Effectiveness of a case-based digital learning interprofessional workshop involving undergraduates in medical technology, radiological science, and physical therapy: A pre-post intervention study.

All healthcare professionals must understand information on a patient's biophysical functions, and it is important to educate professionals on how to use this information in an interprofessional team for diagnosis. However, there is little interprofessional education for students of medical technology and radiological science involved in biophysical function diagnosis. In the present study, we developed a case-based interprofessional learning tool for using biophysical information for diagnosis. The study examined the effects of a collaborative exercise workshop for healthcare professional students using the tool. Participants were 234 students from three healthcare professions (medical technology, radiological science, and physical therapy). They completed the Japanese version of the Readiness for Interprofessional Learning Scale before and after the workshops. The workshops incorporated digital materials that allowed students to examine the test results of a virtual patient, answer questions, and discuss their diagnoses and prognoses. For analysis, a two-way analysis of variance was performed on the total score on the Readiness for Interprofessional Learning Scale of the three departments, and the effectiveness of the workshop for the three departments was compared. Statistical analyses showed no interaction between time and department (p = 0.283). After the workshop, students from all three departments showed significant improvements in total scores on the Readiness for Interprofessional Learning Scale (p < 0.01) with medium to large effect sizes (r = 0.33-0.52). In the comparison between departments, there was a significant difference in the awareness levels of only medical technology and radiological science students before the workshop (p = 0.015). This study conducted case-based learning workshops with students from three departments, in which a patient's biophysical information was conveyed between occupational practices. The workshops improved the awareness of interprofessional education in students from all departments and revealed that interprofessional education is important for healthcare professions involved in biophysical function diagnosis.

Effects of breathing control using visual feedback of thoracoabdominal movement on aerobic exercise.

PURPOSE: To clarify whether voluntary respiratory movement control strategy is sustainable during exercise and to determine its effect on aerobic exercise. MATERIAL AND METHODS: Ten healthy men were enrolled in this study. We developed a device that can convert information on thoracoabdominal changes from an inductance plethysmograph and display the Konno-Mead diagram on the monitor in real time for each breath. On the first day, an incremental load test (ILT) was performed under two conditions. On the second day, a constant load test (CLT) was performed under two conditions using the load 1 min before the anaerobic threshold (AT). RESULTS: In the ILT, a significant prolongation of AT time was observed with voluntary respiratory movement control. In the CLT, carbon dioxide excretion showed no significant interaction, but the gas exchange ratio did. CONCLUSION: Voluntary respiratory movement control using a combination of chest band and visual feedback of thoracoabdominal movements may be a respiratory strategy to enhance aerobic exercise.

Features of electromyography threshold of the respiratory muscles during incremental exercise test.

In this study, we aimed to examine the electromyography threshold (EMGT) of the respiratory muscle and accessory respiratory muscles. Sixteen healthy men underwent an incremental exercise test at 15 W/minute to the end point. Expired gases and electromyograms of the respiratory and lower limb muscles were measured. The breakpoints for the EMG and expired gas data were analyzed using a segmented regression model. EMGT of the sternocleidomastoid and diaphragm was significantly more delayed than the ventilation threshold (VT) (287.94 s, 288.15 s vs. 185.5 s, p = 0.028 and 0.044, respectively). The EMGT of respiratory muscles and VT were not related, though EMGT of rectus femoris and vastus lateralis correlated with VT (r = 0.854, p < 0.001; r = 0.657, p = 0.011, respectively). EMGT of respiratory muscles may be influenced by multiple factors, such as central command and afferent input of mechanical stimulation from muscles, in addition to VT-induced changes in metabolic dynamics.

Effects of visual feedback of thoracoabdominal motion on oxygen consumption during hyperventilation - Pilot study.

INTRODUCTION: Respiratory muscle oxygen consumption increases with the work of breathing. We hypothesized that reducing excessive respiratory muscle activity during exercise may improve exercise tolerance. METHOD: We developed a device to provide real-time visual feedback of thoracoabdominal movement and used it to examine the influence of visual feedback of thoracoabdominal movement during diaphragmatic breathing on oxygen consumption in eight healthy men. While sitting on a wheelchair with the backrest reclined at 60°, oxygen consumption per body weight (VO2/BW), minute ventilation (VE), tidal volume (VT), and breathing frequency (fR) were measured, breath-by-breath, using an expired-gas analyzer. The breathing pattern was analyzed by inductance plethysmography, with transducer bands over the chest and abdomen recording thoracoabdominal movements. RESULTS: There was no significant difference in RatioTH-ABD and the ventilatory parameters between diaphragmatic breathing and diaphragmatic breathing with visual feedback. The average VO2/BW during diaphragmatic breathing with visual feedback was 0.6 ml/kg lower than that during diaphragmatic breathing without visual feedback (p<0.05). CONCLUSION: When visual feedback was used during diaphragmatic breathing, the RatioTH-ABD remained essentially unchanged, but VO2/BW decreased significantly. This suggests that visual feedback of thoracoabdominal movement during diaphragmatic breathing may reduce respiratory muscle oxygen consumption.

Investigation of inspiratory intercostal muscle activity in patients with spinal cord injury: a pilot study using electromyography, ultrasonography, and respiratory inductance plethysmography.

[Purpose] The respiratory function in patients with cervical spinal cord injury is influenced by inspiratory intercostal muscle function. However, inspiratory intercostal muscle activity has not been conclusively evaluated. We evaluated the inspiratory intercostal muscle activity in patients with cervical spinal cord injury by using inspiratory intercostal electromyography, respiratory inductance plethysmography, and ultrasonography. [Participants and Methods] Three patients with cervical spinal cord injury were assessed. The change in mean amplitude (rest vs. maximum inspiration) was calculated by using intercostal muscle electromyography. Changes in intercostal muscle thickness (resting expiration and maximum inspiration) were also evaluated on ultrasonography. The waveform was converted to spirometry ventilation with respiratory inductance plethysmography, and the waveform at the xiphoid was considered to determine the rib cage volume. Each index was compared with the inspiratory capacities in each case. [Results] Intercostal muscle electromyography failed to measure the notable myoelectric potential in all the patients. The rib cage volume was higher at higher inspiratory capacities. The changes in muscle thickness were not significantly different between the patients. [Conclusion] The rib cage volume (measured with inductance plethysmography) was greater in the patients with cervical spinal cord injury when inspiratory intercostal muscle activity was high. Respiratory inductance plethysmography can capture inspiratory intercostal muscle function in patients with cervical spinal cord injury.

Reliability of voluntary cough assessments using respiratory flow waveform.

[Purpose] Voluntary cough can be assessed by recording flow waves. The purpose of this study was to examine the reliability of the measurements of respiratory flow waveforms, using equipment that recorded flow waves during cough. [Participants and Methods] Twenty healthy participants were recruited for this study. They underwent spirometry on them and, subsequently, their flow waves during single and consecutive voluntary cough tasks in the sitting position were recorded. The intra-class correlation coefficient was used to assess the intra-rater and inter-rater reliabilities for the voluntary cough data. [Results] The intra-class correlation coefficients were 0.6 to 0.8 for 'intra-rater reliability' and higher than 0.9 for 'inter-rater reliability', for single and consecutive cough tasks. The first assessment of cough peak flow was significantly higher than the second, during consecutive cough tasks. Similarly, the first assessment of cough volume acceleration was significantly higher than the second. [Conclusion] Our results demonstrated high intra-rater and inter-rater reliabilities for single and consecutive cough tasks. Following additional procedures and valuations, including the storage of data and standard range decisions, this method of cough assessment will be applied to patients with reduced cough function.

Measurement of intercostal muscle thickness with ultrasound imaging during maximal breathing.

[Purpose] Determining the thickness of the intercostal muscle with ultrasound imaging would be a useful parameter in evaluating respiratory muscle activity in patients with tetraplegia and neuromuscular weakness. However, it has not been clarified whether ultrasound imaging can measure changes in intercostal muscle thickness during breathing. This study aimed to measure contractions of the human intercostal muscle in the anterior, lateral, and posterior parts with ultrasound imaging during maximal breathing. [Participants and Methods] The participants were 12 healthy males. Intercostal muscle thickness was measured using ultrasound at rest and at maximal breathing. The measurement sites were the anterior, lateral, and posterior portions of the right intercostal spaces. Statistical analysis was performed using a paired t-test comparing intercostal muscle thickness at rest and maximal breathing. [Results] The thickness of the intercostal muscle showed significant increases in the first, second, third, fourth, and sixth intercostal spaces of the anterior portions. There were no significant differences in the lateral or posterior portions between rest and maximal breathing. [Conclusion] Human intercostal muscle thickness can be measured with ultrasound and increases only in the anterior portions during maximal breathing.

Investigation into the mobility of elderly patients with pneumonia using triaxial accelerometer data.

OBJECTIVE: This study aimed to clarify the levels of physical activity of elderly pneumonia patients. METHOD: This is a prospective observational study among pneumonia patients who were hospitalized in a clinic within a general and respiratory medicine hospital department, and community-dwelling elderly. Activity levels of 29 elderly patients with pneumonia who were aged >75 years (PP group), and 15 community-dwelling healthy elderly (CD group) were measured. Triaxial accelerometers were attached to the patients' left chest regions from 48 h until 7 days after hospitalization. RESULTS: The time spent in the upright position was 320.0 min/day in the PP group and 729.0 min/day in the CD group. The time spent walking was 3.8 min/day in the PP group, and 71.0 min/day in the CD group. In the PP group, the times spent in the upright position and walking did not increase during the period studied, that is, from 48 h until 7 days after hospitalization. CONCLUSION: The time spent in the upright position and walking among elderly patients with pneumonia did not increase, despite gradual improvement of the disease.