[Purpose] The purpose of this study was to clarify the relationship between the forward displacement of the center of pressure (COP), and the weight-bearing capacity of the paretic lower extremity during sit-to-stand, and the spasticity of patients with stroke. [Subjects] Fourteen patients who were hemiplegic due to stroke participated in this study. [Methods] A foot pressure sensor was used to measure the displacement of COP and the weight bearing ratio in the paretic lower extremity during sit-to-stand movement. The spasticity of the paretic plantar flexor muscle was evaluated using the Modified Ashworth Scale (MAS). [Results] The forward displacement of COP showed a significant relationship with the weight-bearing ratio (rs = –0.60) and the MAS (rs = 0.65). [Conclusions] Our results suggest that the forward displacement of COP is caused by excessive activation of the paretic plantar flexor muscle, which results in disturbance of weight bearing by the paretic limb.

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[Purpose] To clarify the effect of gait training using the Robot Suit HAL on walking ability of an individual with incomplete spinal cord injury. [Subject] A subject with Incomplete paraplegia for 13 years. [Methods] We employed a single case study ABA design. Period A was treadmill training and Period B was treadmill training with HAL. Primary outcomes were 10-m walking speed, and cadence. Secondary outcomes were knee extension torque, total length of postural sway, and the ratio of the left stance phase to the right stance phase in the walking cycle. [Results] The walking speed and cadence were greater in A2 than in the other periods. Total length of postural sway was significantly lower at the end of B than at the ends of the other periods. The ratio of the right to left stance was closer to 1:1 at the end of B than at the ends of the other periods. [Conclusions] The subject likely gained muscle strength, static standing balance, and gait improvement by using HAL. However, it will be necessary to do additional gait training without HAL to translate the effects of HAL into walking ability.

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[Purpose] The purpose of this study was to investigate the difference between a normal muscular fiber tear and a muscle contracture fiber tear when the rat soleus muscle is overstretched. [Subjects] The subjects of this study were six Wistar rats. [Methods] The rats’ right hind legs were fixed in full plantar flexion with a plaster cast. After 4 weeks, direct traction of the soleus muscle was done using an Autograph. After fixation of the leg in the Autograph, the tibia, fibula, and all lower leg muscles, except for the soleus, were cut, and the soleus was stretched to the tearing point. [Results] The distance from the head of the fibula of the soleus muscle to the break part point was not significantly different between the fixed and control limbs. The extension distance was significantly different between the normal and contracture limbs. [Conclusion] The skeletal muscle fixed in contracture showed shortening, and the results suggest that its break point occured closer to the center than that of the normal muscle.

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[Purpose] The purpose of this study was to investigate the effect of aging on hallux flexor activity, and the relationship of physical center of mass deflection with hallux flexor activity during response to a backward perturbation. [Subjects] Sixteen community-dwelling elderly individuals and ten young individuals participated in this study. [Methods] A backward step movement was induced by perturbation, and abductor hallucis activity and deflection of the physical center of mass were measured. Two-way layout analysis of variance was performed, with age and step phase as variable factors. In addition, we analyzed abductor hallucis activity and its relationship with deflection of the center of mass. [Results] We found that age and step phase were associated with abductor hallucis activity. Further, anteroposterior acceleration of the pelvic center of mass showed a significant negative association with abductor hallucis activity during the perturbation response. [Conclusion] Our findings confirm that abductor hallucis activity during response to a backward perturbation is high in the elderly, and this suggests that the stability of the pelvis is associated with abductor hallucis activity.

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[Purpose] The purpose of this study was to investigate the effects of a multi-task walking program on attention of the frail elderly. [Methods] The study subjects were 19 frail elderly attending a day-care facility. The nine-month intervention consisted of a three-month single-task walking program, a three-month single and multi-task walking program, and a three-month single-task walking program. Measurements included attention (trail making test part A), and executive function (trail making test part B), balance ability (timed up-and-go test), and 5 m walking speed. [Results] The results of twelve subjects were analyzed. The multi-task walking session was only two minutes whereas the single-task walking session lasted for 25 min. The Attention (TMT-A) changed significantly. In addition, the subgroup with higher balance ability improved after the multi-task intervention. [Conclusion] The multi-task walking program with low frequency and intensity was useful for improving the attention and balance ability of frail elderly attending a day-care facility.

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[Purpose] In this study, we investigated the weight bearing rate on the affected lower limb (WBR) of patients with cerebral vascular disorders (CVD). [Subjects] The subjects were 19 patients with CVD in our hospital who were able to walk more than 10 meters. We classified them into two groups: the independent walking group and the dependent walking group. [Methods] The two groups performed walking tests between parallel bars and outside using a step-aid for the affected lower limb. Outcome measures were: the Berg balance scale (BBS), WBR of standing and walking, 10 m walking time and coefficient of variation (CV). [Results] BBS and WBR were significantly lower in the dependent walking group, and 10 m walking time and CV were significantly higher. [Conclusion] The results show that WBR of walking and CV are involved in the independence of walking.

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[Purpose] We investigated whether or not exercise frequency has a beneficial effect on the lower limb strength of the elderly, and whether or not it was related to self-assessed exercise ability. [Subjects] The subjects were 71 elderly persons over the age of 65. [Methods] The subjects were grouped according to exercise frequency (0, 1~2, 3~5, and 6 or more days a week), and age, isometric knee extension strength, and subjective non-stop walking distance were compared among the groups. [Results] No significant differences in age, isometric knee extension strength or age were found among the groups. The subjective non-stop walking distance of the high frequency exercise groups was significantly longer. [Conclusion] Despite frequency of exercise (mostly walking) having no effect on lower limb strength, it lengthened subjective non-stop walking distance. Thus, physical function assessments of the elderly need to be made objectively with instrumentation, not through exercise frequency and subjective methods.

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[Purpose] To determine the influence of preoperative physical functions on gait and hospitalization of patients after total knee arthroplasty. [Subjects] Thirty-one knees of twenty-eight patients with knee osteoarthritis (knee OA) who underwent primary total knee arthroplasty (TKA). [Methods] We analyzed preoperative body functions influencing length of stay and postoperative period need to acquire walker gait and independent gait. [Results] Among preoperative body functions, the timed up and go test (TUG) was significantly related to the length of the postoperative period needed to acquire walker gait and independent gait. In contrast, there was no significant relation between any preoperative body function and length of stay. [Conclusion] The results suggest that preoperative TUG has a strong relation to early postoperative gait in patients with knee OA who undergo TKA.

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[Purpose] The purpose of this study was to clarify the relationship between fall risk and gait ability under multi-task conditions in community-dwelling elderly individuals. [Subjects] The subjects were 35 community-dwelling elderly individuals living in Ibaraki Prefecture. [Methods] Gait ability was measured during a 10-m walk under multi-task conditions (balance, auditory, reading, subtraction), and it was compared with the gait ability during normal walking. Subjects’ characteristics including fall score were obtained by a self-report questionnaire. [Results] Changes in stride length and the number of steps in the auditory task showed a significant correlation with fall scores. Additionally, changes in stride length were significantly larger in the multi-fall group than in the no-fall group. [Conclusion] Our data suggest that determining gait ability under multi-task conditions might help identify subjects at a high risk of fall, and that tasks more complex than dual tasks are suitable for testing community-dwelling elderly individuals for fall risk.

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[Purpose] To study the activities of the deep abdominal muscles during trunk rotation using ultrasound imaging. [Subjects] The subjects were 10 healthy persons with no lower limb or trunk disorders, and 6 chronic low back pain (LBP) patients. [Methods] In the sitting position, trunk rotation was performed voluntarily, and passively with a device. The thickness changes in the transversus abdominis (TrA) during performance of the task were compared between the healthy subjects and LBP patients. [Results] We found that the TrA thickness increased unilaterally in trunk rotational movement of the healthy subjects, but not in the LBP patients. [Conclusion] The difference observed in the TrA activities of healthy subjects and LBP patients suggests TrA contributes to trunk rotation, and TrA functionality is one aspect of the difference between healthy subjects and LBP patients.

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[Purpose] We investigated the relationships between hip extension angle and weight bearing on the sole of the foot when performing bridging exercises, and standing and locomotion ability, in different diseases. [Subjects] The subjects were 47 femoral neck fracture patients and 36 cerebrovascular accident (CVA) patients. [Methods] The patients were divided into groups according to their standing and locomotion abilities, and the hip extension angles and weight-bearing ratios (WBR) of the groups were compared in single-leg and two-legged bridging. The CVA patients’ values were also compared with their Brunnstrom stage. [Results] For both groups of patients, locomotion and standing ability-dependent differences were found in WBR and hip extension angles in bridging with both legs and single-leg bridging with the affected side; however, CVA patients did not show significant differences in WBR or angle in bridging with the unaffected side. Many of the Brunnstrom stage VI patients had high standing and locomotion abilities. [Conclusion] There is a possibility that the WBR of single-leg bridging with the unaffected side does not sufficiently reflect the locomotion ability of CVA patients.

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[Purpose] The purpose of this study was to investigate the effect on a motoneuron excitability and muscle blood flow, of static stretching (SS) and dynamic stretching (DS). [Subjects] The subjects were 20 healthy adults. [Methods] The subjects were divided into SS and DS groups. We measured ROM of ankle dorsiflexion, H wave amplitude, M wave amplitude, and soleus blood flow of subjects before stretching (Pre), just after stretching (Post1), and 5 minutes (Post2) and 10 minutes after stretching (Post3). [Results] Both SS and DS showed increases in ROM of ankle dorsiflexion. The H wave amplitude of SS tended to decrease. On the other hand, the H wave amplitude of DS significantly increased from Post1 to Post2 and Post3. Neither SS nor DS showed changes in soleus blood flow. [Conclusion] These findings suggest that the difference in temporal H wave amplitude of SS and DS is due to a different inhibition mechanism.

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[Purpose] The purpose of this study was to investigate relationships between fear of falling (FOF), body type and postural control. [Subjects] Seventy-one elderly females participated in this study. [Methods] Participants received a questionnaire about falls and a stabilometry test. The questionnaire inquired about degree of FOF, history or incidence of falls, and body pain. [Results] FOF did not differ due to experience of fall or fall incidents, but obese participants had a significantly greater FOF. A significant correlation was found between locus length per time (LNG/T) of center of pressure with eyes open and FOF. In multiple regression analysis, LNG/T of both eyes open and closed were determined to be related factors. [Conclusion] Experience of fall does not necessarily affect FOF. However, FOF may be affected by LNG / T or obesity.

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[Purpose] We examined and compared the effects on lower limb function and QOL of gender, age, disease, mode, and implantation history in patients with an implanted pacemaker. [Subjects] 45 patients with an implanted pacemaker who are out patinets. [Methods] We measured the CS-30 and 6MWD as indices of lower limb function, and we used the WHO QOL26 to assess QOL. [Results] Significant differences were found in the psychological domain item of QOL between DDD and VVI, as well as between AV-block and Brady-A, and there were significant differences in CS-30 and 6MWD between the under 65 and over 75 age groups. [Conclusion] There were differences in the psychological domain of QOL due to mode and disease, and a trend of declining lower limb function was seen with aging. We consider that knowledge of the characteristics of QOL and lower limb function of patients with an implanted pacemaker will be useful for their ADL assessment and exercise guidance, and in risk management during physical therapy sessions.

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[Purpose] The present study was a cross-sectional investigation of factors that affect physical activity at home of community- dwelling stroke patients. [Subjects] The study analyzed 40 stroke patients and 39 persons aged 65 or over who were living in the community. [Methods] Physical activity was assessed using the life-space assessment (LSA). Stroke patients were examined for factors affecting physical activity. [Results] Multiple regression analysis revealed that subjective health perception, age, fear of falling, and continuous walking distance affected the physical activity of the stroke patients. [Conclusion] Disuse syndrome due to aging and decreases in lower extremity muscular strength and walking ability are predicted to appear in stroke patients. However, we think that factors related to health psychology, such as fear of falling and subjective health perception, interact with one another, leading to a decrease in physical activity.

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[Purpose] This study examined the effect of neck restriction by cervical orthosis on pulmonary function and respiratory muscle activity during spirometry. [Subjects] Twelve healthy young males participated. [Methods] They performed spirometry with and without a Philadelphia collar. We also measured respiratory muscle activity with surface electromyography during spirometry. [Results] Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1.0) and peak expiratory flow ratio (PEFR) with the collar were significantly lower compared to without the collar. The muscle activities of the sternocleidomastoid and scalenus with the collar were significantly lower during maximum inspiration. However, the activities of rectus abdominis (RA) and obliquus externus abdominis (OEA) did not change between with and without collar. [Conclusion] Neck restriction by cervical orthosis decreases neck inspiratory muscle activity and VC. In exhalation, FVC, FEV1.0 and PEFR decrease due to the decrease in VC or restriction due to airway narrowing.

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[Purpose] The purpose of this study was to verify the validity of soleus muscle strength measurements made by hand-held dynamometer (HHD). [Subject] The maximum torque value and the maximum muscle strength of 28 limbs of 14 healthy adults were measured. [Methods] The isometric soleus muscle strength was measured by 5 methods: by HHD using manipulative resistance, and a fixed belt; standard, Biodex measurement and, Biodex measurement of the target soleus muscle; and MMT. [Results] There was a significant correlation between the HHD method using a fixed belt and the Biodex measurement of the target soleus muscle. [Conclusion] The validity of the HDD method using a fixed belt was confirmed.

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[Purpose] The purpose of this study was to investigate the effects of task practice by one hand using the Go/NoGo visuomotor task on the contralateral hand. [Subjects] Subjects were 16 healthy persons who were right-handed. [Methods] Subjects were divided into 2 groups: the right-hand and left-hand practice groups. The Go/NoGo task consists of a light stimulus of 3 types. Subjects were required to extend the finger of one hand in response to presentation of a red circle (Go stimulus) and to keep at rest without exercise in response to presentation of a green circle or red square (NoGo stimulus). We measured the reaction times of both hands before and after 3 days of task practice. [Results] Shortening of the pre-motor time of the practice and no-practice hands occured in both practice groups. [Conclusion] These results suggest that 3 days of task practice causes a plastic change in the function of the posterior parietal cortex (PPC), while processed visual information was transmitted through the corpus callosum to the posterior parietal cortex on the same side as the finger movement.

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[Purpose] The purpose of this study was to clarify the effect of differences in teaching method before the tasks. [Subjects] Subjects were 29 healthy adults. [Methods] The subjects practiced series reaction time tasks before performing the tasks. We divided the subjects into 4 groups: the intentional answer group was taught all of the rules before the tasks, the intentional hint group was taught parts of the rules, the incidental awareness group which recognize the rules by themselves, and the group which was not taught and did not recognize the rules. Fourteen blocks were performed on the first day, and 3 blocks of retention tasks and transfer tasks were performed on the second day. [Results] In the transfer tasks, there were no decreases in reaction times in both the incidental awareness and intentional hint groups. [Conclusion] We found that the most effective learning condition for development of motor learning is to teach the subjects parts of the rules and have them recognize the other rules by themselves.

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[Purpose] The purpose of this study was to investigate for the validity of the attachment sites of surface electromyograph electrodes used to measure intrinsic back muscles. [Subjects] The subjects were 20 healthy young males. [Methods] Ultrasonograms of the intrinsic back muscles were recorded at four sites: 3 cm and 6 cm lateral from L2 and the L4 spinous processes in the prone position. The distances of both lateral borders and the most superficial layer of the transversospinalis muscle from the spinous processes were measured at each site. [Results] In the young Japanese male subjects, the transversospinalis muscle was not identified in many cases at 3 cm lateral from both the L2 and the L4 spinous processes. At 3 cm lateral from the L2 and the L4 levels, the longissimus muscle was identified. At 6 cm lateral side from the L2 and the L4 levels, the ilicostalis muscle was identified. [Conclusion] It is possible that the muscle activity of the multifidus muscle may not be measured at 3 cm laterally from the L2 and the L4 levels by surface electoromyography. Therefore, it may be necessary to reconsider the electrode attachment site used in previous research.

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[Purpose] This study examined the effects of age on ambulation and activities of daily living of motor incomplete spinal cord injury patients. [Methods] The subjects were 87 patients with motor incomplete spinal cord injury who were admitted to the Ibaraki Prefectural University of Health Science Hospital between March 2001 and December 2012, less than 3 months after the injury. They were divided into 3 groups by age to compare ambulation levels, FIM motor sub-scores, and FIM cognitive sub-scores. [Results] The younger groups had got higher FIM motor sub-scores and FIM cognitive sub-scores at discharge. There were no significant differences in independent walking among the 3 groups, but the youngest group had a significantly higher rate of walking outdoors. [Conclusion] Age is one of the important factors affecting ADL and walking outdoors of patients with motor incomplete spinal cord injury.

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[Purpose] The purpose of this study was to clarify the effect of therapeutic ultrasound on pain threshold. [Subjects] The subjects were 10 healthy males. [Methods] All participated in three trials: ultrasound (US) without powered ultrasound (placebo), and rest (control). US was applied at 3 MHz, 1.0 W/cm2, and a duty cycle of 100%, for 10 minutes. The outcome measures were the pin-pricking pain threshold (PPPT), the pressure pain threshold (PPT), the visual analog scale (VAS) of PPPT and PPT measurements, and skin surface temperature (SST). Measurements were taken 10 minutes before trials, just before and after trials, 10 minutes after trials, and 20 minutes after trials. [Results] After the US trial, PPPT, PPT, and SST increased significantly more than after the placebo and control trials at 20 minute after the trials. There were no significant differences in VAS. [Conclusion] The results suggest that US has a sustained effect on the pain threshold.

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[Purpose] We identified relations of spinal sagittal alignment in standing with scapular position and glenohumeral joint abduction range of motion (GHjt-ROM). [Subjects] We examined forty young healthy male subjects. [Methods] We measured neck flexion angle, index of kyphosis, pelvic tilt angle, thoracic circumference, scapular position, and GHjt-ROM in standing. We examined the relevance of scapular position and GHjt-ROM with multiple regression analysis. [Results] We found that thoracic kyphosis, thoracic circumference, and scapular position, are highly related. [Conclusion] Increased anterior pelvic tilt, lumbar lordosis, thoracic kyphosis, thoracic circumference, abduction and upward rotation of scapula are implicated in scapular abduction. We assume that the scapula is directly affected by thoracic kyphosis and thoracic shape, because the scapula is located on the thorax.

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[Purpose] The purpose of study was to examine the reproducibility of evaluation of gastrocnemius muscle length (Achilles tendon length and muscle belly length) using a digital caliper and ultrasound images in adults with cerebral palsy. [Subjects] Nine adults with cerebral palsy (35 ± 9.2years) and 10 normally developing adults (22 ± 0.8 years) participated in this study. [Methods] The apex of the medial femoral condyle, the transition of the tendon and muscle, proximal point of the calcaneus were determined using ultrasound images. The distances were measured between these three points, twice. Reproducibility was analyzed using intraclass correlation coefficients (ICC). [Results] ICC were 0.93-0.98 for adults with cerebral palsy and 0.76-0.99 for normally developing adults. [Conclusion] The reproducibility of measurements of subjects was excellent cerebral palsy. We suggest that this method can be effectively used to evaluate therapeutic effects in cerebral palsy.

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[Purpose] The purpose of this research was to investigate the influence of home-visit rehabilitation on the care burden using the mixed methods approach. [Subjects] The subjects were 7 users and 7 primary caregivers who had newly started home-visit rehabilitation. [Methods] Study 1: Basic information about the users and primary caregiver were collected using the J-ZBI and GHQ28 questionnaires. The information was compared between pre- and post-intervention. Study 2: A semi-structured interview was carried out with the caregivers using the M-GTA. [Results] The total score of J-ZBI and personal strain score were significantly lower at post-intervention than pre-intervention, but there was no significant difference in the role strain score. Psychological intervention was suggested to be a factor in reducing the care burden. [Conclusion] The intervention of home-visit rehabilitation reduced the care burden of caregivers. Psychological assistance was related to the reduction of the care burden.

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[Purpose] We measured the chest wall volume changes of healthy males during ergometer exercise using a 3D motion analysis system, and investigated their characteristics. [Subjects] The subjects were 6 healthy males. [Methods] Under a ramp load protocol, the subjects performed bicycle ergometer exercise until reaching their symptomatic limits, while their chest wall volume was measured using a 3D motion analysis system. [Results] Compared to at rest, at exercise load intensities above 20%, significant increases in upper and lower chest volumes at inspiratory end, and a significant decrease in abdominal volume at expiratory end were found. [Conclusion] The results suggest that with increasing exercise load intensity, the chest wall volume is changed by raising the ribs further at inspiratory end, and by further reducing the abdominal part at expiratory end to realize a greater tidal volume.

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[Purpose] The purpose of this study was to evaluate the frequency of visits for exercise therapy on insulin resistance. [Subjects] The study subjects were 44 overweight outpatients with lifestyle-related diseases. [Methods] They were classified into 2 groups according to the number of exercise visits within the first 6 months of therapy: the frequent group (≥51 sessions) and the infrequent group (≤50 sessions). We then subgrouped the 2 groups according to their frequency of visit during the subsequent six months. [Results] Significant improvements in insulin resistance, fasting immunoreactive insulin level, and homeostasis model assessment for insulin resistance were observed only in the frequent group at 6 months. Comparison of the groups’ clinical profiles at 6 and 12 months showed that the subjects in all the subgroups maintained their improved body composition and insulin resistance, irrespective of the frequency of visits. [Conclusion] Our results show that frequent exercise, at least twice a week, is required to reduce insulin resistance, and that improved clinical profiles can be maintained even when the exercise frequen y is reduced to around once a week.

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[Purpose] This study compared cardiorespiratory responses during wheelchair driving under two different conditions of spinal curvature. [Subjects] Sixteen healthy men who provided their written informed consent. [Methods] We investigated respiratory rate (RR), tidal volume (TV), minute ventilation volume (VE), movements of the thoracic trunk and abdomen at maximal respiration, and heart rate (HR) at rest and during wheelchair driving 20 seconds after the start of driving (phase I), under two spinal curvature conditions. [Results] RR of wheelchair driving was significantly increased by enhanced spinal curvature, whereas TV and HR during wheelchair driving showed no significant changes. TV and VE were significantly decreased by enhanced spinal curvature in phase 1. In addition, O2 debt was significantly increased by enhanced spinal curvature. [Conclusion] We conclude that in wheelchair driving, enhanced spinal curvature increases O2 debt, due to reduced TV and VE responses in phase I.

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[Purpose] The purpose of this study was to investigate the effect on motor skill and pinch grip of two different types of electrical stimulus, targeting the muscles and nerves, before exercise. [Subjects] The subjects were 8 healthy adults. [Method] We used a task of rotating a wooden ball in the palm of the hand. When subjects’ performance had stabilized after practice, we applied the electrical stimulus. The electrical stimulus was delivered to the ball of the thumb (100 Hz, 120 sec) and to the ulnar nerve (centrally, 10 Hz, 60 min). Pinch grip strength and the number of ball rotations were measured before and after the electrical stimuli. [Results] For both stimuli, a significant increase in the number of rotations was found after stimulation, when compared to before, and in the comparison of percentage change, the muscle stimulation showed a significantly higher value. However, no change was found in pinch grip. [Conclusion] The results suggest the possibility that, compared to ulnar nerve stimulation, short-term muscle stimulation is a useful method for raising motor skill.

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[Purpose] We investigated the differences in balance ability without upper limb support in between non-stroke and stroke patients. [Subjects] Twenty-eight stroke patients who had hemiparesis and 76 non-stroke patients were recruited for this study. [Methods] We compared the Berg balance scale (BBS) of the non-stroke group with the stroke group at each walking level. [Results] Although there was only a small difference in the BBS score between the two groups at the walking level of without a cane, the non-stroke group had a higher BBS score than the stroke group at the walking level of with a cane. [Conclusion] The balance ability without upper limb support of the stroke patients was lower than that of the non-stroke patients at the walking level of with a cane.

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