kanada yoshikiyo

OBJECTIVE: When performing knee extension using a leg extension machine, the lower limb is pushed back in the direction in which knee flexion occurs in response to the freefall of the weight after maximal knee extension. Therefore, eccentric contractions of the knee extensors are needed, which may lead to cumulative fatigue of the extensors, consequently reducing the reliability of the knee extensor torque values. This study aimed to determine the relationship between joint torque and angular velocity in one repetition maximum (1RM) measurement for knee extension using a leg extension machine with and without a modification to prevent counter-rotation. METHODS: Twenty-one healthy adult men (mean age: 27.7±5.4 years) participated in the study. A leg extension machine was modified to prevent counter-rotation due to the freefall of weights. The subjects performed knee extension using the modified leg extension machine, and the joint torque and angular velocity were calculated using two-dimensional analysis. A regression equation between these two factors was created to estimate the maximal isometric torque. RESULTS: Both the joint torque and angular velocity tended to increase after modification of the leg extension machine, although these differences were not significant. Similarly, there were no significant post-modification changes in the estimated maximal isometric torque. CONCLUSIONS: Our results showed that the joint torque, angular velocity, and estimated maximal isometric torque remained unchanged after machine modification; thus, the modified leg extension machine may make it possible to produce the knee extensor torque more safely in 1RM measurement.

<p>We initiated the Robotic Smart Home (RSH) project to develop a comfortable, safe home environment for all people, including the elderly and individuals with disabilities. An important consideration when introducing robots into a home environment is the confined living space, the so-called space problem. The RSH project plans to simultaneously develop robots and an architectural design for living spaces to create an optimal home environment that will help elderly people live independently at home for longer periods. The RSH accommodates the following three robotics and assistive systems: mobility and transfer assist system, operational assist system, and information assist system. The mobility and transfer assist system includes three types of devices (lifting type, lateral-transfer type, and suspension type), which can be available to users as appropriate according to the severity of their disability. The operational assist system combines a hand robot with an environmental control system for the convenience of users. An information assist system connects the RSH with remote locations for communication. Inside the RSH, a home automation and monitoring system connected to the Internet of Things provides residents with comfort and security. As part of this project, two RSH centers have been established for effective facility adoption.</p>

Background: The spatiotemporal parameters were used for sophisticated gait analysis in widespread clinical use. Recently, a laser range sensor has been proposed as a new device for the spatiotemporal gait measurement. However, measurement using a single laser range sensor can only be used for short-range gait measurements because the device irradiates participants with lasers in a radial manner. For long-range gait measurement, the present study uses a modified method using dual laser range sensors installed at opposite ends of the walking path. The aim of present study was to investigate the concurrent validity of the proposed method for spatiotemporal gait measurement by comparison to a computer-based instrumented walkway system. Methods: Ten healthy participants were enrolled in this study. Ten-meter walking tests at 100, 75, and 50% of the comfortable speed were conducted to determine the concurrent validity of the proposed method compared to instrumented walkway measurements. Frequency distributions of errors for foot-contact (FC) and foot-off (FO) estimated times between the two systems were also calculated to determine the adequacy of estimation of FC and FO from three perspectives: accuracy (smallness of mean error), precision (smallness of variability), and unambiguity (monomodality of histogram). Intra-class correlation coefficient (2,1) was used to determine the concurrent validity of spatiotemporal parameters between the two systems. Result: The results indicate that the detection times for FC and FO estimated by the proposed method did not differ from those measured by the instrumented walkway reference system. In addition, histogram for FC and FO showed monomodality. Intra-class correlation coefficients of the spatiotemporal parameters (stance time: 0.74; double support time: 0.56; stride time: 0.89; stride length: 0.83; step length: 0.71; swing time: 0.23) were not high enough. The mean errors of all spatiotemporal parameters were small. Conclusions: These results suggest that the proposed lacks sufficient concurrent validity for spatiotemporal gait measurement. Further improvement of this proposed system seems necessary. Trial registration: UMIN000032710. Registered 24 May 2018. Retrospectively registered.

BACKGROUND: Treatment with Botulinum toxin A (BoNT-A) is effective in decreasing upper limb spasticity. OBJECTIVE: This study aimed to determine the differences in the outcome based on the upper limb motor function before BoNT-A treatment. METHODS: The subjects were 61 patients who underwent BoNT-A treatment for upper limb spasticity. Limb function was evaluated using the Fugl-Meyer Assessment upper extremity (FMA-UE), modified Ashworth scale, passive range of motion and disability assessment scale before treatment as well as 2, 6, and 12 weeks after treatment. We divided the total and each subscale of FMA-UE before BoNT-A administration into beyond-the-mean-score group (higher score group) and below-the-mean-score group (lower score group). RESULTS: In both the higher and lower score groups of the FMA-UE total and modified Ashworth scale scores improved significantly after treatment. In FMA-UE, the higher score group of subscale A improved significantly, but subscale C decreased significantly at 2 and 6 weeks after the administration. The lower score group of total, subscale A, and B improved significantly. In the disability assessment scale, the self-dressing capability at 6 weeks and limb position at 2, 6 and 12 weeks after the administration improved significantly in the higher score group. In the lower score group, the hygiene capability at 2 weeks as well as the dressing capability and limb position improved significantly at 2, 6 and 12 weeks after administration. CONCLUSIONS: The time course after administration of BoNT-A differed based on upper limb motor function before injection. When administering BoNT-A into the finger flexor muscles of a patient, we should carefully judge the indications for administration.

BACKGROUND: Most people with hemiplegia experience gait changes after a stroke. Abnormal gait patterns in stroke patients vary across subjects and this make it difficult to assess the cause of gait abnormalities. Therefore, it is necessary to quantitatively evaluate abnormal gait patterns through gait analysis for stroke patients. OBJECTIVE: To develop and evaluate the validity of quantitative assessments of the degree of knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip. METHODS: Forty-six healthy control subjects and 112 people with hemiplegia participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern (knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip) with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the four abnormal gait patterns exhibited by the patients was calculated from the three-dimensional coordinate data. The indices were developed based on the definition of the abnormal gait patterns. The index values for the patients were compared with those of healthy subjects as well as with the results of observational gait assessment by three physical therapists with expertise in gait analysis. RESULTS: Strong correlation was observed between the index value and the median observational rating for all four abnormal gait patterns (-0.64 to -0.86). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects. CONCLUSIONS: The use of these indices in gait analysis of people with hemiplegia can help to diagnose severity of gait disorder, determine the appropriate treatment, and evaluate the effectiveness of the treatment.

Background Intensive motor training with low-frequency repetitive transcranial magnetic stimulation (rTMS) has efficacy as a therapeutic method for motor dysfunction of the affected upper limb in patients with mild to moderate stroke. However, it is not clear whether this combination therapy has the same effect in chronic post-stroke patients with severe upper limb motor impairment. Objectives The aim of this study was to test the treatment effects of intensive motor training with low-frequency rTMS in chronic post-stroke patients with severe upper limb motor impairment. Methods A convenience sample of 26 chronic post-stroke patients with severe upper limb motor impairment participated in this study with the non-randomized, non-controlled clinical trial. All subjects were hospitalized to receive intensive motor training with low-frequency rTMS. During 2 weeks in which Sundays were excluded, a total of 24 sessions (2 sessions per day) of the intervention were conducted. The Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were used to assess motor impairment and function of the affected upper limb, respectively, before and after intervention. Paired t-test was used to analyze the effects of the intervention. Results The FMA total score and WMFT log performance time significantly improved from before to after intervention (FMA: 12.6-18.0; WMFT: 3.6-3.3, p < 0.001). Conclusions The present results suggest that intensive motor training with low-frequency rTMS could improve motor impairment in chronic post-stroke patients with severe upper limb motor impairment and contribute to the expansion of the application range of this combination therapy.

Study Design: Single case report. Introduction: A previous study clarified that spasticity and motor function were improved by combined treatment with botulinum toxin type A (BTX) injection and 1-Hz repetitive transcranial magnetic stimulation (rTMS) with intensive motor training at 4 weeks after injection. However, it is not clear whether 1-Hz rTMS with intensive motor training immediately after BTX injection also improves spasticity and motor function in stroke patients. Purpose of the Case Report: The purpose of this case report is to test the short- and long-term effects of BTX injection and rTMS with intensive motor training on the spasticity, motor function, and usefulness of the paretic hand in a stroke patient. Methods: A 64-year-old male, who suffered from a right cerebral hemorrhage 53 months previously, participated in the present study. BTX was injected into the spastic muscles of the affected upper limb. He then received the new protocol for a total of 24 sessions. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and Motor Activity Log, consisting of the amount of use and quality of movement scales, were assessed before and immediately after BTX injection, at discharge, and monthly for up to 5 months after discharge. Results: For the short-term effects of the therapy, the MAS scores of the elbow and wrist, FMA score, and quality of movement score improved. For the long-term effects of the therapy, the MAS score of the fingers, FMA score, and amount of use score improved for up to 5 months after discharge. Conclusions: The present case report showed the improvement of all assessments performed in the short and/or long term and suggest the possibility of shortening the intervention period of combined therapy of BTX and rTMS with intensive motor training.

Background: The effect of botulinum toxin A (BoNTA) injection on flexed-elbow deformity is usually evaluated using the Modified Ashworth Scale (MAS), but only with the muscle tone at rest. Some patients show the flexed-elbow deformity during gait despite low muscle tone at rest. Objective: This study aimed to evaluate the effect of BoNTA injection on flexed-elbow deformity during gait using a three-dimensional motion analysis system. Methods: Twenty stroke patients with spastic flexed-elbow deformity during gait received BoNTA injections into the upper limb muscles. The MAS score of the elbow flexors, passive elbow range of motion, comfortable overground gait velocity, and elbow flexion angle during treadmill gait were evaluated just before and 2, 6, and 12 weeks after the injection. Twenty-five healthy subjects were also recruited to provide a normal reference of the elbow flexion angle. Results: The MAS scores at 2, 6 and 12 weeks after the injection were significantly lower than that before the injection. Some patients showed no spasticity at rest but an obviously flexed elbow during gait. The elbow flexion angles during gait at 2 and 6 weeks after the injection were significantly lower than that before the injection. Conclusions: BoNTA injections to the upper limb muscles reduced muscle tone at rest and flexed-elbow deformity during gait. However, the elbow flexion angle during gait returned to its pre-injection level sooner than the muscle tone at rest. We strongly recommend evaluating muscle tone during motion and at rest, preferably using three-dimensional motion analysis since it can objectively detect small changes.

The aim of this study was to clarify the intra- and inter-rater reliability of the rate of force development in hip abductor muscle force measurements using a hand-held dynamometer. Thirty healthy adults were separately assessed by two independent raters on two separate days. Rate of force development was calculated from the slope of the force-time curve that was divided into four time intervals (50, 100, 200, and 300 ms). The highest values of the three trials were used for statistical analysis. The intra-class correlation coefficient with a 95% confidence interval, standard error of measurement, and minimal detectable change at the 95% confidence level were calculated for each interval. For assessment of systematic error, Bland-Altman analysis was used. The results indicated that intra-and inter-rater reliability of the highest values at all intervals were sufficient (intra-class correlation coefficient >.7). The Bland-Altman analysis did not show systematic error in either reliability measure.

Purpose: To establish the within-day and between-day intra-rater reliability, inter-rater reliability, validity and systematic errors of the tandem gait test (TGT). Materials and methods: Thirty participants performed the TGT and the timed up and go test (TUG) twice on the first day. Three independent raters measured these tests. After two weeks, the protocol was repeated by one tester to assess between-day reliability. The within-day and between-day intra-rater reliability was estimated by intraclass correlation coefficient (ICC) and Bland–Altman plots to assess systematic errors associated with the learning effect. Inter-rater reliability was estimated by ICC and minimum detectable change at 95% confidence. Concurrent validity was assessed by examination of the correlation between TGT and TUG using Pearson’s correlation coefficient. Results: Within-day and between-day intra-rater reliability were good (ICC > 0.9 and ICC > 0.7). The Bland–Altman plots showed systematic error in the between-day measurements. Inter-rater reliability was supported by strong values for ICC (ICC > 0.9). The Pearson’s correlation coefficient between the TGT and TUG showed a significant positive correlation (r > 0.67, p <.001). Conclusions: These results show that the learning effect of the TGT might be a considerable factor when interpreting follow-up measurements after a few days.

BACKGROUND: The relationship between peak torque of the knee extensor muscles and gait speed was previously investigated in patients with chronic stroke, but whether the rate of force development (RFD), another indicator of muscle strength, affected gait speed remained unknown. OBJECTIVE: To clarify the relationships between the RFD of the knee extensor muscles over multiple time intervals and gait speed in patients with chronic stroke. METHODS: Twenty chronic stroke patients participated in this study. The RFD of affected and unaffected knee extensor muscles was measured. Time intervals of the RFD were set to 0-50 ms, 0-100 ms (100RFD), 0-200 ms (200RFD), and 0-300 ms (300RFD). Gait speed was assessed at comfortable and maximum pace. Pearson correlation coefficient (r) was used to analyze the relationships between RFD and gait speeds. RESULTS: The RFD of affected knee extensor muscles over all intervals was moderately correlated with both comfortable and maximum gait speeds, whereas only limited combinations (100, 200 and 300RFD with maximum gait speed) were correlated on the unaffected side. CONCLUSIONS: The present results suggest that various factors related to the RFD of affected knee extensor muscles, such as neural drive and muscle size, affect gait speed.

AimWe aimed to clarify whether there are differences in the effect of exercise interventions between prefrail older adults and older adults without frailty. MethodsThe participants were community-dwelling older adults (mean age 75.1 5.1 years). The participants were instructed to use a training method at home to prevent frailty. The effects of the intervention were evaluated at 4 months. Outcome measures were the Timed Up and Go test, grip strength, one leg balance, knee extension strength and the fall risk index. The present study used the criteria for frailty status of the National Center for Geriatrics and Gerontology in Japan. The studied sample included prefrail participants (n = 17) and robust participants (n = 24). We compared the value of outcome measures before and after the intervention in each group using two-way repeated measures analysis of variance. ResultsThere were significant differences for the group effect for one leg balance (P &lt; 0.01), and there were significant differences for the time effect for Timed Up and Go, one leg balance and knee extension strength (P &lt; 0.01). In these outcomes, there were no significant interactions between frailty status and intervention. Four prefrail participants (mean age 78.0 +/- 3.8 years) returned to the robust status after the intervention. No participants became frail. ConclusionsThese results suggest that we can expect similar interventional effects for prefrail older adults and robust older adults. It is important that a frail status be prevented in prefrail older adults by using an exercise intervention. Further studies are required to determine the different effects of exercise intervention on prefrail status compared with frailty status in community-dwelling older adults. Geriatr Gerontol Int 2017; 17: 1265-1269.

Background With the development of computer technology, computerized dynamic posturography provides objective assessments of balance and posture control under static and dynamic conditions. Although a force-instrumented treadmill-based balance assessment is feasible for balance evaluations, currently no data exists. Objective This study was undertaken to assess the reliability and validity of balance evaluations using a force-instrumented treadmill. Methods Ten healthy adults participated in evaluations using both the treadmill and the EquiTest. Four balance evaluations were conducted: Modified Clinical Test of Sensory Interaction on Balance, Unilateral Stance, Weight Bearing Squat, and Motor Control Test. Results All balance evaluations using the force-instrumented treadmill method shared good reliability (intraclass correlation coefficient ≥0.6). The Modified Clinical Test of Sensory Interaction on Balance, Unilateral Stance, and Weight Bearing Squat evaluations had a correlation of r &lt  0.5 with EquiTest, whereas the Motor Control Test balance evaluation had moderate correlations (r &gt  0.5) with the EquiTest. Conclusion The results demonstrated that all balance evaluations using the force-instrumented treadmill were reliable, and that the Motor Control Test evaluation was moderately correlated with the EquiTest. Therefore, the use of a force-instrumented treadmill in balance evaluations might provide a certain level of value to clinical practice.

This study investigated the influence of stimulus conditions of transcutaneous electrical nerve stimulation (TENS) on disynaptic reciprocal Ia inhibition (RI) and presynaptic inhibition (D1 inhibition) in healthy adults. Eight healthy participants received TENS (stimulus frequencies of 50, 100, and 200Hz) over the deep peroneal nerve and tibialis anterior (TA) muscle in the resting condition for 30min. At pre- and post-intervention, the RI from the TA to the soleus (SOL) and D1 inhibition of the SOL alpha motor neuron were assessed by evoked electromyography. The results showed that RI was not changed by TENS at any stimulus frequency condition. Conversely, D1 inhibition was significantly changed by TENS regardless of the stimulus frequency. The present results and previous studies pertaining to RI suggest that the resting condition might strongly influence the lack of pre- vs. post-intervention change in the RI. Regarding the D1 inhibition, the present results suggest that the effect of TENS might be caused by post-tetanic potentiation. The knowledge gained from the present study might contribute to a better understanding of fundamental studies of TENS in healthy adults and its clinical application for stroke survivors.

[Purpose] To create a regression formula in order to estimate 1RM for knee extensors, based on the maximal isometric muscle strength measured using a hand-held dynamometer and data regarding the body composition. [Subjects and Methods] Measurement was performed in 21 healthy males in their twenties to thirties. Single regression analysis was performed, with measurement values representing 1RM and the maximal isometric muscle strength as dependent and independent variables, respectively. Furthermore, multiple regression analysis was performed, with data regarding the body composition incorporated as another independent variable, in addition to the maximal isometric muscle strength. [Results] Through single regression analysis with the maximal isometric muscle strength as an independent variable, the following regression formula was created: 1RM (kg)=0.714 + 0.783 × maximal isometric muscle strength (kgf). On multiple regression analysis, only the total muscle mass was extracted. [Conclusion] A highly accurate regression formula to estimate 1RM was created based on both the maximal isometric muscle strength and body composition. Using a hand-held dynamometer and body composition analyzer, it was possible to measure these items in a short time, and obtain clinically useful results.

Background: The toe clearance of a paretic limb in the swing phase of gait is related to tripping, which is considered a major cause of falls. The biomechanical factors for obtaining toe clearance are more complicated in hemiparetic gait than that in normal gait because of the compensatory movements during swing phase. Understanding the biomechanical factors should help in targeting the point for rehabilitative interventions. Objective: To clarify the biomechanical factors behind toe clearance during swing phase in hemiparetic gait. Methods: Fifty patients with hemiparesis after a stroke participated in this study. Three-dimensional motion analysis was used for the kinematic analysis of the hemiparetic gait. The correlation coefficients between limb shortening and angle changes and between limb shortening and hip elevation and foot lateral shift were calculated. Limb shortening was defined as the shortening of the hip-toe distance. The significant factors that determine toe clearance were examined by multiple regression analysis. Independent variables were limb shortening, hip elevation, and foot lateral shift. Results: Limb shortening was negatively correlated with hip elevation (r = -0.75) and foot lateral shift (r = -0.41). Multiple regression analysis showed a significant contribution of limb shortening and hip elevation to toe clearance. The coefficient of determination was 0.95. Conclusions: Toe clearance was mainly determined by limb shortening and hip elevation, which were found to be in a trade-off relationship. These results warrant further investigation into the use of three-dimensional motion analysis in the rehabilitation clinic to facilitate targeted rehabilitative training to restore gait ability.

Objective: The purpose of this study was to analyze the extent to which lower limb shortening and compensatory movements contribute to toe clearance during swing, and to identify the different strategies employed by healthy individuals and hemiplegic stroke patients to achieve toe clearance.<br /> <br /> Methods: The subjects comprised 18 hemiplegic stroke patients and 18 healthy individuals matched for age, gender, and walking speed. We calculated toe clearance and its components for comparison between the two groups. We also calculated the correlations between the components.<br /> <br /> Results: The foot-to-floor distance during mid-swing was smaller in hemiplegic stroke patients than in healthy individuals. Regarding the components, shortening of hip-toe length (SHTL) was smaller in stroke patients, whereas upward movement of the hip due to pelvic obliquity, upward movement of the foot due to abduction, and upward movement of the contralateral hip were all greater. Among hemiplegic stroke patients, there were significant negative correlations between SHTL and the other components.<br /> <br /> Conclusions: Hemiplegic stroke patients achieved smaller upward movement by lower limb shortening compared with healthy individuals. The contribution of hip hiking and other compensatory movements that correlated to SHTL appeared to be important in achieving toe clearance.<br /> <br />

Sugiura, Y, Hatanaka, Y, Arai, T, Sakurai, H, and Kanada, Y. Estimations of one repetition maximum and isometric peak torque in knee extension based on the relationship between force and velocity. J Strength Cond Res 30(4): 980-988, 2016-We aimed to investigate whether a linear regression formula based on the relationship between joint torque and angular velocity measured using a high-speed video camera and image measurement software is effective for estimating 1 repetition maximum (1RM) and isometric peak torque in knee extension. Subjects comprised 20 healthy men (mean +/- SD; age, 27.4 +/- 4.9 years; height, 170.3 +/- 4.4 cm; and body weight, 66.1 +/- 10.9 kg). The exercise load ranged from 40% to 150% 1RM. Peak angular velocity (PAV) and peak torque were used to estimate 1RM and isometric peak torque. To elucidate the relationship between force and velocity in knee extension, the relationship between the relative proportion of 1RM (% 1RM) and PAV was examined using simple regression analysis. The concordance rate between the estimated value and actual measurement of 1RM and isometric peak torque was examined using intraclass correlation coefficients (ICCs). Reliability of the regression line of PAV and % 1RM was 0.95. The concordance rate between the actual measurement and estimated value of 1RM resulted in an ICC(2,1) of 0.93 and that of isometric peak torque had an ICC(2,1) of 0.87 and 0.86 for 6 and 3 levels of load, respectively. Our method for estimating 1RM was effective for decreasing the measurement time and reducing patients' burden. Additionally, isometric peak torque can be estimated using 3 levels of load, as we obtained the same results as those reported previously. We plan to expand the range of subjects and examine the generalizability of our results.

[Purpose] The aim of this study was to clarify essential abilities of novice physical and occupational therapists for independent execution of their duties and to develop a clinical competence assessment tool. [Subjects] Forty-five experienced therapists participated in this study. [Methods] A two-phase mixed-methods design was used. First, semi structured interviews were conducted on 15 experienced therapists to create a comprehensive list of essential abilities that novice therapists need. Second, 30 experienced therapists participated in a two-round Delphi study to select items for the assessment tool being developed. [Results] Fifty-five items were extracted and classified into three categories: basic attitudes, therapeutic skills, and clinical practice-related thoughts. [Conclusion] Present results suggest that not only knowledge of execution of therapy-related duties and therapeutic skills is essential in novice therapist, but also appropriate abilities in social adjustment, self-management, and self-education. The newly developed tool might be useful for postgraduate education in clinical practice.

[Purpose] To investigate the utility of using a behavior observation scale in combination with a cognitive scale in a convalescence rehabilitation ward. [Subjects] Sixty inpatients in the convalescence rehabilitation wards of our hospital. [Methods] The behavior observation NM scale was used to divide the subjects into 4 levels of dementia severity. Then, the MMSE and NM scale at admission of each group was compared, and their associations determined. [Results] For the group with severe dementia, the MMSE assessment was unsatisfactory due to aphasia and depressive tendencies however, a significant difference was found for the NM scale. In addition, for the groups with mild and moderate dementia, the correlation was low. [Conclusion] Because the reliability of a single assessment is poor, and cognitive assessment is affected by aphasia and depressive tendencies, a behavior observation scale which observes and assesses patients’ daily living activities is more useful.

Neurophysiological studies in healthy subjects suggest that increased spinal inhibitory reflexes from the tibialis anterior (TA) muscle to the soleus (SOL) muscle might contribute to decreased spasticity. While 50 Hz is an effective frequency for transcutaneous electrical nerve stimulation (TENS) in healthy subjects, in stroke survivors, the effects of TENS on spinal reflex circuits and its appropriate frequency are not well known. We examined the effects of different frequencies of TENS on spinal inhibitory reflexes from the TA to SOL muscle in stroke survivors. Twenty chronic stroke survivors with ankle plantar flexor spasticity received 50-, 100-, or 200-Hz TENS over the deep peroneal nerve (DPN) of the affected lower limb for 30 min. Before and immediately after TENS, reciprocal Ia inhibition (RI) and presynaptic inhibition of the SOL alpha motor neuron (D1 inhibition) were assessed by adjusting the unconditioned H-reflex amplitude. Furthermore, during TENS, the time courses of spinal excitability and spinal inhibitory reflexes were assessed via the H-reflex, RI, and D1 inhibition. None of the TENS protocols affected mean RI, whereas D1 inhibition improved significantly following 200-Hz TENS. In a time-series comparison during TENS, repeated stimulation did not produce significant changes in the H-reflex, RI, or D1 inhibition regardless of frequency. These results suggest that the frequency-dependent effect of TENS on spinal reflexes only becomes apparent when RI and D1 inhibition are measured by adjusting the amplitude of the unconditioned H-reflex. However, 200-Hz TENS led to plasticity of synaptic transmission from the antagonist to spastic muscles in stroke survivors.

[Purpose] This study examined the contents of supervision needed by novice therapists to develop clinical abilities, focusing on their clinical experience and using an original evaluation table. [Subjects and Methods] An evaluation of clinical abilities basic attitudes, therapeutic skills, and clinical practice-related thoughts was conducted in 29, 21, and 9 therapists with clinical experience of 0-1 (1 year group), 1-2 (2 years group), and 2-3 (3 years group) years, respectively. [Results] There were no significant differences among the 3 groups in basic attitudes. Therapeutic skills markedly varied between the 1 and 3 years groups. In clinical practice-related thoughts, significant differences were observed between the 1 and 3 years groups and between the 2 and 3 years groups. [Conclusion] It may be appropriate for educators to provide technical education regarding skills that are achievable for students in the early stages in consideration of applied movements. Also, education for novices should be provided with importance attached to abilities influenced by clinical experience.

Background: Gait assessment is important to determine the most effective strategy to regain gait function during stroke rehabilitation. To understand the mechanisms that cause abnormal gait patterns, it is useful to objectively identify and quantify the abnormal gait patterns. Objective assessment also helps evaluate the efficacy of treatments and can be used to provide suggestions for treatment. Objective: To evaluate the validity of quantitative indices for retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegic patients. Methods: Forty-six healthy control subjects and 112 hemiplegic patients participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the three abnormal gait patterns was calculated from the three-dimensional coordinate data. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment by three physical therapists with expertise in gait analysis. Results: Strong correlation was observed between the index value and the median observational rating for all three abnormal gait patterns (-0.56 to -0.74). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects. Conclusions: The proposed indices are useful for clinical gait analysis. Our results encourage a more detailed analysis of hemiplegic gait using a motion analysis system.

Background: The efficacy of botulinum toxin A (BoNTA) injection on spasticity is usually measured using Modified Ashworth Scale (MAS), but this only evaluates muscle tone at rest and has poor reliability. There are no reports that quantitatively evaluate pes varus during walking after botulinum treatment. The purpose of this study was to evaluate the efficacy of BoNTA injection on pes varus during gait using 3-dimensional motion analysis. Methods: Twenty-four hemiplegic patients with spastic pes varus deformity during gait received BoNTA injection into lower limb muscles. MAS score, comfortable overground gait velocity, and pes varus angle during treadmill walking were evaluated before, 2, 6, and 12 weeks after the injection. Five healthy subjects were also recruited to develop the pes varus/valgus angle as a normal reference. Results: The median MAS scores were significantly lower at 2 and 6 weeks after the injection. The maximum pes varus angle during the swing phase was significantly lower at 2, 6, and 12 weeks after the injection. It was significantly lower at 6 weeks after the injection during stance phase. The comfortable overground gait velocity was also improved after the injection. However, 2 patients experienced pain during gait and their pes varus angle increased during the follow-up period. Conclusions: BoNTA injection improved pes varus angle during gait. Evaluating motion in addition to spasticity at rest is recommended because improvements in limb function do not always parallel improvements in spasticity at rest.

[Purpose] This study examined the reliability of a clinical ability evaluation table developed in a previous study with the aim of clarifying the abilities necessary for therapists to independently implement their duties. [Subjects and Methods] Forty-eight physical therapists with less than 2 years of clinical experience were targeted for evaluation, 48 main supervisors, and 48 sub-supervisors, 144 in total, were studied. [Results] The total score was lower when the evaluation was conducted by the target therapists themselves than when it was conducted by the main or sub-supervisors. Regarding the reliability of the total scores for the entire scale and each category, values representing the intra-rater reliability were higher when the evaluation was conducted by the target therapists or main supervisors, while there were marked differences between high and low values for each item. Regarding the inter-rater reliability, both the total scores for the entire scale and each category, as well as values for each item, were low. [Conclusion] Values representing the intra-rater reliability of the study table were low, indicating the necessity of further improvement.

Purpose Focusing on the force and velocity relationship, we verified the valid combinations of angular velocity and joint torque for estimations of isometric peak torque in knee extension using 2D movement analysis. [Subjects] Ten healthy males aged between 24 and 38. [Methods] Images captured by a high-speed video camera were edited, and the coordinates of the joints determined by image measurement software were entered into a dynamic model which calculated angular velocity, joint angle and torque. Valid combinations of angular velocity and joint torque were investigated at the estimated values of isometric peak torque, and the estimated and actual values were compared. [Results] The estimated and actual values of isometric peak torque had ICCs ranging from 0.61 to 0.76, and the highly compatible combinations determined using the estimated value were the peak angular velocity and peak torque. [Conclusion] In the future, we would like to investigate the validity of the estimated values with a greater number of subjects and with a limited number of loads, and investigate their compatibility with various muscle strengths.

[Purpose] To demonstrate the relationship between force and velocity in isotonic contraction of knee extension, and with estimation of isometric peak torque, investigate the appropriate load for physical safety in human measurements. [Subjects] Six healthy males in their 20s and 30s. [Methods] Images captured by a high-speed video camera were converted to sequential frames using video editing software. Using the angle measurement tools of image measurement software, angular velocities, and knee angles were determined, and the angular velocities were compared among minimum loads of 20, 30, and 40% 1RM, and maximum loads of 100, 130, 150 and 160% 1RM. [Results] There were no significant differences among the three minimum loads, but there was a significant difference between the maximum loads of 150 and 160% 1RM. [Conclusion] We consider that a minimum load of 40% 1RM and a maximum load of 150% 1RM are appropriate loads.

[Purpose] To propose a method of setting exercise intensity for low-load, simple knee extension exercise, using the rating of perceived exertion (RPE) and weight bands. [Subjects] Sixteen elderly persons with care needs of less than 3 on the long-term care insurance scale. [Methods] With 1RM equivalent to 100%, we investigated the reproducibility of RPE, and its relationship with load at loads of 25, 50, 75 and 100%. The reliability and validity of the simple load setting method was also investigated. [Results] Reproducibility had a weighted kappa statistic ranging from 0.72~0.92, and the relationship between RPE and load had a Spearman rank correlation coefficient of r=0.93, indicating the validity and reliability of the proposed method of setting exercise intensity. [Conclusion] Our results suggest that the method proposed in this study is a simple way of calculating the appropriate exercise load for the elderly.

[Purpose] This study examined the effects of clinical training focusing on level-3 OSCE (analytical and therapeutic skills) items, and compared the achievement levels of physical (PT) and occupational (OT) therapist students. [Subjects] A total of 282 (165 PT and 117 OT) students enrolled at our university between 2008 and 2010 were studied. [Methods] OSCE scores were compared between before and after clinical training focusing on level-3 OSCE items, and between PT and OT students. [Results] Scores for 5 out of the 6 level-3a items were significantly higher after than before clinical training. Increases in scores of 2 or 3 level-3b and -3c items were also observed after clinical training. There were no marked differences between PT and OT students in scores for level-3a, -3b, and -3c items before clinical training. In contrast, after clinical training, OT students' scores for 3a and 3c items related to dressing were higher than those of PT students, and the latter's scores for 3b items related to transfer were higher than those of the former. [Conclusion] The results suggest level-3 OSCE items are effectively taught during clinical training.