Disability, Unemployment, and Inequality: A Cross-Country Comparison of the Situation of Persons With Spinal Cord Injury.

Unemployment and inequality are growing concerns that disproportionately affect people with disabilities. We compared unemployment rates and barriers to labor market participation for persons with spinal cord injury (SCI) as an exemplary case of disability with different socioeconomic positions and from a cross-national perspective across 20 countries worldwide. We showed that persons with SCI have much higher unemployment rates than the general population. While this situation is many times worse for those in low-income groups, persons with SCI in high-income groups are often in a position comparable to the general population. The main barriers to entering the labor market are health status, the impossibility of finding suitable jobs, and the lack of information about employment opportunities. This is the first study that quantifies the extent of inequality in the labor market for persons with SCI. Across the 20 countries analyzed, facing disability has a much higher impact on those in low-income groups. This reality is explained by the fact that people in lower-income groups face many more barriers to entering the labor market than those in higher-income groups.

Increase in Serum Interleukin-1 Receptor Antagonist (IL-1ra) Levels after Wheelchair Half Marathon Race in Male Athletes with Spinal Cord Injury.

Exercise increases the serum level of interleukin-6 (IL-6), which in turn stimulates the production of various inflammatory cytokine antagonists, such as interleukin-1 receptor antagonist (IL-1ra). Individuals with cervical spinal cord injury (CSCI) are at high risk of inflammatory conditions. This study compared the effects of wheelchair half marathon on the immune system of male athletes with CSCI and those with thoracic/lumber spinal cord injury (SCI). Neutrophil count, IL-1ra, IL-6, and various endocrine parameters were measured before, immediately and 1 h after the race in five CSCI and six SCI who completed the wheelchair marathon race. The percentage of neutrophils was significantly higher in CSCI immediately and 1 h after the race, compared with the baseline, and significantly higher in SCI at 1 h after the race. IL-6 was significantly higher immediately and 1 h after the race in SCI, whereas no such changes were noted in IL-6 in CSCI. IL-1ra was significantly higher at 1 h after the race in both SCI and CSCI. The race was associated with an increase in IL-1ra in both CSCI and SCI. These findings suggest wheelchair half marathon race increases IL-1ra even under stable IL-6 status in male CSCI individuals, and that such post-race increase in IL-1ra is probably mediated through circulatory neutrophils.

Effectiveness of a 3-Week Rehabilitation Program Combining Muscle Strengthening and Endurance Exercises Prior to Total Knee Arthroplasty: A Non-Randomized Controlled Trial.

We evaluated the effectiveness of a high-intensity preoperative resistance and endurance training program in improving physical function among patients scheduled for total knee arthroplasty. This non-randomized controlled trial included 33 knee osteoarthritis patients scheduled to undergo total knee arthroplasty at a tertiary public medical university hospital. Fourteen and nineteen patients were non-randomly assigned to intervention and control groups, respectively. All patients underwent total knee arthroplasty and a postoperative rehabilitation program. The intervention group participated in a preoperative rehabilitation program comprising high-intensity resistance and endurance training exercises to increase lower limb muscle strength and endurance capacity. The control group received only exercise instruction. The primary outcome was the 6-min walking distance, which was significantly higher in the intervention group (399 ± 59.8 m) than in the control group (348 ± 75.1 m) 3 months post-surgery. There were no significant differences between the groups 3 months post-surgery in muscle strength, visual analog scale, WOMAC-Pain, range of motion of knee flexion, and extension. A 3-week preoperative rehabilitation program combining muscle strengthening and endurance training improved endurance 3 months after total knee arthroplasty. Thus, preoperative rehabilitation is important for improving postoperative activity.

Comparative Study of Muscle Hardness during Water-Walking and Land-Walking Using Ultrasound Real-Time Tissue Elastography in Healthy Young People.

Compared with land-walking, water-walking is considered to be beneficial as a whole-body exercise because of the characteristics of water (buoyancy, viscosity, hydrostatic pressure, and water temperature). However, there are few reports on the effects of exercise in water on muscles, and there is no standard qualitative assessment method for muscle flexibility. Therefore, we used ultrasound real-time tissue elastography (RTE) to compare muscle hardness after water-walking and land-walking. Participants were 15 healthy young adult males (24.8 ± 2.3 years). The method consisted of land-walking and water-walking for 20 min on separate days. The strain ratio of the rectus femoris (RF) and medial head of gastrocnemius (MHGM) muscles were measured before and immediately after walking using RTE to evaluate muscle hardness. In water-walking, the strain ratio significantly decreased immediately after water-walking, with p < 0.01 for RF and p < 0.05 for MHGM, indicating a significant decrease in muscle hardness after water-walking. On the other hand, land-walking did not produce significant differences in RF and MHGM. Muscle hardness after aerobic exercise, as assessed by RTE, was not changed by land walking but was significantly decreased by water walking. The decrease in muscle hardness induced by water-walking was thought to be caused by the edema reduction effect produced by buoyancy and hydrostatic pressure.

A cross-sectional survey of consistent rehabilitation through long-term care insurance in Japan: a questionnaire survey.

There seems to be a lack of consistency of maintenance/community-based rehabilitation through long-term care insurance. We aimed to clarify whether consistent rehabilitation can be performed through long-term care insurance by questionnaires. Materials and Methods: This study was a cross-sectional study in a nationwide survey among rehabilitation staff and care recipients who completed disease-specific rehabilitation and required maintenance/community-based rehabilitation through long-term care insurance. Consistency of rehabilitation was compared using Fisher's exact tests. The concordance of the rehabilitation evaluation and treatment conducted under medical and long-term care insurance was assessed using the κ coefficient. Results: Six hundred questionnaires from care recipients and staff were analyzed. Of the rehabilitation staff, 264 (44%) obtained rehabilitation plans from medical institutions. There was a significant difference between the responses of "referral from the same medical corporation" and "obtaining the rehabilitation plan" by Fisher's exact test (odds ratio: 3.242; P<0.001). Most rehabilitation treatments under medical insurance comprised walking or training with parallel rods/canes [498 patients (83%)], and 454 patients (76%) received stretching and range-of-motion training for the limbs and spine for long-term care insurance. Muscle strength evaluation was the most frequently conducted under medical and long-term care insurance [383 (73%) and 487 (83%), respectively]. The concordance of the evaluation and treatment content, except for disease-specific evaluation, was low (κ coefficient≤0.6). Conclusions: The rate of provision of rehabilitation plans was low, and evaluation and treatment content under medical and long-term care insurance was inconsistent. Our results draw attention to the need for consistent rehabilitation plans between disease-specific and maintenance/community-based rehabilitation.

Quantification of catecholamine neurotransmitters released from cutaneous vasoconstrictor nerve endings in men with cervical spinal cord injury.

Control of cutaneous circulation is critically important to maintain thermoregulation, especially in individuals with cervical spinal cord injury (CSCI) who have no or less central thermoregulatory drive. However, the peripheral vasoconstrictor mechanism and capability have not been fully investigated after CSCI. Post- and presynaptic sensitivities of the cutaneous vasoconstrictor system were investigated in 8 CSCI and 7 sedentary able-bodied (AB) men using an intradermal microdialysis technique. Eight doses of norepinephrine (NE, 10-8 to 10-1 M) and five doses of tyramine (TY, 10-8, 10-5 to 10-2 M) were administered into the anterior right and left thigh, respectively. Endogenous catecholamines, noradrenaline, and dopamine, collected at the TY site, were determined by high-performance liquid chromatography with electrochemical detection. Regardless of vasoconstrictor agents, cutaneous vascular conductance decreased dose-dependently and responsiveness was similar between the groups (NE: Group P = 0.255, Dose P = 0.014; TY: Group P = 0.468, Dose P < 0.001), whereas the highest dose of each drug induced cutaneous vasodilation. Administration of TY promoted the release of noradrenaline and dopamine in both groups. Notably, the amount of noradrenaline released was similar between the groups (P = 0.819), although the concentration of dopamine was significantly greater in individuals with CSCI than in AB individuals (P = 0.004). These results suggest that both vasoconstrictor responsiveness and neural functions are maintained after CSCI, and dopamine in the skin is likely to induce cutaneous vasodilation.

Serum concentrations of ketones increase after hand-ergometer exercise in persons with cervical spinal cord injuries: a preliminary prospective study.

STUDY DESIGN: Experimental study. OBJECTIVES: To compare lipid profiles during moderate-intensity exercise between persons with cervical spinal cord injuries (SCIC) and able-bodied controls (AB). SETTING: Wakayama Medical University, Japan. METHODS: Six participants with SCIC and six AB performed 30-min arm-crank exercise at 50% VO2peak. Blood samples were collected before (PRE), immediately (POST), and 60 min after exercise (REC). Concentrations of serum free fatty acids ([FFA]s), total ketone bodies ([tKB]s), acetoacetic acid ([AcAc]s), insulin ([Ins]s), and plasma catecholamines and glucose ([Glc]p) were assessed. RESULTS: Catecholamine concentrations in SCIC were lower than AB throughout the experiment (P < 0.001) and remained unchanged, while increased at POST in AB (P < 0.01). [FFA]s remained unchanged in both groups with no differences between groups. [tKB]s in SCIC tended to increase at REC from PRE (P = 0.043), while remaining unchanged in AB (P > 0.42). [AcAc]s in SCIC increased at REC from PRE and POST (P < 0.01) while remaining unchanged in AB (interactions of Group × Time P = 0.014). [Glc]p and [Ins]s were comparable between the groups throughout the study. CONCLUSION: Serum ketone bodies in SCIC increased after exercise while remaining unchanged in AB, suggesting that suppressed uptakes of serum ketone bodies from blood to the muscles in SCIC would partially contribute the increased serum ketones.

Surface electromyographic activity of the erector spinae and multifidus during arm- and leg-ergometer exercises in young healthy men.

Objectives: Ergometer exercise was considered a new loading method that can be used for participants who are unable to assume the core strengthening exercise posture commonly used to strengthen the erector spinae and multifidus. This study aimed to investigate with healthy participants whether arm and leg ergometers could be used for core strengthening exercises and whether different exercise sites would affect the results. Methods: The study was conducted with 15 healthy adult male participants aged 20-35 years. The intervention consisted of arm- and leg-ergometer exercises performed by the participants. The exercise protocol consisted of three 1-min sessions (rest, 50W, and 100 W), which were measured consecutively. Surface electromyography (sEMG) was measured during the sessions. Maximal voluntary contraction (MVC) of the erector spinae and multifidus was also measured, during which sEMG was measured. The sEMG during ergometer exercise was calculated as a percentage of the MVC (calculated as % MVC). The root mean square (RMS) was recorded from the sEMG activity. Muscle activity of the erector spinae and multifidus was compared between ergometer exercises and between intensity levels. Heart rate (HR) was recorded by electrocardiogram. Results: In the arm-ergometer exercise, the % MVC values of the erector spinae were 6.3 ± 3.1, 10.9 ± 5.4, and 16.9 ± 8.3% at rest, 50 W, and 100 W conditions, respectively. The multifidus was 4.6 ± 2.9, 9.2 ± 5.6, and 12.6 ± 7.6% at rest, 50 W, and 100 W conditions, respectively. The respective % MVC values during the leg-ergometer exercise were 3.8 ± 1.7, 7.2 ± 3.8, and 10.4 ± 4.0% at rest, 50 W, and 100 W conditions, respectively. Leg-ergometer exercises were 2.6 ± 2.1, 6.9 ± 5.7, and 10.3 ± 6.8% at rest, 50 W, and 100 W conditions, respectively. The activities of the two muscles increased at comparable levels with increased workload in both types of exercises (p < 0.01, each). HR increased with the increased workload and the increase was larger during arm-than leg-ergometer exercises. Conclusion: These results demonstrate that both arm- and leg-ergometer exercises are potentially alternative methods for erector spinae and multifidus training for healthy participants. Further research is needed to target elderly.

Rehabilitation in the long-term care insurance domain: a scoping review.

PURPOSE: Since the enactment of the long-term care insurance (LTCI) act in 2000, the number of LTCI users has increased annually. However, evidence regarding what is being carried out as rehabilitation treatment under LTCI is lacking. In this study, a scoping review was performed to bridge this knowledge gap. METHODS: Articles related to rehabilitation in connection with LTCI published between April 2000 and November 2020 were searched for in PubMed, CINAHL, CENTRAL (Cochrane Central Register of Controlled Trials), Ichushi Web Ver.5, and CiNii and randomized controlled trials (RCTs) of rehabilitation provided under LTCI were examined. RESULTS: Of the 15,572 publications identified, 15 RCTs, including rehabilitation treatment by physiatrists and therapists, met the eligibility criteria of our review and were included. The rehabilitation trials in the 15 RCTs varied and included balance training, exercise therapy, cognitive tasks, and activities such as singing and dancing. The results allowed us to focus on three categories: fall prevention, dementia, and theory and tools interventions related to occupational therapy practice. CONCLUSION: The focal points of attention in the rehabilitation treatment of LTCI were identified. However, the physical function, quality of life, and activities of daily living (ADL) of those who "need support" vary from person to person. Therefore, the consolidation of evidence on rehabilitation treatment of LTCI must be continued.

Standing and supine positions are better than sitting in improving rightward deviation in right-hemispheric stroke patients with unilateral spatial neglect: A randomized trial.

TRIAL DESIGN: How body position affects unilateral spatial neglect (USN) is unclear. This cluster randomized trial aimed to examine the effects of different positions (supine, sitting, and standing) on USN in stroke patients. METHODS: Twenty stroke patients (hemorrhage [n = 11], infarction [n = 9]) who were right-handed, had left hemiplegia due to right hemisphere damage that occurred within the last 2 years, and were in a state of arousal with a Glasgow Coma Scale score of 15 were included in the study. Table-top pen-and-pencil tests for USN (Bells Test, Line Bisection, Scene Copy, and Star Cancellation) were randomly conducted in the supine, sitting, and standing positions. RESULTS: The mean values in each test were significantly smaller in the supine position than were those in the sitting position (P = .015, .047, .015, and <.001), and those in the standing position were significantly smaller than those in the sitting position (P = .007, <.001, =.006, and < .001). The results of the 4 tests in the standing position were similar to those in the supine position. CONCLUSIONS: Body position affects USN in stroke patients and that the standing and supine positions improve USN better than the sitting position. Some possible mechanisms are: muscle contractions in the lower limbs and the trunk could have affected results in the standing position, and reduction in gravitational stimulation in the supine position could have played a role.

Supervised Exercise Therapy and Adjuvant Chemotherapy for Pancreatic Cancer: A Prospective, Single-Arm, Phase II Open-Label, Nonrandomized, Historically Controlled Study.

BACKGROUND: Improvement of the completion rate of postoperative adjuvant chemotherapy is a key to obtaining favorable prognosis in patients who undergo macroscopically curative pancreatectomy for pancreatic ductal adenocarcinoma. STUDY DESIGN: This study is a prospective single-center phase II trial that aimed to examine whether a supervised exercise therapy for pancreatic ductal adenocarcinoma improved the completion rate of S-1 adjuvant chemotherapy in the development of a tolerable and effective exercise plan for patients undergoing adjuvant therapy. RESULTS: Forty-three patients were included in the study. The completion rate of S-1 therapy, the primary endpoint, was 93%, which exceeded the threshold completion rate of 53% (p < 0.001). As secondary endpoints, the relative dose intensity of S-1 was 100.0 [95.9 to 100.0] (median [interquartile range]), the median recurrence-free survival was 20.4 months, and the median overall survival was not reached, confirming the safety of the protocol treatment. Regarding frailty status, there was significant decrease in the Kihon checklist score (p = 0.002) and significant increase in G8 questionnaire score (p < 0.001), indicating that exercise therapy reduced frailty. There were no incidences of serious adverse events except for 1 case of grade 3 febrile neutropenia. The differences between before/after therapy (between 6 months/baseline) of mean muscle mass, mean body fat mass, mean body fat percentage, and mean controlling nutrition status score were 1.52 (p < 0.001), -1.18 (p = 0.007), -2.47 (p < 0.001), and -0.59 (p = 0.006), respectively. CONCLUSIONS: Adjuvant chemotherapy combined with supervised exercise therapy for pancreatic ductal adenocarcinoma was confirmed to improve the completion rate of S-1 adjuvant chemotherapy.

Evaluation of severe adverse events during rehabilitation for acute-phase patients: A retrospective cohort study.

ABSTRACT: Early mobilization decreases the likelihood of negative outcomes for acute-phase inpatients. Adverse events occurring during intensive care unit rehabilitation have previously been reported; however, no study has reported the incidence rates for adverse events during the acute rehabilitation phase. This study aimed to investigate the incidence of severe adverse events during acute-phase rehabilitation and evaluate them in detail.Reports of adverse events occurring during acute-phase rehabilitation in a university hospital from April 1, 2011 to March 31, 2018 were retrospectively assessed.Nine severe adverse events occurred during this period (incidence rate, 0.032%), comprising 2 cardiopulmonary arrests, 2 pulseless electrical activity events, 2 deterioration in consciousness events, 1 deterioration in consciousness event due to cerebral infarction, 1 fracture due to a fall, and 1 event involving removal of a ventricular drain. Pulmonary thromboembolism was implicated in 1 adverse event involving pulseless electrical activity and 1 deterioration in consciousness event. The causes for the 6 other adverse events could not be identified. The mean days from admission and the onset of rehabilitation to adverse event occurrence were 22.0 ±â€Š18.2 and 17.9 ±â€Š13.5 days (mean ± standard deviation), respectively. Four of 9 patients died, and 5 patients were discharged home or transferred to other stepdown facilities. When assessed retrospectively, there were no conflicts between patient conditions and the cancellation criteria of rehabilitation by the Japanese Association of Rehabilitation Medicine.The occurrences of severe adverse event may not be related to early mobilization (or onset time of rehabilitation) and compliance status of cancellation criteria.

Follow-Up Study of Subdermal Low-Echoic Lesions in the Ischial Region in Wheelchair Users With Spinal Cord Injuries.

Objective: To follow up patients with spinal cord injuries with subdermal low-echoic lesions in the ischial region for abnormalities after 1 year. Design: A retrospective cohort study. Setting: A Japanese rehabilitation center. Participants: We included patients with chronic spinal cord injuries and subdermal low-echoic lesions who underwent routine inspection and palpation examinations (n = 7). Interventions: Education on pressure injury and instruction on pressure relief and seating was provided and the patients were followed up for abnormalities after 1 year. Self-reports were obtained on wheelchair sitting time, and interface pressure was recorded while the patients were seated on the wheelchair. Interface pressure measurements at the bilateral ischial regions were recorded with a force-sensitive application pressure mapping system. Outcome Measures: The primary outcome was the presence of subdermal low-echoic lesions in the bilateral ischial regions on ultrasonography at the 1-year follow-up examination. Secondary outcomes included wheelchair sitting time and interface pressure in the bilateral ischial regions. Results: Of the 10 areas that showed subdermal low-echoic lesions on ultrasonography, nine had improved after 1 year. One area that did not improve was an open wound. At the follow-up examination, the pressure duration was reduced in all patients, and the interface pressure could be reduced in 5/7 patients. Conclusions: This is the first study to follow up with patients having spinal cord injuries and subdermal low-echoic lesions in the ischial region using ultrasonography. The low-echoic lesions improved within 1 year by reducing the pressure duration and interface pressure. Pressure injury prevention in patients with spinal cord injuries relies on the early detection of skin abnormalities, and education and instruction to change self-management behaviors are recommended.

Dose-response Rehabilitation Organized By Pror In Out-patients With Chronic Cerebrovascular Disorder: A single-center retrospective cohort study.

PURPOSE: We aimed to investigate whether out-patient rehabilitation with the same concept as physiatrist and registered therapist operating rehabilitation (PROr) would improve activities of daily living in out-patients with chronic cerebrovascular disorder and whether the improvements were related to the frequency and/or time of therapy. METHODS: Out-patients with chronic cerebrovascular disorder, who visited a clinic affiliated with a university hospital for at least a month between April 2010-September 2020, were retrospectively selected. Changes in the functional independence measure (FIM) from the first visit to the 12th month were calculated. Patients were stratified into two subgroups: improved and non-improved groups. The frequency and time of physical and occupational therapies and total rehabilitation were compared between the groups. RESULTS: Initially, 174 patients were selected and 125 were excluded based on the exclusion criteria. Three patients terminated rehabilitation because of improvements. In 18 of 49 patients, FIM improved at the 12th month by 4.9 [3.1-6.8] (mean [95% CI]). The frequency was ∼2 times/week with no differences between the groups. Physical therapy time/day was higher in the improved group (74.7 [66.7-82.7] min) than the non-improved group (50.7 [44.3-57.0] min; P<0. 001). The total rehabilitation time/day was 121.9 [107.8-136.0] min in the improved group, which was higher than the non-improved group: 97.9 [87.7-107.9] (P=0.001). CONCLUSIONS: Approximately 40% of the patients displayed improved FIM even during the chronic phase, and the improved out-patients took PROr for at least 108 min/day and twice a week. A longer rehabilitation time would be reinforced by patients' motivation.

The Effects of Early Rehabilitation in the Intensive Care Unit for Patients with Severe COVID-19 Pneumonia: A Retrospective Cohort Study.

This retrospective cohort study aimed to examine the rehabilitation effect of patients with coronavirus disease 2019 (COVID-19) in the intensive care unit (ICU) under mechanical ventilation and included ICU patients from a university hospital who received rehabilitation under ventilator control until 31 May 2021. Seven patients were included, and three of them died; thus, the results of the four survivors were examined. The rehabilitation program comprised the extremity range-of-motion training and sitting on the bed's edge. The Sequential Organ Failure Assessment score (median (25-75th percentiles)) at admission was 7.5 (5.75-8.5), and the activities of daily living (ADLs) were bedridden, the lowest in the Functional Independence Measure (FIM) and Barthel Index (BI) surveys. Data on the mean time to extubation, ICU length of stay, and ADLs improvement (FIM and BI) during ICU admission were obtained. Inferential analyses were not performed considering the small sample size. The mean time to extubation was 4.9 ± 1.1 days, and the ICU length of stay was 11.8 ± 5.0 days. ΔFIM was 36.5 (28.0-40.5), and the ΔBI was 22.5 (3.75-40.0). Moreover, no serious adverse events occurred in the patients during rehabilitation. Early mobilization of patients with COVID-19 may be useful in ADLs improvement during ICU stay.

Case Report: A Rehabilitation Practice Report During ICU Management for a Patient With Multiple Disabilities Due to COVID-19 Pneumonia and COPD.

Patients with severe coronavirus disease (COVID-19) and admitted to the intensive care unit (ICU) are at high risk of developing ICU-acquired weakness and disuse syndrome. Although their medical management may include prolonged deep sedation for pulmonary protection and ventilator management, we aim for early mobilization of these patients with COVID-19. We present the case of a 71-year-old man with chronic obstructive pulmonary disease (COPD) and COVID-19 pneumonia. Passive range of motion training and sitting on the edge of the bed were started in the ICU while the patient was under deep sedation. His activities of daily living eventually improved to where he could independently walk to the toilet without respiratory distress. Patients with severe COVID-19 who require mechanical ventilation are at risk of muscle weakness and exercise intolerance. These patients require rehabilitation therapy, beginning in the acute phase of illness, to recover their physical function. Although validation with a larger cohort is necessary, our results suggest that patients with COPD and COVID-19 pneumonia should undergo rehabilitation concurrently with status-driven changes in respiratory management.

Feasibility of sit training for patients with severe COVID-19 pneumonia during deep sedation: A case report.

RATIONALE: There have been a few reports on the early rehabilitation of patients with coronavirus disease (COVID-19), and none on the effectiveness and adverse events of early mobilization for mechanical ventilation patients (other than COVID-19) during deep sedation. This report indicates that sitting without adverse events is possible in patients with severe COVID-19 pneumonia during deep sedation with muscle relaxation. PATIENT CONCERNS: A 65-year-old man with a history of diabetes mellitus, lacunar infarction, and Parkinson's disease was admitted to a local hospital for pneumonia due to COVID-19. After admission, the patient was managed on a ventilator under deep sedation with muscle relaxants and sedatives. Twelve days after admission, the patient was transferred to our hospital due to his worsening respiratory status. DIAGNOSIS: Pneumonia due to COVID-19 was diagnosed using a polymerase chain reaction-dependent method. INTERVENTIONS: The day following transfer, a physical therapist started passive range of motion training and sitting. OUTCOMES: The period spanning his initial rehabilitation to muscle relaxant medication interruption was 9 days, and he underwent 7 rehabilitation sessions. The patient was unable to sit during only one of the 7 sessions due to pre-rehabilitation hypoxemia. In 5 of the 6 sitting sessions, PaO2/FiO2 transiently decreased but recovered by the time of subsequent blood sampling. The patient's PaCO2 decreased during all sessions. His blood pressure did not drastically decrease in any sitting session, except the first. Sputum excretion via sputum suction increased during sitting, and peak inspiratory pressure did not change. LESSONS: The patient eventually died of pneumonia due to COVID-19. However, sitting during deep sedation with muscle relaxants did not cause any serious adverse events nor did it appear to cause obvious negative respiratory effects.

An Urgent Webinar for Therapists Working in Local Facilities by Physiatrists and Therapists in a Regional Core Hospital during the COVID-19 Pandemic.

BACKGROUND: After the emergence of novel coronavirus disease (COVID-19), cluster infections occurred at several rehabilitation facilities in Japan. Because rehabilitation is necessary for deconditioned COVID-19 patients, preventing cluster infections and providing rehabilitation while protecting therapists were also essential in the Wakayama region. WEBINAR: The rehabilitation medicine department and division of Wakayama Medical University Hospital, which consists of physiatrists and registered therapists, proposed that the Wakayama Physical Therapy Association hold an urgent webinar for therapists in the Wakayama region. The webinar (120 min in duration) comprised an overview of severe acute respiratory syndrome coronavirus 2, the significance of rehabilitation therapy for COVID-19 patients, instruction in personal protective equipment, and case reports on COVID-19 patients from an affiliated university hospital. The webinar was held on May 16, 2020, after only 9 days of preparation. Ninety-six members of 29 facilities in the Wakayama region participated, including therapists who lived far from the university. Moreover, the webinar was implemented at a lower cost than a conventional meeting. An opportunity was provided to share information among participants, speakers, instructors, and a supervisor after the presentations. The overall level of satisfaction of participants after the webinar was high. DETAILS: The rehabilitation medicine department and division of Wakayama Medical University Hospital, which consists of physiatrists and registered therapists, proposed that the Wakayama Physical Therapy Association hold an urgent webinar for therapists in the Wakayama region. The webinar (120 min in duration) comprised an overview of severe acute respiratory syndrome coronavirus 2, the significance of rehabilitation therapy for COVID-19 patients, instruction in personal protective equipment, and case reports on COVID-19 patients from an affiliated university hospital. The webinar was held on May 16, 2020, after only 9 days of preparation. Ninety-six members of 29 facilities in the Wakayama region participated, including therapists who lived far from the university. Moreover, the webinar was implemented at a lower cost than a conventional meeting. An opportunity was provided to share information among participants, speakers, instructors, and a supervisor after the presentations. The overall level of satisfaction of participants after the webinar was high. CONCLUSION: This webinar for therapists in local facilities was held by physiatrists and therapists at Wakayama Medical University, a regional core hospital, in collaboration with the regional therapy association. The preparation time was only 9 days and the cost was lower than that for a conventional meeting, thereby allowing participants to share information about infection control for COVID-19 in an efficient and cost-effective manner.

Case Report: Rehabilitation for Lower Extremity Pain Due to Venous Stasis in a Patient With Multisystem Inflammatory Syndrome in Children.

Recently, it was reported that children recovering from coronavirus disease (COVID-19) developed multisystem inflammatory syndrome in children (MIS-C), which causes severe inflammation in multiple organs of the body. Because MIS-C is a new disease, the pathophysiology and prognosis are unknown. Owing to a lack of studies on this subject, we herein provide information on rehabilitation for children with MIS-C. A 12-year-old male patient presented with systemic inflammatory symptoms after approximately 2 months since recovery from COVID-19. He was treated with cyclosporine and steroid pulse therapy after admission to our hospital. His general condition improved significantly within approximately 1 week. Thereafter, his lower legs turned dark purple and he experienced intense pain whenever the lower limbs hung below the heart, such as in the sitting position. The patient was referred to the rehabilitation department, as he had difficulties during standing and walking. Because the symptoms improved with elevation of the lower extremities, we considered that the pain was related to venous stasis. The pain reduced when an elastic bandage was applied for the prevention of venous stasis; therefore, exercise therapy was implemented while the patient wore the elastic bandage. The patient's lower extremity symptoms improved in 10 days. He was discharged after 16 days and could independently perform activities of daily living (ADL). The mechanism underlying the patient's pain could not be determined; however, rehabilitation was effective when combined with compression therapy using an elastic bandage.

Relationship between ultrasonographically low-echoic lesions under the skin, wheelchair sitting time, and interface pressure on ischial region in individuals with chronic spinal cord injury.

Objective: To determine the relationship between physical findings, wheelchair sitting time, and interface pressure on ischial region in subjects with spinal cord injury (SCI).Design: Cross-sectional study.Setting: Rehabilitation center in Japan.Participants: Manual wheelchair users with chronic SCI (n = 45).Interventions: Pressure ulcers (PU) were diagnosed by inspection, palpation, and ultrasonography. Self-reports were obtained on wheelchair sitting time and pressure mapping was recorded while the subject was seated on the wheelchair.Outcome measures: Subjects were divided into those with ultrasonographically low-echoic lesions (PU-positive group, n = 11) and no such lesions (PU-negative group, n = 34). Outcome measures included wheelchair sitting time and interface pressure at bilateral ischial regions.Results: Using ultrasonography, 13 low-echoic lesions were identified in 11 subjects of the PU-positive group. The pressure duration was longer and interface pressure was significantly higher in subjects of the PU-positive group compared with those of the PU-negative group (P < 0.05 and P < 0.001, respectively).Conclusions: This is the first study to evaluate the interrelationship between physical findings, sitting time, and ultrasonographically measured interface pressure on ischial region area in subjects with spinal cord injury. To prevent pressure ulcers, we recommend avoidance of prolonged wheelchair sitting and measures that can reduce the interface pressure. These variables should be carefully tailored to the needs of the individual subjects with SCI.