The action of standing up is often used in, for example, the measurement of performance, lower limb muscle strength and estimates of gait performance. The objective of this study was to clarify the relationship between the 30-second chair-stand test and lower limb muscle strength and gait performance, using 15 hemiplegic stroke patients as subjects, and to investigate the clinical application of the test. Correlations were found between the 30-second chair-stand test and the hemiplegic side knee extension strength (r=0.61), as well as the 10 m maximum gait (r= -0.91). The 30-second chair-stand test measures the number of times it is possible to stand from sitting in a chair within 30 seconds, and it can be easily performed in a clinical situation. Furthermore, the possibility is suggested, that hemiplegic patients' gait performance can be easily assessed by the chair-stand test.

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A decline in joint position sense invites the danger of sudden falls for the elderly. There is considered one general evaluation to measure joint position sense. This method of measurement however has many vague and unclear points. In this research using young healthy adults, as basic research for joint position sense measurement, we examined the influence of joint position sense error and the differences between the angles (i.e. the speed of movement between 2 points of origin within an angle). We measured the knee joint position sense using Barrett's method on 44 limbs (22 young subjects). Starting position was knee flexion at 90 degrees. Angles were set at 10 degrees and 70 degrees and each average knee joint extension speed 10 degrees/sec, 70 degrees/sec was measured. As a result, it was evident that it was easy to make errors on the 70 degree extension speed test when compared to the 10 degree angle flexion speed set up. From this observation, knee joint sense as a part of a set angle was thought to have had an influence on the angle speed for the set joint angle. This influence is thought to be related to a mechanoreceptor although it cannot be said for sure. Taking these points into consideration for future clinical measurements it is thought that this experiment would not make a good time indicator.

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We investigated the effects of changes in outcome trends of patients with cerebrovascular accidents (CVA) and functional independence measure (FIM) before and after the introduction of the long-term care insurance (LTCI). The subjects consisted of 464 CVA patients hospitalized in the Hyogo Rehabilitation Center Hospital before the introduction of the LTCI, and 467 CVA patients after the introduction of the LTCI. The FIM total score and the average hospitalization period were not influenced by the introduction of LTCI. After the introduction of LTCI, discharge from the hospital to home or to a another hospital showed a decreasing trend, but discharge to home care services showed an increasing trend. A detailed study of LCTI is required to increase the number of CVA patients staying at home and returning to the community.

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As part of physical therapists' education, activity in the community in which we can communicate with residents directly is very meaningful. Not only clinical practice, but also activity in the community is suited for understanding medical care, health care and welfare of residents. This paper reports the response of physical therapy students to questionnaire about an activity in the community as part of co-medical education. The trial got the approval and satisfaction of almost all the students. The main reason was an exchange of views with people living in the community. This trial was done to educate students with the following objectives: 1) gaining an opportunity to talk with residents, 2) cultivating a solution to a problem, 3) having an awareness of medical care, 4) having independence, and the importance of personal relations (negotiation, communication, mental care, etc.). Also, the students were told to put this experience to practical use. Thus, activity in the community is very useful and necessary for students having physical therapy education.

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We investigated the relationships between the performance test which employs the standing action (no. of repeats in 10 s) and knee extension strength and the 10 m walking time, with 44 hemiplegic patients as subjects. Significant correlations were found between the performance test and knee extension strength (non-hemiplegic side: r=0.67, p<0.01; hemiplegic side: r=0.75, p <0.01), and 10 m walking time (r=-0.75, p<0.01), and the reproducibility of the test was good. On the basis of the measurement of the number of stand repeats, the subjects were divided into 3 groups, and significant differences were found among knee extension strengths and 10 m walking times of the respective groups. Measurement of the performance test through the number of stand repeats within 10 s is simple, and it also has high reproducibility. Furthermore, since it is highly correlated with lower limb muscle strength and gait ability, we concluded that it is useful as an assessment method of functional movement ability of hemiplegic patients.

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The purpose of this study was to investigate the relationship between knee extension muscle strength and walking ability in the elderly patients. Isometric knee extension muscle strength and unaided walking rate were measured in 78 elderly inpatients (age: 75.7 ± 7.7). Walking ability was classified into three groups: unaided walking in the hospital (n=50), unaided walking in inpatient's room (n=10), not capable of walking (n=18). The knee extension muscle strength in the group of unaided walking in the hospital was higher than those of the group of unaided walking in inpatient's room and not capable of walking. The logistic regression analysis showed that the knee extension muscle strength was a critical factor affecting walking ability. In the case in which the muscle force was below 0.5, the group of unaided walking in the hospital began to decrease. The minimum value of the group of unaided walking in the hospital was 0.28. In the case in which the muscle strength was below 0.3, the group of unaided walking in inpatient's room began to decrease. The minimum value of the group of unaided walking in inpatient's room was 0.13. It was indicated that the leg muscle strength is important as an explainatory factor of the walking ability of the elderly patients.

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The objective of this study was to clarify the control of gait in stepping over different obstacles through quantitative analysis of toe clearance. The subjects were 22 young women, and on level ground and with obstacles raised 0, 1.5 and 18.3 cm from level ground, toe clearance, leg joint angles, stride length and gait velocity were measured. Using a video camera, an easy and convenient method, high precision measurement analysis was possible and satisfactory reproducibility was achieved. A significant difference was seen in toe clearance between level ground (34.5 mm) and the 0 cm obstacle (43.5 mm), and a significant difference in coefficients of variation between level ground (6.1%) and the 0 cm obstacle (9.6%) was also seen. For the 0 cm obstacle, through consciousness of stride, a high level of voluntary control was taking place. Toe clearance showed changes in response to the height of the obstacles, and changes were also seen in leg joint angles, stride length and gait velocity. Also, a difference was seen in right and left leg joint angles, suggesting the influence of differences in lower limb function between the dominant leg and the axopodium. From the above results, it is clear that in stepping over obstacles, complex control of the toe clearance takes place.

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In Japan, pregnant women customarily to wear shoes with flat soles in order to prevent them from falling down. Recent information indicates that shoes with 2-3 cm heel height are appropriate for pregnant women. However there is no study that has investigated the biomechanical effects of heeled shoes when worn by pregnant women. The purpose of this study was to make reference data of pregnant women walking in high heeled shoes in respect of biomechanics. We investigated the basic gait parameters and lower extremity joint moment with seven healthy women who walked wearing simulated pregnancy jackets and shoes with flat sole or 3 cm heel height. We captured their motion and floor reaction force using 4 force plates and a three-dimensional motion analysis system. The results showed that ankle joint plantar flexor moment when subjects used shoes with 3 cm heel height was 4.1% smaller than that when using shoes with flat soles. Therefore using shoes with 3 cm height might decrease excessive ankle plantar flexors load.

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The purpose of this study was to investigate by electromyography whether there was an appropriate load on the lumbar erector spinae during extremity elevation exercise from the all-fours position. Young and elderly women participated in this study. The spinae muscle strength of young women were stronger than those of elderly women. Also, maximum muscle activity of young women was 26.6 ± 13.2%, and for the elderly was 80.7 ± 33.2%, during extremity elevation exercise. The result indicates that this exercise was an effective load for elderly women but was not enough for young women. An EMG assessment of lumbar erector spinae may be needed for an assessment of the appropriate load for the muscle strengthening.

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When lifting the heel, it seems that the angle of spinal extension and the range of shoulder anterior elevation are improved in cases of kyphosis and posterior deflection of center of gravity in the standing position. In this research, with 24 healthy adults as subjects, the effect variation of the angle of ankle joint under 3 conditions of 0°, 10° plantar and dorsal flexion contribute to angle of spinal curve, angle of the pelvis inclination, and the shoulder anterior elevation in the sagittal plane were investigated. In addition, we examined the effect in different classes of standing posture. Focusing on the position relationship of upper center of gravity and lower center of gravity, standing posture was classified into 3 types: the anterior type, posterior type, and neutral type. As a result, in all posture types, the range of shoulder anterior elevation was not changed among 3 conditions, however, the angle of pelvis inclination and center of pressure were changed in the posterior type. Because of varied angle of pelvis inclination, motion of the pelvic and the lumbar vertebra were influenced by shoulder anterior elevation.

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We examined here the effect of the elbow joint posture on elbow flexor fatigability and strength during isometric contraction. Nine healthy subjects, who gave informed consent, participated in the present study. The subjects were seated in a chair with the shoulder joint at 0°, and the shoulders, pelvis, and thigh were immobilized by straps. The elbow joint posture was positioned at 30, 60, 90 and 120° of elbow flexion. First, subjects produced maximal elbow flexion as a maximum voluntary contraction (MVC) in each elbow joint posture. A myodynamometer was used to measure muscular strength. Secondly, the subjects performed 50% MVC effort for over 60 seconds with visual feedback. The surface electromyograms of the biceps brachii and brachioradialis muscles were recorded. The muscle fatigue was characterized by median power frequency (MDPF) calculated from the power spectrum of surface electromyograms using autoregression models. MDPF were calculated for each section, then 60 seconds was divided into each six sections consisting of 10 seconds. Findings of the present study are: 1) the elbow joint posture requiring the maximum strength is 90°; and 2) MDPF decreased over time in both muscles, and the rate of reduction tended to increase with flexion angle. These findings suggest that the elbow joint posture that demonstrates the maximum muscular strength differs from the one which does not cause muscle fatigue easily. When therapist determines training posture, it is necessary to take this point into consideration.

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The purpose of this study was to investigate the influence of a peripheral nerve injury on rat ankle joint contracture and the elasticity of the soleus muscle. Eight-week-old Wistar rats were divided into three groups. The left hind limbs of the first group were immobilized in complete plantar-flexion by a cast. In the second group, the left hind limbs were immobilized in complete plantar-flexion by a cast and left sciatic neurectomy was performed. The third group was the control. After four weeks, the ankle joint motion and soleus elasticity showed a considerable decrease in the second group as compared with the first group. It seems that peripheral nerve injury harmfully influences joints and muscles.

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With 15 cases of hemiplegia as subjects, we measured centre of pressure (COP) in maintenance of the upright sitting position at rest (resting task) and lateral reach in the sitting position (dynamic task), while wearing and not wearing an abdominal belt, and investigated and compared the results. In sitting at rest, maximum x-axis movement with the belt was 0.15 ± 0.06 cm, and was 0.22 ± 0.12 cm without the belt, a significantly (p<0.01) smaller distance with the belt. For lateral reach, the distance was 21.2 ± 5.1 cm with the belt, and 19.3 ± 5.6 cm without the belt, a significantly (p<0.05) greater distance with the belt. Despite the greater lateral reach with the abdominal belt, a significant difference in COP of the dynamic task between with and without the belt was not found. For left-right postural sway in maintenance of the sitting position and lateral reach of hemiplegic patients, an abdominal belt improves stability of the lower trunk, and lumbar spine, suggesting a beneficial effect of increased abdominal muscle pressure.

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It is conjectured that kyphosis in the elderly is affected by the ability to control dynamic posture. In this study, with quantitative assessment of kyphosis as the objective, we performed measurement of the index of kyphosis based on the method of Milne et al. which uses a flexible curve ruler, on elderly persons undergoing physical therapy at our hospital, and investigated its reliability and validity. The inter- and intra-class correlation coefficients were 0.858 and 0.851, respectively, both showing a high reliability, and according to the observations, a significantly high correlation was found in their relationship to kyphosis assessment, Spearman's rank correlation coefficient 0.819 (p<0.01). It is considered that the measurement of the index of kyphosis can be used clinically. Furthermore, according to the observations, since scattering of the index of kyphosis was found at each level of kyphosis assessment, it suggests that measurement of the index of kyphosis is of use as a method which can assess kyphosis in detail.

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This paper reports on the role of the physical therapists in the preventive approach of the long-term care insurance introduced by Tokyo Metropolitan Institute of Gerontology. The preventive approach is a comprehensive approach in which the short-term program aims to improve geriatric syndrome and the long-term program includes involvement of administrative policy. It is thought physical therapists should play a leading role in the preventive approach of the long-term care insurance.

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The main causes initiating conditions requiring care are difficulties with daily living, such as infirmity with age, falls and bone fractures, the so-called geriatric syndrome. In order to establish a strategy for preventing geriatric syndrome, it is necessary to understand the situation regarding age-related changes in old persons' health and physical and mental functions. According to a longitudinal study of old people living locally, it became clear that the occurrence of geriatric syndrome was related to motor functions, suggesting that exercise is important as a principal measure in care prevention. It has already been empirically proven that through exercise training, old peoples' motor functions are improved, and it can be predicted that there will be a greater demand for care prevention involving exercise. It can be said that physical therapists should play a big role in the process of developing such care prevention.

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