Effects of rehabilitation treatments jointly considered by physiatrists and rehabilitation therapists in patients with severe burn injury.

Rehabilitation treatments for patients with severe burn injury (SBI) are difficult owing to the lack of knowledge, skills, and experience among clinicians and physical and occupational therapists, resulting in serious patient disability. This study retrospectively evaluated the effectiveness of rehabilitation treatments jointly considered by physiatrists and rehabilitation therapists (Physiatrist and Registered therapist Operating rehabilitation: PROr) for patients with SBI admitted to our hospital's burn intensive care unit (BICU). Eligible patients were classified into the PROr and standard rehabilitation (SR) groups. Contents of the rehabilitation program in the BICU, the functional ambulation categories (FAC), and the Barthel index at the first rehabilitation, BICU discharge, and hospital discharge were collected. Of the 184 patients with severe burns admitted to the BICU, 29 (PROr group, n = 16; SR group, n = 13) met the eligibility criteria. The PROr group received more types of exercise interventions for a longer time than the SR group. No significant differences in the FAC and Barthel index scores at the first time of rehabilitation were found between the two groups; however, the scores of FAC and Barthel index at BICU and hospital discharges were higher in the PROr group than in the SR group. The PROr program may help in the functional improvement of patients with SBI.

[A Case of Metastatic Renal Cell Carcinoma with Arthritis and Colitis Due to Immune-Related Adverse Events During Ipilimumab-Nivolumab Combination Therapy].

A 73-year-old man with renal cell carcinoma underwent a left-sided open radical nephrectomy at our center. The pathological diagnosis was Fuhrman Grade 2, stage pT3a, clear cell renal cell carcinoma. A follow-up computed tomography (CT) scan revealed lung metastases 9 months after the surgery. The patient was started on ipilimumab with nivolumab combination therapy; however, after two cycles of administration, he developed arthralgia and swelling of the knee. Furthermore, he developed diarrhea almost simultaneously, resulting in the interruption of the ipilimumab plus nivolumab treatment. We diagnosed arthritis and colitis with immune-related adverse events (irAE) and initiated steroid therapy with rehabilitation. His condition improved dramatically, and nivolumab treatment could be resumed after 3 months of treatment interruption.

Differences in Muscle Fatigability of Vastus Medialis between Sexes Using Surface Electromyographic Power Spectral Analysis in Healthy Adults.

Objectives: With a relatively high percentage of type I fibers in the vastus medialis (VM), its fatigability may be more sensitive to the effects of muscle activity in the quadriceps. However, sex-related differences in the muscle fatigability of the VM remain unknown. The purpose of the present study was to assess the differences in fatigability of the VM between healthy adult men and women. Methods: Surface electromyographic (EMG) activities of VM oblique (VMO) and VM long (VML) were recorded during sustained isometric contraction on a leg press machine. The results of EMG power spectral analysis were compared between healthy adult men and women. The decline in the median frequency (MF), defined as MF slope, was calculated using spectrum analysis after fast Fourier transform of the raw EMG signals of VMO and VML. Results: The endurance time and the MF slopes of the VMO and VML were significantly longer and lower, respectively, in women than in men. The present results demonstrated that both VMO and VML are more fatigue-resistant in women than in men. Conclusions: Understanding the sex differences in fatigability could help to design more effective exercise regimens for VMO and VML in healthy individuals. A similar approach should be considered when prescribing practical exercise regimens for patients with muscle atrophy.

Effect of early mobilization in patients with stroke and severe disturbance of consciousness: Retrospective study.

OBJECTIVES: This study aimed to investigate the effectiveness and safety of early mobilization with a physiatrist and registered therapist Operating rehabilitation (PROr) for patients with stroke and severe disturbance of consciousness (DoC). MATERIALS AND METHODS: We retrospectively screened records from patients with stroke admitted to our hospital from January 2015 to June 2021. Eligible patients with severe DoC were classified into two groups: patients who received standard rehabilitation (control group) and patients who received PROr (PROr group). We studied longitudinal change in the level of consciousness using the Japan Coma Scale (JCS) during hospital stay and compared in-hospital mortality, the incidence of respiratory complication, and modified Rankin Scale of discharge between the two groups. RESULTS: Among the 2191 patients screened for inclusion, 16 patients were included in the PROr group, and 12 patients were included in the control group. Early mobilization was more promoted in the PROr group compared to the control group, but there were no significant differences in in-hospital mortality, the incidence of respiratory complication, or modified Rankin Scale at discharge between the two groups. In patients who survived during their hospital stay, JCS scores 2 weeks after the onset of stroke and JCS scores at discharge significantly improved from the start of rehabilitation in the PROr group, but not in the control group. CONCLUSIONS: Early mobilization provided with the PROr program appears to be a safe treatment and may contribute to the improvement of consciousness level for patients with acute stroke and severe DoC.

Comparison of erector spinae fatigability between female patients with Parkinson's disease and healthy individuals: a cross sectional pilot study.

BACKGROUND: Postural abnormality is one of the main symptoms of Parkinson's disease (PD). The erector spinae muscles play an important role in maintaining an upright posture, but the fatigability of the erector spinae in patients with PD is unknown. The purpose of this study was to compare the trunk extension maximum voluntary contraction (MVC) and the fatigability of the erector spinae between female patients with PD and healthy volunteers. METHODS: Th participants of this cross-sectional pilot study comprised 19 patients with PD and nine healthy volunteers matched for sex, age, and physical characteristics as a control group. The MVC of all participants was measured, and after sufficient rest, the Sørensen back endurance test was conducted to the point of exhaustion. The muscle activity of the erector spinae during the Sørensen back endurance test was measured using surface electromyography. The median frequency (MF) slope, which is an index of fatigability, was calculated from the recorded surface muscle activity by means of power spectrum analysis using a Fast Fourier transformation. RESULTS: Nine of the 19 patients with PD were unable to perform the Sørensen back endurance test, and a lower proportion of the PD group were able to perform it compared with the control group. The MVC of those patients with PD who were able to perform the Sørensen back endurance test was lower than that of the control group, and the time for which the pose could be maintained was shorter. There was no significant difference between the MF slope on the left and right side in the PD group, and it was higher on both sides than in the control group. CONCLUSION: This is the first study to demonstrate a reduction of maximum muscle strength and great fatigability of the erector spinae in patients with PD. This discovery strongly underlines the need for paraspinal muscle training from an early stage with the aim of preventing the progression of postural abnormality in patients with PD.

Differences in fatigability of vastus medialis muscle between patients with limb symmetry index of <90% and ≥90% after chronic anterior cruciate ligament reconstruction.

BACKGROUND: A limb symmetry index (LSI) of ≥90% for the quadriceps is recommended for return to sports activity after anterior cruciate ligament reconstruction (ACLR). However, there is no information on differences in muscle fatigability between patients with LSI of <90% and ≥90%. The aim of this study was to assess the difference in quadriceps muscle fatigability on the involved side between post-ACLR patients with LSI of <90% and ≥90%. We hypothesized that there were differences between the two groups in muscle fatigability on the involved side reflecting difference in muscle fiber composition in the vastus medialis (VM) muscle. METHODS: The study subjects were 18 adult men who had undergone ACLR followed by rehabilitation therapy. LSI was <90% in 10 and ≥90% in 8 adult men. Surface electromyography (EMG) of the VM muscle was recorded during sustained quadriceps muscle isometric contraction. The median frequency (MF) was computed from the raw EMG signal using fast Fourier transform spectrum analysis. The MF slope was also calculated. RESULTS: There were no differences in anthropometric characteristics, time since ACLR, anterior tibial translation and peak torque of knee extension on the involved side between the two groups. However, MF slope was significantly lower in the LSI ≥ 90% group than the <90% group. CONCLUSION: Our results demonstrated fatigue-resistant vastus medialis in post-ACLR patients with LSI ≥90% compared to those with LSI <90%. The finding adds support to the use of ≥90% as the cutoff value for LSI for return of post-ACLR patients to sports activity.

Properties of Paraspinal Muscles in Japanese High School Baseball Players With Terminal-Stage Lumbar Spondylolysis.

BACKGROUND: Lumbar spondylolysis is a defect in the pars interarticularis that is common in young athletes; the stress distribution at the pars interarticularis is the highest in extension and rotation movements. The paraspinal muscles play an important role in stabilization of the lumbar spine; however, no study has assessed the properties of paraspinal muscles in athletes with lumbar spondylolysis. OBJECTIVE: To evaluate the properties of paraspinal muscles in athletes with lumbar spondylolysis. DESIGN: Cross-sectional study. SETTING: Laboratory. PARTICIPANTS: Six high school baseball players with terminal-stage lumbar spondylolysis and 11 high school baseball players without organic lumbar lesions of similar anthropometric characteristics. METHODS: All subjects performed the unsupported trunk holding test combined with surface electromyographic (EMG) power spectral analysis until exhaustion. The results of EMG power spectral analysis were compared between the spondylolysis and control groups. MAIN OUTCOME MEASUREMENTS: The median frequency (MF) was computed from the raw EMG signal of the erector spinae and multifidus during trunk holding test using fast Fourier transform spectrum analysis. The initial MF and MF slope were calculated. RESULTS: No significant differences in endurance time were found between the spondylolysis and control groups. The initial MF and the MF slopes of the erector spinae and multifidus were significantly lower in the spondylolysis group than in the control group. CONCLUSIONS: The results suggest lower fast-twitch motor unit recruitment in the erector spinae and multifidus of high school baseball players with terminal-stage lumbar spondylolysis compared with the control. LEVEL OF EVIDENCE: IV.

Fatigue-related differences in erector spinae between prepubertal children and young adults using surface electromyographic power spectral analysis.

BACKGROUND: The erector spinae is more resistant to fatigue in adult women than men. However, no study has reported the sex differences in back muscle fatigue in children. OBJECTIVE: The aim of this study was to evaluate the fatigability of erector spinae in prepubertal children and adults, in both males and females. METHODS: Fourteen prepubertal boys, 13 prepubertal girls, 14 adult men, and 13 adult women performed the Sørensen back isometric endurance test until exhaustion. The results of electromyographic (EMG) power spectral analysis of erector spinae were compared between both age groups and sexes. RESULTS: The slopes of EMG power spectral median and mean power frequency were significantly higher in males than in females, in both age groups. Furthermore, the slopes were significantly lower in prepubertal children than in adults, in both males and females. CONCLUSIONS: Our results showed major differences in the fatigue threshold of the erector spinae between boys and girls and children and adults. The muscle fatigued faster in prepubertal boys and adult men than in prepubertal girls and adult women. In both sexes, a lower slope of EMG power spectrum parameters of the erector spinae was noted during endurance test in prepubertal children compared to adults.

Age-related sex differences in erector spinae muscle endurance using surface electromyographic power spectral analysis in healthy humans.

BACKGROUND CONTEXT: Previous studies reported that the erector spinae muscle is more resistant to fatigue in healthy adult women than in men. However, no study has reported changes in back muscle fatigue with aging in healthy men and women. PURPOSE: The aim of this study was to evaluate age-related changes in muscle fatigue of erector spinae muscle in men and women. STUDY DESIGN/SETTING: This cross-sectional study was conducted in a laboratory. PATIENT SAMPLE: Fifty-three healthy subjects (11 elderly men, 11 elderly women, 17 young men, and 14 young women) without low back pain history. OUTCOME MEASURES: The median frequency (MF) and mean power frequency (MPF) during trunk holding test were derived from the raw electromyographic (EMG) signal using Fast Fourier Transform spectrum analysis program. The rates of changes in MF and MPF were calculated. METHODS: Subjects performed the unsupported trunk holding test until exhaustion. The results of power spectral analysis of the EMG activity of the left erector spinae muscle were compared in both age groups and sexes. RESULTS: The endurance time in young men was significantly shorter than in young women. The slopes of MF and MPF in young men were significantly higher than in young women. There were no significant differences in MF and MPF slopes of elderly men and elderly women. Furthermore, the MF and MPF slopes were significantly lower in elderly men than young men but similar in the two women groups. CONCLUSIONS: Age-related changes in the slopes of MF and MPF of erector spinae muscle occur in healthy men but not in healthy women.