[Purpose] The aim of this study was to clarify the relationships between postural stability in standing and head-neck position (H-N), and muscular strength of the toes (TMS) of elderly people. [Participants and Methods] The subjects were 30 healthy elderly men. Postural stability was assessed using the Index of Postural Stability (IPS). Subjects stood on a posturography force plate and IPS was measured with the H-N in the neutral, flexed, extended, side-flexed and rotated positions with the eyes open. TMS was measured using a toe-grip strength measuring instrument. [Results] IPS showed a significant difference between the H-N flexed and side-flexed positions. Significant positive correlations were found between IPS and TMS in 5 positions. [Conclusion] Postural stability was lower in the H-N side-flexed position than in the flexed position. Furthermore, when IPS was high, TMS also showed a tendency to be high.

[Purpose] To verify factors related to the survival period after discharge of postoperative digestive tract cancer patients. [Participants and Methods] We analyzed 62 patients undergoing a postoperative rehabilitation program for digestive tract cancer patients. For physical function evaluation, hand grip strength, knee extension manual muscle strength, peak flow, one-leg standing time, 10-minute walking test, continuous walking distance, and the Functional Independence Measure were evaluated before and after surgery. We examined the statistical associations between the survival period after discharge and age, the preoperative body function, rate of change of each physical function, duration of postoperative hospital stay, rehabilitation intervention period, and cancer stage. [Results] The survival period after discharge significantly correlated with the rate of change in left handgrip strength, postoperative hospitalization days, rehabilitation intervention days, and cancer stage. [Conclusion] The left hand grip strength change from before to after surgery correlated with the survival period after discharge in postoperative digestive cancer patients.

[Purpose] The purpose of this study was to verify the recovery after disuse atrophy by gradual loading. [Participants and Methods] Eight-week-old male Wistar rats were randomly assigned to control, hind-limb suspension (H), gradual loading after 7 days of hind-limb suspension (G), and constant loading after 7 days of hind-limb suspension (W) groups. At the end of the experimental period, the cross-sectional area and occurrence ratio of necrotic and central nuclear fibers were measured. [Results] The cross-sectional areas of the muscle fibers in the proximal region of the H and W groups were significantly smaller than those of the other groups, but there was no site-dependent difference in G group. [Conclusion] The results suggest gradual loading is an effective intervention for the proximal region which is the region most susceptible to disuse atrophy.

[Purpose] To clarify isometric knee extensor strength levels that lead to limited maximum gait speeds. [Participants and Methods] We examined 138 elderly male inpatients aged 65 to 85, dividing them into 5 groups based on their isometric knee extensor strength levels, and calculating the maximum gait speed, step length, and cadence for each group. [Results] Values representing the maximum gait speed, step length, and cadence were lower among participants with lower isometric knee extensor strength levels. There were no significant differences in the maximum gait speed among groups with a muscle strength level of 0.50 kgf/kg or higher, but there were such differences among all groups with muscle strength levels lower than 0.50 kgf/kg. [Conclusion] Isometric knee extensor strength levels lower than 0.50 kgf/kg may lead to limited maximum gait speeds.

[Purpose] To compare movements of the thoracic cage when inspiring with thoracic expansion restrictions at different levels. [Participants and Methods] Nineteen healthy males. In each case, we attached reflective markers to the higher, middle, and lower parts of the thoracic cage, and analyzed its movements when inspiring while standing. We restricted thoracic expansion at the following levels: right under the lower angular part of the scapula; the spinous process of the twelfth thoracic vertebra; and both levels. As the fourth condition, there was no restriction. We compared the amounts of change in the distance between reflective markers when inspiring under these 4 conditions. [Results] When thoracic expansion was restricted at right under the lower angular part of the scapula, movements of the higher and middle parts of the thoracic cage were limited. Similarly, when it was restricted at the spinous process of the twelfth thoracic vertebra, movements of the middle and lower parts of the thoracic cage were limited. [Conclusion] The results suggest that a partial restriction on thoracic expansion influences the parts of the thoracic cage proximal to the site of restriction, and the influence on the distal parts is less marked.

[Purpose] To clarify the relationship between the femur-tibia (FTA) and knee varus (KVA) angles during gait after open-wedge high tibial osteotomy (OWHTO), as well as the influence of changes in knee joint alignment on the hip and ankle joint angles in the frontal plane during gait. [Participants and Methods] A total of 49 patients who had undergone OWHTO in our hospital. We performed gait analysis before and 1 year after surgery to examine the relationship between the FTA and KVA at the 50% stance phase. We also compared values representing the hip, knee, and ankle joints at the 50% stance phase before and after surgery. [Results] There was a moderate positive correlation between the FTA and KVA at the 50% stance phase. [Conclusion] The results indicate the necessity of considering that the FTA and KVA during gait may not completely coincide after surgery.

[Purpose] This study aimed to clarify the characteristics of the 6 sections of the Brief-Balance Evaluation Systems Test (Brief-BESTest) by analyzing the associations between muscle mass and the strength and balance components of elderly individuals. [Participants and Methods] Fifty-eight elderly individuals were evaluated. Balance was assessed using the Brief-BESTest. The muscle mass of limbs, grip strength, and strength of the quadriceps femoris muscle were measured. Partial correlation coefficients for each section of the Brief-BESTest and the muscle mass of limbs, grip strength, and strength of the quadriceps femoris muscle were calculated. [Results] The floor effect was poor in each section except section I. Spearman’s rank correlation coefficient between each section ranged from 0.33 to 0.77. Correlations between muscle mass and muscle strength differed between the sections. [Conclusion] The results suggest that 6 sections of the Brief-BESTest do not make the same balance assessment, suggesting that close attention to each section could help to determine appropriate interventions for elderly individuals with balance difficulties.

[Purpose] To clarify the association between the function of the ankle joint and activity of the muscles of the ankle on the paralyzed side during gait in patients with spastic hemiplegia. [Participants and Methods] We studied 25 chronic post-stroke patients. We assessed their ankle joint function using the Modified Ashworth Scale, Clonus Score, and active and passive ankle dorsiflexion angles. Additionally, we evaluated their muscle activity during gait based on their results of walking 10 m at a normal speed. To obtain statistical data, we analyzed the correlation between the results of ankle joint function assessment and lower-limb muscle activity evaluation on the paralyzed side. [Results] There was no significant correlation between spasticity of the ankle plantar flexors and the activity of these muscles during the stance phase, but there was a significant correlation between them during the swing phase. [Conclusion] When spasticity is present during rest, it is unlikely to influence the stance phase. On the other hand, abnormal conditions, such as talipes equinovarus, may occur during the swing phase.

[Purpose] The aim of this study was to investigate the effect of the stimulation frequency on EEGs using steady-state flash stimuli. [Participants and Methods] SS-VEPs of ten healthy adult volunteers were recorded. The flash stimulus was displayed to subjects at frequencies from 3 to 18 Hz. EEGs were recorded from 14 scalp electrodes, and their waveforms were subjected to fast Fourier transforms (FFT) to yield the amplitudes. [Results] The first harmonic component was at a maximum at the frequency of 10 Hz [Conclusion] Our results suggest that the neural activity of the visual cortex of healthy adults has different response characteristics to flash stimulation at frequencies from 3 to 18 Hz.

[Purpose] To confirm the effectiveness of novice education. [Participants and Methods] A total of 22 employees, who had participated in a novice education/training program for those in their first to third year in hospital, and consented to cooperate with the study. We compared their scores for the Competence Evaluation Scale in Physical Therapy (CFPT) before and after the program. [Results] There were significant differences in CFPT scores related to “appropriate thoughts” and “PT skills” among employees in their first year, and “appropriate thoughts”, “PT skills”, and “appropriate attitudes” among those in their second year. Employees in their third year in hospital showed scores for all subscales higher than mean values. [Conclusion] The program is designed to enhance novices’ competences, so that they become able to provide basic physical therapy-based intervention for patients on a step-by-step basis. Evaluation using the CEPT revealed marked improvements in PT skills and thoughts needed to provide therapeutic intervention. The effect of the program on employees in their first and second years in hospital was particularly marked, supporting the usefulness of competence training for these novices.

[Purpose] The purpose of this study was to investigate factors related to reducing the caregiver burden in activities of daily living when starting home-based rehabilitation after discharge from a comprehensive rehabilitation unit. [Participants and Methods] The subjects were 17 users. We investigated the correlations among the scores of the Zarit Burden Interview (J-ZBI_8), the change of J-ZBI_8, and other variables on the first, 30th, and 180th day after starting home-based rehabilitation. [Results] The amount of change in J-ZBI_8 on the 30th day showed significant negative correlations with visiting times, degree of relationship between the cared subject and primary caregivers, frequency of family education, and quality of cooperation with care manager. The amount of change in J-ZBI_8 at the end of follow-up showed significant negative correlations with average frequency and average quality of family education. [Conclusion] In the short term after home discharge, intensive and frequent family education, active inter-professional cooperation, and support for building a good relationship between the cared subject and primary caregivers are important for reducing the care burden in home-based rehabilitation. In the medium to long term, a better educational approach to caregivers is important.

[Purpose] To survey the characteristics and differences of discharge support that heart failure patients and physical therapists consider necessary. [Participants and Methods] The subjects were 16 patients with heart failure who were 65 years of age or older and 7 physical therapists (PT). The Q-sort method was used to survey the values relating to discharge support needed by heart failure patients. [Results] The discharge support item considered highly necessary by both groups was “response at times of recurrence.” Differences between the two groups were found in “purpose of exercise” and “explanation of exercise risk”, with the patient group expressing lower need than the PT group. [Conclusion] Both groups were conscious of the need for effective management of salt and water intake, and body weight for prevention of recurrence. The need for “exercise” was lower in the patient group than in the PT group. This suggests that there is a problem with guidance related to exercise.

[Purpose] The purpose of this study was to determine the effects of extracorporeal shock wave therapy (ESWT) on the pain threshold of athletes with chronic pain during their sport season. [Participants and Methods] Seven collegiate American football players with pain lasting for over four weeks participated in this study. The affected sites were four Achilles tendons, four patella tendons, and one tendon of the biceps long head. Radial ESWT was used twice within 72 hours. The 100-mm Visual Analog Scale (VAS) pain, surface pain threshold, and pressure pain threshold (PPT) were measured on day 1 (pre- and post ESWT), day 4 (pre- and post ESWT), day 7 and day 14. [Results] The 100-mm VAS pain was significantly lower on days 7 and 14 than on day 1. PPT was significantly higher on day 7 than on day 1. There were no significant differences in the other parameters. [Conclusion] The results of this study show the efficacy of ESWT for athletes with chronic pain during the season.

[Purpose] The purpose of this study was to examine the gender-related difference in abdominal trunk muscle brightness of ultrasonic images of healthy young adults. [Participants and Methods] The subjects were 25 healthy males (mean age, 23.2 ± 3.0 years) and 28 females (mean age, 23.3 ± 2.5 years). The muscle brightness of the rectus abdominis and transverse abdominal muscles at rest were compared between the sexes. [Results] No significant difference in the muscle brightness of the abdominal trunk muscle was found between the male and female subjects. However, the brightness of the rectus abdominis and abdominal transverse muscles of the female subjects was significantly lower. [Conclusion] No significant gender-related difference was found in the muscle brightness of the abdominal trunk muscles of the healthy adults in this study. We consider that this is because the subjects were healthy adults. In the future, gender-related differences in abdominal trunk muscle brightness by age should be examined.

[Purpose] The purpose of this study was to investigate the effect of time-of-day (early morning vs evening) on dynamic balance control using posturography and electromyography. [Participants and Methods] Nine healthy individuals participated in this study. They performed the Cross Test, moving the center of pressure (COP) laterally and longitudinally on a force plate with their eyes open and closed. The electromyograms (EMGs) from the anterior tibialis, and the medial and lateral gastrocnemius were simultaneously recorded. [Results] Compared with the evening, in the morning, the participants demonstrated decreased longitudinal COP sway when their eyes were closed, and increased EMG activity when their eyes were open. [Conclusion] In the morning, the participants showed significantly poorer performance in the dynamic balance test. Increased muscle activity in the morning might be due to compensation for reduced longitudinal sway.

[Purpose] The purpose of this study was to investigate the muscle contraction characteristics of lower limb amputees. [Participants and Methods] The participants were 6 lower limb amputees and 7 healthy men. Their muscle contraction characteristics were measured by tensiomyography (TMG). TMG is a non-invasive neuromuscular functional assessment. TMG measurements were made of the contraction time and maximum radial displacement of the gastrocnemius lateralis and medialis, rectus femoris, and vastus lateralis and medialis. [Results] Muscle contraction time of the gastrocnemius was significantly delayed in amputees. [Conclusion] The muscle contraction time of the gastrocnemius muscles was significantly different from that of the non-amputees, suggesting it is a characteristic of amputees.

[Purpose] The purpose of this study was to clarify the mechanical characteristics of the knee extensor muscles and the patellar tendon during isometric contraction at different knee and hip joint angles. [Participants and Methods] The subjects were 11 healthy males. The knee extensor torque during isometric contraction was measured using a dynamometer. The degree of deformation as a mechanical activity was measured by a muscle contraction (MC) sensor. [Results] The knee extensor muscle showed a significantly higher degree of deformation when the knee joint was extended rather than flexed. However, the degree of deformation of the patellar tendon was significantly lower in knee extension than in knee flexion. [Conclusion] These results show that the degree of deformation measured using a MC sensor is influenced by deformation of the knee extensor muscles and the patellar tendon due to change in the knee joint angle.

[Purpose] To investigate the optimum condition of the target hand while acquiring Mirror Visual Feedback (MVF). [Participants and Methods] Thirty healthy subjects were divided into three groups: (1) the target hand relaxed group, (2) the synchronized exercise group, and (3) the control group. We assessed changes in the time of the ball rotation task. [Results] There was a significant decrease in the ball rotation time immediately, and at 10 minutes, and 1 day after the intervention in group 1 only. [Conclusion] While acquiring MVF, it is better to keep the target hand relaxed.

[Purpose] We compared the durations of standing while holding horizontal and vertical poles in patients with severe hemiplegia and consequent difficulty in maintaining a standing position. [Participants and Methods] Nine patients with post-stroke hemiplegia and consequent difficulty in maintaining a standing position between parallel bars. In each patient we measured the duration of standing while holding a horizontal (Condition-A) or vertical (Condition-B) pole using one hand for 5 days for comparison. [Results] The duration of standing was significantly longer under Condition-B compared with -A on all days (p<0.05). Six patients became able to maintain a standing position for 60 seconds under Condition-B on the fifth daybut they did not under Condition-A. [Conclusion] Vertical poles should be considered in patients with severe hemiplegia and consequent difficulty in maintaining a standing position between parallel bars.

[Purpose] The present study analyzed the degree of retention of knowledge from physical therapy lectures for the development of practical courses. [Participants and Methods] The participants were 80 second-year students in a department of physical therapy who had registered for both lectures and practical courses. A pop quiz regarding basic knowledge tested in mid- and end-term examinations was administered on the first day of the practical training to check the degree of retention of knowledge demonstrated in the examinations. [Results] The grades of both the mid-term and end-term pop quizzes showed lower values than those of the tests taken in the lecture subject. [Conclusion] The results of the present study suggest that the partial loss of knowledge from lecture subjects should be considered in the development of practical courses, because all such knowledge wasn’t retained, even though the participants in this study had received credit for the lecture subject.

[Purpose] The purpose of this study was to clarify the prevalence and features of sarcopenia in older adults undergoing day-care rehabilitation. [Participants and Methods] A total of 93 older adults (49 males and 44 females) from the Nishinasuno General Home Care Center participated in this study. Grip strength, walking speed, and skeletal muscle mass index were measured. The prevalence rate of sarcopenia was calculated with reference to the AWGS diagnostic algorithm. [Results] Sarcopenia was observed in 48 out of 93 subjects. The prevalence rate was 51.6% overall, 44.9% in males, and 59.0% in females. Only nine males and two females had grip strength, walking speed, and skeletal muscle index above the reference values. [Conclusion] The overall prevalence of sarcopenia in older adults certified with long-term care insurance in day-care rehabilitation was very high (51.6%). The prevalence of sarcopenia was high in females at the present facility. For most females, one or more of the grip strength, walking speed, and skeletal muscle mass index were below their reference values.

[Purpose] The purpose of this study was to determine the prevalence of the ability to voluntarily contract the pelvic floor muscles in young females. [Participants and Methods] The participants were 29 healthy young females without childbirth experience. We confirmed whether they could voluntarily contract their pelvic floor muscles using an ultrasound imaging device, and the extent of the movement was measured. The contracted state was defined as that in which the bladder bottom could be kept in the lifted position for more than 3 seconds without pushing the bladder down to the caudal side due to contraction of the trunk muscle group. [Results] Eleven females (38%) were able to voluntarily contract the pelvic floor muscles; 18 (62%) could not. [Conclusion] More than 60% of females could not correctly voluntarily contract their pelvic floor muscles in this study.

[Purpose] The purpose of this study was to examine the association between physical fitness and academic achievement in elementary school students of grades 3 to 6, and to further examine the changes in the association over time. [Participants and Methods] The participants were 138 healthy elementary school students. The scores of muscular strength, flexibility, instantaneous power, and endurance were calculated from the results of physical fitness tests conducted at school. In addition, the deviation value of each subject was calculated from the results of an academic achievement test, and the relationship between each deviation value and physical assessment score was examined using Spearman’s correlation coefficient (ρ). [Results] There was a significant correlation between each physical assessment score and academic achievement; however, the correlation coefficient was low (ρ<0.4). [Conclusion] The results of the examination using longitudinal data show there wasn’t a high correlation between physical strength and academic achievement in school-age children, suggesting that many factors influence the development of physical fitness and academic achievement.

[Purpose] An assessment of perinatal brain damage characteristics and prognosis was performed using early MRI findings. [Participants and Methods] Cranial MRIs of children receiving rehabilitation, taken at discharge from NICU, were visually assessed for abnormal lesions, and measured for the diameters of the regions, and the results were compared with clinical features. [Results] In all gestational age groups, abnormal findings in MRI were frequently found in cerebral white matter (WM). WM abnormality was found in all regions of the 22–26 gestational weeks (GW) group, the intermediate and periventricular regions of the 27–32 GW group, the intermediate region of the 33–36 GW group, and the subcortical region of the 37–40 GW group. Subcortical WM abnormality showed high incidences of autism spectrum disorder, quadriplegia and severe intellectual disability. Periventricular WM abnormality showed relatively high incidences of mild intellectual disability and spastic diplegia. [Conclusion] Cerebral WM abnormality is a characteristic of each gestational age group, and it is important to estimate prognosis in early infancy and start preventive rehabilitation.

[Purpose] The purpose of this study was to inspect the effect of sustained exercise and intermittent exercise on oxygen change in the vastus lateralis muscle. [Participants and Methods] The participants were 17 healthy males and females. Sustained exercise was performed for 30 minutes at 50% of maximal oxygen uptake, and intermittent exercise was performed for 10 minutes followed by rest of 5 minutes three times. Muscle oxygenation, oxygen uptake, carbon dioxide emission, and cardiac output were measured, and the two exercise conditions were compared. [Results] Muscle oxygenation and cardiac output showed no significant differences between the two conditions, but the oxygen intake and carbon footprint were significantly different with sustained exercise showing lower values than intermittent exercise. [Conclusion] Feelings of dyspnea were felt less in intermittent exercise than in sustained exercise, suggesting that it could be more easily performed.

[Purpose] To investigate the change in intramuscular fat in the quadriceps of stroke patients in a convalescent rehabilitation ward. [Participants and Methods] Two stroke patients in a convalescent rehabilitation ward participated in this study. Intramuscular fat in the quadriceps of the paretic and non-paretic limbs was measured using transverse ultrasound imaging at admission and 3 months later. [Results] Intramuscular fat of both patients decreased after a 3-month hospital stay [case A (paretic side: −2%, non-paretic side: −12.1%); case B (paretic side: −30.7%, non-paretic side: −25.1%)]. The participants' Functional Independence Measure and Fugl-Meyer lower extremity scores after 3 months stay were higher than those of admission. [Conclusion] Intramuscular fat in the quadriceps of stroke patients in a convalescent rehabilitation ward may decrease after a 3-month rehabilitation program together with improvement of lower limb function.

[Purpose] Mechanical insufflation-exsufflation (MI-E) significantly improved atelectasis of the right medial lobe, lower lobe and lower left lobe, and thoracic compliance (Cdyn) in a subject with severe motor and intellectual disabilities (SMID). [Participant and Methods] The subject was a 30-year-old with SMID. Ventilator management under tracheotomy for quadriplegia, scoliosis with Cobb angle 92.8°, and passive right lateral decubitus posture was incomplete. Postural drainage + MI-E was performed for atelectasis of the right middle lobe and the lower lobe. Due to the severity of scoliosis, insufficient postural drainage + MI-E was performed on the lower left lobe. [Results] Atelectasis of the middle and lower lobes of the right lung disappeared, but partial atelectasis of the left lower lobe did not improve. Cdyn improved significantly after 6 weeks of intervention. [Conclusion] Insufficient postural drainage did not improve atelectasis. It took one month to improve Cdyn.

[Purpose] This paper reports the outcomes of intervention using the training device Active Vision Indicator (AVI) to improve upper-limb ataxia after cerebellar infarction. [Participant and Methods] A male patient in his seventies, who had suffered cerebellar infarction approximately 3 years previously. To improve his upper-limb ataxia, intervention using AVI was provided, and its outcomes were evaluated, adopting the ABAB design and 3 indices: the finger-nose-finger test score, dotting test score, and total trajectory length when reaching. [Results] In assessment after the second term of intervention compared with the initial assessment, the number of finger pulp contacts increased in the finger-nose-finger test, and there was a decrease of approximately 0.2 cm in the distance from the center in the dotting test. The total trajectory length when reaching was also shortened by 4 cm. [Conclusion] Intervention using AVI may be effective for patients with ataxia involving visual-motor dysfunction.

We visited three hospitals in Bangkok to 1) summarize the medical situation, 2) understand the situation and education of physical therapy, and 3) understand the approaches to stroke and osteoarthritis in Thailand. The role required of physical therapy is increasing due to rapid aging in Thailand. Physical therapists in Thailand obtained direct access in 2004. There are background organizational approaches such as improvement of education and a national examination system for licensing. In clinical practice, lots of mechanical devices that incorporate virtual reality technology are being used, which contributes to standardized assessment and treatment. Although this report describes only advanced physical therapy, and narrowly focuses on only part of the situation in Thailand, there are points to be referenced for Japan.