Objective: To explore the potential use of artificial intelligence language models in formulating rehabilitation prescriptions and International Classification of Functioning, Disability and Health (ICF) codes. Design: Comparative study based on a single case report compared to standard answers from a textbook. Subjects: A stroke case from textbook. Methods: Chat Generative Pre-Trained Transformer-4 (ChatGPT-4)was used to generate comprehensive medical and rehabilitation prescription information and ICF codes pertaining to the stroke case. This information was compared with standard answers from textbook, and 2 licensed Physical Medicine and Rehabilitation (PMR) clinicians reviewed the artificial intelligence recommendations for further discussion. Results: ChatGPT-4 effectively formulated rehabilitation prescriptions and ICF codes for a typical stroke case, together with a rationale to support its recommendations. This information was generated in seconds. Compared with standard answers, the large language model generated broader and more general prescriptions in terms of medical problems and management plans, rehabilitation problems and management plans, as well as rehabilitation goals. It also demonstrated the ability to propose specified approaches for each rehabilitation therapy. The language model made an error regarding the ICF category for the stroke case, but no mistakes were identified in the ICF codes assigned. Conclusion: This test case suggests that artificial intelligence language models have potential use in facilitating clinical practice and education in the field of rehabilitation medicine.

Background: The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) in 2001 and has been in the process of implementing it in clinics since then. Current international efforts to implement ICF in rehabilitation clinics include the implementation of ICF Core Sets and the development of simple, intuitive descriptions for the ICF Generic-30 Set (also called Rehabilitation Set). The present study was designed to operationalize these ICF tools for clinical practice in Japan. This work included 1) the development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set, 2) the development of a rating reference guide for Activity and Participation categories, and 3) the examination of the interrater reliability of rating Activity and Participation categories.Methods: The Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set was developed following the process employed to develop the Chinese and Italian versions.For further operationalization of this ICF Set in practice, a rating reference guide was developed. The development of the rating reference guide involved the following steps: 1) a trial of rating patients by several raters, 2) cognitive interviewing of the raters to analyse the thinking process involved in rating, 3) drafting of the rating reference guide, and 4) review by ICF specialists to confirm consistency with the original ICF concepts.After the rating reference guide was developed, interrater reliability of the rating with the reference guide was determined. Interrater reliability was examined using weighted kappa statistics with linear weight.Results: Through the pre-defined process, the Japanese version of the simple, intuitive descriptions for 30 categories of the ICF Generic-30 Set and the rating reference guides for 21 Activity and Participation categories were successfully developed. The weighted kappa statistics ranged from 0.61 to 0.85, showing substantial to excellent agreement of the ratings between raters.Conclusions: The present study demonstrates that ICF categories can be translated into clinical practice. Collaboration between clinicians and researchers would further enhance the implementation of the ICF in Japan.

Orthoses and insoles are among the primary treatments and prevention methods of refractory plantar ulcers in patients with Hansen’s disease. While dynamic plantar pressure and tactile sensory disturbance are the critical pathological factors, few studies have investigated whether a relationship exists between these two factors. In this study, dynamic pressure measured using F-scan system and tactile sensory threshold evaluated with monofilament testing were determined for 12 areas of 20 feet in patients with chronic Hansen’s disease. The correlation between these two factors was calculated for each foot, for each clinical category of the foot (0–IV) and across all feet. A significant correlation was found between dynamic pressure and tactile sensation in Category II feet (n = 8, p = 0.016, r² = 0.246, Spearman’s rank test). In contrast, no significant correlation was detected for the entire foot or within the subgroups for the remainder of the clinical categories. However, the clinical manifestation of lesion areas showed high variability: (1) pressure concentrated, sensation lost; (2) margin of pressure concentration, sensation lost; (3) pressure concentrated, sensation severely disturbed but not lost; and (4) tip of the toe. These results may indicate that, even though there was a weak relationship between dynamic pressure and tactile sensation, it is important to assess both, in addition to the basics of orthotic treatment in patients with Hansen’s disease presenting with refractory plantar ulceration.

Performing aerobics and resistance exercise at exactly the same time has not been available although combining both types of exercise in one training program has been attempted. The hybrid training system (HTS) is a resistance exercise that combines voluntary concentric muscle contractions with electrically stimulated eccentric muscle contractions. We devised an exercise technique using HTS on a cycle ergometer (HCE). Growth hormone (GH) and lactate are indicators of adequate training intensity. Interleukin-6 (IL-6) reflects enhancing lipid metabolism. The purpose of this study was to show that HCE provides sufficient exercise to stimulate the secretion of GH, lactate and IL-6. We compared an HCE test with cycle ergometer alone (CE). Ten healthy male subjects performed HCE and CE tests for 30 minutes each. The workload of both tests was set the same at 40% of each subject's peak oxygen uptake. For HCE, 2-minute HTS and 1-minute rest intervals were repeated. GH, lactate, and IL-6 were evaluated before and immediately after exercise, and at 15, 30 and 60 minutes. GH and lactate increased immediately after HCE. Moreover, the degree of the increases in GH after HCE (0 and 15 minutes) was higher than that after CE. IL-6 increased after HCE at 30 min, and the rate of change was higher than for CE. These results showed that HCE was more efficient in stimulating acute increases in GH, lactate and IL-6 than CE at the same workload. We may be able to combine electrically stimulated resistance exercise with aerobic exercise using HCE.

Background: The symptom for identification of pulmonary arterial hypertension (PAH) is dyspnea on exertion, with a concomitant decrease in exercise capacity. Even patients with hemodynamically improved PAH may have impaired exercise tolerance; however, the effect of central and peripheral factors on exercise tolerance remains unclear. We explored the factors contributing to exercise capacity and ventilatory efficiency in patients with hemodynamically normalized PAH after medical treatment. Methods and Results: In total, 82 patients with PAH (age: median 46 [interquartile range, 39–51] years; male:female, 23:59) and mean pulmonary arterial pressure ≤30 mm Hg at rest were enrolled. The exercise capacity, indicated by the 6‐minute walk distance and peak oxygen consumption, and the ventilatory efficiency, indicated by the minute ventilation versus carbon dioxide output slope, were assessed using cardiopulmonary exercise testing with a right heart catheter. The mean pulmonary arterial pressure was 21 (17–25) mm Hg, and the 6‐minute walk distance was 530 (458–565) m, whereas the peak oxygen consumption was 18.8 (14.8–21.6) mLꞏmin ⁻¹ ꞏkg ⁻¹ . The multivariate model that best predicted 6‐minute walk distance included peak arterial mixed venous oxygen content difference (β=0.46, P <0.001), whereas the best peak oxygen consumption predictors included peak cardiac output (β=0.72, P <0.001), peak arterial mixed venous oxygen content difference (β=0.56, P <0.001), and resting mean pulmonary arterial pressure (β=−0.25, P =0.026). The parameter that best predicted minute ventilation versus carbon dioxide output slope was the resting mean pulmonary arterial pressure (β=0.35, P =0.041). Quadriceps muscle strength was moderately correlated with exercise capacity (6‐minute walk distance; ρ=0.57, P <0.001; peak oxygen consumption: ρ=0.56, P <0.001) and weakly correlated with ventilatory efficiency (ρ = −0.32, P =0.007). Conclusions: Central and peripheral factors are closely related to impaired exercise tolerance in patients with hemodynamically normalized PAH.

We developed a laparoscopic radical nephrectomy for malignant disease of the kidney and successfully performed the operation in six patients between July 1992 and October 1993. This procedure is basically derived from that of Clayman and associates. A CO₂ pneumoperitoneum is induced, and five trocars are introduced into the abdominal cavity through the lateral abdominal wall. The kidney is removed en bloc together with the adrenal gland, perirenal fatty tissue, and Gerota's fascia. The free kidney is put into a laparoscopy sack, and the sack is pulled out through a 5- to 6-cm incision in the abdominal wall without morcellation to allow complete pathologic examination. By this procedure, right nephrectomy was performed in four patients and left nephrectomy in two patients. The mean operative time was 6 hours and 13 minutes, and the mean blood loss was 430 mL. There were no severe complications. The average hospital stay was 11 days, and the average time to full convalescence was 21 days. Pathologic examination revealed renal cell carcinoma in five patients and nephroblastoma in one. Of the patients with renal cell carcinoma, the stage was pTlpN0pM0 in three patients and pT2pN0pM0 in two. There has been no recurrent disease in these six patients with a mean follow-up period of 9.5 months.