An Update on Pulmonary Rehabilitation in Patients with Neuromuscular Disease Kozo Hanayama 1,2 1Department of Rehabilitation Medicine, Tokai University School of Medicine Keyword: 神経筋疾患(neuromuscular disease) , 呼吸リハビリテーション(pulmonary rehabilitation) , 非侵襲的陽圧換気(noninvasive positive pressure ventilation) , 咳嗽(cough) pp.799-803
Published Date 2013/10/18
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Abstract : Pulmonary rehabilitation in neuromuscular disease patients is aimed primarily at avoiding tracheostomy, which carries more complications and is associated with a low quality of life compared with noninvasive positive pressure ventilation (NPPV). 1. Efficacy of NPPV and pulmonary rehabilitation : A recent report by researchers at a Japanese facility described a marked prolongation of life in patients with Duchenne muscular dystrophy who underwent NPPV, pulmonary rehabilitation and the management of heart failure. 2. Guidelines : Although evidence regarding the benefits of pulmonary rehabilitation in neuromuscular disease is insufficient, many statements and guidelines recommending the use of NPPV and pulmonary rehabilitation for several neuromuscular diseases have been published. 3. Spreading use of NPPV and pulmonary rehabilitation : There are patients who have not received the benefit of NPPV even if they are appropriate candidates not only in Japan but also in the United States. Hess described the barriers to NPPV use and considered the means of adopting new technologies. 4. Recent progress : 1) Index of respiratory muscle fatigue : In recent years, respiratory muscle fatigue has been highlighted as a clinical indicator. Several indicators, which can be noninvasively calculated, have been proposed as alternatives to the diaphragmatic tension-time index. 2) Techniques for airway clearance : A new study on the effectiveness of a combination of mechanical insufflation-exsufflation and oscillation has been reported. 5. Conclusions : The wide application of NPPV and pulmonary rehabilitation is becoming more widespread. Despite this, some patients still do not receive the benefits of these techniques. Efforts to improve the existing trend are required.

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電子版ISSN 印刷版ISSN 1881-3526 日本リハビリテーション医学会