Patients with chronic obstructive pulmonary disease (COPD) often complain of disorders not only during walking but also in arm-raising postures of daily activities. In the present study, six COPD patients undertook quantitative armergometer exercise training, and their subjective clinical conditions, trunk function, and exercise performance were compared between before and after the training. After the training, dyspnea was significantly improved with an increase in breathing capacity, and the COPD patients showed improvement in trunk plasticity and back muscle strength. These suggest that the quantitative asrmergometer exercise training may play an effective role in improving dyspnea.

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We examined clinical features of 246 patients who had received Home Oxygen Therapy (HOT) during the period from 1984 to the end of 1991 in our hospital. Their clinical characteristics consisted of; 1) basic diseases frequently observed were pulmonary emphysema, tuberculous sequela, diffuse panmicro-bronchitis, lung cancer, and fibroid lung, 2) most of patients were the aged, 3) the patients showed remarkably lower lung function with hypoxemia and severe dyspnea, 4) they were vulnerable to infection, and 5) their prognosis highly depended on basic disease. Chest physical therapy for the patients with relatively longer prognosis like those with pulmonary emphysema, tuberculous sequela, and diffuse panmicrobronchitis should be performed with the aim of preventing respiratory infection and improving breathing function. While, for the patients with poor prognosis like those with lung cancer and fibroid lung, primary purposes of the therapy should be to maintain their total physical conditions and to control dyspnea.

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Of 42 patients with chronic respiratory diseases, we measured oxygen saturation (SpO₂) during the 6-minutes walk distance (6MD) test in order to investigate the relationship between SpO₂ response and pulmonary function and motor endurance. The patients were divided into three groups according to SpO₂ response, and their pulmonary function, blood gas, Hugh-Jone's breathlessness stage (H-J), and ADL score were recorded. For examining the effectiveness of chest physical therapy (CPT), those items were re-evaluated in 31 patients after CPT. It was found that the patients with a larger decrease in SpO₂ during 6MD test showed severer pulmonary diseases and lower ADL scores. After CPT there was no difference in improvement of pulmonary function and motor endurance among the three groups. Even the patietns with a larger decrease in SpO₂ during 6MD test indicated improvement in H-J and SpO₂ response. However, there was a patient who showed a decrease in SpO₂ after CPT, which provided us with lots of suggestions regarding a guidance for the patients. The measurement of SpO₂ during 6MD can be useful for examining not only motor endurance but also severity of the disease and limiting factors for physical performance of the patients with chronic respiratory diseases.

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Among 20 patients (11 males and 9 males) with cerebrovascular disease, knee extensor muscle strength of unaffected side was evaluated in peak torque of the maximum isometric contraction, rate of muscle strength development, and muscular fatigue. The mean peak torque of the patients was 7.8±2.1 kg·m in males and 5.6±1.9 kg·m in females, and that of healthy controls was 12.1±2.3 kg·m in males and 7.2±2.1 kg·m in females. Irrespective of the sexes, the mean peak torque of the patients was significantly lower than that of healthy controls. The mean muscle strength incidence of the patients was 23.3±13.3 kg/sec in males and 17.7±9.5 kg/sec in females, and that of healthy controls was 35.7±11.8 kg/sec in males and 25.9±13.5 kg/sec in females, exhibiting a significant difference between the patients and controls. The rate of muscle strength development for the initial 2 sec to peak torque was lower in the patients than in controls, showing no significant difference. The decreasing rate of peak torque after 30 repetitive muscle contractions was significantly higher in the patients compared with controls. These results purport that muscular quickness and endurance should especially be heightened in muscle strengthening exercise for hemiplegic patients.

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Of hemiplegic patients after stroke, reciprocal muscle contraction was examined by recording changes in amplitudes of antagonist-dominant H reflex during voluntary dorsiflexion of an ankle. It was elucidated that during the dorsiflexion 1) the amplitude was decreased in healthy controls, and 2) the hemiplegic patients showed a significant increase in the amplitude with anomalous simultaneous contraction of agonist and antagonist. In addition, 3) there was a positive correlation between change rate of the amplitude and spastic score.

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Seven patients with pulmonary emphysema (PE) received inspiratory muscle training with PFLEX followed by the preparation of protocol including regular evaluation, and their improvements were studied after discharge from hospital. Before training, the patients showed grade III of Hugh-Jones classification with severer obstructive disorders than middle level. Prior to, and 4 and 8 weeks after the training, maximal inspiratory pressure (MIP) and maximal voluntary ventilatory (MVV) were measured in order to evaluate inspiratory muscle strength and breathing muscle endurance, respectively. Compared with MIP before training, those 4 and 8 weeks after training significantly increased both in RV and FRC, which suggests an effectiveness of the training for inspiratory muscle strength. However, MVV was found unchanged, suggesting no improvement in breathing muscle endurance.

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Longitudinal changes in walking efficiency were examined by physiological cost index (PCI) among eight hemiplegic outpatients who were instructed to perform outdoor walking of over 15 min twice a day for seven months. The initial PCI values of the patients were 0.57±0.31 in comfortable walking and 0.73 ±0.38 in maximal walking, which were significantly higher than those of healthy subjects (p<0.01). After 7-month habitual exercise, the PCI values were decreased by 19.3% in comfortable walking and by 27.4% in maximal walking. This suggests that walking efficiency of hemiplegic patients may be elevated by habitual exercise.

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The final goal of rehabilitation for lower limb amputation is to establish walking by using lower extremity prosthesis. Depending on limited conditions of individual amputees and prostheses, we often find it difficult to attain to satisfactory results. With a special attention to the function of prosthesis, this lecture introduces prostheses widely used, those with some modifications, and those in the developing stages. In the case report of above-knee prosthesis, walking efficiency was examined to clarify how the quality of parts of prosthesis affects walking.

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In order to demonstrate the recent trends in electrical stimulation therapy as well as its problems, the author compared papers presented in domestic journals and scientific meetings with those appearing in “Physical Therapy” magazines during the 3-year period from 1991 to 1993. Electrical stimulation therapy has been mainly administered for muscle strengthening in Japan, while it has frequently used for the treatment of injuries and ulcers and for the inhibition of edema formation in western countries. In “Physical Therapy” magazines, there have appeared lots of fundamental studies with animal subjects. It was further confirmed that the functional mechanism of electrical stimulation should be elucidated by the accumulation of those fundamental studies.

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