Kinesiological evaluation of respiration in patients with Parkinson’s disease using optoelectronic plethysmography

　Aspiration pneumonia, a common cause of mortality in patients with Parkinson’s disease (PD), is associated with impaired coughing ability in addition to dysphagia. Kyphosis, bradykinesia, and muscle rigidity reportedly may be involved in the decline of coughing ability; however, the details are unknown. This study aimed to investigate the respiratory impairment that causes the decreased coughing ability in patients with PD using a three-dimensional motion analysis and surface electromyography in terms of respiratory pattern and respiratory muscle activity. The participants were seven patients with PD without history of respiratory or spinal diseases, and seven healthy men of age and matched for body mass index. Using opto- electronic plethysmography, the participants were placed in a sitting posture, and the volume changes of the upper and lower thorax and abdomen were measured during quiet breathing and during deep breathing in the same manner as in the measurement of lung capacity. Surface electromyograms (EMG) were recorded from the second intercostal muscle, the rectus abdominis muscle, and the external oblique abdominal muscle. The normalized EMG data were divided into inspiratory and expiratory times, and the inspiratory and expiratory times were divided into four equal parts over time to examine the trend of changes in muscle activity during deep breathing. In the patients with relatively unadvanced PD, no significant differences from the control in the amount of change in the angle of the spinal column during deep breathing, ratio of each compartment of the chest wall during deep breathing, whereas abdominal compartment was dominant in patients with PD during quiet breathing, and no significant difference in asynchrony between the chest and abdomen was observed. The PD group did not demonstrate increased respiratory muscle activity toward the end of inspiration and expiration, which was observed in the control group. Although the respiratory patterns of the thorax and abdomen in the PD group, whose disease has not relatively progressed, are not different from those of the control group, a significant difference was observed on the EMG, and it is possible that the respiratory muscles could not be effectively utilized according to the inspiratory and expiratory conditions from an early stage

Effectiveness of impedance parameters for muscle quality evaluation in healthy men

We investigated the relationship between impedance parameters and skeletal muscle function in the lower extremities, as well as the effectiveness of impedance parameters in evaluating muscle quality. Lower extremity impedance of 19 healthy men (aged 23–31 years) measured using the direct segmental multi-frequency bioelectrical impedance analysis were arc-optimized using the Cole–Cole model, following which phase angle (PA), Ri/Re, and β were estimated. Skeletal muscle function was assessed by muscle thickness, muscle intensity, and isometric knee extension force (IKEF). IKEF was positively correlated with PA (r = 0.58, p < 0.01) and β (r = 0.34, p < 0.05) was negatively correlated with Ri/Re (r = − 0.43, p < 0.01). Stepwise multiple regression analysis results revealed that PA, β, and Ri/Re were correlated with IKEF independently of muscle thickness. This study suggests that arc-optimized impedance parameters are effective for evaluating muscle quality and prediction of muscle strength

Ultrasonographic evaluation of geniohyoid muscle mass in perioperative patients

Surgical invasion and postoperative disuse are known to promote systemic skeletal muscle atrophy; however, similar effects on the mass of the muscles of deglutition have yet to be confirmed. Our method of using ultrasonography to measure the area of the geniohyoid muscle (GM), to evaluate the mass of the muscles of deglutition, has been shown to have high reliability. In the present study, we measured the GM area before and after surgery in patients to investigate changes in their muscle mass. Parameters including GM area, quadriceps femoris muscle (QF) thickness, hand grip strength (HGS), and arm muscle circumference were measured preoperatively and at 7 and 14 days postoperatively in patients who underwent thoracotomy and laparotomy. Patient height, weight, and serum albumin (Alb) level were also obtained from medical charts. Comparison of each evaluation parameter between measurement time points demonstrated significant decreases in GM area, QF thickness, HGS, and Alb between preoperatively and both postoperative day (POD) 7 and POD 14. The patients were divided into good (n = 19) and poor (n = 12) postoperative oral intake groups for comparison of GM area. The percentage decrease in GM area was significantly greater in patients with poor oral intake. To our knowledge, this is the first study to demonstrate that muscle atrophy due to surgical invasion or disuse may occur in the muscles of deglutition, as in the limb muscles. The findings showed that muscle atrophy occurs in the early postoperative period and persists even at 2 weeks postoperatively. Furthermore, insufficient oral intake may promote disuse muscle atrophy

Effects of mechanical insufflation-exsufflation on compartmental chest wall volume in patients with chronic cervical spinal cord injuries

　The purpose of this study was to evaluate the effects of mechanical insufflationexsufflation (MI-E) on volume change of the chest wall and each compartment of the chest wall in patients with cervical spinal cord injury using optoelectronic plethysmography (OEP).　Fourteen male patients with chronic cervical spinal cord injuries were included with the following characteristics: age, 56.2 ± 13.6 years; height, 168.4 ± 5.5 cm; body weight, 62.3 ± 12.7 kg; median number of days after injury, 387 days (range, 200-3575 days). The change of chest wall volume was significantly greater during MI-E of ≥ ±30 cmH2O than when taking a deep breath. The volume change in the upper and lower thorax compartment was significantly greater during MI-E of ≥ ±30 cmH2O than when taking a deep breath. However, MI-E made no significant difference to the volume of the upper and lower thorax compartment between pressures of ±30 cmH2O and ±50 cmH2O. The volume change in the abdomen compartment was slightly greater during MI-E than when taking a deep breath, but this was not statistically significant.　The findings of this study indicate the possibility of maintenance or improvement of the compliance of the chest wall, especially the rib cage in patients with spinal cord injuries, using MI-E. In turn, these findings could lead to the prevention of pulmonary complications

Effects of revisions to the health insurance system on the recovery-phase rehabilitation ward

In the present study, we investigated the effects of revisions to the medical fee system made in April 2006 on the recovery-phase rehabilitation ward of our hospital. Subjects were patients admitted to the recovery-phase rehabilitation ward of our hospital between April 1, 2005 and September 30, 2006, and were discharged. Patients admitted between April 1, 2005 and March 31, 2006 were allocated to the pre-revision group and those admitted between April 1, 2006 and September 30, 2006 to the post-revision group. Their medical charts were investigated for comparison of the mean age, duration of hospitalization, and outcome.A total of 126 patients were allocated to the pre-revision group, and 72 to the post-revision group. The number of days from onset to admission to the recovery-phase rehabilitation ward was 41.3 days in the pre-revision group and 26.1 days in the post-revision group, while the duration of hospitalization was 71.4 days in the former group and 41.9 days in the latter. The outcomes were transfer to homecare/discharge to home in 84 patients (67%) and transfer to another department in our hospital in six patients (5%) in the pre-revision group, and 43 patients (60%) and 14 patients (19%), respectively, in the post-revision group. No significant differences in FIM were found between the two groups.The effects of the medical fee system revisions made in April 2006 on the recovery-phase rehabilitation ward of our hospital included shortening of the number of days between onset and admission, duration of hospitalization, increased transfer to other departments, and decreased rates of transfer to homecare/discharge to home. These findings indicate the importance of systemic management and team-based approaches for enabling more efficient rehabilitation

Efficacy of soft palatal augmentation prosthesis for oral functional rehabilitation in patients with dysarthria and dysphagia: a protocol for a randomised controlled trial

Introduction Palatal augmentation prosthesis (PAP) is used in patients with articulation and swallowing disorders caused by postoperative loss of tongue tissue due to tongue cancer, cerebrovascular disease sequelae and age-related hypofunction. We have previously reported a newly designed soft PAP fabricated using an thermoplastic material that is particularly appropriate for early intervention. However, the effect of soft PAP on oral function improvement remains to be elucidated. The aim of this study is to investigate whether soft PAP can improve dysarthria and dysphagia occurring as cerebrovascular disease sequelae. Methods and analysis This prospective, randomised, controlled trial will compare the immediate and training effects of rehabilitation using soft PAP with those of rehabilitation without using it. Primary outcomes are the single-word intelligibility test score and pharyngeal transit time (PTT). Secondary outcomes are tongue function (evaluated based on maximum tongue pressure, repetitions of tongue pressure and endurance of tongue pressure), articulation function (evaluated based on speech intelligibility, oral diadochokinesis, Voice-Related Quality of Life (V-RQOL)) and swallowing function (evaluated using Eating Assessment Tool-10). The study results will help determine the efficacy of Soft PAP in improving functional outcomes of word intelligibility and PTT. We hypothesised that early rehabilitation using Soft PAP would more effectively improve articulation and swallowing function compared with conventional rehabilitation without using soft PAP. Ethics and dissemination Ethical approval was obtained from the Okayama University Certified Review Board. The study findings will be published in an open access, peer-reviewed journal and presented at relevant conferences and research meetings

Assessment of chest movements in tetraplegic patients using a three-dimensional motion analysis system

We used optoelectronic plethysmography (OEP) to evaluate the effects of posture on chest and abdominal movements during respiration in patients with chronic-stage complete spinal cord injuries. The subjects were five cervical injury patients (male, C4-C8 injury, American Spinal Injury Association Impairment Scale grade A) and five healthy people matched to each of the cervical injury patients for age, height, and weight. The chest wall movement each of the subjects was recorded using OEP during six quiet breathing and three deep breathing periods in each of the following positions: supine, with the trunk elevated to 30°, and with the trunk elevated to 60°. Data on the chest wall volume and compartment volumes (upper thorax, lower thorax, abdomen) were then compared among the postures. During quiet breathing in the tetraplegic patients, the change in upper thorax volume was smaller at the end of inhalation than at the end of exhalation, presenting as a paradoxical breathing pattern. During deep breathing in the tetraplegic patients, abdominal volume accounted for a large portion of the change in total chest wall volume. Posture affected the recorded abdominal volume; volume was greatest in the supine position and decreased as the posture became more upright

Investigation into the safety of driving by individuals with higher brain dysfunction

Dangerous driving by drivers with diseases or disabilities such as dementia, epilepsy, or higher brain dysfunction is viewed as a problem In Worldwide. Given that the majority of such cases of dangerous driving are caused by impairments to cognitive function resulting from these conditions, there is an urgent need to create systems to detect drivers with cognitive functional disability and develop criteria for safe resumption of driving. Because driving would understandably be extremely dangerous for people with higher brain dysfunction, particularly in cases of attention dysfunction, we first examined the correlation between the Clinical Assessment of Attention (CAT), a theoretical task offering an index of attention function, and the cathode ray tube (CRT) driving aptitude test. We then examined correlations between CRT total score and CRT sub-scores. Only the time required for the position Stroop test had a moderate correlation (r=-0.43, p<0.01) with CRT total score. Correlations between CRT total score and sub-scores relating to reaction speed showed a strong correlation. Other than reaction speed, items with significant moderate to strong correlations were also seen in the maintenance of moderate mental tension, attention distribution and situation processing skill. The present results show a correlation between CAT score and CRT total score, indicating that CRT total score places relative weights on speed of information processing and suppression of stereotypes, representing a very meaningful result

Kinesiological evaluation of respiration in patients with Parkinson’s disease using optoelectronic plethysmography

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