[Purpose] In response to loading of the femur, the lower leg outwardly rotates, thereby inducing "knee-in". Through this lower leg outward rotation, knee-in, induces valgus of the knee joint. The objective of this study was to clarify the relationships of the muscle activities of the hamstring, which is a rotator muscle, and the vastus medialis and vastus lateralis muscles which contribute to the lateral stability of the knee, at the time of one-leg jump landing. [Subjects] The subjects were 27 healthy female university students with no medical history of knee disease or injury. [Method] The activities of the vastus medialis (VM), vastus lateralis (VL), semimembranosus (SM) and biceps femoris (BF) were derived from electromyography (EMG) and the maximum valgus knee angle was calculated. [Results] A significant positive correlation (p<0.05, r=0.40) was found between the ratio, BF:SM (the ratio of the activities of the medial and lateral hamstring muscles) and the maximum valgus knee angle. [Conclusion] The results suggest that at the time of one-leg jump landing, the valgus knee angle will be large for persons with a high BF:SM ratio.

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[Purpose] The purpose of this study was to investigate the features of bilateral and unilateral leg muscle strength, and suggest effective and efficient training methods for improving exercise ability using leg muscles for healthy male adults. [Subjects] The subjects were 28 healthy adult men. [Methods] We measured bilateral and unilateral isokinetic leg extension strength, height of vertical jump, distance of standing broad jump, number of repetition side steps and time taken for 30 full squats. [Results] Height of vertical jump, distance of standing broad jump and number of repetition side steps were significantly correlated with bilateral leg strength, leg strength of the dominant side used as the supporting leg, leg strength of non-dominant side used as the supporting leg, and the sum of the dominant leg strength and non-dominant leg strength. Squat time was significantly correlated with dominant leg strength and the sum of dominant leg strength and non-dominant leg strength. [Conclusion] These results suggest that different exercises require different leg-strengths, and an appropriate training method is necessary to raise exercise abilities effectively.

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[Purpose] In this study, we examined the characteristics of left unilateral spatial neglect patients with improved conditions. [Subjects] The subjects were 54 left unilateral spatial neglect patients. [Methods] We evaluated eating, grooming, dressing and wheelchair activity which tend to be influenced by unilateral spatial neglect using functional independece measure (FIM). Based on these data, we classified subjects into two groups: the improved group and the unimproved group. We compared the two groups in terms of ages, length of time of symptoms, training contents, training periods, Brunnstrom stage, body function, and neuropsychological assessments using statistical analysis. [Results] A significant difference was observed in age, body function, and neuropsychological assessments between the two groups. [Conclusion] These results suggest that reinforcement of body function and general recognition are necessary to improve the condition of left unilateral spatial neglect.

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[Purpose] The purpose of this study was to determine influences of spatio-temporal gait parameters on walking efficiency of children with cerebral palsy. [Subjects] Subjects were 9 children with spastic diplegia who could walk. Mean ± SD of age was 12.8 ± 3.5 years (range: 7 yrs 5 mo-18 yrs 9 mo). [Methods] We measured gait speed, step length and cadence in 10-m gait as spatio-temporal gait parameters, and pulse rate, walking speed and calculated the Physiological Cost Index (PCI) during 4 min walking as parameters of walking efficiency. Pearson's correlation coefficients were obtained for the spatio-temporal gait parameters and walking efficiency parameters. [Results] No significant correlation was found between the pulse rate during 4 min walking and the spatio-temporal parameters. There were significant positive correlations between walking speed during 4 min walking and 10-m walking speed (p<0.05), and step length in 10-m gait (p<0.01), but no significant correlation was found between walking speed during 4 min walking and cadence in 10-m gait. There were significant negative correlations between PCI and walking speed (p<0.01), and step length in 10-m gait (p<0.05), but no significant correlation was found between PCI and cadence in 10-m gait. [Conclusion] Because walking efficiency was high when walking speed was fast and/or step length was wide, we consider that the factors for high walking efficiency in children with cerebral palsy are fast walking speed and wide step length.

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[Purpose] In this study, we examined the effect of a hot bath on joint components in rats. [Subjects and Methods] We used fifteen Wistar male rats of 9 weeks of age which had their right knee joints immobilized with a casting fixator for 2 weeks. The hot bath groups were subjected to treatment of 42-36 °C hot baths for two weeks. After the knee joints were excised, sectioned knee joints were observed under on optical microscope with hematoxylin-eosin staining. [Results] In the 42 °C and 40 °C warm bath groups, the joint cartilage showed marked deviation from normal histological features. In contrast, in the 38 °C and 36 °C warm bath groups, histological changes of the joint cartilage were similar to those of the control group which showed changes only for contracture. [Conclusion] These findings indicate that increase of intra-articular temperature may have a bad influence on joint cartilage and synovium, and reconsideration of the indication and contraindication about hot baths is necessary.

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[Purpose] With normal healthy males and females as subjects, we investigated the circulation response at the double product break point (DPBP) and its relationship with the Borg scale as well as gender differences. [Subjects] The subjects were 20 each of normally healthy males and females with average ages of 25.0 ± 2.1 and 24.1 ± 4.5, respectively. [Methods] Using a bicycle ergometer with incremental increases of 10 W every 2 min, we performed a ramped exercise load test. The Borg scale was measured about one minute after each increment of exercise load. [Results] The Borg scale at the time the DPBP was detected was 13.9 ± 1.7 for males, and 13.0 ± 1.6 for females. For the circulation response relationships, systolic blood pressure, pulse pressure and double product were found to be significantly related to the Borg scale for males, whereas for females, a significant positive correlation was found for heart rate and the double product. [Conclusion] At the time of detection of DPBP, the double product was profoundly related to the Borg scale for both males and females.

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[Purpose] The purpose of this study was to clarify the effect of the employment situation of physical therapists on clients who were treated by physical therapists. [Methods] This study included 20 residents in a nursing home. A physical therapist worked full time, five days a week for the first six months. Afterward, the therapists worked part time for six months. Over fifteen months of assessment, the first six months were defined as the "full-time period", and the last six month were defined as the "part-time period". The situation of activities of daily living (ADL), and QOL were assessed with the Functional Independence Measure (FIM), the Short-Form 36-Item Health Survey (SF-36) and the Philadelphia Geriatric Center Morale Scale (PGC). In addition, visual analog scale (VAS) was carried out as an index of QOL. [Results] Compared with baseline and normalized scores of SF-36, baseline scores were lower than normalized scores. Some SF-36 sub-item scores went up after 3 months compared with baseline, and the scores were maintained thereafter. The scores of VAS and PGC of the full-time period were significantly higher than those of the part-time period (p<0.05). [Conclusion] The employment situation of therapists effects the QOL of clients who are being treated by them.

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[Purpose] This study was performed with the objective of investigating the relationships between habitual exercise and the status of various physical activities in activities of daily living (ADL), and the body composition of community-dwelling elderly. [Subjects] The subjects were 108 residents of Tokyo who were over the age of 70. [Methods] The subjects were split into 3 groups (obese, masked obesity, and non-obese groups) based on body mass index (BMI) and percentage of body fat, and comparisons among the groups were performed. [Results] Compared to the non-obese group, a significant number of the obese group were found not to have exercise habits or habitual activities. Compared to the non-obese group, it was found that the masked obesity group had a significantly weaker knee extension muscle strength, longer "Timed up-and-go" times, and a higher number of fallers. [Conclusion] It was shown that among the community-dwelling elderly, obese subjects who had maintained their physical function did not exercise habitually. It was also shown that masked obesity subjects had low physical function and were at high risk of falling.

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[Purpose] In this study, we investigated the relationship between the muscle thickness of the quadriceps measured by an ultrasound imaging system and physical function. [Subjects] The subjects were 98 community-dwelling older women aged over 60: average age, 72.7. [Methods] The muscle thickness of the quadriceps femoris at 10 cm above the upper border of the patella was evaluated by an ultrasound imaging system, and physical fitness which included knee extension strength was evaluated. [Results] There were significant correlations between muscle thickness and knee extension strength (r= .333, p< .001), hand-grip strength (r= .255, p< .05), and one-legged standing time (r= .278, p< .001). [Conclusion] The muscle thickness was correlated with physical fitness. However, multiple linear regression analysis indicated that muscle thickness did not predict the strength of knee extension precisely enough.

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[Purpose] Recent reports have shown that therapeutic exercise intervention using action observation activates mirror neurons (MNs) and has an effect on the motor recovery. In this study, we verified brain activities while subjects watched movies with an intent inference task. [Methods] For 10 right-handed healthy adults, cerebral blood flow and oxygen consumption were measured at rest and under four conditions: 1) action observation task, no verbal response; 2) intent inference task, no verbal response; 3) action observation task, with verbal response; and 4) intent inference task, with verbal response. [Results] The results indicate that under conditions 2 and 4 significant activations (p<0.05) of the inferior frontal cortex were noted in both hemispheres where MNs are present. [Conclusion] An intent inference task was determined to be more appropriate for MNs activation than observed action alone.

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[Purpose] The aim of this study was to investigate the relationship between lower limb loading force and independence of transfer activity as well as the effect of lower limb disability. [Subjects] The subjects were 35 elderly patients in long-term care: 16 males, 19 females, average age 79.7 ± 10.1. [Method] The subjects' level of independence in transfer activity was classified into 3 groups based on Functional Independence Measure scores, and lower limb disability was classified as unilateral or bilateral based on medical records as well as information from the patient's therapist. We calculated the lower limb loading force to body weight ratio as a percentage and compared it with level of independence in transfer activity and lower limb disability as factors in two-way analysis of variance, and a multiple comparison test. [Results] A significant difference was found in transfer activity between the Independent and Assistance groups, but a significant main effect was not found for the disability side. [Conclusion] Lower limb loading force is reflected in transfer activity ability, and the results suggest that the measurement of lower limb loading force can even be applied to elderly patients in long-term care suffering from a variety of diseases.

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[Purpose] Here, we publish results of a questionnaire which was carried out to aid the development of a clinical measure of balance ability. [Subjects and Methods] We questioned 23 physical therapists who published about balance on journals. The questionnaire consisted of 7 major questions, such as definition of balance, key concepts for measuring balance ability, and requirements for measures of balance ability. [Results] There were some differences among physical therapists in the answers for the definition of balance and key concepts of balance ability. They regarded shorter measurement time, subjectivity of results and clinical usefulness of the results as important. We also recognized there were some issues in the measures of balance ability in practice. [Conclusion] We will develop a new clinically valid measure of balance ability on the basis of these results.

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[Purpose and Subjects] The present investigation was conducted in order to confirm the symbolization process concerning tactile and visual object recognition in 13 healthy adults. [Methods] After three kinds of stimuli with different surfaces (smooth paper, sand paper and cloth) were presented haptically (T-task) and/or visually (V-task), all participants were asked to express as many words as possible associated with the stimulus within 3 minutes. A verbal report by semi-structured interview was recorded, and the contents of the interview were analyzed by Modified Grounded Theory Approach (M-GTA). [Results] The results show that some concepts such as "intuitive judgment", "judgment by association", "judgment by memory recall", "exploratory judgment" and "functional adherence" were created during the object recognition process in T-task and V-task, and moreover another "judgment by tactile image" in V-task. [Conclusions] These findings suggest that these classified concepts may be adopted as various strategies for retrieval and mapping of base in analogical function, that is one type of human thinking.

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[Purpose] We examined the effect of trunk exercise for prevention of low back pain on trunk back muscle endurance of elderly people. [Subjects] Twenty-four people (74 ± 5.1 years old) participated in this study. They were assigned to an exercise group or a control group. [Methods] The endurance parameters included the holding time of the Trunk Holding Test (THT) and electromyographic fatigability (IMF, MF-Slope) was also evaluated. [Results] Although a significant change in electromyographic fatigability was not observed after eight weeks of exercise in either group, THT increased significantly only in the exercise group. [Conclusion] The results suggest that the exercises conducted in this study were effective for improvement of THT that is one of the risk factors for low back pain.

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[Purpose] We examined the effect of trunk exercise for prevention of low back pain on health-related QOL and balance ability. [Subjects] Twenty-four people (74 ± 5.1 years old) participated in this study. They were assigned to an exercise group or a control group. [Methods] Health-related QOL was evaluated using SF-36. Balance ability was evaluated by postural sway during one leg standing and unstable sitting, and sitting time during unstable sitting. [Results] After eight weeks of exercise, significant changes in health-related QOL and balance ability were observed in the exercise group, but not in the control group. [Conclusion] The results suggest that the exercises conducted in this study were effective for improvement of one leg standing balance, unstable sitting balance and health-related QOL.

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[Purpose] As basic research on the analysis of the effect of use of a stick during standing, we investigated the changes of center of gravity (COG) sway of an apparatus simulating the physical experience of an elderly person. [Subjects] The subjects were 15 healthy persons: 10 males, 5 females, average age 40.4 ± 5.9 (ranging from 31 to 51 years of age). [Methods] The measurement of COG sway was performed with an Active Balancer (Sakai Medical Co.) under 3 conditions: with no stick and no apparatus, with the apparatus only, and with the apparatus and the stick. [Results] It was found that with use of the apparatus the total COG sway path length, COG sway speed (path length/sec), the area of the envelope of COG sway and the rectangular area increased, as well as the displacement of the antero-posterior sway center average and the lateral and antero-posterior sway standard deviations. Furthermore, when the stick was used, the locus of COG sway was anteriorly maintained resulting in a reduction in sway. [Conclusion] From these results, the COG sway, reflecting the knee, hip and trunk flexion, of elderly persons in the standing position, is shifted more forward than that of healthy non-elderly persons, and the sway is larger and more rapid. However when a stick is used, the results suggest the sway is reduced to the same level as that of healthy non-elderly persons.

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[Purpose] The purpose of this study was to investigate the relationship between patterns of putting-on and taking-off socks and flexion range of total arthroplastic hips in the early postoperative period. [Subjects] The subjects of this study were 74 patients (81 hip joints) who had undergone total hip arthroplasty 3-5 weeks earlier. [Methods] When the patients put on or took off their socks, their postures or ways were monitored and classified into five patterns; dangle sitting, long sitting, sitting posture with full-flexed knees, standing or supine posture, and using self-assisting devices. The flexion range of the operated hip was assessed in each group. [Results] The most frequent patterns of treating socks were the standing or supine postures, followed by sitting posture with full-flexed knees, dangle sitting and using self-assisting devices, and long sitting. There was a significant difference among the patterns of treating socks and the flexion range of the hip. [Conclusion] These results suggest that patients need different instructions for the postures of putting-on and taking-off socks, depending on the flexion range of the total arthroplastic hips.

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[Purpose] The purpose of this study was to estimate the relationship between physical function at hospitalization and falls after discharge. [Subjects] The participants were 79, community-dwelling patients with stroke who had independent gait. [Methods] Physical function was measured by Brunnstrom Recovery Stage, one-leg standing time, and 10-m walking time. Subjects recorded experiences of falls for one year after discharge from rehabilitation. [Results] Sixty-three per cent of people (50/79) had a fall accident in the year after discharge. The fall group showed lower Brunnstrom Recovery Stage, lower one-leg standing, weaker knee extensor strength, lower Barthel Index and higher 10-m walking time than the no-fall group (p<0.05). Logistic regression analysis also indicated that the fall group had lower one-leg standing time than the no-fall group (95% CI: 0.829-0.981). The cutoff value for the one-leg standing time in predicted fall was 3.5 sec (sensitivity 86.0%, specificity 69.0%). [Conclusion] One-leg standing time during hospitalization was associated with falls for one year after discharge from rehabilitation, suggesting that this test is effective at predicting fall accidents for patients with stroke.

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[Purpose] The present experiment was conducted to clarify how accurately stroke patients with hemiplegia could recognize their own step length during walking. [Subjects and Methods] Actual and estimated walking distances and lower limb length were measured in 8 hemiplegic patients and 8 healthy elderly persons. Error rates (ERs) were then calculated using the formula, ER (%) = 100 × |X - Y| /X, where X represents the actual distance and Y the estimated distance. [Results] ERs in hemiplegic patients were not significantly different between paralytic and non-paralytic lower limbs, while ERs in hemiplegic patients were reliably higher than those in healthy elderly persons, demonstrating that. [Conclusion] Hemiplegic patients were unable to recognize accurately their own step length on both paralytic and non-paralytic limb sides. These findings are discussed in relation to the representative knowledge concerning recognition and estimation of the step length.

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[Purpose] This study aimed to reveal the relationship between "recognition of body position" and "the ability to maintain balance in the standing posture". [Subjecrs] The subjects were 32 healthy adults. [Methods] The subjects were instructed to raise one of their lower extremities and to estimate the following distances in the sagittal plane: greater trochanter to patella, patella to lateral malleolus, and lateral malleolus to greater trochanter. Next, the researcher measured actual distances and calculated the inaccuracy. In this study, inaccuracy in recognition of body position was defined as the sum of the inaccuracies in the length of each part. The duration for which the subjects were able to maintain their one-legged posture with their eyes-closed was measured. In addition, 20 subjects among 32 subjects were assessed by stabilometry (ANIMA Inc., model Gravicorder G6100) . Performance of stabilometory used LNG. Pearson's theory was used in this study. [Results] The inaccuracy was correlated with eyes-closed one-leg standing time (r= -0.58, p<0.01) and with LNG execution (r=0.65, p<0.01). Distance between the lateral malleolus and the greater trochanter was correlated with eyes-closed one-leg standig time (r= -0.56, p<0.01) and with LNG execution (r=0.53, p<0.05). [Conclusion] These results suggest that recognition of body position is related to postural control.

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[Purpose] The aim of this study was to examine the characteristics of lower limb kinematics in drop jumping (DJ) and their relationships with ability to jump using the stretch-shortening cycle (SSC). [Subjects] The subjects were 28 healthy males. [Method] In a 20cm DJ the changes in lower limb joint angles and vertical and drop jump heights were measured. From the changes in joint angles in DJ, the joint angles just before landing and at the time of takeoff, and the time from the change of ankle angle at takeoff to the time of knee angle change were determined. Subjects were classified into VJ higher or lower than DJ groups, and the differences between the two groups were compared. [Results] For the VJ>DJ group plantar flexion was significantly smaller. Also, the time from the change of ankle angle at takeoff to the time of knee angle change was significantly longer, and the majority of subjects changed the ankle angle earlier than the knee angle. [Conclusion] The results suggests that, in addition to a smaller angle of plantar flexion on landing, adopting a takeoff action in which extension action of the ankle is earlier than the knee enables a DJ which uses SSC efficiently.

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[Purpose, Subjects and Methods] Prediction distances, as subjective estimates of upper limb reach without trunk movement, were measured for 21 spatial directions in 9 hemiplegic patients, 10 healthy elderly person and 9 healthy adults, in order to investigate motor image disorder in hemiplegic patients with cerebrovascular accident. Error rates (ERs) were then calculated for 21 directions for each subject using the formula, ER (%) = 100 × |X-Y |/ X, where X represents the actual length of the upper limb (from the acromial process to the middle fingertip) and Y the prediction distance. [Results and Conclusion] The results clearly demonstrated 1) that ERs with the paralyzed limb were not different from ERs with the healthy limb in hemiplegic patients, and 2) that ERs in hemiplegic patients were reliably higher than those of healthy elderly persons and healthy adults, suggesting that hemiplegic patients hold motor image disorders not only in the paralytic but also healthy limb sides. These findings are discussed in relation to some supposed neural mechanisms of the motor image.

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[Purpose] This study Investigated how activities of the muscles of the upper and lower extremities change in partial weight-bearing (PWB) exercise with crutches. [Subjects] The participants were 43 healthy people. [Methods] Weight-bearing measurement was done using a computer weight-bearing system. The electromyographic (EMG) activities of the rectus femoris (RF), hamstrings (HAM), tibialis anterior (TA), gastrocnemius (GAS), pectoralis major (PM), triceps brachii (TR), biceps brachii (BB), and brachioradialis (BR) were measured. Subjects stood with the measurement foot (load side) on the weighing scale and the other foot (unloaded side) placed pesteriorly. As target values for load, subjects were instructed to apply 10-90% of total body weight. [Results] There were significant correlations (p<0.01) between the average potential of EMG (AEMG) in GAS and the amount of weight-bearing (WB) on the load-side, between AEMG of HAM and WB on the unloaded side, and between AEMG of PM, TB and WB in the upper extremities. [Conclusion] In the adjustment of PWB of the lower limbs, upper extremity not only the load side muscle activities but also the unloaded side and the upper extremity muscles participated.

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[Purpose] The purpose of this study was to verify the benefits of a physical exercise workshop in which we have participated over the past four years in a care preventive project that effectively uses human resources functioning in the community. [Subjects] The subjects were 95 persons (20 men and 75 women, mean age: 77.8 ± 6.1 years) who participated in the exercise class over the 4 years. [Methods] To verify the overall physical benefits of the exercise class, the measurements of subjects' physical strength before and after the exercise were scored, and compared on a total-score basis. In the scoring process, the reference values of physical strength determined from the results of a physical examination performed by the municipal authority were used. To explore factors underlying the benefits of the exercise class, the measurements of subjects' physical strength at the start of the exercise were compared between those with and without physical benefits. [Results] A significant increase in the total score was observed between the pre- and post-exercise class periods. The total score at the start of the exercise class was significantly lower in those with physical benefits, suggesting that the benefits of the exercise were greater in those with low levels of physical strength at the start of the exercise class. [Conclusion] The benefits of the community-based physical exercise class for the elderly were identified. The results suggest that the exercise class could be effectively managed by selecting participants whose physical strength levels were uniformly low.

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[Purpose] To disclose changes of the periphery of the sciatic nerve during contracture, we conducted an animal experiment. [Methods] Wistar male rats (9-week, n=26) were divided randomly into control group (C group, n=4) and immobilized group (I group, n=22). In the I group, their left knee joints were immobilized with plaster cast for 2 weeks in the posture of maximum flexion. After the experimental period, we obtained the cross section tissue of the center of the left thigh, the periphery of the sciatic nerve was observed under an optical microscope with hematoxylin-eosin staining. [Results] In the I group, adherence between the bundle of nerve fibers and the perineurium, and thickening of the perineurium was observed, in contrast with C group. These histological changes were statistically significant. [Conclusion]I mmobilization of the joint could affect the periphery of the nerve tissue was indicated.

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I was engaged in physiotherapy at the national institute for handicapped in the Islamic Republic of Pakistan as a member of Japan Overseas Cooperation Volunteer from 2005 to 2007. The aim of the mission was to improve the rehabilitation section of a physiotherapy department. To this aim we tried to improve the quality of physiotherapy for patients and to instruct counterpart and staff, particularly about manual treatments and their evaluation methods. I report on the current situation of physiotherapy in Pakistan and our activities.

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[Purpose] The purpose of this paper is to introduce and discuss the meaning of clinical reasoning in physiotherapy. [Methods] Articles focused on clinical reasoning were reviewed. [Results] Several recent studies have identified dialectical, and multi-dimensional clinical reasoning strategies in physiotherapy, not only in diagnostic reasoning but also in narrative, collaborative, educational, and ethical reasoning. A new guideline for case reports noted that the reasoning utilized in a case report should be specified. [Conclusion] A case study should be a plausible method for learning reasoning. If reasoning was presented with the context of the situation in which the physiotherapist practices, the reasoning would be effectively shared.

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[Purpose] The 2:1 or 3:1 clinical placement model (two or three students placed with one clinical educator) has been common in overseas physiotherapy clinical education. The purpose of this review was to demonstrate the effects, advantages and disadvantages of the 2:1 model through evaluating previous papers. [Methods] Papers that were published after 1990 and demonstrated the effect of the 2:1 model with physiotherapy students were examined. MEDLINE and CINAHL were used for the search. Six papers, three quantitative studies and three qualitative studies, were selected. [Results] All papers demonstrated the effect of the 2:1 model. The main advantages of the 2:1 model were collaborative learning and peer support. In addition, one paper suggested that the 2:1 model has more advantages and fewer disadvantages compared to the traditional 1:1 model. Meanwhile, many papers suggest that different academic levels and personalities of students may be serious disadvantages for the 2:1 model. [Conclusion] Considering the results, the effect of the 2:1 clinical placement model may be demonstrated. However, small sample size, the limited number of clinical facilities and the small number of studies make it hard to confirm the effect of the 2:1 model. Improvement of the study methodology and an increase in the number of studies are necessary to improve the evidence level for the 2:1 model. In addition, a 2:1 clinical placement model study directed at Japanese physiotherapy students will be needed.

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