Introduction: While some reports have described the use of incentive spirometry (IS) beginning a few days prior to cardiac surgery, there is a lack of studies investigating its implementation from an earlier preoperative period. Furthermore, the relationship between the duration of preoperative IS use and the incidence of postoperative pulmonary complications (PPCs) remains unclear. Therefore, this study aimed to clarify the impact of different durations of preoperative IS use on postoperative outcomes, particularly the incidence of PPCs. Methods: A total of 91 patients who underwent elective cardiac surgery at our institution were included. Preoperative IS instruction was provided, and the duration from the initiation of IS to the day of surgery was recorded. Patients were divided into two groups: the short-term IS group (≤14 days, n=17) and the long-term IS group (≥15 days, n=74). Postoperative outcomes and the incidence of PPCs were compared between the two groups. Results: Compared to the short-term IS group (n=17), the long-term IS group (n=74) had a significantly lower incidence of postoperative pulmonary complications (47.0% vs. 17.5%, p<0.05), and fewer days to achieve sitting (3 vs. 2 days), standing (4 vs. 4 days), and walking (6 vs. 4 days) (p<0.05). Additionally, the long-term group showed significantly better outcomes at discharge in terms of physical function (SPPB: 9 vs. 12), functional status (FSS-ICU: 33 vs. 35, p<0.01), and discharge disposition (transfer to another hospital: 35.2% vs. 9.4%, p<0.05). Conclusion: Initiating IS instruction more than two weeks prior to cardiac surgery may reduce the incidence of postoperative pulmonary complications and contribute to earlier mobilization and better postoperative physical function.

Objective：It is often difficult to provide effective functional training in patients with severe attention deficit caused by organic damage to the brain. Herein, we report a case of attention deficit in a patient with subarachnoid hemorrhage, which was successfully treated by virtual reality (VR)-guided rehabilitation.Methods：A 71-year-old woman was transferred to our hospital for rehabilitation after a subarachnoid hemorrhage. The patient suffered from severe attention deficit. She was unable to follow instructions from therapists and was unable to concentrate on rehabilitation tasks. We attempted VR-guided rehabilitation using mediVR KAGURA (mediVR, Toyonaka, Japan) in order to improve her attention deficit. The training was performed approximately 20 min every weekday, for 4 months in a 360-degree VR environment, with no background image initially. The difficulties in physical and cognitive tasks were adjusted by focusing on the size, range of appearance, and falling speed of each task object, so that even patients with severe attention deficit could respond to these tasks appropriately.Results：After the above-mentioned VR-guided training, the trail making test A, behavioral inattention test, and moss attention rating scale were improved from 300 s (could not complete the test）to 100 s, 119 to 133, and 55 to 98, respectively. In addition, in the clinical assessment for attention, the time required for visual obliteration tests was significantly shortened, and clinical symptoms associated with attention deficit were also improved clinically.Conclusion：VR-guided rehabilitation has the potential to be used as a new therapeutic approach to improve attention deficit.

Objective：It is often difficult to provide effective functional training in patients with severe attention deficit caused by organic damage to the brain. Herein, we report a case of attention deficit in a patient with subarachnoid hemorrhage, which was successfully treated by virtual reality (VR)-guided rehabilitation.Methods：A 71-year-old woman was transferred to our hospital for rehabilitation after a subarachnoid hemorrhage. The patient suffered from severe attention deficit. She was unable to follow instructions from therapists and was unable to concentrate on rehabilitation tasks. We attempted VR-guided rehabilitation using mediVR KAGURA (mediVR, Toyonaka, Japan) in order to improve her attention deficit. The training was performed approximately 20 min every weekday, for 4 months in a 360-degree VR environment, with no background image initially. The difficulties in physical and cognitive tasks were adjusted by focusing on the size, range of appearance, and falling speed of each task object, so that even patients with severe attention deficit could respond to these tasks appropriately.Results：After the above-mentioned VR-guided training, the trail making test A, behavioral inattention test, and moss attention rating scale were improved from 300 s (could not complete the test) to 100 s, 119 to 133, and 55 to 98, respectively. In addition, in the clinical assessment for attention, the time required for visual obliteration tests was significantly shortened, and clinical symptoms associated with attention deficit were also improved clinically.Conclusion：VR-guided rehabilitation has the potential to be used as a new therapeutic approach to improve attention deficit.