[Purpose] To examine the differences in joint position sense (JPS) test methods in patients with functional ankle instability (FAI). [Subjects] The subjects were seventeen patients with FAI and 29 healthy men. [Methods] The subjects were examined using active and passive reduction methods. Targets were located at eight specified angles. Constant errors and absolute errors were used as measurement indicators. [Results] In the active motion test no trend was observed with a change in target angle between the FAI and healthy groups. On the other hand, in the passive motion test the FAI group showed a significant increase in overshoot toward dorsiflexion with higher plantar flexion angles than the healthy group. [Conclusion] In the active motion test, there was less error in the ankle joint position sense because of the effects of the muscle contraction, but in the passive motion test there was a greater tendency of error when the ankle was in plantar flexion.

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[Purpose] The reliability of measuring scapular positions using an experimentally produced tape measure was verified. [Methods] Intra- and inter-rater reliabilities were calculated. The sample comprised six raters and three subjects. To determine reliability, the intra-class correlation coefficient (ICC), 95% confidence intervals (95% CI), and standard error of measurement (SEM) were employed. Measurement was conducted without bone markers to test for differences in clinical experience. [Results] Intra-rater reliability was: ICC, －0.50 to 0.97; 95% CI, －0.05 to 1.00; SEM, 0.14 to 0.74 cm. Inter-rater reliability was: ICC, 0.19 to 0.45; 95% CI, 0.02 to 0.78; SEM, 0.30 to 0.60 cm. We revealed marked variation in values owing to differences in palpatory skills. [Conclusion] This method can be clinically applied to measure scapular position, with or without bone markers to indicate measurement points, if raters’ palpatory skills are high.

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[Purpose] We investigated the excitation levels of spinal motoneurons of the upper limbs during walking in healthy subjects using F waves as a piece of basic research in order to validate the neurophysiological mechanism behind the associated reaction in stroke patients. [Subjects] The subjects were 30 healthy men aged 24.0±5.9 years. [Method] We recorded F waves (frequency, F/M amplitude ratio and latency) in the thenar muscle of the upper arm preceding, during, just after and 1 and 2 min after walking. [Results] F wave frequency changed significantly during walking, but the F/M amplitude ratio and latency did not show any significant changes. [Conclusion] These finding indicate that the excitability of the spinal motoneurons of the upper limbs of healthy subjects had a tendency to increase during walking. From this, we reason that excitation of the spine at the levels of the upper arm muscles also increases in stroke patients during walking, and that this needs to be considered when making treatment plans for them.

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[Purpose] This study was designed to clarify the relationship between grade 3 muscle strength (moment M_fair: M_f) and the maximum muscle strength (moment M_max: M_m) in manual muscle testing. [Subjects] The subjects were 35 right dominant arms of 35 healthy persons (mean age: 21.2 years). [Methods] Tasks performed in the experiment included maximal force isometric muscle contraction in each motion of shoulder flexion, scaption, abduction, and elbow flexion. The maximum resistance in each experimental task was determined with a hand-held dynamometer. M_f and M_m were calculated to test for no correlation, regression analysis, and to test parallelism in analysis of covariance. [Results] There was a highly positive correlation between M_f and M_m in all of the experimental tasks. We confirmed that all of the 4 regression lines could be used to predict M_m, whereas parallelism of the 4 regression lines was rejected. [Conclusion] There was a linear correlation between M_f and M_m, but the results indicate that the correlation was different for each motion.

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[Purpose] To find a clinical method for using Straight Leg Raising (SLR) as an approach to the trunk muscle, we investigated how the leg and the trunk muscle activity were changed by the setting of the contralateral leg in SLR. [Subjects] The subjects were 21 healthy men (average age: 20.6±3.7 years old). [Methods] The SLR task was performed under three conditions: Push, Do not push, and Normal. We defined Push as SLR which is emphatically performed by pushing the supporting surface in a perpendicular direction with the contralateral leg. We defined Do not push as SLR which is performed without pushing the supporting surface. We defined Normal as SLR which is performed without a special condition. The contralateral leg was kept in a straight leg position. Surface electrodes were used to bilaterally measure the electromyographic activity of the erector spinae (lumbar part), rectus abdominis, medial hamstrings and rectus femoris (eight muscles in total). [Results] In Push, the numerical value of %MVC of the right and left erector spinae was significantly larger than that of the other two conditions. In Do not push, the numerical value of %MVC of the right and left rectus abdominis was significantly larger than that of the other two conditions. [Conclusion] Even if the movement of the spine is limited, the results suggest that it is possible to induce trunk muscle activity in a variety of clinical settings using the two conditions of Push and Do not push.

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[Purpose] We investigated the correlation between leg extensor torque and hip flexor and extensor strength in order to examine the correlation between measurements of leg extensor torque with StrengthErgo and measurements of hip flexor and extensor strength with a hand-held dynamometer. [Subjects] The subjects were 50 healthy adults with no lower limb problems. [Method] We measured hip flexor and extensor strength and leg extensor peak torque on the right and left sides relative to body weight, and examined the relationship between them using Spearman correlation coefficients. [Results] We found a strong correlation between leg extensor torque and hip flexor strength and a weak correlation between leg extensor torque and hip extensor strength. [Conclusion] The results suggest that hip flexor and extensor strength are involved in the exertion of leg extensor torque.

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[Purpose] We studied factors affecting maximum walking distance (MWD) after lower limb revascularization of patients with peripheral arterial disease (PAD). [Subjects] Ten patients with PAD (3 patients received percutaneous transluminal angioplasty (PTA) and 7 patients received lower limb bypass surgery). [Methods] We measured the ankle-brachial pressure index (ABPI), ABPI recovery time, MWD and symptoms at the time of termination of walking before and after surgery. [Results] ABPI and ABPI recovery time improved significantly after the operation, but MWD didn’t. Symptoms at the time of termination of walking were leg pain in all patients before surgery, but getting out of breath was on the increase after surgery. [Conclusion] It is possible that MWD after revascularization was affected by circulation of the lower limbs, cardiac pulmonary and lower limb muscle functions and various other factors.

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[Purpose] Electromyography-triggered neuromuscular stimulation (ETMS) is a neurorehabilitation technique. The purpose of this study was to investigate clinical predictors of functional gain in paretic arms of stroke patients related to ETMS. [Methods] Eight stroke patients received ETMS on their paretic arms 6 days a week for 4 weeks. Outcome measures were upper extremity items of Fugl-Meyer assessment (FMA), Active Range of Motion of wrist extension (A-ROM), grip strength and the Box and Block test (BBT). [Results] After the intervention, FMA, A-ROM and BBT had improved significantly for the entire group. In linear regression analysis, the FMA score at inception was indicated to be a predictor of A-ROM change after ETMS. [Conclusion] ETMS is a useful method for upper extremity dysfunction after stroke. FMA score at inception might be a good predictor of functional gain due to ETMS.

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[Purpose] The aim of the present study was to examine the relationship between walking behavior and psychological and environmental factors among patients with severe diabetes mellitus. [Methods] Twenty-two people (mean age 55.3 years) completed a questionnaire during educational hospitalization. Measured variables included the stage of change for walking behavior, self-efficacy for walking behavior, time spent in walking behavior, the Problem Areas In Diabetes survey (PAID), hospital anxiety and depression scale (HADS), and the International Physical Activity Questionnaire Environmental module (IPAQ-E). [Results] The total time spent in walking showed a significant positive correlation with self-efficacy for walking behavior, and a significant negative correlation with depression mood. [Conclusion] The results indicate that intervention approaches enhancing self-efficacy for walking behavior and reducing depressive mood might be effective for walking promotion among patients with severe diabetes mellitus.

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[Purpose] Our objective was to discover through educational practice a usage for the self-efficacy stimulative scale (SESS) of e-learning for physical therapy vocational school students. [Subjects] The subjects were 40 second-year physical therapy vocational school students. [Method] Based on assessments of SESS made before and after e-learning, we determined the construct scores for each student, and interviewed and performed an intervention for the students with low scores. In addition, all subjects answered a questionnaire, and we confirmed common points and differences and changes by comparison between the questionnaire and the results of the interview and intervention. [Results] For the construct scores, the factor for Sense of Accomplishment ranged from －1.02~0.47 (mean±SD: 0.03±0.35), the factor for Accumulation of Experience ranged from －0.64~0.33 (0.01±0.22), and that for Enquiring Mind ranged from －0.95~0.58 (0.01±0.34). Among the five students interviewed, four answered that they hadn’t sufficiently got to grips with e-learning because they were time-constrained by part-time jobs. From the interviews, we deduced that the 5 subjects had limited knowledge of the utility of a mobile phone as an information device, and after the intervention their SESS increased. [Conclusion] We consider that the SESS for e-learning can be used as a screening assessment method when general e-learning effects begin to appear, in order to identify and perform interventions for students whose self-efficacy is not progressing.

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[Purpose] The purpose of this study was to identify characteristics of patterns of movement in rising from a chair among spastic diplegia-type adult cerebral palsy patients. [Subjects] The study subjects were 12 healthy adults and 16 spastic diplegia-type adult cerebral palsy patients. [Method] The 16 spastic diplegia-type adult cerebral palsy patients were divided into a stable rising movement group of 9 members and an unstable movement group of 7 members based on a preliminary test. Movement properties in the 3 groups were compared. The rising movements of the 3 groups, from the sitting position to standing, were captured using a digital video camera. The data were loaded onto a computer, and the movements were analyzed. [Results] Prolongation of total rising movement time, decrease in distance between the base of support and center of gravity of the body while rising from a chair, decrease in maximum horizontal velocity of the center of gravity while rising from a chair, and decrease in lower limbs, inclination angle with the vertical were observed in the unstable rising movement group. [Conclusion] The results suggest that the rising movements of latently unstable subjects can possibly be extracted by evaluating the above 4 parameters for adults with cerebral palsy.

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[Purpose] We investigated the relationships between the measurement values of one-leg standing time with eyes open (one-leg stand) and the timed up-and-go test (TUG), which are assessment items of musculoskeletal ambulation disability symptom complex (MADS), and walking ability [Subjects] The subjects were 522 community-dwelling elderly [Method] We analyzed the correlations between walking ability and one-leg stand and TUG. In addition, we divided the subjects into two groups, those who could stand for more than 15 s on one leg with their eyes open (15Can) and those who could not (15Not), and compared walking ability between the two groups. [Results] We found significant correlations between TUG and one-leg stand with walking ability. Furthermore, walking ability of the 15Not group was significantly lower than that of the 15Can group. [Conclusion] One-leg stand and TUG showed significant correlations with walking ability, indicating that they are simple and easy assessment items which reflect the decline of walking ability. Furthermore, These results suggest that a motor function assessment of MADS with a 15-second boundary for one-leg stand is clinically significant for identifying decline in walking ability.

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[Purpose] The purpose of this study was to clarify the effects of a heel-arch pad on anterior pelvis and knee joint acceleration and timing of the “foot flat” (FF) phase during walking. [Subjects] The subjects were 43 legs of 28 healthy adults, 22 male legs and 21 female legs. [Method] Subjects were allocated to the Early group or Delayed group according to the timing of the incidence of FF, early or delayed. Using an accelerometer, we investigated the differences in acceleration rates between the two groups and the changes in acceleration rates after fixation of the heel-arch pad. [Results] In the Early group, anterior acceleration of the knee joint increased just before FF, and just after FF anterior acceleration of the knee joint decreased. In the Delayed group, anterior acceleration of the knee and pelvis just before FF were significantly decreased by fixation of the heel-arch pad, and just after FF, anterior acceleration of the pelvis was significantly decreased by fixation of the heel-arch pad, revealing the mutual interaction of pad height and the timing of FF. [Conclusion] The results suggest the timing of FF and heel-arch pad influence anterior acceleration of the pelvis and knee.

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[Purpose] To examine sport injuries in the 2009 OSAKA OPEN, we investigated the difference between injuries to tennis players and injuries to wheelchair tennis players. We also investigated the relationship between pain and motion. [Subject] Fifty-three players who had pain participated in the 2009 OSAKA OPEN study. [Methods] A physical therapist used a record sheet to measure the injury of the wheelchair tennis players. [Result] Fifty-five percent of wheelchair tennis players experienced shoulder pain. The serve, being a forward-swing creates painful motion. Wheelchair tennis players had more shoulder pain than healthy tennis players. [Conclusion] These results suggest that injuries experienced by wheelchair tennis players are allied to the serve.

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[Purpose] We investigated the short-term effects arising from basic techniques of proprioceptive neuromuscular facilitation (PNF) using the response time. [Subjects] The subjects were 40 healthy men. [Method] In the sitting and supine positions, we measured the times of elbow flexion movements in the Resting (R) group, Elbow Movement (EM) group and PNF group, which received a PNF intervention of flexion and internal and external rotation, and investigated the duration of effect using the response time (RT) immediately before, just after and at 5, 10, 15, 20 and 30 min after intervention. [Results] In the PNF group, we found that RT was shortened compared to before intervention for 20 min after the intervention in both the sitting and supine positions. In the R and EM groups no significant differences were found. [Conclusion] Irrespective of posture, a short-term PNF effect lasting for 20 min was found in the the PNF group, and we consider this useful for the practical application of physical therapy techniques.

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[Purpose] The purpose of this study was to clarify the time courses of intellectual function and behavioral symptoms before falls, using data from repeated measurements, by older inpatients with dementia. [Methods] Subjects were 51 individuals with dementia, aged 65 years or older, in hospitals during June 2007. Repeated measurements were administer weekly using Karasawa’s clinical criterion of elderly persons’ Intelligence and Dementia Behavior Disturbance scale, over a 6-month period. Changes of function of fallers during the 4 weeks prior to falls were compared with those of non-fallers. Analyses were conducted for the respective groups divided by ambulation status. [Results] In the ambulatory group, the intellectual function of fallers worsened significantly prior to falling. In the non-ambulatory group, both intellectual function and behavioral symptoms of fallers worsened significantly. [Conclusion] Fixed point observation with short measurement intervals of intellectual function and behavioral symptoms can be useful for fall prediction in hospitalized patients with dementia.

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[Purpose] To determine the length of the gait initiation phase before achieving steady state walking in healthy young adults, to provide a source of perspective on assessments of walking in narrow circumstances such as at home. [Methods] The average step length and speed of 10-m maximal walking were measured for 10 subjects. Simultaneously, the variability of step length and speed during the first seven steps from walking initiation were analyzed using a video motion analysis system. Then, the distance to achieve steady state walking speed and step length was calculated and analyzed statistically. [Results] The coefficient of variance of step length and walking speed decreased to a level of 0.01 after step 3 and step 4, respectively, during the first seven steps, and it appeared to become constant. [Conclusion] The average distance of the first 4 steps was 3.27 m, suggesting that an indicative distance for achieving constant walking speed and step length may be 3.5 m.

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[Purpose] The purpose of this study was to investigate the immediate effects of lumbar exercise and tensor fasciae latae (TFL) and hamstring direct stretching. [Subjects] The subject was a single case, a 30-year-old woman diagnosed as having lumbar zygapophyseal-type chronic low back pain symptoms. [Method] The study utilized a single case study design. The design was a randomized controlled trial with an AB construction in which exercise therapy recognized as effective was implemented in period A, and direct stretching of the TFL and hamstrings was implemented in period B. We measured pain on a visual analog scale, finger-floor distance, maximum anterior and posterior pelvic tilt, pelvic range of motion and posterior lumbar flexibility at the end of each intervention period in a random order. We analyzed the changes of the 6 assessment items of the B period using the binomial test. [Results] All the six assessment items were found to have significantly improved at the end of period B compared to period A. [Conclusion] The results suggest that direct stretching of the TFL and hamstrings possibly triggers immediate changes in chronic intervertebral-type lumbar pain symptoms.

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[Purpose] The purpose of this study was to assess the relation between walking frequency and motor ability. [Methods] The subjects were 51 community-dwelling elderly persons. The subjects were divided into the following 2 groups: high-frequency walking groups (n=17) and low-frequency walking groups (n=34). Comfortable and maximum walking speed, step length, step rate, walk ratio, 6-minute walking distance, Functional Reach Test scores, Timed ‘Up-and-Go’ Test scores, knee extension power, sit and reach were measured to evaluate motor ability. [Results] Maximum walking speed, step length, walk ratio and 6-minute walking distance were significantly greater in the high-frequency walking groups than in the low-frequency walking groups. In contrast, the step rate, Functional Reach Test scores, Timed ‘Up-and-Go’ Test scores, knee extension power and sit-and-reach test scores were similar in the two groups. [Conclusion] These results suggest that habitual walking is effective for improving walking ability but not muscle power, balance or flexibility.

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[Purpose] To investigate the effects on respiratory function of expiratory abdominal compression designed as an alternative technique to expiratory rib cage compression. [Subjects] Ten healthy male subjects participated. [Methods] Subjects underwent manual expiratory compression of the upper rib cage, lower rib cage and abdomen in the supine position, and that of the abdomen in Fowler’s position. The tidal volume (VT), minute ventilation (VE), respiratory rate (RR), changes in diaphragm thickness (ΔTdi%), and ΔTdi%/VT during quiet breathing and the interventions were compared. [Results] Compared to quiet breathing, VT and VE significantly increased and RR significantly decreased during all the interventions. However, there were no significant differences between the interventions. ΔTdi% significantly increased in expiratory abdominal compression in Fowler’s position compared to quiet breathing; ΔTdi% was not able to be measured in the lower rib cage compression. ΔTdi%/VT in expiratory abdominal compression in Fowler’s position indicated the highest value and it was significantly increased compared to that in the expiratory compression of the upper rib cage and abdomen in the supine position. [Conclusion] These results suggest that expiratory abdominal compression increases ventilation as well as expiratory rib cage compression, and that in Fowler’s position, it enhances diaphragmatic contribution to tidal volume.

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[Purpose] The purpose of this study was to investigate a method for assessing elasticity values by analyzing the relationship between muscle contraction strength and the hardness of soft tissue (STS) at different joint angles. [Subjects] The subjects were 20 healthy young men. [Method] To determine the relationship between degree of muscle contraction and STS, we measured STS of the quadriceps femoris (QF) at 0, 25, 50, 75 and 100% of maximum contraction with the knee flexed at 90˚ using a STS meter and isometric muscle strength measuring equipment. For the relationship between joint angle and STS, we measured STS from 0˚ of knee extension to maximum flexion in the supine position using a STS meter and an electronic goniometer. STS was measured in the center of the QF with the thigh and lower leg held by a sling in the lateral position at a load of 10 N. The analysis of differences in STS at different joint angles and muscle contraction strengths was performed using multiple comparisons and repeated measures one-way analysis of variance. [Results] Significant decreases in elasticity value were found between all values of muscle contraction and at angles of flexion greater than 90˚. [Conclusion] We consider that measurements of STS during muscle contraction are an index showing pressure changes in the muscle, and measurements of STS at different joint angles are an index of extensibility.

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[Purpose] This study analyzed the gait changes of post-stroke hemiplegic patients during continuous use of Gait Solution for the purpose of verifying the need to adjust users’ body function. [Subjects] Three choronic hemiplegic patients. [Methods] The 3 participants were ordered to continuously use Gait Solution for 3 weeks. Measurement and examination were made of gait speed, unaffected side stride, and center of gravity height in the stance phase, and affected side ankle plantarflexion and dorsiflexion moment peak under the following 3 conditions: walking with AFO used usually, walking with Gait Solution on the first fitting day, and walking with Gait Solution 3 weeks after fitting Gait Solution. [Results] In 2 of 3 patients, a few of the parameters changed on the first fitting day, but after 3 weeks all the parameters had changed. [Conclusion] In order for Gait Solution to function effectively and change the parameters of walking, Gait Solution needs users body function to adjust to it.

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[Purpose] The purpose of this study was to clarify postural control and muscle activity of the gluteus medius and musculus erector spinae in a single-leg stance before and after hip muscle abductor fatigue. [Subjects] Subjects were 22 healthy male adults (mean age; 21.4 yrs) with no significant medical history or current medical problems. [Methods] We examined postural control and muscle activity in a single-leg standing position before and after hip muscle abductor fatigue. A statistical analysis was performed using the paired t-test before and after muscle fatigue, and Pearson’s rank correlation coefficient was obtained for muscle activity associated with postural control. [Results] The results indicate a significant increase in stability indices, a decrease in gluteus medius muscle activity, and an increase in right musculus erector spinae activity after fatigue. There was a positive correlation between the increase in right musculus erector spinae activity and increase in postural control. [Conclusion] We believe that postural control increased in the orientation related to the working of the muscles due to their fatigue, and that muscle activity increased to compensate.

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[Purpose] The purpose of this study was to survey risk management implementation in the physical therapy departments of hospitals treating acute stage patients. [Subjects and Method] Two hundred forty-seven facilities were selected from the 8,818 facilities registered on the Welfare Medical Information Network, and a questionnaire regarding the risk management procedures was sent to each facility. [Results] One hundred forty-seven questionnaires were returned, with a response rate of 59.9%. The facilities employed on average 11.3 physical therapists. In physical therapy departments of the hospitals ranging from 40 to 1,505 beds with on average 24 medical specialties, the standard emergency equipment provided included electrocardiograms, a pulse oximeter, a manually-operated respirator and suction equipment. Facilities that had placed a manually-operated respirator in physical therapy departments increased from 6 (5.4%) in 2006 to 37 (25.0%) in 2009 (p<0.01). Also, facilities that prepared risk check-sheets and criteria for discontinuation of physical therapy had increased from 21 (18.8%) to 60 (40.5%) (p<0.01), and from 60 (40.5%) to 102 (68.9%) (p<0.01), respectively, from 2006 to 2009. [Conclusion] Physical therapy can affect the prognosis of a patient in acute care hospitals. Therefore, rigorous risk management is warranted in physical therapy departments in acute care hospitals.

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[Purpose] The purpose of this study was to evaluate the intra-examiner reliability of rehabilitative ultrasound imaging (RUSI) in obtaining thickness measurements of the lumbar multifidus (LM) with intraclass correlation coefficients (ICC) and minimum detectable change (MDC). [Subjects] Ten healthy volunteers participated in the study. [Method] We measured thickness measurements of LM at 3 angles of pelvic tilt (moderate anterior-tilt, neutral position and moderate posterior-tilt) and different percentages of voluntary isometric contraction. The task was static muscle contraction of LM during pelvic anterior-tilt with nutation of the sacrum in a prone position on the edge of the bed and hanging subject’s legs. Thickness measurements of left LM were obtained by using RUSI during 2 sessions, 1 to 4 weeks apart. ICC and measurement error by 95% confidence intervals of MDC (MDC₉₅) were used to estimate reliability. [Result] Intra-examiner reliability estimates ranged from 0.73-0.96 for same-day comparisons and from 0.67-0.93 for between-day comparisons, except for maximum effort in the neutral pelvic position. MDC₉₅ of thickness measurements were 0.8-2.7 mm for same-day and 1.5-3.0 mm for between-day measurements. [Conclusion] We suggest that RUSI thickness measurements of LM are highly reliable at the 3 angles of pelvic tilt and different percentages of voluntary isometric contraction.

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[Purpose] We evaluated the influence of bed-backrest angles on spinal curvature and compared the results with those for the sitting position. [Subjects] Ten healthy adults. [Methods] Spinal curvature was measured using a Spinal Mouse and compared across 5 conditions: lying supine on a bed with backrest angles of 0°, 30°, and 60°; and slump sitting and erect sitting. [Results] At backrest angles of 30°and 60°, spinal curvature exceeded a neutral position and became kyphotic. Compared to a backrest angle of 0° and erect sitting, there was significant kyphosis. [Conclusions] From the perspective of spinal curvature, the possibility of pain worsening when a patient with a vertebral compression fracture is getting out of bed may be smaller when the patient is in an erect sitting position compared to sitting with a backrest angle of ≧30°.

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[Purpose] In order to investigate whether sitting on a balance cushion (BC) can be used as an assessment method for the trunk, we examined the relationship between ability to sit on a balance cushion and center of pressure (body) sway in one leg standing. [Subjects] The subjects were 93 healthy young women with no balance disorders or decline in muscle strength. [Method] We assessed sitting ability on the BC of 85 subjects without balance disorders or muscle enervation, allocating 14 to an unstable balance (USB) group and 20 to a stable balance (SB) group, and measured sway path length (SPL) and the area of envelope (AoE) body sway by one leg standing on the dominant leg of these 34 subjects. [Results] The AoE was significantly smaller in the SB group, but no significant difference was found in the SPL between the two groups. [Conclusion] The results suggest that since body sway was small when BC sitting ability was high, BC sitting can be used as an index to assess trunk cooperation.

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[Purpose] In this study we investigated the activity of the gluteus maximus when raising an arm in the Puppy position and at various knee angles in the Bridge action. [Subjects and Method] The subjects were 15 men. We measured surface electromyelograms (EMGs) of the gluteus maximus activity of the right leg when an arm was raised in the Bridge action at knee angles of 70, 90, 110 and 130 degrees, and the Puppy position with both legs free (Puppy 1) and both legs fixed (Puppy 2). [Results] In the Bridge action at knee flexion of 90~130˚, there were no significant differences in muscle activity, but at knee flexion of 70˚, muscle activity was significantly lower than those at the other angles. Muscle activity of Puppy 1 was significantly lower than that of Puppy 2. In the comparison of Bridge action with the Puppy positions, Puppy 1 showed an EMG value which was significantly lower than all of the Bridge values, whereas Puppy 2 showed a value which was significantly lower than those of Bridge action at knee flexion of 90˚ and 110˚, but was not significantly different from those at knee flexion of 70˚ and 130˚. [Conclusion] Bridge action at knee flexion of 90~130˚ has good efficacy, whereas Puppy 1 and Puppy 2 had less efficacy. However, the results suggest that Puppy 1 and Puppy 2 can be used for general muscle strengthening or for muscle strengthening when the limb position is restricted.

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[Purpose] We verified the effect of a cognitive approach for a patient with apraxia. [Subjects] The patient presented with apraxia in the right hand following an extensive brain infarct of the left cerebral hemisphere. [Methods] The approach consisted of cross-modal transfer tasks converting visual and tactile information into movements. In an action-oriented approach, the patient repeated actions in order to reduce mistakes in behavior. The study was conducted using a single-case design, and both the cognitive approach and a conventional action-oriented approach were implemented. These two approaches were compared to verify the therapeutic effect of the cognitive approach in treating apraxia. [Results] After the cognitive approach, the patient had greater improvement in the Standard Processing Test of Action, the Simple Test for Evaluating Hand Function, and the number of correct responses to the photograph tasks as proposed by the author. Mitigation of apraxia was noted. [Conclusion] In the current case, the cognitive approach to therapeutic intervention was more closely linked to improvement of apraxia.

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[Purpose] The purpose of this study was to investigate the characteristics of gait in patients with hallux valgus and the effects on the joints of the lower extremities (hip, knee and ankle). [Subjects] The patient was a 69-year-old female diagnosed with rheumatoid arthritis (RA) including hallux valgus. The patient had a chief complaint of pain on the medial side of the right hallux in gait. [Methods] Gait analyses, using the VICON-MX systems were performed preoperatively and postoperatively at 6 months. [Results] The postoperative valgus of knee moments decreased, and valgus of ankle moments had increased on the operated side. The varus of knee moments on the non-operated side was higher than on the operated side. [Conclusion] The results revealed instability in the lateral direction of the lower extremity with deformity of the foot. Hallux valgus associated with valgus knee deformity on the operated and varus on the non-operated side is a potential cause of osteoarthritis of the knee. We should be careful not only to prevent the recurrence of hallux valgus on the operated side but also osteoarthritis of the knee on the opposite side. These results are useful indicators for rehabilitation management of hallux valgus.

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