The Development and Evolution of Physical Medicine and Rehabilitation in Taiwan from 1958 to 2016.

The field of physical medicine and rehabilitation (PM&R) began its development in Taiwan since 1958, and has gradually evolved into a profession that provides a diversity of clinical services and educational activities. The objectives of this brief report were to (1) review its background and milestones in the past 6 decades, (2) describe the current role and function of its Academy of PM&R, (3) present the content and format of its board certification process, focusing on (a) residency training requirements, (b) self-assessment examination, board certification process, and (c) maintenance of certification through continued education. Some challenges and opportunities are also discussed toward the end of this article. It is hoped that this report may serve as a reference material for other countries as they develop or improve their PM&R residency programs.

Resistive inspiratory muscle training in sleep-disordered breathing of traumatic tetraplegia.

OBJECTIVE: To assess the effect of resistive inspiratory muscle training (RIMT) on the static pulmonary function and sleep-induced breathing disorder of individuals with chronic cervical cord injury. DESIGN: Before-after training. SETTING: Home-setting training program. PATIENTS: Fourteen complete traumatic tetraplegic patients (12 men, 2 women; mean age, 41.1 +/- 14y; range, 19-56y) injured for more than 6 months. INTERVENTION: Subjects participated in a 6-week RIMT program for 15 minutes twice daily at a training intensity of 60% of maximum inspiratory pressure (MIP). The participants were reevaluated at the end of 6-week training. MAIN OUTCOME MEASURES: Lung volume, peak expiratory flow (PEF), MIP, and maximum expiratory pressure (MEP) were measured by using a spirometry and inspiratory force meter, respectively. Capnography was used to monitor nocturnal pulse oxyhemoglobin saturation (SpO(2)) and end-tidal carbon dioxide tension level (ETCO(2)) of the patients. RESULTS: The maximum voluntary ventilation (MVV) and MIP of individuals with chronic cervical cord injury substantially improved after RIMT. MIP increased from -68.7 +/- 27.4cmH(2)O to -77.3 +/- 24.0cmH(2)O and MVV rose from 62.7 +/- 33.2L to 73.4 +/- 31.3L (P <.05). Despite increasing from 3.5 +/- 1.8L/s to 4.0 +/- 1.7L/s, PEF was statistically insignificant. For the individuals with improved MIP, the duration of ETCO(2) greater than 48mmHg reduced from 2.2% +/- 3.3% to 1.0% +/- 2.0% of total sleep time (P =.05) and that of SpO(2) less than 90% significantly declined from 1.8% +/- 2.8% to 1.3% +/- 2.4% of total sleep time (P <.05). CONCLUSION: These findings suggest that RIMT can enhance the respiratory muscle strength and endurance of chronic tetraplegia and further ameliorate the sleep-induced breathing disorder. Therefore, RIMT is suggested as a home program for patients with sleep-disordered breathing.