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Jo MR, Kim NS. Combined respiratory muscle training facilitates expiratory muscle activity in stroke patients. J Phys Ther Sci 2017; 29:1970-1973. [PMID: 29200637 PMCID: PMC5702827 DOI: 10.1589/jpts.29.1970] [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: 07/11/2017] [Accepted: 08/13/2017] [Indexed: 12/13/2022] Open
Abstract
[Purpose] The aim of this study was to investigate the effect of combined respiratory muscle training on expiratory muscle activity in stroke patients. [Subjects and Methods] Twenty-five stroke patients were assigned to either the intervention group (n=12) or the control group (n=13). Both groups participated in a conventional stroke rehabilitation program, while the intervention group also received respiratory muscle training for 20 to 30 minutes a day, 3 times a week, for 8 weeks. Surface electromyographic data were collected from the rectus abdominis, internal oblique, and external oblique on the paretic side. Pulmonary function (forced vital capacity) and cough capacity (peak expiratory flow) also were measured. [Results] Both groups showed a significant increase in muscle activity after the intervention. However, the intervention group also showed significant increases in forced vital capacity and peak expiratory flow. Comparison of the 2 groups revealed that the intervention group had greater improvements in pulmonary function, cough capacity, and muscle activity. [Conclusion] The results of this study suggest that combined respiratory muscle training has positive effects on both respiratory function and expiratory muscle activity in stroke patients.
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Affiliation(s)
- Myeong-Rae Jo
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan: 9 Bugok 3-dong, Geumjung-gu, Busan 609-757, Republic of Korea
| | - Nan-Soo Kim
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan: 9 Bugok 3-dong, Geumjung-gu, Busan 609-757, Republic of Korea
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2
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Sukul P, Oertel P, Kamysek S, Trefz P. Oral or nasal breathing? Real-time effects of switching sampling route onto exhaled VOC concentrations. J Breath Res 2017; 11:027101. [DOI: 10.1088/1752-7163/aa6368] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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3
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Seo K, Park SH, Park K. Effects of diaphragm respiration exercise on pulmonary function of male smokers in their twenties. J Phys Ther Sci 2015; 27:2313-5. [PMID: 26311972 PMCID: PMC4540870 DOI: 10.1589/jpts.27.2313] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/16/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We investigated how diaphragm respiration exercises can affect pulmonary
function in long-term male smokers in their twenties. [Subjects and Methods] Twenty-eight
healthy males between 20 and 29 years of age were randomly divided into an experimental
and a control group (14 members each). The experiment was conducted during 30 min
sessions, 3 times a week for 4 weeks. The experimental group performed diaphragm
respiration exercises and the control group performed exercises using MOTOmed. Pulmonary
function (tidal volume, breathing capacity, inspiratory reserve volume, inspiratory
capacity, and expiratory reserve volume) was evaluated and analyzed before and after the
experiment. [Results] Our results revealed significant increases in tidal volume,
inspiratory reserve volume, inspiratory capacity, and breathing capacity in the
experimental group. These increases were greater in the experimental group than in the
control group. [Conclusion] In our study, the experimental group which performed diaphragm
respiration exercises showed a greater improvement in pulmonary function compared with the
control group. It is hypothesized that greater improvement in pulmonary function is
expected if diaphragm respiration exercises are implemented taking into account the age of
the smokers.
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Affiliation(s)
- KyoChul Seo
- Department of Physical Therapy, Korea Nazarene University, Republic of Korea
| | - Seung Hwan Park
- 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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Fagevik Olsén M, Lannefors L, Westerdahl E. Positive expiratory pressure - Common clinical applications and physiological effects. Respir Med 2014; 109:297-307. [PMID: 25573419 DOI: 10.1016/j.rmed.2014.11.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/24/2014] [Accepted: 11/02/2014] [Indexed: 12/01/2022]
Abstract
Breathing out against resistance, in order to achieve positive expiratory pressure (PEP), is applied by many patient groups. Pursed lips breathing and a variety of devices can be used to create the resistance giving the increased expiratory pressure. Effects on pulmonary outcomes have been discussed in several publications, but the expected underlying physiology of the effect is seldom discussed. The aim of this article is to describe the purpose, performance, clinical application and underlying physiology of PEP when it is used to increase lung volumes, decrease hyperinflation or improve airway clearance. In clinical practice, the instruction how to use an expiratory resistance is of major importance since it varies. Different breathing patterns during PEP increase or reduce expiratory flow, result in movement of EPP centrally or peripherally and can increase or decrease lung volume. It is therefore necessary to give the right instructions to obtain the desired effects. As the different PEP techniques are being used by diverse patient groups it is not possible to give standard instructions. Based on the information given in this article the instructions have to be adjusted to give the optimal effect. There is no consensus regarding optimal treatment frequency and number of cycles included in each treatment session and must also be individualized. In future research, more precise descriptions are needed about physiological aims and specific instructions of how the treatments have been performed to assure as good treatment quality as possible and to be able to evaluate and compare treatment effects.
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Affiliation(s)
- Monika Fagevik Olsén
- Department of Physical Therapy and Occupational Therapy, Sahlgrenska University Hospital, Sweden; Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Gastrosurgical Research & Education, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Louise Lannefors
- Cystic Fibrosis Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Elisabeth Westerdahl
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden; School of Health and Medical Sciences, Örebro University, Sweden
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Seo K, Cho M. The effects on the pulmonary function of normal adults proprioceptive neuromuscular facilitation respiration pattern exercise. J Phys Ther Sci 2014; 26:1579-82. [PMID: 25364117 PMCID: PMC4210402 DOI: 10.1589/jpts.26.1579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/21/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to determine whether proprioceptive neuromuscular
facilitation (PNF) respiration exercise increases the pulmonary function of normal adults.
[Subjects and Methods] Twenty-eight normal adults in their 20s were randomly assigned to
an experimental group (n=14) or control group (n=14). Over the course of four weeks, the
experimental group participated in PNF respiration pattern exercises for 30 minutes three
times per week. Subjects were assessed pre-test and post-test by measurement of pulmonary
function (tidal volume, inspiratory reserve volume, expiratory reserve volume, inspiratory
capacity, and vital capacity). [Results] Our findings show that the experimental group had
significant improvements in expiratory reserve volume and vital capacity. In the
comparison of the two groups, the experimental group had higher pulmonary function than
the control group. [Conclusion] In this study, the experimental group showed greater
improvement in pulmonary function than the control group, which indicates that the PNF
respiration exercise is effective at increasing the pulmonary function of normal
adults.
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Affiliation(s)
- KyoChul Seo
- Department of Physical Therapy, Korea Nazarene University, Republic of Korea
| | - MiSuk Cho
- Department of Physical Therapy, Korea Nazarene University, Republic of Korea
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Nespoulet H, Rupp T, Bachasson D, Tamisier R, Wuyam B, Lévy P, Verges S. Positive expiratory pressure improves oxygenation in healthy subjects exposed to hypoxia. PLoS One 2013; 8:e85219. [PMID: 24376872 PMCID: PMC3871630 DOI: 10.1371/journal.pone.0085219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/25/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Positive end-expiratory pressure (PEEP) is commonly used in critical care medicine to improve gas exchange. Altitude sickness is associated with exaggerated reduction in arterial oxygenation. We assessed the effect of PEEP and pursed lips breathing (PLB) on arterial and tissue oxygenation under normobaric and hypobaric hypoxic conditions. Methods Sixteen healthy volunteers were exposed to acute normobaric hypoxia (Laboratory study, FiO2=0.12). The protocol consisted in 3-min phases with PEEPs of 0, 5 or 10 cmH2O, PLB or similar ventilation than with PEEP-10, interspaced with 3-min phases of free breathing. Arterial (pulse oximetry) and quadriceps (near-infrared spectroscopy) oxygenation, ventilation, cardiac function, esophageal and gastric pressures and subjects’ subjective perceptions were recorded continuously. In addition, the effect of PEEP on arterial oxygenation was tested at 4,350 m of altitude in 9 volunteers breathing for 20 min with PEEP-10 (Field study). Results During the laboratory study, PEEP-10 increased arterial and quadriceps oxygenation (arterial oxygen saturation +5.6±5.0% and quadriceps oxyhemoglobin +58±73 µmol.cm compared to free breathing; p<0.05). Conversely, PLB did not increase oxygenation. Oxygenation improvement with PEEP-10 was accompanied by an increase in expiratory esophageal and gastric pressures (esophageal pressure swing +5.4±3.2 cmH2O, p<0.05) but no change in minute ventilation, breathing pattern, end-tidal CO2 or cardiac function (all p>0.05) compared to PEEP-0. During the field study, PEEP-10 increased arterial oxygen saturation by +6.7±6.0% after the 3rd minute with PEEP-10 without further significant increase until the 20th minute with PEEP-10. Subjects did not report any significant discomfort with PEEP. Conclusions These data indicate that 10-cmH2O PEEP significantly improves arterial and muscle oxygenation under both normobaric and hypobaric hypoxic conditions in healthy subjects. PEEP-10 could be an attractive non-pharmacological tool to limit blood oxygen desaturation and possibly symptoms at altitude.
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Affiliation(s)
- Hugo Nespoulet
- INSERM U1042, Grenoble, France
- University Grenoble Alpes, Hypoxia-Physiopathology Laboratory (HP2), Grenoble, France
| | - Thomas Rupp
- INSERM U1042, Grenoble, France
- University Grenoble Alpes, Hypoxia-Physiopathology Laboratory (HP2), Grenoble, France
| | - Damien Bachasson
- INSERM U1042, Grenoble, France
- University Grenoble Alpes, Hypoxia-Physiopathology Laboratory (HP2), Grenoble, France
| | - Renaud Tamisier
- INSERM U1042, Grenoble, France
- University Grenoble Alpes, Hypoxia-Physiopathology Laboratory (HP2), Grenoble, France
| | - Bernard Wuyam
- INSERM U1042, Grenoble, France
- University Grenoble Alpes, Hypoxia-Physiopathology Laboratory (HP2), Grenoble, France
| | - Patrick Lévy
- INSERM U1042, Grenoble, France
- University Grenoble Alpes, Hypoxia-Physiopathology Laboratory (HP2), Grenoble, France
| | - Samuel Verges
- INSERM U1042, Grenoble, France
- University Grenoble Alpes, Hypoxia-Physiopathology Laboratory (HP2), Grenoble, France
- * E-mail:
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Han JM, Kim HA, Koo JP, Seo KC. Effects of Respiratory Muscle Activity in Stroke Patients after Feedback Breathing Exercise. ACTA ACUST UNITED AC 2013. [DOI: 10.5854/jiaptr.2013.10.25.552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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8
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Seo KC, Lee HM, Kim HA. The Effects of Combination of Inspiratory Diaphragm Exercise and Exspiratory Pursed-lip Breathing Exercise on Pulmonary Functions of Stroke Patients. J Phys Ther Sci 2013. [DOI: 10.1589/jpts.25.241] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyo Chul Seo
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University
| | - Hyun Min Lee
- Department of Physical Therapy, Honam University: 330 Eodeungno, Gwangsan-gu, Gwangju 506-714, South Korea
| | - Hyeon Ae Kim
- Department of Physical Therapy, Pohang University
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Rossi RC, Pastre CM, Ramos EMC, Vanderlei LCM. A respiração frenolabial na doença pulmonar obstrutiva crônica: revisão da literatura. FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000300015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Esta revisão teve por objetivo destacar os principais achados publicados nos últimos dez anos sobre os efeitos da respiração frenolabial (RFL) em pacientes com doença pulmonar obstrutiva crônica (DPOC). A busca dos artigos foi realizada nas bases de dados Lilacs, IBECS, MEDLINE e SciELO, por meio dos seguintes descritores da área da saúde (DeCS): doença pulmonar obstrutiva crônica, reabilitação, respiração, hiperinsuflação e dispneia, e suas respectivas versões na língua inglesa (MeSH), além do termo pursed-lip breathing. Após a eliminação dos títulos repetidos, foram selecionados somente os estudos que abordavam a RFL como tema principal, resultando em 12 artigos científicos, 10 ensaios clínicos e 2 revisões bibliográficas. Segundo os achados, a RFL proporciona: alterações sobre a gasometria arterial, caracterizada pelo aumento da saturação e pressão parcial de oxigênio; padrão ventilatório, com diminuição da frequência respiratória e aumento de tempo expiratório e do volume corrente; mecânica ventilatória, por meio do recrutamento de musculatura abdominal expiratória e dos músculos da caixa torácica e acessórios da inspiração; diminuição no consumo de oxigênio; alterações na modulação autonômica cardíaca induzida pelo aumento da atividade parassimpática e, por fim, melhora na qualidade de vida destes pacientes. A RFL é considerada uma manobra de grande importância, por repercutir de forma positiva em diversos sistemas e sobre a qualidade de vida de pacientes portadores da DPOC.
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Seo KC, Kim HA, Yim SY. The Effects of Pulmonary Function in the Stroke Patients after Thoracic Expension Exercise. ACTA ACUST UNITED AC 2012. [DOI: 10.13066/kspm.2012.7.2.157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kierkegaard M, Harms-Ringdahl K, Holmqvist LW, Tollbäck A. Functioning and disability in adults with myotonic dystrophy type 1. Disabil Rehabil 2011; 33:1826-36. [DOI: 10.3109/09638288.2010.549287] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Major advances in the fields of medical science and physiology, molecular genetics, biomedical engineering, and computer science have provided individuals with muscular dystrophy (MD) with more functional equipment, allowing better strategies for improvement of quality of life. These advances have also allowed a significant number of these patients to live much longer. As progress continues to change management, it also changes patients' expectations. A comprehensive medical and rehabilitative approach to management of aging MD patients can often fulfill expectations and help them enjoy an enhanced quality of life.
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13
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Lou JS, Weiss MD, Carter GT. Assessment and management of fatigue in neuromuscular disease. Am J Hosp Palliat Care 2010; 27:145-57. [PMID: 20190203 DOI: 10.1177/1049909109358420] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fatigue is a common and potentially debilitating symptom of neuromuscular disease (NMD). Studies show that patients with NMD subjectively report increased levels of fatigue. Laboratory testing has demonstrated that patients with NMD show objective physiological signs of increased fatigue, with both central and peripheral components. To date, no treatment has been proven to be truly effective through evidence-based medicine. Thus, the clinician must use a multimodality approach to treating fatigue in patients with NMD. Management interventions are generally based on a sequential approach including treatment of comorbid factors, with the goal of maximizing physical and psychological functioning. This might include low-intensity exercise training, cognitive therapy, treatment of associated depression, correction of risk factors such as obesity, poor nutrition, and inactivity (deconditioning). Optimizing cardiopulmonary function is also critical and measures such as noninvasive, positive pressure ventilation may reduce fatigue in patients with NMD. Novel medications such as modafinil, a nonamphetamine stimulant, may be a helpful pharmacological treatment. Nutraceutical agents, such as creatine monohydrate, coenzyme Q10 (CoQ10), and alpha-lipoic acid, may also improve neuromuscular function and reduce fatigue.
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Affiliation(s)
- Jau-Shin Lou
- Oregon Health and Science University, Portland, USA
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Aboussouan LS. Mechanisms of exercise limitation and pulmonary rehabilitation for patients with neuromuscular disease. Chron Respir Dis 2010; 6:231-49. [PMID: 19858353 DOI: 10.1177/1479972309345927] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Indications for exercise and pulmonary rehabilitation extend to neuromuscular diseases tough these conditions pose particular challenges given the associated skeletal muscle impairment and respiratory muscle dysfunction. These challenges are compounded by the variety of exercise prescriptions (aerobic, muscle strengthening, and respiratory muscle training) and the variety of neuromuscular disorders (muscular, motor neuron, motor nerve root, and neuromuscular transmission disorders). Studies support a level II evidence of effectiveness (i.e., likely to be effective) for a combination of aerobic exercise and strengthening exercises in muscular disorders, and for strengthening exercises in amyotrophic lateral sclerosis. The potential deleterious effects of work overload in the dystrophinopathies have not been confirmed in Becker muscular dystrophy. Adjunctive pharmacologic interventions (e.g., theophylline, steroids, PDE5 inhibitors, creatine), training recommendations (e.g., interval or lower intensity training) and supportive techniques (e.g., noninvasive ventilation, neuromuscular electrical stimulation, and diaphragm pacing) may result in more effective training but require more study before formal recommendations can be made. The exercise prescription should include avoidance of inspiratory muscle training in hypercapnia or low vital capacity, and should match the desired outcome (e.g., extremity training for task-specific performance, exercise training to enhance exercise performance, respiratory muscle training where respiratory muscle involvement contributes to the impairment).
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Affiliation(s)
- L S Aboussouan
- Cleveland Clinic Foundation, Respiratory Institute, Cleveland, OH 44195, USA.
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Woravutrangkul S, Jarungjitaree S, Sritara C, Vachalathiti R, Chuaychoo B. Efficacy of Pursed Lips Breathing with Forced Expiration Techniques and Active Cycle of Breathing Technique on Pulmonary Mucus Clearance in Healthy Subjects. J Phys Ther Sci 2010. [DOI: 10.1589/jpts.22.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Chanika Sritara
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
| | | | - Benjamas Chuaychoo
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
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Resqueti VR, Oliveira GWDS, Dourado Junior ME, Andrade ADD, Casan P, Fregonezi GADF. Confiabilidade do teste da caminhada de seis minutos em pacientes com miastenia gravis generalizada. FISIOTERAPIA E PESQUISA 2009. [DOI: 10.1590/s1809-29502009000300006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo objetivou determinar a confiabilidade do teste da caminhada de seis minutos (TC6M) como um teste de capacidade funcional em pacientes com miastenia gravis generalizada (MG). Foram selecionados 11 pacientes com MG - 5 homens, 6 mulheres - com idade de 55±9 anos, avaliados inicialmente quanto à função fulmonar, que se submeteram a três TC6M em dias diferentes. Durante e/ou após cada teste foram medidas freqüência cardíaca e saturação de oxigênio (por oxímetro portátil), sensação de dispnéia (pela escala de Borg) e distância percorrida. Nos três testes as distâncias percorridas foram 498 m, 517 m e 520 m (respectivamente 99%, 103% e 104% do valor predito). Em média, a freqüência cardíaca, dispnéia e saturação de oxigênio mostraram comportamento constante nos três testes. Foram encontradas alta confiabilidade relativa, com coeficiente de correlação interclasse maior que 0,90 entre os testes (TC6M1-TC6M2, 0,960; TC6M1-TC6M3, 0,945; e TC6M2-TC6M3, 0,970) e confiabilidade absoluta de 4%, 3,5% e 4,8%, com reprodutibilidade de 11%, 9,8% e 13,4%, respectivamente para o primeiro, segundo e terceiro testes. Os limites superiores e inferiores de concordância e o valor médio das médias das diferenças (bias) calculados pelo teste de Bland-Altman mostraram-se clinicamente aceitáveis. Conclui-se que o TC6M se mostrou seguro, confiável e reprodutível, podendo ser aplicado para avaliação e seguimento da tolerância ao exercício em pacientes com MG generalizada.
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17
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Comparison study of chest physiotherapy home training programmes on respiratory functions in patients with muscular dystrophy. Clin Rehabil 2008; 22:741-8. [DOI: 10.1177/0269215508091203] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare the effects of home training programmes, threshold inspiratory muscle training and breathing exercise on spirometry and maximal pressures in patients with muscular dystrophy.Design: Prospective blinded 12-week study.Settings: Cardiopulmonary department of university hospital.Subjects: Twenty-three patients with muscular dystrophy (17 patients with limb girdle muscular dystrophy and 6 patients with Becker muscular dystrophy) assigned to the threshold inspiratory muscle training and breathing exercise groups with alternate allocation.Methods: Spirometry, maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) were measured before and after training. In the threshold inspiratory muscle training group threshold pressure load was determined as equal to 30% of weekly PImaxmeasurement. In the breathing exercise group, patients performed deep and forceful diaphragmatic and segmental exercises. All patients performed exercises at home and once a week at hospital under supervision.Results: The improvement of PImaxin the threshold inspiratory muscle training group was more significant than the improvement observed in the breathing exercise group (P= 0.05). PEmaxincreased significantly only in the breathing exercise group (P= 0.01). Spirometry results did not change significantly in both groups after the training.Conclusions: We conclude that respiratory muscle strength is enhanced by training in the patients with muscular dystrophy who are ambulatory, but inspiratory and/or expiratory training effect is specific to the trained muscles. The techniques that improve the strength of respiratory muscles should be included in the physiotherapy management of patients with muscular dystrophy.
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18
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Jiang Y, Liang Y, Kacmarek RM. The principle of upper airway unidirectional flow facilitates breathing in humans. J Appl Physiol (1985) 2008; 105:854-8. [PMID: 18599676 DOI: 10.1152/japplphysiol.90599.2008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Upper airway unidirectional breathing, nose in and mouth out, is used by panting dogs to facilitate heat removal via water evaporation from the respiratory system. Why some humans instinctively employ the same breathing pattern during respiratory distress is still open to question. We hypothesized that 1) humans unconsciously perform unidirectional breathing because it improves breathing efficiency, 2) such an improvement is achieved by bypassing upper airway dead space, and 3) the magnitude of the improvement is inversely proportional to the tidal volume. Four breathing patterns were performed in random order in 10 healthy volunteers first with normal breathing effort, then with variable tidal volumes: mouth in and mouth out (MMB); nose in and nose out (NNB); nose in and mouth out (NMB); and mouth in and nose out (MNB). We found that unidirectional breathing bypasses anatomical dead space and improves breathing efficiency. At tidal volumes of approximately 380 ml, the functional anatomical dead space during NMB (81 +/- 31 ml) or MNB (101 +/- 20 ml) was significantly lower than that during MMB (148 +/- 15 ml) or NNB (130 +/- 13 ml) (all P < 0.001), and the breathing efficiency obtained with NMB (78 +/- 9%) or MNB (73 +/- 6%) was significantly higher than that with MMB (61 +/- 6%) or NNB (66 +/- 3%) (all P < 0.001). The improvement in breathing efficiency increased as tidal volume decreased. Unidirectional breathing results in a significant reduction in functional anatomical dead space and improvement in breathing efficiency. We suggest this may be the reason that such a breathing pattern is preferred during respiratory distress.
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Affiliation(s)
- Yandong Jiang
- Dept. of Respiratory Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Cup EH, Pieterse AJ, ten Broek-Pastoor JM, Munneke M, van Engelen BG, Hendricks HT, van der Wilt GJ, Oostendorp RA. Exercise Therapy and Other Types of Physical Therapy for Patients With Neuromuscular Diseases: A Systematic Review. Arch Phys Med Rehabil 2007; 88:1452-64. [DOI: 10.1016/j.apmr.2007.07.024] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 07/24/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
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20
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Fokkema DS, Maarsingh EJW, van Eykern LA, van Aalderen WMC. Different breathing patterns in healthy and asthmatic children: responses to an arithmetic task. Respir Med 2005; 100:148-56. [PMID: 16338598 DOI: 10.1016/j.rmed.2005.03.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 03/18/2005] [Indexed: 11/23/2022]
Abstract
UNLABELLED Asthma patients have been reported to be sensitive to breathlessness, independent of the degree of airway obstruction. Paying attention and task performance may induce changes in breathing pattern and these in turn may mediate such a feeling. The present experiment investigates whether strained breathing induced by an arithmetic task was different in children with asthma compared to healthy children. METHODS Seven healthy and eight asthmatic but symptom-free school children were equipped with electrodes for surface electromyographic (EMG) measurements of diaphragm, abdominal and intercostal (IC) muscles and with a strain gauge to monitor the pattern of breathing at rest and during an arithmetic task. The relative duration of exhalation and the relative speed of exhalation are used as measures of straining. The phase angle of maximal respiratory muscle activities relative to the maximal chest extension (MCE) are additional discriminating parameters. RESULTS Asthmatic children breathed more slowly and already at rest the phase of their respiratory muscle activity appears to be different. While in healthy children the maximal activity of the (left)abdominal muscles occurred 5+/-29% later than the MCE, in children with asthma the maximal activity occurred 26+/-30% of the cycle earlier than MCE. In children with asthma the activity of the IC muscles starts weaning already at 10+/-30% before MCE, in contrast to the healthy children in which intercostal muscle weaning starts only at 1+/-24% after MCE. During arithmetic, the significant difference between the groups in this respect disappeared. CONCLUSION Children with asthma show, even at rest, signs of respiratory muscle straining, probably in order to keep close control over the airflow in a similar way as healthy children during mental tasks. Such a 'careful' breathing pattern may work to prevent airway irritation also when they are free of symptoms.
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Affiliation(s)
- D S Fokkema
- Department of Biological Psychiatry, University of Groningen, PO box 30.001, 9700 RB Groningen, The Netherlands.
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Kim CT, Strommen JA, Johns JS, Weiss JM, Weiss LD, Williams FH, Rashbaum IG. Neuromuscular rehabilitation and electrodiagnosis. 4. Pediatric issues. Arch Phys Med Rehabil 2005; 86:S28-32. [PMID: 15761797 DOI: 10.1016/j.apmr.2004.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED This self-directed learning module highlights the physician's role in the diagnosis and treatment of neuromuscular disorders in pediatric populations. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses both clinical and electrodiagnostic features of common neuromuscular disorders in pediatric populations. The diagnostic value of somatosensory evoked potential is reviewed in a case of traumatic spinal cord injury without radiographic abnormality. Therapeutic interventions of progressive muscular dystrophy are discussed, as well as the differential diagnosis of floppy infant syndrome, the most common pediatric electrodiagnostic referral. OVERALL ARTICLE OBJECTIVES (a) To become familiar with electrodiagnosis and rehabilitation for common neuromuscular disorders in the pediatric population, (b) to undrstand electrodiagnostic findings of Guillain-Barre syndrome corresponding to pathophysiology, (c) to become familiar with somatosensory evoked potentials, and (d) to be able to make differential diagnosis of floppy infant syndrome based on clinical findings as well as electrodiagnosis.
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Affiliation(s)
- Chong-Tae Kim
- Division of Child Development and Rehabilitation, Children's Hospital of Philadelphia, University of Pennsylvania, 3405 Civic Center Blvd, Philadephia, PA 19104, USA.
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Affiliation(s)
- G A de F Fregonezi
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
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Nitz J, Burke B. A study of the facilitation of respiration in myotonic dystrophy. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2003; 7:228-38. [PMID: 12528578 DOI: 10.1002/pri.262] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Dystrophia myotonica or myotonic dystrophy is a progressive neuromuscular disorder in which patients demonstrate an irregular respiratory pattern and are particularly subject to cardiopulmonary compromise. The aim of the present study was to investigate the effects of both proprioceptive neuromuscular facilitation (PNF) and staged basal expansion (SBE) breathing exercises in subjects with myotonic dystrophy in two different positions: high support sitting and left side-lying. METHOD A randomized, double-blind study design was used. Seven non-congenital myotonic dystrophy subjects took part in the study. Six 'treatment' levels were applied to each subject: resting in high support sitting; resting in left side-lying; PNF of deep breathing in high support sitting; PNF of deep breathing in left side-lying; SBE in high support sitting and SBE in left side-lying. The outcome measures employed were arterial oxygen saturation (SpO2) and heart rate, as measured by oximetry and thoraco-abdominal motion (TAM), and respiratory rate, as measured by a pneumograph. RESULTS The PNF technique was found to be the main contributor to improvement in SpO2 for subjects with myotonic dystrophy, where a 2.2% increase was found in the high support sitting position and a 2.6% increase was found in the left side-lying position. There was an increase of between 377% and 556% in TAM during application of both treatment techniques, in either the high support sitting or left side-lying positions. Respiratory rate declined between 15% and 30% immediately after treatment application and heart rate dropped slightly by between 0.2% and 4.1%. CONCLUSION The present study provides objective evidence that application of these respiratory physiotherapy interventions elicits an improvement in respiratory function in subjects with myotonic dystrophy. Further research into the physiological effects of these techniques could explore the mechanisms responsible for improvement in respiratory indices.
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Affiliation(s)
- Jennifer Nitz
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
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Ugalde V, Walsh S, Abresch RT, Bonekat HW, Breslin E. Respiratory abdominal muscle recruitment and chest wall motion in myotonic muscular dystrophy. J Appl Physiol (1985) 2001; 91:395-407. [PMID: 11408457 DOI: 10.1152/jappl.2001.91.1.395] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abdominal muscles are selectively active in normal subjects during stress and may increase the potential energy for inspiration by reducing the end-expiratory lung volume (EELV). We hypothesized that a similar process would occur in subjects with myotonic muscular dystrophy (MMD), but would be less effective, because of to their weakness and altered chest wall mechanics. Fine-wire electromyography (EMG) of the transversus abdominis (TA), internal oblique (IO), external oblique, and rectus abdominis was recorded in 10 MMD and 10 control subjects. EMG activity, respiratory inductive plethysmography, and gastric pressure were recorded during static pressure measurement and at increasing levels of inspiratory resistance breathing. EELV was reduced and chest wall motion was synchronous only in controls. Although the TA and IO were selectively recruited in both groups, EMG activity of the MMD group was twice that of controls at the same inspiratory pressure. In MMD subjects with mildly reduced forced vital capacity, significant differences can be seen in abdominal muscle recruitment, wall motion, work of breathing, and ventilatory parameters.
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Affiliation(s)
- V Ugalde
- Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, California 95817, USA.
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