[Purpose] The purpose of this study was to determine the effect of knee internal rotation exercises on the knee adduction moment and function of elderly women with knee osteoarthritis (OA). [Subjects] Elderly women with knee OA were enrolled and randomly allocated to either a conventional exercise group or a RRR program (knee rotation exercise) group, which performed knee rotational exercises. The final numbers of subjects were 12 in the conventional exercise group and 9 in the RRR group. [Methods] Subjects’ knee adduction moment was measured during gait and questionnaire surveys (KOOS, SF-36) were conducted before and after the 4-week intervention. [Results] The mean SF-36 score of the RRR program group showed a significantly greater improvement than that of the control group. No significant differences were observed in KOOS results or knee adduction moment, but knee adduction moment in the RRR program group tended to decrease. [Conclusion] The RRR program may be more effective at improving activity than the conventional exercise program.

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[Purpose] To investigate relationships between adaptation to various sensory inputs and impairments of patients with post-stroke hemiplegia by measuring postural sway. [Subjects and Methods] Twenty-five patients with post-stroke hemiplegia participated in this study. Postural sway while standing was measured by posturography under eight standing conditions (visual conditions: eyes open or eyes closed; surface conditions: firm floor, foam rubber, and foam rubber under the affected and sound sides) for 30 sec each. The associations between dependence on visual input and the support surface ratio and standardized clinical measures of balance, gait ability and quantified somatosensory disturbances (touch, vibration) were examined. [Results] Dependence on the support surface ratio increased under the eyes-closed and foam rubber conditions. Dependence on visual input and the support surface ratio showed little correlation with standing balance, gait ability score, or superficial sensory disturbance of the affected side under most conditions. [Conclusion] Patients with hemiplegia show a reduced ability to adapt to the support surface condition of the sound side.

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[Purpose] The purpose of this study was to clarify the external knee adduction moment (KAM) characteristics during stair descent by patients with knee osteoarthritis (OA). [Subjects] Ten patients with knee OA and 15 age-matched asymptomatic controls participated in this study. [Methods] Measurements were taken during stair descent and level walking using a three-dimensional motion analysis system. The maximum KAM, KAM integral and mean KAM values during the stance phase were calculated. [Results] No significant differences between the groups were observed in the maximum KAM, but the knee OA group demonstrated greater KAM integral in both stair descent and level walking. Mean KAM was significantly greater during stair descent in the knee OA group than in the controls; this effect was demonstrated during the single-leg support phase. [Conclusion] A marked increase in KAM of patients with knee OA was observed during stair descent, particularly in the single-leg support phase, when compared to level walking.

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[Purpose] This study examined the difference between the right and left legs in gait time. [Subjects] The subjects were 36 healthy adults: 72 legs, 18 males and 18 females. All the subjects were right-foot dominant in kicking a ball. [Methods] Gait phase times were measured using pressure sensors. The time of one gait cycle was measured from heel strike to heel strike (HS) of the same side, the stance phase from HS to toe off (TO), stance phase I from HS to hallux contact (HC), stance phase II from HC to heel off (HO), and stance phase III from HO to TO. [Results] Significant differences were found between the left and right sides in stance phases II and III expressed as a proportion of one gait cycle. [Conclusion] Differences in the work performed by the legs are the cause of left-right differences in the gait of healthy adults.

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[Purpose] To examine the relationships between air temperature change and physical activity amounts and activities of daily living of home-dwelling stroke patients. [Subjects] The subjects were home-dwelling stroke patients: 6 with certified support needs, the Support group; and 8 with certified care needs, the Care group. [Methods] Air temperature data was collected for 1 year, and the months in which it was below 17˚C were called the Cold period, and those in which was ≥17˚C were called the Warm period. Physical activity was measured with a pedometer, and ADL assessments were made using the functional independence measure (FIM). [Results] A tendency to take fewer steps in the Cold period, which was not reversed in the following Warm period, was noted in the Support group. Over the year, there was no change in the number of steps taken by the Care group, and neither group showed a change in FIM score. [Conclusion] There is a possibility that physical activity amounts in the Cold period will decline, with the attendant prospective risk that ADL will also decline.

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[Purpose] The purpose of this study was to clarify the factors which influence the 6-minute walk distance of severe hemiplegic stroke patients at discharge from a convalescence rehabilitation hospital. [Subjects and Methods] Forty-eight consecutive first-time stroke patients with severe hemiplegia (stage II or worse on the Brunnstrom Recovery Stage) were investigated. Background factors, neurological findings such as cognitive and motor function, and activities of daily living on admission, were retrospectively assessed. At discharge, the 6-minute walk distance was measured, and its relationships with these variables were investigated. [Results] Age, time from stroke onset to rehabilitation hospital admission, and Functional Ambulation Category (FAC) were related to the 6-minute walk distance at discharge. [Conclusion] The 6-minute walk distance at discharge is influenced by FAC, age, and time from stroke onset to rehabilitation hospital admission.

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[Purpose] To examine the loading dynamics of the heel and forefoot during stair walking and slope walking. [Subjects and Methods] Fifteen healthy women with no history of orthopedic disease wore a shoe-type foot pressure measurement device and walked up and down stairs, and up and down a slope. The loads on the heel and forefoot and the time elapsed after heel contact were recorded for each condition. [Results] On the vertical ground reaction force loading curve of stair walking, the maximum forefoot value seen in the curve for walking on a flat surface was not observed during the loading response phase. The curve for ramp walking was similar to that for walking on a flat surface. [Conclusions] During stair walking, the forefoot reaches peak load earlier than the heel during the loading response phase. This probably occurs to smooth minimize vertical shift of the center of gravity when the body is raised and lowered.

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[Purpose] The purpose of this study was to verify the usefulness of the TUG test as a tool for ADL evaluation and the fall risk assessment of hip-fracture patients discharged to home from a convalescence rehabilitation ward. [Subjects] The subjects were 40 hip-fracture patients, who had been injured while falling, who were discharged to home from a convalescence rehabilitation ward. [Methods] The TUG test and FIM were administered within one week of discharge from hospital. The relationship between the two was analyzed, and the incidence of falls in the subsequent three-month period was investigated. [Results] A significant correlation between FIM and TUG performance time was found (p<0.01). Of the 40 patients 7 had falls in the 3-month follow-up period. Some patients with high FIM scores fell, but the number decreased to 0 when the additional condition of a TUG performance time of less than 20 sec was implemented. [Conclusion] This study demonstrated the usefulness of the TUG test as an assessment of fall risk and ADL of hip-fracture patients at discharge to home from a convalescence rehabilitation ward.

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[Purpose] The purpose of this study was to compare the thicknesses of the lateral abdominal muscles among the supine, sitting and standing postures during performance of the abdominal drawing-in manoeuvre (ADIM) or expiratory muscle training (EMT). [Subjects] Eighteen healthy men. [Methods] The subjects were measured at rest, then they performed ADIM or EMT in each of the postures in a random order. EMT was performed using the Threshold™ PEP, and the expiratory threshold was set at 15% of each subject’s maximal expiratory mouth pressure. The thicknesses of the transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) muscles were measured by ultrasonography. [Results] Compared to rest, there were significant increases in TrA thickness during ADIM and EMT in the supine and standing positions, but not in the sitting position. [Conclusion] The result suggests that EMT and ADIM in the supine and standing positions are similarly effective at activating TrA.

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[Purpose] This study examined the relationships of physical function and trunk functional evaluation before and after total knee arthroplasty (TKA). [Subjects] Thirty total knee arthroplasty patients. [Methods] The Trunk Righting Test (TRT) and knee extensor strength, single stepladder position time, step test (ST), Timed up and go test (TUG), 5-times chair-standing test (SS-5), 30-s chair-standing test (CS-30) were conducted. [Results] Significant correlations were found between the pre-TKA operated side TRT and post-TKA TUG, and between post-TKA operated side TRT and TUG, CS-30, SS-5, and post-TKA operated side ST. [Conclusion] Pre-TKA operated side TRT and post-TKA TUG are related, and post-TKA operated side TRT is associated with most post-operative physical functions.

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[Purpose] The effect of malnutrition on the voluntary cough intensity of stroke patients was investigated in this research. [Subjects and Methods] Serum albumin level (Alb), the Stroke Impairment Assessment Set (SIAS), Functional Independence Measure (FIM), peak cough flow (PCF), and respiratory muscle strength (MIP and MEP) of 69 stroke patients (mean age: 68.2 years old) were evaluated during rehabilitation. Malnutrition was defined as Alb of 3.5 g/dl or less. [Results] For comparison, the 69 subjects were divided into two groups, the malnutrition group (n=25) and the no-malnutrition group (n=44). The values of FIM, PCF, and respiratory muscle strength of the malnutrition group were significantly lower than those of the no-malnutrition group. Multiple regression analysis with PCF as the response variable gave a value of 0.513 for the corrected coefficient of determination, and MIP > Alb > item of function to control trunk in SIAS (in order of intensity of effect) as the significant explanatory variables. [Conclusion] The results suggest respiratory muscle weakness, which is affected by malnutrition, is strongly involved in the reduction of the voluntary cough intensity of stroke patients.

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[Purpose] This study was conducted to clarify postural control during single-leg kneeling. [Subjects] The subjects were 28 healthy adults. [Methods] The mean power frequency of the center of pressure was calculated for all subjects. Subjects were divided into possible and not possible groups on the basis of being able to hold a single-leg kneeling position for more or less than 30 s, and the groups’ mean power frequencies were calculated for the center of gravity and center of pressure and compared. [Results] The mean power frequency of the center of pressure was about 2.1 Hz. The mean power frequency of the center of gravity showed a tendency to be higher in the possible group. [Conclusion] Control of the center of pressure was found to be important during single-leg kneeling.

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[Purpose] As a preliminary study of the excitability of spinal neural function by the different methods of motor imagery, individual differences in methods of motor imagery were investigated by interview. [Subjects] Eighty-five healthy volunteers (mean age, 23.3 ± 6.3 years) participated after providing their informed consent. [Methods] Subjects were asked to practice 50% MVC of isometric contraction holding the sensor of a pinch meter between the thumb and index finger for 1 min. During this time, they watched the digital pinch force meter. Next, the subjects were asked to imagine the task of 50%MVC isometric contraction for 1 min. After the motor imagery task, the subjects were interviewed about the method of motor imagery they used. [Results] The subjects used several methods of motor imagery. The most popular pattern (19 subjects) was a combination of the image of the digital display of the pinch power meter (vision-image) and the image of the muscle contraction to control the pinch power (muscle-image). [Conclusion] The results suggest that the most popular method of motor imagery uses multiple imagery involving vision-image of motor tasks.

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[Purpose] The purpose of this study was to clarify the effects of unweighting the lower limbs on joint contractures. [Subjects] The subjects of this study were ten Wistar rats. [Methods] The rats were divided into one control (C) and three experimental groups. The right ankle joints of the first experimental group were fixed in full plantar flexion (F). The second experimental group’s hind limbs were unweighted by suspension (S). The third experimental group’s hind limbs were suspended and the right ankle joints were fixed in full plantar flexion (FS). The period of this study was one week. On the first and last days of this study, all of the rats’ angles of ankle dorsiflexion were measured. [Results] On the last day, the angles of dorsiflexion of the F and FS groups were significantly smaller than those of the C and S groups. The decreased angles of dorsiflexion of the FS group were significantly smaller than those of the F group. [Conclusion] Our results indicate that unweighting the hind limbs causes severe joint contractures in rats.

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[Purpose] The purpose of this study was to clarify the associations between joint function, activities of daily living (ADL), and health-related quality of life (HRQOL) in patients with hemophilia (PWH). [Subjects and Methods] The knee, ankle, and elbow joints of 31 patients with congenital hemophilia were studied. The conditions of the patients were evaluated on the basis of a questionnaire, joint function measurements, and roentgenography of the affected joints. In the assessment of joint function, knee flexor strength, knee extensor strength, and grip strength as well as the passive ROM of the elbows, knees, and ankles were evaluated. [Results] Twenty-seven patients had severe hemophilia, twenty-nine patients had plural arthropathies, and 60.2% of subjects’ joints showed severe arthropathy. Age significantly correlated with joint function, ADL, and HRQOL, and joint function significantly correlated with ADL and HRQOL. The status of knee arthropathy and ankle arthropathy were significantly related to HRQOL. [Conclusion] Our results suggest that improvement of joint function and arthropathy is necessary to improve the ADL and HRQOL of PWH.

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[Purpose] The mental conflicts of a physical therapist (S) tasked with rehabilitation for a terminal stage cancer patient (T) were conceptualized through qualitative analysis, to clarify the true nature of the problem. [Subject] A physical therapist with 3 years experience was the subject. [Methods] Semi-structured interviews were conducted, the verbal content was qualitatively analyzed and interpreted, and a conceptual model created. [Results] S had participated in the therapy program for T, and suffered three mental conflicts: the realization that ultimately T’s life could not be saved, satisfaction and regrets concerning therapy interventions, and the lack of unity in the medical team’s approach. [Conclusion] The mental conflicts of a physical therapist tasked with cancer rehabilitation were clarified.

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[Purpose] The effect on the standing posture of healthy infants w-sitting on a daily basis was investigated in this study. [Subjects] The guardians of 39 healthy infants aged 3–6 year were interviewed about their sitting posture. [Methods] The angle formed by the horizontal line and the line connecting the two points of the iliac spine and the anterior superior iliac spine was measured as the pelvic tilt angle. Hip rotation was classified into five groups using posture analysis. [Results] In children exhibiting w-sitting, an association was found between pelvic forward tilt and hip internal rotation. [Conclusion] With daily w-sitting, a standing posture exhibiting hip internal rotation with forward pelvis tilt is easily adopted even by children showing routine development. This may increase the risk of orthopedic disease, damage to the anterior cruciate ligament, or back pain in the growth process.

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[Purpose] To examine the effects of hip position and the presence or absence of manual fixation on a measurement method using a hand-held dynamometer (HDD) to measure hip extensor strength in the sitting position. [Subjects] The subjects were 10 healthy males. [Methods] The subjects performed isometric hip extension in the prone position, and in the sitting position with the pelvis tilted anteriorly, neutrally, and posteriorly, and with and without pelvis fixation. Hip extensor strength was measured with a HDD, and the muscle activities of the trunk and hip extensors were measured by surface electromyography (sEMG). For each of the measurement conditions, the reproducibility and validity of the muscle strength value was investigated, as well as the differences in muscle strength and sEMG activity values among the conditions. [Results] Muscle strength reproducibility and validity was highest with the pelvis fixed in anterior tilt. In this position, muscle strength and gluteus maximus activity were significantly higher than their respective values in the other measurement positions. [Conclusion] With the pelvis fixed in anterior tilt, the measurement method has high reproducibility and validity.

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[Purpose] This study investigated the effects of botulinum toxin type A (BoNT-A) on the standing and gait parameters of stroke patients. [Subjects] The subjects were 24 chronic hemiparetic stroke patients with lower limb extensor spasticity. [Methods] Injection of 300 units of BoNT-A into the gastrocnemius, soleus, tibialis posterior, flexor digitorum longus muscles or flexor hallucis longus muscles, depending on the case, was performed. The patients’ standing and gait parameters were evaluated before and 4 weeks after the treatment. [Results] Improvements were observed in the grounding area of the affected limb and center of foot pressure position during quiet stance, and stride length during gait. [Conclusion] BoNT-A injection for lower limb spasticity effectively improved the patients’ standing balance and gait ability.

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[Purpose] In this study, the effect on partial weight bearing (PWB) of acoustic alarm feedback provided by portable electronic foot sensor shoes was investigated. [Subjects and Methods] The subjects were 11 healthy young adults aged 28 ± 7 years old. The subjects performed three PWB tasks: the feedback program with acoustic alarm feedback using Step Aid; the feedback program with scale (ordinary method); and the no feedback program. The PWB alarm was set to 1/3 of body weight, and the PWB side was the pivot foot. The PWB of the pivot foot during 50-m walking and the 10 m walking time using Step Aid were measured. [Results] With acoustic alarm feedback provided by Step Aid, subjects were able to keep 1/3PWB significantly better than in the tasks with scales, and no feedback. [Conclusion] PWB walking with acoustic alarm feedback provided by Step Aid effectively enabled appropriate weight bearing during PWB walking rehabilitation.

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[Purpose] To clarify whether or not paralysis of the hip joint muscles causes lateral differences in the lateral trunk flexion strength hemiplegic stroke patients. [Subjects and Methods] The subjects were 9 first-time hemiplegic stroke patients. In a sitting on the edge of the bed position, with and without pelvis fixation, the muscle strengths of isometric trunk flexion to the paretic and non-paretic sides were measured and compared. [Results] Without pelvis fixation, the paretic side muscle strength was significantly lower than that of the non-paretic side, and this tendency was especially strong in subjects with more severe hip joint muscle paralysis. There was no significant difference between paretic and non-paretic sides with pelvis fixation. [Conclusion] In hemiplegic stroke patients, lateral differences appear in trunk muscle strength due to paralysis of the hip joint muscles, which work to stabilize the pelvis, but when the pelvis is passively fixed, this lateral difference disappears due to the minimization of their influence.

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[Purpose] This study was conducted to elucidate the differences of shoulder girdle flexion force and muscle activity among different shoulder positions. [Subjects] This study examined 30 young male adults with no history of shoulder joint impairment. [Methods] Shoulder girdle flexion force was measured at 0 and 90 degrees of shoulder flexion. The upper edge of the scapula spine angle was measured before force measurement. Surface electromyography was performed of the trapezius upper, pectoralis major, serratus anterior during force measurement. [Results] The maximum force was significantly higher at the 90-degree position, but the only muscle activity significantly higher than that at the 0-degree position was that of the serratus anterior. [Conclusion] The results of this study suggest that, for measurement and strengthening of the shoulder girdle flexion force, the serratus anterior muscle and scapula rotation angle configuration should be considered.

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[Purpose] The purpose of this study was to reconsider the crawling of infants by focusing on their repertoire. [Subjects] The subjects were 8 healthy infants aged 5-8 months who were using a Child Care Support Center. [Methods] The crawling of the infants on two types of floor (normal and unstable floor) was recorded on video, and analyzed for the motion of the head and trunk, the limbs, the movement of the center of gravity, and the driving force. The number of the repertoires of crawling was noted after agreement by three researchers. [Results] The repertories of crawling increased, and then decreased with experience of crawling. [Conclusion] Our results suggest that motor learning in infants’ crawling progresses from random to rational movements, and that the process is repeated during development.

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[Purpose] The purpose of this study was to clarify the relationships between heavy intensity warm-up exercise and τVO₂, τDeoxyHb, VO_2peak and AT. [Subjects] Twelve healthy adult males were the subjects. [Methods] On the first day, subjects performed a maximum exercise tolerance test, and VO_2peak and AT were measured. After 2-5 days, subjects performed a moderate constant load exercise test, and τVO₂ and τDeoxyHb were measured. [Results] VO_2peak and AT showed no correlation with τVO₂, but, τVO₂ correlated significantly with τDeoxyHb. [Conclusion] These results suggest that heavy intensity warm-up exercise’s effect on τVO₂ is independent of oxygen delivery ability, indicating τVO₂ is an index of oxygen utilization ability.

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[Purpose] The purpose of this study was to reveal the differences in joint angles between the unanticipated condition and the preplanned condition during 90° side-step cutting (SSC). [Subjects] Six healthy female collegiate basketball players participated in this study. [Methods] All subjects performed two tasks, 90° right side SSC, and 90° left side SSC. Lower limb joint kinematics were analyzed by 5 high speed cameras. SSC motion was divided into the stop phase and the side movement phase. [Results] The execution time of SSC in the unanticipated condition was longer than in the preplanned condition. The knee joint flexion angle of foot ground time in the unanticipated condition was greater than that in the preplanned condition. The maximum knee joint valgus angle in the unanticipated condition was greater than that in the preplanned condition. [Conclusion] These findings may contribute to the understanding of the mechanism of anterior cruciate ligament injury.

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[Purpose] The purpose of this study was to investigate campus life anxiety to clarify the causes of differences among academic years. [Subjects] The subjects were 223 first- to third-year physical therapy students (121 males, 102 females). [Methods] The students were surveyed in late May using the College Life Anxiety Scale (CLAS). [Results] Comparisons of CLAS subscales revealed there were no differences between males and females in each academic year, nor in the items of “anxiety about daily life” and “anxiety about assessment”. However, the item of “maladjustment to university” became significantly higher among males in the second and third years, compared to the first year. The main cause was “maladjustment to the department of physical therapy” itself. [Conclusion] The number of male students experiencing campus life anxiety because of maladjustment to the department increases from the second academic year on. Therefore, appropriate consultation, such as offers to change the department, is necessary for students during their first year.

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[Purpose] The purpose of this study was to investigate the conditions necessary to facilitate a terminal cancer patient’s return home from a recovery phase rehabilitation ward. [Subject] The subject of this case study was a 59-year-old female with malignant lymphoma. [Methods] Physical therapy from hospital admission to discharge was summarized and the conditions structured. [Results] Case discussions after discharge revealed: the intention of the patient and her family was clear; all staff changed their mental orientation to terminal care; all the staff shared all information; the primary physician was well-suited to the patient; and the hospital was fully prepared to receive the patient in the case of an emergency. [Conclusion] These conditions make it possible for terminal cancer patients to receive appropriate home medical care.

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[Purpose] The usefulness of a dissolution approach for belief conflict (DAB) for a COPD patient receiving a respiratory rehabilitation program is reported. [Subjects] The subject was a 79-year-old man diagnosed with disuse syndrome after acute exacerbation of COPD. [Methods] Although the patient’s body function had improved, his level of physical activity did not increase with respiratory rehabilitation. Because the improvement in the extent of body activities was forced, a belief conflict arose. Hence, DAB was introduced into the respiratory rehabilitation program. [Results] From the day after DAB introduction, the patient personally planned his time for ambulation. This practice continued until his discharge. [Conclusion] Introduction of DAB to the respiratory rehabilitation program may be useful for patients.

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