ABSTRACT
We herein report the outcomes of rehabilitation intervention for a patient in his 80s with chronic obstructive pulmonary disease on prolonged mechanical ventilation after COVID-19 infection. The patient was forced to be long-term bedridden due to respirator dependence, showing notable muscle weakness and needing full assistance for all of his activities of daily living (ADL). We implemented rehabilitation for the purposes of withdrawal from mechanical ventilation and improvement of his physical function. We provided a combination program of range of motion exercise, resistance training, and gradual mobilization, such as sitting on the edge of the bed, moving between the bed and wheelchair, sitting on the wheelchair, standing and walking. After rehabilitation for 24 days, the patient was withdrawn from mechanical ventilation, his muscle strength recovered to a level of 4 (Good) on manual muscle testing (MMT) and he became able to walk using a walker. A follow-up survey one year later confirmed that he performed ADL without assistance and returned to work.
Subject(s)
COVID-19 , Medicine , Male , Humans , Activities of Daily Living , Follow-Up Studies , Respiration, ArtificialABSTRACT
OBJECTIVE: This study examined how the effects of botulinum toxin therapy changed over time by sequential evaluation of clinical improvements in spasticity and contracture in 24 chronic-stage stroke patients on repeated botulinum toxin therapy who were receiving fewer rehabilitation interventions. METHODS: Botulinum toxin injection was administered into the spastic muscle of the paralyzed upper or lower limb 5 times with at least 3-month intervals. Modified Ashworth Scale and range of motion were measured before and 2 weeks after each dose in the extremities to compare the first measurement value with subsequent values. Each predose value was also compared with the first predose value. RESULTS: Compared with predose scores, Modified Ashworth Scale significantly improved in all flexors after 2 weeks from the first to fifth doses. Range of motion significantly improved in wrist dorsiflexion and ankle dorsiflexion. Comparison of values before each dose versus the first predose value showed significant improvement both in the Modified Ashworth Scale score of wrist flexors, finger flexors, and ankle planter flexors, and the range of motion of elbow extension, wrist dorsiflexion, and ankle dorsiflexion. CONCLUSION: The comparison of predose values versus 2-week postdose values indicated that the effect of botulinum toxin formulation would not lessen after repeated injections with continuous improvements of Modified Ashworth Scale and range of motion. The comparison of predose values versus the first predose value also suggested that multiple injections of botulinum toxin formulation could be more effective in reducing spasticity and increasing the range of motion than a single injection.
Subject(s)
Acetylcholine Release Inhibitors/therapeutic use , Botulinum Toxins, Type A/administration & dosage , Muscle Contraction/drug effects , Muscle Spasticity/drug therapy , Muscle, Skeletal/innervation , Stroke/drug therapy , Acetylcholine Release Inhibitors/adverse effects , Adult , Aged , Aged, 80 and over , Biomechanical Phenomena , Botulinum Toxins, Type A/adverse effects , Drug Administration Schedule , Female , Humans , Injections, Intramuscular , Lower Extremity , Male , Middle Aged , Muscle Spasticity/diagnosis , Muscle Spasticity/physiopathology , Range of Motion, Articular , Recovery of Function , Retrospective Studies , Stroke/diagnosis , Stroke/physiopathology , Time Factors , Treatment Outcome , Upper Extremity , Young AdultABSTRACT
The Parker Flex-Tip(®) tube, in combination with the Pentax-Airwayscope(®) (AWS), is anecdotally reported to facilitate intubation when the AWS tip fails to be inserted behind the epiglottis. We examined whether the Parker tube facilitates intubation when the AWS tip is inserted into the vallecula. Forty patients were randomly assigned into either the standard or Parker tube group. Following general anesthesia induction, AWS intubation was attempted with the blade tip inserted into the vallecula. After obtaining an optimal laryngeal view, the tube was advanced toward the glottis. The laryngoscopist allowed additional adjustment of the blade tip direction when the first tube insertion failed because of involvement or folding of the epiglottis resulting from advancement of the tube. The primary outcome was defined as the success rate for intubation and secondary outcome as the time needed for tube placement. The Parker tube provided both a higher intubation success rate (17/20 vs. 4/20, P < 0.01), and a faster intubation time (17 ± 5 s vs. 25 ± 4 s, P < 0.01), than the standard tube. We conclude the use of the Parker tube in combination with the AWS is an optional technique allowing the laryngoscopist to obtain more reliable intubation success despite insertion of the AWS tip into the vallecula.
