The purpose of this study was to identify the primary muscles during long-time walking in young and elderly adults by mean of positron emission tomography using [¹⁸F]fluorodeoxyglucose (FDG-PET) for quantitative evaluation of glucose metabolism in the skeletal muscle. Ten young males (mean 24.1 ± 2.1 years old) and six elderly males (mean 75.5 ± 2.1 years old) underwent a FDG-PET after 50 min treadmill walks. Regions of interest (ROIs) were located on the central or activated regions of skeletal muscles: the hip flexors, extensors, and abductors, knee flexors and extensors, and ankle dorsiflexors and plantar flexors. Glucose metabolism in ROIs was evaluated as the standardized uptake value (SUV). FDG uptakes were high values significantly in the hip abductors, ankle plantar flexors, and ankle dorsiflexors in the young adults. The elderly adults showed markedly high SUV value in the hip abductors. There was a significant difference in SUV values between the hip abductors and hip flexors, knee extensors, ankle plantar flexors in elderly adults. The gluteus minimum showed especially high SUV uptake nearly threefold SUV in the gluteus medius in the young adults (p < 0.01). On the other hand, the elderly adults showed high SUV uptake in the hip surrounding muscles including the gluteus medius or the gluteus maximus. The ankle plantar flexors showed high SUV values in the young adults, whereas the low SUV values were recognized in the elderly adults. These results suggest that the hip abductors had an important functional role during long-time walk, and that muscle activity of ankle plantar flexors deteriorated with age. We considered that physical therapy focused on these muscles might be beneficial intervention to improve long-time walking ability.

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The purpose of this study was to investigate the relationship between error in estimated reach distance and falls in community-dwelling elderly people. Subjects consisted of 163 community-dwelling elderly people (mean age 75.9 ± 5.2 years, 55 males and 108 females). Experimental protocol required subjects first to estimate maximum-distance forward reaches and then execute that. The error in estimated reach distance (ED) was defined as the differences between actual and estimated forward reaches, with positive values of error representing underestimates, and negative value representing overestimates. Other assessments included the number of falls in the previous year, absolute value of ED, Functional Reach Test (FRT), Falls Efficacy scale (FES). Then it was explored whether error in estimated reach distance, together with FRT and FES, was associated with falls in elderly people. 52 (31.9%) subjects reported history of fall, 25 of them (15.3%) multiple falls. Mean value of error distance in multiple-fallers was negative and significantly smaller than that in non-fallers (p < 0.05). In logistic regression analysis, ED (Odds Ratio = 0.93) and FES (Odds Ratio = 1.10) were detected as risk factors of multiple falls. Multiple-fallers tended to overestimate their reach excursion. To clarify the relationship between error in estimated reach distance and falls, it is necessary to evaluate other risk factors for falls in prospective study.

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The purpose of this study is to investigate the effects of an inspiratory muscle training using incentive spirometer (IS) on respiratory function in patients with amyotrophic lateral sclerosis (ALS). This study was carried out as a multi-institutions non-randomized controlled trial. The subjects were 14 ALS patients who have been notified their diagnosis, and assigned treatment or control group by the institutions. The treatment group was 9 patients with the inspiratory muscle training in addition to ordinary physical therapy, while control group was 5 patients without any additional training. The inspiratory muscle training was performed at a moderate load, once a day for 8 weeks. The outcome measure were the Japanese version ALS functional rating scale-revised edition (ALSFRS-R), respiratory function test (VC, FVC, PEF, PCF), respiratory muscle strength (PImax, PEmax), and arterial blood gas test. The evaluation was done at before training, 4th week (except ALSFRS-R) and 8th week. After 8 weeks training period, the score of ALSFRS-R declined in treatment group due to progress of disease while the score did not change in control group.
Regarding the respiratory function test, the result was that only PCF showed a significant decreasing in control group, whereas keeping with no change in treatment group. In the change rate of respiratory function, the change rate of PCF also showed a significant difference.
As the respiratory muscle strength and the change rate of respiratory muscle strength, although the differences were not significant, %PImax tended to increase in treatment group and to decrease in control group. %PEmax tended to decrease in both groups.
Although the results of arterial blood gas test also did not show any significant difference between two groups, there was a tendency to keep in treatment group.
These results suggest that the inspiratory muscle training has a possibility to inhibit declining of respiratory functions in ALS patients. It is considered that the degree of load of respiratory training in this study is not overwork and could be provide for ALS patients safely.

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The purpose of this study was to investigate the functional difference of upper, middle and lower portions of subscapularis muscle. The electromyography (EMG) activities were detected using fine-wire electrode and were recorded from upper, middle and lower parts of the subscapularis. Six subjects with no previous history of shoulder injury were evaluated in this study. Each subject performed maximum isometric internal rotation in 21 positions (abduction at 0°, 60°, 120°, flexion at 60°, 120°, scapular elevation at 60°, 120°, at three degrees of Numeral rotation, internal rotation at 45°, midposition of roration and external rotation at 45°) using BIODEX system 3 for 5 sec. Integrated EMG activites (%IEMG) of internal rotation ware normalized with the humerus in 0° abduction and midposition of rotation. The results demonstrated that peak torque value at 120° scapular elevation and abduction in midposition of roration was statistically significant lower than elevation at 0° and 60°. In the abduction in midposition of roration, the %IEMG value in the upper parts of subscapularis at 0° was higher than at 60° and 120°. In the scapular elevation in midposition of roration, the middle parts of the subscapularis at 60° was higher than at 0° and 120°, in the lower part of subscapularis was higher at 120° than at 0° and 60°. These findings suggest that maximal activation of 3 portions of subscapularis during internal rotation depend to the angle of humeral axis to be perpendicular to each portion of subscapularis muscle.

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