In older adults, muscle weakness contributes greatly to functional restrictions on daily living activities, increased risk of falls, and adverse physiological changes. It has been suggested that not only muscle mass but also muscular infiltration of noncontractile elements may influence muscular performance such as strength and rapid force production. It is proved that resistance training may provoke substantial increases in muscle size even if it is performed at low intensities in older individuals. Also, recent studies have demonstrated the effectiveness of resistance training on muscle quality such as muscular infiltration of noncontractile elements for older people. This review shows the age-related changes in muscle mass and muscle quality, which were measured by muscle echo intensity on ultrasound images, and low-intensity resistance training effects on muscle volume and muscle quality.

For central nervous system disorders' rehabilitation, it is important to accurately understand motor control and implement an appropriate motor learning process to induce neuroplastic changes. The neurophysiological studies have revealed that neural control mechanisms are crucial during both the onset of muscular activities and muscle release after contraction. When performing various movements during daily activities, muscle relaxation control enables precise force output and timing control. Moreover, surround inhibition is a functional mechanism in the motor system. Surround inhibition of the motor system may be involved in the selective execution of desired movements. This review demonstrates cortical excitability resulting from motor learning, movement control mechanisms including muscle relaxation and the suppression of nontarget muscle groups, and the voluntary drive's importance that is required for movement.

Objective: Joint contractures are a major complication following joint immobilization. However, no fully effective treatment has yet been found. Recently, carbon dioxide (CO₂) therapy was developed and verified this therapeutic application in various disorders. We aimed to verify the efficacy of transcutaneous CO₂ therapy for immobilization-induced joint contracture. Method: Twenty-two Wistar rats were randomly assigned to three groups: caged control, those untreated after joint immobilization, and those treated after joint immobilization. The rats were treated with CO₂ for 20 min once a daily either during immobilization, (prevention) or during remobilization after immobilization (treatment). Knee extension motion was measured with a goniometer, and the muscular and articular factors responsible for contractures were calculated. We evaluated muscle fibrosis, fibrosis-related genes (collagen Type 1α1 and TGF-β1) in muscles, synovial intima's length, and fibrosis-related proteins (Type I collagen and TGF-β1) in the joint capsules. Results: CO₂ therapy for prevention and treatment improved the knee extension motion. Muscular and articular factors decreased in rats of the treatment group. The muscular fibrosis of treated rats decreased in the treatment group. Although CO₂ therapy did not repress the increased expression of collagen Type 1α1, the therapy decreased the expression of TGF-β1 in the treatment group. CO₂ therapy for treatment improved the shortening of the synovial membrane after immobilization and decreased the immunolabeling of TGF-β1 in the joint capsules. Conclusions: CO₂ therapy may prevent and treat contractures after joint immobilization, and appears to be more effective as a treatment strategy for the deterioration of contractures during remobilization.

Objective: To determine the recovery process of respiratory muscle strength during 3 months following stroke, and to investigate the association of change in respiratory muscle strength and physical functions. Additionally, we compared respiratory muscle strength with those of healthy subjects. Method: In this prospective, observational study, 19 stroke patients and 19 healthy subjects were enrolled. Maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), motricity index, trunk control test, 6-minute walk test (6MWT) and functional independence measure were assessed at 1, 2, and 3 months from stroke onset in stroke patients. MIP and MEP were assessed at arbitrary times in healthy subjects. Repeated one-way analysis of variance with Bonferroni post-hoc test was used to compare the change in respiratory muscle strength in each period in stroke patients. Pearson's correlation coefficient was computed for changes in respiratory muscle strength and physical functions. Student's t-test was used to compare respiratory muscle strength between stroke patients at 3 months from onset and healthy subjects. Results: MIP was significantly increased at 3 months compared to 1 month. MEP was significantly increased in 2 months and 3 months, compared to 1 month. MIP changes associated with 6MWT changes. Compared to healthy subjects, MIP and MEP at 3 months were significantly lower in stroke patients. Conclusion: Respiratory muscle strength significantly increased during 3 months following stroke. However, the trend of recovery may be different. MIP changes may associated with walking endurance changes. During 3 months following stroke, respiratory muscle strength did not recover to healthy subjects.

Objective: To examine the changes in postural alignment and kyphosis-correlated factors after 6 months of back extensor strengthening exercise in a group of community-dwelling older adults aged ≥65 years. Methods: We quasi-randomized 29 subjects into an intervention group treated with a back extensor strengthening program and a control group treated with a full-body exercise program. These groups completed 20-30 minutes of exercise directed by a physical therapist one or more times per week and were instructed to exercise at home as well. The participants were assessed prior to and after the intervention using the following criteria: postural alignment of "usual" and "best" posture, physical function, physical performance, self-efficacy, and quality of life. The differences between two factors (group and period) were compared for each of the measurement variables. Results: Subjects who adequately completed the exercises were analyzed. A reduced knee flexion angle was noted in the "best" posture of both groups, as were improved physical function and performance with the exception of one-leg standing time. Verifying the effect size in the post-hoc analysis, the body parts that showed changes to postural alignment after the intervention differed between groups. Conclusions: Back extensor strengthening exercises improved physical function and performance, but did not improve spinal alignment. The changes due to these interventions were not significantly different from changes observed in the full-body exercise group. However, post-hoc analysis revealed that the effect size of posture change was different, possible indicating that the two groups experienced different changes in the postural alignment.

Background: We investigate the association with knee flexion range of motion (ROM) during the acute phases and that at 12 months after total knee arthroplasty (TKA). We also clarified the cut-off ROM during the acute phases in predicting the goal of knee flexion ROM at 12 months. Methods: In this retrospective study, 193 patients with knee osteoarthritis (female:144 patients, age:73.2 ± 7.7 years) who underwent unilateral TKA at an orthopedic clinic were recruited. They underwent assessments of knee flexion ROM at 5 days, 1 month, and 12 months after TKA. The goal of knee flexion ROM at 12 months after TKA was set at 120°. Single and logistic-regression analyses were performed with the dependent variables including the outcome of the goal of knee flexion ROM at 12 months, and the independent variables included knee flexion ROM at 5 days and 1 month, separately. We calculated the cut-off ROM at 5 days and 1 month for predicting the goal of knee flexion ROM at 12 months with receiver operating curve analysis. Results: Knee flexion ROM at 5 days and 1 month were significantly associated with the goal of that at 12 months (p < 0.01). The cut-off ROM were 85° at 5 days and 105° at 1 month separately. Conclusions: Our results suggest the importance of early improvement in knee flexion ROM after TKA, and that at 1 month postoperatively indicates the likelihood of achievement of the goal of knee flexion ROM at 12 months after TKA.

Objective: Many studies have demonstrated that the loss of muscle mass (LMM) poses a risk of postural instability in the elderly; however, few studies have shown how LMM decreases proprioception. In this study, we investigated the changes in postural sway among older individuals with LMM induced by application of a local vibratory stimulus. Method: We enrolled 64 older adults (mean age). Postural sway was measured while applying vibration stimuli of 30, 60, and 240 Hz to both the gastrocnemius and lumbar multifidus muscles. We also measured the relative proprioceptive weighting ratio (RPW) of postural sway. The patients were divided into LMM and non-LMM (NLMM) groups. The study subjects were compared in terms of their age, height, weight, body mass index (BMI), lower leg skeletal muscle mass index (LSMI), L4/5 lumbar multifidus cross-sectional area ratio, and RPW at 30, 60, and 240 Hz. Results: Subjects in the LMM group showed a significantly lower RPW at 60 Hz, LSMI, and BMI than did those in the NLMM group. Conclusions: Decrease in RPW with 60-Hz stimulation concerning the lower leg proprioception is a risk factor for LMM-associated postural instability in the elderly. Consequently, with respect to the gastrocnemius muscles proprioception in LMM, it is necessary to perform assessments using muscle spindle stimuli.

Objective: A poor social network and the decline of physical function are known to be critical risk factors for functional decline in older adults. The aim of this study was to investigate the relationships between social network and physical function in Japanese community-dwelling older adults. Methods: Participants were 339 adults aged 65 years or older (mean age : 73.0 years, women :70.2%), living independently in their communities. A self-reported questionnaire was used to assess social network on two different scales-the 6-item Lubben Social Network Scale (6LSNS) and frequency of contact with other people. Handgrip strength, knee extension strength, gait speed, Timed Up and Go Test (TUG) results, and 5-repetition chair stand test (CST) scores were used to determine physical function. A multiple regression analysis that adjusted for confounding factors was used to analyze the relationship between the social network scales and each physical function test. Results: According to the results of a multiple regression analysis, a high 6LSNS score was significantly associated with greater handgrip strength (B = 0.63, p = 0.03), faster CST (B = −0.23, p = 0.01), and faster TUG (B = −0.12, p = 0.03), and high frequency of contact was significantly associated with greater handgrip strength (B = 1.08, p = 0.01). Conclusions: Social network was associated with muscle strength and physical performance. Consequently, older adults with poor social networks require an assessment of physical function, since their physical functions have possibly deteriorated.

Objective: Although elderly inpatients are known to experience decreased physical activity in the morning, falls occur frequently during this time. Gait variability is an evaluation of gait instability and a risk factor for falls. Gait initiation requires complex processes, and it is important to evaluate gait variability not only during steady-state gait but also during gait initiation. However, the effect of the diurnal pattern on variability in gait characteristics is still unknown. The aim of this study was to investigate the effect of the diurnal pattern on initiation and steady-state gait variability in elderly inpatients. Method: Thirty-seven elderly inpatients (28 women; mean age, 79.7 ± 9.5 years) who could walk without support were sampled in this study. The quantitative measure of gait variability was evaluated using the coefficient of variation (CV) based on four consecutive stride durations determined using triaxial accelerometers. Gait characteristics were evaluated during initiation and steady-state gait and defined as initiation CV and steady-state CV, respectively. This measurement was performed at two time points, morning and daytime. Results: There was no significant difference between initiation and steady-state gait characteristics in the daytime condition. However, in the morning condition, the initiation CV was higher than the steady-state CV. Furthermore, the initiation CV was higher in the morning than during daytime (p < 0.01). Conclusion: Our study revealed that the variability of initiation gait is higher in the morning. It may be important to assess the risk of falls, including initiation gait, in the morning.

Objective: Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse event experienced by cancer patients. In general, CIPN is evaluated subjectively based on patient self-assessment or clinician-reported scales; evidence supporting the utility and validity of quantitative sensory tests (QST) is lacking in this patient population. The aim of this study was to objectively assess CIPN of lower extremities by QSTs, and to evaluate the concordance between QSTs and subjective assessments. Methods: In this prospective cohort study, outpatients with cancer receiving chemotherapy were recruited at a single university hospital. We assessed CIPN at the lower extremities at baseline and three months after baseline. The QSTs were performed by applying a monofilament and a tuning fork to determine touch and vibration thresholds, respectively, at the affected site. Subjective assessments were performed based on the visual analog scale (VAS) and the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) toxicity grade. Kappa coefficients were calculated to evaluate the concordance between QSTs and subjective assessments. Results: After exclusion and drop-outs during follow-up, nineteen patients were included in the analysis. The prevalence of patients with abnormal sensation was 37% based on QSTs, 32% based on the VAS, and 14% based on CTCAE grading, respectively. Kappa coefficients were 0.32 between QSTs and VAS, and 0.28 between QSTs and CTCAE. Conclusions: The concordance rates between quantitative and subjective assessments were low. CIPN should be assessed using both quantitative and subjective assessments.

Objective: This study aimed to define the efficacy and features of physical therapy (PT) using the Nintendo Wii Fit U (Nintendo Inc., Kyoto, Japan) in patients with hematological malignancies confined to a bioclean room. Method: A total of 33 patients with hematological malignancies confined to a bioclean room were enrolled in this study. This study was designed as a randomized crossover test between two weeklong interventions: PT program (Therapist PT) and Wii Fit U program (Wii PT). We compared the efficacy of Wii PT and Therapist PT with regard to physical and psychological function test scores. Results: Of the 33 patients, 22 were analyzed. The validity of the crossover design was demonstrated, as there were no significant differences in period and carryover effects between the two groups. Therapist PT resulted in significantly better improvements in fatigue scores and total mood disturbance (TMD) scores in the Profile of Mood States short-form Japanese version compared to Wii PT (fatigue score, -5.2±8.3 vs 2.7±8.2; TMD score, -22.5±32.8 vs -2.6±20.5; p<0.05). Physical function improved post-Wii PT and post-Therapist PT interventions (p<0.05), and there was no difference in treatment effect. Conclusion: Improvements in physical function were clearly observed following the use of Wii PT in patients confined to a bioclean room. However, compared to Therapist PT, Wii PT was less effective in improving the psychological function of patients.

Objective: We focused on locomotive syndrome as a low physical function factor that may prevent patients with psychiatric disease from being discharged. The purpose of this study is to clarify the factors, including locomotive syndrome, that prevent discharge from psychiatric long-term care wards. Method: We enrolled 74 patients who were admitted to psychiatric long-term care wards at three different hospitals in Japan. Nurses or medical social workers in the ward were asked whether the planned discharge destination had been decided, and patients were categorized into a decided group and an undecided group. Outcome measures were age, sex, F code in the ICD-10 Classification of Mental and Behavioral Disorders, length of stay, chlorpromazine equivalent dose of antipsychotics, locomotive syndrome test scores (25-question GLFS, two-step test, stand-up test), and Barthel Index. Results: Based on the multivariate logistic regression analysis results, the length of stay and the two-step test score significantly explained the difference between the two groups. The odds ratio of a length of stay greater than 10 years was 8.42 times that of a length of stay less than 2 years (P=0.012, 95% CI=1.59, 44.53). Regarding the twostep test, the odds ratio for obtaining stage 2 was 10.62 times that for obtaining stage 0 (P=0.013, 95% CI=1.65, 68.23). Conclusion: Those who with longer length of stays and lower two-step test scores tended not to be decided the planned discharge destination.

Objective: The stroke survivors exhibit change in muscle quantity and quality compared to healthy older adults. This study aimed to compare the muscle thickness (MT) and echo intensity (EI) values of individual muscles between stroke survivors and age- and sex-matched healthy older adults. Methods : In total, 27 stroke survivors and 34 healthy older adults participated in this study. The MT and EI values of the following muscles were assessed from transverse ultrasound images: rectus abdominis (RA), external oblique, internal oblique, transversus abdominis, rectus femoris, vastus intermedius (VI), vastus lateralis (VL), vastus medialis (VM), tibialis anterior (TA), gastrocnemius (Gas), and soleus (Sol). The MT and EI values of these muscles were compared between stroke survivors and healthy older adults. Results : The MT values of the VL, VM, and RA on the non-paretic sides were significantly higher and those of the TA, Gas, and Sol on the paretic sides were significantly lower in the stroke survivors than in the healthy older adults (P < 0.05). The EI values of the VI, VL, VM, TA on the paretic sides and those of the Gas on both the paretic and non-paretic sides were significantly higher in the stroke survivors than in the healthy older adults (P < 0.05). Conclusion : Stroke survivors seem to develop muscle hypertrophy of the non-paretic thigh muscles owing to a compensatory strategy. In addition, the lower-leg muscles on the paretic side of stroke survivors tend to show both quantitative and qualitative muscle changes.

Objective: Neuromuscular electrical stimulation (NMES) has been noted as an effective pre- contraction for an increase of neural and muscle factors during twitch contractions. However, it is unknown if this intervention is effective for the rate of force development (RFD), which is the ability to increase joint torque strength as quickly as possible, during tetanic contractions. NMES can be safely used by anyone, but, the strength setting of NMES requires attention so as not to cause pain. Therefore, the purpose of this study investigated whether NMES at less painful levels was effective for RFD during tetanic contractions. We also investigated effect activation by analyzing electromyogram (EMG) and RFD for each phase. Methods: Eighteen healthy males were studied. Before and after NMES intervention at 10% or 20% maximal voluntary isometric contraction (MVIC) level (10%NMES, 20%NMES respectively), EMG activity and the initial phase (30-, 50-, 100-, and 200-msec) RFD were measured. Visual analog scale (VAS) was also measured as an indicator of pain during each NMES. Results: 20%NMES increased EMG activity and 30-, 50-, and 100-msec of RFD during MVIC, but could not improve 200 msec of RFD. However, 10%NMES could be failed to increase all phases RFD, but VAS was lower than that of 20% NMES. Conclusion: These results suggest that muscle pre-contraction using 20%NMES could induce moderate pain, but could be an effective intervention to improve RFD via neural factor activity.

Objective: To derive a clinical prediction rule for early recovery of knee range of motion after total knee arthroplasty. Methods: This prospective cohort study evaluated the data of 273 individuals undergoing primary total knee arthroplasty. The individual factors, the physical and motor function data were assessed preoperatively upon admission as a baseline survey. The knee joint extension angle and knee joint flexion angle were re-evaluated on postoperative day 14 as a follow-up. The recovery group comprised individuals with a knee joint extension angle of more than -5 degrees and knee joint flexion angle of more than 110 degrees on postoperative day 14. The other patients constituted the non-recovery group. Multivariate logistic regression analysis was used for deriving a clinical prediction rule. Results: The results indicated that the use of a cane, knee joint extension and flexion angles, and Timed Up and Go test time were significant factors for predicting early recovery of knee range of motion after total knee arthroplasty. Furthermore, a clinical prediction rule was derived and included the use of a cane, knee joint extension angle ≥ -15 degrees, knee joint flexion angle ≥ 125 degrees, and a Timed Up and Go test time < 11.2 s. A total clinical prediction rule score ≥ 8 indicated a positive likelihood ratio of more than 10 for a successful outcome and the post-test probability was approximately 95%. Conclusions: The derived clinical prediction rule might be a useful screening tool for proper postoperative goal setting and the establishment of individualized physical therapy programs.

Objective: The purpose of this study was to compare the effects of first mobilization following a stroke with independently performing the activities of daily living at discharge in acute phase ischemic stroke patients in a general ward of a hospital. Methods: A total of 158 patients with ischemic strokes were admitted to a general ward from June 1, 2014 to March 31, 2015. Of the 158 patients, 53 met the study's eligibility criteria. First mobilization was defined as the transfer of a patient from the bed to a wheelchair by a rehabilitation therapist. A favorable primary outcome at discharge was defined as a modified Rankin Scale score of < 3. The outcome was analyzed using the proportional hazards analysis and receiver operating characteristic curves. Results: The age of the participants was 78.2 ± 11.7 years, stroke severity evaluated by the National Institutes of Health Stroke Scale scores on admission was 14.3 ± 10.6 points, and first mobilization of this population was 6.4 ± 5.2 days. Thirteen [25%] patients had a favorable outcome. Hazards analysis showed a favorable outcome due to first mobilization (adjusted hazards ratio 0.80, 95% confidence interval 0.65-0.98; p < 0.05). The cutoff point for first mobilization to produce a favorable outcome was 6.5 days after the stroke onset (area under the curve 0.729; p < 0.05). Conclusion: As seen in stroke units, early first mobilization is associated with improved clinical outcomes in ischemic stroke patients admitted to a general ward.

Objective. Increase in population's longevity has led to considerable efforts worldwide on physical therapy aging research. The aim of this study is to identify which are the main scientific journals, as well as the most productive authors, institutions and keywords related to the journals, that have published about physical therapy and aging. Methods. Original articles published from 1990 to 2014 were retrieved from the bibliographic database Science Citation Index Expanded of Web of Science Core Collection. After standardization of the bibliographic information, a series of bibliometric indicators was obtained regarding authors, institutions, citation and keywords of the core journals using bibliometric software. The PAJEK network analysis program was used for graphic representation. Results. A total of 2,237 original articles are included in this analysis. The number of identified journals is 573, with an average growth of publishing journals throughout the studied period of 9.41%. Bradford's distribution shows 12 core journals, out of which 41.67% have published constantly all throughout the 25-year period, being the most productive one Physical Therapy. Fritz, Julie M is the most productive author, and University of Sydney the most productive institution. The keyword exercise is used in an outstanding way. Conclusions. The productivity trends provided an indication of the greater scientific interest of physical therapy in aging as a line of research. Collectively, the data indicated that physical therapy-specific journals are being consolidated but non-specific are still a significant research source, and that a fundamental element of their research includes exercise and movement.