Rationale: Spinal cord injury (SCI) patients who experience difficulties with independent walking use gait-assistive devices such as a cane, walker, or wheelchair. Few studies have explored gait patterns or cardiopulmonary function in chronic SCI patients after powered exoskeleton training. We investigated whether the cardiopulmonary function of a patient with an incomplete chronic cervical SCI and a hemiplegic gait pattern could be improved by walking training using a powered exoskeleton (Angelegs).Patient concerns: A 57-year-old male was diagnosed with an SCI at C3-C4. The right upper and lower limb motor functions differed when evaluated before entry into the program. Motor function was good in the right leg but poor in the left one. Before program entry, the patient could walk for about 10 m using a cane. He did not have a history of severe medical or psychological problems and was not cognitively impaired. Diagnosis:The patient was tetraplegia with incomplete SCI at C3-C4. Interventions:The patient was trained for 6 weeks using a powered exoskeleton. The training program consisted of sit-to-stand and stand-to-sit movements, maintenance of balanced standing for 5 minutes, and walking for 15 minutes.Outcomes: After 6 weeks of training, gait speed improved in the timed up-and-go test, and cardiac function was enhanced as measured by the metabolic equivalent and VO 2 tests.Lessions: Walking training using a powered exoskeleton can facilitate the effective rehabilitation and improve the gait speed and cardiopulmonary function of patients with chronic SCIs or strokes.

Objective To test the hypothesis that a longer duration of phase II cardiac rehabilitation is required to recover the exercise capacity of elderly patients compared to younger patients. Methods We retrospectively reviewed and analyzed the medical records of patients who were referred to our cardiac rehabilitation (CR) center and underwent percutaneous coronary intervention for acute myocardial infarction (AMI). A total of 70 patients were enrolled who underwent an exercise tolerance test (ETT) 3 weeks after the occurrence of an AMI (T0), 6 weeks after the first ETT (T1), and 12 weeks after the first ETT (T2). Patients older than 65 years were assigned to the elderly group (n=24) and those aged 65 years and younger to the younger group (n=46). Both groups performed center-based or home-based CR for 12 weeks (3 times per week and 1 session per day). Exercise intensity for each individual was based on the target heart rate calculated by the Karvonen formula. The change in maximal metabolic equivalents (MET max ) of the two groups was measured at each assessment point (T0, T1, and T2) to investigate the recovery of exercise capacity. Results The younger group showed improvement in MET max between T0 and T1. However, MET max of the elderly group showed no significant improvement between T0 and T1. The exercise capacity, measured with MET max , of all groups showed improvement between T0 and T2. Conclusion Elderly patients with AMI need a longer duration of CR (>6 weeks) than younger patients with AMI.

Hypoxic brain injury is accompanied by a decrease in various functions. It is also known that obstructive sleep apnea (OSA) can cause hypoxic brain injury. This study aimed to produce a model of an intermittent hypoxic brain condition in rats and determine the activity of the brain according to the duration of hypoxic exposure. Forty male Sprague–Dawley rats were divided into four groups: the control group (n = 10), the 2 h per day hypoxia exposure group (n = 10), the 4 h per day hypoxia exposure group (n = 10), and the 8 h per day hypoxia exposure group (n = 10). All rats were exposed to a hypoxic chamber containing 10% oxygen for five days. Positron emission tomography–computed tomography (PET-CT) brain images were acquired using a preclinical PET-CT scanner to evaluate the activity of brain metabolism. All the rats were subjected to normal conditions. After five days, PET-CT was performed to evaluate the recovery of brain metabolism. Western blot analysis and immunohistochemistry were performed with vascular endothelial growth factor (VEGF) and brain-derived neurotrophic factor (BDNF). The mean SUV was elevated in the 2 h per day and 4 h per day groups, and all brain regions showed increased metabolism except the amygdala on the left side, the auditory cortex on the right side, the frontal association cortex on the right side, the parietal association cortex on the right side, and the somatosensory cortex on the right side immediately after hypoxic exposure. However, there was no difference between 5 days rest after hypoxic exposure and control group. Western blot analysis revealed the most significant immunoreactivity for VEGF in the 2, 4, and 8 h per day groups compared with the control group and quantification of VEGF immunohistochemistry showed more expression in 2 and 4 h per day groups compared with the control group. However, there was no significant difference in immunoreactivity for BDNF among the groups. The duration of exposure to hypoxia may affect the activity of the brain due to angiogenesis after intermittent hypoxic brain conditions in rats.

Rationale: Pelizaeus–Merzbacher disease (PMD) is an X-linked recessive trait and a rare disease characterized by abnormal myelin formation in the central nervous system. Since Pelizaeus and Merzbacher reported the pathology of PMD in the 1990s most studies have examined pharmacological treatments. No studies have reported the effects of rehabilitation on patients with PMD aimed at improving their functional abilities. We report the first case of improved development after rehabilitation in a patient with Pelizaeus–Merzbacher disease. Patient concerns: A 1-month-boy developed focal seizures, nystagmus, and jerky head movements. He was brought to our outpatient clinic for rehabilitation of developmental delay at 11 months of age. He showed hypotonia, nystagmus, and developmental delay of 4 to 5 months in his gross and fine motor ability. Diagnoses: Developmental delay in a patient with PMD. Interventions: A child with PMD was hospitalized 3 times for 3 months and underwent rehabilitation to improve developmental delay. Developmental assessments were conducted before and after each admission for rehabilitation training. Outcomes: Before training, the patient was unable to maintain a sitting position. After the first and second training sessions, his gross motor ability had improved, and he could sit with a mild assist. Fine motor function also improved. Before training, the patient was able to transfer a cube from one hand to the other. After training, he could perform a pincher grasp. Lessons: Rehabilitation training can help PMD patients achieve maximal function and catch-up in their growth.

The number of patients with ischemic heart disease is increasing worldwide. And mortality and treatment costs are also increasing. Cardiac rehabilitation is effective in reducing disease recurrence, readmission, and mortality rates. Therefore, it is strongly recommended to introduce cardiac rehabilitation after ischemic heart disease. The cardiac rehabilitation team consists of rehabilitation medicine doctors, rehabilitation nurses, physical therapists, occupational therapists, clinical psychologists, nutritionists, and social workers. Cardiac rehabilitation programs include risk factor management, physical activity, medication management, psychological problem management, vocational rehabilitation training, and vocational counseling. Individual treatment programs should be created for each patient. Prior to the introduction of a rehabilitation program, the patient's risk factors and functional status should be evaluated. And patients receive education on blood pressure, blood sugar, lipids, weight, smoking cessation, and nutritional status management. An aerobic exercise is the most important cardiac rehabilitation program, and resistance exercise and flexibility exercise may also be included. Even after the cardiac rehabilitation program is finished, the changes in exercise and lifestyle should be continued through connection with the local community. Currently, there are differences in cardiac rehabilitation programs around the world. In the future, multinational, multi-center and large-scale research should be conducted. Through those studies, the effects of cardiac rehabilitation are confirmed, and important parts of each guideline are identified.