The purpose of this study was to investigate the influence of physical fitness on outdoor walking abilities of chronic hemiplegic patients. The subjects consisted of twenty four chronic hemiplegic patients (mean age : 64.5 ± 6.28 years old, 21 males and 3 females) with cerebrovascular diseases who participated in community rehabilitation services. They were classified into two groups according to outdoor walking ability; an independent group (n=13), and a dependent group (n=11). The items measured were age, the term from onset, side of hemiplegia, and Brunstrom stage. The physical fitness was assessed by 1) grip and isometric knee extension strength on the sound side, 2) maximum walking speed and step length of 10-m level walking, and 3) Physical Cost Index (PCI). These items were analyzed by the X² test, t-test, and multiple regression analysis. The results of X² test and t-test showed no significant difference in age, the term from onset, side of hemiplegia, and Brunstrom stage between the two groups. The results of t-test revealed a significant relation between grip strength, maximum walking speed, step length, and PCI and outdoor walking ability. The results of multiple regression analysis showed that PCI was most related to outdoor walking ability. The obtained results suggest that the ability to walk independently outdoors may be influenced by PCI.

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With a primary purpose of predicting gait independence of hemiplegic patients after stroke, we, in the present study, examined whether a coefficient of variation (CV) of gait time or one-legged standing time can be of valuable indices for the necessity of supervision while walking. The patients were divided into those who needed supervision and those who could walk independently, and there was a significant difference in CV and one-legged standing time of affected side between them. Seven out of 13 patients who needed supervision exhibited CV close to that of patients who could walk independently, but their ability to keep one-legged standing was obviously lower. These findings suggest that not only CV but also one-legged standing time is necessary to enhance reliability of prediction of gait independence.

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Physical therapy in the medical treatment and the welfare field is aimed at realizing the maximum independence in daily and leisure activities among handicapped persons. Physical therapy in an occupational health likewise serves the purpose of realizing the independence in occupation activities. From now on, it is desirable that physical therapists (PTs) play an integral role in prevention of disorders, and rehabilitation for handicapped persons; that is, PTs should find their roles in rehabilitation of occupational activities as well as daily or leisure activities. In Japan, however, PTs should have necessary qualifications in order to work in the occupational-health field. This review describes such qualifications; an occupational health care manager and an occupational health consultant, and mentions the possibility of private practice of physical therapy in the field. It also describes the present situation of PTs from the viewpoint of examination qualification; disadvantages or problems to be solved.

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Elucidation of causes is essential to the treatment of temporomandibular joint disorders, and physical therapy should be administered under strict evaluation of the disorders based on anatomy and kinesiology of the temporomandibular joint. The present review introduces the treatment theory and actual treatment of temporomandibular joint disorders of Western countries, and then describes physical therapy and living guidance for the disorder. As for physical therapy, it also outlines myofascial release, soft tissue mobilization, active stretch, relaxation, mandibular depression release, joint mobilization, re-education of intracapsular movement, muscle strengthening, coordination exercise, etc.

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