In group exercises in care facilities for the elderly, there is a possibility of excessive exercise load. We performed cardiopulmonary assessment of elderly residents at a care facility, at rest and during exercise utilizing repeated standing as the exercise load. The assessment took place before and after the exercise of repeated standing, measurements being made at rest for 5 minutes. Eleven of the subjects (45.8%) showed cardiopulmonary problems, suggesting that it is possible to overdo exercise in group exercises. We consider that it is necessary to provide exercise based on individual assessment of cardiopulmonary function even in group exercise.

View full abstract

The TUG test measures the maximum effort speed. Subjects were 8 healthy women whose mean (± SD) age were 20.4 ± 0.7 years who wore a vest containing 10 kg weights. There were three types of groups : standing up while pushing down on the armrests (PA group); standing up while pushing down on the knees (PK group); and standing up while pushing down on the seat (PS group). The results were analyzed using the Wilcoxon rank test, with statistical significance set at p<0.05. Performance of the PK group was markedly slower than for the other two groups (both P<0.01), but there was no significant difference between the PS and PA groups (P<0.18). We think it is necessary to rerify the results of previous reports of the TUG test again, and using a standard method with the same height chair with armrests for measuring TUG. Moreover, if TUG is measured using no armrests, the concrete instruction may be required.

View full abstract

To clarify the characteristics of the screw home movement, we performed 3-dimensional motion analysis using the point cluster method. Thirty healthy adults aged 20-65 years performed active knee extension in a non-weight bearing position. In 19 subjects, the tibias externally rotated during extension. In 5 subjects, the tibia started to rotate internally near the terminal range of motion. The other 6 subjects showed internal rotation of the tibia during extension. Most subjects showing rotation of the tibia at the terminal range of motion were female. All subjects with this finding showed positive results for the laxity test, and the amount of tibial anterior shift during extension was large. The subjects showing internal rotation of the tibia during extension were older than the other subjects. These results suggest that the screw home movement is affected by tension of the ligaments and age.

View full abstract

The purpose of this study was to investigate the change in spinal curvature after spinal mobilization exercise using a gym ball. Ten healthy males aged 21 ± 1.1 years without pathologies in the leg or trunk participated in this study as subjects. Spinal curvature was measured by the Spinal Mouse system (Index Corp.). The relevant parameters recorded by the Spinal Mouse were total inclination, the thoracic curvature (T1-2 to T11-12), the lumbar curvature (T12-L1 to sacrum), and the sacral angle. Trunk flexion was measured in a standing position before and after intervention. Intervention was relaxation and adopting a prone position on the ball for 60 seconds. The spinal curvature before and after intervention were tested by means of the Wilcoxon test (p<0.05). The results indicate that spinal mobilization exercise using a gym ball had a significant effect on the change in spinal curvature especially the sacral angle.

View full abstract

Therapeutic heat has long been used clinically. In recent studies, it has been reported that heat therapy can be used to prevent muscular atrophy. We studied the effects of therapeutic heat before a treadmill running exercise on prevention of muscular atrophy. The soleus muscles of female Wistar rats that had atrophied due to immobilization in a cast were used in this study. Muscular atrophy occurred in the groups of "cast", "cast and treadmill", and "cast and heat" after one week. There was a significant decrease (p<0.05) in the wet weight of the soleus muscles of all these groups, but muscular atrophy did not occur in the group of "cast, heat and treadmill". These results, demonstrate the effectiveness of therapeutic heating before a running exercise on preventing muscular atrophy in rats, and we believe that the same results may be found in future studies involving humans.

View full abstract

We investigated the concerns of physical therapists involved in the preventive approach to long-term care adopting the International Classification of Functioning, Disability and Health (ICF) core set. Physical therapists concerns were, in order: body function, activity and participation, and environmental factors. Moreover, the concern of the physical therapist for each of factors these was 50% or less. In addition, the values of the categories were seen to be strongly biased. These values show that even though physical therapists appreciate the idea of ICF they are not applying it. Therefore, it is necessary to consider the relationship between body function, activity and participation, and environmental factors in the planning and execution of the preventive approach to long-term care.

View full abstract

We measured the sagittal plane alignment of the lumbosacral spine in a static, upright position in 20 healthy adult subjects, and investigated the correlation with the trunk muscle strength and leg muscle flexibility. For the lumbosacral spine alignment, we used an X-ray to measure the sacral inclination angle and the angle of the lumbar secondary curvature. Trunk muscle strength was measured using the maximal isometric trunk flexion as well as extension strength. In addition, the trunk extension/flexion muscle strength ratio (E/F ratio) was considered. Leg flexibility of the rectus femoris and hamstrings was also measured. No correlation was found between the lumbosacral spine alignment and trunk muscle strength and leg muscle flexibility. However, a positive correlation was observed between the lumbosacral spine alignment and the E/F ratio. This is believed to be due to the change produced by the lumbosacral spine alignment causing a change in the trunk muscle activity, which in turn causes a change in the E/F ratio.

View full abstract

The objective of this study was to survey risk management implementation in physical therapy departments of hospitals treating acute stage patients. One hundred sixty-nine facilities were selected from the 9,019 facilities registered on the Welfare Medical Information Network and sent a questionnaire regarding their risk management systems. One hundred twelve questionnaires were returned, a response rate of 66.3%. The sizes of the hospitals ranged from 200 to 1,500 beds; they had on average 24 medical specialties and employed an average of 10.5 physical therapists. In physical therapy departments, the main emergency equipment provided were: electrocardiograms, percutaneous oxygen saturation monitors, oxygen and suction equipment. In the facilities with suction equipment (53.6% of the total) only 35.6% had regular nursing staff. Accordingly we consider the time has come for physical therapists to be trained in the use of suction equipment. Measures for the safe performance of physical therapy were considered to be risk management through provision of manuals and provision of emergency equipment; however root and branch reform of emergency procedures is required.

View full abstract

The purpose of this study was to clarify characteristic changes in muscle activities around the ankle exposed to perturbation while standing on floors of different friction, and whether the patterns of muscle activities were modified by repeated perturbations. The subjects were 7 healthy men. The subjects were required to stand quietly on 3 kinds of different frictional floors, with heel-up at a continuous angle change from 0° to 12°. The 3 kinds of different fictional floors were as follows: 1) rubber mat (high friction); 2) wooden board (medium friction); and 3) plastic sheet (low friction). The perturbations in each floor were repeated 5 times, and the muscle activities of the medial head of the gastrocnemius and tibialis anterior were recorded in the 1st and 5th trials. The results indicate that the magnitude of the muscle activities of the medial head of the gastrocnemius differed with the friction of the floor surface, and the pattern of muscle synergies adapted and modified in repeated trials.

View full abstract

The purpose of this study was to investigate an index based on the trajectory of the center of mass (COM) to determine whether it could distinguish between stable and unstable gaits. Eleven healthy males volunteered for this study. To generate an unstable gait condition, we used a separated-belt treadmill. The treadmill belt could be driven at the same speed (stable condition) and at different speeds (unstable condition). In the stable condition, the subjects walked at slow (1.0 km/h), normal (2.5 km/h), and fast (5.0 km/h) rates. In the unstable condition, the subjects were perturbed by randomly decelerating and accelerating one side of the walking belt (0.1 km/h - 5.0 km/h). Lateral sway of COM and stride time were calculated from the trajectory of COM in the frontal plane, and these values were compared between the stable and unstable gait conditions. The result was that coefficient of variation and standard deviation of lateral sway and stride time increased significantly only in the unstable gait condition, while the values were not influenced by gait speed changes between the three stable gait conditions. The results suggest that the trajectory of COM could be used to indicate the stability of the gait, in terms of both spatial and temporal factors.

View full abstract

We conducted Moseley's motor imagery program (MIP) for a patient with left upper limb complex regional pain syndrome type 1 (CRPS1) after right thalamic hemorrhage. The treatment aims at activation of cortical networks that serve the affected limb. The MIP consists of three different interventions 1) hand laterality cognition task, 2) imaged hand movement, and 3) mirror therapy. We investigated the effect of MIP using a single-case study design. The results showed pain relief during the MIP period, and the effect was maintained during the follow-up period. Body-schema assessed by affected hand tracing at pre-MIP changed to a more detailed picture post-MIP. We suggest the MIP altered the disrupted body-schema, and improved central pain due to cortical abnormalities.

View full abstract

The purpose of this study was to compare the effects of practice programs using shaping, chaining and prompting and fading methods devised for above-knee prosthesis trail walking with iterative practice by the subject. After practice a significantly shortening in the 10 m walking time, and decrease in knee break frequency, abduction gait frequency and lateral bending of the trunk was recognized between the control and intervention groups. The improvement was significant for all items in the intervention group, but a significant improvement was recognized only in the vaulting gait frequency in the intervention group. Therefore, the devised practice method seemed to improve more rapidly the skill of above-knee prosthesis trail walking in comparison with oral description and iterative practice by the subject.

View full abstract

We studied the relationship between effective treatment with range of motion exercises and the preventive effect of joint contracture development. For this experiment, the removal of immobilization and then re-immobilization was needed during the load on immobilization of the knee joint. We therefore devised an external joint fixation method for immobilization of the knee joint in rats. The parts included 0.7-mm Kirschner wires (K-wires) and interconnected fixation devices (4.0 mm vertical × 3.0 mm horizontal × 2.0 mm depth). Each device was perforated with 1.0 mm perpendicular two holes for the K-wires, which were secured with captive screws. K-wires were inserted into the middle portion of the femur and the tibia in the left extremity of the rats in the vertical sagittal plane. Each K-wire was fixed to another perpendicular K-wire using the interconnecting device. This immobilized the knee joint, which made it easy to remove the immobilization and then re-immobilize the knee joint by loosening and tightening a screw. We conducted effectiveness testing of this external joint fixation method in experimental rat knee joint contracture models. Characteristic changes in joint contracture, such as decrease in joint range of motion and adhesion, vascular proliferation, and intra-articular hemorrhage were identified after five weeks of immobilization loading. Moreover, harmful effects, such as edema, inflammation and congestion, were not found. These results suggest that this external joint fixation method is useful for establishing experimental joint contracture models.

View full abstract

In this study we measured the one-leg standing time with eyes open of 56 elderly community dwelling women and investigated its relationship with upper and lower limb strength and flexibility, sole proprioception? and other physical functions together with attention function. The factors affecting one-leg standing time as indicated by repeated measures regression analysis were foot-gripping strength and age: one-leg standing was more stable at higher foot-gripping strengths and younger ages. These results suggest the importance of increasing foot-gripping strength for improving the one-leg standing ability of elderly community-dwelling females.

View full abstract

This study investigated the relationships among lifestyle, functional capacity and social attributes that influenced independence over a period of 2 years. The subjects were 223 elderly people (average age:76.4 years) living on Amami Island who were independent in Instrumental Activities of daily Living (IADL) at the baseline survey conducted in 2005. The survey was conducted by interviews. There were 22 items for lifestyle, 13 items for functional capacity and 5 items for social attributes in the survey. The percentage of subjects who were independent in IADL at the time of the follow-up survey was 75.4%. Logistic regression analysis was carried out to determine the degrees to which factors influenced independence. The results suggest that efforts to maintain social lifestyle and functional capacity may be useful for maintaining active independence in the elderly.

View full abstract

The purpose of this study was to investigate the effect of the stimulation of mechanoreceptors in the sole of the big toe on tracking movement of the center of foot pressure. The subjects were 15 healthy students. We set 2 conditions, namely, no stimulation of the bare foot and stimulation of the sole of the big toe using rubber balls. On the force plate, we set the tracking movement such that the center of foot pressure corresponded with the target point projected on a monitor at the front for the task. The items evaluated in the task were rise time, positional error of the target point, improvement rate of the error, deflection velocity of the center of foot pressure, and deflection acceleration value. According to the results, under the condition in which the sole of the first toe was stimulated, the improvement rate of the positional error significantly increased. Furthermore, the deflection velocity and the acceleration of the center of foot pressure significantly decreased. These results demonstrate that an increase in the information transmitted from the mechanoreceptors of the sole of the big toe on the tracking movement of the center of foot pressure contributes to correction of the positional error of the target point and the stability of the deflection of the center of foot pressure.

View full abstract

The purpose of this study was to find out what kind of body image hemiplegic stroke patients have of themselves. We conducted semi-structured interviews with 7 hemiplegic stroke patients and analyzed the results using the revised grounded theory. We applied definitions to the data we obtained in the interviews and conceptualized them under the following four headings: perceptions of indistinctiveness of body; feelings of strange sensations; perceptions of reliable movement; and requirements of improvement of movement. Furthermore, we investigated the relationships among the concepts and categories we created and made a diagram of the results to present the overall picture of our analysis. The results suggest that it is possible to partially express the structure of the disability of the body image of hemiplegic stroke patients. We anticipate that qualitative research has a major role to play in the establishment of the the assessment of body image.

View full abstract

This study aimed to examine the usefulness of muscle mass measurement using the segmental bioelectric impedance analysis on the non-paretic and paretic sides of patients with hemiplegia due to stroke. The subjects were 11 stroke patients and 16 healthy individuals. The stroke patients had developed stroke within the previous 6 months and had performed exercise. The muscle mass was measured in the four limbs in a supine position using a muscle mass measuring apparatus with 12 conduction electrodes using segmental bioelectric impedance analysis. There was no significant difference between the muscle mass on the non-paretic side of the stroke patients and that on the right and left side of the healthy individuals. The muscle mass on the paretic side of the stroke patients was significantly lower than that on the right and left sides of the healthy individuals. The difference between the muscle mass on the non-paretic and paretic sides of the stroke patients was significantly higher than that between the muscle mass on the right and left sides of the healthy individuals. These results suggest that segmental bioelectric impedance analysis can accurately detect the difference between the muscle mass on the non-paretic and paretic sides after the onset of stroke and is useful in physical therapy as a simple and non-invasive method for muscle mass measurement.

View full abstract

We investigated the appropriate level of exercise in an exercise therapy menu for the prevention of disuse muscular atrophy of the gastrocnemius muscle (GM). The subjects were 10 healthy individuals. Assessments were made of the medial and lateral heads of GM. Measurements of GM activity were made 1) in raising the hell of one leg while sitting, 2) in raising both heels while standing, 3) raising the heel of one leg while standing, 4) in walking on tip-toes, and 5) in maximal isometric plantar flexion. First we determined the number of paces corresponding to each item on the exercise therapy menu by subtracting the muscle activities of 1) to 5) from that of free walking. Then, assuming a low activity level, we determined th volume of exercise for each item on the exercise therapy menu corresponding to muscle activity of 6,000 paces (3,000 per leg). The results suggest that the volume of exercise performed in general clinical practice is extremely unlikely to prevent muscle atrophy.

View full abstract

For third year students approaching clinical assessment practice, I ran trial classes with "simulated" patients. The simulated patients were senior students who played the role of hemiplegia in the clinical practice. Groups of 4 or 5 students performed physical therapy evaluations, prepared physical therapy programs and gave presentation of their works. I investigated how well the class was received by questionnaire. The students chose the respective examinations among the state of simulated patient. From the point of view of the students, practice with bedside manner, examination method and measurement, and the preparation of the physical therapy program with fellow students was an excellent experience.

View full abstract

Utilizing the triangulation principle of general surveying methods we developed a system for measuring the spatial position of solid objects with 3D co-ordinates and investigated its reliability and validity. For the reliability, we assessed measurement of a plastic triangle by 10 examiners. The validity was assessed by comparison with a 3D motion analysis system. The examiners' intraclass correlation coefficient was 0.97, and their intraclass correlation coefficient for three repeated measurements was 0.93. The measurement error in camparison with the 3D motion analysis system was within 1 mm. By these results, we consider the validity and reliability of the spatial position measuring system was demonstrated, and we think it can be used effectively, especially as a local motion analyzer.

View full abstract

Sit-to-walk (STW) motion is a series of motions in which subjects stand up from chair and initiate gait. We researched the relationships between the STW motion and the muscle strength of the knee (extension / flexion), balance tests, and fall experiences of elderly people living at home. The subjects were 18 men (mean age 73.9 ± 5.3 years). The subjects were instructed to perform STW motion as fast as possible. Balance tests were evaluated with the Timed Up and Go test (TUG test), functional reach test, and maximal step length. In the results, some relationships were confirmed between the biomechanical characteristics of STW and muscle strength or balance tests. Subjects who spent longer performing the TUG test and who had fall experiences rose until they were standing almost upright before initiating gait.

View full abstract

We investigated the relation between independent walking ability and agility on the non-paretic side of hemiplegic stroke patients [independent walking (IW) group, 9 persons; assisted walking (AW) group, 9 persons] and 9 healthy middle-aged persons (HW group). We measured the interval time of maximum tapping and maximum stepping on the non-paretic side. Significant differences were found among all the groups for maximum tapping and stepping and maximum tapping and stepping became faster in the order of the AW, IW and HW groups. The results suggest that, as the agility of the non-paretic side decreases in hemiplegic stroke patients, so does their walking ability. We consider that approaches focusing not only on the paretic side, but also on the non-paretic side would possibly lead to improvements in walking ability of hemiplegic stroke patients.

View full abstract

With 22 healthy persons as subjects, we investigated the effect of measurement location on agility and synchronization of the upper limbs. The task was tapping as fast as possible and synchronous with a 4 Hz audible signal with both fingers and hands and we determined the tapping time interval and its variation. In comparison of the dominant and non-dominant side hands, the dominant hand values for tapping time interval and variation were significantly lower. There was no significant difference in tapping time interval in finger tapping, but the variation was significantly lower on the dominant side. The hand joints of the dominant side had lower tapping time intervals and variation than those of other locations. These results suggest that the dominant hand in hand tapping shows the best performance.

View full abstract

ACL injuries often occur in landing from a jump during sports participation, so this study focused on knee joint movement in drop-jump landing. A series of drop-jump landings were quantified using a derice we developed which is designed to evaluate tibiofemoral motion in succession, from the starting position to the landing position. Thirty students (15 males and 15 females) who had no past history of knee injury volunteered for this study. The results show that male subjects demonstrated external rotation between the tibia and femur. On the other hand, both internal and external rotation of tibia was observed for female subjects. Consequently, internal and external rotation of tibia can be observed in drop-jump landing in uninjured females.

View full abstract

The purpose of this study was to investigate the clinical usefulness of the forward reach test in the sitting position for patients with cerebrovascular disorders. Twenty-two cerebrovascular disorder patients performed the forward reach test in the sitting position and we investigated its relationships with Optical Righting Reactions (ORR), the Trunk Control Test (TCT), the Functional Reach Test (FRT), the Functional Movement Scale (FMS), and the Function Independence Measure motor item (FIM-m). A moderate correlation with ORR was found for the forward reach test, and the participation of the trunk was also seen. A significant correlation between the forward reach test and FRT was found, and this is very meaningful in the context of its potential use in prognosis, as the forward reach test can be performed in the early stage after the onset of stroke. A moderate correlation was found between the forward reach test in the sitting position and FMS, and we consider measurements including the lower limbs useful. The forward reach test in the sitting position quantitatively follows temporal changes in the trunk function, and we consider it to be clinically useful, because it is an evaluation index which can be performed easily and in a short time.

View full abstract

In this research, aiming to develop a walking assistance dolly which provides assistance in rising to stand, we analyzed the action of standing up and made an improved prototype walking dolly. For the analysis of the standing up action we measured the leg joints' torque of 20 healthy university students, who used two handrails at different heights in five patterns of standing up action, with a floor reaction force plate and a 3D motion analysis system. The leg joints' torque was highest without the handrails and decreased in the order of low handrails, changing grip from a low to a high handrail, high handrails and simultaneous grip of a low and a high handrail, and significant differences were found in one-way ANOVA. In comparison of the leg joints, the hip joint showed a significantly high torque value (p < 0.05). Elderly residents at a care facility who used the prototype walking dolly responded in interviews that, with the dolly, standing up was easy and that all kinds of standing up were possible.

View full abstract

The purpose of this study was to investigate the relationship between pelvic rotation angle and trunk lean angle. Fifteen patients with symptoms of knee OA were recruited for this study. Pelvic rotation angle and trunk lean angle during one stride were calculated using three-dimensional gait analysis data. The mean values of trunk lean angle were 2.9° on the knee OA limb side, and 3.5° on the healthy limb side. The mean values of pelvic rotation angle were 8.6° on the knee OA limb side, and 8.1° on the healthy limb side. Significant negative correlations with trunk lean angle existed in both limbs for pelvic rotation angle (knee OA limb side; r = -0.53, Healthy limb side; r = -0.56, p<0.05). We consider that therapeutic exercise which improves the pelvic rotation angle may be useful for reduction of trunk lean motion during walking with knee OA patients.

View full abstract

The purpose of this study was to examine the amount of stretch time necessary for preventing ROM limitation and morphologic changes in muscles. Thirty-five 9-week-old female Wistar rats were divided into 5 groups: group a control (n=7), a group with ankles immobilized for 1 week (n=7), and groups that had the casts removed daily and the foot held in dorsiflexion for periods of 10 minutes (n=7), 30 minutes (n=7), and 60 minutes (n=7). Prolonged stretching had the effect of preventing the generation of ROM limitation. In addition, 30 minutes prolonged stretching was the most effective. Moreover, morphological phenomena suggest that more than 30 minutes of prolonged stretching may cause muscle fiber weakness.

View full abstract

The purpose of this research was to clarify the effect of the proprioceptive neuromuscular facilitation (PNF) approach to a unilateral upper limb on the contralateral lower limb. The PNF group performed unilateral upper limb flexion-abduction-external rotation pattern. Flex group performed unilateralupper limb shoulder flexion. Both group performed isometric resistance exercises at the start, middle and final positions. During these exercises the extension force of both lower lims were measured with two hand-held-dynamometers. Simultaneously, the resistance value of the upper limb was also measured. The force on the contralateral lower limb increased in the final position of the PNF group showing a value of 54.3% MCV. Unilateral upper limb resistance showed a tendency to be low at the final position. Isometric resistance exercise in the final position of the unilateral PNF pattern gave a low value in the upper limb, but the extension force of the contralateral lower limb was increased.

View full abstract