Publishing type：Research paper (scientific journal)   Publisher：European Respiratory Society (ERS)  

Objective

Inspiratory muscle training (IMT) is used to improve inspiratory muscle strength in patients with chronic obstructive pulmonary disease (COPD). However, the effect of IMT on diaphragmatic function has not yet been thoroughly evaluated. This study aimed to evaluate the effect of IMT on maximum diaphragmatic excursion (DE_max) using ultrasonography in patients with COPD.

Methods

This was a single-center, randomised, prospective, parallel-group, unblinded controlled trial involving 38 participants with stable COPD. Participants underwent a standardised 12-week pulmonary rehabilitation (PR) program followed by a 12-week IMT program, consisting of home-based IMT and low-frequency outpatient PR sessions supervised by physiotherapists (once every 2 weeks),versuslow-frequency outpatient PR alone as a control. The DE_maxand exercise tolerance were measured.

Results

Out of the 38 patients initially enrolled in the PR program, 33 successfully completed it and were subsequently randomised to the IMT program. Finally, 15 (94%) and 14 (88%) patients from the IMT and control groups, respectively, completed the study. Following the IMT program, DE_maxincreased in the IMT group (50.1±7.6 mm to 60.6±8.0 mm, p<0.001), but not in the control group (47.4±7.9 mm to 46.9±8.3 mm, p=0.10). Changes in DE_maxand exercise tolerance (peak VO₂) were greater in the IMT group than in the control group (both p<0.01).

Conclusions

IMT following the PR program improved DE_maxand exercise tolerance. Therefore, DE_maxmay be an important outcome of IMT.

DOI： 10.1183/23120541.00035-2024

Language：Japanese   Publisher：(一社)大阪府理学療法士会生涯学習センター  

DOI： 10.50918/cptr.2024-003

Open Access

Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J07665&link_issn=&doc_id=20240806210010&doc_link_id=%2Ffq6compr%2F2024%2F000400%2F010%2F0081-0087%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffq6compr%2F2024%2F000400%2F010%2F0081-0087%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

This study aimed to investigate the association between the level of tissue oxygen saturation (StO2) and quadriceps/skeletal muscle dysfunction, measured using the Medical Research Council (MRC) scale and ultrasonography, in critically ill patients. Thirty-four patients hospitalized at the Critical Care Medicine Center of Kindai University Hospital, between January 2022 and March 2023, were enrolled in this study. The StO2 of the quadriceps muscle was measured via near-infrared spectroscopy. Muscle atrophy was measured by the thickness, cross-sectional area (CSA), and echo intensity of the rectus femoris (RF). These values were evaluated every alternate day until 13 days after admission or until discharge, whichever occurred first. Muscle weakness was assessed using the sum score of the MRC scale (MRC-SS), with the patient sitting at bedside. The mean age of the patients was 67.3 ± 15.3 years, and 20 (59%) were men. Seven patients (21%) were admitted for trauma, and 27 (79%) were admitted for medical emergencies or others. The mean score for the MRC-SS was 51.0 ± 7.9 points. RF thickness and CSA significantly decreased after day 7 (p < 0.05). There were no significant changes in StO2 levels during hospitalization. However, there were positive correlations between the nadir StO2 during hospitalization and MRC-SS, and changes in RF thickness and CSA at discharge (r = 0.41, p = 0.03; r = 0.37, p = 0.03; and r = 0.35, p = 0.05, respectively). StO2 in the quadriceps muscle may be useful for predicting muscle atrophy and dysfunction in patients with critical illnesses.

DOI： 10.1038/s41598-024-55118-1

Open Access

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Decreased respiratory muscle strength and muscle mass is key in diagnosing respiratory sarcopenia. However, the role of reduced diaphragm activity, expressed as the maximal level of diaphragmatic excursion (DEmax), in diagnosing respiratory sarcopenia in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to characterize patients with COPD and low DEmax and maximal inspiratory pressure (MIP), a measure of inspiratory muscle strength, and assess the role of DEmax in respiratory sarcopenia. METHODS: Patients with COPD underwent spirometry, exercise tolerance (VO2peak) test, and MIP measurement. DEmax and sternocleidomastoid thickness at the maximal inspiratory level (TscmMIL) were assessed using ultrasound sonography. RESULTS: Overall, 58 patients with COPD (median age, 76 years; median %FEV1, 51.3 %) were included, 28 of whom showed a %MIP of ≥80 %, defined as having preserved MIP. Based on the %MIP of 80 % and median value of DEmax (48.0 mm) as thresholds, the patients were stratified into four groups: both-high (n = 18), %MIP-alone low (n = 11), DEmax-alone low (n = 10), and both-low (n = 19) groups. The both-low group exhibited the lowest %FEV1, Δinspiratory capacity, VO2peak, and TscmMIL, and these values were significantly lower than those of the both-high group. Except for %FEV1, these values were significantly lower in the both-low group than in the %MIP-alone low group despite adjusting DEmax level for body mass index. CONCLUSION: Measuring DEmax along with MIP can characterize patients with COPD, reduced exercise capacity, and decreased accessory respiratory muscle mass and can help diagnose respiratory sarcopenia.

DOI： 10.1016/j.resinv.2023.12.013

PubMed

Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.rmcr.2024.102078

Language：English   Publishing type：Research paper (scientific journal)  

The low attenuation area percentage (LAA%) is gaining popularity. LAA% is an index of quantitative emphysema on computed tomography (CT) imaging of the chest. This study aims to retrospectively investigate whether preoperative LAA% is associated with postoperative prognosis in patients with esophageal cancer who were scheduled for esophagectomy. From January 2016 to March 2020, 105 patients with esophageal cancer underwent esophagectomy via right thoracotomy and neoadjuvant chemotherapy. A Synapse Vincent volume analyzer (Fujifilm Medical, Tokyo, Japan) was used for measurement. The software automatically quantified LAA% using a threshold of less than - 950 Hounsfield units on CT images of lung regions. Cox proportional hazard analyses were performed in univariable and multivariable forms. Estimates of the receiver operating curve are used to determine the cutoff value for death of LAA%, and the binary value is then inserted into Cox proportional hazard analyses. The preoperative LAA% cutoff value was ≥ 6.3%. Patients with a preoperative LAA% ≥6.3% had a significantly worse prognosis than those with a preoperative LAA% of < 6.3%. LAA% ≥6.3% (hazard ratio: 6.76; 95% confidence interval: 2.56-17.90, P < .001) was the most influential preoperative factor for overall survival after esophagectomy in multivariate Cox proportional hazard analyses. LAA% is one of the preoperative risk factors for survival after esophagectomy and an indicator of lung condition using routinely performed preoperative CT images. We quantified the extent of preoperative emphysema in patients with esophageal cancer, who were scheduled for surgery, and for the first time, reported LAA% as one of the preoperative risk factors for survival after esophagectomy.

DOI： 10.1097/MD.0000000000035547

Open Access

PubMed

Publishing type：Research paper (scientific journal)   Publisher：European Respiratory Society (ERS)  

Background and objective

Dynamic lung hyperinflation (DLH) can play a central role in exertional dyspnoea in patients with chronic obstructive pulmonary disease (COPD). Chest X-ray is the basic tool for assessing static lung hyperinflation in COPD. However, the predictive capacity of DLH using chest X-ray remains unknown. This study was conducted to determine whether DLH can be predicted by measuring the height of the right diaphragm (dome height) on chest X-ray.

Methods

This single-centre, retrospective cohort study included patients with stable COPD with pulmonary function test, cardiopulmonary exercise test, constant load test, and pulmonary images. They were divided into two groups according to the median of changes of inspiratory capacity (ΔIC=IC lowest − IC at rest). The right diaphragm dome height and lung height were measured on plain chest X-ray.

Results

Of the 48 patients included, 24 were classified as having high DLH (ΔIC≤−0.59 L from rest; −0.59 L, median of all) and 24 as having low DLH. Dome height correlated with ΔIC (r=0.66, p&lt;0.001). Multivariate analysis revealed that dome height was associated with high DLH independent of %low attenuation area on chest computed tomography and %FEV₁. Furthermore, the area under the receiver operating characteristic curve of dome height to predict high DLH was 0.86, with sensitivity and specificity of 83% and 75%, respectively, at a cutoff of 20.5 mm. Lung height was unrelated to ΔIC.

Conclusion

Diaphragm dome height on chest X-ray may adequately predict high DLH in patients with COPD.

DOI： 10.1183/23120541.00079-2023

Open Access

Language：Japanese   Publisher：(株)医学書院  

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

DOI： 10.15032/jsrcr.21-26

Open Access

Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J04907&link_issn=&doc_id=20230117470026&doc_link_id=10.15032%2Fjsrcr.21-26&url=https%3A%2F%2Fdoi.org%2F10.15032%2Fjsrcr.21-26&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have difficulties inhaling as the diaphragm becomes flattened and weakened due to lung hyperinflation. This weakened respiratory function is compensated for by the increased activity of the accessory respiratory muscles, such as the sternocleidomastoid muscle (SCM). OBJECTIVES: This study aimed to evaluate the difference in the SCM thickening fraction (SCM TF) of each respiratory phase (end-expiration, resting inspiration, and end-inspiration), as measured using ultrasonography (US), between patients with COPD and control subjects. We also evaluate the correlation between the SCM TF of each respiratory phase and exercise tolerance in patients with COPD. METHODS: Patients with COPD (n = 44) and age-matched controls (n = 20) underwent US for determination of the SCM TF. Ventilation parameters, including the peak oxygen uptake (peak VO2) and the change in the inspiratory capacity, were measured during cardiopulmonary exercise testing. The SCM thickness and TF was measured during end-expiration, resting breathing, and end-inspiration. RESULTS: The SCM was significantly thinner in patients with COPD than in controls at end-expiration. The increase in the SCM TF from end-expiration to end-inspiration in patients with COPD did not differ significantly from that in control subjects. In contrast, the SCM TF from end-expiration to resting inspiration was significantly greater in patients with COPD than in control subjects. The peak VO2 was strongly positively correlated with the SCM TF from end-expiration to end-inspiration in patients with COPD (r = 0.71, p < 0.01). CONCLUSIONS: The SCM may be thinner in patients with COPD than in controls. The SCM TF may also be associated with exercise tolerance.

DOI： 10.1159/000527100

Open Access

PubMed

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

DOI： 10.15032/jsrcr.30.3_355

Open Access

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: In patients with chronic obstructive pulmonary disease (COPD), the maximum level of diaphragm excursion (DEmax) is correlated with dynamic lung hyperinflation and exercise tolerance. This study aimed to elucidate the utility of DEmax to predict the improvement in exercise tolerance after pulmonary rehabilitation (PR) in patients with COPD. METHODS: This was a prospective cohort study. Of the 62 patients with stable COPD who participated in the outpatient PR programme from April 2018 to February 2021, 50 completed the programme. Six-minute walk distance (6MWD) was performed to evaluate exercise tolerance, and ultrasonography was performed to measure DEmax. Responders to PR in exercise capacity were defined as patients who demonstrated an increase of > 30 m in 6MWD. The receiver operating characteristic (ROC) curve was used to determine the cut-off point of DEmax to predict responses to PR. RESULTS: Baseline levels of forced expiratory volume in 1 s, 6MWD, maximum inspiratory pressure, DEmax and quadriceps muscle strength were significantly higher, and peak dyspnoea of modified Borg (mBorg) scale score was lower in responders (n = 30) than in non-responders (n = 20) to PR (p < 0.01). In multivariate analysis, DEmax was significantly correlated with an increase of > 30 m in 6MWD. The area under the ROC curve of DEmax to predict responders was 0.915, with a sensitivity and specificity of 83% and 95%, respectively, at a cut-off value of 44.9 mm of DEmax. CONCLUSION: DEmax could adequately predict the improvement in exercise tolerance after PR in patients with COPD.

DOI： 10.1186/s12931-021-01870-1

Open Access

PubMed

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: A recent paper reported that low muscle mass in the erector spinae muscles (ESM) was strongly associated with poor prognosis and declining muscle mass over time in subjects with COPD. However, effects of pulmonary rehabilitation (PR), if any, on ESM mass have not been reported. We hypothesized that PR reduces the annual decline in ESM mass. METHODS: This was a retrospective cohort study. Thirty-nine subjects with COPD who received PR and underwent chest computed tomography before and after PR were evaluated (rehabilitation group). We also evaluated 39 age-matched subjects with COPD who did not receive PR (nonrehabilitation group). Data were collected from August 2010 until March 2020 in both groups. The ESM cross-sectional area (ESMCSA) was measured using axial computed tomography images, and annual changes were calculated. The 6-min walk distance (6MWD) was measured before and after PR; the minimum clinically important difference was defined as 30 m. RESULTS: ESMCSA declined in the nonrehabilitation group over time (-116.0 ± 141.2 mm2/y) but increased in the PR group (51.0 ± 95.3 mm2/y; P < .001). The annual increase in ESMCSA was significantly higher among subjects with an increase in 6MWD that exceeded the minimum clinically important difference compared with nonresponders in the rehabilitation group. The annual change in ESMCSA was negatively correlated with comorbidity index, and triple therapy (long-acting β2-agonist/long-acting muscarinic antagonist/inhaled corticosteroid) had a favorable effect on annual change in ESMCSA. Multiple regression analysis revealed that only PR was an independent factor for annual change in ESMCSA. CONCLUSIONS: ESM mass was shown to decline yearly in subjects with COPD. The annual decline in muscle mass was reduced by PR.

DOI： 10.4187/respcare.08678

PubMed

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

DOI： 10.15032/jsrcr.29.3_365

Open Access

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J04907&link_issn=&doc_id=20210623390002&doc_link_id=10.15032%2Fjsrcr.29.3_365&url=https%3A%2F%2Fdoi.org%2F10.15032%2Fjsrcr.29.3_365&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

DOI： 10.15032/jsrcr.29.3_453

Open Access

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J04907&link_issn=&doc_id=20210623390020&doc_link_id=10.15032%2Fjsrcr.29.3_453&url=https%3A%2F%2Fdoi.org%2F10.15032%2Fjsrcr.29.3_453&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)大阪府理学療法士会生涯学習センター  

DOI： 10.50918/cptr.1.0_25

Open Access

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J07665&link_issn=&doc_id=20220729200004&doc_link_id=10.50918%2Fcptr.1.0_25&url=https%3A%2F%2Fdoi.org%2F10.50918%2Fcptr.1.0_25&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)  

Dysphagia is frequently observed in patients with chronic obstructive pulmonary disease (COPD). Decreased tongue strength is one of the causes of dysphagia, and it is often observed in patients with sarcopenia. Sarcopenia is also frequently observed in COPD patients. We hypothesized that tongue strength is lower in COPD patients compared to normal subjects. This was a single-center, observational, cross-sectional study. Maximum tongue pressure (MTP) was measured in 27 patients with COPD and 24 age-matched control subjects. We also evaluated handgrip strength, gait speed, and appendicular skeletal muscle mass to define subjects as having sarcopenia. We used bioelectrical impedance analysis to assess body composition. The eating assessment test-10 was used to diagnose dysphagia. MTP was significantly lower in COPD patients than in control subjects (33.8 ± 8.4 vs 38.0 ± 5.3; p = 0.032). All measures of muscle and fat free body mass, handgrip strength, and gait speed were also significantly lower in COPD patients compared to control subjects (p < 0.01). The prevalence of sarcopenia in COPD patients was higher than that in control subjects (6/27 versus 0/24; p = 0.007), but the prevalence of dysphagia was not different between groups (COPD: 5/27, versus control: 1/24; p = 0.112). MTP was moderately correlated with skeletal muscle mass index (r = 0.56, p = 0.003) and handgrip strength (r = 0.43, p = 0.027) in COPD patients. Tongue strength was lower in COPD patients compared to normal subjects, and decreased tongue strength may be correlated with sarcopenia in COPD patients.

DOI： 10.1007/s00455-021-10314-3

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Background: Although the pathophysiological mechanisms involved in the development of dyspnoea and poor exercise tolerance in patients with COPD are complex, dynamic lung hyperinflation (DLH) plays a central role. Diaphragmatic excursions can be measured by ultrasonography (US) with high intra- and interobserver reliability. The objective of this study was to evaluate the effect of diaphragmatic excursions as assessed by US on exercise tolerance and DLH in patients with COPD. Methods: Patients with COPD (n=20) and age-matched control subjects (n=20) underwent US, which was used to determine the maximum level of diaphragmatic excursion (DEmax). Ventilation parameters, including the change in inspiratory capacity (ΔIC), were measured in the subjects during cardiopulmonary exercise testing (CPET). We examined the correlations between DEmax and the ventilation parameters. Results: The DEmax of patients with COPD was significantly lower than that of the controls (45.0±12.8 mm versus 64.6±6.3 mm, respectively; p<0.01). The perception of peak dyspnoea (Borg scale) was significantly negatively correlated with DEmax in patients with COPD. During CPET, oxygen uptake/weight (V'O2 /W) and minute ventilation (V'E) were significantly positively correlated with DEmax, while V'E/V'O2 and V'E/carbon dioxide output (V'CO2 ) were significantly negatively correlated with DEmax in patients with COPD. DEmax was also significantly positively correlated with ΔIC, reflecting DLH, and with V'O2 /W, reflecting exercise capacity. Conclusion: Reduced mobility of the diaphragm was related to decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patients.

DOI： 10.1183/23120541.00589-2020

Open Access

PubMed

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

DOI： 10.15032/jsrcr.28.3_484

Open Access

Language：Japanese   Publisher：(公社)日本理学療法士協会  

DOI： 10.15063/rigaku.11609

Open Access

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01747&link_issn=&doc_id=20200116290008&doc_link_id=10.15063%2Frigaku.11609&url=https%3A%2F%2Fdoi.org%2F10.15063%2Frigaku.11609&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

DOI： 10.15032/jsrcr.28.1_103

Open Access

Language：Japanese   Publisher：(公社)大阪府理学療法士会  

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

DOI： 10.15032/jsrcr.27.3_358

Open Access

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J04907&link_issn=&doc_id=20181116220026&doc_link_id=10.15032%2Fjsrcr.27.3_358&url=https%3A%2F%2Fdoi.org%2F10.15032%2Fjsrcr.27.3_358&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)  

AIM: Although the effects of pulmonary rehabilitation (PR) have been well defined for chronic obstructive pulmonary disease (COPD), it remains controversial whether PR improves physical activity (PA). The purpose of the present study was to identify factors associated with the effect of PR on PA. METHODS: This was a prospective study of 29 patients with COPD. They underwent pulmonary rehabilitation twice weekly for 12 weeks, and were assessed using the hospital anxiety and depression score, 6-min walk distance (6MWD), and the St. George Respiratory Questionnaire (SGRQ) before and after they underwent PR. The PA of patients was measured by a three-axis accelerometer. Physical activity level (PAL) was calculated by dividing each patient's total energy expenditure by basal metabolic rate. Correlations between changes in PAL after PR and 6MWD, St. George Respiratory Questionnaire, and hospital anxiety and depression score scores, and clinical parameters, including forced expiratory volume in 1 s were determined. RESULTS: 6MWD was significantly increased, but PAL was unchanged after PR. PAL was positively correlated with 6MWD, but not with percent predicted forced expiratory volume in 1 s nor St. George Respiratory Questionnaire scores before PR. The increase in PAL was negatively correlated with changes in hospital anxiety and depression score anxiety and depression scores, but was not correlated with the change in 6MWD. CONCLUSIONS: A PR program for COPD patients improved results of the 6MWD, but not PAL. Increased PAL was associated with improvements in anxiety and depression, but not with increased exercise capacity. Treating the depression and anxiety of patients with COPD might not only reduce emotional distress, but also improve their PAL. Geriatr Gerontol Int 2017; 17: 17-23.

DOI： 10.1111/ggi.12656

PubMed

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

DOI： 10.15032/jsrcr.25.3_457

Open Access

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J04907&link_issn=&doc_id=20160125300026&doc_link_id=10.15032%2Fjsrcr.25.3_457&url=https%3A%2F%2Fdoi.org%2F10.15032%2Fjsrcr.25.3_457&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

DOI： 10.15032/jsrcr.25.3_384

Open Access

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J04907&link_issn=&doc_id=20160125300013&doc_link_id=10.15032%2Fjsrcr.25.3_384&url=https%3A%2F%2Fdoi.org%2F10.15032%2Fjsrcr.25.3_384&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

DOI： 10.15032/jsrcr.24.2_246

Open Access

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J04907&link_issn=&doc_id=20140911140021&doc_link_id=10.15032%2Fjsrcr.24.2_246&url=https%3A%2F%2Fdoi.org%2F10.15032%2Fjsrcr.24.2_246&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(株)医学書院  

Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

DOI： 10.15032/jsrcr.21.2_142

Open Access

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J04907&link_issn=&doc_id=20120227310016&doc_link_id=10.15032%2Fjsrcr.21.2_142&url=https%3A%2F%2Fdoi.org%2F10.15032%2Fjsrcr.21.2_142&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)理学療法科学学会  

DOI： 10.1589/rika.26.537

Open Access

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J02929&link_issn=&doc_id=20110906390014&doc_link_id=%2Fca8ryoho%2F2011%2F002604%2F014%2F0537-0540%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fca8ryoho%2F2011%2F002604%2F014%2F0537-0540%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(公社)静岡県理学療法士会  

Language：Japanese   Publisher：(株)メディカルプレス  

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Event date： 2020.8

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Event date： 2020.8

Language：Japanese  

Event date： 2019.11

Language：Japanese  

Event date： 2019.10

Language：Japanese  

Event date： 2019.10

Language：Japanese  

Event date： 2019.8

Language：Japanese  

Event date： 2019.8

Language：Japanese  

Event date： 2019.8

Language：Japanese  

Event date： 2019.8

Language：Japanese  

Event date： 2019.6

Language：Japanese  

Event date： 2019.6

Language：Japanese  

Event date： 2019.6

Language：Japanese  

Event date： 2019.6

Language：Japanese  

Event date： 2019.6

Language：Japanese  

Event date： 2019.4

Language：Japanese  

Event date： 2019.1

Language：Japanese  

Event date： 2019.1

Language：Japanese  

Event date： 2019.1

Language：Japanese  

Event date： 2018.10

Language：Japanese  

Event date： 2018.10

Language：Japanese  

Event date： 2018.10

Language：Japanese  

Event date： 2018.7

Language：Japanese  

Event date： 2018.7

Language：Japanese  

Event date： 2018.7

Language：Japanese  

Event date： 2017.10

Language：Japanese  

Event date： 2017.10

Language：Japanese  

Event date： 2017.6

Language：Japanese  

Event date： 2016.9

Language：Japanese  

Event date： 2016.9

Language：Japanese  

Event date： 2016.9

Language：Japanese  

Event date： 2016.9

Language：Japanese  

Event date： 2016.9

Language：Japanese  

Event date： 2016.9

Language：Japanese  

Event date： 2015.9

Language：Japanese  

Event date： 2015.9

Language：Japanese  

Event date： 2015.9

Language：Japanese  

Event date： 2015.9

Language：Japanese  

Event date： 2015.8

Language：Japanese  

Event date： 2014.10

Language：Japanese  

Event date： 2014.9

Language：Japanese  

Event date： 2014.9

Language：Japanese  

Event date： 2014.9

Language：Japanese  

Event date： 2014.9

Language：Japanese  

Event date： 2014.9

Language：Japanese  

Event date： 2014.9

Language：Japanese  

Event date： 2013.9

Language：Japanese  

Event date： 2013.9

Language：Japanese  

Event date： 2013.9

Language：Japanese  

Event date： 2013.9

Language：Japanese  

Event date： 2013.5

Language：Japanese  

Event date： 2013.5

Language：Japanese  

Event date： 2012.10

Language：Japanese  

Event date： 2012.10

Language：Japanese  

Event date： 2012.10

Language：Japanese  

Event date： 2012.10

Language：Japanese  

Event date： 2012.6

Language：Japanese  

Event date： 2012.6

Language：Japanese  

Event date： 2011.10

Language：Japanese  

Event date： 2011.10

Language：Japanese  

Event date： 2010.3

Language：Japanese