Difference in the Physiological Response to Exercise in Patients With Distinct Severity of COPD Pathology.
Difference in the physiological response to exercise in patients with distinct severity of COPD pathology.
Respir Care. 2013 Jul 2;
Maekura R, Hiraga T, Miki K, Kitada S, Yosimura K, Miki M, Tateishi Y
Patients with chronic obstructive pulmonary disease (COPD) have reduced exercise tolerance associated with dyspnea. This exercise intolerance is primarily due to impaired ventilatory mechanics, but it is also associated with a combination of factors, including inefficient gas exchange, lactic acidosis at a low work rate, and exercise-induced hypoxemia. The survival prognosis of COPD patients with severely reduced exercise capacity is extremely poor, but the pathophysiology of these patients during exercise remains to be accurately established. The present study aimed to characterize life-threatening factors such as hypoxemia, acidosis, and sympathetic activation during exercise in these patients.We monitored changes in life-threatening factors and compared these factors among quartile groups, defined according to their peak oxygen uptake status. Ninety-one COPD patients (82 males, 9 females; average age, 69.7 ± 6.8 years) consecutively underwent incremental cardiopulmonary exercise testing (CPET) using a cycle ergometer. Levels of arterial blood gases, lactate, and catecholamines were measured during CPET.We found that the pathophysiology of the COPD patients differed among patient groups. Patients with the most severely reduced exercise capacity (peak oxygen uptake ?623 ml·min(-1)) were characterized by exercise-induced steep decrease in arterial oxygen pressure (PaO2-slope: -78 ± 70 mmHg·L(-1)·min(-1)), rapid progression of respiratory acidosis, little change in lactic acidosis, and sympathetic activation at low-intensity workload (plasma norepinephrine level, 1.41 ± 0.94 ng·ml(-1) at 20 W), in addition to the limitation of increase in ventilation and impaired gas exchange.The mechanisms of exercise intolerance in COPD patients significantly varied among patients with different exercise capacities. Patients with the most severely reduced exercise capacity had the characteristics of exercise-induced hypoxemia, sympathetic overactivity, and progressive respiratory acidosis at low-intensity exercise. These life-threatening pathophysiological conditions could be improved by medication and/or pulmonary rehabilitation. HubMed – rehab
Acromiohumeral distance measurement in rotator cuff tendinopathy: is there a reliable, clinically applicable method? A systematic review.
Br J Sports Med. 2013 Jul 2;
McCreesh KM, Crotty JM, Lewis JS
Narrowing of the subacromial space has been noted as a common feature of rotator cuff (RC) tendinopathy. It has been implicated in the development of symptoms and forms the basis for some surgical and rehabilitation approaches. Various radiological methods have been used to measure the subacromial space, which is represented by a two-dimensional measurement of acromiohumeral distance (AHD). A reliable method of measurement could be used to assess the impact of rehabilitation or surgical interventions for RC tendinopathy; however, there are no published reviews assessing the reliability of AHD measurement.The aim of this review was to systematically assess the evidence for the intrarater and inter-rater reliability of radiological methods of measuring AHD, in order to identify the most reliable method for use in RC tendinopathy.An electronic literature search was carried out and studies describing the reliability of any radiological method of measuring AHD in either healthy or RC tendinopathy groups were included. Eighteen studies met the inclusion criteria and were appraised by two reviewers using the Quality Appraisal for reliability Studies checklist.Eight studies were deemed to be of high methodological quality. Study weaknesses included lack of tester blinding, inadequate description of tester experience, lack of inclusion of symptomatic populations, poor reporting of statistical methods and unclear diagnosis. There was strong evidence for the reliability of ultrasound for measuring AHD, with moderate evidence for MRI and CT measures and conflicting evidence for radiographic methods. Overall, there was lack of research in RC tendinopathy populations, with only six studies including participants with shoulder pain.The results support the reliability of ultrasound and CT or MRI for the measurement of AHD; however, more studies in symptomatic populations are required. The reliability of AHD measurement using radiographs has not been supported by the studies reviewed. HubMed – rehab
An innovative technique to restore velopharyngeal incompetency for a patient with cleft lip and palate.
BMJ Case Rep. 2013; 2013(jul02_1):
Ahmad M, Dhanasekar B, Aparna IN, Naim H
Treatment of cleft lip and palate patients often demand well-coordinated work of medical and dental specialists. In spite of surgical and orthodontic therapy, prosthetic rehabilitation is always necessary because of partial anadontia, maxillary hypoplasia and velopharyngeal dysfuction. The aim of the prosthetic treatment is to improve aesthetics, function and speech of the patients; however, factors like underdeveloped and collapsed maxillary arch, retrognathic maxilla and reduced alveolar ridge height make the treatment challenging. This clinical report describes an interdisciplinary approach for the management of cleft lip and palate patient associated with mutilated dentition. The prosthetic phase began along with orthodontic treatment to achieve sufficient space distribution, which was restored with fixed dental prosthesis to stabilise the achieved status of occlusion. Palatal lift prosthesis was fabricated to restore the velopharyngeal incompetency with an innovative technique using ‘standard orthodontic expansion screw’ to eliminate hypernasality, decrease intelligibility of speech and to aid in deglutition. HubMed – rehab
Perceptual weighting of pain behaviours of others, not information integration, varies with expertise.
Eur J Pain. 2013 Jul 2;
Prigent E, Amorim MA, Leconte P, Pradon D
Being able to estimate effort pain in patients is important for health care providers working in physical rehabilitation services. Previous studies have shown that clinicians and physiotherapists underestimate patients’ pain.The present study examined how two sources of visual information, namely body kinematics (movement speed and postural constraints) and facial expressions are integrated in order to estimate effort pain magnitude experienced by a paraplegic person performing a sitting pivot transfer. In addition, the effect of familiarity with paraplegia on judgment was assessed by comparing performance among physiotherapists, paraplegic patients and unfamiliar participants. Functional measurement was used to determine the psychophysical law of visual information integration carried by pain behaviours (guarding and facial expression).?Results indicate that guarding behaviour (specified by movement speed) carried important information for perceived effort pain independently of familiarity. In contrast, facial expression of pain was relevant only to unfamiliar and physiotherapist participants and not to paraplegic participants. Even if physiotherapists underestimated effort pain as compared to the other groups, they relied more strongly on facial expression, than other participants, in their estimation of effort pain expressed by a paraplegic patient.These results bring further insights into understanding physiotherapists’ perception of patients’ pain. In order to improve their ability to adapt the difficulty of the rehabilitation sessions, they should learn to raise their global level of pain magnitude estimation (for example, by performing themselves the body movement) instead of overweighting facial pain expression signals. HubMed – rehab
Has the time come for using intrathecal baclofen in neuropathic pain?
Eur J Pain. 2013 Aug; 17(7): 949-950
Hatem SM, Minooee K
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