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Editorials |

Disorders of Ventilation : Weakness, Stiffness, and Mobilization

John R. Bach, MD, FCCP; Seong-Woong Kang, MD, PhD
Author and Funding Information

Affiliations: Newark, NJ 
 ,  Dr. Bach is Professor of Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation, and Professor of Neurosciences, Department of Neurosciences, UMDNJ-The New Jersey Medical School. Dr. Kang is from the Department of Physical Medicine and Rehabilitation, UMDNJ-The New Jersey Medical School and Yonsei University College of Medicine, Seoul, South Korea.

Correspondence to: John R. Bach, MD, FCCP, Professor and Vice Chairman, Department of Physical Medicine and Rehabilitation, University Hospital B-403, 150 Bergen St, Newark, NJ 07103; e-mail: bachjr@umdnj.edu



Chest. 2000;117(2):301-303. doi:10.1378/chest.117.2.301
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Extract

The article by Misuri et al, “Mechanism of CO2 Retention in Patients With Neuromuscular Disease,” in this issue of CHEST (see page 447) points out something concerning the lungs of patients with neuromuscular disorders that has long been recognized concerning their limbs: the loss of function results from a combination of weakness and increases in soft tissue elastance. The latter is caused by the failure to fully mobilize the soft tissues and joints because of muscle weakness.1 Muscle strength also diminishes as soft tissues adaptively shorten over time. As muscle loses its normal flexibility and weaker muscles are stretched by their stronger antagonists, changes in their length-tension relationships result in decreased peak tensions, strength, and endurance.23 When a foreshortened position of a muscle is maintained for > 5 to 7 days, the loose connective tissue in the muscle belly shortens and then gradually changes into dense connective tissue.1 These tissues lose their normal elasticity and plasticity, resulting in the loss of range of motion (ROM) and joint contractures.2 A joint is contracted when it lacks full passive ROM. The muscle and other soft tissue limitations that result in joint contractures can also cause bony deformities, particularly in young, growing patients.1


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