Objectives: The aim of this study was to investigate the effect of diaphragmatic breathing training with visual biofeedback on respiratory function in patients with multiple rib fractures. Patients and methods: Between June 2021 and October 2021, a total of 16 patients (15 males, 1 female; mean age: 49.50±11.85 years; range, 25 to 66 years) who were diagnosed with multiple rib fractures were randomly assigned into two groups as the control group (CG, n=8) and the visual biofeedback group (VBG, n=8). The effect of each diaphragmatic breathing training on respiratory function was evaluated before and after eight interventions. For respiratory function, pulmonary function test was used to measure pulmonary function and respiratory muscle strength, and the Pain, Inspiratory capacity, Cough (PIC) score was used to evaluated pain, inspiratory capacity, and cough ability. Results: In both groups, the pulmonary function representing the ratio of measurements to predicted values of both forced vital capacity (CG mean difference=25.37±4.58, p=0.002, VBG mean difference=24.25±3.96, p=0.007) and forced expiratory volume in 1 sec (CG mean difference=32.38±5.7, p=0.002, VBG mean difference=26.15±5.73, p< 0.001) increased significantly. The maximal inspiratory (CG mean difference=14.00±0.35, p=0.002, VBG mean difference=20.5±6.26, p=0.009) and expiratory pressure (CG mean difference=43.72±29.44, p=0.034, VBG mean difference=25.76±6.78, p=0.015), the indicators of respiratory muscle strength, increased significantly in both groups. The PIC score, which evaluated pain, inspiratory capacity, and cough ability, also increased significantly in both groups (CG mean difference=1.63±0.26, p≤0.001, VBG mean difference=3.13±0.19, p< 0.001). The change of PIC score after intervention did not significantly differ between the groups (F=1.439, p=0.250); however, there was a significant difference over time (F=38.476, p< 0.001). The change of PIC scores differed over time between the groups (F=2.806 p=0.011). Conclusion: Diaphragmatic breathing training and diaphragmatic breathing training with visual biofeedback can improve pulmonary function, respiratory muscle strength, pain, inspiratory capacity, and cough ability in patients with multiple rib fractures.

Background and Objectives: In this study, we evaluated clinical factors associated with implementing a rehabilitation program for patients with COVID-19-associated acute respiratory distress syndrome (ARDS) requiring mechanical ventilation (MV) during the quarantine period. Materials and Methods: This observational study was conducted in the National Designated Isolated ICU, a dedicated COVID-19 center with 18 beds, from 30 December 2020 to 30 May 2022. One hundred and fifty-four patients (mean age: 67.3 ± 13.4 years; male: 59.7%) were enrolled. The ICU rehabilitation program included early mobilization, chest physiotherapy, and dysphagia treatment. Results: Forty-five patients (29.3%) participated in the rehabilitation program. Multivariate logistic regression identified three significant factors: tracheostomy (odds ratio [OR], 2.796; 95% confidence interval [CI], 1.238–6.316; p = 0.013), body mass index ≥ 25.0 kg/m² (OR, 2.724; 95% CI, 1.276–5.817; p = 0.010), and extracorporeal membrane oxygenation (OR, 2.931; 95% CI, 1.165–7.377; p = 0.022); patients with all three factors were younger (median 44 vs. 70 years, p < 0.001) and had significantly lower Acute Physiology and Chronic Health Evaluation II scores (median 12 vs. 16, p = 0.002) on the MV day. One-year cumulative mortality rates for patients with 0 to 3 factors were 66.7%, 50.8%, 38.9%, and 15.4%, respectively, with a significant difference among them (log-rank, p < 0.001). Conclusions: Three clinical factors associated with implementing a rehabilitation program during the quarantine period for COVID-19-associated ARDS patients were identified. The program was feasible and beneficial, particularly for younger patients with lower illness severity and fewer comorbidities on the day of MV.

Intensive care unit-acquired weakness (ICUAW) occurs secondary to patients treated for life-threatening conditions in the ICU being diagnosed based on the Medical Research Council sum score (MRC-SS). However, patients often complain of fatigability and poor endurance, which are not evaluated by muscle strength. In this study, we explored the feasibility of assessing muscle quality and endurance in trauma ICU patients. The modified Functional Index-2 (FI2) testing was applied to evaluate muscle endurance. The maximal voluntary contraction (MVC) was measured when evaluating the MRC-SS using surface electromyography (sEMG), and the fatigue index (FI) was also recorded at the time of endurance testing. The ultrasonic muscle echogenicity by gray-scale analysis of rectus femoris (RF) and tibialis anterior (TA) muscles was evaluated at the initial (<72 h) and end of ICU care. A total of 14 patients were enrolled in this study. Fatigue was induced in eight patients (fatigue group), and six (non-fatigue group) completed endurance testing. All patients except one had an MRC-SS exceeding 48 points. There was no difference in US echogenicity, MRC-SS, and FI between groups. In sEMG, the root mean square (RMS) values of MVC in RF and TA muscles showed a significant difference (p < 0.05). To evaluate and predict the functional activity of ICU patients, measuring muscle strength alone is insufficient, and it is necessary to evaluate muscle endurance. In this respect, the modified FI2 test and sEMG monitoring are considered to be promising procedures for evaluating the muscle condition of critically ill patients even in complex situations in the ICU.

Objectives: This study aims to investigate the effects of bodyweight support and therapist supervision on gait parameters and vital signs during overground gait training in stroke patients. Patients and methods: Between August 2023 and September 2023, a total of 18 stroke patients (10 males, 8 females; mean age: 61.2±12.0 years; range, 32 to 81 years) with hemiparesis were included in this factorial-design study. The patients underwent three different walking conditions: supervised bodyweight support (SBS), unsupervised bodyweight support (UBS), and supervised training without bodyweight support (SWBS). Gait parameters, including velocity, cadence, gait distance, gait cycle, stride length, step length, and single limb support, as well as vital signs (pulse rate and SpO2), were measured and compared using the 4-m walking test (4MWT) and 2-min walking test (2MWT). Results: Twelve patients had an ischemic stroke, while six had a hemorrhagic stroke. The mean onset period was 9.61±5.96 months. Eight patients had right-sided paralysis, and 10 patients had left-sided paralysis. There were no significant differences in gait parameters or vital signs during the 4MWT and 2MWT among the SBS, UBS, and SWBS groups (p>0.05 for all). Conclusion: Gait training using therapist supervised walking and bodyweight support may both be beneficial for stroke patients. However, incorporating both conditions into an intervention may not be efficient in terms of cost, space, and personnel utilization.

Objective: Skeletal muscle dysfunction, which is characterized by decreased muscle strength and endurance, contributes to dyspnea during exercise in patients with chronic obstructive pulmonary disease (COPD), regardless of pulmonary function. This study analyzed skeletal muscle function in patients with COPD through surface electromyography (sEMG) evaluations and signal processing and attempted to determine whether sEMG parameters for muscle fatigue reflect the course of the disease. Methods: In 24 patients with COPD, maximal voluntary isometric contraction and ramp contraction were performed during isometric knee extension, and the sEMG activity of the rectus femoris muscle was measured. The patients were divided into three groups according to their modified Medical Research Council (mMRC) grade and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Patients with mMRC grades 0 and 1 were classified into group A, grade 2 into group B, and grades 3 and 4 into group C. Patients with GOLD stage 1 were classified into group I, stage 2 into group II, and stages 3 and 4 into group III. sEMG parameters were compared between groups using one-way analysis of variance. Results: There were significant differences in the minimum median frequency and fatigue index between the mMRC groups. However, the sEMG parameters did not differ significantly among the GOLD groups. Conclusion: Muscle fatigue differs according to the severity of subjective dyspnea in COPD. sEMG evaluations and signal processing can play supplementary roles in evaluating muscle endurance and predicting functional capacity in COPD.

Diaphragmatic injury (DI) following blunt trauma can cause pulmonary complications and increased duration of ventilator-dependent intensive care unit stay. Herein, we present a 62-year-old female patient with severe trauma who was diagnosed with liver laceration and multiple rib fractures and underwent emergency laparotomy. Extubation was attempted; however, the patient had to be reintubated due to dyspnea. After reintubation, decreased right diaphragmatic excursion was confirmed by ultrasonography and the patient was diagnosed with DI. Surface electromyographic biofeedback was performed during diaphragmatic breathing training to increase the effect of pulmonary rehabilitation. Early diagnosis of DI may be possible using ultrasonography, and the use of surface electromyographic biofeedback is suggested for pulmonary rehabilitation in critically ill trauma patients.