Functions of extremities are based on the dynamic stability of the trunk. The dynamic stability of the trunk is maintained by the integrated function of passive tissues, active tissues, and nervous systems. Local muscles which are located deep in the trunk have an important role for the segmental stability of the vertebral column. In this article, I focused on the functional aspects of these muscles and described the method of evaluation and training for those muscles.

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The mechanism of motor functional recovery after stroke is still largely unknown. However, recent advances in functional neuroimaging techniques, such as functional MRI (fMRI) and near infrared spectroscopy (NIRS) have enabled us to study directly the brain activity of humans. We have performed fMRI and NIRS on stroke patients from the acute through chronic stages using a task of unilateral hand movement. We have also visualized the pyramidal tracts with MRI diffusion tensor tractography. Our results suggest that motor functional recovery after stroke occurs primarily through use of the existing functional system when brain damage to the motor system is partial, recruiting functionally related systems when necessary or the damage is severe. These restorative and reorganizing processes occur within the first few months after stroke, and this period seems critical to motor function recovery.

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Among the higher nerve function disorders due to brain damage, unilateral spatial neglect, mainly caused by right hemisphere damage, is an important clinical issue. Much research into its evaluation and therapeutic approaches have been done since Brain (1941). Various approaches other than the conventional "promoting awareness" have been advocated. As non-cognitive ways, TENS, trunk rotation and prism adaptation are focused on attention. Especially, we studied prism adaptation in relation to wheelchair operation. Furthermore, we report the outline of the Side Mirror Approach, the effect of mirror therapy that has recently come under the spotlight again, on unilateral spatial neglect. In addition, as a related symptom, the primary lesion and the mechanism of Pusher phenomenon (contraversive pushing/ipsilateral pushing) were analyzed symptomatologically, and we propose a basic policy for treatment and improvement methods of sitting balance as a clinical approach.

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The validity of clinical diagnosis for planning of intervention policy in physical therapy may influence the intervention effects itself. Therefore, it is important to promote a conversion conceptual framework from conventional empirical rule-based physical therapy to evidence-based physical therapy (EBPT). To put EBPT into practice, not only evidence of experimental proof by clinical research but patients' intention and values, and total clinical diagnosis which integrates physical therapists' specialized knowledge and skills are important.

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The activities of daily living and its evaluation in long-term care insurance must be made in order to achieve the most appropriate physical, mental and social life for the patient after discharge from hospital and to prevent declining physical function and ability. It is also important to perceive the care service features and progress the therapy recognizing the role of physical therapy in the service.

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Impairments resulting from stroke are wide ranging. In this article, I discuss the nature of motor palsy and spasticity, which are the main impairments of stroke patients, and the assessment of them. For the assessment of motor palsy, Brunnstrom's recovery stages and motor function tests in the Stroke Impairment Assessment Set (SIAS) are compared; and for the assessment of spasticity, the Modified Ashworth Scale and the Modified Tardieu Scale are compared. I also discuss the assessment of balance ability in patients with stroke.

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Sleep disorders are frequent in Parkinson's disease (PD) patients. Sleep disorders decrease PD patients' quality of life, and caregivers of PD patients, who need to help them with turning over in bed and going to the restroom, also tend to suffer from sleep disorders. It is important to understand the realities of sleep disorders of PD patients to support them and their caregivers, so we have done a follow-up study of sleep disorders of PD patients. An evaluation of sleep-wake patterns as measured by a wrist-worn activity monitor, and a questionnaire survey concerning sleep and sleepiness was done for 5 PD patients who were able to participate in the study in fiscal year 2005. These 5 PD patients were part of a group of 10 PD patients who participated in an investigation done in fiscal year 2003. The 2005 evaluation suggested that excessive daytime sleepiness of PD patients tends to become stronger over time. We did not observe this tendency in nighttime sleep disorders. We did find in the survey responses, that PD patients suffer from a variety of sleep problems, and the severity of these reported problems changes over time. Three patients whose sleep efficiency improved had taken steps such as wearing diapers and making a habit of bathing in the middle of the night. It appears that taking these steps allowed these patients to alleviate their nighttime sleep disorders.

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During the developmental period of the cortex, neurocyte cells are produced, differentiated in each area, then move in radial and tangential directions and form a layer structure. We immunohistochemically studied the expression of PGP9.5 (Ubiquitin-carboxyl terminus-enzyme) which was discovered as a unique protein substance in the neurocyte cells of the human cortex during the developmental period. The expression of PGP9.5 during development in humans increased in Cajal-Retzius cells in the external molecular layer at 13 weeks of gestation, then in the fifth layer pyramidal cells, the second and fourth layers granular cells, the third layer pyramidal cells and neurophils in that order, and decreased with advancing age. In cerebral white matter, PGP9.5 was increased in the deep layer around the same time as the molecular layer, then decreased with advancing age. The expression of cells positive for PGP9.5 increases with the healthy development of the human cortex, and it is thought that it reflects the growth and development of neurites and dendrites. Furthermore, from the fact that nerve stem cells develop after damage and show development of neurites and dendrites, they are thought to be an index of regeneration of neurites and dendrites as protein after damage.

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The purpose of this study was to examine differences of function at the knee joint between subjects with and without anterior cruciate ligament deficiency (ACLD) during stair descent, using a three dimensional motion analysis system and electromyography (EMG). Knee joint moment of subjects with ACLD showed a similar tendency in subjects without ACLD during stair descent. However, there were differences in EMG activities of the semitendnosus and soleus. Comparing the EMG activity of the semitendnosus between subjects with and without ACLD, the EMG activity in subjects without ACLD increased in the first half of the early stance phase; on the other hand, those in subjects with ACLD increased in the late stance phase. As for the soleus, the EMG activity in subjects without ACLD in the first half of the early stance phase was smaller than that in the late stance phase; however, that of subjects with ACLD showed larger activity in the first half of the early stance phase than in the late stance phase. These results suggest that the semitendnosus and soleus might compensate for the function of ACL during stair descent.

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We conducted a questionnaire among physical therapists working in intermediate welfare facilities to confirm the existence of cardiopulmonary function risks in individual instruction and group exercises performed in intermediate welfare facilities. The monitoring items of physiological reactions while exercising were chosen from the options in order of priority, then points to were allocated them and the order confirmed. In the results, it was found that accidents both in individual counseling and in group exercises had occurred, and 62.5% of physical therapists answered that PTs did not receive enough information to manage the risks. The monitoring situation was that sequential pulse variation and adjusted exercise load were evaluated in individual counseling, but only physiological reactions which occurred after motor stress were evaluated in group excercises. The subjects of group exercises had many conditions and their exercise load was difficult to establish, so it was thought that we should confirm the existence of risks more that in individual counseling.

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We assessed the caregiver's burden in the family and examined the factors which increase the care burden. For the assessment of the care burden we used the Japanese Version of the Zarit Caregiver Burden Interview (J-ZBI) and compared it with the caregiver's age, relationship, care term and the number of usage items of care insurance service. Analyzing the total score of J-ZBI and subscales in J-ZBI, correlations between the total score and subscales, and between subscales were found (p<0.05). The factors which increase the care burden could be extracted from the subscales. Being incapable of leading a former life greatly influenced the increase of care burden.

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To reveal the changes of joint formation due to contracture we studied the histopathological changes using an exterior fixation model of the rat knee joint. Twenty Wistar male rats of 9-weeks of age had their right hind legs fixed in plaster a posture of maximum knee joint flexion. Four rats each were grouped into 2, 4, 8, 16 and 32 weeks fixation and their knee joints were observed under an optical microscope with hematoxylin-eosin staining. In the group of 2 weeks fixation, we recognized atrophy and fiber outgrowth of fat tissues surrounding the joint and those changes developed along with prolongation of fixation. Adhesion of the arthrodial cartilage to adjacent tissues was obsereved in the group of 4 weeks fixation. From the groups after 16 weeks fixation, there were examples of the cnemis and femur connecting with tissues. After long term plaster fixation of 32 weeks, the whole joint formation had developed atrophy, fibrination and narrowing articular cavity leading to tissue ankylosis. Inflammation and cartilage necrosis or disappearance were not observed.

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The purpose of this study was to investigate the effect of different instructions on the weight shift task and the partial weight bearing task. Thirty-nine participants asked to keep 2/3 of their own body weight on their right leg and 1/3 of their own body weight on their left leg while standing. One group started with two-leg standing at the beginning and the other group started with one-leg (right) standing. Then, each group was asked to put 2/3 of their body weight on their right leg and the 1/3 of it on their left leg. Participants practiced 18 trials with 4 opportunities to receive knowledge of the result (KR), followed by 3 no-KR retention trials 5 minutes later and 24 hours later. The performance was superior when subjects were instructed to put more weight on a leg than when they were asked to reduce it. Therefore, in the practice of partial weight bearing, giving a proper instruction for the direction of the load is more effective than one for the participant's weight. It was also apparent that some of the participants practiced this task with their own strategy.

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The purpose of this study was to investigate clinical test skills and satisfaction of training in pre- and post-training. Sixty-five physical therapy students in their second grade who agreed to participate in this study were divided in into three groups according to learning method before training: a combination learning with senior students group, a knowledge acquisition group, and a skill exercise group. Subjects were evaluated using a questionnaire consisting of 7 items related to the clinical test skills and one item related to satisfaction of the training by a subjective rating scale. In the combination learning group, the clinical test skills and satisfaction of training significantly increased after training. In the knowledge acquisition group, the clinical test skills significantly increased after training. In the skill exercise group, were the clinical test skills tended to decrease after training. This study suggests that although there were different result due to learning method before training, the previous training in school was useful for recognizing the necessity of learning more skills.

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We carried out the CS-30 (30 second sitting to standing) test on 60 elderly subjects classified as care group 1 or group 2 based on the elderly care grading system. Subjects did not have any difficulty in toileting and had no conditions such as dementia or central nervous system diseases. The relationship between stand up ability and excretion independence was examined. Subjects who were both able and unable to safely and independently use toilets within a facility were divided into an excretion independent group and an excretion independent difficulty group. Each group then carried out the Japanese CS-30 test using the Jones method. The excretion independent difficulty group showed a significant decline in the CS-30 test (p<0.01) when compared to the excretion in dependent group. Discriminant characteristic analysis indicated a possible distinction between both groups at a cut-point of 5.5 stand ups (discriminant rate 94.4%, sensitivity 85.0%). However, careful consideration should be given to putting these results to practical use at home due to environmental differences in individual households.

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To figure out the situation of independence of daily functions of elderly Paraguayans of Japanese descent, we performed an assessment using the TMIG Index of Competence and compared it with that of elderly people living in Japan. The subjects were 271 Japanese-descended elderly people over 65 years old (response rate was 67.8%). The average score of the TMIG Index of Competence of Japanese-descended elderly people was 10.8 ± 2.5, which was similar to that of Japanese elderly people. There were no significant differences in the average rate by attributes. On comparison of each item, significant differences were revealed in 10 of 13 items. The rate at which Paraguayan Japanese-descended elderly people answered "I can" in the instrumental independent items was lower than that of Japanese elderly people. In the social role items the answer rate of "I can" was higher. This result suggests that different living environments are sources of the different answers.

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The aim of this study was to evaluate the characteristics of infants' spontaneous movements using dynamical systems analysis. The participants were 4 healthy full-term newborn infants, 1 month of age. A tri-axial accelerometer was used to measure limb acceleration in three-dimensional space. Acceleration signals were recorded on the right wrist when the infant was in an active alert state, lying supine. The recording time was 200 seconds, based on recommendations for the characteristics of this accelerometer. Digitized data were transferred to a PC for subsequent processing using analysis software. The time-series data, analyzed by linear and non-linear methods using the software package TISEAN, provided some evidence for a non-linear deterministic structure. Fast Fourier transform (FFT) analysis siggested it to be largely a linear random process. Non-linear analysis (recurrence plot, maximal Lyapunov exponent and surrogate data), which facilitates hypothesis testing of dynamical measures, provided evidence that the infants' spontaneous movements had non-linear chaotic dynamic characteristics with 5 or 6 optimal embedding dimensions in structuring. The findings support the hypothesis that chaotic behavior dominates physiological systems, including neuronal networks.

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Using three-dimensional analysis, we measured the knee joint angle in walking for gonarthrosis patients and healthy elderly people and performed chaos analysis on the knee joint angle data of 3 gait cycles. In the comparison of the patients and healthy people using the Lyapunov index, which is a chaos index, the Knee OA group showed a significantly lower value compared with healthy elderly people (healthy elderly people: 1.90 ± 0.59, knee OA group: 1.61 ± 0.40, p<0.05). In correlation analysis of the Lyanupuv index of knee OA and clinical data (time from onset; the Japanese Orthopaedic Association knee joint function evaluation, JOA score; femorotibial joint, FTA; knee joint ROM, gait speed), a significant correlation was only obtained for the JOA score (r=0.73, p<0.05). These results show that the more serious the osteoarthritis was, the smaller the Lyapunov index became, suggesting this chaos index is related to the knee joint function.

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The purpose of this study was to estimate the height of elderly people for whom it is difficult to make an actual measurement of their height. The length of the forearm and leg below the knee, which are easy to measure, of 47 elderly hospital patients (mean age 71.6 ± 9.0) were measured. The length of the forearm was defined as from proximal part of the point of the elbow to the distal part of processus styloideus ulnae, and the length of the leg below the knee was defined as from the proximal part of the head of fibula to the distal part of the lateral malleolus. The total length of the forearm and leg below the knee was calculated and the correlation coefficient of standing position height and the total length of the forearm and leg below the knee was r=0.87 (p<0.01). The regression expression was height=2.1 × total length of forearm and leg below the knee + 37.0, and the determination coefficient was 0.76. Using this regression expression makes the estimation of heights of many elderly people possible without dependence on ADL ability, and we think it will be of significant use in physical evaluation, such as BMI, which can be applied to nutrition status.

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The purpose of this study was to examine the relation between the growth height velocity curve and the muscle flexibility of the lower extremity among junior high school soccer players. There were seventy subjects without injuries of trunk and lower extremities: 4 were in phase I (phase I group); 28 were in phase II (phase II group); and 38 were in phase III (phase III group). An unpaired t-test of the muscle flexibility of the lower extremity between phase II group and phase III group was performed, and the flexibility of the right iliopsoas, left quadriceps, right hamstrings, and left gastrocnemius of the phase III group were significantly lower. The kick movement is one of the competition characteristics of soccer and long-term accumulation of imbalance of growth in bone and muscle/tendon according to the growth spurt influenced this. This study shows the necessity of the longitudinal examination of the relation between the growth height velocity curve and the muscle flexibility, and suggests that there is a possibility of intervention to prevent sport injuries in the growth period.

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The purpose of this study was to find an appropriate pain scale to assess delayed onset muscle soreness (DOMS). Seventeen healthy subjects (21.1 × 1.8 yr) performed 70 eccentric dorsiflexions in order to induce DOMS. Four pain scale VAS; Talag scale; Painmatcher; and our original scale assessments were conducted at 5 different times: pre-exercise, post-exercise, 24 hours post-exercise, 48 hours post-exercise, and 72 hours post-exercise. Simultaneously, we asked for 2 different subjective assessments, 1) subjective alteration, changes between current DOMS and previous DOMS perceived, and 2) subjective difference between right and left. For the reliability of the 4 pain scales, we calculated the kappa coefficient from the agreement between the alteration of results with each scale and the subjective assessments. The kappa coefficient of the Talag scale was higher than those of the other pain scales, indicating good to fair agreement. The results of this study suggest that the Talag scale is a more reliable pain scale for DOMS assessment.

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The purpose of this study was to determine the correlation between the daily physical activity, physical characterisics and pulse wave velocity in middle-aged and elderly subjects. The study subjects were 40 persons (11 male and 29 female; mean age, 62.5 ± 4.9 years). Physical activity was measured using an accelerometer with a focus on the number of steps and physical exercise. Partial correlation analysis revealed no correlation between physical activity and cardiovascular endurance. The number of steps was significantly correlated with the weight bearing index, quadriceps femoris muscle mass, pulse wave velocity, body fat mass and lean body mass. Physical exercise was significantly correlated with the weight bearing index, body fat mass, quadriceps femoris muscle mass, lean body mass and basal metabolism. Stepwise multiple regression analysis revealed the weight bearing index and pulse wave velocity as determinants of the number of steps, and lean body mass as a determinant of exercise. These results indicated that physical activity was closely correlated with the weight bearing index, pulse wave velocity and lean body mass.

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Healthy subjects performed toe compression exercise for six weeks to strengthen the flexor pollicis longus and tibialis posterior muscles, which are component muscles of the inner longitudinal arch. We calculated the arch height percentage as an index of the inner longitudinal arch, and measured static standing balance before the exercises, at 2 weeks and 4 weeks after the start of the exercises. The toe compression exercise performed was an isometric contraction of 100 times on both sides with a motor stress of "strong" or "very strong". For each measurement result we determined the main effect from one-way analysis of variance (ANOVA) (p<0.05). It was confirmed that the toe compression strength and navicular bone height were increased by the toe compression exercise. With toe compression exercise, the muscle activities of toe flexor muscles, tibialis posterior muscle and plantar fascia were increased.

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The purpose of this study was to clarify the changes in activities of trunk and hip extensor muscles, in the forward bending posture, while in continuous isometric pulling up. Nine healthy male volunteers (mean age, 22.6 years; range, 19-29 years) participated in this study. Surface electromyography was recorded during the contractions of erector spinae of L3 (L3 ES), erector spinae of L5 (L5 ES), rectus abdominus (RA), abdominal oblique (AO), latissimus dorsi (LD), and biceps femoris (BF) muscles. The task was to maintain the pulling up force at 60% of maximal voluntary exertion for 60 seconds in the 30° forward inclination of the trunk relative to a vertical line. The values of median power frequency and average electromyographic activity during the task were calculated. The results showed that the median power frequency of L3 ES, L5 ES and LD significantly decreased at the end of the task compared with its beginning. The average electromyographic activities of RA, AO, LD and GM significantly increased. These results suggest that ES and LD fatigue early and the contractions of RA, AO, LD and GM increase in order to maintain pulling up force while continuous isometric pulling up in the forward bending posture.

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The purpose of this study was to examine what influence different methods of descending stairs has on the lower extremity joints, with the consideration of securing safety for senior citizens and handicapped persons. Subjects were 11 healthy adult men. The angles of the lower limb joints and moments when descending forward, backwards, sideways with the swing leg diagonally forward (SF), and sideways with the swing leg diagonally behind (SB) were measured using a 3-dimensional motion analysis system combined with two force plates. It was found that the hip flexion angle and hip extension moment in the support leg decreased when descending forward and SF. On the other hand, the ankle dorsal flexion angle and plantar flexion moment, and the knee flexion angle and extension moment in the support leg decreased when descending backwards and SB. We suggest that SF may be a good alternative for descending forward, and SB may be a good alternative for descending backwards. We suggest that descending backwards and SB are suitable for knee and ankle dysfunctions, and descending forward and SF are suitable for hip dysfunctions. We confirmed that the difference in the method of stair descending influences the lower extremity joint angles and moments, and the methods taught to patients should be suitable to their situation.

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We studied the effects of lumbar and gluteus medius muscle supporters on healthy person's standing position and lateral movement with change of the supporter's application. We measured the postural sway and performed the right and left functional reach test (lateral FRT) for 18 healthy people (mean age 27.0 ± 8.3). With the application of both lumbar and gluteus medius muscle supporters, significant decreases in the total length of sway path and rectangular area with both legs in standing, and the length of lateral FRT were shown. With the application of soft supporter, we found a stabilizing action on both legs in standing, and a gluteus medius muscle supporter restricted the reach in lateral FRT. The possibility of increasing the right and left stability with a supporter was suggested.

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The objective of this research was to examine whether regulation of step length and walking velocity were observed as a timing control before mounting a moving surface, by-comparing mounting of a motorized treadmill with that of a stopped treadmill. Twenty healthy young adults participated in this experiment. We measured step length and walking velocity before mounting the motorized treadmill moving at a velocity of 1.8 km/h and a stopped treadmill. Coefficient of variation (CV) was the index of variance of step length. We found that although there was no difference in walking velocity between a motorized treadmill and a stopped treadmill, CV increased on nearing the treadmill in mounting both the motorized treadmill and the topped treadmill (F_4.190=13.61, p<0.01) and that CV increased at 2 steps before mounting the motorized treadmill (p<0.01). These results suggest two significant points. First, the gait in mounting the treadmill was affected by regulation of step length for transfer. Second, in mounting the motorized treadmill, regulation of step length was seen earlier than in mounting the stopped treadmill.

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Unilateral spatial neglect (USN) is commonly observed following right hemisphere injury. Many authors suggest this is because the right hemisphere constructs the network of spatial attention. Recently, prism adaptation (PA) has been reported as a remarkable approach for USN to reconstruct space representation. In this study, a patient with right brain injury with crossed aphasia and USN showed improvement of USN following PA. Crossed aphasia refers to aphasia occuring after right brain damage in right-handers and is recognized as atypical cerebral dominance. The present results suggest that the function of spatial representation was located in the right brain of this patient and redundancy of each cortical function might have been occurring at the individual level. So we need to take care in choosing therapeutic approaches for cases with anomalous dominance.

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This paper introduces a relatively new therapeutic approach called "Functional Physical Therapy" for children with cerebral palsy. The paper includes the therapeutic principles, model, effects and limitations.

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This paper examines the concept and services of Therapeutic Recreation (TR), which is frequently utilized in medical and rehabilitation fields in the United States of America. First, the definition of TR, its educational system and professional qualification, and theories and models are explained, followed by a discussion of TR facilitation techniques and clinical examples of TR services in medical and rehabilitation settings, so that Japanese health professionals can explore the possibility of innovative approaches in their services.

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