ABSTRACT
Adipose triglyceride lipase (ATGL) catalyzes the first step of triglyceride hydrolysis. The gene mutations cause neutral lipid storage disease with myopathy (NLSDM) and/or triglyceride deposit cardiomyovasculopathy (TGCV) . Here we give the first report on rehabilitation of a patient with NLSDM and TGCV. The 62-years-old patient was admitted to our hospital for rehabilitation for skeletal myopathy and rehabilitation for cardiac dysfunction (NYHA class Ⅲ , ejection fraction 20%) . He complaint of dyspnea during the activity of daily life and exercise torelance was low. Our rehabilitation program consisted of physical therapy, occupational therapy, nutrition and cardiac education. We had paid a special attention to the intensity of exercise (aerobic training and resistance training) due to the low cardiac function, energy dysfunction and myopathy. After rehabilitation for two months, muscle strength had increased and 6MWT, ATVO<sub>2</sub> had improved. Importantly, the reduction of dyspnea on exertion as well as the increase in exercise capacity are considered to have led to improvement of quality of life.
ABSTRACT
The number of the patients requiring rehabilitation has been rapidly increasing. Rehabilitation patients and their families face various troubles and problems in their illness, their functional state, their convalescence, and a wide range of domains including their at-home life and care burden. And rehabilitation staffs must deal with these problems appropriately and take pride in their efforts and strive to provide continuing reliable care. However, most hospitals and rehabilitation centers only have one or at most a few physiatrists. Thus, most physiatrists and co-medical rehabilitation staff have few advisers and are frustrated by the many kinds of problems faced in providing medical service and management. In this lecture, I discuss how to build safety measures, how to write medical records to prevent future troubles, the proper on-site manner, and the 15 traits of a disliked physiatrist. I hope that this lecture can blow away the frustration from the rehabilitation scene and be helpful not only for patients and their families, but also for physiatrists and co-medical rehabilitation staff.
ABSTRACT
Visceral impairment (VI), including cardiac, renal, pulmonary, hepatic, intestinal, urinary and rectal, AIDS is a worldwide public health problem. Recently, the number of patients with VI dramatically increased, reaching 30% of the total population of disabled patients in Japan in 2006, which corresponds to 60% of patients with limb impairment. Visceral rehabilitation (VR) is a coordinated, multifaceted intervention designed to optimize a patient’s physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the disease, thereby reducing morbidity and mortality. VR includes five major components : exercise training, diet & fluid management, medication & medical surveillance, education, psychological & vocational counseling. VR is a feasible, effective (Class I, evidence label A) and safe secondary prevention strategy following VI, and offers a promising model for a new field of rehabilitation. Medical science basically aims to “Adding Years to Life” by increasing life expectancy. Rehabilitation generally aims to “Adding Life to Years” by helping patients with impairment achieve, and use, their full physical, mental and social potential. However, recent growing evidence suggests that rehabilitation for patients with VI not only improves exercise performance and quality of life, but also increases survival. Therefore, modern comprehensive rehabilitation for patients with visceral impairment does not simply aim to “Adding Life to Years” but “Adding Life to Years and Years to Life”, which is a new rehabilitation concept. Urgent efforts should be made to increase the implementation rate of VR.
ABSTRACT
The Great East Japan Earthquake occurred on March 11, 2011. As a representative of a local earthquake relief headquarters, I report what we have done in the stricken area following the Great East Japan Earthquake for the three months afterwards. As a result of this report, I strongly recommend the establishment of a “Disaster Rehabilitation” and “Disaster Acute Rehabilitation Team (DART)” as well as creating a “Disaster Rehabilitation Manual or Guideline” in order to pass the knowledge learned through our experience on to future generations and to be able to respond to any forthcoming disaster quickly and efficiently.
ABSTRACT
The Great East Japan Earthquake occurred on March 11, 2011. As a representative of a local earthquake relief headquarters, I report what we have done in the stricken area following the Great East Japan Earthquake for the three months afterwards. As a result of this report, I strongly recommend the establishment of a “Disaster Rehabilitation” and “Disaster Acute Rehabilitation Team (DART)” as well as creating a “Disaster Rehabilitation Manual or Guideline” in order to pass the knowledge learned through our experience on to future generations and to be able to respond to any forthcoming disaster quickly and efficiently.
ABSTRACT
We evaluated the influence of a twice-weekly group exercise program on visceral fat area (VFA) and plasma adiponectin (APN) in the elderly. Thirty-three community-dwelling elderly (age : 72.4±6.9 yrs) participated in a 12-week supervised, geriatric exercise training program (GET) followed by a 12-week unsupervised GET (u-GET), which included stretching, strengthening, and balance-training exercises. Participants were evaluated for physical fitness, blood glucose, HbA1c, triglyceride, cholesterol, insulin, and APN. VFA was measured by computed tomography. All measurements were taken before the GET (TR1), after 12-weeks of GET (TR2), and at the end of the u-GET (TR3). Twelve weeks of GET produced significant increases in physical function measures. Both walking speed and functional mobility values at TR3 were significantly higher than TR1 values. A significant reduction in VFA was seen at TR3 in men. APN progressively elevated from TR1 to TR3 in women. In the frail elderly, 12 weeks of GET effectively increased functional ability and APN. The beneficial effects on VFA and APN were sustained following the participation in the unsupervised setting, suggesting that the frail elderly should be encouraged to participate and maintain a resistance training routine to achieve preferable effects on both functional ability and cardiovascular risk factors.
ABSTRACT
Electrical stimulation (ES) is an established method for providing muscle activity. Moreover, there are some reports that ES induces angiogenesis. It was thought that the angiogenesis from ES is induced by physical phenomenon such as calculated shear stress, capillary wall tension, and stretch. However, there is a report that the electrical field itself might play a role in angiogenesis by stimulating the vascular endothelial growth factor (VEGF) receptor signaling pathway. Therefore, there is a possibility that ES might be used as a new therapy for ischemic diseases such as arteriosclerosis obliterans (ASO). The limited physical performance of chronic heart failure (CHF) patients may not only be entirely due to impairment of cardiac and lung function but may also result from peripheral hemodynamic variables and abnormalities in skeletal muscle metabolism and structure, such as a decrease in capillary density, mitochondrial content etc. There are some studies showing the positive effect of low frequency electrical stimulation on muscle strength and blood flow in patients who have advanced CHF and can not achieve conventional exercise training. Thus, ES could be recommended for the treatment of patients with severe CHF. Furthermore, cardiac-resynchronization therapy in the form of biventricular stimulation with a pacemaker would reduce the risk of death and hospitalization among patients with advanced CHF. Further studies are required to precisely define the underlying mechanism and determine the most effective mode of application.
ABSTRACT
We investigated the effects of long-term administration of bisoprolol (β-blocker), exercise and their combination on blood pressure, heart rate, and baroreflex function in spontaneously hypertensive rats (SHR).SHR aged 5 week were randomly assigned to control group (C), bisoprolol-treated group (Biso), exercise group (Exer), and combination group (Biso+Exer)(n=8/each group). In Biso and Biso+Exer, bisoprolol (20 mg/kg/day) was administered. In Exer and Biso+Exer, exercise training was performed on treadmill 5 days/week for 12 weeks. Systolic blood pressure (SBP) and heart rate (HR) were measured using the tail-cuff method under restraint from 5 to 16 weeks of age. After 12-week intervention period, sigmoidal mean artery pressure (MAP) and HR reflex curve were obtained by intravenous injections of various doses of phenylephrine and nitroprusside under non-restraint condition. To determine vagal component of baroreflex function, baroreflex MAP-HR relation were also examined after intravenous injections of atenolol (β-blocker). After measurements of all baroreflex function, atropine was additionally injected to determine intrinsic HR.At 15 and 16 weeks of age, SBP and HR in Biso and Exer were significantly lower than those in C. SBP and HR in Biso+Exer were further reduced compared with Biso. Before atenolol, resting MAP, HR and upper and lower HR plateaus in the sigmoid curve were lower in Biso, Exer, and Biso+Exer compared with C. There were no significant differences in these parameters between Biso and Biso+Exer. There were no significant differences in baroreflex gain before atenolol among the four groups except for between Biso and Biso+Exer. After atenolol, baroreflex gain and HR range in Biso, Exer, and Biso+Exer were significantly higher than those in C. HR range of sympathetic component (upper HR plateau before atenolol-itrinsic HR) was significantly reduced in Biso, Exer, and Biso+Exer compared with C. There were no significant differences in baroreflex gain of vagal component or HR range of vagal and sympathetic component between Biso and Biso+Exer.These findings suggest that both chronic treatment with β-blocker and exercise decrease resting blood pressure and HR in SHR, associated with reduced sympathetic component and increased vagal component of baroreflex function. The additive effects of β-blocker and exercise are not evident under non-stressful conditions, but could be obtained in the presence of stress such as restraint.