The risk management of physical therapy for long-term bedridden elderly patients was examined from the point of view of bone density. The osteo sono-assessment index (OSI) of the heel was measured and compared between 33 long-term bedridden patients (bedridden group) and 29 femoral neck fracture patients (fracture group), all females over 70 years of age. The OSI of the bedridden group was significantly lower than that of the fracture group (p<0.001). When implementing a physical therapy program it is important that: 1) information concerning body weight (nutritional status), age and bedridden period should be collected beforehand; that 2) disuse atrophy and aging cause a remarkable drop in bone density should not be forgotten; and that 3) the dangers that falls and small external forces pose for easily causing fractures should be reconsidered.

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The purpose of this study was to clarify the significance of evaluating exercise capacity during upper limb exercise. The subjects were 10 healthy adults. Anaerobic threshold (AT), VE/VCO₂ slope and TV/RR slope were measured using a portable ergometer during upper and lower limb exercises and the exercise capacity was computed. The results show the exercise capacity was significantly correlated between upper and lower limb exercises (AT, r=0.77; VE/VCO₂ slope, r=0.96, p<0.05). Upper limb exercise induced a rapid, shallow breathing pattern. These results suggest that upper limb exercise might reflect total exercise capacity and this might be a useful index for exercise capcity in patients with lower limb impairments.

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The purpose of this study was to compare the walking abilities of elderly people between before and after training preventive approaches. Twenty-seven elderly people who were utilizing Long-Term Care Insurance participated in a three-month training program. One subject was selected from each of three groups: disuse syndrome (A), orthopedic disease (B) and neurological disease (C). Walking speed, step length and cadence were measured and the gait pattern was analyzed by a three-dimensional motion analysis system before and after the training. Subjects A and B improved their gait parameters, and joint moment and power spectrum was similar to healthy adults after the training. However, subject C showed no improvement, not only in gait parameters but also in joint moment and power spectrum after the training. These results suggest the importance of further examination of strategies of training and tests for persons with neurological diseases.

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In this research, we analyzed the differences in the motor abilities of those who attended ambulatory rehabilitation, those living in health care facilities for the elderly and other elderly people participating in fall prevention classes in the community, and studied home care support for the elderly with care needs. The motor abilities were evaluated from 7 tests: 10-m walking time at full speed, maximum step width, frequency of footstep elevation, frequency of sit-to-stand, one leg standing time, upright standing ability on a balance board and forward reach in long sitting. The results show that the motor abilities of those who use ambulatory rehabilitation and live in health care facilities for the elderly were significantly lower in value (p<0.01 respectively) in 6 tests, excluding all but the forward reach in long sitting test, compared to the other elderly people. Furthermore, in multiple logistic regression analysis, 10-m walking time at full speed showed a significant value (p<0.01). In conclusion, we consider the maintenance and improvement of motor ability are important for supporting living at home.

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The purpose of this study was to determine the effects of instruction by physical therapists on the lower extremity joint moment during sit-to-stand movement with handrails. Using a three-dimensional motion capture system, hip, knee and ankle joint moments were calculated by inverse dynamics. Eight young healthy males participated in this study. They were required to stand up using the handrail without instruction, with instruction of pushing the handrail and pulling the handrail. The results show that knee joint extensor moment decreased in trials with pushing the handrail, and knee joint extensor moment and ankle joint plantar flexor moment increased in trials with pulling the handrail. Activity of the upper extremity compensated the vertical reaction forces applied to the lower extremity joints. These results suggest that an instruction to push the handrail by physical therapists is beneficial for diminishing the lower extremity load.

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We studied the load on the diagonally opposite left lower limb in performing the isometric resistance exercise by the manual method at the start, the middle and the final positions of right upper limb proprioceptive neuromuscular facilitation (PNF) flexion-abduction-external rotation pattern. The subjects were 14 healthy, right-handed men (average age 20). The loads on the left lower limb by the resistance exercise in the right upper limb pattern were 4.04±2.40 kgf , 9.01±3.00 kgf , 6.10±4.09 kgf at the start, middle and final positions respectively. The resistance exercise of the upper limb in the middle position on the left lower limb was significantly high (p<0.05) compared to the start and final positions. The ratio of left lower limb flexion to the maximum muscle strength were 28.8% for the right upper limb in the start position, 61.2% for the middle and 43.7% for the final. Isometric resistance by one side upper limb spread the exercise to the trunk and the lower limb, and it was concluded that the opposite side lower muscle activities improved in the dynamics reaction.

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The purpose of this study was to examine differences between stroke outpatients and physical therapists in terms of understanding the goals of physical therapy. In this study, sixty physical therapy goal items and the Q-technique (factor analysis) were used. Twenty-nine pairs of stroke outpatients and physical therapists participated in this study. The results indicated the following: 1) most stroke outpatients believed that improvements in the movement functions and gait functions were their own physical therapy goals; 2) most physical therapists believed that improvements in the gait functions were goals for convalescent stroke outpatients, and that realizing a community and social life were goals for chronic stroke outpatients; and 3) therefore, there were differences between stroke outpatients and physical therapists understanding of the goals of physical therapy. These results suggest that stroke outpatients and physical therapists need a system for involving patients in the establishment of physical therapy goals.

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The purpose of this study was to analyze the influence of low back pain of pregnant women on daily living by determining the actual conditions of low back pain through conducting a questionnaire. The research was conducted on 769 pregnant women who went to maternity clinics and departments of obstetrics and gynecology of general hospitals and sports facilities in Ibaraki prefecture using an original question sheet. The results showed the 56.7% of pregnant women experienced low back pain in pregnancy. The degree of pain on a visual analog scale (VAS) was "light", but the group with low back pain had been feeling difficulties doing back burden activities in daily living from the first stage of pregnancy. From this result, low back pain was self-consciously moderate, but affected activities of daily living badly from the beginning of pregnancy, so precautions are needed from the first stage of pregnancy.

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The purpose of this study was to clarify the influence of posture on lateral abdominal muscles' thickness by using ultrasonography. Twelve male subjects (mean age: 28.6±4.4 years old) were measured for the muscle thicknesses of the external oblique, internal oblique, transversus abdominis and lateral abdominal muscles (the total thickness of three muscles). We measured the thicknesses in the following five postures: supine, sitting and standing postures with neutral pelvic tilt, anterior and posterior pelvic postures in sitting. Then, we compared the muscle thicknesses among the various postures. The muscle thickness of the transversus abdominis and lateral abdominal muscles in sitting and standing postures was significantly greater than in the supine posture. In comparison with the neutral pelvic tilt posture in sitting, all the muscle thicknesses in the posterior pelvic tilt posture were significantly increased. In the anterior pelvic tilt posture, the thickness of the transverses abdominis and lateral abdominal muscles were significantly decreased. Therefore, we should take into consideration the influence of pelvic tilt and antigravity posture when measuring lateral abdominal muscles' thicknesses.

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This study examined the influence of subjective visual vertical (SVV) on sitting postural control in patients with cerebral vascular accident. SVV of right hemiplegic subjects (n=7), left hemiplegic subjects (n=8), healthy young subjects (n=9), and healthy elderly subjects (n=4) were measured as well as the mean tilt angle of the body axis and vertical line when the subjects adjusted their body axis to an oblique target line. The CVA groups showed significant small values in the tilt angle of the body compared to the healthy groups. Statistical analysis indicated that there were no significant correlation between the severity of hemiplegia and the tilt angle of body. The standard deviation (SD) of SVV was significantly large in the left hemiplegic group. Furthermore, there was a tendency for the SD of SVV to be large in left hemiplegic group when the body tilted toward the left side. These results suggest that there is a tendency for the SD value of SVV in left hemiplegic group to be larger than that of the other groups and that this might influence the amplitude of the body axis when the body is tilted.

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The purpose of this study was to clarify the age-related changes of postural control in initiation of lateral step motions. The participants comprised two groups: a young group of 10 females (mean age 24.3, SD 1.8 years), and an elderly group of 10 females (mean age 60.6, SD 3.7 years). They were instructed to step laterally in short (S10) and long (S20) steps as fast as possible. The variables for analysis contained movement duration, shift of center of pressure (CoP) and center of gravity (CoG), displacement and inclination of the shoulder and the pelvis, electromyography of the bilateral erecter spinae (ES), gluteus medius (GM) and adductor longus (AL). In S10, the weight-shift time, CoP shift toward step side, CoG shift toward support side, inclination of shoulder to supporting side, displacements of shoulder and pelvis to supporting side, and bilateral ES activity were higher in the elderly group. When step length was lengthened from S10 to S20, the young group increased the magnitude of GM activity in the supporting limb and shift of pelvis toward the stepping side. The elderly group increased co-activation of GM and AL in the supporting limb but showed no significant differences in kinematic variables. These results suggest that females apply a safer strategy in the dynamic condition with aging.

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This study evaluated the efficacy of a 5-month Tai Chi intervention for improving physical fitness and preventing falling in community-dwelling elderly women. Sixty elderly women were randomly assigned to either Tai Chi intervention (n=30, average age: 72.2 (3.5 years) or control (n=30, average age: 71.6 (4.5 years) groups. Physical fitness measures and questionnaires (including subjects' history of falling, compliance with daily practice of Tai Chi, impression of Tai Chi, and wish to continue with Tai Chi) were conducted before and after the intervention. In the Tai Chi group, the physical fitness measures, including one-leg standing time, grip strength, Functional Reach (FR), walking speed, standing trunk flexion, and swing one-leg while standing on the other leg, improved significantly by the end of the 5-month intervention. In the control group, none of the measures showed significant differences. Significantly fewer people fell during the intervention and the subsequent 6-month period compared with the 1-year period before the intervention.

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It is desirable for an elderly resident who can self-operate a wheelchair in a welfare facility to improve and maintain control of the speed, stability and endurance in wheelchair propulsion. The purpose of this study was to clarify the effects of the improvement of trunk rotation ability on the ability of wheelchair propulsion after trunk rotation machine training for a certain period. We asked 14 residents who self-operate wheelchairs in welfare facilities to train trunk rotation movement using machine, 5 times a week for in 3 weeks. Before and after the training, the trunk rotation strength and wheelchair propulsion ability were measured, and the trunk rotation strength improved significantly. The wheelchair propulsion ability showed no changes in to and from 2.5-m propulsion time, and 6-minutes propulsion distance before and after the training, but a tendency to reduce the 5-m propulsion time was recognized. In conclusion, 3 weeks machine training for residents who self-operated wheelchairs in a welfare facility did not improve drive stability and endurance, but suggested the possibility of speeding up the to fasten the wheelchair propulsion speed by reinforcing the trunk rotation strength.

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Weight increase and the body changes during pregnancy exert various influences on walking. A few studies have been undertaken on the biomechanics associated with gait of pregnant women. Although a previous study reported that ankle joint plantar flexor moment of 3-cm high-heeled shoes was smaller than that of flat shoes during level walking with a simulation pregnancy jacket, the study was not conducted using real pregnant women. The purpose of this study was to compare gait among three pregnant women. We investigated lower extremities' joint moments and gait parameters when subjects walked wearing shoes with a flat sole and 3-cm high-heels using six force plates and a three-dimensional motion analysis system. The results showed that a distinctive effect of pregnancy on walking was observed in two of the pregnant women. Also, ankle joint plantar flexor moment when pregnant women walked wearing 3-cm high-heeled shoes was smaller than that when using shoes with a flat sole. This result suggests that using 3-cm high-heeled shoes decreases excessive ankle plantar flexors loads.

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The purpose of this study was to investigate the relationship between the backrest of a chair and the position of the pelvis on the peak load value at the ischium and the shear stress in sitting on a chair, using an instrument to measure pressure distribution and an experiment model. Ten healthy male subjects (mean age 22.4±2.3 years old) participated in the study. The results showed the peak load value to be significantly lower when the trunk of the body leaned against the chair's backrest, and that it became lower when the pelvis was moved forward and the trunk leaned against the backrest. In addition, the estimated value of shear stress was 1.8±0.7 kgf in the standard position, 2.2±0.6 kgf in the 5-cm forward position, and 2.2±0.5 kgf in the 10-cm forward position. The shear stress value was higher when the pelvis was moved forward. These results suggest that leaning the trunk of the body against the backrest of a chair with the pelvis close to the backrest might be effective for preventing pressure ulcers, because the peak load value on the ischium and the shear stress were lower than they were in the other positions.

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We used a 3-dimensional motion analysis system to analyze a free-style swimming form simulated on land in air space and investigated its relevance to shoulder injury in 12 male competitive swimmers. In the hand entry and mid recovery of free-style stroke, a difference was been between the form of the group with breathing on the same side as the shoulder injury and the group with breathing on the side opposite to shoulder injury, suggesting a relationship between breathing side and shoulder injury. It is thought that we can interpret the results of this study more concretely in the future by analyzing swimmers' form in the water.

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The cardiovascular and respiratory organs are closely related to each other, and sufficient attention to cardiovascular disorders is indispensable for the implementation of respiratory physical therapy. Recently, in the field of cardiovascular surgery, the incidence of respiratory complications has been reduced largely due to increased application of non-invasive positive pressure ventilation (NPPV) as the first choice for the respiratory management of patients with cardiogenic pulmonary edema. This has been made possible by less invasive surgical procedures, improvements in postoperative management, and consequent early weaning from the respirator followed by early release from a bedridden state. In this report, the characteristics of cardiovascular diseases and strategies and implementation of respiratory physical therapy are evaluated by focusing on respiratory physical therapy related to cardiovascular diseases.

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Since the heart and lungs are internal organs connected directly, each organ has always influenced the other. Therefore, respiratory problems such as deoxygenation due to cardiac problems are not improved by only assisting breathing in many cases. Respiratory physiotherapy needs to be applied to patients with cardiac disease with an understand of the pathophysiology of cardiac disease and the limitations of respiratory physiotherapy. Early mobilization is one of the most effective respiratory physiotherapy techniques after cardiac surgery, while clinical evidence has disproved the effectiveness of traditional breathing exercises using incentive spirometry. Patients with heart failure and patients after cardiac surgery show weakness of respiratory muscle strength; however, further research needs to be performed about the necessity of respiratory muscle training for patients with cardiac disease since the relationship between respiratory muscle training and physiotherapy outcomes is not sufficiently clear.

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The early treatment and early discharge components of cardiac rehabilitation have been well established in Europe and America for a long time. Japan is beginning to establish these as well due to the development of various medical devices and research. The Japanese concept of cardiac rehabilitation is centered around three important components, rehabilitation as early and safely as possible to obtain the highest QOL, and that is also our aim. In this report, we summarize the history of cardiac rehabilitation, the system of the cardiac rehabilitation instructor, the method of the three-phased program, and the practical approaches we use at our hospital.

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