[Purpose] In the present study, we related verbalization of physical skills to the characteristics of skilled and unskilled subjects performing a waving movement with the upper extremities in a dance performance and investigated factors constituting physical skills. [Subjects] The skilled group consisted of five subjects, while the unskilled group comprised of nine subjects who had no experience of performing waving movements. [Methods] Each waving movement performed in this study was analyzed with a motion capture system and surface electromyograms to calculate %up-and-down movement, propagation velocities, %angular variation and %MVC. Further, the skilled subjects were interviewed to verbalize the skill of the waving movement. [Results] As compared with the unskilled group, the skilled group showed at least four types of movement characteristics and two types of these characteristics were verbalized in explanations. [Conclusion] Two types of movement characteristics, substantiated by verbalization, were found to be the probable factors constituting physical skills.

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[Purpose] The purpose of this study was to investigate the effects of relaxation postures by measuring airway occlusion pressure (P_0.1) and heartbeat variability as indicators of respiratory motor output and autonomic nervous function, respectively. [Subjects] Eleven healthy university students (5 males, 6 females, aged 20.3 ± 0.5 years) participated in this study. [Methods] The measurement postures were standing, sitting, forward-leaning sitting, and semi-Fowler's posture. Subjects maintained each posture for four minutes and their respiration and heartbeat variability were measured, following which P_0.1 was measured five times in one minute. [Results] P_0.1 and heart rate were significantly lower in the semi-Fowler's posture compared with sitting. Also, in terms of heartbeat variability, the activity level of the parasympathetic nervous system was high in the semi-Fowler's posture. [Conclusion] This result suggests that the semi-Fowler's posture is more effective than sitting at reducing heart rate and increasing parasympathetic nervous system activity as a relaxation posture.

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[Purpose] We investigated the number of times of needed to accurately measure the simple reaction time of a vocal response to auditory stimulus in physical measurements for the prevention of care of the community-dwelling elderly. [Subjects] The subjects were 24 healthy elderly persons (5 men, 19 women) with no history of central nervous system diseases or orthopedic disorders who participated in a government sponsored exercise guidance and physical measurements program for the prevention of falls. [Methods] With subjects in the sitting position, one practice trial was performed to accustom them to the task, then measurements were performed 10 times. [Results] The intra-class correlation coefficients, ICC(1,1), of the 4th to the 7th measurements with the average of all 10 measurements was greater than 0.81; thus, the minimum number of measurement times needed for an ICC of greater than 0.81 is 4. [Conclusion] The results suggest, that in physical measurements of elderly subjects, after a single practice, the fourth value of the oral response time can be used as a representative value.

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[Purpose] The purposes of this study were to compare the dynamic knee function of healthy young subjects and subjects with Anterior Cruciate Ligament Deficiency (ACLD) during stair descent and to demonstrate the relationship between the knee joint moment and muscular force obtained in an Open Kinetic Chain (OKC). [Subjects and Methods] Eight healthy young and 8 ACLD subjects participated in this study. We measured stair descent movement using a three dimensional motion analysis system and six force plates. The knee muscular forces in OKC were obtained by dynamometer. The muscular forces were measured in the supine and sitting positions. We compared these parameters and calculated the correlation coefficient between the knee joint moment during stair descent and extension and flexion muscular forces. [Results] No significant differences of the knee joint moment were observed between healthy subjects and ACLD subjects. Only the knee extension muscular force of ACLD subjects showed a lower value than that of healthy subjects. Also, significant negative correlations in healthy subjects and positive correlations in ACLD subjects were observed between the knee joint moment during stair descent and the H/Q ratio. [Conclusion] Significant correlations were observed between the knee joint moment during stair descent and the H/Q ratio but not with extension and flexion muscular forces.

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[Purpose] In this study, we measured the circumference of the thigh and muscle thickness at 10, 15 and 20 cm above the top of the patella, and investigated which values relate best to quadriceps femoris strength. [Subjects] The subjects were 56 community-dwelling elderly women, average age 71.6 ± 6.5 years. [Methods] We measured quadriceps femoris thickness with ultrasonography equipment, the thigh circumference with a tape measure and quadriceps femoris strength with a hand-held dynamometer, and investigated the relationships with quadriceps femoris strength using Pearson's correlation coefficient. [Results] All circumference measurements and the ultrasonography thickness measurement made at 10 cm above the patella showed moderate correlations with quadriceps femoris strength, whereas muscle thickness measured with ultrasonography at 15 and 20 cm above the patella showed strong correlations with quadriceps femoris strength. [Conclusion] The results suggest, that when estimating quadriceps femoris strength from muscle thickness measured by ultrasonography, measurements should be made at more than 15 cm above the top of the patella.

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[Purpose] We investigated the effectiveness of e-learning by measuring the self-efficacy of physical therapy students before and after the implementation of e-learning. We also created a scale of self-efficacy effects and looked for factors influencing students' self-efficacy. [Subjects] The subjects were thirty-three 2nd-year students at a 4-year physical therapy vocational college. [Methods] An e-learning course complementing normal face-to-face classes was implemented for 6 weeks. We measured students' self-efficacy using Sherer's Generalized Self-Efficacy Scale (GSES) before and after the e-learning implementation and compared the results. We also made measurements using our original `e-learning self-efficacy effects scale' after the e-learning and looked for factors influencing e-learning. [Results] After the implementation of the e-learning, GSES scores of 23 students increased, 2 remained the same, and 8 decreased. Also, regarding the self-efficacy scale, among Bandura's four factors affecting self-efficacy, `verbal persuasion' showed the lowest value, and for the group showing reduced GSES scores, `vicarious learning' had not taken place. [Conclusion] In raising students' self-efficacy, in addition to e-learning, encouraging students and methods which confer practical experience such as mock clinical experience are effective.

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[Purpose] In order to examine the significance of the sit-and-reach distance of the elderly, we investigated its correlations with spinal mobility and straight leg raising range (SLR). [Subjects] The subjects were 161 community-dwelling elderly: 42 men, 119 women, average age 72.6 ± 6.9 years. [Methods] We measured sit-and-reach distance, spinal mobility and SLR and investigated their correlations. [Results] We found a significant correlation between sit-and-reach distance and SLR (r=0.60), but no correlation (lumbar or thoracic) was found with spinal mobility. [Conclusion] The results suggest that sit-and-reach distance is a test which reflects the suppleness of the hip joint and hamstrings, which are expressed in SLR, but not the flexibility of the spine.

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[Purpose] The aim of this study was to measure the stance phase walking pattern of young adults and investigate the characteristics by comparing it with prior reports that the center of foot pressure (COP) moves from the heel to the vicinity of the 5th metatarsal before advancing to the big toe. [Subjects and Methods] The subjects were 17 vocational students who gave their consent to participation in the study. In addition to measurements of 10 m walking and physique, we investigated the characteristics of COP in the stance phase. [Results and Conclusion] COP showed a tendency to a central pattern. From the load response phase to the end of the stance phase, we found the time factor tended to be prolonged. The results suggest, that particularly after the initial contact, the movement of the lower ankle joint, foot length and width (arch function), and the angle of dorsiflexion of the middle toes contribute to functional adjustments of COP.

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[Purpose] To get an understanding of the home life of infants with lower limb disability, a 20-page A4 Health and Living Log (provisional name) was created to facilitate sharing of information with families. The process of the log creation is reported, and the recorded items and ease of log entry by families was investigated. [Subjects] The subjects were 44 families with children attending a kindergarten facility for infants with physical disabilities in T city. [Methods] How the items of children's growth and development and life at home were being recorded, and the actual status of information exchange was surveyed by questionnaire. Furthermore, to record the information, a Health and Living Log was distributed, and the items and their ease of entry were investigated. [Results] Replies were received from 37 out of the 44 families, a response rate of 84.1%. Families were recording their children's growth and development, life at home or medical consultations in commercially available growth records, diaries, or blogs, but had given up recording items related to growth in Mother and Child Health Notebooks. Regarding the Health and Living Log, families gave a high evaluation to the inclusion of information offered by health facilities and the items of Condition at Birth and Growth and Development. [Conclusion] As a future topic, there is a need to investigate the information needed by related organizations and professions.

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[Purpose] We investigated what kind of an effect the simple feeling of "like" or "dislike" of exercise had on amount of physical activity and duration of activities of daily living. [Subjects] The subjects were 115 healthy students. [Methods] We surveyed the times spent on 5 items representative of general living activities (sleeping, working, housework, exercise, leisure) and subjects feelings towards exercise, and measured physical activity (total energy expenditure) with a pedometer. [Results] Among those who "liked" exercise, a significant correlation with exercise time was found, and total energy expenditure was maintained at more than 1758 kcal. [Conclusion] The results suggest that feelings toward exercise regulate a persons physical activity, affecting the daily hours of exercise and exercise activities for maintaining health.

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[Purpose] Using five motor function tests, we performed an assessment as to whether or not elderly persons had appropriate self-recognition of their motor ability and examined the the correlation with falls. [Subjects] The subjects were 76 elderly persons using a day-care service. [Methods] For five motor function tests (Functional Reach Test, Chair-Stand Test, the Matagi Test, the Harvard Step Test, Maximum Step Width) profoundly related to daily activities, we asked the participants to estimate their ability, then measured it. We created an aptness scale on the basis of the agreement of the measured value with the predicted value, and examined the relationship with falls after dichotomizing the results. [Results] For the Chair-Stand Test and Matagi Test results, the groups assessed Inapt had significantly higher proportions of persons with experience of falls than the groups assessed Apt. Also, an overall assessment of aptness, judging all 5 motor function tests, delivered a similar result. Furthermore, in investigations of sensitivity and specificity using the aptness scales as predictors of falls, the compound scale using all 5 motor function tests showed better sensitivity and specificity than the individual test scales. [Conclusion] The assessment of self-recognition of motor ability used in this study has a potential clinical application as a predictor of falls, and the results suggest the possibility that using the compound aptness scale rather than the individual test aptness scales would raise the accuracy of fall prediction.

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[Purpose] The aim of this study was to examine the change of fatigue, psychological status and QOL before surgery and at the time of discharge in patients with esophageal cancer, and in addition, to examine the correlation of fatigue with psychological status and QOL. [Subjects] The subjects were 20 patients with esophageal cancer who underwent surgery. [Methods] We used a questionnaire for assessing the fatigue, psychological status and QOL. The changes of fatigue, psychological status and QOL before surgery and at the time of discharge time were analyzed using Student's t test. The correlations of fatigue with psychological status and QOL were analyzed using Pearson's product-moment correlation coefficient. [Results] Fatigue increased from before surgery to time of discharge. Depression, stress and QOL showed no significant differences. The correlations between fatigue and stress, and between fatigue and QOL were significant. [Conclusion] It is important to understand patient's condition well, and execute rehabilitation that considers the patient's psychology in order to evaluate fatigue, psychological status, and QOL.

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[Purpose] This study examined the clinical utility of the JSS-H (Japan Stroke Scale-Higher Cortical Function) with proximal femoral fracture as a predictor of gait ability, mental function and intellectual function. [Subjects] Fifty-nine subjects with proximal femoral fracture. [Methods] Using multiple regression analysis, we examined the degree to which evaluation of physical function at one week was related to gait ability at three weeks after operation. [Results] The examination picked out the JSS-H and the power of the unaffected side of the quadriceps femoris as factors that were significantly related to the gait ability at three weeks after operation. And the former of standard partial regression coefficient is -0.446, the later is 0.429. [Conclusion] Adding JSS-H to the evaluation of physical function will support the planning of more appropriate physical therapy programs.

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[Purpose] The purpose of this study was to perform a detailed examination of regions with nervous activities specifically reacting to mental rotation imagined by motor imagery, and to verify the usefulness of LORETA analysis using the components of event-related potentials (ERPs). [Subjects] The subjects were 24 healthy people aged 22.7 ± 3.4 years. [Methods] The ERPs were determined during mental rotation of the hand and foot, and analyzed by LORETA as nervous activities during mental rotation. [Results] Significant nervous activities of mental rotation were observed in the frontal lobe and anterior cingulate gyrus. Furthermore, for the hand, significant nervous activities were observed in the inferior temporal gyrus and amygdala. [Conclusion] These results show that nervous activities during mental rotation are similar to real motions of the hand or foot, and suggest the possibility that the activated regions participate in cognitive function and emotion.

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[Purpose] The present study aimed to clarify whether dysesthesia affected daily living in persons who underwent surgery for slight cervical myelopathy. [Subjects] Thirty-five persons who could walk stably after surgery were selected. [Methods] The following three items were inquired using a questionnaire: intensity of dysesthesia in the lower extremity, difficulty of activities of daily living (ADL) and physical activity. Relationships among these items were statistically investigated. [Results] The response rate was 74.3% [26 persons (men 19, women 7); 62.0 ± 10.6 years]. Although a significant correlation between the intensity of dysesthesia and the difficulty of ADL was found, the correlation was no longer significant when a person with intractable dysesthesia was excluded. [Conclusion] Dysesthesia didn't much affect the daily living of most of the persons who underwent surgery for slight cervical myelopathy.

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[Purpose] The purpose of this study was to investigate the factors related to balance and walking ability in patients with kyphosis. [Subjects] The subjects were 20 patients with kyphosis (6 men and 14 women, average age 77.8 ± 4.7 years). [Methods] We measured passive extension mobility of the spinal column, active extension mobility of the spinal column, the angle of anterior inclination of the trunk, age, one legged standing (OLS), timed up-and-go test (TUG), maximum walking speed (MWS), and the physiological cost index (PCI). [Results] There was a significant correlation between the passive extension mobility of the spinal column and OLS, and MWS (p<0.01). There was no significant correlation between passive extension mobility of the spinal column and PCI, between active extension mobility of the spinal column and age, the angle of anterior inclination of trunk, OLS, TUG, MWS, and PCI. [Conclusion] These results suggest that passive extension mobility of the spinal column is related to the balance and walking ability of patients with kyphosis.

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[Purpose] The aim of this study was to examine whether motor imagery declined and whether it could be improved by increasing physical activity in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). [Subjects] The participants were 20 allo-HSCT patients. [Methods] We assessed the relationship between the number of daily steps measured with a pedometer and the parameters of motor imagery (actual walking time and mental walking time) after neutrophil engraftment and at discharge. [Results] There was a negative correlation between the daily steps, and the actual walking time and the mental walking time at discharge. [Conclusion] The motor imagery declined in the course of allo-HSCT and it was improved by increasing the physical activity of allo-HSCT patients.

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[Purpose] The purpose of this study was to identify the current status and issues related to problem-based learning (PBL) tutorials in Japanese physical therapy education by conducting a questionnaire survey of physical therapy educators. [Subjects and Methods] A mail questionnaire was sent to 236 physical therapy school educators from November to December in 2009. [Results] One hundred thirty educators responded. Seventy schools had introduced PBL tutorial into their curriculum but 60 schools had not. Many educators who had implemented PBL tutorials chose different instruction methods during PBL tutorials. Furthermore, many educators who had not implemented PBL tutorials felt unfamiliar with PBL methods. [Conclusion] Making PBL guidelines and providing support for educators are necessary to conduct more effective PBL tutorials.

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[Purpose] The purpose of this study was to analyze the kinematics of sit-to-stand motion (STS) in subjects with knee osteoarthritis (knee OA) and to demonstrate the factor of impairment responsible for pathogenesis and progression of knee OA based on discussion from the standpoint of the kinetic chain of the thorax-pelvis-lower extremity. [Subjects] The subjects were 17 patients with knee OA and 16 age-matched asymptomatic controls. [Methods] Subjects performed STS from a chair with a seat adjusted to the height of the subject's lower leg. Kinematic data of the body segment and joint angles were collected using a motion analysis system (Kissei Comtec). [Results] There were no significant differences between joint angular velocity averages of the body segment in forward movement of center of mass (COM), but those of the knee and ankle in upward movement of COM were significantly smaller. [Conclusion] These results suggest that knee OA subjects can't transfer kinetic energy generated in trunk forward tilting to the lower extremity, making it difficult for them to keep appropriate knee movement and alignment.

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[Purpose] The purpose of this study was to identify the potential risk factors of community-dwelling diabetes patients who are not currently receiving physical therapy in preparation for their future physical therapy. [Subjects] The subjects were 18 diabetes patients and 10 non-diabetic patients receiving outpatient treatment at a clinic without a resident physical therapist. [Methods] Using a pulse wave monitor, we measured pulse wave velocity and the brachial-ankle blood pressure ratio. Together with height, weight, blood pressure, exercise habits and the results of other clinical examinations, we compared the values between the diabetic and non-diabetic patients. [Results] We found significant differences between the two groups for average pulse wave velocity, hemoglobin A1c, and fasting blood glucose level. [Conclusion] We could identify the potential risk factors of community-dwelling diabetic patients.

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[Purpose] The purpose of this study was to evaluate the reliability and validity of IPAQ (International Physical Activity Questionnaire; Japanese Version) by comparing the physical activity measured by an activity monitor with IPAQ. [Subjects and Methods] IPAQ was evaluated and re-evaluated for one week after the first evaluation of fifty-six healthy students who were in the validity study. Daily physical activity of 16 healthy students was continuously monitored for one week by an activity monitoring and evaluation system (A-MES; triaxial accelerometer). [Results] The values of interclass correlation coefficients were all larger than 0.75 suggesting the high reliability of IPAQ. Significant correlations were obtained for total sitting and lying times on holidays. [Conclusions] These results suggest the high reliability of IPAQ (Japanese version) and the high validity of the evaluation of physical activity of sitting and lying times on holidays. The data also suggest limitations of IPAQ in the evaluation of walking time in daily life.

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[Purpose] The purpose of this study was to verify the differences between sthenometry of the hip flexor muscles in trunk fixation with both arms or the contralateral lower extremity and without trunk fixation. [Subjects] In this study, 20 healthy subjects (10 male, 10 females; aged 19 to 33) participated after we obtained their informed consent. [Methods] We measured the hip flexor muscles strength using a hand-held dynamometer, and recorded electromyograms around the trunk and hip. We compared hip flexion isometric strength and electromyograms in three postures: 1) trunk fixation with both arms, 2) trunk fixation with the contralateral lower extremity, 3) without trunk fixation. [Results] Isometric hip flexor strength without trunk fixation was lower than that in the trunk fixation with both arms or the contralateral lower extremity. In trunk fixation with both arms, external abdominal obliqus and paraspinalis muscle activities were higher than without trunk fixation. Moreover, in trunk fixation with the contralateral lower extremity, the hip flexor and biceps femoris muscles activities were also higher than without trunk fixation. [Conclusion] The results demonstrate that trunk fixation enhanced hip flexor muscles strength because muscle activity rose due to posture maintenance.

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[Purpose] We conducted a care prevention course for potentially dependent elderly and investigated its effect on their health-related QOL and motor function. [Subjects] The subjects were 45 potentially dependent elderly persons (11 men, 34 women) who enrolled for the care prevention course. [Methods] The care prevention course lasted 3 months and was conducted once a week for 12 weeks. Each session lasted 2 hours and consisted of a lecture, stretching, muscle strength training and whole body exercise. The assessments used were motor function and the SF-36 questionnaire. [Results] At pre-intervention, no significant differences were found in motor function or the SF-36 score between those with and without a history of falls. Significant improvements in motor function of both groups were found post-intervention, and a significant improvement in the SF-36 score was found post-intervention for the group without a history of falls, but not for the group with a history of falls. [Conclusion] We consider that the lack of improvement in health-related QOL in the group with a history of falls was due to the psychological impact of the falls. Thus, we consider that care prevention interventions for the elderly with a history of falls need to address not only motor function, but also psychological aspects.

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[Purpose] The purpose of this study was to compare the effects of static stretching (SS) and dynamic stretching (DS) on temporal range of motion (ROM) and muscle strength and investigate better ways of stretching before some sporting activities. [Subjects] The Subjects were 18 healthy Japanese women. [Method] Subjects performed SS and DS of their triceps surae muscles. We measured ROM of ankle dorsiflexion and muscle strength of ankle plantar flexion of subjects before stretching, just after stretching, and 5 minutes and 10 minutes later. [Results] ROM of subjects who did SS increased just after stretching and this was maintained for 10 minutes. On the other hand, ROM of DS increased gradually and reached that of SS. Subjects who performed DS showed significantly greater ankle plantar flexion strength than subjects who did SS from just after the stretching to 10 minutes later. [Conclusion] These findings indicate that DS 10 minutes before performing some sporting activities in which peak muscle strength is necessary would enhance performance.

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[Purpose] The purpose of this study was to investigate effects of "Aki genki" exercise on both physical function and ability. In addition, we also investigated the effects of "Aki genki" exercise on both participation and continuation of an exercise. [Subjects] The subjects were 29 community-dwelling persons. [Methods] The intervention group (n=20) performed "Iki-Iki 100 years old" exercise and "Aki -genki" exercise, and the control group (n=9) performed only "Iki-Iki 100 years old" exercise. The intervention period was 13 weeks. [Results] Exercise participation on days of the intervention period in the intervention group was on average 4 days/week and in the control group 1 days/week. The intervention group showed significant improvements in percent of body fat, 5 m maximal gait speed, and the Timed Up&Go Test. [Conclusion] The "Aki genki" intervention was useful for encouraging exercise participation and improved both physical function and ability.

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[Purpose] The purpose of this study was to investigate whether the Ankle Plantar Flexors Tone Scale (APTS) can distinguish the tone of the gastrocnemius from the soleus. [Subjects] Seventy-four cerebrovascular disease patients participated in this study. [Methods] Ankle plantar flexor tone was measured using the APTS with the knee extended and with the knee flexed at 90°. [Results] In all measurement items of the APTS, we found that the value measured in the knee extended position was significantly different from that in the knee flexed at 90° position. [Conclusion] The results suggest that discrimination of the tone of the gastrocnemius from the soleus is possible using the APTS.

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[Purpose] Lateral bending is a simple movement, but there are many unclear aspects about its influence on breathing motion. In this study, we measured chest wall motion with a 3D analysis system and investigated the influence of lateral bending on breathing motion. [Subjects] The subjects were 12 healthy adult men. [Methods] In lateral bending, we measured the chest wall motion through the variations of body markers. With regard to extension and reduction in variation of chest wall motion, we performed a comparison with upright standing of the bent and extended sides. [Results] Compared to standing, in lateral bending, breathing variation and variation of chest wall motion decreased. Also, we found that compared to the extended side, inspiration motion was greater on the bent side, and that expiration motion was greater on the extended side compared to the bent side. [Conclusion] Lateral bending is a restrictive position for breathing motion, however, we conjecture that, together with breathing, it could be used to improve unilateral symptoms.

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[Purpose] Questionnaires about knee function have not been directly translated into Japanese due to the unique daily activities of Japanese. The Knee Outcome Survey (KOS-ADLS) has already been translated into many languages. The purpose of this report was to introduce the translation process of KOS-ADLS into Japanese and the issues resulting from the process that may prevent acquisition of accurate subjective information in clinical practice. [Methods] The translation proceeded using established guidelines for the cross-cultural adaptation of self-report questionnaires until it met the approval of the original authors. [Results] The Japanese KOS has been made with minimized language and cultural differences. In the translation process, limitations of Japanese expressions for impairments during activities were faded up. [Conclusion] We think that translation issues need to be disclosed in order to develop the profession of physical therapy in Japan prior to a further report about the Japanese KOS.

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[Purpose] The purpose of this study was to investigate the duration effect of PNF pattern, from the reaction time (RT). We divided the subjects into a PNF group, with flexion-adduction-external rotation of the upper extremity, and a non-PNF group without PNF. We measured the RT of elbow flexion before and after the exercise and over a period of time, to investigate the duration effect. [Subjects] The Subjects were 20 healthy males. [Methods] We divided the subjects into a PNF group, who underwent a flexion-adduction-external rotation pattern of the upper extremity, and a non-PNF group who were told just to flex and extend their elbow. We measured the RT during elbow flexion movement before exercise, right after exercise, and at 5, 10, 15, 20, and 30 minutes after exercise. [Results] There were no significant differences among the results of the non-PNF group. For the PNF group, there were significant differences in RT between pre-and post-exercise, and 5-20 minutes after exercise. [Conclusion] The results suggest that arousal of the central nervous system was maintained for up to 20 minutes by PNF.

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[Purpose] The purpose of this survey was to investigate how care workers assist institutionalised disabled elderly in care health centers for the elderly from the viewpoint of learning theory. [Subjects] Participants in this study were 29 care workers and 3 institutionalised elderly who are cared by them. [Methods] We recorded and classified, what kind of assistance carers used, whether they were able to wait or not, and what kind of responses they made to each of the elderly's behavior, and then we calculated the total number of them. [Results] The results revealed that 87% "totally assisted", 4% of the time carers were "not able to wait", 82% of the time carers gave "no response", 3% of the time carers gave "praise" for elderly's behavior, and 15% of the time assistance was given in the middle of elderly's behavior. [Conclusion] The results of this survey suggest that carers' assistance increased the elderly's dependent behavior and decreased independent behavior from the viewpoint of learning theory.

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