Rotational acetabular osteoplasty (RAO) has been obtaining satisfactory results as an open treatment for shelf aplasia, and arthropatic changes have been, however, reported to advance in the unoperated side. The purposes of the present study were to confirm whether sufficient load was administered to the operated side of the patients receiving RAO, and to examine the change in load rate of the operated side and the required time regaining sufficient load. Load rates of the operated and unoperated sides of 42 patients receiving RAO (42 joints) were measured, and the patients were divided into 4 groups according to elapsed time from the operation. Patient group within 2-year period after the operation showed a significantly smaller load rate in the operated side, compared with other groups, but the rate tended to reach 50% in both sides with an elapse of time. In patient group of more than 3 years after the operation, there were a few patients who had received the operation to the unoperated side without any loading on the operated side, and who had been diagnosed as suitable for operation. These results indicate that load rate should be increased to 50% in both operated and unoperated sides at the earlier time.

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The purpose of this study was to determine the standing balance reaction in healthy young and older subjects using a movable platform. The subjects were 20 volunteers in good health; 10 young subjects with a mean age of 24.5 years and 10 older subjects with a mean age of 65.4 years. Each subject stood on a movable platform with their eyes open or closed, as the following three conditions were performed: 1) standing on a stable support surface, 2) toes up and toes down with rotational motions of both support surfaces in the sagittal plane, 3) an upward displacement of the one support surface and downward displacement of the other with lateral rotational motions in the frontal plane.The dispersion, the mean displacement of the center of pressure, and the rate of weight shift were calculated by using the dynamic balance system (CHATTEX). The results were as follows: 1) The dispersion in older subjects was slightly greater than (that) in the young subjects under all conditions, but was not significant. 2) The dispersion with the eyes closed was significantly greater than (that) with the eyes open under all conditions in both groups. 3)With the eyes closed, the standing balance in both groups was affected greater by the stimulation of toes up and down rather than that of upward displacement of one foot up and downward displacement of the other. But standing balance with the eyes open was not affected. These results indicate that the task of toes up and down is more difficult for subjects standing with their eyes closed.

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The purpose of this study was to examine the knee extensor strength required for independence in locomotion activities in the elderly. Subjects were 80 nursing home residents with the average age of 81.3 ± 5.48 years. They were divided into two groups; independent and dependent (need some assistance), according to the Mobility index of Barthel Index on climbing activity of steps, bathing activity, gait, toilet activity, and transfer from bed to wheelchair. A total of %BW of the maximum isometric knee extensor strength of the both sides measured by a manually holding myometer was used as the subject's knee extensor strength. Independent group exhibited significantly greater knee extensor muscle in all the activities compared with dependent group (p<0.01). The discriminatory analysis indicated that %BW discriminating independent from dependent groups was approximately 48.5% in climbing activity of steps and 44-45% in other activities. These values are considered the standard knee extensor strength required for independence in locomotion activities in the elderly.

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In order to examine the applicability of the Physiological Cost Index (PCI), PCI of 17 hemiplegic patients were measured for 5 consecutive days. The subjects were divided into two groups according to the PCI results; group A (0.22-0.60) and group B (1.39-5.02). Subjects of group A could walk independently except one subject, and those of group B used wheelchair except one subject, which suggested that PCI results corresponded to locomotion ability. Group A exhibited the walking velocity over 20 m/min, which was faster than group B. PCI results of group B tended to be unstable, and especially a subject of lower gait frequency showed varying results of heart rate and gait distance. Although it remains to be further examined whether PCI is applicable to the assessment of gait ability of hemiplegic patients, the present results suggest that PCI of hemiplegic patients may be a little higher than that of healthy controls.

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Respiratory impairment observed in patients with apoplectic hemiplegia has frequently been reported as restrictive impairment, but there has been no effective physical therapy for this impairment. To improve the sitting posture and body trunk function in hemiplegic patients, we evaluated the effect of single performance of exercise therapy on the respiratory function. After exercise therapy, %VC and the thoracic expansion difference were significantly increased. These findings suggest that a secondary decrease in thoracic mobility and functional failure in the muscles in the trunk are involved in the respiratory impairment in hemiplegic patients. To improve these factors, a systemic approach may be necessary.

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The purpose of this article was to describe the differentiation between local hip pain and lumbar spine referred pain. In clinical practice, it is essential to differentiate the hip pain from the lumbar pain (referred pain or project pain) in order to manage patient's problem. In this article, several local problems and special tests for differentiation between hip and lumbar spine referred pain were described.

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Disorders in nervous system lead to various dyskinesia, sensory and autonomic disorders. The present review deals with abnormal signs recognized in the functional examinations for stroke, Parkinson's disease, neuropathy, and myasthenia gravis, as well as the functional evaluation tests widely used for disorders of central and peripheral nervous systems.

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A series of the reviews have described the interactions between pharmacotherapy and physical therapy in the treatment of various diseases. This third part deals with the interaction occurring in the treatment of Parkinson's disease and diabetes mellitus. Therapeutic agents for Parkinson's disease consist of dopamine agonists and anticholinergic agents, and those for diabetes mellitus are composed of insulin preparations and oral agents for diabetes. Effects of these agents and the interactions with physical therapy were described.

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