Bakgrund Vården rör sig mot en mer patientcentrerad syn. Detta reflekteras i den fysioterapeutiska behandlingen där man kan se holistiska modaliteter göra ett inträde. En metod utanför skolmedicinens ramar som samlat uppmärksamhet det senaste decenniet är Wim Hof-Metoden. Den bygger på köldterapi, andningsövning och meditation. För var av dessa delar finns stöd, och lovande forskning har utförts på metoden i sig. Dock så är stödet fortfarande begränsat. Syfte Undersöka om utövandet av Wim Hof-metoden under tre veckor ger effekter på livskvalitet och självskattad hälsa. Metod Deltagare rekryterades via mail och annonser på social media. 8 individer utav 14 intresserade (57%) avlade medgivande och påbörjade intervention. Under tre veckor utförde de dagligen Wim Hof-Metoden. En mätning av livskvalitet med formuläret RAND-36 gjordes vid baseline och efter intervention. Så även med en generell hälsoskattning ur formuläret EQ-5L. Resultat Av 8 deltagare genomförde 5 (62,5%) studien. Således skedde ett bortfall på 3 individer (37,5 %). Efter intervention kunde man se parametriska tendenser till en ökad livskvalitet enligt RAND-36, där sammanlagt medelvärde för domänerna vitalitet, psykiskt välbefinnande och allmän hälsa ökade från 61,6 till 71,0 poäng. För generell hälsa enligt barometern från EQ-5L ökade medelvärdet från 75,4 till 85,6 enheter. Diskussion Resultatet indikerar tendenser till ökad livskvalitet och generell hälsa. Dock var antalet deltagare för lågt för statistisk analys, och gruppens förväntningar höga - vilket sänker datans tillförlitlighet. Forskning av större omfattning och med högre kvalitet behövs för att dra slutsatser kring metodens verkan.

Title: Effect of mobility exercises in offline and online environment on subjective perception of back pain Objectives: The main goal of this work was to determine whether the onset of daily mobility contributes to the reduction of individual's back pain perception. Within the work the results between the offline and online group was compared. Methods: The diploma thesis has the character of qualitative research, where case study of 20 probands was applied. Online input and output questionnaires were compiled to obtain data, which respondents filled in at the beginning and end of the intervention. Results: The research included 11 women and 9 men aged 21 - 44 years. Individuals have mostly sedentary jobs and some of them play recreational sports in their free time. At the end of the intervention, all individuals showed an improvement on the scale of the pain intensity, when the perceived back pain was alleviated or disappeared. The offline group performed better than the online group. Conclusion: The study confirmed that the inclusion of daily mobility contributes to the reduction of subjectively perceived back pain. It confirmed that exercising in offline lessons is more effective than in an online environment. Keywords: mobility, back pain, diaphragmatic breathing, torso stabilization, DNS

The present study trained three adult male stutterers to increase speech fluency using relaxed breathing and a-x; biofeedback. A one group time-series design with 2 treatments was used. After an initial baseline phase (A) all 3 subjects received a relaxed breathing procedure (B), followed by a combined procedure featuring relaxed breathing and EMG biofeedback (BC). Results indicated that after 8 sessions stuttering was reduced by 19.1% from baseline levels across the 3 subjects. Despite these promising results , however, methodological questions in the baseline phase make conclusions regarding a clear relationship between the variables tentative.

This thesis focuses on recorder playing as prevention of respiratory diseases and its significant impact on proper diaphragmatic breathing. The main goal is to monitor the effect of the active exercise on child players' health and analyzing the aspects of the recorder playing. The theoretical part describes the recorder's history and evolution as well as its therapeutic use, wind instrument in relation to musicotherapy and well-established breathing methods. This work also presents suitable literature related to the recorder, significant personalities connected with the recorder playing and healthy breathing methods propagators. The practical part introduces the implementation of pedagogical research that specializes in observation of skills and abilities of preschool and middle school kids improved by the recorder playing. It also shows the results of an experiment that monitored the effect of breathing exercises on breathing parameters progress within an authentic environment of elementary school music lessons.

INTRODUCTION: Research has consistently shown that sleep apnea is strongly associated with atrial fibrillation, with several lines of evidence demonstrating that this relationship is bidirectional and that each condition predisposes to and/or exacerbates the other. Many studies have suggested potential pathophysiologic mechanisms underlying this relationship, and that sleep apnea and atrial fibrillation share many of the same cardiovascular risk factors further implies that multiple pathways are likely involved in the mechanistic link between the two. Although the sleep apnea-atrial fibrillation relationship is quite established, numerous aspects of this association still require further study, such as the role of gender and the potential impact of positive airway pressure therapy. A deeper understanding of how these individual factors may be involved in the interrelationship between sleep apnea and atrial fibrillation has important clinical implications, such as for risk stratification and screening of patients. Thus, this study aims to further understand the different aspects and modulating factors of the sleep apnea-atrial fibrillation link, focusing on central sleep apnea as less is known about the central sleep apnea-atrial fibrillation relationship. METHODS: A total of 153 patients, originally seen at the cardiac electrophysiology clinic at Beth Israel Deaconess Medical Center and subsequently offered home sleep apnea testing, were included in this study. Several databases – home sleep apnea testing results, polysomnography reports, electrocardiogram reports and patient management systems – were used to obtain a variety of data on sleep pathology, high loop gain status, left ventricular ejection fraction and positive airway pressure therapy efficacy and compliance. Patients were considered to have central sleep apnea if home testing results demonstrated a central apnea-hypopnea index of 5 or greater and/or if the patient was documented as having high loop gain on polysomnography. Data were analyzed using the Statistical Package for Social Sciences software in order to examine how factors such as gender and therapy use may affect the sleep apnea-atrial fibrillation relationship, in a patient population with sleep pathology of at least moderate severity. RESULTS: Statistical analysis revealed significant sleep disturbances in the central sleep apnea patients compared to the non-central sleep apnea patients. Gender was found to be significantly associated with central sleep apnea, but not obstructive sleep apnea. When postmenopausal (age≥51) women were analyzed, very few patients met the study criteria for central sleep apnea, yet the majority were documented as having atrial fibrillation. As expected, positive airway pressure therapy was found to be beneficial for all users, but the common pattern of declining compliance to therapy was seen as adherence decreased over the course of three months. Of the select central sleep apnea patients who had sufficient data available, comparison of positive airway pressure therapy and cardiac data revealed possible benefits to cardiac health with compliant use of positive airway pressure therapy. CONCLUSION: Through examining different aspects of the sleep apnea-atrial fibrillation relationship, this study found promising evidence showing that gender and positive airway pressure therapy play important roles. Further studies, with larger sample sizes, need to be conducted in order to fully understand the specific impact of factors such as gender, gender and age and positive airway pressure therapy on the risks and outcomes in patients with sleep apnea and/or atrial fibrillation, and how these factors may change depending on the type of sleep apnea. Finally, these results further highlight the growing need for an effective collaborative care model between cardiologists and sleep medicine clinicians, as the management of patients with sleep apnea and atrial fibrillation requires an interdisciplinary approach in order to deliver the most optimal patient care.

Smartphone capnography is a new concept for respiratory monitoring using a colorimetric sensor in combination with a smartphone and an Android application. Compared to using an infrared spectrophotometric carbon dioxide analyzer (IR-analyzer), the gold standard for respiratory carbon dioxide monitoring, smartphone capnography offers a cheaper and less bulky solution. This master thesis evaluates the performance of smartphone capnography and the colorimetric sensor engineered for this concept. Three different techniques (side stream, shunt stream and main stream) were tested. Additionally, an iPhone application was developed as a proof of concept when using an iPhone for smartphone capnography.   An experimental set-up simulating human breathing was assembled and measurements, at different breathing rates (6-30 breaths/min) and carbon dioxide levels (2-7vol%), were performed with an IR-analyzer as reference. Results showed that capnograms from smartphone capnography was comparable to those from the IR-analyzer and that the approximate accuracy was ±0.25vol% for up to 6 days of use. Results strongly motivate further elaboration of the concept and the three different techniques for measuring. / ”Smartphone capnography” är ett nytt koncept för att monitorera andning. Principen är en kombination av en kolorimetrisk sensor, en smartphone samt en Androidapplikation. Jämfört med den dominerande tekniken, en IR-spektrofotometrisk koldioxidanalysator (IR-analysator), så är “smartphone capnography” både billigare och mindre skrymmande. Detta examensarbete utvärderar konceptet ”smartphone capnography” och en kolorimetrisk sensor speciellt utvecklad för ändamålet. Tre olika tekniker (side stream, shunt stream och main stream) har utvärderats. Slutligen utvecklades en iPhoneapplikation för att visa att konceptet ”smartphone capnography” kan användas även med denna typ av smartphone.   Utvärderingen bestod i att göra mätningar i en experimentell uppställning som simulerar andning. Mätningar gjordes vid varierande andningsfrekvenser (6-30 andetag/min) och koldioxidnivåer (2-7vol%). Mätdata från ”smartphone capnography” jämfördes med mätdata från en IR-analysator. Resultaten visar att kapnogram från ”Smartphone capnography” är jämförbara med kapnogram från IR-analysatorn och att den uppskattade noggrannheten är ±0,25vol% för upp till 6 dagars användning. De goda resultaten motiverar fortsatt utveckling av konceptet smartphone capnography samt de olika mätteknikerna.

The 'exponential peeling' technique has been applied to minute ventilation and tidal volume transients occurring after the abrupt removal of 7,6 and 5% CO2 in inspired air. These transients, in many cases, were found to be composed of three exponential components, each contributing to the total ventilatory response and each having individual time responses. Gelfand and Lambertsen (1973) have attributed these components to the peripheral chemoreceptors as a group and to two central chemoreceptors. Statistical analysis to determine the constancy of the contribution of the three components over the the range of CO2 values studied showed that, although the values for each at the different stimulus levels were not significantly different, the great subject-to-subject variation in the data precluded a firm conclusion about the constancy of the components. Because of a number of considerations it was concluded that exponential peeling of respiratory transients following abrupt removal of CO2 inhalation is not a satisfactory way to approach the problem of the numbers, relative contributions and time responses of the various receptor groups comprising the respiratory controller.

Respiratory-swallow coordination (RSC) is critical for safe and efficient swallowing. In healthy adults, RSC is most frequently characterized by an exhale-swallow-exhale pattern initiated within the mid-lung volume range with a respiratory pause of approximately one second. This combination in RSC behaviors is thought to be most optimal for swallowing-related bolus clearance and airway protection. Deviations from these RSC behaviors are observed at disproportionately higher rates in people with Parkinson’s disease (PD) when compared to non-dysphagic, healthy adults. However, little is known about which variables influence RSC in PD, if the RSC behaviors that are most optimal for swallowing in healthy adults are also most optimal for swallowing in PD, and if respiratory-swallow training can be used to successfully rehabilitate suboptimal RSC, swallowing safety, and swallowing efficiency in PD. This dissertation document includes a series of four studies that address these important clinical research questions. Chapter 1 will begin by reviewing the current body of literature as it relates to dysphagia in PD, RSC in healthy adults and PD, respiratory-swallow training as a skill-based treatment for dysphagia rehabilitation, and motor learning considerations for respiratory-swallow skill training in PD. Chapter 2 will be used to examine the relationships among RSC with patient- and swallowing-specific factors in PD. Chapter 2 will also be used to assess the influence of RSC behaviors on measures of swallowing safety (penetration-aspiration) and swallowing efficiency (pharyngeal residue) in PD. Chapter 3 will then evaluate the effects of verbal cueing on RSC in PD as a method of determining if RSC is stimulable for rehabilitative change. Chapter 4 will explore the effects of respiratory-swallow training on swallowing safety and efficiency rehabilitation in a person with mid-stage PD and severe dysphagia within the context of a single-subject experimental design. Chapter 5 will then examine the effects of respiratory-swallow training on dysphagia and RSC rehabilitation within the context of a cohort study. Chapter 5 will also be used to compare the effects of constant versus variable practice in order to explore how principles of motor learning can be used to enhance respiratory-swallow training outcomes. This document will then conclude by synthesizing the results from Chapters 2-5 and by discussing directions for future research.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18450号 / 医博第3905号 / 新制||医||1004(附属図書館) / 31328 / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 稲垣 暢也, 教授 森田 智視 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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