This study assessed relationships between changes in walking pattern, caused by changes in walking speed and the application of a short leg brace (SLB), and energy efficiency. The subjects were 18 healthy men. Two foot switches and an accelerometer were applied to the subject's right leg for the determination of walking cycle. Energy efficiency during walking was obtained by the physiological cost index (PCI). The subjects were instructed to walk on a treadmill at walking speeds of 86 and 58 m/min. Another task was given to 11 of them; they were instructed to walk at 77 and 51 m/min with SLB applied to the left leg, and measurements similar to those without SLB were performed. The subjects were divided into the following three groups according to patterns for changes in walking cycle, which were observed when walking speed without SLB became slow: in Group I the subjects showed the increased ratio of time for the stance phase; in Group II the subjects showed the increased ratio of time for the heels to touch the ground; in Group III the subjects showed no changes in walking cycle. PCI was significantly lower during walking at 58 m/min than during walking at 86 m/min in Groups I and II, while PCI was unchanged in Group III. The subjects who were instructed to walk with SLB were divided into the following two groups according to patterns for changes in walking cycle, which were observed when walking speed with SLB became slow : in Group A the subjects showed the increased ratio of time for the stance phase; in Group B the subjects showed no changes in the ratio of time for stance phase. There was a significant difference in energy efficiency between Groups A and B, and PCI was significantly lower in Group A. The advantageous strategy for energy efficiency may vary in the presence of changes in walking circumstances such as applying SLB.

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The relation between the load-bearing ability of an affected lower extremity and standing balance, and the influence of load exercise on the standing balance were examined for 14 stroke hemiplegic subjects. The apparatus for balance analysis was used to measure, during static standing, the length and area of instability of the center of gravity, and the body weight load on the affected lower extremity. The subject with a higher load on the affected lower extremity showed a short length and small area of instability of the center of gravity, and was thus considered to have stable standing balance. The four subjects who had underwent load exercise for the affected lower extremity, exhibited an increase in the load on the affected lower extremity and a decrease in the length and area of the center of gravity, which suggested that their standing balance became more stable. These results suggested that not only the balance exercise during standing or gait, but also the exercise for improving load-bearing ability of the affected lower extremity is necessary for hemiplegic patients after stroke.

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The purpose of this study is to examine the effects of an 8-week training program of “standing up from a chair” on motor functions among 10 elderly women (mean age 81.3 ± 4.8 yrs) who are residents of a health institution for the aged. After the training, the following factors significantly improved: the maximum endurance time of the standing up activity (314 ± 190→710 ± 326 msec), the best mean torque value of the quadriceps muscle (0.46 ± 0.27→0.78 ± 0.37 Nm/kg), IEMG (100→146 ± 32%) of the quadriceps muscle (vastus lateralis), motor time of the knee extension (159 ± 30→121 ± 29 msec) and a six minute walk distance (159 ± 48→238 ± 59 m). It was shown that Δ best mean torque value significantly correlated with ΔIEMG, Δ maximum endurance time and Δ motor time. It was also indicated that the six minute walk distance significantly correlated with both the maximum endurance time and the best mean torque. These results suggest that the training program is effective for an improvement in neuromuscular activation of quadriceps muscle, thereby subsequently increasing muscle strength and endurance, and that the increase in muscle strength then improves muscular response, resulting in an increase in walking ability.

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In order to examine the relation between visual field and gait stability, 10-m walking time and coefficient of variation (CV) of 10 trials were obtained from 8 healthy adult subjects under the 4 different conditions of visual fields; without visual constriction, with left homonymous hemianopsia, with left homonymous three fourths hemianopsia, and with complete visual block. With complete visual block, the walking time nearly doubled, and CV was significantly greater, compared with other conditions of visual fields. CV with left homonymous hemianopsia and that with left homonymous three fourths hemianopsia was almost the same as that without visual constriction. These results suggest that the supply of sensory information like lighting of steps or installation of handrails is important for the elderly disabled who have a decreased reserve balance.

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During the session of the 13th International Congress of World Confederation for Physical Therapy (WCPT), we investigated the actual condition of physical therapy of 16 foreign countries using a questionnaire. The results indicated that the proportion of female physical therapists exceeds that of male physical therapists in all countries but Korea and Jordan, and that private practice is allowed in 12 out of 16 countries. There was a difference in major diseases and equipments relating to physical therapy between Japan and foreign countries. In the replies of questionnaire, most of foreign participants expressed praise on the first international physical therapy congress in Asia, and we. Japanese physical therapists, were pleased to achieve our purpose.

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1. The reason why a professional for the diabetes education is necessary. ^* The small number of medical doctor major in diabetes. ^* A rapid increase in the number of diabetes patients in Japan. ^* Cost reduction of medical service based on society demands. 2. Certified Diabetes Educator (CDE) in Japan; purpose of the system and a judgement organ. ^* A CDE is a qualified profession who perform medical treatment with sufficient knowledge on treatment and education of diabetes. ^* The purposes of the system are to maintain the specified level of knowledge and skill on diabetes care among medical staffs, and to increase the population who can perform treatment service under the instruction of certified medical doctors. ^* The judgement organ is a certain body by mutual consent of Japan Diabetes Society and Japan Diabetes Association. 3. The system of foreign countries and American CDE. In the U.S., the system was under examination in 1972, and started in 1985, describing that medical doctors are requested to pass the examination of CDE. In Japan, the time was getting ripe for introducing the system, and Dr. Mimura, a former professor of the University of the Ryukyus, and colleagues translated the textbook of the qualification. 4. CDE in Japan from the viewpoint of physical therapist. Although physical therapists are not allowed to administer an insulin injection in Japan, they are qualified for examination and expected to play an active part in diabetes care. Especially, exercise therapy, foot care, prevention of overuse syndrome of motor organs will become their major professional fields. 5. Prospect. Provided that the society admits the role of physical therapists in reducing medical expenditures, the system of CDE in Japan possibly give rise to the relationship with public medical insurance system of Japan.

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