Brainstem stroke is characterized by central apnea with a decreased level of consciousness that often necessitates intervention by mechanical ventilation (MV). We report a unique case of a patient who was weaned off MV after 7 years. [Subjects] A male who required MV presented with apnea and decreased level of consciousness after sustaining damage to his brainstem 7 years previously. Several attempts to wean him off MV were unsuccessful. [Methods] We focused on evaluation of physical action, consciousness, respiratory rhythm, and respiratory fatigue. We carried out physiotherapy practice that focused on gait training to extend the time the patient spent in a seated position. [Results] The patient was successfully weaned off MV after 37 days of therapy. He was discharged from hospital 59 days after the initiation of therapy. [Conclusion] We believe that the results of this study will improve physiotherapy practice in the management of patients.
[Purpose] Oxygenated hemoglobin (oxy-Hb) concentrations in the prefrontal cortex are
closely associated with dyspnea. Dyspnea is influenced not only by physical activity, but
also by visual stimuli, and several studies suggest that oxy-Hb concentrations change in
response to certain external stimuli. However, the effects of internal psychological
states on dyspnea have not been reported. This study explored the influence of
anticipation triggered by previous episodes of dyspnea on brain activity. [Subjects] The
subjects were 15 healthy volunteers with a mean age of 25.0 ± 3.0 years. [Methods] The
subjects were shown a variety of photographs and instructed to expect breathing resistance
matched to the affective nature of the particular photograph. After viewing the images,
varying intensities of breathing resistance that were identical to, easier than, or harder
than those shown in the images were randomly administered to the subjects; in fact, the
image and resistance were identical 33% of the time and discordant 66% of the time.
[Results] The concentrations of oxy-Hb in the right medial prefrontal cortex (rMPFC)
increased significantly with an inspiratory pressure that was 30% of the maximum intensity
in the subjects shown a pleasant image compared to the concentrations in subjects shown an
unpleasant image. Moreover, rMPFC activity was significantly correlated with the magnitude
of the dyspnea experienced. [Conclusion] These results suggest that a correlation exists
between increased oxy-Hb in the rMPFC and the effects of expectations on dyspnea.
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