[Purpose] We examined the characteristic appearances of the H-reflex and F-wave of the soleus with increased stimulus intensity in subjects with hemiparesis caused by cerebrovascular disease (CVD) as a preliminary study to explore the clinical application of these appearances. [Subjects] The subjects were 10 patients with hemiparesis caused by CVD. [Method] With subjects supine, the H-reflex and F-wave were induced and recorded at the soleus with increasing stimulus intensity. Characteristic appearances were classified according to the method used by Suzuki et al. who classified the appearances into four patterns in cases of CVD with upper extremity involvement. [Results] Characteristic appearances of the H-reflex and F-wave of the soleus were classified as type 1 in 1 patient, and type 3 in 9 patients. We were able to classify them as two kinds, A and B, from the characteristic of the wave pattern. [Conclusion] The findings in patients with CVD revealed that the F-wave started appearing with the H-reflex with high-intensity stimuli. In the future, these findings can be used in an objective functional evaluation if combined with the functional evaluation of movement during the assessment of neurological function in physiotherapy.

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[Purpose] The purpose of this study was to show that locomotive syndrome is associated with self-rated health or health-related quality of life (HRQOL) in community-dwelling elderly people. [Subjects] The participants were 122 elderly people (age, 69.9 ± 4.6 years [mean ± standard deviation]). [Method] Self-rated health and EuroQOL were estimated on the basis of the questionnaire. Subjects were categorized into either a locomotive syndrome group (n=73) or a non-locomotive syndrome group (n=49) on the basis of a locomotion check. Student’s t test and the chi-squared test were used to test for statistical differences between the 2 groups. [Result] The EuroQOL index score was significantly lower in the locomotive syndrome groups than in the non-locomotive syndrome groups. Furthermore, self-rated health, mobility, usual activities, and pain/discomfort were significantly lower in the locomotive syndrome group than in the non-locomotive syndrome group. [Conclusion] Our results show that locomotive syndrome is associated with self-rated health and HRQOL in community-dwelling elderly people.

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[Purpose] The purpose of this study was to investigate the swing phase differences in ankle joint angles of young and elderly subjects. [Subjects] The subjects were 10 young persons and 14 elderly persons (no-fall group, n=10; falls group, n=4). [Method] Using a video camera we recorded the lower leg during walking and determined the maximum ankle joint angle using Dartfish software. [Results] In the young persons’ group we found differences between the early and middle swing phases, and between the early and late swing phases. In the no-fall group, we found differences between the early and middle swing phases, and between the middle and late swing phases. No differences were found among the phases in the falls group. In the early swing phase, differences were found between the young and no-fall groups, and between the young and falls groups. In the middle swing phase, differences were found between the young and no-fall groups, and between the young and falls groups. In the late swing phase, no differences were found among the groups. [Conclusion] The results reveal the elderly group had reduced ankle dorsi- and plantar-flexion.

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[Purpose] We examined the brain mechanisms of different mechanisms of motor imagery for the neck region using functional near-infrared spectroscopy (fNIRS). [Subjects and Methods] Oxyhemoglobin (Oxy Hb) concentrations were measured in 15 healthy adults under the following two conditions: 1) kinesthetic motor imagery of the neck region with the eyes closed, and 2) motor imagery of the neck region after following a laser pointer target with head movement. The Wilcoxon signed-rank test was used for statistical analysis. [Result] Task 2 elicited a significant increase in Oxy Hb in the premotor and supplementary motor areas compared with the rest condition. [Conclusion] The results suggest that by visually following a target with head movement, motor imagery of the neck region can be clearly recognized.

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[Purpose] To devise an effective exercise instruction method for elderly patients with heart failure (HF), we investigated the status of home-exercise practice. [Subjects] Ninety-three HF patients aged 75 years or older who received exercise instruction from a physical therapist during hospitalization. [Method] The questionnaires were mailed to the ninety-three subjects and replies were obtained from fifty-four. The questionnaire consisted of questions about: the behavior change stage about the exercise, recognition of the necessity of the exercise, problems with exercising, the terms of use of medical care after discharge, and health-related quality of life. [Result] Seventy-seven percent of the respondents recognized the necessity of the exercise and sixty-four percent of the respondents actually exercised. However, the instructions for exercise programs were not utilized enough. [Conclusion] The review of exercise programs according to physical condition is necessary for elderly HF patients after discharge.

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[Purpose] We measured the line of sight of novice physical therapists, and by analyzing their investigative ability of motion, we tried to develop a skill index. [Subjects and Method] The subjects were 12 fourth-year students of a vocational training school. We showed them a video of a shoulder being raised after surgery for rotator cuff tear, and measured the stopping points before and after disclosing the profile. We also asked them to describe the type of disorder, points for attention, changes in points for attention, and points for attention in motion analysis, and investigated the line of sight characteristics. [Results] One subject answered the disorder type correctly, and there were significant differences between before and after profile disclosure, in the numbers of stopping points at the shoulder joint, the scapula area, and the elbow region. All subjects responded that the shoulder joint and scapula area were points for attention, answers which were in agreement with the measurement results. After disclosure, we determined the stopping points of those who answered that their points for attention had changed, and the number of points had reduced. [Conclusion] We consider that by presenting novices with a simple task, we can focus their sight on the points necessary for analysis, making it possible for them to gather information.

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[Purpose] The purpose of the present study was to examine the effects of selective attention to plantar cutaneous sensation on muscular co-contraction of stroke patients during the stance phase of walking. [Subjects] Seven sub-acute stroke patients participated in this study. [Method] Subjects were given tasks of discriminating hardness differences of foam rubber with the sole of the paretic side. Electromyograms of the paretic leg during walking were recorded before, immediately after, and 15 min after the discrimination tasks. The muscular activity and the co-contraction index (CI) during the stance phase were determined. [Result] The muscular activity of the gastrocnemius and CI of the ankle joint significantly decreased immediately after the discrimination tasks. [Conclusion] These results suggest that selective attention to plantar cutaneous sensation on the paretic side immediately reduces muscular co-contraction of stroke patients during walking.

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[Purpose] The displacement of center of pressure (DCOP) and the distribution of foot pressure (DFP) in standing was investigated in elderly subjects with and without Parkinson’s disease (PD). [Subjects] Eight PD and 8 healthy elderly subjects participated in this study. [Methods] Subjects were asked to perform a series of forward-backward body sway movements when standing on a pressure plate. The DCOP of the two groups was compared and the relationships between DCOP and DFP were analyzed. [Results] Compared to the normal elderly, the peak DCOP (% foot length) was significantly decreased in the PD group. The partial regression coefficients were found to be lower in the toes but higher in the metatarsal area in the PD group. [Conclusion] The decreased voluntary body sway of the PD patients might be a result of the decreased DFP at the toes during stance. Tasks such as bringing weight from the mid- to the fore-foot area may be helpful in PD patients’ balance training.

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[Purpose] The purpose of this study was to examine the measurement reliability in Forward Accelerated Step Test (FAST) that we developed. [Subject and Method] 19 young people were recruited to examine the intra-rater reliability. Two testers, who were qualified physical therapists and 11 young people were also recruited to investigate inter-rater reliability. The intra-rater and inter-rater reliabilities were tested using the Intraclass Correlation Coefficient (ICC), Bland-Altman analysis, Standard Error of Measurement (SEM) and the Minimal Detectable Change (MDC₉₅). [Results] The intra-rater reliability, ICC (1.1), was 0.90, SEM was 4.31%, and MDC₉₅ was 11.96%. The inter-rater reliability, ICC (2.1) and ICC (3.1), were 0.88 and 0.87, respectively. SEM was 3.46%, and MDC₉₅ was 9.59%. Systematic bias was found in neither the intra-rater nor the inter-rater reliability. [Conclusion] The measurement value obtained by the FAST had good reliability, and the degree and limits of measurement error were demonstrated.

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[Purpose] We examined how stroke patients with hemiparesis change hip and ankle joint power generation from the pre-swing to initial swing phase as their gait speed increased. [Subjects] Eight adult individuals with stroke in the stable phase and eight healthy individuals participated. [Method] Gait was analyzed using a motion analysis system and force-plates. Participants were asked to walk at three different speeds: their preferred speed, a fast speed, and a slow speed. Hip and ankle joint power of the affected limb were calculated. We analyzed the change of peak power accompanying the increase in walking speed. [Results] The hip joint power generation was larger than the control group in two patients, and the ankle joint power generation became smaller than the control group in two patients when they walked at the fast speed. [Conclusion] The results suggest the necessity of training of the ankle joint function in the pre-swing phase.

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[Purpose] In this study, human body movement when lifting loads of different weights was recorded, and the characteristics were investigated. [Subjects] The subjects were 13 healthy males. [Method] Human body movement when lifting loads was recorded using a three-dimensional motion analyzer. There were 3 types of load: no-load, 10 kg, and 15 kg. [Result] The vertical movement range of the physical center of gravity, the knee joint flexion angle, the hip flexion angle, the hip joint extension moment, and the ankle joint plantar flexion moment were significantly increased by lifting heavy loads. The acceleration of the physical center of gravity upward was significantly decreased when lifting heavy loads. There were no significant differences in the ankle joint dorsiflexion angle, the anteversion angle of the body trunk, the knee joint extension moment, and the velocity of the physical center of gravity among the different loads. [Conclusion] The knee joint flexion angle, the hip joint flexion angle, the hip joint extension moment, and the ankle joint plantar flexion moment increased in line with increasing load.

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[Purpose] We investigated the ADL outcomes necessary for very elderly stroke patients to be discharged to home from a recovery stage rehabilitation ward. [Subjects] The subjects were 71 stroke patients aged over 85 who were discharged to home, or a facility or long-term care. [Method] We divided the subjects into a Home group (n=41) and a Facility group (n=30), and compared the basic characteristics of the two groups and their FIM scores at discharge. We also performed logistic regression analysis on the each of the FIM scores, which were found to be significantly different, to determine the receiver operating curve and cut-off values. [Results] Age, time from stroke onset to entering the recovery ward, and transfer items were found to be significantly different between the two groups. The cut-off value of the FIM mobility items’ score was 39. [Conclusion] As an additional ADL outcome, a FIM mobility items’ total score below 39 at discharge indicates discharge to home would be a difficult situation for very elderly stroke patients.

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[Purpose] The purpose of this study was to examine the reproduciblity of the oxygen uptake (VO₂) and its associated variables, carbon dioxide production (VCO₂) and expiratory ventilation (VE), measured by the METAMAX 3B portable metabolic system. [Subjects] Twenty-two healthy young volunteers. [Method] We performed the multistep exercise test twice and measured the VO₂, VCO₂ and VE during each test with the METAMAX 3B. Then, the reproducibility of the METAMAX 3B was tested by comparing VO₂, VCO₂, and VE of each test. [Result] The ICC between each variable measured by METAMAX 3B were 0.96 (VO₂), 0.98 (VCO₂) and 0.98 (VE) for Test 1 vs. Test 2. Bland-Altman analysis showed there were no systematic errors in VO₂, VCO₂ and VE. [Conclusion] We conclude the METAMAX 3B produces acceptably stable and reliable results.

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[Purpose] The purpose of this study was to design a gluteus medius weight-bearing exercise and quantify the activity of the gluteus medius during the exercise. [Methods] The electromyography of the right gluteus medius was recorded during maximum isometric abduction of the left hip during right single-leg standing. The activity of the gluteus medius during the task was normalized to the maximum voluntary contraction (%MVC). [Results] The activity of the gluteus medius was 108 %MVC during the task. [Conclusion] This result suggests that the task of this study increased variation of a weight-bearing strengthening exercise for the gluteus medius.

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[Purpose] The purpose of this study was to investigate the effects of directional differences in longitudinal, transverse, and diagonal muscle elasticity on physical performance of Yamuna Body Rolling. [Subjects] Ten healthy subjects participated in this study. [Methods] We used ultrasonography to measure stretched muscle belly distance. We also measured the muscle elastography, side step, two steps, anterior and lateral functional reach, and eyes-closed single leg standing before and after Yamuna Body Rolling and conventional static stretch. [Results] We observed significant increases in elastography, side step, two steps, anterior and lateral functional reach, and eyes-closed single leg standing in the Yamuna group. [Conclusion] The method of Yamuna Body Rolling can be used for functional evaluation and therapeutic uses, and it is a method which may prove very beneficial in the treatment of many conditions.

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[Purpose] The purpose of this study was to investigate the effectiveness of superficial (hot-pack: HP) and deep (microwave diathermy: MW) heating as a pretreatment for muscle stretching. [Subjects and Method] Sixteen healthy volunteers participated in this study. They received three 20-minute interventions for the bilateral posterior thighs: HP, MW, and rest with neither HP nor MW (control). Hamstrings muscle hardness, the degree of active-knee-extension and the skin temperature of the posterior thigh were compared among the three interventions. [Result] There were no significant differences in hamstrings muscle hardnesses among the three interventions. In contrast, both the degree of active-knee-extension and skin temperature of the posterior thigh after HP and MW were significantly higher than those of the control, but there were no significant differences in the two items between HP and MW. [Conclusion] These results suggest HP and MW may serve as a pretreatment for muscle stretching by reducing stretch pain due to heat stimulation of the skin rather than improving muscle extensibility.

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[Purpose] We examined the center of pressure (COP) of cerebrovascular accident patients in two-legged standing while holding a hand rail, in order to know in which direction carers should give support to ensure patients’ safe movement. [Subjects] The subjects were 25 hemiplegic cerebrovascular accident patients. [Method] We measured patients’ COP while they held a hand rail in three places with the trunk in upright standing and inclined 15° to the paretic side (the rotation position). [Results] Compared to right side hemiparetics, the COP distribution of standing of left hemiparetics covered a wider area, and differences in COP distance were seen among the hand rail positions. Patients presenting unilateral spatial neglect (USN) showed posterior shift of center of balance in the rotation position. [Conclusion] Left side hemiparetics require assistance appropriate to the COP, while USN patients require assistance on the non-paretic side in the anterior direction when in the rotation position.

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[Purpose] The aim of this study was to investigate effects on cerebral activation of electrical stimulation (ES) delivered to the posterior neck during a sitting balance task. [Subjects and Method] Twenty healthy volunteers participated in this study. Three different frequencies (100 Hz, 10 Hz, 3 Hz) of ES were delivered to the posterior neck while subjects performed a sitting balance task. During the sitting balance task, the concentration of oxyhemoglobin in the right and left prefrontal cortices (PF-HbO₂) was measured to evaluate the degree of cerebral activation. [Result] Significant bilateral increases in PF-HbO₂ were observed only when relatively high frequency (100 Hz and 10 Hz) ES was delivered to the left posterior neck during the sitting balance task. [Conclusion] These results suggest that relatively high frequency (10~100 Hz) ES delivered to the left posterior neck may be suitable for activating the cerebrum during a sitting balance task.

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[Purpose] The purpose of the present study was to reveal the accuracy and superiority of 3 prognosis prediction models in predicting the rate of independent ambulation among stroke patients at 3 months after onset in the acute phase. [Subjects] We analyzed 153 hospitalized stroke patients aged between 40 and 79 who had experienced stroke for the first time, and had started to receive rehabilitation within a week after the onset of stroke. [Method] During physical therapy, the 3 models were used to predict the subjects’ independent ambulation. [Result] The cut-off point (sensitivity; specificity) was the 14th day after admission for a model developed by R. Niki (80%; 77%), the first rehabilitation after admission for a model developed by S. Ishigami (62%; 89%), and the 14th day after admission for a model developed by the author of this paper (87%; 75%). [Conclusion] This author’s model was slightly superior to the other 2 models until the 14th day after admission.

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[Purpose] The aim of this study was to investigate whether a mental rotation task of the foot influences postural control. [Subjects] The participants were 12 healthy adults. [Method] We checked the effect using three different postural conditions: bipedal with the eyes open, bipedal with the eyes closed, and unipedal. The participants were randomly assigned to one of two groups: an intervention group and a control group. The intervention group performed mental rotation of the foot, while the control group performed a simple lateral judgement task. [Result] Comparison of the postural sway prior to and after the intervention showed that postural sway was significantly reduced after the intervention in the unipedal condition but not in the bipedal with eyes open and closed conditions. [Conclusion] These findings suggest that the intervention of a mental rotation task facilitates body awareness and reduces postural sway in one-legged standing.

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[Purpose] The purpose of this study was to identify the influence on standing posture of transcranial direct current stimulation (tDCS) over the right vestibular-cerebellar area. [Subjects] Ten healthy young adult volunteers were studied. [Methods] The anode was placed on Cz, and the cathode was placed on the right mastoid process. tDCS (2 mA) was applied to each subject for 10 minutes. The center of pressure (COP) was measured before, and during, tDCS, and immediately and, 15, 30, and 60 minutes after tDCS with or without visual information. [Results] The total path length of COP in the condition without visual information was longer and posteriorly shifted until 15 minutes after tDCS, but there was no change in the condition with visual information. [Conclusion] These results suggest that placing the cathode for tDCS over the right mastoid process inhibits the influence of the vestibular-cerebellar system.

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[Purpose] To study the effect of motor imagery by recording the F-wave, which indicates spinal excitability, in patients with a history of falls because of decreased toe flexor strength. [Subjects] Thirty healthy subjects (16 males, 14 females, mean age: 29.2 ± 8.6 years) participated in this study. [Method] The F-wave was recorded with all subjects in a resting state. Subjects were subsequently instructed to contract the left flexor hallucis brevis with maximum effort. After a 5-min rest period, subjects were asked to imagine the muscle contraction. F-waves were recorded at 0, 5, 10, and 15 min after completion of the motor imagery exercise. [Result] An upward trend was observed in the persistence of the F-response and F/M amplitude ratio during imagery. This trend was more evident during imagery than at rest. [Conclusion] Application of motor imagery has potential for the prevention of falls, as part of fall avoidance therapy.

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[Purpose] The purpose of this study was to investigate the relationship between knee extensor strength and leg extension torque in males and females. [Subjects] The subjects were 48 healthy adults with no problems in the lower leg. [Method] Using a StrengthErgo, we measured the peak torque relative to body weight of right and left leg extension. We also measured left and right knee extension strength relative to body weight, using a hand-held dynamometer. We then examined the relationships between knee extension strength and leg extension torque. [Results] We found a significant difference in males’ and females’ leg torque, but not in their knee extension strengths. We also found a mild correlation between males’ knee extension strength and leg extension torque, but not for females. [Conclusion] We found a difference between males and females in the contribution of knee extension strength to the exertion of knee torque.

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[Purpose] To determine the factors associated with differences in anterior tibial translation (ATT) between healthy subjects and patients one year after anterior cruciate ligament (ACL) reconstruction. [Subjects] Ten ACL reconstruction patients (8 males, 2 females) with a mean ± SD age of 24.6 ± 7.3. [Method] We performed regression analysis with the dependent variable as ATT at 1 year post-surgery, and independent variables of the pre-surgery knee flexion and extension strength ratio (H/Q ratio), the pre-surgery angle of knee valgus in a single leg squat, and the maximum knee extension and flexion angles at 2 weeks post-surgery. [Results] Pre-surgery H/Q ratio, pre-surgery knee valgus angle in a single-leg squat, and maximum knee extension at 2 weeks post-surgery were determined to be factors associated with ATT. [Conclusion] The results suggest that pre-surgery, a high H/Q ratio and a small knee valgus angle in single leg squat prevent increase of ATT, and that in the post-surgery acute phase, the maximum extension angle of the knee should be restricted.

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[Purpose] This study investigated the reliability of measuring the muscle thicknesses of the external oblique (EO), internal oblique (IO) and transversus abdominis (TrA) by B-mode ultrasound in the neutral position and with 50% trunk rotation, in sitting. [Subjects] The subjects were 21 healthy young men. [Method] Muscle thicknesses were measured three times, at rest, with rising abdominal muscle pressure, and with added resistance, in the two positions. The coefficient of reliability of each condition was calculated from the measured values. When we found a low coefficient of reliability, we determined the the number of measurements that would guarantee high reliability. [Result] The coefficient of reliability of measuring the muscle thicknesses of EO and IO was better than 0.70, but that of TrA was 0.46. To achieve a coefficient of reliability of 0.70, 2.7 measurements are required. [Conclusion] In order to guarantee a high coefficient of reliability when measuring abdominal muscle thicknesses, it is necessary to use the average value of three measurements.

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[Purpose] The purpose of this study was to investigate the differences in activities of the trunk muscles (mainly local muscles) between young adults and elderly adults in the supine and standing positions. [Subjects] The participants were 30 young adults (17 men and 13 women, mean ± SD age 25.4 ± 5.0, height 175.4 ± 8.2 cm, weight 64.2 ± 7.9 kg) and 35 elderly adults (20 men and 15 women, mean ± SD age 76.8 ± 8.4, height 161.1 ± 6.9 cm, weight 57.8 ± 7.9 kg). [Method] Using ultrasonography, the thicknesses of the trunk muscles at rest and under voluntary contraction were measured in both the supine and standing positions. In addition, changes in the thicknesses of these muscles in the standing position were recorded for one minute. [Results] The young adults were able to contract the local muscles of the trunk both in the standing and supine positions, whereas the elderly adults had difficulty contracting these muscles when standing. The thicknesses of the local muscles of the young adults did not change during the one-minute standing task while they decreased significantly in the elderly adults. [Conclusion] The results suggest that when standing, elderly people have difficulty contracting the local muscles voluntarily, because they tend to concentrate more on keeping postural balance. The fact that the thickness of the local muscles of elderly people decreases with time suggests that they cannot maintain contraction of these muscles.

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[Purpose] To clarify whether an increase in the hip flexion angle influences balance in the wind-up pitching position in baseball. [Subjects] Subjects were 12 male university baseball pitchers and 12 healthy male students with no experience of baseball. [Method] We measured the shifts in the center of pressure of the subjects. The comparison of the pitchers and the healthy men was performed at the same hip flexion angle. The pitchers were compared between the hip flexion angle of the position ready to throw the ball and the maximum possible hip flexion. [Result] The pitchers showed a significantly lower shift in the center of pressure than the healthy men (p<0.05). In pitchers, the shift in the center of pressure significantly increased at the maximum possible hip flexion angle (p<0.05). [Conclusion] Baseball pitchers had superior balance in the normal wind-up position, however their balance ability decreased at the maximum possible hip flexion angle.

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