[Purpose] This study examined the effect of introducing an observation-based walking independence ward assessment sheet. [Subjects and Methods] The subjects were 181 stroke patients who achieved walking independence between April 2012 and March 2014. Basic information, motor function, higher brain function, and behavioral ADL were retrospectively extracted from medical records, and compared between patients with occurrence and absence of falls after achievement of walking independence. [Results] Falls occurred in 21 cases after achievement of walking independence. No significant differences were found in all survey items between the two groups. [Conclusion] From the fall rate and injury situation after the achievement of walking independence, the introduction of the assessment sheet can be introduced for practical use.

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[Purpose] The purpose of this study was to observe three-dimensional morphological changes of the foot after inserting a medial or lateral heel wedge. [Subjects and Methods] The subjects were 52 feet of 26 healthy subjects. To measure the morphological change of the foot, a three-dimensional foot digitizer was used to measure subjects in the standing position. Heel wedges with 5, 10 and 15 degrees of inclination were placed under the calcaneus. Each wedge was used for both medial and lateral comparisons of foot posture; there were seven conditions in total. [Results] The angle of calcaneus changed significantly with more than 10 or more degrees of inclination of the heel wedge. Medial and lateral malleolus inclination angle, midfoot inclination angle and forefoot inclination angle showed reciprocal changes to the calcaneus in the frontal plane. [Conclusion] The frontfoot may mutually complement the function of the rearfoot.

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[Purpose] To investigate the 3-year prognosis of mobility and factors related to it in patients with Parkinson’s disease. [Subjects and Methods] The subjects were 120 Parkinson’s disease (PD) patients who consulted a neurologist in the 5 years from 2008 to 2013. Their data over a follow-up period of three years was retrospectively collected. The patients were divided into two groups of less than 5 years and more than 5 years since PD onset, and using binomial logistic regression analysis with maintenance of mobility at 3 years later as the dependent variable, related factors were investigated. [Results] PD symptoms, with the exception of tremor, and mobility significantly deteriorated over the three years. Factors related to mobility prognosis were PD symptoms, anamnesis, complications and dementia in the less than 5 years since onset group, and age, years since onset, and dementia in the more than 5 years since onset group. [Conclusion] Factors related to mobility prognosis of PD patients can be used in the planning of physical therapy programs aimed at independent living.

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[Purpose] To clarify whether or not differences can be observed after exercise in the level of fatigue and recovery characteristics of the dominant and non-dominant legs, and to help with determination of exercise prescription. [Subjects and Methods] The subjects were 11 healthy adults. After exercise on a bicycle ergometer, the dynamics of blood oxygen in the vastus lateralis were assessed for 10 minutes using near-infrared spectroscopy, and the temporal changes in total hemoglobin (ΔHbT), an index of fatigue, and differences between the dominant and non-dominant, and right and left legs were analyzed. [Results] No significant differences were found in the temporal changes of the dominant and non-dominant legs. However, in the differences between the right and left legs, ΔHbT of the dominant leg was significantly higher at 6 minutes, and showed a rising trend from 4 minutes, when the difference was not significant. [Conclusion] Consideration of the predominance of the dominant leg in muscle activity and fatigue could possibly be useful in both leg exercise tasks in physical therapy.

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[Purpose] We investigated the immediate and time-course effects of the thermal stimulus caused by ultrasound therapy on delayed onset muscle soreness (DOMS). [Subjects and Methods] This study had a randomized controlled trial design. The subjects were 14 healthy university students (8 males and 6 females). DOMS was induced in the biceps brachii muscle, and ultrasound was used for 10 min. Visual analog scales (VAS) for pain and feelings of muscle tension and fatigue during elbow motion, as well as the ROM of the elbow joint, were used to evaluate the effects of ultrasound therapy. [Results] After exercise on the second day, the ultrasound irradiation group showed a significant improvement in the VAS scores of muscle tension and fatigue during elbow motion. [Conclusion] The thermal stimulus of ultrasound therapy for DOMS is temporarily effective at reducing muscle soreness and fatigue after exercise.

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[Purpose] The purpose of this study was to determine the body alignment of patients with knee osteoarthritis (OA), and to investigate the relationship between body alignment and physical functions. [Subjects and Methods] Twenty-five subjects with knee OA and twenty healthy elderly subjects participated. Body alignment was measured using two-dimensional video analysis. Range of motion, muscle strength, 5-m walking time, and one-leg standing duration were also measured. [Results] Patients with knee OA had forward head posture, lumbar flexion, pelvic posterior tilt, trunk anterior tilt, and knee varus. Moreover, lumbar flexion and trunk anterior tilt significantly correlated with back strength in knee OA patients. [Conclusion] In patients with knee OA, the alignment of not only the leg but also the trunk changed. These body alignment changes may affect physical functions.

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[Purpose] The influence of work-related low back pain (LBP) on care work performed by care workers was investigated. [Subjects and Methods] The subjects were 264 care workers working at 9 facilities for the disabled. Data on basic details, years of work experience, presence of work-related LBP, countermeasures for LBP and their implementation, the care activities actually performed were collected via a paper questionnaire survey. The subjects were divided into two groups based on the presence or absence of work-related LBP and compared. [Results] There were 147 respondents (59.8%) with work-related LBP. Those reporting work-related LBP were significantly older than those without it, and were implementing countermeasures for LBP. A significant difference in care activities was not found between the two groups. [Conclusion] The results suggest that work-related LBP might not affect care activities.

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[Purpose] The purpose of this study was to assess the validity of the functional elevation muscle strength and maximum isometric abduction muscle strength of the elderly, and to analyze the relationships between muscle mass, muscle thickness, and grip strength. [Subjects and Methods] Forty left and right shoulders of 22 healthy, community-dwelling elderly were the subjects of this study, after excluding those with shoulder joint pain or movement disorders. Functional elevation muscle strength, maximum isometric abduction muscle strength, muscle mass, fat mass, deltoid muscle thickness, and grip strength were measured. The relationships among the items assessed were evaluated using Pearson’s correlation coefficient. [Results] Functional elevation muscle strength of the elderly demonstrated significant positive correlations with muscle mass, grip strength, and body fat. Conversely, maximum isometric abduction muscle strength demonstrated no significant correlations with muscle mass, deltoid muscle thickness, or grip strength. [Conclusion] These results show the validity of functional elevation muscle strength measurement as a test of shoulder elevation muscle strength of the elderly.

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[Purpose] The purpose of this study was to verify the influence of ingesting water and dietary supplements on chair-sitting posture. [Subjects and Methods] The subjects were 10 healthy young males. We measured their body sway with a stabilometer and the position of 9 landmarks attached to their upper body with a three-dimensional motion analysis system. Measurements were conducted for ninety seconds before drinking water or eating dietary supplement, just after drinking or eating, and 150, 300, and 450 seconds after drinking or eating. [Results] Compared to the initial condition, body sway increased significantly after drinking water. The position of landmarks on C7 and Th7 moved significantly anterior just after drinking water compared to the other measurement times. There was no significant change of landmarks after eating dietary supplement. [Conclusion] Change of weight or location in the visceral organs might have been larger when drinking water than when eating supplement.

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[Purpose] The clinical clerkship is a recommended model of clinical practice training; however, there is little indication as to what and how to practice within each field’s clinical clerkship. This study investigated the content and methods of clinical clerkships as reported in previous studies. [Subjects and Methods] A qualitative systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, searching for previous studies that reported the methods and content of clinical clerkships. The chosen search terms were “clinical clerkship” and “students”. To help interpret and characterize the content of the clinical clerkship outlined in each study, we integrated similar data about the description using a content analysis. [Results] In total, 538 studies were identified and 8 studies were analyzed. Almost all studies included content regarding “students’ participation in clinical practice”. [Conclusion] This study showed that “students’ participation in clinical practice” is a key aspect of clinical clerkships.

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[Purpose] The purpose of this study was to investigate the factors related to the care burden of stroke survivor’s caregivers, as reported by previous studies. [Subjects and Methods] Studies concerning the factors related to the care burden of stroke survivor’s caregivers were extracted from two electronic databases and their contents were comprehensively identified via a systematic review. [Results] In total, 78 studies were identified, of which 7 were analyzed. Adverse factors related to the care burden included the worsening of caregivers’ mental state, and a lack of adequate social support. No association between this burden and the ability to carry out activities of daily living was found. [Conclusion] A worsening of mental state of the caregiver and poor social support appear to be factors amplifying the care burden felt by cargivers.

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[Purpose] The aim of this study was to investigate the effect of divided attention on the first response of the somatosensory system using somatosensory evoked potentials (SEP). [Subjects and Methods] Twelve right-handed healthy subjects participated in this study. To evoke somatosensory responses, we used median nerve stimuli of the left or right side. The participants performed the mental arithmetic task of serial subtraction for the experimental condition, and did nothing for the control condition. The amplitudes and latencies of SEP components (N 20, P 25, N 33 and P 45) were measured. [Results] The latency of N 33 on left median nerve stimulation was significantly delayed by the mental arithmetic task, but not by right median nerve stimulation. [Conclusion] These findings suggest that a change in latency due to performance of mental arithmetic tasks inhibits activation of the right primary somatosensory area.

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[Purpose] This study aimed to verify the reliability and validity of “the sense of position” application (APP) for measurements of joint-position sense with a smartphone. [Subjects and Methods] Ten young healthy adults were recruited for the reliability analysis, and 2 young healthy adults for the validity analysis. The position sense of the right elbow joints was measured using the APP. Test-retest reliability was evaluated by calculating intraclass correlation coefficients (ICC), and the validity was determined by calculating Pearson’s correlation coefficients for the values measured using the APP and digital images. The number of required measurements was determined using the ICC calculated from the mean value of each measurement. [Results] A high reproducibility was found for the values of elbow joint-position sense measured using the APP, as well as a strong correlation with values measured on digital images. In addition, a high reliability was found when the measurement was performed 5 or more times. [Conclusion] The APP developed by us showed high reliability and validity for measurements of young healthy adults. The results of this study demonstrated that the APP enabled the assessment of elbow joint-position sense, suggesting its potential application in clinical practice or other areas.

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[Purpose] The aim of this study was to develop a method to statistically analyze the techniques of manual stretching for equinovarus. [Subjects and Methods] Six physical therapists (PTs) and three stroke survivors participated in this study. The manual stretching motions of PTs and forces and torques applied to the patient’s heel were measured by a motion capture system and a six-axial force sensor. For statistical analysis, principal component analysis (PCA) was expanded and performed on the recorded data. [Results] Three principal components were extracted by the statistical analysis. According to the primary component, PTs increased their force, on the toe side, and moment on dorsiflexion with slight abduction moments. The second and third components indicated the differences in the abduction/adduction and eversion/inversion torques around the heel and in the forces pulling or pushing the heel. [Conclusion] Our method based on PCA enables the statistical analysis of the similarities and differences of complex manual stretching techniques among PTs.

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[Purpose] The purpose of this study was to discuss the effect of a Robotic Knee Orthosis (RKO) exercise using an ABA-type single case study. [Subjects and Methods] The subjects were 5 hemiplegic stroke patients in a recovery rehabilitation unit. The ABA design consisted of Phase A (normal exercise) and phase B (RKO exercise). This study was performed for 30 days with 10 days of each phase. The evaluation items were transfer and gait abilities, degree of hemiplegia, sensory dysfunction, the Berg Balance Scale, stride length, step length, the time of one-leg support, and they were evaluated 4 times: before A1, after A1, after B, and after A2. The 10-meter gait time was evaluated 5 times in each phase, a total of 15 times. The results were compared using one-way ANOVA. [Results] The Berg Balance Scale, stride length, step length, the of one-leg support time and the 10-meter gait time improved in phase B. [Conclusion] These results suggest the RKO exercise is effective for stroke patients.

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[Purpose] This study evaluated a novel virtual 3D anatomy training system. [Subjects and Methods] Evaluation of this innovative pedagogical tool was performed by administering a questionnaire to 100 second-year physical therapy students after using the training system to study anatomy. The questionnaire asked students to provide responses concerning anatomy practice, learning, and potential aversions to anatomy. Statistical comparisons of the data were carried out using the chi-squared test. [Results] The 3D anatomy training system raised students’ interest in and motivation to study anatomy. The number of students who performed poorly in assessments for the anatomy module after being trained to use the virtual system was significantly smaller than that of the previous year when this training was not available. [Conclusion] This virtual anatomy training system has the potential to be a powerful tool in the teaching of anatomy to paramedical students.

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[Purpose] To investigate the same-session intra-rater reliability of blinded and inexperienced examiners measuring extension strength with a hand-held dynamometer at maximal shoulder abduction. [Subjects and Methods] The subjects were 14 healthy male university students, and the examiners were two university students with no experience of muscle strength measurement. Measurements were performed with subjects for the prone position, the shoulder maximal abduction position the elbow extension position, and the forearm neutral position. [Results] Both examiners had ICC_1,3 of 0.9 (almost perfect) for the dominant and non-dominant sides. [Conclusion] This method is unaffected by experience or examiner, making it a simple and highly reliable method.

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[Purpose] To determine the relationships of hip abductor muscle strength with 10-meter maximum walking speed (10MWS) and level of gait independence, and to calculate the cutoff value for gait independence. [Subjects and Methods] The subjects were 31 hemiparetic stroke patients. Their 10MWS and gait independence level were determined, and hip abductor muscle strength was measured using a hand-held dynamometer. [Results] A significant correlation (r=0.74) was found between 10MWS and the paretic side hip abductor strength. In the search for factors affecting gait independence level, only hip abductor strength of the paretic side was identified [odds ratio (OR) 11.92, OR 95% confidence level 2.19-65.15], and the cutoff value for gait independence was 0.23 kgf/kg. [Conclusion] The results suggest there is a high possibility that the paretic side hip abductor muscle strength is an important factor of gait speed and gait independence.

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[Purpose] To investigate the training effect of the three-dimensional multiple object tracking task (3D-MOT). [Subjects and Methods] The subjects were 25 community-dwelling elderly. Changes in the mini-mental state exam, the trail making test part A (TMT-A), 5 m walking speed, timed up and go test (TUG), and the functional reach test were compared between an intervention group which performed the 3D-MOT and a control group. [Results] In the intervention group, the TMT-A result was significantly shorter after the intervention, and a significant positive correlation was found between the percentage changes in the TMT-A and TUG results. [Conclusion] The 3D-MOT appears to raise attention function and dynamic balance ability, and it should therefore be effective at preventing falls among the community-dwelling elderly.

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[Purpose] To investigate the effects of Hybrid Assistive Limb^® (HAL^®) gait training on the quality of life and mood states, and its suitability for recovery phase stroke patients. [Subjects and Methods] Twenty-four patients with stroke completed the randomized controlled trial. Over 4 weeks, all the patients received twelve 20-min sessions of either HAL or conventional gait training (CGT). The outcome measures were evaluated prior to the training and after the 12 sessions. [Results] The HAL group showed a significant improvement in the Functional Ambulation Category compared with those who received CGT. However, some patients were not suited to HAL training. [Conclusion] The results obtained in this trial suggest that a gait training program based on HAL may improve independent walking more efficiently than one based on CGT. However, severe hemiplegic patients whose nerve signals are not detected by HAL or patients with complicated higher brain dysfunction are not suited to HAL training.

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[Purpose] The purpose of study was to investigate complications in patients who had underwent lung cancer resection and to examine which surgical procedures affect improvements in physical activity (PA). [Subjects and Methods] The subjects were 71 patients, who had underwent pulmonary resection, and were assessed for postoperative complications within postoperative day (POD) 7. Forty-four patients without complications were divided by operative procedure into 27 patients with thoracotomy, 11 patients with video-assisted thoracic surgery (VATS), and 6 patients received extended surgery. Respiratory function, biochemical data, intraoperative findings, and thoracic drain placement days were investigated. PA (number of steps, energy consumption, active time) on postoperative days 2-7 were compared. [Results] Atrial fibrillation was the most common complication seen. The extended surgery group had a significantly greater quantity of operative blood loss, and longer operative and anesthesia times compared with the other groups. Furthermore, PA in the extended surgery group showed a reduction from POD 4 to 6. [Conclusion] Extended surgery was invasive and PA improvement was delayed compared to the other procedures.

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[Purpose] To clarify the influence of isometric knee extension strength (IKES) on the one-leg standing (OLS) time. [Subjects and Methods] The subjects were 323 elderly inpatients. They were divided into groups, on the basis of IKES, from 0.2 to 0.6 kgf/kg at 0.1 kgf/kg intervals, and their OLS times were compared. [Results] The results showed that when both the left and right leg IKES was low, OLS times were short. When subjects were dichotomized on the basis of 0.4 kgf/kg IKES for both the right and left legs, a significant difference was found in the OLS times of the two groups. However, no significant difference in OLS times was found between the group of subjects with IKES > 0.5 kgf/kg, and any of the other groups. [Conclusion] There is a close relationship between IKES and OLS time, and it seems that, when IKES drops below 0.4 kgf/kg, the effect on OLS time is large.

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[Purpose] The purpose of this study was to clarify the effects of unweighting the lower limbs on the extensibilities of the skin and soleus muscle around a contracted joint. [Subjects and Methods] Twelve wistar rats were divided into two experimental groups. The right ankle joints of the first experimental group were fixed in full plantar flexion (F). The hind limbs of the second experimental group were suspended, and their right ankle joints were fixed in full plantar flexion (FS). The period of fixation was one week. On the last day, the extensibilities of the soleus muscles and skin of the right ankle joint were measured. [Results] The extensibility of the soleus muscle of the FS group decreased more than that of the F group. [Conclusion] Our results indicate that unweighting the hind limbs of rats may cause severe joint contractures by decreasing muscle extensibility.

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[Purpose] In this study we evaluated performance in the 30-sec chair-stand test (CS-30) and investigated its relationship with physical function. [Subjects and Methods] The subjects were 71 community-dwelling elderly. CS-30, long-sitting body anteflexion, grip strength, raising the upper body, quadriceps strength, one-leg standing time with the eyes open, 10-m obstacle walking time, and maximum walking speed were measured, and the timed up and go test (TUG), functional reach test, and four square step test (FSST) were conducted to evaluate physical function. [Results] The factors affecting performance in the CS-30, as indicated by repeated measures regression analysis, were the TUG and FSST times, with better CS-30 performance associated with a shorter TUG time. [Conclusion] These results suggest that increasing balance function is important for improving the performance of community-dwelling elderly in the CS-30.

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[Purpose] This study analyzed the factors related to discharge to home from geriatric health service facilities. [Subjects and Methods] A postal survey was sent to 542 care managers in geriatric health service facilities in Kyushu and Okinawa, Japan. [Results] A total of 147 valid responses were received (valid response rate: 27.7%). Exploratory factor analysis indicated three factors were related to discharge to home from geriatric health service facilities. Logistic regression analysis indicated that ADL support for those dependent on care and provision of information significantly influenced discharge to home from geriatric health service facilities. [Conclusion] ADL support is needed for those dependent on care, and educational support is necessary for family caregivers when individuals are discharged to home from geriatric health service facilities.

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[Purpose] To clarify the factors determining the life-space extent of urban-dwelling hemiparetic stroke patients. [Subjects and Methods] The subjects were 115 hemiparetic stroke patients, who were attending out-patient departments. The Life-Space Assessment was used to determine subjects with a living space greater than a 16-km radius, and those with a living space of less than an 800-m radius, and logistic regression analysis was performed on the two groups using physical assessment items as independent variables. In addition, cutoff points were calculated for the discriminating factors. [Results] Discriminant factors were identified as the 6-minute walking distance for increasing order, and 10 m walking time for decreasing order, and their respective cutoff points were 213.5 m, and 13.9 s. [Conclusion] The extent of the life-space area can be determined by gait assessment.

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[Purpose] This study investigated the influence of pelvic angles on back muscle activity during upper limb elevation. [Subjects] Ten healthy males participated in this study. [Methods] We measured back muscle activities at 5° anterior pelvic tilt, and 5 and 15° of posterior pelvic tilt while sitting with upper limb elevation of 90°. Surface electromyography of the activities of the right trapezius upper fibers, middle fibers, lower fibers, lumbar erector spinae and lumbar multifidus were recorded. [Results] Posterior tilt of the pelvis decreased the lumbar multifidus activity, but increased trapezius muscle activity. [Conclusion] The results suggest that exercise of the back muscles with 5° anterior pelvic while sitting would effectively activate the lumbar multifidus.

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[Purpose] The aim of this study was to model the image formation process of clinical training of students who were just about to start clinical training. [Subjects and Methods] The subjects were 12 physical and occupational therapy students who were about to start long-term clinical training. The study method was individual, semi-structured interviews, lasting about 1 hour, and at the end of the interview, a verbatim transcript was made. The interview record was analyzed using a qualitative research method, the M-GTA. [Results] The results suggest that with regard to clinical training, the students flip-flopped between “unease” and “expectation”, and that “unease” was particularly strong. [Conclusion] In order to help students recognize that clinical training is a place for their personal growth and development, it is important for them to have a great “expectation” of it. We consider that it will be necessary for supervisors to develop ideas for clinical training guidance, using the model demonstrated in this study.

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[Purpose] This study investigated changes in physical function and quality of life (QOL) after three months of outpatient physical therapy and a home-exercise program for a patient with degenerative lumbar kyphosis. [Subjects and Methods] The subject was a female in her 70s who was diagnosed as having degenerative lumbar kyphosis. Evaluations included muscle strength, balance and gait function, spinal alignment on X-rays, and muscle thickness and muscle echo intensity measured by ultrasound sonography. Physical therapy interventions included trunk strengthening, balance training, education, and a home-exercise program. [Results] Gait function assessed as the 6-minute walking distance improved from 200 to 435 m. Trunk endurance measured as trunk extension endurance time also improved from 15 to 35 seconds. The muscle thickness of the multifidus on the painful side increased from 1.89 to 2.28 cm, and the muscle echo intensity decreased from 55.4 to 50.0 pixels; however, spinal alignment, muscle strength, balance function, and QOL showed no improvement. [Conclusion] After 3 months of physical therapy, trunk endurance had improved, possibly due to changes in the multifidus muscle thickness and echo intensity; however, muscle strength and QOL showed no overall improvement.

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