Solar powered mobility scooters could soon be on the streets thanks to the work of a student at The University of Nottingham. Matt Alvey, who is studying Architecture and Environmental Design, says the photovoltaic (solar electric) recharging system will turn the mobility vehicles truly green.

The project began when a company that manufactures secure storage sheds for the scooters approached the university about integrating solar power to recharge the vehicle. If Matt can find a solution it will overcome problems often associated with connecting mains power to the shed. This can prove costly as it requires a qualified electrician to do the work. It would also prevent the possibility of the charger overloading the owner’s mains electricity supply to their home. Matt says “the other big advantage is that it will generate electricity by a renewable means and therefore has no harmful emissions”.

Caroline Moore, Director of Securit GB, the Chesterfield based company that sells the storage sheds, says “We wanted a solar panel system that would reduce the electric costs for disabled users and cut costs on getting a power supply connected to the shed.”

Dr Mark Gillott, Co-Director of the Institute for Sustainable Energy Technology at the School of the Built Environment says “Increasingly more and more people are becoming aware of their own impact on the environment. Renewable energy technologies are becoming extremely popular with the general public and this project is one example of how demand for a green solution was sought by the consumer.”

Shortly after the project began Loughborough based 50cycles brought along one of their electric bikes for testing. Scott Snaith from 50cycles says “there is a growing market for electric bikes and they want to find a way of making them 100% sustainable”. Matt is hoping he can use the same technology to charge the bikes.

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Matt Alvey is in the 3rd year of his 4 year course and took on the project for his dissertation study module. He has set up a working prototype to test the proposed design and the results, so far, look promising.

The University of Nottingham is Britain’s University of the Year (The Times Higher Awards 2006). It undertakes world-changing research, provides innovative teaching and a student experience of the highest quality. Ranked by Newsweek in the world’s Top 75 universities, its academics have won two Nobel Prizes since 2003. The University is an international institution with campuses in the United Kingdom, Malaysia and China.

For additional information go to securit.gb/ or 50cycles/

Contact: Lindsay Brooke

University of Nottingham

A minimally invasive procedure to treat tendonitis in the rotator cuff of the shoulder provides immediate symptom relief to the patient, according to a study published in the July issue of Radiology. The study found that ultrasound-guided nonsurgical therapy significantly reduces pain from calcific tendonitis of the rotator cuff and restores lasting mobility after treatment.

“With this treatment, we were able to establish a single inexpensive and effective treatment for calcific tendonitis of the rotator cuff. This has never happened before,” said co-author Luca M. Sconfienza, M.D., from the Unit of Radiology, IRCCS Policlinico San Donato, University of Milan School of Medicine in Milan, Italy. “Symptoms improved in patients treated with our procedure compared to non-treated patients.”

Calcific tendonitis is a condition that causes the formation of small calcium deposits within the tendons of the rotator cuff in the shoulder. It is most common in adults in their 40s. In most cases, the deposits become painful and can restrict mobility of the shoulder. In minor cases, physical therapy or anti-inflammatory medications may be sufficient to address the problem until the calcifications break apart spontaneously. In severe cases, patients may require shockwave treatment or open surgery to remove the calcium. Open surgery requires a hospital stay and rehabilitation and, on rare occasions, may result in major complications, such as tendon rupture.

“This treatment could completely replace other treatments that are affected by several limitations and complications,” Dr. Sconfienza said.

Ultrasound-guided percutaneous (through the skin) therapy represents an effective and inexpensive alternative to surgery that is less stressful for the patient. For the 20-minute procedure, the shoulder is anesthetized and, with ultrasound guidance, a radiologist injects a saline solution into the rotator cuff to wash the area and break up the calcium. A second needle is used to aspirate, or withdraw, the calcium residue. Recovery time is about an hour.

“People with calcific tendonitis should know that with a simple, one-time ultrasound-guided procedure, they could recover completely from the terrible pain constantly affecting their shoulder,” Dr. Sconfienza said.

For the study, Dr. Sconfienza, senior author Giovanni Serafini, M.D., from the radiology unit at Santa Corona Hospital in Pietra Ligure, Italy, and colleagues used ultrasound-guided percutaneous therapy to treat 235 shoulders in 133 women and 86 men (mean age 42) with calcific tendonitis. An additional 68 patients (31 men and 37 women) did not receive treatment and acted as a control group. All of the patients had shoulder pain that was unresponsive to previous medical treatment. Follow-up was conducted after 1 month, 3 months, 1 year, 5 years and 10 years.

The results showed that treated patients exhibited a considerable reduction in pain and significant improvement to mobility of the affected limb after 1 month, 3 months and 1 year compared to non-treated patients. Five and 10 years after the procedure, the condition of non-treated patients had improved to the point that reported outcomes were similar to those of the treated group.

While few institutions currently offer this therapy, Dr. Sconfienza says that, theoretically, the procedure could be performed in any hospital or clinic that has ultrasound equipment with a superficial probe.

“There are millions of people in the world affected by calcific tendonitis,” Dr. Sconfienza said. “This treatment can provide quick and inexpensive relief for all of them.”

“Rotator Cuff Calcific Tendonitis: Short-term and 10-year Outcomes after Two-Needle US-guided Percutaneous Treatment: Nonrandomized Controlled Trial.” Collaborating with Drs. Serafini and Sconfienza were Francesca Lacelli, M.D., Enzo Silvestri, M.D., Alberto Aliprandi, M.D., and Francesco Sardanelli, M.D.

Source:
Linda Brooks

Radiological Society of North America

A specialist new residential service in Birmingham for people with acquired brain injury, run by leading national charity the Brain Injury Rehabilitation Trust (BIRT), has been officially opened by ITV Central News presenter Llewela Bailey. Coinciding with national Brain Injury Awareness Week, the opening of this new facility, at 1101 Bristol Road, Selly Oak, Birmingham, comes at a time when the issues around severe head injury are generating increased media profile.

Built in partnership with the Bournville Village Trust, the new purpose-built facility will provide continuing rehabilitation and residential facility for eight service users with an acquired brain injury, caused typically as a result of a car accident, stroke, assault or disease. The service will help these people to regain skills lost as a result of their injury, recover their independence and reintegrate into the community. The new unit’s excellent facilities include a separate independent living flat where service users can be supported through a gradual programme for discharge for independent living in the community.

Several of the new service users will have previously undergone assessment and rehabilitation with BIRT’s established rehabilitation service at nearby West Heath, which will be providing medical and clinical support to the new facility.

Nick Archer, Service Manager of 1101 Bristol Road, said “Provision of high quality continuing rehabilitation services is scarce in this area. 1101 Bristol Road will be an important resource for those who need additional support over a longer period to achieve their potential for independence. Our specialist new service will complement BIRT’s existing clinical expertise locally and will add to the continuum of rehabilitation BIRT is able to offer across the Birmingham area.”

1. The Brain Injury Rehabilitation Trust (BIRT) is one of Europe’s leading independent providers of brain injury rehabilitation services, ranging from assessment to comprehensive rehabilitation, long-term housing and care, and community-based support. BIRT currently supports over 550 people with acquired brain injury through ten specialist residential units and several community-based housing schemes across the country. For further information, please visit www.birt.

2. BIRT is a division of the national charity, The Disabilities Trust, which provides expert care and support services to people with profound physical impairments, autism and learning disabilities, as well as brain injury. For further information on the work of The Disabilities Trust, please visit www.disabilities-trust.

3. Bournville Village Trust was established in December 1900 by George Cadbury to provide a balanced community of decent homes in attractive surroundings. The Bournville Village in South Birmingham covers one thousand acres and now contains nearly eight thousand dwellings which are managed by the Trust. The Trust has also developed and is managing two new urban villages in inner city Birmingham at Bordesley and Bloomsbury, Nechells. A third is underway at Lightmoor in Telford. The Trust owns and manages housing schemes in Redditch, as well as over 500 properties in Shropshire.

Bournville Village Trust is a registered charity, which puts quality of life for its residents at the heart of its mission for the future.

4. National Brain Injury Awareness Week was held from 12-18 March 2007.

www.disabilities-trust

www.birt

Statement by APTA President R. Scott Ward, PT, PhD

On Tuesday, June 30, the Institute of Medicine (IOM) and the Federal Coordinating Council for Comparative Effectiveness Research released their recommendations on comparative effectiveness research priorities that should be funded by the $1.1 billion made available under the American Recovery and Reinvestment Act (ARRA). I am pleased to report that many of the priorities outlined by IOM and the council include research that will draw conclusions about physical therapy intervention as compared with pharmaceutical and medical management.

The IOM has recommended that comparative effectiveness research evaluate the effectiveness of prevention methods (exercise and balance) vs clinical treatments for falls risk; treatment strategies for low back pain; school based interventions, including physical education, on childhood obesity; long term effectiveness of weight bearing exercise and bisphosphonates on osteoporosis; treatment strategies, including physical therapy, on cervical disc and neck pain; and various quality improvement strategies on rehabilitation services for diverse populations. The council’s report cites the need for studies to “investigate the comparative effectiveness of rehabilitation interventions to restore or maintain functioning or minimize its loss,” including physical therapy interventions.

APTA is carefully reviewing the reports and will provide members in the coming days with a detailed summary of the recommendations. We expect to find that APTA’s priorities , which were outlined to the council in April, have been considered in the council’s report to Congress.

As we stated to the council earlier this year, “Comparative effectiveness research will contribute to a high quality health care delivery system and improve the health of the nation.” It is our hope that the funds provided in ARRA will go toward research that results in optimal care to those patients we serve.

Source
APTA

After analyzing the birth history of over 400,000 schoolchildren, Scottish researchers found that the risk of autism and/or special educational needs (SEN) were 1.16 times greater for babies born at 37 to 39 weeks of gestation, compared to those born at the full 40 weeks. This finding has important implications for the timing of elective Cesarean deliveries.

Children with SEN (special educational needs) may have either:

A learning difficulty, such as dyslexia or autism that requires special educational help.
A physical difficulty, such as poor vision or deafness that requires special educational help.

The researchers, led by Jill Pell, Section of Public Health, University of Glasgow, Glasgow, United Kingdom explained that we already knew that a baby born, say at 24 weeks, has a higher risk of SEN later in life compared to a full term baby (40 weeks of gestation).

However, the risks of SEN later in life for babies born across a whole range of gestation (from 24-40 weeks) had not previously been investigated.

Pell and team’s study showed that compared to babies born at 40 weeks, those born at 37-39 weeks of gestation were 1.16 times as likely to have an SEN. Although the risk of SEN was much higher in preterm than in early term babies, because many more children were born between 37 and 39 weeks (about a third of babies) than before 37 weeks (one in 20 babies), early term births accounted for 5.5% of cases of SEN whereas preterm deliveries accounted for only 3.6% of cases.

The researchers explained that the these results demonstrate that even a baby born at 39 weeks has a higher risk of SEN, compared to babies born a week later. The normal timing for elective deliveries (e.g. cesarean section) is 39 weeks.

“Gestational Age at Delivery and Special Educational Need: Retrospective Cohort Study of 407,503 Schoolchildren.”
MacKay DF, Smith GCS, Dobbie R, Pell JP (2010)
PLoS Med 7(6): e1000289
doi:10.1371/journal.pmed.1000289

Heart transplant recipients’ cardio-respiratory fitness is around 30 to 50 per cent lower than age-matched healthy sedentary individuals. As a result, exercise rehabilitation should be very important to these patients, and a University of Alberta study shows they can improve their overall physical fitness.

Mark Haykowsky, in the Faculty of Rehabilitation Medicine, led the largest randomized exercise intervention trial in heart-transplant patients, which was published in the April edition of American Journal of Transplantation. The study involved 43 participants, half sedentary, and the other half on a 12-week exercise program. He found that exercise improved cardio-respiratory fitness, muscle mass and maximal strength; surprisingly, however, exercise training didn’t improve heart or blood-vessel function. Those exercising improved the size of the muscle mass, but blood vessels were still hardened and the heart’s ability to fill and relax was not improved.

The study’s findings show that people who are classified as “long-term post-transplant” are trainable. The results also served as a springboard for Dwight Kroening, who went on to become the first heart-transplant recipient to complete an Ironman triathlon (2.4 mile swim, 112 mile bike and 26 mile run). And the inspiration goes both ways, as Haykowsky went on to train and complete his first marathon because of Kroening’s own determination.

Source:
Quinn Phillips

University of Alberta

In the light of the recent announcement about the re-introduction of the Cycling Proficiency Test through the ‘Bikeability’ award scheme, leading national charity the Brain Injury Rehabilitation Trust (BIRT) is reminding children and young people about the importance of wearing cycle helmets in its second annual Look After Your Head campaign.

In its campaign launched last month as part of national Brain Injury Awareness Week, BIRT (which is a division of The Disabilities Trust) has teamed up with the Moto in the Community Trust to promote a poster campaign (downloadable from www.birt). This is aimed at highlighting the key message that the wearing of cycle helmets is a crucial factor in reducing the possibilities of a serious head injury. The poster campaign is currently running alongside a competition, in which pupils at selected schools near to BIRT’s rehabilitation services across the country are being invite to produce a design for a poster which will be adopted as the poster for its 2008 campaign. The Moto in the Community Trust, which is the charitable arm of Moto, the UK’s largest provider of motorway service stations, will also be holding a competition involving its own network of over 40 schools situated close to its sites. Creativity International are also supporting the campaign with prizes of ‘Art Attack’ sets.

BIRT’s campaign is again being endorsed by the British Medical Association (BMA), from whom statistics show that an estimated 90,000 road-related and 100,000 off-road-related accidents occur every year in the UK, of which 53% involve children under 16.

Lynn Turley, Service Director for BIRT, says “we are pleased to support the move towards encouraging more children and young people to benefit from taking up cycling. However, at a time when the issue around severe head injury is receiving some significant media attention, with the aftermath of the Richard Hammond case and the recent primetime television drama, this is a timely opportunity to make a contribution to help in the prevention of brain injury by promoting a simple, yet effective message.”

Brian Lotts, Chairman of The Moto in the Community Trust said: “One of the key objectives for The Moto in the Community Trust is to promote road safety in our communities. It’s a fact that you don’t have to be travelling quickly to sustain a serious head injury. That’s why it’s vital that children always wear protective helmets when they’re riding their bikes and why Moto in the Community Trust is delighted to be supporting this campaign.”

The BMA’s Head of Science and Ethics, Dr Vivienne Nathanson, said “The BMA would like to see every cyclist and particularly every child cyclist wearing a good quality helmet. The evidence from countries where compulsory cycle helmet use has already been introduced shows a decrease in cycling-related deaths and head injuries. The BMA is 100% behind the Brain Injury Rehabilitation Trust’s campaign to encourage children to wear cycle helmets.”

– The Look After Your Head competition is being targeted only at selected schools in the vicinity of BIRT’s services nationwide, which include York, Leeds, Liverpool, Birmingham, Milton Keynes, Aylesbury, Cullompton, Ely and Horsham. For further information about the competition, please visit www.birt.

– The Brain Injury Rehabilitation Trust (BIRT) is one of Europe’s leading independent providers of brain injury rehabilitation services, ranging from assessment to comprehensive rehabilitation, long-term housing and care, and community-based support. BIRT currently supports over 550 people with acquired brain injury through ten specialist residential units and several community-based housing schemes across the country.

– BIRT is a division of the national charity, The Disabilities Trust, which provides expert care and support services to people with profound physical impairments, autism and learning disabilities, as well as brain injury. For further information on the work of The Disabilities Trust, please visit www.disabilities-trust.

– For further information about getting involved with the 2008 Look After Your Head campaign, please contact David Eggleston, Marketing & Fundraising Manager for The Disabilities Trust, on 01444 237294 or 07734 972779.

– The Moto in the Community Trust aims to make a difference to the local communities that its Moto sites are part of. Moto operates 48 service areas around the UK, employing around 5,000 staff. For more information, please visit www.motointhecommunity.

– For more information on the new ‘Bikeability’ award scheme, please visit www.bikeability.

www.disabilities-trust

www.birt

An assistive technology that enables individuals to maneuver a powered wheelchair or control a mouse cursor using simple tongue movements can be operated by individuals with high-level spinal cord injuries, according to the results of a recently completed clinical trial.

“This clinical trial has validated that the Tongue Drive system is intuitive and quite simple for individuals with high-level spinal cord injuries to use,” said Maysam Ghovanloo, an assistant professor in the School of Electrical and Computer Engineering at the Georgia Institute of Technology. “Trial participants were able to easily remember and correctly issue tongue commands to play computer games and drive a powered wheelchair around an obstacle course with very little prior training.”

At the annual conference of the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) on June 26, the researchers reported the results of the first five clinical trial subjects to use the Tongue Drive system. The trial was conducted at the Shepherd Center, an Atlanta-based catastrophic care hospital, and funded by the National Science Foundation and the Christopher and Dana Reeve Foundation.

The clinical trial tested the ability of these individuals with tetraplegia, as a result of high-level spinal cord injuries (cervical vertebrae C3-C5), to perform tasks related to computer access and wheelchair navigation — using only their tongue movements.

At the beginning of each trial, Ghovanloo and graduate students Xueliang Huo and Chih-wen Cheng attached a small magnet — the size of a grain of rice — to the participant’s tongue with tissue adhesive. Movement of this magnetic tracer was detected by an array of magnetic field sensors mounted on wireless headphones worn by the subject. The sensor output signals were wirelessly transmitted to a portable computer, which was carried on the wheelchair.

The signals were processed to determine the relative motion of the magnet with respect to the array of sensors in real-time. This information was then used to control the movements of the cursor on a computer screen or to substitute for the joystick function in a powered wheelchair. Details on use of the Tongue Drive for wheeled mobility were published in the June 2009 issue of the journal IEEE Transactions on Biomedical Engineering.

Ghovanloo chose the tongue to operate the system because unlike hands and feet, which are controlled by the brain through the spinal cord, the tongue is directly connected to the brain by a cranial nerve that generally escapes damage in severe spinal cord injuries or neuromuscular diseases.

Before using the Tongue Drive system, the subjects trained the computer to understand how they would like to move their tongues to indicate different commands. A unique set of specific tongue movements was tailored for each individual based on the user’s abilities, oral anatomy and personal preferences. For the first computer test, the user issued commands to move the computer mouse left and right. Using these commands, each subject played a computer game that required moving a paddle horizontally to prevent a ball from hitting the bottom of the screen.

After adding two more commands to their repertoire — up and down — the subjects were asked to move the mouse cursor through an on-screen maze as quickly and accurately as possible.

Then the researchers added two more commands — single and double mouse clicks — to provide the subject with complete mouse functionality. When a randomly selected symbol representing one of the six commands appeared on the computer screen, the subject was instructed to issue that command within a specified time period. Each subject completed 40 trials for each time period.

After the computer sessions, the subjects were ready for the wheelchair driving exercise. Using forward, backward, right, left and stop/neutral tongue commands, the subjects maneuvered a powered wheelchair through an obstacle course.

The obstacle course contained 10 turns and was longer than a professional basketball court. Throughout the course, the users had to perform navigation tasks such as making a U-turn, backing up and fine-tuning the direction of the wheelchair in a limited space. Subjects were asked to navigate through the course as fast as they could, while avoiding collisions.

Each subject operated the powered wheelchair using two different control strategies: discrete mode, which was designed for novice users, and continuous mode for more experienced users. In discrete mode, if the user issued the command to move forward and then wanted to turn right, the user would have to stop the wheelchair before issuing the command to turn right. The stop command was selected automatically when the tongue returned to its resting position, bringing the wheelchair to a standstill.

“Discrete mode is a safety feature particularly for novice users, but it reduces the agility of the wheelchair movement,” explained Ghovanloo. “In continuous mode, however, the user is allowed to steer the powered wheelchair to the left or right as it is moving forward and backward, thus making it possible to follow a curve.”

Each subject completed the course at least twice using each strategy while the researchers recorded the navigation time and number of collisions. Using discrete control, the average speed for the five subjects was 5.2 meters per minute and the average number of collisions was 1.8. Using continuous control, the average speed was 7.7 meters per minute and the average number of collisions was 2.5.

While this initial performance trial only required six tongue commands, the Tongue Drive system can potentially capture a large number of tongue movements, each of which can represent a different user command. The ability to train the system with as many commands as an individual can comfortably remember and having all of the commands available to the user at the same time are significant advantages over the common sip-n-puff device that acts as a simple switch controlled by sucking or blowing through a straw.

Some sip-n-puff users also consider the straw to be a symbol of their disability. Since Tongue Drive users simply wear headphones that are commonly worn to listen to music, the system is more acceptable to potential users.

John Anschutz, manager of the assistive technology program at the Shepherd Center, identified advantages the Tongue Drive system has over the tongue-touch keypad.

“The Tongue Drive system seems to be much more supportable if there were a failure of some component within the system. With the old tongue-touch keypad, if the system went down then the user lost all of the functions of the wheelchair, phone, computer and environmental control,” explained Anschutz. “Ghovanloo’s approach should be much more repairable should a fault arise, which is critical for systems for which so much function is depended upon.”

A future system upgrade will be to move the sensors inside the user’s mouth, according to Ghovanloo. This will be an important step for users who are very impaired and cannot reposition the system for best results, according to Anschutz.

“All of the subjects successfully completed the computer and powered wheelchair navigation tasks with their tongues without difficulty, which demonstrates that the Tongue Drive system can potentially provide individuals unable to move their arms and hands with effective control over a wide variety of devices they use in their daily lives,” said Ghovanloo.

Source:
Abby Vogel

Georgia Institute of Technology Research News

Childhood hardships may be related to future pregnancy outcomes, in part through their association with smoking during pregnancy and adult socioeconomic position, according to a report in the June issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Hardships faced in childhood are often associated with health behaviors later in life, which can include smoking, depression, mood and sleep disturbances, and substance use and abuse, according to background information in the article. “Mounting research evidence suggests a relation between psychosocial stressors during pregnancy and poor pregnancy outcomes, such as low birth weight, intrauterine growth retardation and preterm birth.”

Emily W. Harville, Ph.D., of Tulane University, New Orleans, and colleagues studied 4,865 women who experienced at least one hardship during childhood and had at least one live birth by age 41. “A shared limitation of past studies is that the period of investigation is limited to the pregnancy itself,” the authors write. “Hypothetically, psychosocial and material hardships in childhood and adolescence may ultimately influence pregnancy outcome.”

Most of the women in the study had their first child in their 20s and most had one, two or three children in their lifetime. Also, about half were current or former smokers. Childhood hardships ranged from family problems with alcohol (1 percent) to fathers not taking an interest in child’s schooling (almost 30 percent), with financial problems and minor neglect, particularly from the father, as the most common.

Of the women included in the study, in their first pregnancy, 7.9 percent (385 women) gave birth to a low birth weight baby, and 7.5 (349 women) percent gave birth more than three weeks early. Overall, 5.8 percent of pregnancies resulted in a low birth weight baby, and 6.5 percent resulted in pre-term birth. Additionally, 39 percent of women had smoked at some point during their first pregnancy.

“When results were examined by timing of exposure, family structure hardships and violence/mental health hardships most strongly influenced the birth outcomes if they happened in adolescence,” the authors note. “Overall, the highest risk for both low birth weight and pre-term birth was in those who had multiple hardships in adolescence only, but this was also a very small group.”

“Our findings suggest that mothers who have experienced childhood hardship are more likely to smoke during pregnancy,” the authors write. “They also more often give birth to low birth weight babies who are born prematurely, but this association may be primarily due to health behaviors and associated social class.” The authors also conclude that the findings suggest that, “there are critical periods for elevated risk, as well as a cumulative effect of hardships over time. Further research is needed to specify pathways between childhood adversities and reproductive health outcomes and to evaluate protective factors that could help to alleviate long-term influences of early adversity.”

Archives of Pediatrics & Adolescent Medicine. 2010;164[6]:533-539.

Source
Archives of Pediatrics & Adolescent Medicine

New evidence-based guidelines from the American College of Chest Physicians (ACCP) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommend a comprehensive pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD), citing that pulmonary rehabilitation can help improve a patient’s exercise tolerance, dyspnea, and health-related quality of life, as well as decrease hospital stay and health-care utilization. Guidelines also state that pulmonary rehabilitation can be beneficial for patients with other non-COPD-related respiratory diseases, including asthma, lung cancer, and pulmonary fibrosis. The guidelines are published in the May issue of CHEST, the peer-reviewed journal of ACCP.

“COPD partially blocks the airways, making it difficult to breathe and participate in simple, everyday activities,” said Andrew Ries, MD, MPH, FCCP, chair of the pulmonary rehabilitation guidelines committee. “The primary goal of pulmonary rehabilitation is to restore the patient to the highest possible level of independent function. We want patients to become more physically active and to learn more about their disease, treatment options, and how to cope.” Pulmonary rehabilitation can include exercise training, education, instruction in various respiratory techniques, and psychosocial support. Research shows that pulmonary rehabilitation is appropriate for any stable patient with COPD who is disabled by respiratory symptoms.

INTERVENTIONS

The new guidelines, developed by an expert panel from the ACCP and AACVPR, contain recommendations about specific interventions needed for pulmonary rehabilitation, duration of rehabilitation, and benefits of rehabilitation for patients with COPD and those with other chronic respiratory diseases. The guidelines consider exercise training a mandatory aspect of comprehensive rehabilitation, stating that both low- and high-intensity exercise training produce clinical benefits for patients with COPD. Furthermore, the guidelines stress that strength and endurance training, lower and upper extremity exercise training, as well as education about self-management of the disease are integral aspects of a comprehensive pulmonary rehabilitation program.

DURATION

Regarding duration, guidelines state that 6 to 12 weeks of pulmonary rehabilitation will produce benefits in several outcomes, but these benefits will decline gradually over 12 to 18 months. Longer pulmonary rehabilitation programs (beyond 12 weeks) may produce greater benefits than shorter programs.

PATIENT BENEFITS

Pulmonary rehabilitation can result in significant physical and psychosocial benefits for patients with COPD. A comprehensive rehabilitation program can improve symptoms of dyspnea, improve health-related quality of life, and decrease hospital stay and health-care utilization. Patients may also experience improved cognitive function and reduced symptoms of anxiety and depression. Guidelines also state that pulmonary rehabilitation can benefit patients with non-COPD-related chronic respiratory diseases; however, experts suggest that pulmonary rehabilitation programs be modified to include treatment strategies specific to individual diseases and patients.

“With the increasing incidence of COPD, pulmonary rehabilitation is more important than ever before,” said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. “Although no intervention has been shown to cure COPD, pulmonary rehabilitation can help patients manage their condition and improve their ability to lead active and productive lives.”

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For a complete listing of the ACCP/AACPR pulmonary rehabilitation guidelines, visit the ACCP Web site at chestnet/.

ABOUT COPD

COPD is the fourth leading cause of death in the United States and is primarily a result of smoking. More than 12 million people are diagnosed with the disease and an additional 12 million are likely to have the disease, but are undiagnosed. Worldwide, the burden of the COPD is projected to increase substantially, paralleling the rise in tobacco use, particularly in developing countries.

CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at chestnet/. The journal’s Web site also provides public access to thousands of archived studies, dating back to 1946 – a newly added feature that is free of charge. The ACCP represents 16,600 members who provide clinical respiratory care, sleep medicine, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP’s mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at chestnet/.

Contact: Jennifer Stawarz

American College of Chest Physicians