In our aging society, due to increases in infirm elderly persons and those requiring care, chronic invalidity and structural complications of diseases, the rehabilitation of elderly persons has become increasingly important. The changes in society, changes in motor function, and problems in rehabilitation of the elderly, as well as future issues are discussed.

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The aging of animals is considered focussing on illnesses of old-aged pet animals. In recent years, due to improvements such as environments in which they are kept and disease prevention, dogs and cats' lives are extending rapidly, and previously, seldom seen illnesses of old age are increasing. A big difference between human and animal diseases of aging, with reference to a limited number of species, domesticated cats and dogs, is that arterial sclerosis is rare, and its degree of severity is extremely light. For this reason, clinically, myocardial infarction and stroke are rare illnesses in animals. Also, pathologically, essential high blood pressure has not been verified in animals. In conclusion, although animals have many diseases which are intrinsically identical to human ones, their prevalence and incidence are very different among breeds and species, making them extremely diverse.

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The interim report titled "Courses of action we should be taking in rehabilitation for the elderly" from The Institute of Rehabilitation for the Elderly, a private consultatiive body of the Ministry of Health and Welfare's Health and Welfare Bureau for the Elderly, has been published. The report states the need for an appropriate approach responding to the overall condition of the elderly in their rehabilitation, and proposes three rehabilitation models: the stroke model, the disuse atrophy model, and the senile dementia model. Based on the above proposals, a general discussion is given of the characteristics of geriatric illnesses, physiological changes with aging, and which illnesses are subjects of rehabilitation for the elderly. From each of the above viewpoints an account is given of rehabilitation in the acute stage of stroke relating to the stroke model, the pathologies of disuse atrophy relating to the disuse atrophy model, and the latest developments in diagnosis and treatment of senile dementia relating to the senile dementia model.

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1. The aim of this study was to clarify the effect of a fall prevention program since December 1997, that consists of guidance in exercise and life style for community-dwelling older people. In this study we measured the effects of exercise and life style guidance on fall prevention and assessed the usefulness of the program based on fundamental data from health surveillance of community-dwelling older people. 2. Mobility parameters were evaluated by 10-m rapid walking time, maximal step length, 40-cm steps (Kenkyakudo ^®), tandem gait, and single leg stance for the balance test. 3. The fall prevention program requires individual instruction and careful education on exercise and activities of daily living. It also needs to provide advice on choice and use of walking sticks and evaluation of the living environments of elderly people.

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The purpose of this study is to describe a recreation program, the make-up of participating groups and the basic considerations behind it (group structures and characteristics; objectives and efficacy of recreation), instituted for elderly persons with disability, and from an occupational therapists perspective the four points which need to be heeded in its implementation. It is stressed that a variety of means are needed, especially as to participants "enjoyment", which is one of the principles of the recreational activities.

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It has been recognized that improvement of disability of living functions should be the target of rehabilitation for the elderly, and the establishment of a system offering active and effective rehabilitation for persons currently needing care is rapidly taking place. At the same time, with regard to infirm persons currently not requiring care but predicted to need care in the future, to raise their physical abilities, various initiatives as "care prevention" methods have been proposed and are progressing. Power rehabilitation is one of these proposed methods. The considerations behind it are the improvement or prevention of disability of living functions through offering regular, prescribed machine training, and its principal objective is "behavior change". As of May 2004, there were 693 facilities implementing power rehabilitation and their breakdown, in order of number, was as follows: health care facilities for the elderly, hospitals, independent day service providers, clinics and local councils. Services offering not only care prevention, but also disease prevention, disability deterioration prevention, and social participation activities are introduced as examples of actions taken by medical organizations. The author believes that we should now be discussing how care prevention should be tackled within the process of rehabilitation from medical services to the community, how it links in with existing services and its practice, rather than discussing what care prevention methods should be implemented.

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This study was designed to investigate the effects of abnormal autonomic cardiovascular function on heart rate variability and circadian rhythm in individuals with cervical cord injuries. We characterized the sympathovagal balance and autonomic responsiveness by power spectral analysis of heart rate variability in 7 male paraplegic patients (26 ± 5 yr) and 8 male healthy volunteers (25 ± 2 yr). Very low frequency, low frequency, high frequency and low frequency-to-high frequency ratio, as well as CV_R-R intervals of heart rate variability were compared during daytime and night-time in both groups. The daytime low : high frequency ratio and CV_R-R value were significantly higher than the night-time values of both groups. The very low frequency and low frequency values in daytime in the paraplegic group tended to be lower compared to those in the control group, although the high frequency value did not change in either group. The low : high frequency ratio in daytime in the paraplegic group was significantly lower than that in the control group. These results suggest that there are circadian rhythms and abnormal autonomic cardiovascular functions, which are related to sympathovagal balance of heart rate variability, as measured by power spectral analysis, in individuals with cervical cord injuries.

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The objective of this study was to investigate using the time study method, with users of day care services provided for hemiplegic stroke patients as subjects, conditions within the facility from the perspectives of amount of physical activity as well as maintaining and improving time spent on it. The subjects were 36 (18 male, 18 female) users of day care services provided for hemiplegic stroke patients. For the time study method, subjects' activities were recorded on a one minute basis from arrival until the conclusion of their services within the facility. Activity times were classified into 7 items, care by a physical therapist, independent exercising, rehabilitation care by staff other than physical therapists, leisure, resting, living activities, and others, and calculated as percentages of the whole time of facility use. The results showed that subjects' physical activity time within the facility was short, and there was a declining trend for this time with the degree of care required. From this result, we consider that there is a need to offer services giving longer periods of physical activity within the facility in day care service.

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In this study, we analyzed optimal walk and fastest walk using the gait analysis system, GAITRite, and investigated the reliability of different measurement methods as well as characteristics of gender, the dominant leg and non-dominant leg. The results of gait analysis of 42 subjects (18 male, 24 female, average age 22.1 years) gave high reproducibility with an intra-class correlation coefficient greater than 0.9 in both optimal walk and fastest walk for step width, step time, walking speed and walking rate. No differences for gender were found in optimal walk, however at fastest walk significant differences were found in all indices other than step time and walking rate. With regard to the dominant leg and the non-dominant leg, no significant differences were found in any of the measurement values. These results suggest that whichever of optimal walk or fastest walk is used for gait analysis in clinical practice, a highly reproducible value will be obtained, however, in order to more accurately elaborate individual gait performance, fastest walk is superior to optimal walk.

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The purpose of this study was to clarify the factors related to general results of clinical internship in the field of physical therapy education. The subjects of this study were 39 students belonging to the final school year, who had experienced clinical internship three times. The duration of each clinical internship was seven weeks and three days. The relationship between general results and each statement for evaluation of student's skill was analyzed to calculate the correlation coefficient and multiple regression analysis. The evaluation of student's skill consisted of twenty-one statements, which were passion and spirit as a physical therapist, knowledge of physical therapy, ability of physical therapy evaluation and level of physical therapy technique. The findings of this study were as follows. 1) Passion and spirit and physical therapy evaluation had a large effect on general results. 2) The method of integration and picking up the main problem was the most important in the physical therapy evaluation. 3) Regarding knowledge, knowledge about diseases, test and measurement were important. 4) Concerning technique, training on limitation of range of motion in a joint and risk management were important. 5) In the case of low scores in passion and spirit and physical therapy evaluation, even if the results of knowledge and technique were high, the general results was judged lower than in actual assessments.

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To clarify factors influencing the recovery process of joint function after discharge, the authors investigated serial changes by using the criteria proposed by the Japan Orthopedics Association (Hip score) and Manual Muscle Testing (MMT) in patients with THA. One hundred and sixteen female patients were registered in this study. By using the criteria proposed by Hip score, we evaluated pain, ROM, gait performance and ADL at discharge and at 24 months after discharge. On the same occasion, we also measured muscle strength around both hip joints with MMT. The mean Hip score before operation was 56.3 ± 13.9, and 24 months after operation, it was 88.3 ± 8.6 (P<0.01). Muscle strength around the hip joint improved significantly (P<0.01). Multiple regression analysis between the sum of each JOA score and background factors using stepwise selection was performed, and it revealed that 4 factors, history of operation, complication, muscle strength in non-operated side, and age were significantly related to the sum. We made a construct by Structural Equation Modeling, and the result was consistent with the upward and downward model proposed by Whyte in 1994 and 1997.

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The purpose of this study was to quantitatively analyze differences in normal diaphragmatic motions during spontaneous breathing (SB) and maximal deep breathing (MDB) using dynamic analysis of magnetic resonance imaging (dynamic MRI), to examine whether there is correlation between total diaphragmatic motion during MDB and BMI, vital capacity (VC), and chest expansion. Mean cephalocaudal distance in diaphragmatic motion was 14 mm in the ventral region, 20 mm in the central region, 27 mm in the dorsal region during SB, and 41 mm in the ventral region, 64-67 mm in the central region, and 74 mm in the dorsal region during MDB. No correlation was apparent between total diaphragmatic motion during MDB and BMI, VC, or chest expansion.

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In this study, we measured the body sway in one-leg standing with vision of 33 healthy females (average age 22.2 ± 2.6 years), and investigated the relationship between the principal leg muscle strengths and foot function (foot-gripping and plantar sense). Through multiple regression analysis, foot-gripping and plantar sense (2-point discrimination sense) were determined as factors affecting body sway, suggesting the preservation of one-leg standing is stable when foot-gripping is strong, or plantar sense is sharp. This information suggests that in a subject with good maintenance of one-leg standing, it is the foot function, foot-gripping and plantar sense, which affects body sway in one-leg standing rather than the strength of the principal leg muscles, such as the quadriceps femoris. That is to say, in order to raise the one-leg standing ability of a subject who can stand on one-leg for more than 30 seconds, rather than strengthening the principal leg muscles, the importance of plantar sense and foot-gripping training is suggested.

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The purpose of this study was to investigate the influence of the spinal cord injury on contracture of the rat soleus muscle. Eight-week-old Wistar rats were divided into three experimental groups. The first group had their left hind limbs immobilized in complete plantar-flexion by pins. The second group had their left hind limbs immobilized in complete plantar-flexion by pins and spinal transections were made at the T8 level. The third group was the control. After four weeks, the soleus contracture showed a considerable increase in the first and second groups as compared to the third group. But there was no difference between the first and second groups. It seems that the muscle contractures were influenced by disuse due to joint fixation but not by muscle spasticity resulting from the spinal cord injury.

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The purpose of this study was to investigate how much stress is applied to the knee joint during comfortable gait, using a computer simulation technique. The subjects were 7 males, aged 19-20 years old. A force platform and a three-dimensional motion analysis system were used for the measurements. The muscle activity of the lower extremities and the anterior draw force of the tibia during comfortable gait were calculated using a musculoskeletal model. The results were as follows: Muscle activity of the quadriceps and the anterior drawer force of tibia tended to be higher in the early period of the gait cycle. This result suggests that physicians must be careful about greater-than-expected load in the gait exercise for anterior cruciate ligament rupture patients.

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Recently, evidence based physical therapy (EBPT) has become topical. The items of importance in examinations for EBPT are the outcome measures, however, there are several problems with outcome measures, and one of these is reliability. Here, by reliability, we mean inter-rater reliability and inter-class reliability. Pearson's product-moment correlation coefficent, for example, is often cited as an expression of reliability, but in this study we discuss the intra-class correlation coefficient and outline methods for determining inter- and intra- rater reliability

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