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Ramli MI, Hamzaid NA, Engkasan JP, Usman J, Salleh M, Hueh WD. Accessory respiratory muscles performance among people with spinal cord injury while singing songs with different musical parameters. PLoS One 2024; 19:e0305940. [PMID: 38968230 PMCID: PMC11226013 DOI: 10.1371/journal.pone.0305940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/08/2024] [Indexed: 07/07/2024] Open
Abstract
People with spinal cord injury (SCI) experience respiratory dysfunctions which include hypersecretions, bronchospasm, and respiratory muscles weakness. Singing therapy has been implemented as part of respiratory muscle training (RMT) to improve their muscle strength. Singing different types and genres of songs may elicit specific recruitment of respiratory muscles, attributed to the variation of the songs' characteristics including tempo, pitch, and rhythmic complexity. This study aims to determine the effect of singing songs with different characteristics on the accessory respiratory muscle performance among people with SCI. Thirteen male SCI participants of ASIA A and B (C4 -T11) were recruited. Respiratory muscle signals were retrieved by placing two mechanomyography (MMG) sensors on the sternocleidomastoid (SCM) and rectus abdominis (RA) muscles. Eight music experts categorized several songs into four categories based on their pitch, tempo, and rhythmic complexity. Each participant sang one song from each category. Findings showed statistically significant difference in RA and SCM responses among all categories (P < 0.01). The SCM muscle is most active while singing high pitch songs. While the RA is most active during slow tempo and easy rhythmic complexity. This shows that different accessory respiratory muscle is activated by people with SCI while singing songs with different characteristics. Clinicians could benefit from this knowledge while prescribing singing therapy or exercise among people with SCI in the future.
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Affiliation(s)
- Muhammad Imran Ramli
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Julia Patrick Engkasan
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Juliana Usman
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Marzelan Salleh
- Department of Music, Faculty of Creative Arts, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wee Duen Hueh
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
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Tsai CS, Li HT, Yang WL, Jhan YT. The effect of craniocervical flexion and neck endurance exercises plus pulmonary rehabilitation on pulmonary function in spinal cord injury: a pilot single-blinded randomised controlled trial. Spinal Cord Ser Cases 2024; 10:27. [PMID: 38654004 DOI: 10.1038/s41394-024-00637-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
STUDY DESIGN Randomised controlled trial with computerised allocation, assessor blinding and intention-to-treat analysis. OBJECTIVE This study wanted to prove that cervicocranial flexion exercise (CCFE) and superficial neck flexor endurance training combined with common pulmonary rehabilitation is feasible for improving spinal cord injury people's pulmonary function. SETTING Taoyuan General Hospital, Ministry of Health and Welfare: Department of Physiotherapy, Taiwan. METHOD Thirteen individuals who had sustained spinal cord injury for less than a year were recruited and randomised assigned into two groups. The experimental group was assigned CCFEs and neck flexor endurance training plus normal cardiopulmonary rehabilitation. The control group was assigned general neck stretching exercises plus cardiopulmonary rehabilitation. Lung function parameters such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), inspiratory capacity (IC), dyspnoea, pain, and neck stiffness were recorded once a week as short-term outcome measure. RESULT The experimental group showed significant time effects for FVC (pre-therapy: 80.4 ± 21.4, post-therapy: 86.9 ± 16.9, p = 0.021, 95% CI: 0.00-0.26) and PEFR (pre-therapy: 67.0 ± 33.4; post-therapy: 78.4 ± 26.9, p = 0.042, 95% CI: 0.00-0.22) after the therapy course. Furthermore, the experimental group showed significant time effects for BDI (experimental group: 6.3 ± 3.0; control group: 10.8 ± 1.6, p = 0.012, 95% CI: 0.00-0.21). CONCLUSION The exercise regime for the experimental group could efficiently increase lung function due to the following three reasons: first, respiratory accessory muscle endurance increases through training. Second, posture becomes less kyphosis resulting increasing lung volume. Third, the ratio between superficial and deep neck flexor is more synchronised. IRB TRIAL REGISTRATION TYGH108045. CLINICAL TRIAL REGISTRATION NCT04500223.
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Affiliation(s)
- Cheng Shin Tsai
- Department of Physiotherapy, TaoYuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
| | - Hsin-Tzu Li
- Department of Physiotherapy, TaoYuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wan-Li Yang
- Department of Physiotherapy, TaoYuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yi-Ting Jhan
- Department of Physiotherapy, TaoYuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
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Palladino L, Ruotolo I, Berardi A, Carlizza A, Galeoto G. Efficacy of aquatic therapy in people with spinal cord injury: a systematic review and meta-analysis. Spinal Cord 2023; 61:317-322. [PMID: 36966260 DOI: 10.1038/s41393-023-00892-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 02/28/2023] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. Spinal cord injury (SCI) is a pathological condition that provokes the loss of one or more body functions due to an injury to the spinal cord as a result of trauma or disease. Hydrotherapy plays a key role in the rehabilitation of neurological patients due to the properties of water environments. OBJECTIVES The goal of this study was to evaluate the efficacy of hydrotherapy in patients who suffer from SCIs. METHODS We searched 5 different databases: CINAHL, PubMed, Scopus, Web of Science, and PEDro for studies to include. Only randomized controlled trials (RCTs) published in English were considered. To evaluate the risk of bias, Jadad and PEDro scales were used. RESULTS Eleven Randomized Controlled Trials were included, and 3 articles remained to be analyzed. According to the evaluation through Cochrane Risk of Bias tool, one study had a high level of quality. The remaining 2 studies achieved a score indicative of a low level of quality. A total of 71 individuals with SCI were included in the studies; age and level of injury varied in each study. The outcome measures used in the studies were: Functional Independence Measure (FIM), Ashworth scale, CardioTouch 3000 s in sitting position and Quark CPET. CONCLUSION The aquatic environment provides a rehabilitation tool able to facilitate movement, physical and cardiovascular exercise, resistance training, and body relaxation.
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Affiliation(s)
| | - Ilaria Ruotolo
- MS Center, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University, Rome, Italy.
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Ramli MI, Hamzaid NA, Engkasan JP, Usman J. Respiratory muscle training: a bibliometric analysis of 60 years' multidisciplinary journey. Biomed Eng Online 2023; 22:50. [PMID: 37217941 DOI: 10.1186/s12938-023-01103-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Over the decades, many publications have established respiratory muscle training (RMT) as an effective way in improving respiratory dysfunction in multiple populations. The aim of the paper is to determine the trend of research and multidisciplinary collaboration in publications related to RMT over the last 6 decades. The authors also sought to chart the advancement of RMT among people with spinal cord injury (SCI) over the last 60 years. METHODS Bibliometric analysis was made, including the publications' profiles, citation analysis and research trends of the relevant literature over the last 60 years. Publications from all time frames were retrieved from Scopus database. A subgroup analysis of publications pertinent to people with SCI was also made. RESULTS Research on RMT has been steadily increasing over the last 6 decades and across geographical locations. While medicine continues to dominate the research on RMT, this topic also continues to attract researchers and publications from other areas such as engineering, computer science and social science over the last 10 years. Research collaboration between authors in different backgrounds was observed since 2006. Source titles from non-medical backgrounds have also published articles pertinent to RMT. Among people with SCI, researchers utilised a wide range of technology from simple spirometers to electromyography in both intervention and outcome measures. With various types of interventions implemented, RMT generally improves pulmonary function and respiratory muscle strength among people with SCI. CONCLUSIONS While research on RMT has been steadily increasing over the last 6 decades, more collaborations are encouraged in the future to produce more impactful and beneficial research on people who suffer from respiratory disorders.
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Affiliation(s)
- Muhammad Imran Ramli
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
- Biomechatronics and Neuroprosthetics Laboratory, Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
- Biomechatronics and Neuroprosthetics Laboratory, Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Julia Patrick Engkasan
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Juliana Usman
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
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Kang D, Park J, Eun SD. A preliminary study on the feasibility of community game-based respiratory muscle training for individuals with high cervical spinal cord injury levels: a novel approach. BMC Sports Sci Med Rehabil 2022; 14:137. [PMID: 35869532 PMCID: PMC9306039 DOI: 10.1186/s13102-022-00534-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background Respiratory disorders result in rehospitalization and premature death of patients with cervical spinal cord injuries (CSCI). Community game-based respiratory muscle training (RMT) programs could reduce secondary complications. Methods We examined the feasibility and preliminary efficacy of RMT as a community-based exercise program. Among the 10 included participants (eight male and two female), four, one, one, and four reported C3, C4, C5, and C6 complete injuries, respectively (eight graded by American Spinal Injury Association impairment scale [ASIA] A and two by ASIA B). Their mean age was 43 ± 12.3 y. The time since injury was 10 ± 6.7 y. The participants completed an RMT program for 60 min/day, twice weekly, for 8 weeks. The participants were trained in the use of a newly developed game-based RMT device. The device provides consistent pressure for respiratory muscle strength and endurance training. Seven RMT devices were modified to allow 10 game-based RMT programs. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), vital capacity (VC), inspiratory capacity (IC), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and peak cough flow (PCF) were measured. Results There were improvements after RMT compared to pre-RMT in FVC (p = 0.027, 10.62%, 0.22 effect size [ES]), PEF (p = 0.006, 23.21%, 0.45 ES), VC (p = 0.002, 35.52%, 0.60 ES), IC (p = 0.001, 46.94%, 0.81 ES), IRV (p = 0.001, 90.53%, 1.22 ES), MIP (p = 0.002, 97.25%, 1.32 ES), MEP (p = 0.005, 141.12%, 1.07 ES), and PCF (p = 0.001, 35.60%, 0.74 ES). The participants reported a positive impact of the program. Conclusions Community game-based RMT for individuals with CSCI appears to be safe and feasible. Community exercise with RMT use may have a positive impact on the respiratory measures for patients with CSCI who are vulnerable to respiratory compromise. Trial registration KCT0005980.
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KANG D, PARK J, EUN SD. Practical mobile game-based respiratory muscle training program for patients with cervical spinal cord injury during the COVID-19 pandemic. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.21.04687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Woods A, Gustafson O, Williams M, Stiger R. The effects of inspiratory muscle training on inspiratory muscle strength, lung function and quality of life in adults with spinal cord injuries: a systematic review and Meta-analysis. Disabil Rehabil 2022:1-12. [PMID: 35931101 DOI: 10.1080/09638288.2022.2107085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the effectiveness of inspiratory muscle training (IMT) on respiratory muscle strength, lung function and quality of life (QOL) in adults with spinal cord injuries (SCI). METHODS Databases were searched up to June 2022; CENTRAL, CINAHL, MEDLINE, PEDRo, and PubMed. Following PRISMA reporting guidelines, two independent reviewers selected studies and extracted data. Study quality and levels of evidence were assessed. RESULTS Following selection from 624 initial search results, six randomised controlled trials were identified, comprising 124 participants. Quality of Evidence was very low to moderate. Meta-analysis showed that post intervention, IMT significantly improved maximal inspiratory pressure (MD 15.72 cmH2O, 95% CI 5.02, 26.41, p = 0.004) when compared with a control intervention. There was no significant benefit for physical QOL (SMD 0.12, 95% CI -1.01, 1.25, p = 0.84), mental QOL (SMD -0.2, 95% CI -1.72, 1.33, p = 0.80), maximal expiratory pressure (MD 5.19 cmH2O, 95% CI -4.16, 14.55, p = 0.80), or FEV1 (MD 0.26 L, 95% CI -0.19, 0.7, p = 0.26). Sensitivity analyses found larger effects for studies with 8 week interventions (MD 17.5 cmH2O (95% CI 3.36 to 31.66)) and spring loaded devices alone (MD 21.18 cmH2O, 95% CI 9.65 to 32.72). CONCLUSION Moderate quality evidence suggests IMT improves respiratory strength in adults with an SCI. The mental and physical QOL outcomes provided very low quality of evidence, with considerable heterogeneity between study results, leading to inconsistency. Further research is warranted to investigate medium and long-term impact of robust IMT protocols, accounting for patient motivation and adherence to IMT.IMPLICATIONS FOR REHABILITATIONInspiratory muscle training (IMT) significantly improves respiratory muscle strength in adults with spinal cord injuries-irrespective of time since injury, or degree of injury completeness.IMT is a feasible, safe, and worthwhile intervention to implement with adults with spinal cord injuries and can be utilized in a variety of settings.IMT interventions that are 8 weeks long and utilize a spring-loaded inspiratory threshold device may generate the largest improvements in respiratory strength.
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Affiliation(s)
- Alyson Woods
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Owen Gustafson
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHSFT, Oxford, UK.,Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Mark Williams
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, UK.,Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Robyn Stiger
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, UK.,Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
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Randelman M, Zholudeva LV, Vinit S, Lane MA. Respiratory Training and Plasticity After Cervical Spinal Cord Injury. Front Cell Neurosci 2021; 15:700821. [PMID: 34621156 PMCID: PMC8490715 DOI: 10.3389/fncel.2021.700821] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022] Open
Abstract
While spinal cord injuries (SCIs) result in a vast array of functional deficits, many of which are life threatening, the majority of SCIs are anatomically incomplete. Spared neural pathways contribute to functional and anatomical neuroplasticity that can occur spontaneously, or can be harnessed using rehabilitative, electrophysiological, or pharmacological strategies. With a focus on respiratory networks that are affected by cervical level SCI, the present review summarizes how non-invasive respiratory treatments can be used to harness this neuroplastic potential and enhance long-term recovery. Specific attention is given to "respiratory training" strategies currently used clinically (e.g., strength training) and those being developed through pre-clinical and early clinical testing [e.g., intermittent chemical stimulation via altering inhaled oxygen (hypoxia) or carbon dioxide stimulation]. Consideration is also given to the effect of training on non-respiratory (e.g., locomotor) networks. This review highlights advances in this area of pre-clinical and translational research, with insight into future directions for enhancing plasticity and improving functional outcomes after SCI.
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Affiliation(s)
- Margo Randelman
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States.,Marion Murray Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Lyandysha V Zholudeva
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States.,Marion Murray Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, PA, United States.,Gladstone Institutes, San Francisco, CA, United States
| | - Stéphane Vinit
- INSERM, END-ICAP, Université Paris-Saclay, UVSQ, Versailles, France
| | - Michael A Lane
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States.,Marion Murray Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, PA, United States
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Park J, Kang D, Eun SD. Development and pilot testing of novel game-based respiratory rehabilitation exercise devices for patients with tetraplegia. Technol Health Care 2021; 29:1119-1127. [PMID: 34180438 PMCID: PMC8673545 DOI: 10.3233/thc-212860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: Individuals with spinal cord injuries (SCI) show restricted breathing patterns with reduced lung volumes and capacities. OBJECTIVE: To improve breathing in such individuals, we aimed to develop breathing exercise devices using a user-centered design (UCD) and then assess the effects of these devices on breathing. METHODS: Patients with SCI were involved in the device development. Preliminary online survey participants were recruited from the community, and interview and pilot test participants were recruited from a patient self-help group. The four UCD phases were repeatedly performed. Users required fun, easy, multi-player, and safe exercise devices. RESULTS: Seven breathing exercise devices were developed, and 10 different game-based exercises were performed. Two individuals participated in a pilot test involving a respiratory rehabilitation exercise program conducted twice weekly for 60 min/session over 8 weeks. Lung function was assessed using a spirometer. Forced vital capacity, forced expiratory volume in 1 s, and vital capacity showed minimal changes, whereas maximum inspiratory and expiratory pressures improved. Participants reported that the exercises were entertaining and that the competitive nature of the game-like exercises encouraged further participation. CONCLUSION: Breathing exercise programs using our developed devices can improve breathing and positively affect the psychological states and sociability of users.
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Affiliation(s)
| | | | - Seon-Deok Eun
- Corresponding author: Seon-Deok Eun, %****␣thc-29-thc212860_temp.tex␣Line␣125␣**** Ministry of Health and Welfare, National Rehabilitation Center, National Rehabilitation Research Institute, Department of Healthcare and Public Health Research, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Korea. Tel.: +82 2 901 1917; Fax: +82 2 901 1930; E-mail:
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Validation of Using Smartphone Built-In Accelerometers to Estimate the Active Energy Expenditures of Full-Time Manual Wheelchair Users with Spinal Cord Injury. SENSORS 2021; 21:s21041498. [PMID: 33671481 PMCID: PMC7926507 DOI: 10.3390/s21041498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/09/2021] [Accepted: 02/17/2021] [Indexed: 12/19/2022]
Abstract
This study aimed to investigate the validity of using built-in smartphone accelerometers to estimate the active energy expenditures of full-time manual wheelchair users with spinal cord injury (SCI). Twenty participants with complete SCI completed 10 5-min daily activities that involved the upper limbs, during which their oxygen consumption and upper limb activity were registered using a portable gas analyzer and a smartphone (placed on the non-dominant arm), respectively. Time series of 1-min averaged oxygen consumption and 55 accelerometer variables (13 variables for each of the four axes and three additional variables for the correlations between axes) were used to estimate three multiple linear models, using a 10-fold cross-validation method. The results showed that models that included either all variables and models or that only included the linear variables showed comparable performance, with a correlation of 0.72. Slightly worse general performance was demonstrated by the model that only included non-linear variables, although it proved to be more accurate at estimating the energy expenditures (EE) during specific tasks. These results suggest that smartphones could be a promising low-cost alternative to laboratory-grade accelerometers to estimate the energy expenditure of wheelchair users with spinal cord injury during daily activities.
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Lemos JR, da Cunha FA, Lopes AJ, Guimarães FS, do Amaral Vasconcellos FV, Dos Santos Vigário P. Respiratory muscle training in non-athletes and athletes with spinal cord injury: A systematic review of the effects on pulmonary function, respiratory muscle strength and endurance, and cardiorespiratory fitness based on the FITT principle of exercise prescription. J Back Musculoskelet Rehabil 2020; 33:655-667. [PMID: 31594206 DOI: 10.3233/bmr-181452] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Respiratory muscle training (RMT) has been recommended to mitigate impacts of spinal cord injuries (SCI), but the optimal dosage in terms of the frequency, intensity, time, and type (FITT principle) to promote health in SCI individuals remains unclear. OBJECTIVE To discuss research related to the effects of RMT on pulmonary function, respiratory muscle strength and cardiorespiratory fitness in athletes and non-athletes with SCI, presenting the FITT principle. METHODS We performed a systematic review. PubMed, Lilacs, Scopus, Web of Science, PEDro, SciELO and Cochrane databases were searched between 1989 and August 2018. Participants were athletes and non-athletes with SCI. RESULTS 4,354 studies were found, of which only 17 met the eligibility criteria. Results indicated that RMT is associated with beneficial changes in pulmonary function and respiratory muscle strength and endurance among athletes and non-athletes, whereas no effect was reported for maximal oxygen uptake. It was not possible to establish an optimal RMT dose from the FITT principle, but combined inspiratory/expiratory muscle training seems to promote greater respiratory changes than isolated IMT or EMT. CONCLUSION The use of RMT elicits benefits in ventilatory variables of athletes and non-athletes with SCI. However, it remains unclear which RMT type and protocol should be used to maximize benefits.
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Affiliation(s)
- Júlia Ribeiro Lemos
- Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Rio de Janeiro, Brazil
| | - Felipe Amorim da Cunha
- Postgraduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Rio de Janeiro, Brazil
| | | | - Fabrício Vieira do Amaral Vasconcellos
- Postgraduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil
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Sustained Abdominal Exercises Affect Abdominal Muscle Activation and Maximal Expiratory Pressures Differently in Healthy Men and Women. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thompson AK, Sinkjær T. Can Operant Conditioning of EMG-Evoked Responses Help to Target Corticospinal Plasticity for Improving Motor Function in People With Multiple Sclerosis? Front Neurol 2020; 11:552. [PMID: 32765389 PMCID: PMC7381136 DOI: 10.3389/fneur.2020.00552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022] Open
Abstract
Corticospinal pathway and its function are essential in motor control and motor rehabilitation. Multiple sclerosis (MS) causes damage to the brain and descending connections, and often diminishes corticospinal function. In people with MS, neural plasticity is available, although it does not necessarily remain stable over the course of disease progress. Thus, inducing plasticity to the corticospinal pathway so as to improve its function may lead to motor control improvements, which impact one's mobility, health, and wellness. In order to harness plasticity in people with MS, over the past two decades, non-invasive brain stimulation techniques have been examined for addressing common symptoms, such as cognitive deficits, fatigue, and spasticity. While these methods appear promising, when it comes to motor rehabilitation, just inducing plasticity or having a capacity for it does not guarantee generation of better motor functions. Targeting plasticity to a key pathway, such as the corticospinal pathway, could change what limits one's motor control and improve function. One of such neural training methods is operant conditioning of the motor-evoked potential that aims to train the behavior of the corticospinal-motoneuron pathway. Through up-conditioning training, the person learns to produce the rewarded neuronal behavior/state of increased corticospinal excitability, and through iterative training, the rewarded behavior/state becomes one's habitual, daily motor behavior. This minireview introduces operant conditioning approach for people with MS. Guiding beneficial CNS plasticity on top of continuous disease progress may help to prolong the duration of maintained motor function and quality of life in people living with MS.
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Affiliation(s)
- Aiko K Thompson
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Thomas Sinkjær
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Lundbeck Foundation, Copenhagen, Denmark
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Lee S, Kim SH. A Systematic Review on the Effects of Respiratory Rehabilitation Programs in Spinal Cord Injury. ACTA ACUST UNITED AC 2020. [DOI: 10.7587/kjrehn.2020.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gautam C, Kaur J, Singh H. Effect of Upper Limb Proprioceptive Neuromuscular Facilitation with Resistance Training on Respiratory Muscle Strength in Quadriplegics: A Randomized Controlled Trial. EXERCISE MEDICINE 2020. [DOI: 10.26644/em.2020.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Supporting front crawl swimming in paraplegics using electrical stimulation: a feasibility study. J Neuroeng Rehabil 2020; 17:51. [PMID: 32299483 PMCID: PMC7164248 DOI: 10.1186/s12984-020-00682-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 04/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background Participation in physical and therapeutic activities is usually severely restricted after a spinal cord injury (SCI). Reasons for this are the associated loss of voluntary motor function, inefficient temperature regulation of the affected extremities, and early muscle fatigue. Hydrotherapy or swim training offer an inherent weight relief, reduce spasticity and improve coordination, muscle strength and fitness. Methods We present a new hybrid exercise modality that combines functional electrical stimulation (FES) of the knee extensors and transcutaneous spinal cord stimulation (tSCS) with paraplegic front crawl swimming. tSCS is used to stimulate the afferent fibers of the L2–S2 posterior roots for spasticity reduction. By activating the tSCS, the trunk musculature is recruited at a motor level. This shall improve trunk stability and straighten the upper body. Within this feasibility study, two complete SCI subjects (both ASIA scale A, lesion level Th5/6), who have been proficient front crawl swimmers, conducted a 10-week swim training with stimulation support. In an additional assessment swim session nine months after the training, the knee extension, hip extension, and trunk roll angles where measured using waterproof inertial measurement units (IMUs) and compared for different swimming conditions (no stimulation, tSCS, FES, FES plus tSCS). Results For both subjects, a training effect over the 10-week swim training was observed in terms of measured lap times (16 m pool) for all swimming conditions. Swimming supported by FES reduced lap times by 15.4% and 8.7% on average for Subject A and Subject B, respectively. Adding tSCS support yielded even greater mean decreases of 19.3% and 20.9% for Subjects A and B, respectively. Additionally, both subjects individually reported that swimming with tSCS for 30–45 minutes eliminated spasticity in the lower extremities for up to 4 hours beyond the duration of the session. Comparing the median as well as the interquartile range of all different settings, the IMU-based motion analysis revealed that FES as well as FES+tSCS improve knee extension in both subjects, while hip extension was only increased in one subject. Trunk roll angles were similar for all swimming conditions. tSCS had no influence on the knee and hip joint angles. Both subjects reported that stimulation-assisted swimming is comfortable, enjoyable, and they would like to use such a device for recreational training and rehabilitation in the future. Conclusions Stimulation-assisted swimming seems to be a promising new form of hybrid exercise for SCI people. It is safe to use with reusable silicone electrodes and can be performed independently by experienced paraplegic swimmers except for transfer to water. The study results indicate that swimming speed can be increased by the proposed methods and spasticity can be reduced by prolonged swim sessions with tSCS and FES. The combination of stimulation with hydrotherapy might be a promising therapy for neurologic rehabilitation in incomplete SCI, stroke or multiples sclerosis patients. Therefore, further studies shall incorporate other neurologic disorders and investigate the potential benefits of FES and tSCS therapy in the water for gait and balance.
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Shin JC, Han EY, Cho KH, Im SH. Improvement in Pulmonary Function with Short-term Rehabilitation Treatment in Spinal Cord Injury Patients. Sci Rep 2019; 9:17091. [PMID: 31745108 PMCID: PMC6863911 DOI: 10.1038/s41598-019-52526-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/15/2019] [Indexed: 11/15/2022] Open
Abstract
Cervical and upper thoracic spinal cord injury causes impairments in respiratory muscle performance, leading to variable degrees of pulmonary dysfunction and rendering deep breathing difficult for affected individuals. In this retrospective study, we investigated the effects of self-directed respiratory muscle training in this context by assessing pulmonary function relative to spinal cord injury characteristics. A total of 104 spinal cord injury patients (tetraplegia/paraplegia; 65/39, acute/subacute/chronic; 14/42/48) were admitted for short-term (4–8 weeks) in-patient clinical rehabilitation. Initial evaluation revealed a compromised pulmonary function with a percentage of predicted value of 62.0 and 57.5 in forced vital capacity in supine and forced vital capacity in sitting positions, respectively. Tetraplegic patients had more compromised pulmonary function compared with paraplegic patients. At follow-up evaluation, the percentage of predicted value of forced vital capacity in supine and sitting position improved overall on average by 11.7% and 12.7%, respectively. The peak cough flow improved by 22.7%. All assessed pulmonary function parameters improved significantly in all subgroups, with the greatest improvements found in patients with tetraplegia and subacute spinal cord injury. Therefore, short-term self-directed respiratory muscle training should be incorporated into all spinal cord injury rehabilitation regimens, especially for patients with tetraplegia and subacute spinal cord injury, as well as those with chronic spinal cord injury.
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Affiliation(s)
- Ji Cheol Shin
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Kye Hee Cho
- Department of Rehabilitation Medicine, CHA Gumi Medical Center, CHA University, Gumi, Gyeongsangbukdo, Republic of Korea
| | - Sang Hee Im
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Silva IS, Pedrosa R, Azevedo IG, Forbes A, Fregonezi GAF, Dourado Junior MET, Lima SRH, Ferreira GMH. Respiratory muscle training in children and adults with neuromuscular disease. Cochrane Database Syst Rev 2019; 9:CD011711. [PMID: 31487757 PMCID: PMC6953358 DOI: 10.1002/14651858.cd011711.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neuromuscular diseases (NMDs) are a heterogeneous group of diseases affecting the anterior horn cell of spinal cord, neuromuscular junction, peripheral nerves and muscles. NMDs cause physical disability usually due to progressive loss of strength in limb muscles, and some NMDs also cause respiratory muscle weakness. Respiratory muscle training (RMT) might be expected to improve respiratory muscle weakness; however, the effects of RMT are still uncertain. This systematic review will synthesize the available trial evidence on the effectiveness and safety of RMT in people with NMD, to inform clinical practice. OBJECTIVES To assess the effects of respiratory muscle training (RMT) for neuromuscular disease (NMD) in adults and children, in comparison to sham training, no training, standard treatment, breathing exercises, or other intensities or types of RMT. SEARCH METHODS On 19 November 2018, we searched the Cochrane Neuromuscular Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. On 23 December 2018, we searched the US National Institutes for Health Clinical Trials Registry (ClinicalTrials.gov), the World Health Organization International Clinical Trials Registry Platform, and reference lists of the included studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs, including cross-over trials, of RMT in adults and children with a diagnosis of NMD of any degree of severity, who were living in the community, and who did not need mechanical ventilation. We compared trials of RMT (inspiratory muscle training (IMT) or expiratory muscle training (EMT), or both), with sham training, no training, standard treatment, different intensities of RMT, different types of RMT, or breathing exercises. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodological procedures. MAIN RESULTS We included 11 studies involving 250 randomized participants with NMDs: three trials (N = 88) in people with amyotrophic lateral sclerosis (ALS; motor neuron disease), six trials (N = 112) in Duchenne muscular dystrophy (DMD), one trial (N = 23) in people with Becker muscular dystrophy (BMD) or limb-girdle muscular dystrophy, and one trial (N = 27) in people with myasthenia gravis.Nine of the trials were at high risk of bias in at least one domain and many reported insufficient information for accurate assessment of the risk of bias. Populations, interventions, control interventions, and outcome measures were often different, which largely ruled out meta-analysis. All included studies assessed lung capacity, our primary outcome, but four did not provide data for analysis (1 in people with ALS and three cross-over studies in DMD). None provided long-term data (over a year) and only one trial, in ALS, provided information on adverse events. Unscheduled hospitalisations for chest infection or acute exacerbation of chronic respiratory failure were not reported and physical function and quality of life were reported in one (ALS) trial.Amyotrophic lateral sclerosis (ALS)Three trials compared RMT versus sham training in ALS. Short-term (8 weeks) effects of RMT on lung capacity in ALS showed no clear difference in the change of the per cent predicted forced vital capacity (FVC%) between EMT and sham EMT groups (mean difference (MD) 0.70, 95% confidence interval (CI) -8.48 to 9.88; N = 46; low-certainty evidence). The mean difference (MD) in FVC% after four months' treatment was 10.86% in favour of IMT (95% CI -4.25 to 25.97; 1 trial, N = 24; low-certainty evidence), which is larger than the minimal clinically important difference (MCID, as estimated in people with idiopathic pulmonary fibrosis). There was no clear difference between IMT and sham IMT groups, measured on the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALFRS; range of possible scores 0 = best to 40 = worst) (MD 0.85, 95% CI -2.16 to 3.85; 1 trial, N = 24; low-certainty evidence) or quality of life, measured on the EuroQol-5D (0 = worst to 100 = best) (MD 0.77, 95% CI -17.09 to 18.62; 1 trial, N = 24; low-certainty evidence) over the medium term (4 months). One trial report stated that the IMT protocol had no adverse effect (very low-certainty evidence).Duchenne muscular dystrophy (DMD)Two DMD trials compared RMT versus sham training in young males with DMD. In one study, the mean post-intervention (6-week) total lung capacity (TLC) favoured RMT (MD 0.45 L, 95% CI -0.24 to 1.14; 1 trial, N = 16; low-certainty evidence). In the other trial there was no clear difference in post-intervention (18 days) FVC between RMT and sham RMT (MD 0.16 L, 95% CI -0.31 to 0.63; 1 trial, N = 20; low-certainty evidence). One RCT and three cross-over trials compared a form of RMT with no training in males with DMD; the cross-over trials did not provide suitable data. Post-intervention (6-month) values showed no clear difference between the RMT and no training groups in per cent predicted vital capacity (VC%) (MD 3.50, 95% CI -14.35 to 21.35; 1 trial, N = 30; low-certainty evidence).Becker or limb-girdle muscular dystrophyOne RCT (N = 21) compared 12 weeks of IMT with breathing exercises in people with Becker or limb-girdle muscular dystrophy. The evidence was of very low certainty and conclusions could not be drawn.Myasthenia gravisIn myasthenia gravis, there may be no clear difference between RMT and breathing exercises on measures of lung capacity, in the short term (TLC MD -0.20 L, 95% CI -1.07 to 0.67; 1 trial, N = 27; low-certainty evidence). Effects of RMT on quality of life are uncertain (1 trial; N = 27).Some trials reported effects of RMT on inspiratory and/or expiratory muscle strength; this evidence was also of low or very low certainty. AUTHORS' CONCLUSIONS RMT may improve lung capacity and respiratory muscle strength in some NMDs. In ALS there may not be any clinically meaningful effect of RMT on physical functioning or quality of life and it is uncertain whether it causes adverse effects. Due to clinical heterogeneity between the trials and the small number of participants included in the analysis, together with the risk of bias, these results must be interpreted very cautiously.
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Affiliation(s)
- Ivanizia S Silva
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaBairro Lagoa NovaNatalRio Grande do NorteBrazil59072‐970
| | - Rafaela Pedrosa
- Federal University of ParaibaDepartment of Physical TherapyJoão PessoaParaibaBrazil
| | - Ingrid G Azevedo
- Ana Bezerra University HospitalPhysical TherapyAvenida Senador Salgado Filho, 3000Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
- Federal University of Rio Grande do NortePhD Program in Physical TherapyAvenida Senador Salgado Filho, 3000Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
| | - Anne‐Marie Forbes
- University of TasmaniaCreative Arts & Health ‐ School of Creative Arts & MediaPrivate Bag 63HobartTASAustralia7001
| | - Guilherme AF Fregonezi
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaBairro Lagoa NovaNatalRio Grande do NorteBrazil59072‐970
- Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH)PneumoCardioVascular LabNatalRio Grande do NorteBrazil59078‐970
| | - Mário ET Dourado Junior
- Federal University of Rio Grande do NorteIntegrated MedicineAv. Nilo Peçanha, 620PetrópolisNatalRio Grande do NorteBrazil59012‐300
| | - Suzianne RH Lima
- Federal University of Rio Grande do NorteIntegrated MedicineAv. Nilo Peçanha, 620PetrópolisNatalRio Grande do NorteBrazil59012‐300
| | - Gardenia MH Ferreira
- Federal University of Rio Grande do NortePhD Program in Physical TherapyAvenida Senador Salgado Filho, 3000Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
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McDonald T, Stiller K. Inspiratory muscle training is feasible and safe for patients with acute spinal cord injury. J Spinal Cord Med 2019; 42:220-227. [PMID: 29400990 PMCID: PMC6419641 DOI: 10.1080/10790268.2018.1432307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To investigate the feasibility and safety and, to a lesser extent efficacy, of inspiratory muscle training (IMT) for patients with acute complete cervical or thoracic spinal cord injury (SCI). DESIGN Prospective, observational pilot study comprising a series of case reports. SETTING Tertiary care, public hospital. PARTICIPANTS Seven adult subjects with an acute complete cervical or thoracic SCI. INTERVENTIONS Participants received IMT as soon as their respiratory condition was stable. A high-resistance, low-repetition program of IMT using a POWERbreathe KH1 device was instituted. Training comprised 3-6 sets of 6 breaths, commenced at 50% maximum inspiratory pressure with the training load progressively increased. OUTCOME MEASURES Feasibility (number of sessions when the criteria to participate in IMT were met/not met), safety (symptoms and physiological stability) before, during and after IMT sessions and efficacy (lung function) were measured. RESULTS There were 50 sessions in total where participants met the criteria to receive IMT, with a mean (range) of 7.1 (3-11) IMT sessions per participant delivered over 10.7 (4-17) days. IMT was feasible, with all 50 planned sessions of IMT able to be delivered, and safe, with stable physiological parameters and no adverse symptoms or events recorded before, during or after IMT. Maximal inspiratory pressure increased for four participants and forced vital capacity increased for three participants over the duration of their IMT sessions. CONCLUSION A high-resistance, low-repetition program of IMT was feasible and safe in adults with an acute complete cervical or thoracic SCI whose respiratory status was stable. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN 12614000975695).
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Affiliation(s)
- Tony McDonald
- Physiotherapy Department, Royal Adelaide Hospital, Adelaide, Australia,Correspondence to: Tony McDonald, 5G-183 Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia5000. Ph: 61 8 70740000.
| | - Kathy Stiller
- Allied Health, Central Adelaide Local Health Network, Adelaide, Australia
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21
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Effects of long-term respiratory muscle endurance training on respiratory and functional outcomes in patients with Myasthenia gravis. Respir Med 2018; 144:7-15. [PMID: 30366587 DOI: 10.1016/j.rmed.2018.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 07/16/2018] [Accepted: 09/02/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Myasthenia gravis (MG) is characterized by reduced muscle endurance and often leads to respiratory complications. OBJECTIVE A long-term respiratory muscle endurance training (RMET) based on normocapnic hyperpnea was introduced for the first time in MG patients. We investigated RMET effects on respiratory endurance (RE), MG symptoms, lung function and physical fitness and compared the results with a control group (CG). METHODS The training period consisted of four weeks intensive training (IT; five 30-min training sessions per week) followed by twelve months maintenance training (MT; five 30-min training sessions over two weeks). Eighteen patients with mild to moderate MG participated as the training group (TG), six patients served as CG. RE, lung function, MG score and physical fitness were tested before and after IT and after three to twelve months of MT. RESULTS Only 12 TG patients completed the entire training period. Thirteen months of training significantly increased RE measured as time until exhaustion (Tlim) to 412% of baseline (P < 0.001). The MG score improved from 0.67±0.09 to 0.41 ± 0.1 (p = 0.004), and the number of squats per minute as a measure of physical fitness increased in the TG to 160% of baseline (p = 0.015). While lung function did not change during the training period, we observed a modulation in the breathing pattern at rest with prolonged expiration (122% of baseline, p = 0.028). In addition, TG reported subjective improvements in MG symptoms, respiratory symptoms and physical fitness by 49%, 58% and 64%, respectively (P < 0.001). No significant changes were observed in the CG. CONCLUSION AND SIGNIFICANCE This is the first controlled long-term RMET study in MG patients. The results demonstrated that this normocapnic hyperpnea training is feasible and beneficial for patients with mild to moderate MG and is a valuable supplement to conventional drug treatment.
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Taşkin H, Telli Atalay O, Yuncu G, Taşpinar B, Yalman A, Şenol H. Postoperative respiratory muscle training in addition to chest physiotherapy after pulmonary resection: A randomized controlled study. Physiother Theory Pract 2018; 36:378-385. [DOI: 10.1080/09593985.2018.1488189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Harun Taşkin
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Orçin Telli Atalay
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Gökhan Yuncu
- Department of Chest Surgery, Kent Hospital, İzmir, Turkey
| | - Betül Taşpinar
- Department of Physical Therapy and Rehabilitation, Dumlupınar University, School of Health Sciences, Kütahya, Turkey
| | - Ali Yalman
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Hande Şenol
- Faculty of Medicine, Department of Biostatistics, Pamukkale University, Denizli, Turkey
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Rapidi CA, Tederko P, Moslavac S, Popa D, Branco CA, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for persons with spinal cord injury. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2018; 54:797-807. [PMID: 29952157 DOI: 10.23736/s1973-9087.18.05374-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Spinal cord injury (SCI) is a devastating condition and a challenge for every health system and every society. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians for people with SCI. The aim of the paper was to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for persons with SCI in order to improve their functionality, social and community reintegration, and to overcome activity limitations and/or participation restrictions. EVIDENCE ACQUISITION A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. EVIDENCE SYNTHESIS The systematic literature review is reported together with thirty-eight recommendations resulting from the Delphi procedure. CONCLUSIONS The professional role of PRM physicians who have expertise in the rehabilitation of SCI is to run rehabilitation programmes in multi-professional teams, working in an interdisciplinary way in a variety of settings to improve the functioning of people with SCI.
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Affiliation(s)
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Sasa Moslavac
- Department of Physical and Rehabilitation Medicine, Special Hospital for Medical Rehabilitation, Varaždinske Toplice, Croatia
| | - Daiana Popa
- Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania
| | - Catarina A Branco
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga E.P.E, Porto, Portugal
| | - Carlotte Kiekens
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University School of Medicine, Madrid, Spain
| | - Nicolas Christodoulou
- Medical School, European University Cyprus, Nicosia, Cyprus.,UEMS PRM Section, Brussels, Belgium
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25
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Ellapen TJ, Hammill HV, Swanepoel M, Strydom GL. The benefits of hydrotherapy to patients with spinal cord injuries. Afr J Disabil 2018; 7:450. [PMID: 29850439 PMCID: PMC5968875 DOI: 10.4102/ajod.v7i0.450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/04/2018] [Indexed: 11/30/2022] Open
Abstract
Background Many patients with spinal cord injury (PWSCI) lead sedentary lifestyles, experiencing poor quality of life and medical challenges. PWSCI don’t like to participate in land-based-exercises because it’s tedious to perform the same exercises, decreasing their rehabilitative compliance and negatively impacting their well-being. An alternative exercise environment and exercises may alleviate boredom, enhancing compliance. Objectives Discuss the benefits of hydrotherapy to PWSCI concerning underwater gait-kinematics, thermoregulatory and cardiovascular responses and spasticity. Methodology A literature surveillance was conducted between 1998 and 2017, through the Crossref meta-database and Google Scholar, according to the PRISMA procedures. Key search words were water-therapy, aquatic-therapy, hydrotherapy, spinal cord injury, rehabilitation, human, kinematics, underwater gait, cardiorespiratory, thermoregulation and spasticity. The quality of each paper was evaluated using a modified Downs and Black Appraisal Scale. The participants were records pertaining to PWSCI and hydrotherapy. The outcomes of interest were: hydrotherapy interventions, the impact of hydrotherapy on gait-kinematics, thermoregulation during water submersion and cardiorespiratory function of PWSCI. Omitted records included: non-English publications from before 1998 or unrelated to hydrotherapy and PWSCI. The record screening admissibility was performed as follows: the title screen, the abstract screen and the full text screen. Results Literature search identified 1080 records. Upon application of the exclusion criteria, 92 titles, 29 abstracts and 17 full text records were eligible. Only 15 records were selected to be included in this clinical commentary. Evidence shows a paucity of randomised control trials (RCT) conducted in this field. Conclusion Hydrotherapy improves PWSCI underwater gait-kinematics, cardiorespiratory and thermoregulatory responses and reduces spasticity.
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Affiliation(s)
- Terry J Ellapen
- School of Biokinetics Recreation and Sport, Physical Activity Sport and Recreation (PhASRec), North-West University, South Africa
| | - Henriëtte V Hammill
- School of Biokinetics Recreation and Sport, Physical Activity Sport and Recreation (PhASRec), North-West University, South Africa
| | - Mariëtte Swanepoel
- School of Biokinetics Recreation and Sport, Physical Activity Sport and Recreation (PhASRec), North-West University, South Africa
| | - Gert L Strydom
- School of Biokinetics Recreation and Sport, Physical Activity Sport and Recreation (PhASRec), North-West University, South Africa
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Kokatnur L, Rudrappa M. Diaphragmatic Palsy. Diseases 2018; 6:E16. [PMID: 29438332 PMCID: PMC5871962 DOI: 10.3390/diseases6010016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/11/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022] Open
Abstract
The diaphragm is the primary muscle of respiration, and its weakness can lead to respiratory failure. Diaphragmatic palsy can be caused by various causes. Injury to the phrenic nerve during thoracic surgeries is the most common cause for diaphragmatic palsy. Depending on the cause, the symptoms of diaphragmatic palsies vary from completely asymptomatic to disabling dyspnea requiring mechanical ventilation. On pulmonary function tests, there will be a decrease in the maximum respiratory muscle power. Spirometry shows reduced lung functions and a significant drop of lung function in supine position is typical of diaphragmatic palsy. Diaphragmatic movements with respiration can be directly visualized by fluoroscopic examination. Currently, this test is being replaced by bedside thoracic ultrasound examination, looking at the diaphragmic excursion with deep breathing or sniffing. This test is found to be equally efficient, and without risks of ionizing radiation of fluoroscope. Treatment of diaphragmatic palsy depends on the cause. Surgical approach of repair of diaphragm or nonsurgical approach of noninvasive ventilation has been tried with good success. Overall prognosis of diaphragmatic palsy is good, except when it is related to neuromuscular degeneration conditions.
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Affiliation(s)
- Laxmi Kokatnur
- Department of Neurology, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 711031, USA.
- Department of Neurology, Overton Brooks VA Medical Center, 501 E Stoner Ave, Shreveport, LA 71101, USA.
- Department of Neurology, Mercy Hospital, 100 Mercy Way, Joplin, MO 64804, USA.
| | - Mohan Rudrappa
- Department of Pulmonary and Critical Care Medicine, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 711031, USA.
- Department of Pulmonary and Critical Care Medicine, Overton Brooks VA Medical Center, 501 E Stoner Ave, Shreveport, LA 71101, USA.
- Department of Pulmonary and Critical Care Medicine, Mercy Hospital, 100 Mercy Way, Joplin, MO 64804, USA.
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Crytzer TM, Cheng YT, Bryner MJ, Wilson Iii R, Sciurba FC, Dicianno BE. Impact of neurological level and spinal curvature on pulmonary function in adults with spina bifida. J Pediatr Rehabil Med 2018; 11:243-254. [PMID: 30741703 DOI: 10.3233/prm-179451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe pulmonary function and determine the impact of neurological level, scoliosis, and obesity on pulmonary function in people with spina bifida (SB). METHODS Participants with SB (N= 29) (15 females; age, 30 ± 12 years) completed spirometry and body plethysmographic lung volume testing. Univariate and multivariate regression analyses were used to describe the factors associated with pulmonary function in people with SB. RESULTS Distribution of category of impairment in pulmonary function was: 55% (n= 16) restricted, 6.9% (n= 2) spirometric restricted, 1 combined obstructed and restricted, and 35.5% (n= 10) normal. In univariate analyses, neurological level was negatively associated with pulmonary function parameters, i.e., forced vital capacity (FVC) (p= 0.005), forced expiratory volume in 1 second (FEV1) (p= 0.008), total lung capacity (TLC) (p= 0.001), and degree of scoliosis were inversely associated with FVC (p= 0.005), FEV1 (p= 0.003), and TLC (p= 0.004). In multivariate models, level of lesion and degree of scoliosis independently contributed to the degree of lung function impairment. Restrictive pulmonary function was observed in 9/10 (90%) of those with thoracic neurological levels and was associated with decreased inspiratory capacity (IC) and expiratory reserve volume (ERV). Lumbar level lesions were associated with either normal lung function or an isolated reduction in FVC due to reduction in only ERV and preserved TLC representing spirometric restriction. CONCLUSIONS High prevalence of restrictive pulmonary physiology is present in people with SB, with more rostral neurological levels and greater degree of scoliosis associated with a higher degree of pulmonary function impairment.
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Affiliation(s)
- Theresa M Crytzer
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yu-Ting Cheng
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Jo Bryner
- Division of Pulmonary, Allergy, and Critical Care Medicine, Emphysema COPD Research Center, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Wilson Iii
- Division of Pulmonary, Allergy, and Critical Care Medicine, Emphysema COPD Research Center, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy, and Critical Care Medicine, Emphysema COPD Research Center, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Brad E Dicianno
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Adult Spina Bifida Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
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Fremion E, Morrison-Jacobus M, Castillo J, Castillo H, Ostermaier K. A chronic care model for spina bifida transition. J Pediatr Rehabil Med 2017; 10:243-247. [PMID: 29125512 DOI: 10.3233/prm-170451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Providing comprehensive transition care for adolescents and young adults with spina bifida (AYASB) requires a structured approach to addressing chronic condition management, self-management, care coordination, and health care navigation that is adaptable to the various levels of cognitive ability, physical function, and family/community environments within the population. This commentary (1) highlights AYASB transition program needs identified in the literature and within a local community, (2) analyzes advantages and limitations of published AYASB transition care models in addressing these needs, (3) demonstrates how a spina bifida (SB) transition clinic used the Chronic Care Model (CCM) to develop a comprehensive AYASB transition program, and (4) examines the potential feasibility in adapting this model to other SB clinics. A SB-specific transition clinic based on the CCM model facilitates the complex chronic care management and transition planning for AYASB. Further study is needed to evaluate health care outcomes using the CCM for SB transition.
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Affiliation(s)
- Ellen Fremion
- Center for Transition Medicine, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital Spina Bifida Transition Clinic, Houston, TX, USA
| | | | - Jonathan Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Heidi Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Kathryn Ostermaier
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Legg Ditterline BE, Aslan SC, Randall DC, Harkema SJ, Castillo C, Ovechkin AV. Effects of Respiratory Training on Heart Rate Variability and Baroreflex Sensitivity in Individuals With Chronic Spinal Cord Injury. Arch Phys Med Rehabil 2017; 99:423-432. [PMID: 28802811 DOI: 10.1016/j.apmr.2017.06.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/13/2017] [Accepted: 06/27/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the effects of pressure threshold respiratory training (RT) on heart rate variability and baroreflex sensitivity in persons with chronic spinal cord injury (SCI). DESIGN Before-after intervention case-controlled clinical study. SETTING SCI research center and outpatient rehabilitation unit. PARTICIPANTS Participants (N=44) consisted of persons with chronic SCI ranging from C2 to T11 who participated in RT (n=24), and untrained control subjects with chronic SCI ranging from C2 to T9 (n=20). INTERVENTIONS A total of 21±2 RT sessions performed 5 days a week during a 4-week period using a combination of pressure threshold inspiratory and expiratory devices. MAIN OUTCOME MEASURES Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and beat-to-beat arterial blood pressure and heart rate changes during the 5-second-long maximum expiratory pressure maneuver (5s MEP) and the sit-up orthostatic stress test, acquired before and after the RT program. RESULTS In contrast to the untrained controls, individuals in the RT group experienced significantly increased FVC and FEV1 (both P<.01) in association with improved quality of sleep, cough, and speech. Sympathetically (phase II) and parasympathetically (phase IV) mediated baroreflex sensitivity both significantly (P<.05) increased during the 5s MEP. During the orthostatic stress test, improved autonomic control over heart rate was associated with significantly increased sympathetic and parasympathetic modulation (low- and high-frequency change: P<.01 and P<.05, respectively). CONCLUSIONS Inspiratory-expiratory pressure threshold RT is a promising technique to positively affect both respiratory and cardiovascular dysregulation observed in persons with chronic SCI.
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Affiliation(s)
- Bonnie E Legg Ditterline
- Department of Physiology, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Sevda C Aslan
- Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - David C Randall
- Department of Physiology, University of Kentucky, Lexington, KY
| | - Susan J Harkema
- Department of Physiology, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Camilo Castillo
- Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Alexander V Ovechkin
- Department of Physiology, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY.
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Cruz S, Blauwet CA. Implications of altered autonomic control on sports performance in athletes with spinal cord injury. Auton Neurosci 2017; 209:100-104. [PMID: 28457670 DOI: 10.1016/j.autneu.2017.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/25/2017] [Accepted: 03/31/2017] [Indexed: 11/26/2022]
Abstract
It is well known that athletes with spinal cord injury (SCI) may experience altered autonomic physiology that impacts their exercise capacity and sports performance. This is particularly relevant given the ever-increasing number of individuals with SCI who are actively engaged in sports at all levels, from community-based adaptive sports to elite Paralympic competitions. As such, the purpose of this article is to review the present literature regarding the implications of altered autonomic control on the safety and performance of athletes with SCI. A particular emphasis will be placed on the autonomic aspects of cardiovascular and thermoregulatory control in the athlete population, as well as the implications of autonomic dysreflexia in enhancing sports performance. Further research is needed to understand the autonomic factors that influence athletes with SCI in order to ensure optimal and safe sports competition. Additionally, this information is crucially relevant to the coaches, sports administrators, and team medical staff who work closely with athletes with SCI.
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Affiliation(s)
- Sebastian Cruz
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital/Brigham and Women's Hospital, Boston, MA, USA.
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31
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Impact de l’étirement du grand pectoral sur la capacité vitale des patients atteints de tétraplégie basse : pré-étude randomisée contrôlée. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.kine.2017.02.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Hachmann JT, Calvert JS, Grahn PJ, Drubach DI, Lee KH, Lavrov IA. Review of Epidural Spinal Cord Stimulation for Augmenting Cough after Spinal Cord Injury. Front Hum Neurosci 2017; 11:144. [PMID: 28400726 PMCID: PMC5368218 DOI: 10.3389/fnhum.2017.00144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/13/2017] [Indexed: 12/13/2022] Open
Abstract
Spinal cord injury (SCI) remains a debilitating condition for which there is no cure. In addition to loss of somatic sensorimotor functions, SCI is also commonly associated with impairment of autonomic function. Importantly, cough dysfunction due to paralysis of expiratory muscles in combination with respiratory insufficiency can render affected individuals vulnerable to respiratory morbidity. Failure to clear sputum can aggravate both risk for and severity of respiratory infections, accounting for frequent hospitalizations and even mortality. Recently, epidural stimulation of the lower thoracic spinal cord has been investigated as novel means for restoring cough by evoking expiratory muscle contraction to generate large positive airway pressures and expulsive air flow. This review article discusses available preclinical and clinical evidence, current challenges and clinical potential of lower thoracic spinal cord stimulation (SCS) for restoring cough in individuals with SCI.
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Affiliation(s)
- Jan T Hachmann
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA
| | | | - Peter J Grahn
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA
| | - Dina I Drubach
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo ClinicRochester, MN, USA; Department of Physical Medicine and Rehabilitation, Mayo ClinicRochester, MN, USA
| | - Igor A Lavrov
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA
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Seo K, Hwan PS, Park K. The effects of inspiratory diaphragm breathing exercise and expiratory pursed-lip breathing exercise on chronic stroke patients' respiratory muscle activation. J Phys Ther Sci 2017; 29:465-469. [PMID: 28356632 PMCID: PMC5361011 DOI: 10.1589/jpts.29.465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/29/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study is to examine the effects of inspiratory diaphragm
breathing exercise and expiratory pursed-lip breathing exercise on chronic stroke
patients’ respiratory muscle activation. [Subjects and Methods] All experimental subjects
performed exercises five times per week for four weeks. Thirty chronic stroke patients
were randomly assign to an experimental group of 15 patients and a control group of 15
patients. The experimental group underwent exercises consisting of basic exercise
treatment for 15 minutes and inspiratory diaphragm breathing exercise and expiratory
pursed-lip breathing exercise for 15 minutes and the control group underwent exercises
consisting of basic exercise treatment for 15 minutes and auto-med exercise for 15
minutes. The activation levels of respiratory muscles were measured before and after the
experiment using MP 150WSW to obtain the results of the experiment. [Results] In the
present study, when the pulmonary functions of the experimental group and the control
group before and after the experiment were compared, whereas the experimental group showed
significant differences in all sections. In the verification of intergroup differences
between the experimental group and the control group before and after the experiment.
[Conclusion] The respiratory rehabilitation exercise is considered to be capable of
inducing positive effects on stroke patients’ respiratory muscles through diaphragm
breathing exercise and lip puckering breathing exercise.
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Affiliation(s)
- KyoChul Seo
- Department of Physical Therapy, Korea Nazarene University, Republic of Korea
| | - Park Seung Hwan
- Department of Medical Engineering, Eulji University, Republic of Korea
| | - KwangYong Park
- Department of Rehabilitation Technology, Korea Nazarene University, Republic of Korea
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Ang K, Maddocks M, Xu H, Higginson IJ. The Effectiveness of Singing or Playing a Wind Instrument in Improving Respiratory Function in Patients with Long-Term Neurological Conditions: A Systematic Review. J Music Ther 2017; 54:108-131. [PMID: 28391305 DOI: 10.1093/jmt/thx001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Many long-term neurological conditions adversely affect respiratory function. Singing and playing wind instruments are relatively inexpensive interventions with potential for improving respiratory function; however, synthesis of current evidence is needed to inform research and clinical use of music in respiratory care. OBJECTIVE To critically appraise, analyze, and synthesize published evidence on the effectiveness of singing or playing a wind instrument to improve respiratory function in people with long-term neurological conditions. DESIGN Systematic review of published randomized controlled trials and observational studies examining singing or playing wind instruments to improve respiratory function in individuals with long-term neurological conditions. METHODS Articles meeting specified inclusion criteria were identified through a search of the Medline, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, CAIRSS for Music, WHO International Clinical Trials Registry Platform Search Portal, and AMED databases as early as 1806 through March 2015. Information on study design, clinical populations, interventions, and outcome measures was extracted and summarized using an electronic standardized coding form. Methodological quality was assessed and summarized across studies descriptively. RESULTS From screening 584 references, 68 full texts were reviewed and five studies included. These concerned 109 participants. The studies were deemed of low quality, due to evidence of bias, in part due to intervention complexity. No adverse effects were reported. Overall, there was a trend toward improved respiratory function, but only one study on Parkinson's disease had significant between-group differences. CONCLUSIONS The positive trend in respiratory function in people with long-term neurological conditions following singing or wind instrument therapy is of interest, and warrants further investigation.
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Affiliation(s)
- Kexin Ang
- Department of Neurology, National Neuroscience Institute, Singapore; King's College London, Cicely Saunders Institute, Division of Palliative Care, Policy and Rehabilitation
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute, Division of Palliative Care, Policy and Rehabilitation
| | - Huiying Xu
- Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute, Division of Palliative Care, Policy and Rehabilitation
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Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies. J Clin Med 2016; 5:jcm5120113. [PMID: 27929389 PMCID: PMC5184786 DOI: 10.3390/jcm5120113] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 12/12/2022] Open
Abstract
The diaphragm is the main inspiratory muscle, and its dysfunction can lead to significant adverse clinical consequences. The aim of this review is to provide clinicians with an overview of the main causes of uni- and bi-lateral diaphragm dysfunction, explore the clinical and physiological consequences of the disease on lung function, exercise physiology and sleep and review the available diagnostic tools used in the evaluation of diaphragm function. A particular emphasis is placed on the clinical significance of diaphragm weakness in the intensive care unit setting and the use of ultrasound to evaluate diaphragmatic action.
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36
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Kim JS, Oh DW. Real-time ultrasound imaging biofeedback training is diaphragmatic function in nontraumatic cervical spinal cord injury: a single-subject experimental study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2016. [DOI: 10.1080/21679169.2016.1247909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ji-Seon Kim
- Department of Physical Therapy, College of Health and Welfare, Kyungwoon University, Gumi-si, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health Science, Cheongju University, Cheongju-si, Republic of Korea
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37
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Thoracoabdominal mobility is improved in subjects with tetraplegia after one year of wheelchair rugby training. Sci Sports 2016. [DOI: 10.1016/j.scispo.2016.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Montesinos-Magraner L, López-Bueno L, Gómez-Garrido A, Gomis M, González LM, García-Massó X, Serra-Añó P. The influence of regular physical activity on lung function in paraplegic people. Spinal Cord 2016; 54:861-865. [PMID: 26927294 DOI: 10.1038/sc.2016.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 11/30/2015] [Accepted: 12/15/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES The main goal of this study was to examine the influence of regular physical activity (PA) on lung volumes and flows. SETTING The study was conducted in the Vall d'Hebrón Hospital, Barcelona (Spain), and La Fe Hospital, Valencia (Spain). METHODS Spirometric tests were performed to 67 paraplegics, and differences were established between the active group (AG) (n=37) that performed >60 min per week of moderate-to-vigorous PA (MVPA) and 30 non-AG (NAG). Further, we established the relationship between the spirometric and PA variables and between being active and reaching the lower limit of normal (LLN) of the spirometric variables. RESULTS AG had greater values than the NAG: FVC (P<0.01), FEV1 (P<0.01) and PEF (P<0.01). Moderate correlations between the MVPA and FVC (r=0.41, P<0.01) and the MVPA and FEV1 (r=0.39, P<0.01) were obtained. The relationship between being physically active and reaching the LLN was statistically significant for FEV1 (χ2=6.184, P<0.05) but not for FVC (P>0.05). CONCLUSIONS The performance of MVPA for a minimum of 60 min per week can have a beneficial effect, both on lung volumes and on expiratory flow, and led to an achievement of the LLN in FEV1.
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Affiliation(s)
| | - L López-Bueno
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - A Gómez-Garrido
- Cardiorespiratory rehabilitation unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - M Gomis
- School of Health Sciences TecnoCampus, Pompeu Fabra University, Barcelona, Spain
| | - L M González
- Department of Physical Education and Sports, University of Valencia, Valencia, Spain
| | - X García-Massó
- Department for Teaching of Musical, Visual and Corporal Expression, University of Valencia, Valencia, Spain
| | - P Serra-Añó
- Department of Physiotherapy, University of Valencia, Valencia, Spain
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Respiratory Training Improves Blood Pressure Regulation in Individuals With Chronic Spinal Cord Injury. Arch Phys Med Rehabil 2015; 97:964-73. [PMID: 26718236 DOI: 10.1016/j.apmr.2015.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the effects of respiratory motor training (RMT) on pulmonary function and orthostatic stress-mediated cardiovascular and autonomic responses in individuals with chronic spinal cord injury (SCI). DESIGN Before-after intervention case-controlled clinical study. SETTING SCI research center and outpatient rehabilitation unit. PARTICIPANTS A sample of (N=21) individuals with chronic SCI ranging from C3 to T2 diagnosed with orthostatic hypotension (OH) (n=11) and healthy, noninjured controls (n=10). INTERVENTIONS A total of 21±2 sessions of pressure threshold inspiratory-expiratory RMT performed 5d/wk during a 1-month period. MAIN OUTCOME MEASURES Standard pulmonary function test: forced vital capacity, forced expiratory volume in one second, maximal inspiratory pressure, maximal expiratory pressure, beat-to-beat arterial blood pressure, heart rate, and respiratory rate were acquired during the orthostatic sit-up stress test before and after the RMT program. RESULTS Completion of RMT intervention abolished OH in 7 of 11 individuals. Forced vital capacity, low-frequency component of power spectral density of blood pressure and heart rate oscillations, baroreflex effectiveness, and cross-correlations between blood pressure, heart rate, and respiratory rate during the orthostatic challenge were significantly improved, approaching levels observed in noninjured individuals. These findings indicate increased sympathetic activation and baroreflex effectiveness in association with improved respiratory-cardiovascular interactions in response to the sudden decrease in blood pressure. CONCLUSIONS Respiratory training increases respiratory capacity and improves orthostatic stress-mediated respiratory, cardiovascular, and autonomic responses, suggesting that this intervention can be an efficacious therapy for managing OH after SCI.
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Pedrosa R, Silva IS, Azevedo IG, Forbes AM, Fregonezi GAF, Dourado Junior MET, Lima SRH, Guerra RO, Ferreira GMH. Respiratory muscle training in children and adults with neuromuscular disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Rafaela Pedrosa
- Federal University of Rio Grande do Norte; PhD Program in Physical Therapy; Avenida Senador Salgado Filho, 3000 Lagoa Nova Natal Rio Grande do Norte Brazil 59072-970
| | - Ivanizia S Silva
- Federal University of Rio Grande do Norte; PhD Program in Physical Therapy; Avenida Senador Salgado Filho, 3000 Lagoa Nova Natal Rio Grande do Norte Brazil 59072-970
| | - Ingrid G Azevedo
- Federal University of Rio Grande do Norte; Physical Therapy; Avenida Senador Salgado Filho, 3000 Bairro Lagoa Nova Natal Rio Grande do Norte Brazil 59078-970
| | - Anne-Marie Forbes
- Conservatorium of Music; Senior Lecturer in Musicology; University of Tasmania Private Bag 63 Hobart TAS Australia 7001
| | - Guilherme AF Fregonezi
- Federal University of Rio Grande do Norte; PhD Program in Physical Therapy, Phd Program in Biotechnology; Avenida Senador Salgado Filho, 3000 Bairro Lagoa Nova Natal Rio Grande do Norte Brazil 59078-970
| | - Mário ET Dourado Junior
- Federal University of Rio Grande do Norte; Integrated Medicine; Av. Nilo Peçanha, 620 Petrópolis Natal Rio Grande do Norte Brazil 59012-300
| | - Suzianne RH Lima
- Federal University of Rio Grande do Norte; Integrated Medicine; Av. Nilo Peçanha, 620 Petrópolis Natal Rio Grande do Norte Brazil 59012-300
| | - Ricardo O Guerra
- Federal University of Rio Grande do Norte; PhD Program in Physical Therapy; Avenida Senador Salgado Filho, 3000 Lagoa Nova Natal Rio Grande do Norte Brazil 59072-970
| | - Gardenia MH Ferreira
- Federal University of Rio Grande do Norte; PhD Program in Physical Therapy; Avenida Senador Salgado Filho, 3000 Lagoa Nova Natal Rio Grande do Norte Brazil 59072-970
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Hartley NA. Spinal cord injury (SCI) rehabilitation: systematic analysis of communication from the biopsychosocial perspective. Disabil Rehabil 2015; 37:2383-2392. [DOI: 10.3109/09638288.2015.1027008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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A center's experience: pulmonary function in spinal cord injury. Lung 2014; 192:339-46. [PMID: 24723067 DOI: 10.1007/s00408-014-9575-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/10/2014] [Indexed: 01/24/2023]
Abstract
Traumatic spinal cord injury (SCI) is associated with significant psychological and physical challenges. A multidisciplinary approach to management is essential to ensure recovery during the acute phase, and comprehensive rehabilitative strategies are necessary to foster independence and quality of life throughout the chronic phase of injury. Complications that beset these individuals are often a unique consequence of SCI, and knowledge of the effects of SCI upon organ systems is essential for appropriate management. According to the National SCI Statistical Center (NSCISC), as of 2010 there were an estimated 265,000 persons living with SCI in the United States, with approximately 12,000 incidence cases annually. Although life expectancy for newly injured individuals with SCI is markedly reduced, persons with chronic SCI are expected to live about as long as individuals without SCI; however, longevity varies inversely with level of injury. Since 2005, 56 % of persons with SCI are tetraplegic, and due to paralysis of respiratory muscles, these individuals may be especially prone to pulmonary complications, which remain a major cause of mortality among persons with chronic SCI. We at the VA Rehabilitation Research and Development Center of Excellence for the Medical Consequences of SCI at the James J. Peters VA Medical Center have devoted more than 25 years to the study of secondary medical conditions that complicate SCI. Herein, we review pulmonary research at the Center, both our past and future endeavors, which form an integral part of our multidisciplinary approach toward achieving a greater understanding of and improving care for veterans with SCI.
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Tamplin J, Berlowitz DJ. A systematic review and meta-analysis of the effects of respiratory muscle training on pulmonary function in tetraplegia. Spinal Cord 2014; 52:175-80. [DOI: 10.1038/sc.2013.162] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/02/2013] [Accepted: 12/09/2013] [Indexed: 01/25/2023]
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An exploratory study of respiratory muscle endurance training in high lesion level paraplegic handbike athletes. Clin J Sport Med 2014; 24:69-75. [PMID: 24326928 DOI: 10.1097/jsm.0000000000000003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the impact of respiratory muscle endurance training (RMET) on lung function and exercise performance in athletes with high lesion level paraplegia. DESIGN This was a case-control intervention study. SETTING Sport and exercise science laboratories and bike path. PARTICIPANTS Twelve competitive handbike athletes with high lesion level paraplegia matched by lesion and fitness level in training (T) group (7) and control (C) group (5). INTERVENTIONS The T group performed 20 RMET training sessions over a 4-week period using a SpiroTiger. Each session lasted for 30 minutes. The C group did not perform any RMET. MAIN OUTCOME MEASURES Resting lung function, respiratory muscle endurance, and exercise performance (arm cranking maximal incremental test and simulated handbike time trial). RESULTS Resting lung function was not different between groups and did not change with the intervention. After RMET, the respiratory muscle endurance was significantly increased by 27% in the T group but did not alter in the C group. Final minute ventilation was increased from 89 ± 20 L/min to 112 ± 20 L/min after RMET in the T group and the sensation of dyspnea decreased (P < 0.05). Peak oxygen consumption, peak mechanical power output, and handbike time trial performance were not different between groups and did not change with the RMET intervention. CONCLUSIONS A short-term RMET intervention in handbike athletes with high lesion level paraplegia improved respiratory muscle endurance but had little impact on overall exercise performance.
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Terson de Paleville DGL, McKay WB, Folz RJ, Ovechkin AV. Respiratory motor control disrupted by spinal cord injury: mechanisms, evaluation, and restoration. Transl Stroke Res 2013; 2:463-73. [PMID: 22408690 DOI: 10.1007/s12975-011-0114-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pulmonary complications associated with persistent respiratory muscle weakness, paralysis, and spasticity are among the most important problems faced by patients with spinal cord injury when lack of muscle strength and disorganization of reciprocal respiratory muscle control lead to breathing insufficiency. This review describes the mechanisms of the respiratory motor control and its change in individuals with spinal cord injury, methods by which respiratory function is measured, and rehabilitative treatment used to restore respiratory function in those who have experienced such injury.
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Affiliation(s)
- Daniela G L Terson de Paleville
- Exercise Physiology, University of Louisville, Louisville, KY, USA. Physiology and Biophysics, University of Louisville, Louisville, KY, USA
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Hoh DJ, Mercier LM, Hussey SP, Lane MA. Respiration following spinal cord injury: evidence for human neuroplasticity. Respir Physiol Neurobiol 2013; 189:450-64. [PMID: 23891679 DOI: 10.1016/j.resp.2013.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 07/01/2013] [Accepted: 07/01/2013] [Indexed: 12/17/2022]
Abstract
Respiratory dysfunction is one of the most devastating consequences of cervical spinal cord injury (SCI) with impaired breathing being a leading cause of morbidity and mortality in this population. However, there is mounting experimental and clinical evidence for moderate spontaneous respiratory recovery, or "plasticity", after some spinal cord injuries. Pre-clinical models of respiratory dysfunction following SCI have demonstrated plasticity at neural and behavioral levels that result in progressive recovery of function. Temporal changes in respiration after human SCI have revealed some functional improvements suggesting plasticity paralleling that seen in experimental models-a concept that has been previously under-appreciated. While the extent of spontaneous recovery remains limited, it is possible that enhancing or facilitating neuroplastic mechanisms may have significant therapeutic potential. The next generation of treatment strategies for SCI and related respiratory dysfunction should aim to optimize these recovery processes of the injured spinal cord for lasting functional restoration.
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Affiliation(s)
- Daniel J Hoh
- Department of Neuroscience, College of Medicine, University of Florida, McKnight Brain Institute, Gainesville, FL 32611, USA; Neurological Surgery, College of Medicine, University of Florida, McKnight Brain Institute, Gainesville, FL, 32611, USA
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Mueller G, Hopman MTE, Perret C. Comparison of respiratory muscle training methods in individuals with motor complete tetraplegia. Top Spinal Cord Inj Rehabil 2013; 18:118-21. [PMID: 23459602 DOI: 10.1310/sci1802-118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the effects of inspiratory resistance training (IRT) and isocapnic hyperpnea (IH) versus incentive spirometry (placebo) on respiratory function, voice, and quality of life in individuals with motor complete tetraplegia. METHODS In this randomized controlled trial, 24 individuals with traumatic, motor complete (AIS A) tetraplegia (C5-C8), 6 to 8 months post injury, were randomly assigned to 1 of 3 groups. They completed either 90 repetitions of IRT, 10 minutes of IH, or 16 repetitions of placebo training in 32 supervised training sessions over 8 weeks. Before and after the training period, the following tests were performed: bodyplethysmography, inspiratory and expiratory muscle strength, subjective breathing parameters using the visual analogue scale (VAS), voice measurements, and an adapted SF-12 quality of life questionnaire. A Friedman test and Cohen's effect sizes for IRT and IH versus placebo were calculated for differences between pre- and posttraining values. RESULTS Compared to placebo training, IRT showed high effect sizes for inspiratory muscle strength (d = 1.19), VAS values of "cleaning the nose" (d = 0.99), and the physical component of subjective quality of life (d = 0.84). IH compared to placebo training showed only medium and low effect sizes. The Friedman analysis showed a significant effect for IRT versus placebo on inspiratory muscle strength (P = .030). Neither all other parameters of respiratory function nor voice measurements, subjective breathing parameters, or quality of life were significantly improved by one of the tested training methods. CONCLUSION In individuals with motor complete tetraplegia, inspiratory muscle strength can be improved by IRT. Therefore, IRT is advantageous compared to IH for this group of patients and during the first year post injury.
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Affiliation(s)
- Gabi Mueller
- Clinical Trial Unit, Swiss Paraplegic Centre , Nottwil , Switzerland ; Swiss Paraplegic Research , Nottwil , Switzerland
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Wong SL, Shem K, Crew J. Specialized respiratory management for acute cervical spinal cord injury:: a retrospective analysis. Top Spinal Cord Inj Rehabil 2013; 18:283-90. [PMID: 23459555 DOI: 10.1310/sci1804-283] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In individuals with cervical spinal cord injury (SCI), respiratory complications arise within hours to days of injury. Paralysis of the respiratory muscles predisposes the patient toward respiratory failure. Respiratory complications after cervical SCI include hypoventilation, hypercapnea, reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Ultimately, the patient must use increased work to breathe, which results in respiratory fatigue and may eventually require intubation for mechanical ventilation. Without specialized respiratory management for individuals with tetraplegia, recurrent pneumonias, bronchoscopies, and difficulty in maintaining a stable respiratory status will persist. OBJECTIVE This retrospective analysis examined the effectiveness of specialized respiratory management utilized in a regional SCI center. METHODS Individuals with C1-C4 SCI (N = 24) were the focus of this study as these neurological levels present with the most complicated respiratory status. RESULTS All of the study patients' respiratory status improved with the specialized respiratory management administered in the SCI specialty unit. For a majority of these patients, respiratory improvements were noted within 1 week of admission to our SCI unit. CONCLUSION Utilization of high tidal volume ventilation, high frequency percussive ventilation, and mechanical insufflation- exsufflation have demonstrated efficacy in stabilizing the respiratory status of these individuals. Optimizing respiratory status enables the patients to participate in rehabilitation therapies, allows for the opportunity to vocalize, and results in fewer days on mechanical ventilation for patients who are weanable.
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Abstract
BACKGROUND Cervical spinal cord injury (SCI) severely comprises respiratory function due to paralysis and impairment of the respiratory muscles. Various types of respiratory muscle training (RMT) to improve respiratory function for people with cervical SCI have been described in the literature. A systematic review of this literature is needed to determine the effectiveness of RMT (either inspiratory or expiratory muscle training) on pulmonary function, dyspnoea, respiratory complications, respiratory muscle strength, and quality of life for people with cervical SCI. OBJECTIVES To evaluate the efficacy of RMT versus standard care or sham treatments in people with cervical SCI. SEARCH METHODS We searched the Cochrane Injuries and Cochrane Neuromuscular Disease Groups' Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 1), MEDLINE, EMBASE, CINAHL, ISI Web of Science, PubMed, and clinical trials registries (Australian New Zealand Clinical Trials Registry, ClinicalTrials, Controlled Trials metaRegister) on 5 to 8 March 2013. We handsearched reference lists of relevant papers and literature reviews. We applied no date, language, or publication restrictions. SELECTION CRITERIA All randomised controlled trials that involved an intervention described as RMT versus a control group using an alternative intervention, placebo, usual care, or no intervention for people with cervical SCI were considered for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently selected articles for inclusion, evaluated the methodological quality of the studies, and extracted data. We sought additional information from the trial authors when necessary. We presented results using mean differences (MD) (using post-test scores) and 95% confidence intervals (CI) for outcomes measured using the same scale or standardised mean differences (SMD) and 95% CI for outcomes measured using different scales. MAIN RESULTS We included 11 studies with 212 participants with cervical SCI. The meta-analysis revealed a statistically significant effect of RMT for three outcomes: vital capacity (MD mean end point 0.4 L, 95% CI 0.12 to 0.69), maximal inspiratory pressure (MD mean end point 10.50 cm/H2O, 95% CI 3.42 to 17.57), and maximal expiratory pressure (MD mean end point 10.31 cm/H2O, 95% CI 2.80 to 17.82). There was no effect on forced expiratory volume in one second or dyspnoea. We could not combine the results from quality of life assessment tools from three studies for meta-analysis. Respiratory complication outcomes were infrequently reported and thus we could not include them in the meta-analysis. Instead, we described the results narratively. We identified no adverse effects as a result of RMT in cervical SCI. AUTHORS' CONCLUSIONS In spite of the relatively small number of studies included in this review, meta-analysis of the pooled data indicates that RMT is effective for increasing respiratory muscle strength and perhaps also lung volumes for people with cervical SCI. Further research is needed on functional outcomes following RMT, such as dyspnoea, cough efficacy, respiratory complications, hospital admissions, and quality of life. In addition, longer-term studies are needed to ascertain optimal dosage and determine any carryover effects of RMT on respiratory function, quality of life, respiratory morbidity, and mortality.
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Affiliation(s)
- David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia.
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West CR, Taylor BJ, Campbell IG, Romer LM. Effects of inspiratory muscle training on exercise responses in Paralympic athletes with cervical spinal cord injury. Scand J Med Sci Sports 2013; 24:764-72. [DOI: 10.1111/sms.12070] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- C. R. West
- Centre for Sports Medicine and Human Performance; Brunel University; Uxbridge UK
| | - B. J. Taylor
- Centre for Sports Medicine and Human Performance; Brunel University; Uxbridge UK
| | - I. G. Campbell
- Centre for Sports Medicine and Human Performance; Brunel University; Uxbridge UK
| | - L. M. Romer
- Centre for Sports Medicine and Human Performance; Brunel University; Uxbridge UK
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