Short-Term Pulmonary Rehabilitation for a Female Patient with Chronic Scleroderma under a Single-Case Research Design

Abstract

Although previously proposed that chronic scleroderma should be cared for clinically and early rehabilitation should be performed in hospital by a chest physical therapist, little evidence is currently available on its benefits. Therefore, this study demonstrated the benefits of short-term pulmonary rehabilitation during hospitalization in a female patient with chronic scleroderma. The aim of rehabilitation was to improve ventilation and gas exchange by using airway clearance, chest mobilization, and breathing-relearning techniques, including strengthening the respiratory system and the muscles of the limbs by using the BreathMax® device and elastic bands. Gross motor function and activities of daily life were regained by balancing, sitting, and standing practices. Data on minimal chest expansion, high dyspnea, high respiratory rate, and low maximal inspiratory mouth pressure were recorded seven days before rehabilitation or at the baseline period. But there was a clinically significant improvement in dyspnea, chest expansion, maximal inspiratory mouth pressure, and respiratory rate, when compared to baseline data, which were recorded by a chest physical therapist during seven days of rehabilitation. Furthermore, physicians decided to stop using a mechanical ventilator, and improvement in functional capacity was noted. Therefore, in the case of chronic and stable scleroderma, short-term rehabilitation during hospitalization for chest physical therapy possibly shows clinical benefits by improving both pulmonary function and physical performance.

Effects of a simple prototype respiratory muscle trainer on respiratory muscle strength, quality of life and dyspnea, and oxidative stress in COPD patients: a preliminary study

“… 51 Previous evidence has claimed the possibility of dyspnea from respiratory muscle dysfunction, and that free radicals can be produced during muscle contraction. 52 Assessment on dyspnea during the use of an RMT device is a simple and gold standard protocol for evaluating respiratory impairment or maximal capacity during exercise, especially by a respiratory therapist, 53 and it can present the benefits of the pulmonary rehabilitation program either in the hospital 54 or at home. 55 …”

Ultrasonic Evaluation of Diaphragm in Patients with Systemic Sclerosis

“…It is known that diaphragmatic dysfunction can contribute to the worsening of dyspnea, especially in patients with known cardiorespiratory comorbidities in SSc. It is possible that if selected patients are referred for pulmonary rehabilitation [48][49][50], the integral part of which is inspiratory muscle training, with concomitant treatment of the underlying disease, respiratory symptoms would decrease but further prospective studies are needed.…”

Application of a Single-Case Research Design to Present the Effectiveness of Rehabilitation in the Clinic

“…Therefore, it can be assumed that the results have no autocorrelation within the data, so changes in the data did not reflect the time dependence or pathological condition [22]. In addition, a previous study on a scleroderma patient having short-term chest physical therapy (CPT) for 7 days compared pre-treatment with an A-B design and showed that CPT significantly reduced the dyspnea score and respiratory rate and increased chest expansion and maximal inspiratory mount pressure (PImax) by using Bloom Table analysis [13]. Therefore, both previous studies present the effectiveness or benefits of rehabilitation in specific patients.…”

“…For instance, the effectiveness of a 7-day chest wall-stretching exercise in patients with chronic obstructive pulmonary disease (COPD) compared with 7 days in the baseline phase [12]. The same applies to 7-day pulmonary rehabilitation in patients with chronic scleroderma [13]. Therefore, various designs with a control period or baseline (A), intervention (B), withdrawn (A), or new intervention phase (B 0 ) can be performed.…”