[Purpose] The purpose of this study was to assess the reliability and construct validity of three observational measures of mobility for elderly inpatients with dementia. [Subjects and Methods] The subjects were 51 inpatients, who were aged 60 or over and diagnosed as having dementia (mean age ± SD, 84.4 ± 6.9; range 60-96 years). The Physical Performance and Mobility Examination (PPME), Hierarchical Assessment of Balance and Mobility (HABAM) and the Rivermead Mobility Index (RMI) were chosen as a measure to observe the mobility behaviors of persons with dementia, and the reliability and construct validity were investigated. [Results] Intra-class correlation coefficients (ICC) showed that all scales had a good inter-rater reliability (ICC>0.8) and test-retest reliability (ICC>0.9). These scales significantly correlated with symptoms of dementia. Principal component analysis found a uni-factorial nature for the PPME and HABAM. [Conclusion] PPME and HABAM may be suitable measurement tools of mobility for elderly inpatients with dementia.

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[Purpose] The aim of this research was to compare the effects of manually assisted cough performed by physical therapists (PTs) and non-physical therapists (non-PTs). [Subjects] Seven PTs and seven non-PTs performed manually assisted cough on two healthy volunteers. [Methods] After providing instruction on manually assisted cough to PT’s and non-PTs, we measured the subjects’ Peak Cough Flow (PCF) and their comfort in assisted cough under the three conditions: unassisted, assisted with abdominal pressure, assisted with abdominal pressure plus manual chest compression. [Results] The PCF through abdominal pressure plus manual chest compression significantly exceeded unassisted cough or assisted cough only with abdominal pressure. The feeling during manual chest compressions by PTs was more comfortable than that performed by non-PTs. [Conclusion] We found that non-PTs could increase PCF with similar results to PTs. This indicates that effective assisted cough can be done by the patients’ families or caregivers when they receive proper instruction.

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[Purpose] To clarify the psychological and subjective stress level changes among vocational school physical therapy students between normal term time and just before end-of-term tests. [Subjects] The subjects were first- to third-year students of a 4-year physical therapy vocational training school: 237 students during normal term time, and 236 students before end-of-term tests. [Methods] Using a visual analog scale (VAS), and the profile of mood states (POMS) for psychological changes, students were assessed, once during normal term time, and once before end-of-term tests. [Results] A significant difference was found between students’ normal term time VAS and that before the end-of-term test. Significant differences in POMS “anxiety” were found for 1st-year students, in “anxiety”, “depression”, “fatigue”, “confusion”, and “vigor” for 2nd-year students, and in “anxiety”, “depression”, “fatigue”, and “confusion” for 3rd-year students. [Conclusion] End-of-term tests are events that easily elicit stress in students, and there are differences in the types of stress elicited among the academic years.

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[Purpose] The purpose is the effects of intermittent stretching exercise on disuse atrophy of the rat soleus muscle with respect to sites and muscle type. [Subjects] Twenty-one 8-week-old male Wistar rats were used. [Methods] The rats were divided into 3 groups: the CON group which received standard breeding, the HS group in which disuse atrophy of the soleus muscle was induced by hind-limb suspension, and the ST group which received intermittent stretching exercise during the hind-limb suspension period. At the end of the suspension period, the soleus muscle was excised and cut into proximal, middle, and distal samples which were stained with hematoxylin-eosin and ATPase. Subsequently, the cross-sectional area (CSA) was measured. [Results] CSAs of both type I and II fibers were significantly higher in the ST group than in the HS group, and the values of the middle region were significantly higher than those of the distal region. Also, the values of the distal region were significantly higher than those of the proximal region. [Conclusion] The results suggest that atrophy of both type I and II fibers of disused muscles is inhibited by stretching, and that there are differences in effect among the longitudinal sites of the rat soleus muscle.

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[Purpose] The purpose of this study was to reveal the characteristics of dynamic postural adjustments in rats using a posturography technique. [Subjects] Five adult rats. [Methods] We measured changes of center of pressure (COP) during floor inclination in the lateral (left) side and anteroposterior directions at angles from 0 to 30 degrees using different angular velocities ranging from 1.8 to 15 degree/sec. [Results] Animals maintained a standing posture at all inclination angles in all directions, and exhibited COP changes along with increase of the inclination angle. Animals showed dynamic postural adjustments together with characteristic COP changes in lateral side direction at angular velocities from 1.8 to 10 degree/sec. In anteroposterior directions, however, animals showed COP changes without dynamic postural adjustments in accordance with the increase of floor inclination. [Conclusion] These results suggest that animals correct posture in response to lateral disturbances using dynamic postural adjustments, and that animals stabilize posture without dynamic postural adjustments in anteroposterior disturbances.

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[Purpose] The purpose of this study was to investigate the influence of cognitive mental factors and nutritional status on postoperative pain after hip fracture. [Subjects] The subjects were 50 patients who received surgery for hip fracture. [Methods] We investigated postoperative pain, cognitive mental factors, and nutritional status in the third week after operation, and their associations. [Results] We found correlations between VAS of postoperative pain and NLS-s, rumination, helplessness, and MNA-SF, TP. Multiple regression analysis revealed that rumination, MNA-SF, NLS-s, helplessness were significantly associated with postoperative pain. [Conclusion] The results suggest the possibility that cognitive mental factors and nutritional status influence postoperative pain.

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[Purpose] To conduct G-FIM (Geriatric Functional Independence Measure), which is a simple and versatile ADL evaluation measure designed for geriatric health service facilities, to assess its practical use. [Subjects and Methods] First, FIM and G-FIM assessments were conducted by 14 rehabilitation staff and 16 nursing care professionals at rehabilitation facilities for the elderly. Then, a questionnaire survey with four categories, time, ease of use, comprehensibility, and appropriateness, was conducted of the rehabilitation staff and nursing care professionals. The scores of the four categories were examined using the Wilcoxon signed-rank test. [Results] There was no significant difference between FIM and G-FIM scores among the 14 rehabilitation staff and 16 nursing care professionals, but the G-FIM score was higher than the FIM score among the 16 nursing care professionals. [Conclusion] The results indicate that G-FIM is an evaluation measure which has sufficient practical use in the evaluation of ADL of rehabilitation facility users. We anticipate the G-FIM will be of great practical use.

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[Purpose] The purpose of this study was to analyze the differences of the kinetic and kinematic factors when choosing the leg for gait initiation after stroke from the viewpoint of dynamic stability. [Subjects] Fifteen stroke patients. [Methods] Subjects performed gait initiation (GI) starting with either leg. GI was measured using a 3D motion analysis system and force plates. The difference in kinetic and kinematic data, which is duration, displacement of center of mass, center of pressure (COP), extrapolated center of mass (Xcom), the relationship between the time integral of the COP displacement and the amount of forward COM momentum, and joint moment between the two tasks was compared using the paired t-test. [Results] When the unaffected leg was used as the first swing leg, a smaller mediolateral sway and larger forward sway of Xcom was found, and the time integral of the COP displacement and the amount of forward COM momentum were correlated. [Conclusion] It is more stable for stroke patients to start walking with the affected leg than the unaffected leg, though it is not as efficient.

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[Purpose] This study examined the effect of energy balance on the discharge to home of frail elderly persons in a health facility for the aged. [Subjects] One hundred twenty-one frail elderly persons receiving residential care in a health facility for the aged. [Methods] Participants were divided into the following two groups: the discharge to home group (n=58), and the residential care group (n=63). We determined energy consumption, energy intake, energy balance, demographic data and the Functional Independence Measure of all the subjects. Energy consumption was calculated using METs values and a 24-h timetable. Evaluations were conducted 1 month after admission. [Results] Energy balance differed significantly between the two groups. [Conclusion] The results of this study suggest that controlling energy balance would support discharge to home of frail elderly persons.

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[Purpose] This study examined the relation between functional prognosis, and nutritional status in patients with proximal femoral fracture. [Subjects and Methods] Two hundred and sixty-six patients with proximal femoral fracture were recruited for this study. Their mean age was 85.2 years. Logistic regression analysis was performed to determine the relationship between nutritional status and functional prognosis. [Results] Serum Albumin (Alb) ratios at admission were shown to significantly influence the recovery process. [Conclusion] Our results suggest that the nutritional state on admission may significantly affect functional prognosis.

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[Purpose] To determine the present circumstances, a survey was conducted of whether or not co-medical student abuse is taking place in clinical practice. [Subjects] The subjects were 159 final-year students of all disciplines who had received clinical practice. [Methods] The students were surveyed immediately after completing practical training using a free-style comment questionnaire. They were asked about the use of “verbal abuse”, “inappropriate physical contact”, “behavior inappropriate for the academic discipline”, “sexual harassment”, “sexual discrimination”, and “relations with different disciplines or professions”. [Results] Abuse was reported by all disciplines: by 59.7% of physical therapy students, by 53.3% of occupational therapy students, by 61.5% of speech therapy students, by 88.8% of nursing students, and by 35.0% of orthoptic therapy students. [Conclusion] In this country, there have been few surveys of co-medical student abuse during clinical practice. We intend to make further efforts to research the structure and methods of clinical practice.

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[Purpose] The aim of this study was to investigate the pain-relief effect of transcutaneous electrical nerve stimulation (TENS) focusing on changes in physiological responses and TENS stimulus intensity. [Subjects and Methods] Sixteen healthy volunteers participated in this study, and received three interventions for artificially induced pain: no treatment control, and TENS at 100 Hz of high intensity (above the motor threshold), and low intensity (sensory level). The pain-relief effect of the three interventions was compared using a subjective pain rating scale (NRS) and two physiological responses: cerebral blood flow of the prefrontal cortex (PF-CBF) and sympathetic nerve activity (SNA). [Results] NRS and PF-CBF findings showed that the pain-relief effect of high intensity TENS was significantly better than that of low intensity TENS and the control. There was no significant differences in SNA among the three interventions. [Conclusion] High intensity TENS should provide an excellent pain-relief effect in terms of both subjective and physiological aspects.

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[Purpose] Motor learning is a relatively permanent change in performance, and we can use what we learned when we do similar tasks. The purpose of this study was to determine the relationship between skill levels at the training time and the skill level a few weeks later. [Subjects] The subjects were 14 healthy adult men. [Methods] The task was to imitate handwriting of a model letter which was written by another person. Skill levels were deviation from the model letter. Skill levels were measured at pre-test, retention-test, and transfer-test. After the pre-test measurement, subjects performed practice until they met the criteria which was within the error range of the model letter. [Results] Significant differences were noted between two groups of subjects. In the group which acquired a higher skill level in training, learning skill could be maintained over many hours and transferred to another task. [Conclusion] The results of this study suggest that when the skill level at the end of training is high, it can be maintained over many hours and transferred to another task.

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[Purpose] To examine the feasibility of a measurement method using a hand-held dynamometer (HHD) of hip extensor strength in the sitting position. [Subjects] The subjects were 20 healthy male adults. [Methods] Subjects performed an isometric hip extensor task in the sitting, standing and prone positions. Muscle strength was measured with a HHD, and the activities of the hip and trunk muscles were measured using surface electromyography (sEMG). The measurement reliability, the differences in muscle strength and muscle activity among the positions, and their correlation were investigated. [Results] The reliability was significantly high in the sitting position, and the muscle strength value was significantly higher in the standing, followed by the sitting position, than the other position. There was no significant difference in the muscle activity of the gluteus maximus (GM) between the standing and sitting positions, and both muscle strength and sEMG of GM showed high correlations between the sitting and prone positions. [Conclusion] Measurement reliability is high in the sitting position, and there is a correlation with the values measured in the prone position. However, it is necessary to note that the muscle strength values of the sitting and prone positions are different.

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[Purpose] The purpose of this study was to investigate the reproducibility of the 15-m Shuttle Run Test (15mSRT), a modified form of the 20-m Shuttle Run Test (20mSRT). [Subjects] Twenty-five healthy young volunteers. [Methods] Subjects performed the 15mSRT three times within two weeks (Test 1, Test 2, Test 3). The reproducibility of the 15mSRT performance (distance completed) between the three tests was evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. In addition, the mean differences of the predicted VO2 were investigated using repeated measures ANOVA. [Results] ICC of the distance completed in the three tests ranged between 0.96–0.97. According to Bland-Altman analysis, an addition error was present in the distance completed in Test 1 vs Test 2 and Test 1 vs Test 3, although the results were free of systematic errors. [Conclusion] The 15mSRT provides reproducible results for the assessment of exercise capacity in healthy young subjects.

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[Purpose] The aim of this study was to elucidate the kinematic characteristics of female subjects with anterior cruciate ligament reconstruction (ACLR) during stair descent. [Subjects] Fourteen reconstructed knees of 11 females (ACL group) and 13 healthy knees of female subjects who formed the control group were evaluated. [Methods] A 3D motion analyzer was used to measure the joint angles of the hip, knees and ankles during stair descent and static standing. [Results] Maximal internal rotation ROM (the angle difference of internal rotation of the hip joint in the standing position and the angle reached in maximal internal rotation of hip during stair descent) in the ACL group was significantly larger than in the control group. [Conclusion] This result suggests that female subjects with ACLR increase knee joint instability by internally rotating the hip joint during stair descent.

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[Purpose] The inter-examiner reliability of a new hand fixation method of isometric hip extension muscle strength was verified using a hand-held dynamometer (HHD). [Subjects] The subjects were 10 healthy adult men and women. There were two examiners, one man and one woman. [Methods] A new hand fixation method was used. The elbow was fixed on the side of the treatment table with the HHD in the examiner’s hands. The method of measurement and the examiner were randomly selected from among the combinations of the two fixation methods (belt and manipulative) and the two examiners. Intraclass correlation coefficients were used to verify the intra-class and inter-class reliability. [Results] The intra-class and inter-class reliabilities of both fixation methods were “good.” [Conclusion] We consider the new hand fixation method for assessing isometric hip extension strength has high reliability.

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[Purpose] To investigate the knee flexor and extensor strengths of women measured without a fixed belt. [Subjects] Seventeen healthy adult women with no medical history of lower limb disorders. [Methods] Using a hand-held dynamometer (HHD), we measured right and left knee flexor and extensor strengths in the manual muscle testing (MMT) posture, and the basic sitting posture: sitting with the knees and hips in 90˚ flexion. We calculated the intraclass correlation coefficients (ICC) of knee flexion and extension, and used the t-test to compare them between the positions. [Results] ICCs of both the basic sitting posture and the MMT posture were greater than 0.7, and the extensor and flexor strengths of both the right and left knees were significantly larger in the basic sitting posture. [Conclusion] Knee flexor and extensor strength can be easily and simply measured by a hand-held dynamometer.

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[Purpose] The purpose of this study was to investigate the characteristics of quiet standing control using cross-correlation analysis of the center of foot pressure and the center of mass sway. [Subjects] Twenty elderly individuals participated in this study. [Methods] Using a 3D motion analysis system, we created segment models of the head, thoracic, and pelvic regions. The 3D system was used to measure the center of mass sway of the body and of each segment, as well as the center of foot pressure sway on a force plate. [Results] The results revealed that the correlation coefficient peak value of the center of mass of the head and the center of foot pressure showed a significantly lower value than the center of mass of the body in the mediolateral direction. [Conclusion] The results of this study indicate that the center of mass sway of the head in the mediolateral direction has a low association with the center of foot pressure sway; therefore, the center of mass sway of the other body segments of elderly individual during quiet standings is possibly controlled independently.

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[Purpose] The purpose of this study was to examine the relationship between sensory disturbance in the affected lower limb and the walking speed of hemiplegic patients. [Subjects and Methods] Twenty-two patients who were suffering from their first stroke participated in this study. The subjects had mild motor damage to be investigated the influence of sensory disturbance on walking. Assessments of kinesthesis and touch sensation were performed. Each sensory disturbance of the patients was graded as either normal, slight, moderate, or severe. The relationships between walking speed and the severity of the sensory disturbance for each test were investigated. [Results] There were no significant correlations with walking speed and the severity of the sensory disturbance in both kinesthesis and touch sensation. [Conclusion] Walking speed is not influenced by severity of the sensory disturbance in the affected lower limb.

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[Purpose] The purpose of this study was to investigate the effect of two abdominal exercises on the lateral transfer movement in the sitting position of healthy elderly subjects. [Subjects] The subjects were 17 healthy elderly persons. [Methods] We measured the center of pressure during lateral movement in the sitting position and the muscular activity of the trunk and lower extremities before and after the abdominal exercises. [Results] In the group which showed decreased center of pressure, the activity ratio of the external oblique muscle and internal oblique muscle (EO/IO ratio) was close to 100%. On the other hand, in the group which showed increased center of pressure, the EO/IO ratio was not close to 100%. [Conclusion] Abdominal exercise mainly focuses on muscular activity, however the results of this study suggest that the relative ratio of the oblique muscle in lateral movement is more important than the difference in muscular activity or the method of the abdominal exercise.

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[Purpose] To clarify the influence by gender of satisfaction with learning and living at the end of the junior and senior college years of PT students on their results in the National Examination for Physical Therapists. [Subjects] The subjects were 98 physical therapy students (59 males, 39 females), who graduated from the International University of Health and Welfare in March 2013, who agreed to cooperate with this survey. [Methods] Satisfaction levels were assessed at the end of the students’ junior year, and one month before the National Examination using a visual analog scale (VAS). The subjects were divided on the basis of higher and lower levels of satisfaction and compared. [Results] Satisfaction with living declined during the period among male students, and compared with those whose satisfaction levels increased, those whose satisfaction levels declined had significantly poorer results in the National Examination. [Conclusion] For male students, measures are necessary to combat declines in their satisfaction with living.

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[Purpose] To investigate the difference in walking speed of cerebrovascular disease (CVD) patients in the convalescent stage elicited by use of the Honda Walking Assistant Robot (HWAR). [Subjects] Sixteen first onset CVD patients in a hospital convalescence ward. [Methods] Subjects’ walking speed was measured 1 week before using HWAR, after 2 weeks use of HWAR, and 1 week later, after ending use of HWAR, a period of 4 weeks. Subjects were divided into fast and slow walking groups (walking speeds of greater or less than 1 m/s), based on the first assessment, and compared. [Results] Increases in walking speed and step length were not observed in the “fast” group, but they were observed in the “slow” group. [Conclusion] The walking speed before the intervention affected the outcomes of walking training for CVD patients using HWAR, which tended to increase the walking speeds and step lengths of “slow” group subjects.

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[Purpose] To investigate the reliability of the measurement of intestinal peristalsis using an Actigraph micro-sound sensor. [Subjects] Nine healthy subjects. [Methods] Noise was simultaneously measured by three sensors, three times, and the intraclass correlation coefficient and test-retest reliability were calculated. Next we measured intestinal peristaltic sounds, heart sounds, breathing sounds, and investigated whether breathing sounds and heart sounds affected the intestinal peristaltic sound measurement. [Results] The intraclass correlation coefficient was “good” at 0.66, and the test-retest reliability was also “good.” It was possible to measure the intestinal peristaltic sound without interference from breathing and heart sounds. [Conclusion] We confirmed the reliability of the Actigraph micro-sound sensor, and it was possible to measure intestinal peristaltic sounds without interference from breathing and heart sounds.

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[Purpose] To clarify the effect of knee extensor strength on the weight-bearing ability of the lower limbs. [Subjects] The subjects were 237 inpatients over the age of 65. [Methods] Starting from 0.2 kgf/kg, we divided isometric knee extension strength into 0.1 kgf/kg levels and calculated the average lower limb weight-bearing ratio for each level. [Results] At low levels of muscle strength, the weight-bearing ratio showed low values. At muscle strength levels below 0.3 kgf/kg, the weight-bearing ratio showed significant differences from those at all the other levels. However, at muscle strength levels above 0.4 kgf/kg, significant differences in the weight-bearing ratios were not found. [Conclusion] Isometric knee extension strength and the weight-bearing ratio are closely related, and when knee extension strength falls below a certain level, the ability of the lower limbs to support body weight is impaired.

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[Purpose] The purpose of this study was to investigate the effect of pulmonary physical therapy for a patient with cryptogenic organizing pneumonia (COP), a type of idiopathic interstitial pneumonia. [Subjects] The subject was a patient with COP. [Methods] This was a case study. The respiratory function test, cardiopulmonary exercise test (CPX), Nagasaki University respiratory activities of daily living questionnaire (NRADL) at the start and end of the 7-week were evaluated. [Results] The subject’s exercise tolerance capacity and NRADL improved, indicating that the pulmonary physical therapy was effective for this patient with COP. [Conclusion] We conclude that the pulmonary physiotherapy was effective for this patient with COP.

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[Purpose] We conducted a questionnaire survey about a “supervisor-student cooperative clinical practice” in a workshop for clinical practice supervisors. [Subjects] The subjects of the study were the 133 respondents to the questionnaire out of the 135 workshop attendees. [Methods] The content of the workshop emphasized the following two points: (1) the focus of clinical instruction should be placed on learning experiences through interaction with patients during cooperative supervisor–student clinical involvement; and (2) report supervision should be provided by university teachers. [Results] Respondents generally agreed with (1), but expressed no more than a weak level of confidence regarding whether this method could actually be implemented. The rate of agreement with (2) was low. [Conclusion] These results suggest the need for training workshops that provide more practical teaching techniques for clinical practice. They also suggest the need for new proposals for report guidance methods.

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