[Purpose] Discharge planning is important at advanced treatment hospitals. Therefore, we investigated the participation of physiotherapists in discharge arrangements at a university hospital, an advanced treatment hospital. [Subjects and Method] We investigated patients discharge from the hospital involving the Department of Physiotherapy and/or Department of Medical Community Network & Discharge Planning over 3 months, Physiotherapists’ participation in discharge arrangement was also investigated for patients belonging and not belonging to the Department of Orthopedic Surgery, and differences between the two groups were analyzed. [Result] In patient discharges involving both departments, the rate of transfer to other hospitals was significantly high. Physiotherapists participated in discharge arrangement significantly more frequently for patients who did not belong to the Department of Orthopedic Surgery than for those belonging to it. [Conclusion] These findings suggest that active participation in the discharge arrangement is needed by physiotherapists belonging to advanced treatment hospitals, especially for patients with non-orthopedic conditions.

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[Purpose] The purpose of this study was to clarify what kinds of communication skills students of a technical school gained experience in during practical training at hospitals. [Subjects] The subjects were 102 students of K technical school of physical therapy. [Methods] We carried out a questionnaire survey in comment form about successful factors and unsuccessful factors in communicatation with patients, and the points of improvement in communication skills. The analysis used Burnard’s content analysis. [Results] The successful factors were classified as: the attitudes of students themselves who were senders, the situations of the patients who were receivers, the topics of conversation, the manner of speaking of the students who were senders, non-verbal communication skills and spending time together. [Conclusions] The students gained experience in the communication skills necessary for physical therapists, such as consideration, actions, and attitudes. The results provide material on how to support students’ communication skills.

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[Purpose] Using the laterality quotient of left and right wrist actigraphy counts (acti-LQ), we evaluated the lateral differences in upper limb function. [Subjects] Forty students (Experiment 1) and fifteen right-handed students (Experiment 2) wore an accelerometer on both wrists for 24 hours. [Method] Experiment 1: we investigated the correlation between acti-LQ and the handedness questionnaire. Experiment 2: acti-LQs were compared among three conditions: 1) without limitation, 2) limitation of the range of motion (ROM) simulated by an athletic supporter attached to the right wrist, and 3) limitation of ROM simulated by an athletic supporter attached to the right elbow. [Result] Experiment 1: a significant correlation was found, which showed the validity of acti-LQ in evaluating the laterality of upper limb function. Experiment 2: a significant reduction in acti-LQ was found in right elbow limitation, which showed a compensatory increase in left upper limb activity. [Conclusion] Our results suggest that the laterality quotient derived from an accelerometer counts on both wrists is sensitive to the lateral differences in upper limb function. It also seems to be sensitive enough to evaluate lateral dysfunction due to orthopedic diseases.

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[Purpose] The purpose of this study was to contribute to the reconsideration of calf circumference measurement as a physical therapy evaluation item. We aimed to assess the correlation between maximum calf circumference and the histological factors of the soleus muscle as well as the strength of ankle plantar flexion. [Subject] Fifty healthy adults who had no history of lower limb pathology participated in this study. [Methods] With the length of the leg considered to be 100%, the maximum calf circumference was measured at 26% of the length from the head of the fibula. We assumed that the soleus is a pennate muscle and measured the thickness and length of muscle fibers (histological factors) using ultrasonography. Ankle plantar flexion was used to measure the power of the soleus muscle. [Results] The histological factors were associated with maximum calf circumference, and the strength of ankle plantar flexion. [Conclusion] Our results suggest that maximum calf circumference reflects histological factors of the soleus muscle and the strength of ankle plantar flexion.

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[Purpose] We examined whether the 10-second chair-standing test for the frail elderly (Frail CS-10) was useful for the assessment of the lower limb function of inpatients with various illnesses. [Subjects] The subjects were 28 inpatients of Hospital A who were in the recovery stage. [Method] We measured the Frail CS-10, and investigated its associations with lower limb strength, gait ability, and ADL ability as assessed by FIM Mobility and its subscales for men and women separately. [Results] We found that the Frail CS-10 results of men and women showed significant correlations with most of the assessment items or a tendency toward significant correlation with the assessment items. [Conclusion] The results suggest that the Frail CS-10 is a simple and useful assessment method of lower limb function, which can be used for patients with a variety of illnesses without discriminating among illnesses.

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[Purpose] In this study, we assessed the displacement of center of pressure (COP) in the anteroposterior and lateral directions to investigate anticipatory postural adjustments when subjects extend their elbow joint while maintaining flexion of the shoulder joint. [Subjects] The subjects were 10 healthy men with an average age of 23.8 ± 1.9 years. [Method] Subjects extended their right elbow joint at two different speeds (high and low) while maintaining flexion of the ipsilateral shoulder joint, and we assessed the COP displacement pattern. [Result] In the anteroposterior direction, a significant difference was shown between COP displacement in the posterior direction at high speed and COP displacement in the anterior direction at low speed, but no significant differences were seen in the lateral directions. [Conclusion] The results of this study suggest that COP displaces just before the part of the upper extremity distal to the elbow is moved.

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[Purpose] The purpose of this study was to clarify differences in muscular activities between elderly and young people during level walking, stair ascent and descent. [Subjects] The subjects were 14 healthy elderly and 14 young adults. [Method] We employed force plates and surface EMG to capture kinetic and kinematic data of level walking, stair ascent and descent. Activities of the soleus and tibialis anterior muscles were recorded and compared in each phase between the elderly and young subjects. [Results] Elderly subjects showed significantly larger tibialis anterior muscular activities than the young adults in the terminal stance of gait and throughout the cycle during stair ascent and descent. [Conclusion] High stiffness of the ankle joint might be caused by increase of tibialis anterior muscular activity in elderly subjects.

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[Purpose] To clarify the anxiety factors of students immediately before practical care training. [Subjects] One hundred fifty-one, fourth year, physical therapy and occupational therapy students of a vocational training school in Kagoshima prefecture. [Method] Using CS portfolio analysis, we determined the factors related to anxiety from the answers to a questionnaire. [Results] Immediately before practical care training, we determined that students had anxieties about: making a report, clinical examinations and measurements, being asked questions, clinical treatments and training, and risk management. [Conclusion] The results reflect students’ image of practical care training as emphasizing factors of being in charge of individual clients, independent assessment and treatment and guidance for report writing, which is considered the norm in the field of therapy.

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[Purpose] The purpose of this study was to clarify the changes in lower limb muscle activities during gait caused by affixation of a heel-arch pad and timing of sole grounding (FF). [Subjects] Forty-three legs (22 male, 21 female) of 28 healthy adults. [Method] Using a foot switch, we divided the subjects into an FF-Early group and an FF-Late group, and examined and compared the groups for changes in lower limb muscle activities using surface electromyography before and after affixation of a heel-arch pad. [Results] The muscle activities of the lateral hamstrings and tibialis anterior changed significantly with FF timing. The muscle activities of the pereneous longus and medial hamstrings changed significantly when the heel-arch pad was affixed. [Conclusion] The results suggest that muscle activities are changed by the timing of FF and heel-arch pad height.

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[Objective] To ascertain the effectiveness of an intervention to improve balance through exercises with the Stretch Pole padded exercise bar. [Subjects] The subjects were 26 healthy adults. [Methods] Four balance indices, the duration of one-leg standing balance with the eyes closed, performance time in the timed up and go test (TUG), and forward functional reach and lateral functional reach on the functional reach test (FRT), were compared before and after the exercises. [Results] The duration of one-leg standing balance (eyes closed) and the performance time of TUG improved significantly, while forward functional reach decreased significantly. Significant differences in lateral functional reach were not noted. [Conclusion] Exercises to improve balance must be considered carefully since they may not lead to improvement in balance indices in some instances.

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[Purpose] The purpose of this study was to examine the effects of a care prevention program on the multi-domain self-efficacy. [Subjects] The subjects were 51 frail elderly (79.1 ± 5.6 years old, 14 males and 37 females) without cognitive symptoms who were enrolled into this program under the LTCI (Long Term Care Insurance) scheme. [Methods] A questionnaire investigation was conducted before and after the 3-month community care prevention program for improvement of body movement. History of falls, demographic and three self-efficacy measures (Going-out Self-efficacy scale: GES; Fall Self-efficacy scale: FES; and Healthy Self-efficacy scale: HES) were self-reported. Self-efficacy perceptions of HES were assessed for the four domains of health, exercise, dieting and mental health. [Results] The going-out self-efficacy, health self-efficacy and exercise self-efficacy (measured by subscale) improved significantly after the intervention. No significant differences were found in any self-efficacy score between fallers and non-fallers. The going-out self-efficacy of non-fallers improved, and health self-efficacy (measured by subscale) of fallers improved significantly after the intervention. [Conclusion] This study examined the multi-domain self-efficacy of frail elderly subjects and demonstrated that improved self-efficacy was an important outcome of the intervention.

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[Purpose] The aim of this study was to investigate which items are improved by home-visit rehabilitation for stroke patients. [Subjects] Seventy-six stroke patients making initial requests for home-visit rehabilitation. [Method] The assessment items were FIM and items other than FIM (ex-FIM) that improved according to patients’ self-report. Patients showing improvement in FIM alone, or FIM and ex-FIM were classed as the FIM+ group, and those showing improvement in only ex-FIM were classed as the ex-FIM+ group. Patients were also classified according to the recovery stage (REC group) and the chronic stage (CHR group), and comparisons of the groups were made. [Results] 97% of the REC group and 72% of the CHR group were in the FIM+ group. In the ex-FIM+ group, various improvements, such as being able to stand up from the floor, were reported. [Conclusion] The majority of improvements resulting from home-visit rehabilitation were in items that can be assessed by FIM. This study also showed that the assessment of ex-FIM items spans a wide range.

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[Purpose] The purpose of this study was to show the effect of different ankle alignments on kinematic parameters of the lower extremities, pelvis and thorax in one-legged standing. [Subjects] Forty young healthy subjects participated in this study. [Method] We employed a 3-dimensional motion analysis system to capture kinetic data of one-legged standing. Ankle alignments were set in five experimental conditions which were eversion, inversion, plantar flexion and dorsal flexion using a slope of 10 degrees and a free alignment without it. [Result] Significant differences were observed mainly in the coronal and horizontal planes. [Conclusion] Postural control in the coronal plane was activated by change of base of support, and the kinetic chain of the hip and pelvis reacted to changes in ankle alignment.

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[Purpose] The aim of this study was to evaluate the influence of the leading hand positions on the performance of sitting pivot transfers (SPT). [Subjects] Three individuals (2 men, 1 woman) with spinal cord injury (SCI) who could perform independent SPT in daily living volunteered. [Method] They performed SPT with respect to the target seat using six leading hand positions (2 locations × 3 heights) twice. We calculated the height from seat to coccyx using a digital video camera and expressed it as a percentage of the maximum vertical height of the lift of their buttocks during pushing up. [Result] There were significant main effects for the leading hand locations, but no significant main effects for the leading hand heights or interaction effects according to two-way repeated measures ANOVA. [Conclusion] These results provide useful data for better understanding SPT and for teaching the SPT techniques to individuals with SCI.

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[Purpose] The purpose of this study was to investigate ward-based practice in a convalescence rehabilitation ward. [Subjects] The subjects were 682 patients who were admitted to and discharged from a convalescence rehabilitation ward in the period from April 2007 to March 2010. [Method] Records of all patients were retrospectively reviewed for length of stay, training time (number of units), Functional Independence Measure (FIM) scores at admission and discharge, FIM gain and efficiency, and the rate of discharge to home. [Results] The proportion of the patients who received ward-based practice in the convalescence rehabilitation ward was 45.8% in 2007, 26.8% in 2008 and 38.4% in 2009. Significant differences between the patients with ward-based practice and without ward-based practice were noted in length of stay, training time, FIM at admission, FIM gain and efficiency, and the rate of discharge to home. Those patients with ward-based practice performed better. [Conclusion] Our findings suggest that a ward-based practice improves activities of daily living and the rate of discharge to home in a convalescence rehabilitation ward.

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[Purpose] The aim of this study was to determine the factors that affect the performance of home-based exercises by older people requiring support or care. [Subjects] A total of 86 day-care service clients participated in this study. They were categorized into an exercise group of 59 persons, and a non-exercise group of 27 persons. [Method] A semi-structured interview was conducted about the reasons why they performed the home-based exercise or did not. The data were analyzed using the KJ method. [Result] In main diseases the exercise group differend significantly. The factors affecting the condition of the exercise indicated 4 categories and 8 subcategories in both promotional and barrier factors. [Conclusion] The results suggest the possibility that an effective home-based exercise method can be developed for these older people.

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[Purpose] We examined the effect on scapula position of Kinesio^® taping between the shoulder blades. [Subjects and Method] The subjects were 18 males with no disorders of the shoulder. We measured the position of the shoulder blades with a tape measure, with the arms hanging down, and in shoulder abduction of 90, and 180°, and compared the changes in position after the application of Kinesio^® tape. [Results] After the application of Kinesio^® tape between the shoulder blades, thoracic kyphosis reduced, and in the arms hanging down position the scapula became adducted. [Conclusion] The results suggest the possibility that scapula motion is changed by the application of Kinesio^® taping between the shoulder blades.

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[Purpose] To clarify the structural elements of the the functional balance scale (FBS). [Subjects] Fifty-nine hemiplegic cerebrovascular disease patients. [Method] We performed factor analysis of FBS assessment values, and investigated the validity of the classified factors. [Results] FBS was classified into active balance, static balance and gross muscle strength of the lower limbs. For each of the structural elements, we found relationships with physical function, and activity ability. [Conclusion] The results support the conventional utility of FBS, and suggest the possibility of gaining more detailed assessments using the classifications of the present study.

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[Purpose] We investigated whether the International Physical Activity Questionnaire (IPAQ) was valid for use in assessing the physical activity levels of diabetes patients, who are expected to have reduced physical activity. [Subjects] The subjects were 16 type 2 diabetes mellitus patients. [Method] Using Pearson’s correlation coefficient and Student’s t-test we investigated the correspondence of 1-week exercise energy consumption calculated from the Short Version of the Japanese IPAQ, and 1-week exercise energy consumption calculated by a Suzuken Lifecorder GS/Me. [Results] We found no significant difference between the two measures according to the Student’s t-test result, and the correlation coefficient for the two measures was, r=0.69. [Conclusion] The level of physical activity of diabetes patients calculated from IPAQ was confirmed and validated against the level of physical activity measured by Lifecorder.

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[Purpose] The objective of this study was to clarify the relationship between the voluntary cough intensity level and the ability to perform activities of daily living of patients with stroke. [Subjects and Methods] The subjects of this study were 41 stroke patients in the convalescence stage (21 females, 20 males: mean age: 70.7 ± 10.9 years). The voluntary cough intensity level was examined by measuring peak cough flow (PCF), and respiratory muscle strength was examined by measuring maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP). As indexes of ADL performance, the functional independence measure (FIM), basic activities, and ability to rise from bed were used. [Results] A significant positive correlation was observed between PCF and FIM/basic activities. The levels of PCF, MEP, and MIP of subjects who were unable to sit up were significantly lower than those of subjects with independence in rising. [Conclusion] We demonstrated that a relationship exists between voluntary cough intensity and ADL performance in stroke patients. The voluntary cough intensity level of the subjects who were unable to sit up was lower than that of subjects with independence in rising. This result demonstrates that the voluntary cough intensity level of the former group of subjects was affected by their weakened abdominal muscles.

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[Purpose] Taking into consideration the contact condition of the toes during different actions, we investigated the toe functions of a pseudo-floating toe group and a genuine floating toe group, to gain indications for the determination of floating toe. [Subjects] The subjects were 95 adult women. [Method] From images of the toe contact positions taken with a pedoscope, we determined the quiet stance floating toe score, the stance with toe-grip floating score, and the forward transfer floating toe score, and classified the subjects as normal (N group), incomplete contact (IC group), pseudo-floating toe (PF group), and genuine floating toe (GF group). We measured and compared the toe-grip strength and forward transfer ability of the four groups. [Results] We found a significant difference in toe-grip strength between the N and GF groups, and in forward transfer ability between the N and PF groups, the N and GF groups, and the PF and GF groups. [Conclusion] It is necessary to investigate how to discriminate between pseudo-floating to and genuine floating toe.

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[Purpose] This study investigated the reliability of a hand-held dynamometer (HDD) in the measurement of soleus muscle strength. [Subjects] Fourteen soleus muscles of 7 healthy adults were selected for the intra-rater and inter-rater reliability confirmation. [Method] The measurement was performed while the subjects sat on a chair without the toes touching the ground. The sensor was set at the MP joint on the sole and it was fixed by a belt attached to the thigh. Measurement was performed three times for each muscle. We calculated the intra-class correlation coefficient (ICC) to determine the reliability of the measurement. [Results] The intra-rater reliability was 0.975 (ICC) and inter-rater reliability was 0.915 (ICC). [Conclusion] The results of this study indicate that anyone can use the HDD as an objective and a reliable method to measure the soleus muscle strength.

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[Purpose] We kinematically investigated the relationships of asymmetric pelvic rotation during gait with trunk rotation, hip joint flexion and extension, step length and standing posture. [Subjects] Twenty-two healthy adult males were the subjects. [Method] Using a 3D motion analysis system, we measured the angles of pelvic rotation, trunk rotation, and right and left hip joint extension and flexion, and left and right step length during gait, as well as the pelvic rotation angle in quiet standing. [Results] We found that the left and right pelvic rotation angles varied widely during gait. We found no relationship between the left and right rotation angle differences of the pelvis and trunk, and the right and left hip joint flexion and extension showed fixed values, as well as the left and right step lengths showed fixed values. We found a very strong correlation between the pelvic rotation angle in quiet standing and the left and right pelvic rotation angle difference during gait. [Conclusion] Pelvic rotation angle during gait is not necessarily symmetric and there are individual differences. The results suggest that assessment of pelvic rotation in the standing position would be useful for observations of gait.

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[Purpose] To investigate the relationships among the normal Falls Efficacy Scale (subjective FES), the therapist’s FES (objective FES), the difference between the two assessments ΔFES and physical function assessment. [Subjects] Seventeen hemiplegic stroke patients. [Method] The objective FES was scored on the basis of therapists’ assessments of the range of activities patients could perform without falling. The difference between subjective FES and objective FES was obtained by simple subtraction. We investigated the relationships of these items with mobility, activities of daily living, and gait independence. [Results] Objective FES and subjective FES were correlated with the Berg Balance Scale, and we found a correlation between ΔFES and gait independence. [Conclusion] In addition to whether or not subjects have a fear of falling, it is important to investigate the mutual relationship between fear of falling, subjective feelings, and objective assessments of physical functions.

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[Purpose] The purpose of this study was to investigate the effects on ankle jump performance of different compression intensities applied to different regions of the lower leg. [Subjects] Fifteen healthy males (mean age, 21.6 ± 0.9 years old) participated in this study. [Method] We first measured the deep aponeurosis displacement of the gastrocnemius medial heads generated by compression using a sphygmomanometer and a manchette of all participants. The manchette was set on the proximal or distal regions of the calf, and compression was applied at 50,100 or 150 mmHg. We measured the ankle jump height on a pulley stand under each compression condition. [Results] Ankle jump height with proximal region compression of 150 mmHg was significantly lower than that with no compression. [Conclusion] The results suggest that ankle jump height doesn’t change with distal compression or proximal compression of 100 mmHg or less.

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[Purpose] To measure muscle activities at different pedal rates and work loads during ergometer cycling at work rates of 60, 120, and 180 W, and determine their average and maximum values. [Subjects] The subjects were 10 healthy adults. [Method] Electromyographic activities of the rectus femoris, vastus medialis, vastus lateralis, semimembranosus, gastrocnemius, and tibialis anterior were measured. [Results] At 60 and 120 W, the average muscle activities showed high values at low work loads with fast pedal rates, and showed low values at moderate work load and pedal rate at 180 W. For the maximum value, all of the muscles, except the semimembranosus, showed high values at low load with fast pedal rate at 60 W. At the higher work rates of 120 and 180 W, maximum muscle activities showed low values at moderate load and pedal rate, and high values at high load and low pedal rate. [Conclusion] At each work rate, there is a work load and pedal rate combination that will achieve endurance training with suppressed muscle activity and high exercise efficiency, as well as one that will raise muscle activity for muscle strengthening, and the results suggest consideration needs to be given to this during training.

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