Vol.17(No.1 2017)

【The Original】 page 1-5

The after-effects of resistive static contraction facilitation technique using Proprioceptive Neuromuscular Facilitation in the middle range of pelvic motion on the improvement of time to ascend stairs in stroke patients

Tanaka Toshiyuki , Shiratani Tomoko, Masumoto Kazue, Miyahara Takato, Arai Mitsuo

Abstract: The purpose of this study was to determine the after-effects of resistive static contractions of pelvic posterior depression (SCPD) and pelvic anterior elevation (SCAE) using the Proprioceptive Neuromuscular Facilitation (PNF) pattern in the middle range of pelvic motion to improve the time for ascending stairs in hemiplegic patients. Nine stroke subjects (mean age = 68.3±11　years) with various levels of motor impairments (Brunnstrom stages III-V) were randomly assigned to the SCPD group, SCAE group, or control group. The participants stood 1 foot from the bottom of a 12-step flight of stairs. They were instructed to walk as quickly as possible (but not to run) and to take one step at a time. Before the intervention, the differences of the actual times of ascending stairs did not show a significant difference among the three groups. The change in ratios of ascending stairs before and after the interventions was calculated for each group. As a result of a one-way ANOVA, three groups showed a significant difference after the interventions. The results of a multiple comparison test showed that the SCAE procedure group and the SCPD procedure group had significant improvements as compared to the control group. The SCPD group also showed a significant improvement as compared to the SCAE group. These results suggest that the SCPD may have immediate after-effects for improving the actual times in ascending stairs in hemiplegic patients.

Key Words: Hemiplegia, Static contraction, Speed of ascending stairs, Mobilization PNF

【The Original】 page 6-10

The after-effects of the resistive static contraction facilitation technique in the middle range of motion on the improvement of the active range of motion of the shoulder joint in orthopedic patientsascend stairs in stroke patients

Masumoto Kazue, Shiratani Tomoko, Akagi Satoko, Takezawa Miho, Tanaka Toshiyuki, Arai Mitsuo

Abstract: The purpose of this study was to determine the after-effects of different sustained contraction facilitation techniques in the middle range of motion in orthopedic patients with active range of motion limitation and pain in the shoulder. Ten subjects (mean age=64.1 years, SD=15.7) were randomly given static contraction of the pelvic depressors (SCPD) on the affected side, sustained contraction facilitation techniques in the middle range of motion (SCF) on the unaffected upper limb, and sustained stretch (SS). A two-way ANOVA demonstrated a significant difference between the groups based upon the percentage of improvement in the active range of motion (AROM). Scheffé's post hoc test revealed that the SCPD showed significant improvements as compared with SS (P<0.05). With respect to pain, there were no significant differences between the three techniques, but SCPD and SCF showed a tendency to decrease the pain during AROM. These results suggest that SCPD may show immediate after-effects for increasing AROM and decreasing the pain during AROM.

Key Words: PNF, Sustained contraction facilitation technique in the middle range of motion, Active range of motion, Pain, Aftereffect

【Research and Report】 page 11-15

The effect of resistive static contraction facilitation of the scapular muscles technique on the improvement of restricted ankle dorsiflexion in hemiplegic patients

Sakino Yugo, Shiratani Tomoko, Ide Natsuki, Ueda Ryo, Arai Mitsuo

Abstract: The purpose of this study was to determine the after-effects of resistive static contractions of the scapular posterior depression (SCPD) using the Proprioceptive Neuromuscular Facilitation (PNF) pattern in the mid-range of scapular motion or sustained stretch (SS) to improve restricted ankle dorsiflexion in hemiplegic patients． The alternating treatment design (ATD) for comparing the effects of two treatments was used for two hemiplegic patients (mean age: 78.5 years) with a randomization design． Following a 7-day period of phase A1, a 7-day period of B1 was performed,　which was then followed by a 7-day period of phase A2 and then a 7-day period of phase B2. In phases A1, A2, and A3, the subjects were treated with the SS. In phases B1, B2 and B3, the subjects were treated with the SCPD technique． The Scheffé`s post-hoc test revealed that a significant difference was observed between phases A1 and B3, which suggests that as compared to the SS technique the SCPD technique had cumulative effects in hemiplegic patients to increase the active range of motion of ankle dorsiflexion．

Key Words: Hemiplegia, Ankle dorsiflexion, Scapular posterior depression, Static Contraction, Mobilization PNF

【Case Report】 page 16-19

The effect of resistive static contraction of lower trunk muscles on chair rising time in a hemodialysis patient

Murasaki Yukiko, Shiratani Tomoko 

Abstract: The purpose of this study was to determine the after-effects of resistive static contractions of the scapular posterior depThe purpose of this study was to determine how a resistive sustained contraction using the mobilization PNF for pelvic posterior depression (SCPD) influences the time to rise from a chair and the rate of perceived exertion (RPE) for a hemodialysis patient who experienced fatigue during standing．The case was a 77-year-old man who could walk independently and was not showing a decline in cognition．For verification, a single case ABAB study was used and performed alternately three times a week on non-dialysis days for a period of 6 weeks. In phase A，five rising motions were performed，and, in phase B, five SCPD technique procedures were performed．As a result，the rising times shortened from phase A to phase B，and the RPE in phase A also showed a low value as compared with phase B．In addition，the SCPD procedure in phase B did not show an increase in fatigue and as compared with phase A showed improvements in objective indicators. The hemodialysis patient stated that not only was the movement easier but also the rising time was shortened．These results suggest that as an indirect-approach the SCPD technique procedure of muscle contraction of the trunk muscle group may help decrease fatigue during standing for a hemodialysis patient．

Key Words: Hemodialysis patient, Chair rising motion, mobilization PNF

【Report】 page 20-24

A study of the remote after-effects of resistive static contractions of the lower trunk depressors on muscle strength of knee extensors in vertebral compression fracture patients 

Ide Natsuki, Shiratani Tomoko, Hobara Rui

Abstract: Previous studies have reported that the application of resistive static contraction with manual resistance using a Proprioceptive Neuromuscular Facilitation technique in the mid-range pelvic posterior depression pattern (RSCPD) improved range of motion and ADL ability as an indirect-approach. The purpose of this study was to investigate the after-effects of RSCPD on the strength of knee extensors as compared with the resistive static contraction of knee extensors alone (RSCKE). Five subjects with vertebral compression fractures (2 men and 3 women, mean age = 76.6 years, SD = 7.3) performed two static contractions (RSCPD, RSCKE) in a random order. A two-way ANOVA analysis showed no significant differences between the two techniques. However, the average change rate of improvement tended to increase after the RSCPD as compared with the RSCKE, which may suggest the facilitatory effects are remote after-effects of RSCPD. However, there were individual differences in this study. Because of the decreasing value of muscle strength after RSCPD in some cases, the inhibitory effects may also occur as remote after-effects of RSCPD.

Key Words: PNF, RSCPD, Knee extensor strength, Remote after-effect, Mobilization PNF

【Report】 page 25-29

The efficacy of Proprioceptive Neuromuscular Facilitation (PNF) combined with center bridge brace attachment for back knee patients : Case Reports

Yamamoto Sokatsu, Kaburaki Makoto, Jingami Syuichi,

Matsubara Shigehito, Howashi Kishio, Sakima Tamotsu,

Matsuoka Uichiro, Tsuneoka Takehisa

Abstract: [Purpose] To investigate the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) combined with a center bridge brace (CBB) attachment for back knee patients, we conducted a biomechanical research and report on a patient who showed an improvement in activities of daily living in long-term care. [Method] As a preliminary study, we investigated the vertical floor reaction force (VFRF) and integrated electromyogram (IEMG) on the gluteus maximus (Gmax), gluteus medius (Gmed), rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), tibialis anterior(TA), and gastrocunemius (Gas), using a simulated back knee by a normal subject for comparison with patients. Then we compared the results with three patients who have a tendency for back knee during the supporting phase of gait. The Functional Independence Measure (FIM) was also used to assess long-term changes in the level of disability. [Result & Discussion] In the imitated back knee by a normal subject, IEMG increased about 3 times at VL, VM using PNF, while applying approximation at the anterior of both iliac crests and attaching the CBB on the knee. In Case 1, the IEMG data pattern was different for each muscle group. Then the IEMG of the knee extensor muscles for the affected side with PNF and CBB increased notably from 2 to 6.7 times during gait. In Case 2, the normalized percentage in VFRF of the affected side after applying PNF combined with CBB increased from 56.2% to 82.4% for the ratio of the affected/unaffected side. Case 3 showed an improvement in both back knee angles and a dramatic change in activities of daily living. The FIM score increased from 116 to 123 over an approximate five-year period, resulting in the ability of the subject to stand without any hand support and walk with Lofstrand crutches. The results in these case studies suggest that PNF combined with a CBB may help to improve the activities of daily living by facilitating muscle activities of the leg and enhancing knee stability for back knee patients. Further investigation is merited.

Key Words: PNF, Center Bridge Brace (CBB), electromyogram (EMG), vertical floor reaction force (VFRF)