Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease

BackgroundGiven the extent of the surgical indications for pulmonary lobectomy in breathless patients, preoperative care and evaluation of pulmonary function are increasingly necessary. The aim of this study was to assess the contribution of preoperative pulmonary rehabilitation (PR) for reducing the incidence of postoperative pulmonary complications in non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD). MethodsThe records of 116 patients with COPD, including 51 patients who received PR, were retrospectively analyzed. Pulmonary function testing, including slow vital capacity (VC) and forced expiratory volume in onesecond (FEV1), was obtained preoperatively, after PR, and at one and sixmonths postoperatively. The recovery rate of postoperative pulmonary function was standardized for functional loss associated with the different resected lung volumes. Propensity score analysis generated matched pairs of 31 patients divided into PR and non-PR groups. ResultsThe PR period was 18.712.7days in COPD patients. Preoperative pulmonary function was significantly improved after PR (VC 5.3%, FEV1 5.5%; P<0.05). The FEV1 recovery rate onemonth after surgery was significantly better in the PR (101.6%; P<0.001) than in the non-PR group (93.9%). In logistic regression analysis, predicted postoperative FEV1, predicted postoperative %FEV1, and PR were independent factors related to postoperative pulmonary complications after pulmonary lobectomy (odds ratio 18.9, 16.1, and 13.9, respectively; P<0.05). Conclusions PR improved the recovery rate of pulmonary function after lobectomy in the early period, and may decrease postoperative pulmonary complications

Advanced Equipment Development and Clinical Application in Neurorehabilitation for Spinal Cord Injury: Historical Perspectives and Future Directions

Partial to complete paralysis following spinal cord injury (SCI) causes deterioration in health and has severe effects on the ability to perform activities of daily living. Following the discovery of neural plasticity, neurorehabilitation therapies have emerged that aim to reconstruct the motor circuit of the damaged spinal cord. Functional electrical stimulation (FES) has been incorporated into devices that reconstruct purposeful motions in the upper and lower limbs, the most recent of which do not require percutaneous electrode placement surgery and thus enable early rehabilitation after injury. FES-based devices have shown promising results for improving upper limb movement, including gripping and finger function, and for lower limb function such as the ability to stand and walk. FES has also been employed in hybrid cycling and rowing to increase total body fitness. Training using rehabilitation robots is advantageous in terms of consistency of quality and quantity of movements and is particularly applicable to walking training. Initiation of motor reconstruction at the early stage following SCI is likely to advance rapidly in the future, with the combined use of technologies such as regenerative medicine, brain machine interfaces, and rehabilitation robots with FES showing great promise

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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ANALYSIS OF REACHING MOVEMENTS WITH THE ADDITION OF RESISTANCE FORCES IN THE HORIZONTAL AND VERTICAL PLANES USING A ROBOT ARM IN NON-DISABLED INDIVIDUALS

A new, simpler, quantitative evaluation method, with higher reproducibility and validity than the conventional method used to evaluate hemiplegic upper extremities, is needed. The general properties of reaching movements were examined in healthy subjects by adding resistance forces to establish a new evaluation method using robotic technology. The subjects included 14 non-disabled males and 2 non-disabled females whose average age was 25 years. Their reaching movements were measured in both the horizontal and vertical planes with resistance force to add disturbance using a robot arm. Then, the jerk cost, the largest swinging distance, and the end¬point displacement were calculated. Significant differences were seen between subjects with and without disturbance in the horizontal jerk cost and largest swinging distance in the horizontal plane, and vertical jerk cost and largest swinging distance in the vertical plane. The horizontal and vertical jerk costs and largest swinging distances were also greater with a larger disturbance. In the reaching movements of healthy people in the horizontal and vertical planes, when the reaching movement was subjected to orthogonal disturbance, jerk cost and largest swinging distance in the direction of the disturbance were easily affected in response to the disturbance

Advanced Equipment Development and Clinical Application in Neurorehabilitation for Spinal Cord Injury: Historical Perspectives and Future Directions

Partial to complete paralysis following spinal cord injury (SCI) causes deterioration in health and has severe effects on the ability to perform activities of daily living. Following the discovery of neural plasticity, neurorehabilitation therapies have emerged that aim to reconstruct the motor circuit of the damaged spinal cord. Functional electrical stimulation (FES) has been incorporated into devices that reconstruct purposeful motions in the upper and lower limbs, the most recent of which do not require percutaneous electrode placement surgery and thus enable early rehabilitation after injury. FES-based devices have shown promising results for improving upper limb movement, including gripping and finger function, and for lower limb function such as the ability to stand and walk. FES has also been employed in hybrid cycling and rowing to increase total body fitness. Training using rehabilitation robots is advantageous in terms of consistency of quality and quantity of movements and is particularly applicable to walking training. Initiation of motor reconstruction at the early stage following SCI is likely to advance rapidly in the future, with the combined use of technologies such as regenerative medicine, brain machine interfaces, and rehabilitation robots with FES showing great promise

CONSTRUCTION AND VALIDATION OF A NOVEL THREE-DIMENSIONAL TRUNK MUSCULOSKELETAL MODEL

Studies of internal biological forces during motion using musculoskeletal models have mainly focused on the extremities. Few reports have examined internal biological forces in spine motion using a trunk model. The aim of this study was to analyze detailed three-dimensional motion of healthy adults using a novel trunk model, and estimate internal biological forces in a standing position. We constructed a three-dimensional trunk musculoskeletal model. Dimensions of the vertebrae, other segments such as upper or lower extremities and muscles were based on a 31-year-old healthy man. Joint angle data for trunk and extremities kinematics were obtained from a standing position using a three-dimensional motion analysis system. To analyze motion of the spine in detail, we applied markers to three different places in each vertebral body from C7 to L5. Flexion moments accorded with spinal curvature at the apex of curvature of the thoracic spine at T8-9. Mean intradiscal pressure calculated from muscle strength was 802.9 N. The thoracolumbar three-dimensional trunk musculoskeletal model generated in the present study could potentially be used to analyze spinal moment and trunk muscle strength during static and dynamic motions