[Purpose] This study investigated the characteristics of patellar alignment and their effect on the reduction in maximum knee flexion angle after total knee arthroplasty (TKA). [Participants and Methods] Twenty-eight participants who underwent TKA were recruited for this study. Age, Body Mass Index, maximum knee flexion angle, patella alignment (lateral tilt, lateral shift) were evaluated. We divided participants into a group with a postoperative decrease in maximum knee flexion angle, and a group with a postoperative increase in maximum knee flexion angle. We examined the associations in each of the two groups of each of the measurement items. [Results] The results show that the maximum knee flexion angle decrease group had significantly higher values of preoperative and postoperative patella lateral shift and postoperative patella lateral tilt. [Conclusion] The results suggest that the maximum knee flexion angle decreases postoperatively when patella lateral tilt increases postoperatively, and patella lateral shift is large preoperatively and postoperatively.

[Purpose] To examine changes in indoor life-space and subjective well-being due to home-visit rehabilitation. [Participants and Methods] Eight new home-visit rehabilitation users with orthopedic disease participated in this study. The Home-based Life-Space Assessment (Hb-LSA) was used to analyze indoor life-space, and the Philadelphia Geriatric Center Morale Scale (PGC-MS) was used to evaluate subjective well-being. [Results] After 6 months, both Hb-LSA and PGC-MS had significantly improved. [Conclusion] Home-visit rehabilitation improved life-space according to the life function of users, and Hb-LSA has the potential to provide a detailed assessment of the changes. Besides, the results show that improvements in ADL and life-space may improve subjective well-being.

[Purpose] The assessment of non-operative knee function is important for the recovery of activities of daily living (ADL) of patients with knee arthroplasty. Therefore, we established reference intervals (RIs) for knee muscle strength and range of motion, taking into account the factors that affect values before and after surgery. [Participants and Methods] We evaluated knee muscle strength and range of motion in knee extension and flexion, as well as knee extension and flexion joint range of motion in 390 patients who had undergone knee arthroplasty, excluding those who had undergone the same surgery on the opposite side. The partitioning of RI by these factors was judged using the standard deviation ratio (SDR) representing the magnitude of between-subgroup differences. Variables were evaluated, and the SDR was calculated, and 0.3 was used as a stratification criterion. [Results] From the SDR values, it was judged that each muscle strength and each range of motion should be stratified by gender and by whether the knee arthropathy was unilateral or bilateral. The RIs were established using the Box-Cox parametric method for muscle strength and by a nonparametric method for range of motion. [Conclusion] The reference range of non-operative knee function is useful for evaluating knee function before and after surgery.

[Purpose] The purposes of this study were to compare the respiratory function of non-obese and obese young healthy subjects, and to clarify the relationship between the respiratory function and the body composition (e.g. the amount of skeletal muscle in the limbs). [Participants and Methods] The subjects were defined as non-obese if their Body Mass Index (BMI) was less than or equal to 24 and their waist was less than 84 cm, and as obese if their BMI was greater than or equal to 25 and their waist was greater than or equal to 85 cm. [Results] The obese group had significantly higher %VC and %FEV1.0 than the non-obese group. In the non-obese group, there was a negative correlation between %PImax and BMI. In the obese group, there was a significant positive correlation between %ERV and right upper extremity muscle mass and BMI. [Conclusion] The results suggest that obesity may reduce respiratory function in young people.

[Purpose] To clarify the effects of abdominal breathing on mood and cerebral blood flow. [Participants and Methods] Ten healthy adult subjects performed slow abdominal breathing or normal control breathing in a sitting position for 10 minutes. This was followed by a Stroop task for 3 minutes. During the experiments, frontal oxygenated hemoglobin (Oxy-Hb) was continuously measured using functional near-infrared spectroscopy (fNIRS). The mood state was evaluated using a mood profile test before and after the abdominal or control breathing, and after the Stroop tasks. [Results] Confusion-bewilderment, tension-anxiety, and total mood disturbance decreased after abdominal breathing, and the decrease in tension-anxiety persisted after the Stroop task. Oxy-Hb decreased after abdominal breathing, but increased after normal breathing. Oxy-Hb increased after the Stroop task under both breathing conditions. [Conclusion] 1) Abdominal breathing improves mood and inhibits blood flow to the frontal lobe. 2) When psychological stress was applied after abdominal breathing, the decrease in tension-anxiety persisted, suggesting that mood continued to improve and that blood flow to the frontal lobe was slightly reduced.

[Purpose] To investigate changes in self-efficacy of physical therapy students before and after clinical training, and to examine the factors related to these changes. [Participants and Methods] A questionnaire survey was conducted of 142 fourth-year students at a physical therapist training school before and after the first and second terms of training. The questionnaire items mainly focused on the trait self-efficacy scale and questions about practice. [Results] Self-efficacy was significantly improved after the second term of training compared to before the training. The group with unchanged or improved self-efficacy had significantly higher scores for the items of number of assignments, goal attainment, task attainment, understanding of cases, positive behaviors of supervisors, and sense of accomplishment in the questions about practice after the second term compared to the group with decreased scores. [Conclusion] The results suggest accumulated clinical training and the content of the final training had an effect on the change in self-efficacy.

[Purpose] To clarify the prevalence and characteristics of complications of obstructive ventilatory disturbance in motor disorders treated with physical therapy after orthopedic surgery. [Participants and Methods] The patients were males aged 40 or older with rotator cuff tears, who had received physical therapy after surgery in the study facility. Their backgrounds, preoperative respiratory function test results, and status of smoking were retrospectively examined to clarify the prevalence and characteristics of complications of obstructive ventilatory disturbance among them. [Results] A total of 101 patients were analyzed. Complications of obstructive ventilatory disturbance developed in 6 (5.9%), and 3 of them were current smokers (Brinkman index: 1000 or higher) aged 70 or older. [Conclusion] It is necessary for physical therapists to recognize that obstructive ventilatory disturbance may be present in some elderly patients with motor disorders and a smoking history.

[Purpose] To clarify the effect of exercise guidance for day care service users refraining from going out (self-restraint) due to infection with the new coronavirus (COVID-19), provided by a physical therapist. [Participants and Methods] The participants were 21 day care/rehabilitation services users. The physical therapist, who had been treating these users with exercises as regular physical therapy daily, sent self-training guidance documents to them, so that they could perform the same exercises in their homes during the self-restraint period. The effect of this approach was evaluated using a questionnaire on self-training, the Timed Up & Go Test (TUG), and Hasegawa Dementia Scale-Revised (HDS-R) through comparison between before and after self-restraint. [Results] Twelve and 9 were classified into self-training and non-self-training groups, respectively. After self-restraint, there were no marked changes in the self-training group’s TUG scores, whereas those of the non-self-training group significantly worsened (the time needed significantly increased). [Conclusion] The results suggest that self-restraint due to COVID-19 decreases mobility, and exercise guidance provided by physical therapists prevents physical dysfunction.

[Purpose] This study investigated the association between cough peak flow and the chest and abdominal wall mobility of older adults. [Participants and Methods] Cough peak flow, chest and abdominal wall mobility (upper chest, lower chest, and abdomen) of 188 community-dwelling older adults (63 males, 125 females) were assessed using the breathing movement scale and respiratory function (forced vital capacity, forced expiratory volume in 1 s, and maximum inspiratory and expiratory pressures). [Results] The female participants had lower values of all the measurement items except age, body mass index, and upper chest wall mobility. In multiple regression analyses by sex, the value of the abdominal scale was a significant predictor of cough peak flow in both sexes. [Conclusion] This study provides evidence that cough strength may be associated with abdominal wall mobility in ambulatory community-dwelling older adults.

[Purpose] To clarify the current status of rehabilitation for elderly cancer patients admitted to the study facility. [Participants and Methods] A total of 109 inpatients aged 65 or older, treated with oncology rehabilitation, were included to collect information mainly on primary lesions and the details of rehabilitation from their medical records. [Results] The rates of patients with primary lesions in the digestive and respiratory systems, those at the palliative care phase, and those living with other family members were high. They had received rehabilitation until immediately before discharge and 92% had maintained their physical/mental functions throughout hospitalization. As for the details of rehabilitation, more than 80% of all patients received gait and bed-to/from-wheelchair transfer trainings during physical therapy, range-of-motion and bed-to/from-wheelchair transfer trainings during occupational therapy, and eating, swallowing, and communication trainings during speech-language-hearing therapy. [Conclusion] In inpatient rehabilitation for elderly cancer patients, interventions to maintain their physical/mental functions throughout hospitalization, focusing on their lives after discharge, are required.

[Purpose] The purpose of this study was to clarify the orthosis issues which ought to be tackled in clinical training. [Participants and Methods] The participants were 118 physiotherapists at a single facility. The questionnaire asked about years of experience, experience of supervisor, team in charge, facility equipment of lower extremity orthoses, percentage of vocational schools giving instruction on lower extremity orthoses, knowledge and techniques that students lack, frequency of use of orthoses by physiotherapists, students’ frequency of observation and experience of lower extremity orthoses, causes of insufficient observation and experience, etc. [Results] More than 70% of students had observation and experience of orthoses less than once a week. The causes of insufficient observation and experience were lack of cases and lack of instruction at vocational schools. A few vocational schools gave instruction on lower extremity orthoses. [Conclusion] Vocational schools need to be specific about instruction regarding lower extremity orthoses.

[Purpose] The purpose of this study was to investigate the standard value of the mechanical axis inclination angle (MIA) during one-leg standing, and clarify the relationship between MIA and the motions of the trunk and pelvis. [Participants and Methods] Twenty-four healthy young males (n=12) and females (n=12) participated in this study. MIA and each joint angle of the trunk and lower limbs were measured with the subjects performing one-leg standing with or without a lateral wedge insole. [Results] MIA of females was significantly greater than that of males. MIA correlated with both the trunk and pelvic angles. No significant difference was found between with or without the lateral wedge insole. [Conclusion] There is a standard value of MIA in healthy persons, suggesting there is a postural strategy based on the trunk and pelvis to keep MIA constant when knee joint alignment changes during one-leg standing.

[Purpose] To identify factors influencing vascular endothelial function in male university students. [Participants and Methods] A total of 34 healthy male university students were included to examine the relationships between vascular endothelial function (flow-mediated dilation: FMD) and the following parameters: body composition, blood pressure (systolic blood pressure: SBP; and diastolic blood pressure: DBP), and intensity-based physical activity (low: LPA; moderate: MPA; vigorous; VPA; and moderate to vigorous: %MVPA). [Results] The mean FMD was 8.1 ± 2.2%. FMD was significantly, positively correlated with VPA and %MVPA (r=0.432, 0.383, respectively). In the normal FMD group, it was significantly, negatively correlated with DBP (r=－0.445). Furthermore, VPA was significantly higher in this compared with the decreased FMD group. [Conclusion] Male university students’ vascular endothelial function was suggested to be influenced by the duration of high-intensity physical activity and DBP.

[Purpose] The purpose of this study was to examine the temporal changes of the modified Gait Efficacy Scale (mGES) of patients admitted to convalescent rehabilitation wards. [Participants and Methods] Eleven patients with lower limb fracture participated in this study. mGES was measured at admission, then monthly, and at discharge, and at the time of walking independence in the ward. [Results] mGES showed significant differences between at admission, at the time of walking independence, and at discharge. The mGES scores at admission, at the time of independence of walking in the ward, and at discharge were higher in the same order. Compared to just before walking independence, mGES had significantly increased at just after walking independence. The change in mGES before walking independence was significantly higher than after walking independence. [Conclusion] The results suggest that gait self-efficacy is more likely to improve before walking independence than after walking independence.

[Purpose] This study determined the reliability and minimal detectable change of lower extremity muscle thickness measurements and ultrasound echo intensities of inpatients with stroke. [Participants and Methods] Ten patients with acute stroke were included in the study. Muscle thickness and echo intensity were measured of both leg muscles to assess muscle mass and muscle quality using ultrasonography. In order to verify the reliability of muscle thickness and echo intensity measurements, the intraclass correlation coefficient (ICC), standard error of measurement, 95% limit of agreement, and the minimal detectable change of the 95% confidence interval (MDC₉₅) were calculated. [Results] The ICC was more than 0.70 for both the muscle thickness measurements and echo intensities, demonstrating high reliability. The MDC₉₅ for muscle thickness ranged from 0.18 to 0.32 cm on the unaffected side and 0.13 to 0.30 cm on the affected side. The MDC₉₅ for echo intensity ranged from 6.83 to 11.81 a.u. on the unaffected side and 6.21 to 13.49 a.u. on the affected side. [Conclusion] Evaluation of skeletal muscle by ultrasound of inpatients with stroke was highly reliable. These findings should contribute to future evaluations of the effectiveness of rehabilitation interventions by clarifying the MDC.

[Purpose] We monitored the physical function, physical activity self-efficacy (SE) and health-related quality of life (HRQOL) recovery of patients for 2 years after total knee arthroplasty (TKA). [Participants and Methods] Thirty-three first-time unilateral TKA recipients were evaluated using the timed up-and-go test, one-leg standing time with eyes-open, and Western Ontario and McMaster Universities Osteoarthritis Index (Japanese) pain and function components. The Physical Activity SE Scale for the Frail Elderly was used to measure self-efficacy, and SF-36v2 was used to evaluate HRQOL. [Results] Physical function and all scales of physical activity SE, SF-36v2 physical function, role physical and bodily pain had significantly improved at 3 months post-operatively, and with the exceptions of vitality and mental health, the other 6 scales maintained significant improvements up to 2 years after surgery. [Conclusion] Physical function and physical activity SE, and HRQOL, except for psychological measures, of TKA patients improved within 3 months post-operatively and these improvements were maintained up to 2 years postoperatively.

[Purpose] To clarify the characteristics of non-resistance training in elderly patients participating in outpatient cardiac rehabilitation. [Participants and Methods] Twenty-four outpatients (mean age 78.9 ± 7.8 years) were administered a questionnaire on health-related quality of life and self-efficacy. The participants were divided into two groups: those who underwent resistance training each time (11 participants) and those who did not (13 participants). [Results] The non-performing group had significantly lower physical component summary (PCS) scores and significantly higher role/social component summary (RCS) scores in the SF-36 health survey than the performing group. [Conclusion] It is necessary to assess the physical and social aspects of outpatient cardiac rehabilitation and to consider interventions that embed resistance training.

[Purpose] The purpose of this study was to longitudinally examine the skeletal muscle strength in skeletal muscle function and related factors in patients with chronic obstructive pulmonary disease (COPD) belonging to Group A of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, indicating mild disease. [Participants and Methods] Physical characteristics such as the skeletal muscle strength and skeletal muscle mass of 23 male COPD patients belonging to Group A were analyzed. [Results] Muscle mass was retained after 1 year, but grip strength had significantly reduced. There was no significant relationship between initial physical characteristics and the change in grip strength after 1 year. [Conclusion] In COPD patients in Group A, muscle weakness was observed after 1 year, and impairment appeared in the upper limbs, not in the lower limbs, indicating the presence of disease-specific skeletal muscle dysfunction.[Purpose] The purpose of this study was to longitudinally examine the skeletal muscle strength in skeletal muscle function and related factors in patients with chronic obstructive pulmonary disease (COPD) belonging to Group A of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, indicating mild disease. [Participants and Methods] Physical characteristics such as the skeletal muscle strength and skeletal muscle mass of 23 male COPD patients belonging to Group A were analyzed. [Results] Muscle mass was retained after 1 year, but grip strength had significantly reduced. There was no significant relationship between initial physical characteristics and the change in grip strength after 1 year. [Conclusion] In COPD patients in Group A, muscle weakness was observed after 1 year, and impairment appeared in the upper limbs, not in the lower limbs, indicating the presence of disease-specific skeletal muscle dysfunction.

[Purpose] To examine the relationship between sitting pressure and lateral bending of the trunk by categorizing sitting pressure as greater on one side. [Participants and Methods] The participants were 20 healthy adult males: 10 put pressure on the right side, and 10 put pressure on the left side. Sitting pressure was measured with a floor reaction force meter. The lateral inclinations of the upper and lower trunk were measured with Kinovea software and compared, and the correlation between sitting pressure and lateral inclination of the trunk was determined. [Results] The left side sitting pressure group showed a difference in the left and right trunk lateral flexion angles between the upper trunk and the lower trunk (p＜0.05). A significant correlation was shown between the right sitting pressure group and the right bending angle of the lower trunk, and the right sitting pressure group and the left bending angle of the upper trunk (| r |＝－0.7～－0.65). The left sitting pressure group showed a significant correlation with the left and right trunk lateral flexion angles in the upper trunk (| r |＝－0.65～0.82). [Conclusion] Leaning to the side where one puts more pressure when sitting causes greater bending of the upper trunk; leaning to the opposite side causes bending of the lower trunk.

[Purpose] This paper reports a case, where intervention, mainly promoting the integration of information from several somatic senses in the cervical region, was effective to continuously manage chronic pain after surgery for cervical spondylosis by improving the cognitive/emotional aspects of pain and resolving its vicious cycle. [Participants and Methods] The patient was a female in her eighties, who had undergone cervical fusion surgery for cervical spondylosis about 5 months previously. As defensive contraction and fear were reduced by promoting the integration of information from several somatic senses involved in cervical motor control (deep sensation in the neck, tactile pressure perception in the back of the head, and weight perception in the head), she performed active assistive neck exercise combined with this. [Results] Chronic pain in the cervical region was alleviated, activities of daily living improved, and fear of pain and active exercise was reduced. [Conclusion] This intervention may be effective to manage chronic pain in the cervical region after surgery.

[Purpose] We report the case of a patient with myxedema who was successfully weaned from mechanical ventilation (MV) after cardiopulmonary resuscitation due to coma. [Participant and Methods] A 48-year-old woman restarted spontaneous circulation within 20 minutes after cardiopulmonary resuscitation. However, the patient suffered from post-resuscitation encephalopathy accompanied by myxedema coma, and required intensive care with MV. [Results] On the 22nd day of hospitalization, when the patient was being treated with manually assisted respiration in a supine position to promote ventilation, apnea was frequently observed. Our multidisciplinary medical team conducted intensive respiratory care, promoted bed leaving, and gradually trained the respiratory muscles. The patient was successfully weaned from MV on the 43rd day, and transferred to another hospital on the 50th day of hospitalization. [Conclusion] The results of this case suggest that respiratory rehabilitation with accurate characterization of the underlying metabolic disease and proper respiratory care is essential for weaning from MV.

[Purpose] To investigate whether developmental stages focused interventions are effective in preventing motor developmental delays in a very low birth weight infant. [Participant and Methods] The participant was a baby girl who was born weighing 755 g. Developmental stages focused interventions took into account the modified age of the child and allowed the child to experience movements that should be acquired during the next developmental stages. The frequency of the intervention was twice a week and the intervention duration was 40 minutes per session. [Results] In this infant, the process of motor development to the sitting position was similar to that of a regular term baby. [Conclusion] The results of developmental stages focused interventions for a very low birth weight infant suggest that they may be effective in preventing motor developmental delays.

[Purpose] To examine evidence supporting the effectiveness of physical therapy for complications of poor posture due to physical inactivity. [Methods] Relevant research papers available in a literature database were systematically searched for, and qualitatively and quantitatively analyzed. [Results] Among 415 papers identified by entering searching phrases and adding options, 30 and 11 were adopted for qualitative and quantitative analyses, respectively. A systematic review of these papers clarified that physical therapy had been reported to be effective in terms of body functions/structure, symptoms, and abilities in a relatively large number of studies. On the other hand, meta-analysis revealed that motor training to improve spinal stability/postural control and interventions to manage pain in each body part by promoting activity had been ineffective. [Conclusion] Only a limited number of papers were quantitatively analyzable, but the results of qualitative analysis suggest the possibility of physical therapy improving complications of physical inactivity-associated poor posture. To establish evidence for this, further high-quality studies are required.