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Introduction：Here we report the case of a patient with Parkinson disease (PD) who showed improved physical function and non-motor symptoms, including fatigue and dysautonomia, through a multidisciplinary collaboration involving rehabilitation treatment, nutrition, and medication management.Case：A 77-year-old woman with PD was hospitalized for condition assessment and environmental adjustments and complained of fatigue and dizziness. She presented with decreased physical function, sarcopenia, orthostatic hypotension, and an impaired circulatory response during exercise. A multidisciplinary conference was conducted to address these issues, and we decided to implement rehabilitation treatment, nutrition, and medication management.The rehabilitation program consisted of 1 h/day physiotherapy sessions involving stretching exercises, muscle-strengthening exercises, and walking training. Because she often made medication administration errors, a nurse managed them on her behalf. Nutrition management was established to ensure sufficient energy for her total energy expenditure.At discharge, a notable improvement was recorded in Part 1 of the Movement Disorder Society Unified Parkinson's Disease Rating Scale, and the patient's complaints of fatigue and dizziness had subsided. Additionally, physical function measures such as skeletal muscle mass, comfortable walking speed over a 10-m distance, 6-min walking distance, and Berg Balance Scale score improved. To optimize the patient's home environment, home nursing, home-visit rehabilitation, and meal delivery services were introduced to manage her medication and nutritional needs.Discussion：In addition to rehabilitation treatment, the reconsideration of a patient's daily living activities, such as taking medications and meals, is important for improving their physical function and non-motor symptoms including fatigue and dysautonomia.
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Objective To explore the implementation effects and application value of the Clinical Rehabilitation Integration Plan based on the graded management of rehabilitation treatment programs in a 3A general hospital.Methods The details of the programme were firstly formulated according to the needs of clinical rehabilitation and the implementation plan was formed,and then the integrated clinical rehabilitation work was carried out for 1 year accordingly,and finally the effects before and after the implementation of the programme were compared and analysed by selecting the indicators of departmental operation and patient satisfaction.Results The rehabilitation programme was classified into 4 levels according to the degree of technical difficulty and medical risk,and its connotation and management requirements were defined in detail.The implementation of the programme included organisational structure,training and assessment,authorisation management and quality control.The programme was carried out in 8 clinical departments in the hospital,and the overall willingness of the clinical departments to develop early rehabilitation was improved since 2022.Conclusion This program can improve the operational efficiency of clinical departments and patient prognosis.
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Sino-foreign cooperative education not only introduces foreign teachers and curriculums, but also brings new teaching concepts, teaching methods, and the training of teachers. With the example of rehabilitation treatment in the national first-class undergraduate specialty construction site of Nanjing University of Chinese Medicine, this study discusses the talent training mode of Sino-foreign cooperative education from the five aspects of professional system, discipline characteristics, curriculum system, teaching methods, and evaluation methods. The mode of Sino-foreign cooperative education provides a reference for the development of modern rehabilitation higher education.
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Typical cases of neuralgic amyotrophy present with sudden onset of excruciating pain in the shoulders and upper extremities, followed by marked muscle weakness and atrophy over a period of hours to days. Neuralgic amyotrophy is not confined to the brachial plexus, and difficulties in its diagnosis may delay the start of rehabilitation therapy. Here, we report a case of rehabilitation of a patient with neuralgic amyotrophy presenting with Collet-Sicard syndrome (9th, 10th, 11th, and 12th cranial nerve disorder)．A 44-year-old man developed severe pain from the left posterior neck to the occipital region, followed by sporadic onset of dysarthria, dysphagia, and difficulty in raising the left upper limb over several weeks. Nerve conduction studies showed marked bilateral differences in the amplitude of the compound muscle action potential recorded from the trapezius during accessory nerve stimulation. Needle electromyography showed abnormal resting potentials in the left trapezius and left side of the tongue and a decrease in the interference pattern during voluntary contraction. Based on the clinical course, neurological and laboratory findings, a diagnosis of neuralgic amyotrophy was made. Speech language hearing therapy was performed for dysarthria and dysphagia, and physical therapy was performed for difficulty in raising the left upper limb due to accessory nerve palsy. Rehabilitation along with recovery from inflammation-induced neuropathy allowed the patient to become independent in activities of daily living.
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Typical cases of neuralgic amyotrophy present with sudden onset of excruciating pain in the shoulders and upper extremities, followed by marked muscle weakness and atrophy over a period of hours to days. Neuralgic amyotrophy is not confined to the brachial plexus, and difficulties in its diagnosis may delay the start of rehabilitation therapy. Here, we report a case of rehabilitation of a patient with neuralgic amyotrophy presenting with Collet-Sicard syndrome (9th, 10th, 11th, and 12th cranial nerve disorder)．A 44-year-old man developed severe pain from the left posterior neck to the occipital region, followed by sporadic onset of dysarthria, dysphagia, and difficulty in raising the left upper limb over several weeks. Nerve conduction studies showed marked bilateral differences in the amplitude of the compound muscle action potential recorded from the trapezius during accessory nerve stimulation. Needle electromyography showed abnormal resting potentials in the left trapezius and left side of the tongue and a decrease in the interference pattern during voluntary contraction. Based on the clinical course, neurological and laboratory findings, a diagnosis of neuralgic amyotrophy was made. Speech language hearing therapy was performed for dysarthria and dysphagia, and physical therapy was performed for difficulty in raising the left upper limb due to accessory nerve palsy. Rehabilitation along with recovery from inflammation-induced neuropathy allowed the patient to become independent in activities of daily living.
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Patients with severe coronavirus disease 2019 (COVID-19) have poor prognosis, with many cases being difficult to treat and many reports of neurological complications in patients who have been in the intensive care unit for a long time. Rehabilitation of patients with severe COVID-19 is important；however, no rehabilitation program has shown effectiveness. Thus, this study aimed to investigate the effects of a rehabilitation program developed and used at our hospital for patients with severe COVID-19. We enrolled 28 patients with severe COVID-19 (age 61［23-88］years；female/male, 9/19, body mass index, 25.0［18.0-33.6］kg/m2). We assessed the medical research council scoring (MRC) of the patients at the time of entry and exit from the ordinary ward using Wilcoxon signed-rank tests. MRC was significantly improved after exiting the ordinary ward compared with that on entering the ordinary ward (43 vs. 50 points；P＜.001). Moreover, Barthel index improved significantly after exiting the ordinary (32.5 vs. 77.5 points, P＜.001). Therefore, our acute rehabilitation treatment for patients with severe COVID-19 may be effective in improving their muscle strength and daily living.
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Patellofemoral pain syndrome (PFPS) has been attracting more and more attention in the field of rehabilitation treatment due to its high incidence rate and low cure rate. Researches show that the abnormal anatomy, muscle activity changes due to pain and insufficient muscle strength in patients with PFPS can cause wrong movement patterns of lower limb joints, which will lead to aggravation of the disease and is not conducive to the rehabilitation of patients. Movement patterns of the hip, knee, ankle joints can be improved by exercise therapy, taping, neuromuscular training and joint orthosis, thus to reduce the pain. In this paper, the movement pattern characteristics of patients with PFPS and the corresponding rehabilitation treatment method were summarized, so as to provide references for the rehabilitation of PFPS.
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We provided inpatient rehabilitation treatment and return-to-school guidance to a junior high school student with medulloblastoma and pervasive developmental disorder (autism spectrum disorder). Here we describe the rehabilitation treatment for patients with physical and developmental disabilities. A 13-year-old boy who was diagnosed with pervasive developmental disorder at 4 years of age was able to perform activities of daily living independently and attend junior high school. However, he was admitted to our hospital with new-onset ataxia. Magnetic resonance imaging revealed a cerebellar tumor. After total tumor excision was performed, pathological analysis revealed medulloblastoma, which was treated initially with radiation therapy and then chemotherapy for 1 year. Rehabilitation was initiated 2 days post-surgery. We evaluated his communication abilities. He showed stereotypical behavior owing to the autism spectrum disorder；therefore, we performed low-intensity repetitive exercises. The functional independence measure score at discharge was 67/126 (motor 44/91, cognitive 23/35). We taught his teachers how to properly assist him, and he successfully returned to school post-discharge. Although this was a case in which the child had multiple disabilities, ataxia caused by the medulloblastoma aggravated his developmental disability. Thus, understanding the characteristics of communication and its strengths was vital in determining a treatment plan that enabled his return to school.
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Knee rotationplasty is a surgery wherein the rotated ankle serves as the new knee joint after resecting the original knee joint and lesion. However, details of postoperative rehabilitation treatment in a convalescent rehabilitation ward are not well-known. Therefore, we reported the rehabilitation progress of a 36-year-old man who underwent knee rotationplasty in the convalescent rehabilitation ward. In the early postoperative period, the surgery required no weight bearing on the operated lower limb until bone healing. Even during this period, we conducted physical therapies such as joint range of motion training and muscle strength training as outpatient rehabilitation therapy. After being admitted to the convalescent rehabilitation ward, physical therapy was intensified and the patient's rotationplasty prosthesis was then fabricated and fitted by a prosthetist and orthotist. The patient was discharged 80 days after his hospitalization and could eventually walk stably with his prosthesis and returned to work. In Japan, the length of stay in a convalescent rehabilitation ward is limited. If patients are provided with enough physical therapy during the postoperative course and rotationplasty prosthesis by a skilled prosthetist and orthotist, rehabilitation treatment after knee rotationplasty can achieve good results in a convalescent rehabilitation ward.
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The patient was a 76-year-old woman who developed involuntary movements in both hands and gait disorder. Weakness in both lower limbs gradually worsened, and she was referred to our hospital. Neurological findings included spastic paraplegia, deep sensory disturbance, sensory ataxia, and bladder and bowel dysfunction. Approximately 4 months after the onset, she became unable to walk independently and had to use a walker. MRI showed a long spinal cord lesion extending from the cervical to thoracic spinal cord. Blood and spinal fluid samples tested positive for anti-human T-cell leukemia virus type 1 (HTLV-1) antibodies. Given these findings and subacute course, she was diagnosed with rapidly progressive HTLV-1 associated myelopathy (HAM). High levels of neopterin and CXCL10 in the cerebrospinal fluid suggested high disease activity；thus, she underwent steroid pulse therapy followed by treatment with maintenance oral prednisolone in our convalescent rehabilitation ward. After approximately 3 months of muscle strength training, mainly for the trunk muscle and the proximal muscle of the lower limbs, and balance exercise, she was able to walk independently and her activities of daily living (ADL) and instrumental ADL (IADL) improved；however, dysuria persisted. The use of clean intermittent self-catheterization instead of indwelling urethral catheter improved her quality of life (QOL). Although rapidly progressive HAM is generally associated with poor prognosis, steroid therapy combined with comprehensive rehabilitation treatment was effective in the present case.
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We provided inpatient rehabilitation treatment and return-to-school guidance to a junior high school student with medulloblastoma and pervasive developmental disorder (autism spectrum disorder). Here we describe the rehabilitation treatment for patients with physical and developmental disabilities. A 13-year-old boy who was diagnosed with pervasive developmental disorder at 4 years of age was able to perform activities of daily living independently and attend junior high school. However, he was admitted to our hospital with new-onset ataxia. Magnetic resonance imaging revealed a cerebellar tumor. After total tumor excision was performed, pathological analysis revealed medulloblastoma, which was treated initially with radiation therapy and then chemotherapy for 1 year. Rehabilitation was initiated 2 days post-surgery. We evaluated his communication abilities. He showed stereotypical behavior owing to the autism spectrum disorder；therefore, we performed low-intensity repetitive exercises. The functional independence measure score at discharge was 67/126 (motor 44/91, cognitive 23/35). We taught his teachers how to properly assist him, and he successfully returned to school post-discharge. Although this was a case in which the child had multiple disabilities, ataxia caused by the medulloblastoma aggravated his developmental disability. Thus, understanding the characteristics of communication and its strengths was vital in determining a treatment plan that enabled his return to school.
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The patient was a 76-year-old woman who developed involuntary movements in both hands and gait disorder. Weakness in both lower limbs gradually worsened, and she was referred to our hospital. Neurological findings included spastic paraplegia, deep sensory disturbance, sensory ataxia, and bladder and bowel dysfunction. Approximately 4 months after the onset, she became unable to walk independently and had to use a walker. MRI showed a long spinal cord lesion extending from the cervical to thoracic spinal cord. Blood and spinal fluid samples tested positive for anti-human T-cell leukemia virus type 1 (HTLV-1) antibodies. Given these findings and subacute course, she was diagnosed with rapidly progressive HTLV-1 associated myelopathy (HAM). High levels of neopterin and CXCL10 in the cerebrospinal fluid suggested high disease activity；thus, she underwent steroid pulse therapy followed by treatment with maintenance oral prednisolone in our convalescent rehabilitation ward. After approximately 3 months of muscle strength training, mainly for the trunk muscle and the proximal muscle of the lower limbs, and balance exercise, she was able to walk independently and her activities of daily living (ADL) and instrumental ADL (IADL) improved；however, dysuria persisted. The use of clean intermittent self-catheterization instead of indwelling urethral catheter improved her quality of life (QOL). Although rapidly progressive HAM is generally associated with poor prognosis, steroid therapy combined with comprehensive rehabilitation treatment was effective in the present case.
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Fat embolism syndrome (FES) is a serious complication of orthopedic surgery. We describe a woman in her 30s, who experienced cerebral FES after extensive femoral tumor resection and intercalary endoprosthesis for a malignant soft tissue tumor of the thigh. Before the surgery, the patient was able to walk with a single axillary crutch, capable of independent self-care and had no cognitive problems. After the surgery, the patient developed respiratory and central nervous system symptoms, which are characteristic of FES. After critical care, we provided rehabilitation treatment, which included getting out of bed, basic motion training, cognitive rehabilitation treatment, and Activity of Daily Living (ADL) training. At the time of commencement of the rehabilitation treatment, the patient presented with higher brain dysfunctions, such as cognitive dysfunction (Mini Mental State Examination：MMSE score 21 points), attentional dysfunction and left unilateral spatial neglect (USN). However, apparent motor paralysis of the extremities was not detected. On the 95th day after the surgery, the patient's MMSE score was 29 points, and the attentional dysfunction and USN were resolved. Additionally, the patient was again able to walk with axillary crutch. Six months after the surgery, the patient could walk independently without the aid of a crutch. One year after the surgery, the patient's reinstated to work. Cerebral FES may be accompanied with higher brain dysfunction；present a variety of higher brain dysfunctions；however, the symptoms may be reversible and resolved with rehabilitation treatment.
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Fat embolism syndrome (FES) is a serious complication of orthopedic surgery. We describe a woman in her 30s, who experienced cerebral FES after extensive femoral tumor resection and intercalary endoprosthesis for a malignant soft tissue tumor of the thigh. Before the surgery, the patient was able to walk with a single axillary crutch, capable of independent self-care and had no cognitive problems. After the surgery, the patient developed respiratory and central nervous system symptoms, which are characteristic of FES. After critical care, we provided rehabilitation treatment, which included getting out of bed, basic motion training, cognitive rehabilitation treatment, and Activity of Daily Living (ADL) training. At the time of commencement of the rehabilitation treatment, the patient presented with higher brain dysfunctions, such as cognitive dysfunction (Mini Mental State Examination：MMSE score 21 points), attentional dysfunction and left unilateral spatial neglect (USN). However, apparent motor paralysis of the extremities was not detected. On the 95th day after the surgery, the patient’s MMSE score was 29 points, and the attentional dysfunction and USN were resolved. Additionally, the patient was again able to walk with axillary crutch. Six months after the surgery, the patient could walk independently without the aid of a crutch. One year after the surgery, the patient’s reinstated to work. Cerebral FES may be accompanied with higher brain dysfunction；present a variety of higher brain dysfunctions；however, the symptoms may be reversible and resolved with rehabilitation treatment.
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Wide resection of malignant bone and soft tissue tumors of the extremities may require resection of muscles, which correspondingly impairs limb movements. We describe a 67-year old man with a malignant soft tissue tumor of the right upper arm. Preoperatively, there was no impairment of right upper extremity function. The patient underwent wide resection of the tumor and triceps muscle. Postoperative rehabilitation included range of motion exercises, residual muscle strength exercises, and activities of daily living (ADL) exercises. One week postoperatively, the patient could independently perform the ADL exercises. Two weeks postoperatively, the patient scored 2 during manual muscle testing (MMT) for elbow extension, indicating a complete range of motion in a gravity-eliminated position. However, the patient could not raise the arm without bending it. Considering the needs of the patient, we prescribed an elbow extension brace to support the upper limb while being raised. With this brace, the patient was able to sustain elbow extension during upper limb elevation. Three months postoperatively, the patient’s elbow joint extension remained MMT 2, grip strength was 28 kg, and the International Society of Limb Salvage and Musculoskeletal Tumor Society score was 76.7％．Although the triceps muscle was resected, there was no problem with the patient’s ADL. However, the patient could not maintain elbow extension in an anti-gravity position while raising the upper limb. In such cases, prescribing an elbow brace may be useful.
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Forequarter amputation is a rare procedure, performed mainly for patients with malignant bone and soft tissue tumors. The present case involved a 59-year-old man with left scapula chondrosarcoma. Rehabilitation began on the second day after amputation for a left shoulder chondrosarcoma. We performed early mobilization, wound management, mirror therapy for phantom pain, strength training for the remaining muscles, and activities of daily living (ADL)/instrumental ADL (IADL) training for only the remaining upper limb. In addition, we made a shoulder disarticulation prosthesis. Six months after the operation, the International Society of Limb Salvage-Musculoskeletal Tumor Society functional score was 36.7％ for 6 items and 73.3％ for 3 items, while the Disability of Arm, Shoulder and Hand score was 31.7. The patient-reported outcome had a low score because of the lack of an upper limb, including the scapula. However, when he was discharged from the hospital, he gained self-care independence with only the remaining upper limb and resumed fishing as a hobby. We suggest that rehabilitation after forequarter amputation requires careful intervention based on a deep evaluation of the patient's ADL/IADL, hobbies, and quality of life, in accordance with the patient's lifestyle.
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Wide resection of malignant bone and soft tissue tumors of the extremities may require resection of muscles, which correspondingly impairs limb movements. We describe a 67-year old man with a malignant soft tissue tumor of the right upper arm. Preoperatively, there was no impairment of right upper extremity function. The patient underwent wide resection of the tumor and triceps muscle. Postoperative rehabilitation included range of motion exercises, residual muscle strength exercises, and activities of daily living (ADL) exercises. One week postoperatively, the patient could independently perform the ADL exercises. Two weeks postoperatively, the patient scored 2 during manual muscle testing (MMT) for elbow extension, indicating a complete range of motion in a gravity-eliminated position. However, the patient could not raise the arm without bending it. Considering the needs of the patient, we prescribed an elbow extension brace to support the upper limb while being raised. With this brace, the patient was able to sustain elbow extension during upper limb elevation. Three months postoperatively, the patient's elbow joint extension remained MMT 2, grip strength was 28 kg, and the International Society of Limb Salvage and Musculoskeletal Tumor Society score was 76.7％．Although the triceps muscle was resected, there was no problem with the patient's ADL. However, the patient could not maintain elbow extension in an anti-gravity position while raising the upper limb. In such cases, prescribing an elbow brace may be useful.
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Forequarter amputation is a rare procedure, performed mainly for patients with malignant bone and soft tissue tumors. The present case involved a 59-year-old man with left scapula chondrosarcoma. Rehabilitation began on the second day after amputation for a left shoulder chondrosarcoma. We performed early mobilization, wound management, mirror therapy for phantom pain, strength training for the remaining muscles, and activities of daily living (ADL)/instrumental ADL (IADL) training for only the remaining upper limb. In addition, we made a shoulder disarticulation prosthesis. Six months after the operation, the International Society of Limb Salvage-Musculoskeletal Tumor Society functional score was 36.7％ for 6 items and 73.3％ for 3 items, while the Disability of Arm, Shoulder and Hand score was 31.7. The patient-reported outcome had a low score because of the lack of an upper limb, including the scapula. However, when he was discharged from the hospital, he gained self-care independence with only the remaining upper limb and resumed fishing as a hobby. We suggest that rehabilitation after forequarter amputation requires careful intervention based on a deep evaluation of the patient's ADL/IADL, hobbies, and quality of life, in accordance with the patient's lifestyle.
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Introducción: La curación de las secuelas dentofaciales de la tortícolis congénita, una vez establecidas, solo puede lograrse mediante cirugías. La identificación temprana de los pacientes aquejados de esta dolencia y un tratamiento precoz es imprescindible, pues de ello dependerá la evolución a largo plazo de los mismos. Objetivo: Identificar los factores que pueden tener utilidad desde la perspectiva de la prevención primordial de la tortícolis congénita. Métodos: Se realizó una investigación observacional, longitudinal y prospectiva en pacientes con diagnóstico de tortícolis muscular congénita atendidos en el Policlínico de Especialidades del Hospital Infantil Sur de Santiago de Cuba, en el periodo de septiembre de 2016 a septiembre de 2018. La muestra fue de 20 pacientes con dicho diagnóstico. Las variables fueron agrupadas en clínicas e imagenológicas. Resultados: Predominaron los pacientes del sexo masculino, 14 casos (70 por ciento). El diagnóstico de la mayoría de los casos fue precoz, 3 (15 por ciento) en la etapa neonatal y 14 (70 por ciento) entre los 29 días y 6 meses. Las complicaciones más temidas tales como la asimetría facial, la deformidad plagiocefálica, la distopia orbitaria y auricular aparecieron sobre todo asociadas a un diagnóstico y tratamiento tardío. La tomografía axial computarizada solo superó a las radiografías para descubrir complicaciones neurológicas. Conclusiones: La atención a temprana edad es la mejor opción terapéutica para evitar complicaciones en niños con tortícolis muscular congénita(AU)
Introduction: Once established, dentofacial sequels of congenital torticollis can only be healed by surgery. Early identification of sufferers and timely treatment are indispensable to achieve a favorable long-term evolution. Objective: Identify potentially useful factors from the perspective of fundamental prevention of congenital torticollis. Methods: An observational longitudinal prospective study was conducted of patients diagnosed with congenital muscular torticollis attending the Secondary Care Polyclinic at the South Children's Hospital in Santiago de Cuba from September 2016 to September 2018. The sample was 20 patients diagnosed with the disease. The variables analyzed were grouped into clinical and imaging. Results: There was a predominance of male patients with 14 cases (70 percent). Diagnosis of most cases was performed early: 3 (15 percent) at the neonatal stage and 14 (70 percent) between 29 days and 6 months. The most feared complications, such as facial asymmetry, plagiocephalic deformity, and orbital and auricular dystopia, were mainly found to be associated to late diagnosis and treatment. Computed axial tomography only surpassed radiography in spotting neurological complications. Conclusions: Early care is the best therapeutic option to prevent complications in children with congenital muscular torticollis(AU)
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Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Congenital Abnormalities , Torticollis/complications , Torticollis/diagnostic imaging , Prospective Studies , Observational StudyABSTRACT
Objective@#To explore the effect of comprehensive rehabilitation treatment of individualized exercise program on lung function, exercise ability, quality of life and biochemical indexes of coal workers’ pneumoconiosis patients, and to provide scientific and effective methods for rehabilitation treatment of coal workers' pneumoconiosis.@*Methods@#In Huaibei Coal Mine Occupational Disease Prevention and Control Hospital, the data of pneumoconiosis patients treated by pneumoconiosis department in the hospital were collected and sorted out. 80 patients were selected according to the inclusion and exclusion criteria. Using a random number table, they were randomly divided into two groups with 40 cases in each group. The data investigated in this study include the results before and after treatment. Pulmonary function index, BMI index, six-minute walking distance (6MWD) , quality of life questionnaire (SF-36) , hospital anxiety and depression scale (HADS) , st George's breathing questionnaire (sgrq) , c-reactive protein (CRP) and blood oxygen saturation (SpO2) were used to evaluate and compare the efficacy of the two groups.@*Results@#The lung function indexes of the test group were significantly higher than those of the control group after treatment (P<0.05) , including forced vital capacity, forced vital capacity in the first second, maximum expiratory flow, expiratory flow when vital capacity was 75% and expiratory flow when vital capacity was 25%. The forced vital capacity, the first-second forced vital capacity and the maximum expiratory flow of the patients in the test group were higher after treatment than before (P<0.05) . The six-minute walking distance of the test group was greater than that of the control group after treatment (P<0.05) . After treatment, the scores of st George’s breathing questionnaire in the test group were lower than those in the control group (P<0.05) . The scores of quality of life questionnaire in the test group were higher than those in the control group after treatment (P<0.05) .@*Conclusion@#The comprehensive rehabilitation treatment of individualized exercise program improved the endurance and exercise ability of pneumoconiosis patients, improved the respiratory status and quality of life of pneumoconiosis patients in Huaibei Coal Mine, improved the lung function of pneumoconiosis patients, and improved the forced vital capacity of patients, but the small airway function has not been significantly improved.