed in the artificially carbonated spring and sodium chloride spring groups, which increased the delta power during the first sleep cycle compared with that observed in the plain hot bath group, followed by the no-bath group. [Conclusion] An artificially carbonated spring would be the most appropriate given each circumstance because it did not cause fatigue, as observed with the sodium chloride spring.

[Purpose] This study aimed to determine whether certain research activities improve the attitude of rehabilitation professionals towards evidence-based practice and its implementation in Japan. [Participants and Methods] We included physical, occupational, and speech therapists currently working in clinical settings. We employed hierarchical multiple regression analyses to assess the attitude of rehabilitation professionals towards evidence-based practice and research activities. Scores of the five dimensions of the Health Sciences-Evidence Based Practice questionnaire were considered the dependent variables. The five dimensions were as follows: Dimension 1, attitude towards evidence-based practice; Dimensions 2–4, evidence-based practice implementation; and Dimension 5, work environment related to evidence-based practice barriers–facilitators. The four sociodemographic variables (gender, academic degree, clinical experience, and the number of therapists at work) were initially included, following which self-reported research achievements were supplemented as independent variables (the number of case studies, literature reviews, cross-sectional studies, and longitudinal studies). [Results] We analyzed data from 167 participants. In addition to sociodemographic variables, the research achievements that statistically increased F-values of the modeling were case study achievements in Dimensions 2–3, cross-sectional study achievements in Dimensions 2 and 4, and longitudinal study achievements in Dimension 5. [Conclusion] Case studies and cross-sectional studies could improve evidence-based practice implementation among rehabilitation professionals in Japan.

[Purpose] This study aimed to determine the effects of a mobile health application, and exercise instructions by a physical therapist on exercise frequency, duration, and intensity for middle-aged and older adults. [Participants and Methods] The study included males and females in their 50s to 70s, who provided consent to participate. Thirty-six people who wished to participate in the online group were divided into groups of five or six each, with a physical therapist as group leader. The frequency, intensity, duration of exercise, and group activities were surveyed using questionnaires: before coronavirus disease (COVID-19) (before March 2020, when the novel coronavirus began to spread in Japan), during COVID-19 (after April 2020), after digital versatile disc (DVD) distribution, and after online group initiation (3 weeks after DVD distribution for the control group). [Results] The online group received significantly more frequent instructions by a physiotherapist than the control group. The control group did not show significant changes over time, whereas the online group exercised significantly, more frequently after the intervention. [Conclusion] The online mode and physical therapist intervention resulted in a significant increase in exercise frequency. Exercise advice from professionals and peer presence to continue exercising together were beneficial.

[Purpose] The purpose of this study was to clarify whether the presence of obstructions changes the crossing motion during walking based on the visual perception of obstacles. [Participants and Methods] We included 25 healthy university students as the participants in this study. They were asked to step over obstacles while walking under two conditions i.e., with obstruction and without obstruction. We analyzed the distance between the foot and obstacle (clearance), trajectory of foot pressure movement and distribution as measured by a foot pressure distribution measurement system, and stance phase time. [Results] No significant differences were found between the two conditions for either clearance or foot pressure distribution. In other words, no difference in crossing motion was observed after visual recognition of the obstacle, both in the presence or absence of the obstruction. [Conclusion] The results suggest that no differences exist in the accuracy of recognizing visual information about an obstacle through different mechanisms of selective visual attention.

[Purpose] We aimed to explore the factors that predict falls in community-dwelling older people over 6 months during their voluntary self-isolation for the coronavirus disease (SARS-CoV-2). [Participants and Methods] In this longitudinal study, we surveyed older people aged ≥65 years living in Takasaki City, Gunma Prefecture, using a questionnaire. We investigated the relationship between the frailty screening index and fall rate. [Results] A total of 588 older adults (response rate, 35.7%) filled and returned the questionnaire during the study period. Of these, 391 participants who had not applied for long-term care insurance and had completed the data on the response items were included in the study. Based on their responses in the survey questionnaire, 35 (8.95%) participants were grouped into the fall group and 356 into the non-fall group. Subsequently, the “no” response to “Can you recall what happened 5 minutes ago?” and “yes” response to “Have you felt tired for no reason (in the past 2 weeks)?” were identified as the significant factors associated with falls. [Conclusion] It is important to pay attention to the subjective evaluation of patients’ cognitive decline and fatigue to prevent falls owing to the implementation of SARS-CoV-2 countermeasures.

[Purpose] This study aimed to clarify the power source for the swing phase of a hip disarticulation prosthetic limb using biomechanical gait analysis. [Participants and Methods] In this cross-sectional study, six participants who underwent hip disarticulation and seven healthy adults were recruited. Their gaits were assessed using the three-dimensional motion analysis and four force plates. [Results] From pre-swing to initial swing, the angle of the lumbar spine’s angle changed by 9° from the flexion to extension positions. However, the power of the lumbar spine was <0.003 W/kg for the entire gait cycle. The peak value of joint moment and hip joint power on the unaffected side were 1 nm/kg and 0.7 W/kg, respectively. From pre-swing to initial swing, the prosthetic limb is pushed forward by extension of the hip joint on the intact side, while the spine returns to the flexion direction. [Conclusion] The hip extension force on the unaffected side was the main force responsible for swinging out the prosthesis, not the lumbar vertebrae’s force.

[Purpose] This study aimed to validate whether scapular motion measured using a pad with retroreflective markers and optical motion analyzer (VICON MX) can reflect the motion calculated by images using multi-posture (gravity) magnetic resonance imaging. [Participants and Methods] The participants were 12 healthy males (12 dominant-side shoulders). The measurement items were the scapular angle at shoulder flexion 140° and 160° and abduction 100°, 120°, 140°, and 160°. The scapular angle changes were extracted from the upward/downward and internal/external rotations. Angular changes were calculated by subtracting the scapular angle in static position (drooped upper limb and external shoulder rotation) during resting chair sitting from the scapular angle in each of the six limb positions and subtracting it at shoulder abduction 100° from the scapular angle at shoulder abduction 120°, 140°, and 160°. [Results] The results showed no agreement in most cases and no consistent bias. [Conclusion] The result questions the validity of scapular motion analysis using pads with optical markers. However, the facility environment imposes many study limitations, and this method requires further validation eventually.

[Purpose] This study aimed to investigate the relationship between clinical outcomes after high tibial osteotomy and metabolic syndrome-related factors, such as hypertension, dyslipidemia, diabetes mellitus, and obesity. [Participants and Methods] A total of 73 patients (73 knees) who underwent high tibial osteotomy for knee osteoarthritis between 2018 and 2020 were included. We investigated the correlation between metabolic syndrome-related factors and clinical symptom assessment (Japanese Orthopedic Association Score) and examined knee function and lower alignment. [Results] At three months postoperatively, the Japanese Orthopedic Association score showed no main and synergistic effects on metabolic syndrome-related factors, and the preoperative Japanese Orthopedic Association score only showed a main effect on metabolic syndrome-related factors. At 12 months postoperatively, the Japanese Orthopedic Association score showed main and synergistic effects on diabetes mellitus, obesity, hypertension and dislipidemia. [Conclusion] Metabolic syndrome-related factors are associated with poorer clinical outcomes after high tibial osteotomy.

[Purpose] This study aimed to examine whether trunk stability is related to closed kinetic chain motor performance of the upper and lower limbs. [Participants and Methods] In this study, 27 healthy male university students participated. Trunk stability was measured under two conditions, with and without rhythmic stabilization, as a proprioceptive neuromuscular facilitation procedure. The shortest time required to perform 20 push-ups and lateral step-up/-downs (closed kinetic chain motor performances) immediately after rhythmic stabilization or sitting rest (without rhythmic stabilization) was measured. [Results] Left and right trunk stabilities were significantly higher, and the time required to perform the closed kinetic chain motor task was significantly shorter under the rhythmic stabilization condition than that of the non-rhythmic stabilization condition. Regarding the relationship between the difference between the two trunk stability conditions and difference between upper/lower limbs closed kinetic chain exercise capacity conditions, left trunk stability correlated with each closed kinetic chain movement, whereas right trunk stability did not correlate with either movement. [Conclusion] Trunk stability was shown to improve closed kinetic chain exercise capacity in the upper and lower limbs, and stability of the trunk’s dominant side (here, left side) seemed to regulate.

[Purpose] Femoral neck fractures are a common problem resulting from balance impairment. Toe grip strength is related to balance function. This study aimed to confirm the type of balance function that is highly related to toe grip strength. [Participants and Methods] The participants included 15 patients who were examined for differences in toe grip strength between the affected and nonaffected side. The relationship between toe grip strength and functional balance scale (FBS) and index of postural stability (IPS) was analyzed. [Results] The result showed no significant difference between the nonaffected and affected sides. A correlation exists between toe grip strength and FBS and IPS. In addition, the data from the center-of-gravity sway meter showed a correlation only between the toe grip strength and anteroposterior diameter of the stable area but not between the right and left diameters of the stable area and anterior and posterior trajectory lengths. [Conclusion] No significant difference was found between the affected and nonaffected sides. The results suggest that toe grip strength is related to the ability to move the center of gravity forward and backward rather than to sustain the center of gravity.

[Purpose] To present a case demonstrating dramatic restoration of the cervical lordosis and reduction of forward head posture by use of Chiropractic BioPhysics^® (CBP^®) technique. [Participant and Methods] A 24-year-old cervical asymptomatic female presented with poor craniocervical posture. Radiography revealed forward head posture and an exaggerated cervical kyphosis. [Results] The patient received CBP care including mirror image^® cervical extension exercises, cervical extension traction and spinal manipulative therapy. After 36 treatments over 17-weeks, repeat radiography demonstrated a dramatic improvement of an alteration of the cervical kyphosis to a lordosis and a reduction of forward head posture. Subsequent treatment increased the lordosis further. Long-term follow-up at 3.5 years showed some loss of original correction, however, a maintenance of the global lordosis. [Conclusion] This case demonstrates that non-surgical reversal of a cervical kyphosis to a lordosis is possible in a short time using CBP cervical extension protocols. It is logical if the kyphosis had not been corrected, over time, osteoarthritis and various craniovertebral symptoms would have evolved as the literature indicates. The diagnosis of gross spinal deformity, we argue, requires its correction prior to the onset of symptoms and permanent degenerative changes.

[Purpose] We describe a new method of functional electrical stimulation therapy for severe hemiparesis. Conventional functional electrical stimulation of the lower legs has limited applications. It is only suitable for patients who can monitor their muscle contractions, and it has complicated equipment installation procedures. [Participant and Methods] The participant was a male in his 40s with severe motor paralysis following brain surgery. We monitored the participant’s healthy side using the external assist mode of an Integrated Volitional Control Electrical Stimulation (IVES^® OG Giken, Okayama, Japan) system while forcibly contracting the paralyzed side. The participant received this new functional electrical stimulation therapy five times per week. [Results] Two weeks after initiation of therapy, paralysis was noticeably improved, and motor function was maintained for approximately 1 year. [Conclusion] The outcomes of this case suggest that the addition of forced contraction therapy, mirror therapy, and repetitive exercise therapy to regular physical therapy may be beneficial. This treatment method may also be useful in postoperative patients with central motor palsy and no muscle contraction ability.