Efficacy of Combined Hand Exercise Intervention in Patients With Chemotherapy-induced Peripheral Neuropathy: a Randomized Controlled Trial

Abstract Purpose Previous evidence regarding the impact of exercise interventions on chemotherapy-induced peripheral neuropathy often focuses on lower limb functions, such as muscle strength and balance ability, while the effect on upper extremities remains unknown. We aimed to evaluate the efficacy of combined hand exercise intervention on upper extremity function, symptoms, and quality-of-life in patients with chemotherapy-induced peripheral neuropathy. Methods After screening 341 patients, 42 were randomly assigned to either the intervention (n=21) or control (n=21) groups. Participants were evaluated at baseline (T0), after one chemotherapy cycle (T1), and after two chemotherapy cycles (T2). The primary outcome was upper extremity function measured using the Michigan Hand Outcomes Questionnaire at T2. The intention-to-treat and as-treated populations were compared using a mixed-effect model.Results In the intention-to-treat analysis, the decline in activities of daily living was significantly suppressed in the intervention group than in the control group at T2 (difference: 7.23; 95% confidence interval: 0.35, 14.10; P=0.0397). Similarly, in the as-treated analysis, the decline in activities of daily living was significantly suppressed in the intervention group than in the control group at T2 (difference: 13.09; 95% confidence interval: 5.68, 20.49; P=0.0008); and pain was also significantly improved in the intervention group than in the control group at T2 (difference: 13.21; 95% confidence interval: -22.91, -3.51; P=0.0083).Conclusion Performing a combined hand exercise intervention may prevent worsening in the activities of daily living using upper extremities in patients with chemotherapy-induced peripheral neuropathy.Trail registration number: UMIN000029389.Date of registration: 2017/10/02

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Modified Pro-Self Pain Control to Increase Activity in Patients with Colorectal Cancer

Nurse Media Journal of Nursing ◽

10.14710/nmjn.v7i1.15128 ◽

2017 ◽

Vol 7 (1) ◽

pp. 56

Author(s):

Khoirunnisa’ Munawaroh ◽

Untung Sujianto ◽

Mardiyono Mardiyono

Keyword(s):

Colorectal Cancer ◽

Experimental Design ◽

Activities Of Daily Living ◽

Pain Control ◽

Daily Living ◽

Intervention Group ◽

Control Group ◽

Patients With Cancer ◽

Katz Index ◽

Significant Difference

Background: Barriers to performing activities of daily living are common complaints of patients with cancer. One of the factors causing these barriers is pain. A modified pro-self pain control is a method used to enhance the patients’ ability to cope with pain to increase their activity.Purpose: This study aimed to evaluate the modified pro-self pain control to increase activity in patients with colorectal cancer undergoing chemotherapy.Methods: The present study employed an experimental design. Patients with colorectal cancer undergoing chemotherapy were randomly assigned to the intervention group (n=24) and the control group (n=24). The patients in the control group were given a standard hospital intervention, while the patients in the intervention group were given the modified pro-self pain control for nine days. The data were collected using the instrument of KATZ index and analyzed using the independent t-test.Results: The result of this study showed that there was a higher increase of activity among the patients in the intervention group than in the control group. Independent t-test showed that there was a significant difference between the intervention group and the control group (p=0.00).Conclusion: The modified pro-self pain control was found more effective to increase the activity in patients with colorectal cancer undergoing chemotherapy than that of the standard hospital intervention.

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Efficacy of Group Reminiscence Therapy on Cognition, Depression, Neuropsychiatric Symptoms, and Activities of Daily Living for Patients With Alzheimer Disease

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988719882099 ◽

2019 ◽

Vol 33 (5) ◽

pp. 272-281 ◽

Cited By ~ 2

Author(s):

Mo Li ◽

Ji-hui Lyu ◽

Yi Zhang ◽

Mao-long Gao ◽

Rena Li ◽

...

Keyword(s):

Alzheimer Disease ◽

Activities Of Daily Living ◽

Daily Living ◽

Neuropsychiatric Symptoms ◽

Intervention Group ◽

Disease Assessment ◽

Control Group ◽

Time Points ◽

Reminiscence Therapy ◽

Group Reminiscence

The current study aimed to investigate the effects of group reminiscence therapy on cognitive function, depression, neuropsychiatric symptoms, and activities of daily living in patients with mild-to-moderate Alzheimer disease (AD). A single-blind randomized parallel-design controlled trial was conducted between May 1, 2017, and April 30, 2018. Ninety patients with mild-to-moderate AD recruited from Beijing Geriatric Hospital were randomly allocated into intervention (n = 45) and control groups (n = 45). In the intervention group, group-based reminiscence therapy was performed in two 30- to 45-minute sessions weekly for 12 weeks. Control participants received only conventional drug treatments and routine daily care. Alzheimer disease–related symptoms were evaluated using the Alzheimer’s Disease Assessment Scale-Cognitive section, the Cornell Scale for Depression in Dementia (CSDD), the Neuropsychiatric Inventory, and the Barthel Index. Four time points were set for data collection: baseline (before treatment), 4 weeks (during treatment), 12 weeks (end of treatment), and 24 weeks (12 weeks posttreatment). χ2 Tests, independent t tests, repeated-measures analysis of variance, and Bonferroni tests were used for data analysis. Significant improvements in depressive and neuropsychiatric symptoms were found in the intervention group compared to the control group ( P < .05). Mean CSDD scores in the intervention group were improved at all 3 time points compared to baseline and showed the greatest effect at 12 weeks ( t = 2.076, P = .041) and 24 weeks follow-up ( t = 3.834, P = .000) compared to controls. Group reminiscence therapy was effective for improving depressive symptoms and was beneficial for treating neuropsychiatric symptoms in patients with AD.

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Contribution of a multicomponent intervention on functional capacity and independence on activities of daily living in individuals with neurocognitive disorder

BMC Geriatrics ◽

10.1186/s12877-021-02591-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Flávia Borges-Machado ◽

Duarte Barros ◽

Laetitia Teixeira ◽

Oscar Ribeiro ◽

Joana Carvalho

Keyword(s):

Activities Of Daily Living ◽

Functional Capacity ◽

Daily Living ◽

Exercise Intervention ◽

Controlled Trial ◽

Upper Body ◽

Control Group ◽

Neurocognitive Disorder ◽

Walk Test ◽

Timed Up And Go

Abstract Background To examine the effects of a 6-month multicomponent (MT) exercise intervention in the functional capacity and ability to independently perform activities of daily living (ADL) of individuals diagnosed with neurocognitive disorder (NCD). Methods A quasi-experimental controlled trial with a parallel design study was conducted in multicentered community-based settings. Forty-three individuals (N Female: 30) were allocated to an exercise group (EG; N: 23; mean 75.09, SD = 5.54 years) or a control group (CG; N:20; mean 81.90, SD = 1.33 years). The EG engaged in a 6-month MT program (60-min sessions, twice a week). Exercise sessions were divided into a warm-up, specific training (e.g., coordination and balance, lower and upper body strength, and aerobics), and cool down. Lower body function, mobility, and gait speed were evaluated through Short Physical Performance Battery (SPPB), Timed-Up and Go test (TUG) and 6-Meter Walk test, respectively. The Barthel Index (BI) was administered to assess individuals’ ADL independence. Evaluations were performed before and after the 6-month intervention. Results Linear Mixed Models revealed a statistically significant interaction (time X group) effect factor on SPPB (B = 2.33, 95% CI: 1.39–3.28, p < 0.001), TUG (B = − 11.15, 95% CI: − 17.23 – − 5.06, p = 0.001), and 6-Meter Walk test (B = 0.17, 95% CI: 0.08–0.25, p < 0.001). No differences between groups or assessment moments were found in the ability of individuals to independently perform ADL. Conclusions The 6-month MT exercise intervention improves the functional capacity of older adults living with NCD. Trial registration ClinicalTrials.gov – identifier number NCT04095962; retrospectively registered on 19 September 2019.

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Contribution of a Multicomponent Intervention on Functional Capacity and Independence on Activities of Daily Living in Individuals With Neurocognitive Disorder

10.21203/rs.3.rs-537422/v1 ◽

2021 ◽

Author(s):

Flávia Borges-Machado ◽

Duarte Barros ◽

Laetitia Teixeira ◽

Óscar Ribeiro ◽

Joana Carvalho

Keyword(s):

Activities Of Daily Living ◽

Functional Capacity ◽

Daily Living ◽

Exercise Intervention ◽

Controlled Trial ◽

Upper Body ◽

Control Group ◽

Neurocognitive Disorder ◽

Walk Test ◽

Timed Up And Go

Abstract Background: To examine the effects of a 6-month multicomponent (MT) exercise intervention in the functional capacity and ability to independently perform activities of daily living (ADL) of individuals diagnosed with neurocognitive disorder (NCD). Methods: A quasi-experimental controlled trial with a parallel design. This study was conducted in multicentered community-based settings. Forty-three individuals (N Female: 30) were allocated to an exercise group (EG; N: 23; mean 75.09, SD=5.54 years) or a control group (CG; N:20; mean 81.90, SD=1.33 years). The EG engaged in a 6-month MT program (60-min sessions, twice a week). Exercise sessions were divided into a warm-up, specific training (e.g., coordination and balance, lower and upper body strength, and aerobics), and cool down. Lower body function, mobility, and gait speed were evaluated through Short Physical Performance Battery (SPPB), Timed-Up and Go test (TUG) and 6-Meter Walk test, respectively. The Barthel Index (BI) was administered to assess individuals’ ADL independence. Evaluations were performed before and after the 6-month intervention. Results: Linear Mixed Models revealed a statistically significant interaction (time X group) effect factor on SPPB (B = 2.33, 95% CI: 1.39 – 3.28, p < 0.001), TUG (B = -11.15, 95% CI: -17.23 – -5.06, p = 0.001), and 6-Meter Walk test (B = 0.17, 95% CI: 0.08 – 0.25, p < 0.001). No differences between groups or assessment moments were found in the ability of individuals to independently perform ADL.Conclusions: The 6-month MT exercise intervention improves the functional capacity of older adults living with NCD.Trial Registration: ClinicalTrials.gov – identifier number NCT04095962; retrospectively registered on 19 September 2019.

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Combined Exercise and Cognitive Training System for Dementia Patients: A Randomized Controlled Trial

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000490613 ◽

2018 ◽

Vol 45 (5-6) ◽

pp. 318-325 ◽

Cited By ~ 4

Author(s):

Hitoshi Okamura ◽

Michiaki Otani ◽

Naonori Shimoyama ◽

Takayuki Fujii

Keyword(s):

Activities Of Daily Living ◽

Cognitive Training ◽

Daily Living ◽

Controlled Trial ◽

Intervention Group ◽

Training System ◽

Control Group ◽

Combined System ◽

Combined Exercise ◽

Dementia Patients

Background/Aims: We investigated the efficacy of a combined exercise and cognitive training system that we devised for improvement of attention and concentration, cognition, and activities of daily living in older adults with dementia. Methods: A total of 100 dementia patients were randomly assigned to an intervention group or a control group. The intervention group was subjected to a combined exercise and cognitive training for 6 consecutive weeks. Evaluations were performed using the Trail Making Test-Part A, the Mini-Mental State Examination, and an N-type activities of daily living evaluation scale for the elderly. Results: A comparison of the changes in scores on the evaluation scales between the intervention group and the control group showed significant interactions for all scores. Conclusions: The combined system is effective in increasing attention and concentration and improving cognitive function and activities of daily living in dementia patients.

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Effects of a Cognitive Rehabilitation Programme on the Independence Performing Activities of Daily Living of Persons with Dementia—A Pilot Randomized Controlled Trial

Brain Sciences ◽

10.3390/brainsci11030319 ◽

2021 ◽

Vol 11 (3) ◽

pp. 319

Author(s):

María Jiménez Palomares ◽

María Victoria González López-Arza ◽

Elisa María Garrido Ardila ◽

Trinidad Rodríguez Domínguez ◽

Juan Rodríguez Mansilla

Keyword(s):

Occupational Therapy ◽

Activities Of Daily Living ◽

Daily Living ◽

Cognitive Rehabilitation ◽

Intervention Group ◽

Cognitive Stimulation ◽

Control Group ◽

Neurocognitive Disorder ◽

Cognitive Level

Background: In all types of dementia, cognitive abilities are affected, behaviour is altered and functional capacity is progressively lost. This cognitive deterioration manifests in the decrease of abilities required to perform the activities of daily living (ADL). The objective of this pilot study was to assess the effect of an Occupational Therapy programme based on the training of ADL through cognitive stimulation on the independence of ADL of persons with dementia. Methods: Institutionalized older adults with major neurocognitive disorder or dementia (N = 58) were randomly allocated to receive either the Occupational Therapy ADL cognitive stimulation programme or conventional Occupational Therapy. The cognitive level and the independence level performing ADL were measured at baseline (week 0), after 5 weeks of treatment (week 5) and after 6 weeks of follow up (week 12). A value of p < 0.05 and α = 0.0025 (Bonferroni correction) was considered as statistically significant. Results: The results obtained showed improvements in the level of independence performing ADLs in the intervention group compared to the control group (p = 0.006). The improvements were seen in relation to feeding (p = 0.001), dressing (p = 0.005) and bladder and bowel incontinence (p = 0.003), the changes observed in feeding are statistically significant. However, those improvements were not maintained after the follow up period. There were no significant changes in relation to the cognitive level (p = 0.741). Conclusions: Occupational Therapy based on ADL cognitive stimulation can have a positive effect, increasing the independence of subjects with major neurocognitive disorder or dementia who are institutionalised.

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PENGARUH AKUPRESUR TERHADAP PENINGKATAN KEKUATAN OTOT DAN ACTIVITIES OF DAILY LIVING (ADL) PADA PASIEN STROKE NON HEMORAGIK DI UNIT STROKE RSUD A. WAHAB SJAHRANIE SAMARINDA

Jurnal Keperawatan Dirgahayu (JKD) ◽

10.52841/jkd.v1i1.84 ◽

2019 ◽

Vol 1 (1) ◽

pp. 32-42

Author(s):

Theresia Tutik Ismiati

Keyword(s):

Muscle Strength ◽

Activities Of Daily Living ◽

Daily Living ◽

Intervention Group ◽

Complementary Therapy ◽

World Health ◽

Control Group ◽

Stroke Patients ◽

Range Of Movement ◽

Permanent Disability

Stroke is a disease caused by the interruption of blood supply to the brain. WHO (World Health Organization) stated 15 million people world wide suffer a stroke each year. As many as 5 million people are death sand 5 million people have permanent disability. Stroke Foundation of Indonesia (Yastroki) noted that Indonesia ranks first in Asia with the majority of stroke patients and become leading causes of death in Indonesia. Stroke affects extremity dysfunction such decreased muscle strength which will contribute to the decline ability of Activities of daily living (ADL). There are several the rapies that have been done to over come muscle weakness and limitations of the ADL such as range of movement exercises, positioning, and acupressure is one form of therapy that can be done to restore extremity function. This study aims to determine the effect of acupressure intervention on limb muscle strength and Activities Of Daily Living (ADL) In Stroke Patients. Quantitative Study of quasi-experiment pre-post test design involved 113 respondents into two groups: the intervention group with 88 respondents and the control group with 25 respondents.The result showed male respondents (51.3%), aged 45-59 years (58.4%), and the first attack (85%). After the intervention of 7 day sine ach ofthe respondents, found significant differences increase muscle strength and ADL before the after intervention: right limbmuscle strength(p =0.000); left limbstrength (p =0.000); and ADL (p =0.000). Respondent characteristics that influence muscle strength and ADL were age and frequency of stroke (P <0.05), where as no influence of gender (p> 0.05). The conclusions of this study that acupressureis an effective therapy on increase muscle strength and ADL of stroke patients. This research recommended acupressure as a complementary therapy to improve muscle strength andADLof stroke patients.

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An extended stroke rehabilitation service for people who have had a stroke: the EXTRAS RCT

Health Technology Assessment ◽

10.3310/hta24240 ◽

2020 ◽

Vol 24 (24) ◽

pp. 1-202

Author(s):

Lisa Shaw ◽

Nawaraj Bhattarai ◽

Robin Cant ◽

Avril Drummond ◽

Gary A Ford ◽

...

Keyword(s):

Confidence Interval ◽

Activities Of Daily Living ◽

Usual Care ◽

Daily Living ◽

Intervention Group ◽

Depression Scale ◽

Quality Adjusted Life Years ◽

Early Supported Discharge ◽

Life Years ◽

Quality Adjusted Life

Background There is limited evidence about the effectiveness of rehabilitation in meeting the longer-term needs of stroke patients and their carers. Objective To determine the clinical effectiveness and cost-effectiveness of an extended stroke rehabilitation service (EXTRAS). Design A pragmatic, observer-blind, parallel-group, multicentre randomised controlled trial with embedded health economic and process evaluations. Participants were randomised (1 : 1) to receive EXTRAS or usual care. Setting Nineteen NHS study centres. Participants Patients with a new stroke who received early supported discharge and their informal carers. Interventions Five EXTRAS reviews provided by an early supported discharge team member between 1 and 18 months post early supported discharge, usually over the telephone. Reviewers assessed rehabilitation needs, with goal-setting and action-planning. Control treatment was usual care post early supported discharge. Main outcome measures The primary outcome was performance in extended activities of daily living (Nottingham Extended Activities of Daily Living Scale) at 24 months post randomisation. Secondary outcomes at 12 and 24 months included patient mood (Hospital Anxiety and Depression Scale), health status (Oxford Handicap Scale), experience of services and adverse events. For carers, secondary outcomes included carers’ strain (Caregiver Strain Index) and experience of services. Cost-effectiveness was estimated using resource utilisation costs (adaptation of the Client Service Receipt Inventory) and quality-adjusted life-years. Results A total of 573 patients (EXTRAS, n = 285; usual care, n = 288) with 194 carers (EXTRAS, n = 103; usual care, n = 91) were randomised. Mean 24-month Nottingham Extended Activities of Daily Living Scale scores were 40.0 (standard deviation 18.1) for EXTRAS (n = 219) and 37.2 (standard deviation 18.5) for usual care (n = 231), giving an adjusted mean difference of 1.8 (95% confidence interval –0.7 to 4.2). The mean intervention group Hospital Anxiety and Depression Scale scores were not significantly different at 12 and 24 months. The intervention did not improve patient health status or carer strain. EXTRAS patients and carers reported greater satisfaction with some aspects of care. The mean cost of resource utilisation was lower in the intervention group: –£311 (95% confidence interval –£3292 to £2787), with a 68% chance of EXTRAS being cost-saving. EXTRAS was associated with 0.07 (95% confidence interval 0.01 to 0.12) additional quality-adjusted life-years. At current conventional thresholds of willingness to pay for a quality-adjusted life-year, there is a 90% chance that EXTRAS is cost-effective. Conclusions EXTRAS did not improve stroke survivors’ performance in extended activities of daily living but did improve their overall satisfaction with services. Given the impact on costs and quality-adjusted life-years, there is a high chance that EXTRAS could be considered cost-effective. Future work Further research is required to identify whether or not community-based interventions can improve performance of extended activities of daily living, and to understand the improvements in health-related quality of life and costs seen by provision of intermittent longer-term specialist review. Trial registration Current Controlled Trials ISRCTN45203373. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 24. See the NIHR Journals Library website for further project information.

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Efficacy and Feasibility of Home-Based Training for Individuals With Homonymous Visual Field Defects

Neurorehabilitation and Neural Repair ◽

10.1177/1545968313503219 ◽

2013 ◽

Vol 28 (3) ◽

pp. 207-218 ◽

Cited By ~ 36

Author(s):

Lina Aimola ◽

Alison R. Lane ◽

Daniel T. Smith ◽

Georg Kerkhoff ◽

Gary A. Ford ◽

...

Keyword(s):

Visual Field ◽

Activities Of Daily Living ◽

Daily Living ◽

Intervention Group ◽

Computer Training ◽

Visual Field Defects ◽

Control Group ◽

Home Based ◽

Response Task ◽

Field Defects

Background. Homonymous visual field defects (HVFDs) are one of the most common consequences of stroke. Compensatory training encourages affected individuals to develop more efficient eye movements to improve function. However, training is typically supervised, which can be time consuming and costly. Objective. To develop and evaluate the efficacy and feasibility of an unsupervised reading and exploration computer training for individuals with HVFDs. Methods. Seventy individuals with chronic HVFDs were randomly assigned to 1 of 2 groups: intervention or control. The former received 35 hours of reading and exploration training, and the latter received 35 hours of control training. Visual and attentional abilities were assessed before and after training using perimetry, visual search, reading, activities of daily living, the Test of Everyday Attention, and a Sustained Attention to Response task. Results. Eighteen individuals failed to complete the training; analyses were conducted on the remaining 28 intervention and 24 control group participants. Individuals in the intervention group demonstrated significant improvements in the primary outcomes of exploration (12.87%, 95% confidence interval [CI] = 8.44% to 17.30%) and reading (18.45%, 95% CI = 9.93% to 26.97%), which were significantly greater than those observed following the control intervention (exploration = 4.80%, 95% CI = 0.09% to 9.51%; reading = 1.95%, 95% CI = −4.78% to 8.68%). Participants in the intervention group also reported secondary subjective improvements, although these were not matched by objective gains in tasks simulating activities of daily living. Conclusions. Home-based compensatory training is an inexpensive accessible rehabilitation option for individuals with HVFDs, which can result in objective benefits in searching and reading, as well as improving quality of life.

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Effect of Home-based Pulmonary Rehabilitation on Fatigue, Dyspnea, and Activities of Daily Living of COVID-19 Patients

Medical - Surgical Nursing Journal ◽

10.5812/msnj.122546 ◽

2022 ◽

Vol 10 (3) ◽

Author(s):

Romina Kalantari ◽

Fatihe Kermansaravi ◽

Fariba Yaghoubinia

Keyword(s):

Activities Of Daily Living ◽

Repeated Measures ◽

Pulmonary Rehabilitation ◽

Daily Living ◽

Intervention Group ◽

Teaching Hospitals ◽

Control Group ◽

Medical Sciences ◽

Home Based ◽

The Mean

Background: The acute nature and complications of COVID-19, including fatigue and dyspnea, reduce the ability of the affected individuals to play individual and social roles and perform activities of daily living, and have adverse effects on the life quality and economic status of patients. Conducting pre-discharge rehabilitation programs following a home-based approach can be effective in reducing fatigue and dyspnea and improving the activities of daily living of COVID-19 patients. Objectives: This study aimed to investigate the effect of home-based pulmonary rehabilitation on fatigue, dyspnea, and activities of daily living of COVID-19 patients in the teaching hospitals of Zahedan University of Medical Sciences in 2020. Methods: The quasi-experimental study enrolled 60 patients with COVID-19 respiratory symptoms admitted to the COVID-19 intensive care units of teaching hospitals affiliated with Zahedan University of Medical Sciences in 2020. The patients who met the inclusion criteria were selected using convenience sampling and randomly divided into intervention and control groups with color cards. The instruments used to collect the data were the Fatigue Severity Scale (FSS), the Borg Dyspnea Scale, and the Barthel Index completed by the participants before, two weeks, and two months after the intervention. The rehabilitation training was provided to the patient and the primary caregiver in the intervention group in three 45-min sessions individually and using training videos during the hospital stay. After discharge, the patients were followed up in person or by phone for eight weeks to ensure the effectiveness of the rehabilitation program. The collected data were analyzed using SPSS-22 software through repeated measures analysis of variance (ANOVA), independent samples t-test, and chi-square test at a significance level of 0.05 (P < 0.05). Results: The repeated measures ANOVA showed that changes in the fatigue and dyspnea scores were significant over time (P < 0.001). Furthermore, the intervention effect was significant (P = 0.04), and more remarkable changes were observed in the intervention group than in the control group. Given the significance of the group-time interactive effect on the two given variables, the comparisons were made point by point and with Bonferroni correction again by time and group. There were significant differences in the mean fatigue scores in the second (P = 0.03) and third (P < 0.001) stages and the mean dyspnea scores (P < 0.001) between the two groups. The mean scores of activities of daily living two weeks and two months after the intervention were significantly different between the two groups, with higher scores in the intervention group than in the control group (P = 0.01). The repeated measures ANOVA confirmed a statistically significant difference between the two groups in terms of the effect of time (P < 0.001) and group (P = 0.03) on the patients’ activities of daily living. Conclusions: The study showed that home-based pulmonary rehabilitation measures were effective on fatigue, dyspnea, and activities of daily living of COVID-19 patients. Thus, this intervention approach by nurses for family participation can be practical for treating acute and chronic respiratory diseases.

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