The purposes of this study were to assess the working conditions and cardiorespiratory responses during snow removal. The subjects consisted of 12 young healthy volunteers (mean age, 20.5 ± 1.0 years) and 11 middle-aged volunteers (mean age, 49.2 ± 7.8 years). They performed shovel snow removal (with an ordinary-size shovel) and dump snow removal (with a large-size shovel) for 5 minutes each at their own pace. The working conditions and cardiorespiratory responses were compared between the young and middle-aged groups. The frequency of snow shoveling was significantly higher in the young group than in the middle-aged group. The oxygen intake had a positive correlation with the weight of snow shoveled at one time for shovel snow removal, and it had a positive correlation with the frequency of snow shoveling for dump snow removal. The exercise intensity of shovel or dump snow removal did not significantly differ between the young and middle-aged groups. However, the relative exercise intensity was significantly higher for the middle-aged group than for the young group. The mean exercise intensity of shovel snow removal was 6.7 Mets and the percent peak VO₂ was 70.7%, being at the Anaerobic Threshold (AT) level. The mean exercise intensity of dump snow removal was 8.3 Mets. The percent peak VO₂ was 89.2% and was higher than the AT level for the middle-aged group. The distolic blood pressure during snow removal was significantly higher for the middle-aged group than for the young group, which was more remarkable in the dump snow removal. The exercise intensity of snow removal in the middle aged was higher than that of the AT level, and it is necessary to note the blood pressure increased for dump snow removal.

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The present study investigated to suggest the way to record electromyographic (EMG) data without motion artifact using fine wire electrodes during rapid and ballistic movement like a throwing. EMG was recorded with the fine wire electrode from the supraspinatus of a university baseball pitcher. EMG from the middle deltoid was recorded using active surface electrodes. Throwing phases were divided from digital video images. The breakthrough point in EMG recording during throwing was to employ the spring clamp, which was connected directly to the buffer amplifier, to put the fine wire electrode. This solution produced the fine EMG recording with less motion artifact. Power spectrum densities of the EMGs from both of middle deltoid and supraspinatus were similar figures to the power spectrum density of the EMGs recorded during manual muscle testing. It was recognized that our improved technique of electromyogram recording with 70 Hz low cut filter was valuable for recording of temporal dynamic alterations of individual muscle activity during rapid and ballistic movement.

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The purpose of this study was to investigate the correlation between ankle joint movement and limitation of ankle joint range of motion (ROM) in hemiplegic patients. Fourteen patients with hemiplegia due to a cerebrovascular accident (CVA) without any history of ankle joint disorders, aged 58 to 76 years (mean = 68.4, SD = 6.1), and six healthy subjects, aged 18 to 30 years (mean 22.0, SD = 5.8), participated in this study. Joint movement for 24 hours and ankle joint ROM were measured 2 and 4 weeks after the onset of a CVA. In this study, limitation of ankle joint ROM was defined as a decrease in the dorsiflexion angle, as measured by a goniometer. Joint movement was defined as a 24-hour recording of changes in ankle angles, measured by an electrogoniometer. Seven limbs of six patients showed a decrease in the ankle dorsiflexion angle (Decrease-group), while eight patients showed no change in the ankle dorsiflexion angle (No change-group). Two weeks after the onset of a CVA, the time spent with the ankle moving from ― 10 degrees up in dorsiflexion for the Decrease-group and No change-group was 19 ± 40 and 137 ± 138 minutes, per 24 hours, respectively. Four weeks after the onset of a CVA, the time spent with the ankle moving from 0 degrees up in dorsiflexion for the Decrease-group and No change-group was 106 ± 103 and 343 ± 170 minutes, per 24 hours, respectively. These differences in the time spent in dorsiflexion were significant between the two groups. In order to maintain ankle ROM, it was suggested to move the ankle in dorsiflexion daily for 137 minutes 2 weeks after onset and for 343 minutes 4 weeks after onset. It was also suggested that these results might be especially useful for preventing a decrease in ankle joint ROM.

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Long-term physical therapy for outpatients with stroke extending beyond the expected recovery period is not uncommon in Japan. The objective of the present study was to clarify the current situation of long-term physical therapy for stroke outpatients, patient hopes and therapist objectives in outpatient physical therapy, and differences between stroke patients who continued physical therapy at hospital and those who terminated therapy. Two questionnaire surveys by mail were conducted, one of 284 stroke survivors and another of 200 physical therapists engaged in outpatient therapy.
According to the therapists, physical therapy for stroke outpatients is prolonged in most hospitals (82.5%) and prolongation of therapy is problematic in some of these (42.1%). Although more than 95% of therapists indicated maintenance of function and activity as the aim of outpatient therapy, most patients (95.9%) demanded recovery from paralysis and improvements in physical function, instead of maintenance even 1 year after stroke onset. Stroke patients who continued both physical therapy at hospital and group exercise at community health centers were significantly older at onset of stroke than those who only continued group exercise (p < .001). In addition, using ridit analysis, the former displayed lower mean ridit for Index of Independence scores in activities of daily living (Katz Index) than the latter (p < .05).
These results suggest that physical therapists must share the objectives of therapy with stroke patients in order to complete outpatient therapy and establish new independent lifestyles for stroke patients.

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[in Japanese]

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We tried a therapeutic exercise this time to a case diagnosed as piriformis syndrome and three other cases suspected of piriformis syndrome.
The objectives of the treatment were to remove pressure from the sciatic nerve, separate the conglutinated parts, and recover mobility by relieving the tension of 6 outward rotators including the piriformis. We expected these effects by the therapeutic exercise instead of the treatment of operation.
We had the patients to contract the outward rotators to the extent accompanying no pain in case the treatment inflicted sharp pain, and then exercised the ROM exercise in order to remove pressure from the sciatic nerve. If right and left difference was recognized or shortened hamstrings existed when the patient did the straight leg rising (SLR) after the muscle around the hip joint became flexible, we improved the ROM and attempted to remove pressure from the sciatic nerve to expect separation of the conglutinated parts and recovery of mobility.
By the time the treatment was completed, pain was relieved in the three cases, and in the two cases in which there had been claudication, improvement of gait was achieved. Besides, no sign of recurrence has been observed.
This method, as a treatment for piriformis syndrome, was considered to be an effective conservative treatment that should be tried before choosing the treatment of operation.

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There were few established standard protocols that were effective for pulmonary rehabilitation of chronic obstructive pulmonary disease (COPD) patients on mechanical ventilation after acute respiratory failure.
We experienced a case that was difficult to wean from mechanical ventilation after acute respiratory failure with severe COPD. As for pulmonary rehabilitation, we performed not only inspiratory muscle strengthening exercise but also on-off trial for weaning. For the purpose of achieving independent ambulation, we performed lower extremities muscle strengthening exercise and ambulation training using Ambu-bag ventilation. Then his inspiratory muscle strength was recovered, and the weaning was accomplished. Muscle strength of his lower extremities was also recovered to the extent he was able to walk independently approximately 150 meters.
It is considered that on-off trial in the early phase may play an important role in inspiratory muscle strengthening in this case. In addition, ambulation training as well as lower extremities muscle strengthening exercise could be effective for the weaning.

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