An examination was made of the present conditions of physical therapy facilities with respect to room accommodations and equipment. From the Japanese Physical Therapy Association list in 1997, 811 physical therapy departments were selected. Data from 568 physical therapy departments (70% of all) were obtained from questionnaires. An investigation was made into hospital facilities, management, diseases, and so forth. Cross tables and chi squares were used.
The following results were obtained:
1) Physical therapy facilities, without hydrotherapy rooms and/or physical agents and mechanical modality rooms, are increasing particularly at private hospitals or chronic disease care hospitals with physical therapy departments.
2) For therapeutic exercise rooms with an area of 200 square meters or more, component equipment is not in proportion to the number of patients, but depends on the particular number of beds in the wards and the treatment period.
3) Most of the facilities were found to have no space specifically for rehabilitation in the wards. Special consideration should be given in the future to what a hydrotherapy room should be, what a physical agents and mechanical modality room should be, and what physical therapy equipment should be.

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In physical therapy for the elderly patients with hip fracture, although we had used the eight-week program until 1996, we have been working on a shorter one, a four-week program, since 1998. To evaluate the efficiency of the short program, we investigated the period of each step of the program, the ability of mobility before fracture and after the program, and the total number of local complications during the past five years. The periods before sitting up and to be able to walk with T-cane have been shortened since 1997. The short-term program made patients get up from bed much earlier and let them walk obviously earlier. On the other hand, no change was shown in the patients' ability of the mobility at the end of the program during the past five years. We conclude that our short-term program for hip fracture in the elderly can be performed effectively and safely.

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A circuit weight training (CWT) program that was mainly composed of isometric exercise was designed for this study. A CWT and a treadmill graded exercise test (TGXT) were performed on 15 young healthy male subjects to assess whether the CWT could apply safely to examine the circulatory function by using hemodynamic response and oxygen uptake (VO₂). The CWT included ① bicep curl, ② arm extension, ③ leg extension, ④ leg curl and ⑤ back extension. The subjects underwent the CWT and the TGXT after the measurement of maximal voluntary contraction (MVC) of respective muscle. Three sets of exercise were performed in order of ① to ⑤ by imposing a workload of 60% MVC with an interval of 30 sec between every 30 sec exercise. During the CWT and TGXT VO₂ heart rate (HR), blood pressure and rate-pressure product (RPP) were measured. Statistical analysis were performed by the analysis of variance or Post-hoc test. VO₂ during the CWT was 43-57% of that during the TGXT attained with load of an anaerobic threshold level (AT load). The systolic blood pressure (SBP) during the CWT was equivalent to or slightly higher than those of TGXT measured with the AT load. However, the RPP values during the CWT were almost equivalent to those of TGXT during the AT load as HR values of the CWT had been equivalent to or slightly lower than those of TGXT with the AT load. If the RPP was accepted as a marker of load to the heart during exercise, these results suggest that current protocol of CWT could be safely applied since the load to the heart is thought to be identical to AT load of TGXT.

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Postural control during a lateral shift of center of gravity (COG) in sitting was studied for ten healthy subjects (age 22 ± 1 years, height 172.5 ± 4.7cm, weight 63.3 ± 6.1 kg). The electromyography (EMG), trunk alignment and center of pressure (COP) during the lateral shift of COG in sitting were measured. The EMG signals (TELEMG, BTS) were recorded bilaterally from four parts; (1) lower lumbar part (LL), (2) upper lumbar part (UL), (3) lower thoracic part (LT), and (4) gluteus maximus (GM). Bipolar surface electrodes were placed over the muscle belly. The date were sampled at 1000 Hz, and kinetic date were recorded using a force plate (9287, Kistler) at 1000 Hz of sampling frequency. Kinematics were recorded synchronously with the other signals using a four camera system (ELITE, BTS), and the date were then sampled at 50 Hz. The lateral shift in sitting was classified into three movements; (1) lateral bending of trunk (LB), (2) reverse lateral bending of trunk (RLB), and (3) combined lateral bending (CLB). The lateral shift movements were separated to five phases with cue signal and COP trajectory. The direction of the COG shift was right side at both fast and normal speed. The right anterior superior iliac spine (ASIS) trajectory was similar to the COP trajectory during fast speed movement; both the COP and the right ASIS trajectory moved to left side immediately after cue. Thereafter, these trajectories rapidly moved to right side that was the direction of COG shift. In contrast, the right acromion part didn't move to left side. On the other hand, neither the COP or ASIS tajectory moved to left side during normal speed movement for the half of subjects. The activity of left LL decreased at phase II during fast speed movement (p<0.01). Thereafter, the left LL activity increase again in the midst of phase III except for LB. On the other hand, the activity of right LL obviously increased at phase III for LB. The correlation between Al and V_max was significant during fast speed movement (p<0.01, r=0.628). The results indicated that the initial change in COP for fast speed movement was very important for producing the moment of gravity, and that the characteristic COP change was related to the pelvic motion and the activity of erector spinae muscles.

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The purpose of this study was to investigate the effect of early stand-up and gait exercise for severe hemiplegic patients after stroke one month after the start of physical therapy (PT). The subjects were twenty-eight severe hemiplegic patients in the acute phase after stroke. We selected patients who met after two criteria during the time from the onset of stroke to the start of PT ; (1) patients who needed total assistance when performed all basic movements, including side sitting, and (2) patients whose Brunnstrom stage of their affected lower extremity was less than stage II. We divided these subjects randomly into two groups which included fourteen subjects respectively ; one was the early group which received early stand-up and gait exercise consisted of assistive gait exercise and repeated stand-up and sit-down exercise, the other was the control group which received conventional PT for hemiplegic patients. PT for both group was started as soon as possible after the onset of stroke. We compared the early group with the control group from the standpoint of the improvement in Brunnstrom stage of affected lower extremity, Barthel Index (BI) and the degree of independence of basic movements ; rolling over, rising, side sitting, standing, transfer activity between wheelchair and bed, and gait one month after the start of PT. No significant difference in improvement of Brunnstrom stage of affected lower extremity was demonstrated between both groups. However, improvement in BI and the degree of independence of basic movements except gait in the early group was more marked than that in the control group. These results suggest that early stand-up and gait exercise might be more effective PT regime than conventional PT for severe hemiplegic patients after stroke.

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In order to evaluate the ability to maintain a sitting position, we placed a Hand-Held Dynamometer (HHD) on a subjects right or left lateral brachium, pushed it until the subject could not keep the position, and measured the maximum value. We also examined the change with aging and difference between the right and left sides in the value. Subjects consisted of 18 healthy males and 21 healthy females, and they were instructed to sit on a tilt table with the popliteal region apart from the edge of the table and without the feet touching the floor. They were also asked to cross the upper extremities in front of the trunk, and to keep the trunk as upright as possible. A sitting surface was set flat, and tilted by 10 degrees on the right or left side. We continued to push HHD until a subjects ischial bone leaves from the sitting surface, and each measurement was randomly undertaken. It was found that the maximum value of HHD tended to become small with aging, and that subjects aged from 60 to 80 years are liable to show the difference between the right and left sides when pushed from tilted side. The results suggest a possible application of the present method to the evaluation of the ability to maintain a sitting position in the elderly, by comparing the values on a flat surface with those on a tilted surface.

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[in Japanese]

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