Changes in Musculoskeletal Discomfort and Postural Alignment According to the Height of the Worktable When VDT Activities were Performed by Patients in a Wheelchair with C6 and T6 Spinal Cord Injuries

Purpose: This purpose of the study was to identify the effects of computer worktable heights on musculoskeletal changes in the neck and upper extremities and postural alignment in patients with C6 and T6 level spinal cord injuries. Materials and Methods: The participants in the present study were patients diagnosed with AIS A. The level of the worktable was set 5 cm below the elbow, at elbow level, and 5 cm above elbow level. Subjective musculoskeletal discomfort (Borg-RPE) was measured at the end of the experiment. To compare the side posture for the wheelchair axle, patients with C6 and the T6 injuries were selected to measure the angle of the centerline for the axle, the tip of the chin, and the postural change for the tragus of the ear. Results: First, in the patient with C6 injuries, the Borg-RPE scores decreased when the worktable height was 5 cm above the elbow, whereas, in the patient with T6 injuries, the Borg-RPE scores decreased when the worktable height was decreased. Second, in the patient with C6 injuries, the chin tip and tragus of the ear were close to the center of the wheelchair when the height of the worktable was 5 cm above the elbow in the lateral position. In the patient with T6 injuries, there was no difference in lateral posture according to the height of the worktable. Conclusion: To reduce musculoskeletal system discomfort in patients during video display terminal (VDT) work, it is necessary to set the worktable height higher than the elbow standard for patients with C6 injuries and lower than elbow height for patients with T6 injuries. In the case of posture change, in the patient with C6 injuries, the higher the worktable height, the more the neck and head changed from forward flexion to a neutral posture.

Does the Head Position Affect Neonatal Lateral Ventricular Volume?

Objective This study aimed to determine whether there are differences in the lateral ventricular volumes, measured by three-dimensional ultrasound (3D US) depending on the posture of the neonate (right and left lateral decubitus). Study Design This was a prospective analysis of the lateral ventricular volumes of preterm neonates recruited from Victoria Hospital, London, Ontario (June 2018–November 2019). A total of 24 premature neonates were recruited. The first cohort of 18 unstable premature neonates were imaged with 3D US in their current sides providing 15 right-sided and 16 left-sided 3D US images. The neonates in the second cohort of six relatively stable infants were imaged after positioning in each lateral decubitus position for 30 minutes, resulting in 40 3D US images obtained from 20 posture change sessions. The images were segmented and the ventricle volumes in each lateral posture were compared with determine whether the posture of the head influenced the volume of the upper and lower ventricle. Results For the first cohort who did not have their posture changed, the mean of the right and left ventricle volumes were 23.81 ± 15.51 and 21.61 ± 16.19 cm3, respectively, for the 15 images obtained in a right lateral posture and 13.96 ± 8.69 and 14.92 ± 8.77 cm3, respectively, for the 16 images obtained in the left lateral posture. Similarly, for the second cohort who had their posture changed, the mean of right and left ventricle volumes were 20.92 ± 17.3 and 32.74 ± 32.33 cm3, respectively, after 30 minutes in the right lateral posture, and 21.25 ± 18.4 and 32.65 ± 31.58 cm3, respectively, after 30 minutes in the left lateral posture. Our results failed to show a statistically significant difference in ventricular volumes dependence on posture. Conclusion Head positioned to any lateral side for 30 minutes does not have any effect on the lateral ventricular volumes of neonates. Key Points

Prevention of Cerebral Palsy with Novel Hypoxia Index Composed of Fetal Heart Rate Deceleration

Fetal brain damage develops after the loss of FHR variability followed by infantile cerebral palsy due to severe hypoxia in frequently repeated fetal heart rate (FHR) decelerations (transient bradycardia) or prolonged fetal bradycardia, where novel hypxia index is 25 or more, and it is prevented if the hpoxia index is 24 or less. The hypoxia index (HI) is the sum of FHR deceleration durations (min) divided by the lowest FHR (bpm), and multiplied by 100 (Figure 1). The HI is calculated by visual measurement, while it is also suitably calculated by computerized FHR monitoring. Cerebral palsy is prevented when HI is 24 or less with almost zero error probability in the delivery. The cases whose HI was 25 or more will develop cerebral palsy, thus, it can receive early cerebral palsy trearments in neonatal stage. As late deceleration disappeared when the parturient woman changed her posture to lateral one from supine, a parturient woman is recommended to have lateral posture, when they notice the appearance of FHR deceleration during the delivery to disappear deceleration to prevent the increase of HI value. As the HI is adopted not only late deceleration, but also all decelerations and continuous bradycardia, fetal diagnosis will change to objective numeric FHR analysis from the monitoring with vague subjective FHR pattern classification.

Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial

Keeping airways clear of mucus by airway clearance techniques seems essential in bronchiectasis treatment, although no placebo-controlled trials or any studies lasting longer than 3 months have been conducted. We evaluate the efficacy of the ELTGOL (slow expiration with the glottis opened in the lateral posture) technique over a 1-year period in bronchiectasis patients with chronic expectoration in a randomised placebo-controlled trial.Patients were randomised to perform the ELTGOL technique (n=22) or placebo exercises (n=22) twice-daily (ClinicalTrials.gov,NCT01578681). The primary outcome was sputum volume during the first intervention and 24 h later. Secondary outcomes included sputum volume during the intervention and 24 h later at month 12, exacerbations, quality of life, sputum analyses, pulmonary function, exercise capacity, systemic inflammation, treatment adherence, and side effects.Sputum volume during intervention and 24 h later was higher in the ELTGOL group than in the placebo group both at the beginning and end of the study. Patients in the ELTGOL group had fewer exacerbations (p=0.042) and a clinically significant improvement in the St George's Respiratory Questionnaire score (p<0.001) and the Leicester Cough Questionnaire score compared with the placebo group (p<0.001).Twice-daily ELTGOL technique over 1 year in bronchiectasis patients facilitated secretion removal and was associated with fewer exacerbations, improved quality of life, and reduced cough impact.

Physiotherapy Intervention During Level I of Pulmonary Rehabilitation on Chronic Obstructive Pulmonary Disease: A Systematic Review

Background: The progressive and chronic course of COPD, characterized by difficulty in breathing, can be aggravated by periods of increased symptoms (exacerbation). The treatment often involves in-hospital care and among the interventions applied in COPD patients, physical therapy prompts good results. However the most used techniques are not properly pinpointed and there is no consensus in the literature regarding its effectiveness. Methods: A systematic review was performed to identify which physical therapy treatment was applied in these cases. The following bibliographic databases were consulted: PubMed, and Bireme Portal, Periódicos Capes. Controlled randomized clinical trials that is under went physical therapy intervention in patients hospitalized for exacerbated COPD without the use of NIV (non-invasive ventilation) were included in the study. The PEDro scale, which has a score of 0-10, was used to evaluate the quality of studies included in this review. Results: The electronic search yielded a total of 302 references published in English, of which only 6 met the criteria for inclusion and exclusion. Conclusion: It is possible to infer that physiotherapy’s techniques used in patients hospitalized for COPD exacerbation, based on this review, were the high frequency chest wall oscillation (HFCWO) on the chest; relaxing massage and active exercises, electrical stimulation via electro-acupuncture; strengthening of the quadriceps; the ELTGOL bronchial drainage technique (expiration with the glottis open in the lateral posture) and an incentive spirometer.