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Coronavirus disease 2019 (COVID-19) has been spreading globally since 2019；however, comprehensive rehabilitation of elderly patients with COVID-19 pneumonia remains a challenge. A 76-year-old American woman with COVID-19 pneumonia was admitted to our hospital. Because her disease was complicated by acute respiratory distress syndrome (ARDS), she was treated with intensive care, including invasive ventilation and extracorporeal membrane oxygenation (ECMO). During and after intensive care, she exhibited physical symptoms such as weakness, pain, shortness of breath, and difficulty in movement and exercise. Furthermore, during approximately 3.5 months of hospitalization, she received swallowing and speech therapies along with physical therapy. These rehabilitation therapies enabled her to get home in the United States. Her rehabilitation schedule had to be carefully planned according to her symptoms and infectiousness of COVID-19. This paper highlights few important points regarding the difficulty in rehabilitation including that of physical function, mental health, and cognitive function of patients with COVID-19. Furthermore, this report provides a problem-solving approach for long-term rehabilitation in elderly patients with COVID-19 pneumonia.
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Objective To investigate the micro vibration with the hand nursing methods for disuse syndrome patients constipation curative effect. Methods During the time of March 2016 to September, 76 patients who had long term disuse syndrome with the constipation in two Elderly Care Homes in Urumqi were randomly divided into intervention group (n=37) and control group (n=39), in the experimental group, was treated by manual micro vibration nursing method which included hand micro vibration therapy, exercise therapy, health education guidance once a day, 50 minutes each time, a total of 4 weeks of intervention, while the control group received routine rehabilitation nursing. Before the intervention, intervention after 4 weeks, follow-up period after the end of 8 weeks according to the symptoms of constipation and evaluate the stool frequency. Results Preliminary experimental group and control group patients have different degrees of constipation symptoms, with the hand micro vibration method of nursing intervention, the experimental group had not constipation of symptoms, 17(43.6%) had constipation symptoms in the control group. Compared with the incidence of two groups of constipation patients. Before the intervention, intervention after 4 weeks, follow-up period after the end of 8 weeks, the experimental group patients defecation frequency was (5.33 ± 1.47), (29.70 ± 6.49) , (43.41 ± 6.15)times, The control group patients was(5.77 ± 1.39), (13.10 ± 1.27), (21.15 ± 4.23) time, comparison of the two groups, t=-1.357, 15.275, 18.458, P=0.179, 0.000, 0.000. Conclusions Hand micro vibration nursing method has remarkable effect on relieving constipation, and the treatment effect can be maintained for a long time, no recurrence occurred and adverse reactions, however, this method also economic, convenient, less time consuming and efficient.
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<p>Objective：In Parkinson's disease and Parkinsonian syndrome (referred to collectively as PD), the progression of functional decline is influenced by complications such as bone fracture or pneumonia. We aimed to assess the efficiency of short-term inpatient rehabilitation therapy for patients with PD in terms of functional recovery and cost-effectiveness.</p><p>Methods：We investigated differences in outcomes of inpatient rehabilitation for 84 patients with PD, in relation to reasons for hospitalization. Patients with complications, including orthopedic diseases (n＝15), and disuse syndrome (n＝16) received therapy for 3 hours/day in Kaifukuki postacute convalescent rehabilitation wards (KRW) or 2 hours/day in other facilities. Fifty-three patients without complications and thus not eligible for admission to KWR were provided with short-term inpatient rehabilitation therapy (training for 2 hours/day, 6 days/week for 1 month).</p><p>Results：In the patients without complications, the efficiency of FIM (FIM gain/hospital stay) was significantly greater (p＝0.03) and the amount of training and the medical expenses needed to improve the FIM score by 1 point, calculated as total training units (1 unit＝20 minutes of therapy as per the Japanese medical insurance system) divided by FIM gain and total medical cost divided by FIM gain, showed a decreasing trend (p＝0.07, 0.10, respectively) in comparison with that in the patients with complications.</p><p>Conclusion：Short-term inpatient rehabilitation for PD patients without complications is beneficial in terms of rehabilitation efficiency and cost-effectiveness, and appears effective at preventing complications and reducing costs. Reconsideration of the medical insurance system may be necessary so that short-term inpatient rehabilitation can be offered in various facilities, including Kaifukuki wards.</p>
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Understanding the societal and personal impact of immobilization or disuse syndrome is important in Japan with its large elderly population. The indication of disuse syndrome for rehabilitation was narrowed and the fee for disuse syndrome was set at a low level. Muscle strength decreases at a rate of 2.3 % per day in 40 % of the people. Also, the muscle fractional synthetic rate decreased with 10 days rest. Other functional or morphological changes also occur in the neuromuscular junction and the muscle internal structure. Additionally, we must consider the contribution of muscle to the limitation of joint angle after immobilization. Both elasticity and viscosity increase. Cardiac wall thickness and cardiorespiratory fitness decrease during immobilization. Gravitational dependent lung disease or deep vein thrombosis may occur. The brain is also affected by immobilization, leading to condition of learned non-use. The best solution for immobilization is to be active ; however, we must have a detailed knowledge of the pathophysiology of a patient's disease in order increase their activity level. In an acute hospital setting, prevention of immobilization is crucial. The system used in Japan, whereby therapists are assigned full-time in the ward was introduced in April 2014. Furthermore, even though 20.35% of maximal strength training is effective in atrophied muscles, it is ineffective in trained muscles. Another sticking point is that there is no evidence-based recommendation for range of motion exercise. However, rehabilitation intervention in respirator patients improves their ADL. Prophylaxis of deep vein thrombosis is also very important. And learned non-use of the brain may be diminished by the skillful application of vibrations that makes patients feel that their hand is moving even when it is not. Finally, the mechanism of hibernation may be the key to improving our rehabilitation against immobilization in the future.
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We report a patient displaying several symptoms of myelitis associated with atopic dermatitis. The patient, a 35-year-old female, initially suffered from gait titubation that gradually developed into motor disturbance. She underwent many tests (blood, cerebrospinal fluid, electromyography, and brain, cervical, and lumbar spinal cord and muscle MRIs) at several hospitals, including a university institution, over the course of two years until she finally came to our hospital. However, her disease was never identified by these tests, and she was referred to our hospital to start rehabilitation for her disability which was believed to be caused by disuse syndrome. On first examination, muscle hypertonia of both legs, hypoesthesia of all extremities, difficulty sitting, and a low performance level of ADL were observed. Judging by the factors (e.g. age, neurological symptoms), we considered that the patient was not suffering disuse syndrome, and recommended that she attend another medical college hospital for a thorough investigation. The disease was finally diagnosed as atopic myelitis, as indicated by the test results (e.g. hyperIgEemia). She could sit without a back rest and undertake gait training between parallel bars after steroid pulse therapy at the hospital. While she undertook rehabilitation at our hospital, we applied some approaches to adapt to her fluctuating symptoms (e.g. making short leg braces for both legs, injection of botulinum toxin A (BOTOX<sup>®</sup>) in the leg). We recognized we should gather as much information as possible given the rarity of the disease.
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A Major earthquake and giant tsunami occurred on 3.11, which broadly affected the eastern Japan area along the Pacific Ocean. A large elderly population was confined to their place of refuge and faced a high risk of disuse syndrome due to immobility. Elderly survivors aged 65 and over who were markedly found in an inactive state due to immobilization were regarded as the “risk group” for inactive lifestyles, possibly leading to disuse syndromes. Intervention by means of rehabilitation assistance was required in approximately one third of these inactive survivors (“high risk group”), a rate which was significantly higher in the elderly over 65 years than in younger survivors. Establishment of a rehabilitation assistance system for use in the event of a mass disaster is one of the critical lessons learned following 3.11, which will contribute to serve as a prophylaxis against disuse syndromes arising from inactivate locomotive function. Legal reform of relief actions in mass disasters is highly required to also include physical therapists as official members.
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A Major earthquake and giant tsunami occurred on 3.11, which broadly affected the eastern Japan area along the Pacific Ocean. A large elderly population was confined to their place of refuge and faced a high risk of disuse syndrome due to immobility. Elderly survivors aged 65 and over who were markedly found in an inactive state due to immobilization were regarded as the “risk group” for inactive lifestyles, possibly leading to disuse syndromes. Intervention by means of rehabilitation assistance was required in approximately one third of these inactive survivors (“high risk group”), a rate which was significantly higher in the elderly over 65 years than in younger survivors. Establishment of a rehabilitation assistance system for use in the event of a mass disaster is one of the critical lessons learned following 3.11, which will contribute to serve as a prophylaxis against disuse syndromes arising from inactivate locomotive function. Legal reform of relief actions in mass disasters is highly required to also include physical therapists as official members.
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<b>Background:</b> To determine whether nutrition is associated with rehabilitation outcome in the disuse syndrome.<br><b>Methods:</b> A retrospective cohort study was performed in 223 inpatients admitted to a university hospital who were diagnosed by physicians in the rehabilitation department as having the disuse syndrome, and subsequently prescribed physical therapy. Malnutrition was defined as a body mass index<18.5 kg/m<sup>2</sup>, hemoglobin level<10.0 g/dl, serum albumin level<3.0 g/dl, or total lymphocyte count<1200 cells/mm<sup>3</sup>. Rehabilitation outcome was defined as whether or not the ADL score improved during rehabilitation. Nutritional status was assessed at referral using the Onodera's prognostic nutritional index (PNI).<br><b>Results:</b> The study cohort included 136 men and 87 women (mean age 67.5 years; median duration between admission and referral 17 days; median rehabilitation duration 32 days). A total of 202 patients (91%) were defined as being malnourished. Mean PNI was 32.9, with the ADL score improving in 135 patients (61%) during rehabilitation. Rehabilitation outcome was better in patients with normal nutrition compared to malnourished patients (relative risk: 0.72, p=0.04). Patients with a hemoglobin level>10.0 g/dl (relative risk: 0.69, p=0.001), total lymphocyte count>1200 cells/mm<sup>3</sup> (relative risk: 0.78, p=0.03), or PNI>35.0 (relative risk: 0.74, p=0.01) had a better rehabilitation outcome. Logistic regression analysis showed that hemoglobin level was associated independently with rehabilitation outcome (odds ratio 2.34, p=0.005).<br><b>Conclusions:</b> Malnutrition is common in patients with the disuse syndrome. Patients with low hemoglobin level and PNI at referral are more likely to have a poor rehabilitation outcome.
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@#This article introduced the form of the rehabilitation evaluation discussion, which was moderated by the rehabilitation doctors, together with relevant therapists and nurses, aiming to discuss the obstacles and the rehabilitation plan for a difficult patient. This case showed the importance of early rehabilitation after stroke.
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Objective: To develop a weighted disuse risk score rating. Design : Based on specified selection criteria, items of the disuse risk factor were chosen. Then, a conjoint questionnaire for physicians was created using orthogonal cards with ordinal disuse risk grade. Conjoint analysis (SPSS 15.0) was performed, weighting each item and making a formula for calculating the disuse risk score. Setting : The Rehabilitation Department of a University Hospital. Participants : Forty-one physician respondents and 129 consecutive inpatients referred to the rehabilitation department. Main outcome measures : Agreement of the rated disuse risk grade with the calculated disuse risk score, and the reliability of the calculated disuse risk score of the 129 inpatients. Results : Eleven disuse risk factor items were selected ; age, malignant tumor, heart impairment, respiratory impairment, kidney impairment, pain, gait disorder, psychiatric impairment, intellectual disability, dementia, and body mass index. Forty-one physicians completed and returned a postal questionnaire. Cronbach's a of the rated disuse risk grade was 0.948. The correlation coefficient of the average rated disuse risk grade to the calculated disuse risk score was 0.985 (<i>p</i>=0.000). Items of high overall importance (%) were gait disorder (14.0%), malignant tumor (11.5%), and respiratory impairment (11.0%). Those of low overall importance (%) were body mass index (6.8%), kidney impairment (6.6%), and psychiatric impairment (6.1%). For the 129 patients, the calculated disuse risk score of the 11-item was correlated to that of the 9-item weighted disuse risk factor (<i>R</i>=0.930, <i>p</i>=0.000). Conclusions : Both the 11-item disuse risk factor and the weighted disuse risk score rating were considered reliable and useful.
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To assess the factors affecting home return after convalescent rehabilitation, we retrospectively compared such items between the patients returning home (subgroup I) and those requiring long-term institutionalization (subgroup II) as follows : the patient's ADL level before admission and the their living environment, the serial changes in their ADL after admission, the duration of acute care, and the length of stay. Subjects comprised 32 patients with cerebrovascular disorder (CVD) and 22 with disuse syndrome (DS) and each of these two groups was divided into subgroup I and II (<i>n</i>=19 and 13 in the CVD group, 11 and 11 in the DS group, respectively). In the CVD group, the mean age of subgroup I was significantly lower than that of subgroup II (65.4±14.0 and 80.3±10.9, respectively). The FIM scores (total, motor, cognition) in subgroup I were significantly higher than those in subgroup II, both at the time of admission and discharge. In the FIM motor items, the scores for mobility and locomotion significantly improved at discharge. In the DS group, there was no difference in the ages between the subgroups (80.5±11.0 and 81.5±11.2, respectively). Subgroup I had more family members and showed a significant increase in their scores for self-care and mobility after admission. In conclusion, home return appears most related to improvement in motor ADL, and this improvement was further influenced by age and cognitive function in the CVD group and by the number of family members in the DS group.
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The patient, a 72-year-old man, was admitted for disuse syndrome after left lower thigh cellulites, who originally developed left hemiparesis at age 60. At the time of admission, he was alert, his Body Mass Index was 18.5 and his FIM (Functional Independence Measure) score was 49. We thought this was a case of post stroke disuse syndrome manifesting after long-term bedridden inactivity. He underwent a hospital rehabilitation program; however, he gained only poor functional recovery after one month. He complained about nighttime snoring and awakening from sleep. So he was evaluated with a portable device for SAS (Sleep Apnea Syndrome). His ESS (Epworth Sleepiness Scale) was 21, his Apnea-Hypnea Index was 58.2 and his lowest SpO<sub>2</sub> level was 75%. With a diagnosis of severe SAS, he was treated with nighttime nCPAP (nasal Continuous Positive Airway Pressure). After treatment, his lowest SpO<sub>2</sub> level rose to 90%, and the patient's excessive daytime sleepiness (ESS=15) and ADL (FIM=85) improved. When patients exhibit poor recovery after training, the possibility of SAS should be taken into consideration and they should be tested accordingly.
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@#The purpose of this paper is to introduce the advance of J.Carr and R. Shepherd's A Motor Relearning Programme for Stroke. In the neurosciences, it has been typical to consider the dyscontrol characteristics associated with the upper motor neuron syndrome as positive features and negative features for a long time. Recently Dr. Carr and Dr. Shepherd have proposed another group of characteristics which they call adaptive features, since it appears likely that adaptive changes to neural system, muscles and other soft tissues and adaptive motor behaviors underline some clinical signs. They point out that early rehabilitation and active life should be arranged for the stroke patient. It is the author's suggestion that we should pay more attention to the “disuse syndrome”in training of the stroke patient according to the adaptive features, and we should understand the “misuse syndrome” correctly and we should not neglect to train the muscle strength in correcting the patient's abnormal movement pattern, since the negative features are major reasons for functional disability, together with the adaptive changes that occur in soft tissues as a result of denervation, immobility and disuse.