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Lista-Paz A, Kuisma R, Canosa JLS, Sebio García R, González Doniz L. Pulmonary function in patients with chronic stroke compared with a control group of healthy people matched by age and sex. Physiother Theory Pract 2023; 39:918-926. [PMID: 35098873 DOI: 10.1080/09593985.2022.2031363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/21/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Effects of chronic stroke on pulmonary function are largely unknown. AIM To compare lung volumes in people with chronic stroke with a control group of healthy people matched by age and sex, as well as to investigate the relationship between the lung volumes and functional capacity. METHODS A cross-sectional study involving people with chronic stroke. Cases were matched to a control group of healthy people. Lung function and the distance walked during the Six-Minute Walk Test (6MWD) were the main outcomes. Independent t-tests were used to compare pulmonary function between groups and the Pearson correlation coefficient was used to assess any relationship between lung volumes and the 6MWD in the stroke group. RESULTS Sixty-six participants (24 males in each group; 56.5 ± 15.5 years) were included. People with stroke presented significantly lower lung volumes when compared to the control group. The median of forced vital capacity (FVC) was 79% and peak expiratory flow was 64% of the reference value. The 6MWD was found to be weakly correlated with inspiratory reserve volume (r = 0.39, p = .03) and peak inspiratory flow (r = 0.35, p = .05). CONCLUSIONS People with chronic stroke show decreased lung volumes when compared with healthy people and this likely impacts on their functional capacity.
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Affiliation(s)
- Ana Lista-Paz
- Faculty of Physiotherapy, The University of A Coruña. Campus Universitario de Oza, n°1, A Coruña, Spain
- Psychosocial and Functional Rehabilitation Intervention Research Group, The University of A Coruña. Campus Universitario de Oza, n°1, A Coruña, Spain
| | - Raija Kuisma
- Karelia University of Applied Sciences. Tikkarinne, Joensuu, Finland
| | - Jesús L Saleta Canosa
- Faculty of Physiotherapy, The University of A Coruña. Campus Universitario de Oza, n°1, A Coruña, Spain
- Department of Preventive Medicine, Complejo Hospitalario Universitario de A Coruña. As Xubias, A Coruña, Spain
| | - Raquel Sebio García
- Department of Rehabilitation. Hospital Clinic de Barcelona. Barcelona, Spain Casanova bis Barcelona, Spain
- Research Group in Attention to Chronicity and Innovation in Health (GRACIS). School of Health Sciences TecnoCampus - University Pompeu Fabra. Avinguda Ernest Lluch, Mataró, Spain
| | - Luz González Doniz
- Faculty of Physiotherapy, The University of A Coruña. Campus Universitario de Oza, n°1, A Coruña, Spain
- Psychosocial and Functional Rehabilitation Intervention Research Group, The University of A Coruña. Campus Universitario de Oza, n°1, A Coruña, Spain
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Zaltieri M, Massaroni C, Di Tocco J, Bravi M, Morrone M, Sterzi S, Caponero MA, Schena E, Lo Presti D. Preliminary Assessment of a Flexible Multi-Sensor Wearable System Based on Fiber Bragg Gratings for Respiratory Monitoring of Hemiplegic Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13525. [PMID: 36294108 PMCID: PMC9603331 DOI: 10.3390/ijerph192013525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/23/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Respiratory diseases are common in post-stroke hemiplegic patients and represent a major social problem as they worsen the quality of life and reduce the life span. As a consequence, being able to monitor respiratory parameters such as the respiratory rate (RR) and assess the presence of respiratory asynchronies could be of paramount importance to define hemiplegics' health status. Moreover, RR is a useful parameter to investigate the level of fatigue and distress that these patients undergo during rehabilitation processes. Although motion capture systems and flowmeters are the leading instruments for respiratory pattern evaluation, smart wearable systems are gaining ever more acceptance since they allow continuous monitoring by detecting chest wall breathing displacements, ensuring reduced costs and no need for dedicated spaces. Among other sensing technologies, fiber Bragg grating (FBG) sensors have emerged thanks to their high sensitivity to strain, lightness, and multiplexing capability. In this work, a wearable system composed of four flexible dumbbell-shaped sensing modules is proposed for respiratory monitoring in hemiplegic patients. The system is light and easy to wear and can be adapted to any anthropometry thanks to the modular anchoring system. Its feasibility assessment in RR evaluation was performed on seven hemiplegic volunteers in eupnea and tachypnea breathing conditions. In addition, an explorative investigation was conducted to assess the system's ability to detect asynchronies between torso compartments. The good results suggest that this device could be a useful instrument to support clinicians and operators in hemiplegic patients' management.
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Affiliation(s)
- Martina Zaltieri
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Joshua Di Tocco
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Marco Bravi
- Unit of Physical and Rehabilitative Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Michelangelo Morrone
- Unit of Physical and Rehabilitative Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Silvia Sterzi
- Unit of Physical and Rehabilitative Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | | | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Daniela Lo Presti
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
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3
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Patel N, Chong K, Baydur A. Methods and Applications in Respiratory Physiology: Respiratory Mechanics, Drive and Muscle Function in Neuromuscular and Chest Wall Disorders. Front Physiol 2022; 13:838414. [PMID: 35774289 PMCID: PMC9237333 DOI: 10.3389/fphys.2022.838414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with neuromuscular and chest wall disorders experience respiratory muscle weakness, reduced lung volume and increases in respiratory elastance and resistance which lead to increase in work of breathing, impaired gas exchange and respiratory pump failure. Recently developed methods to assess respiratory muscle weakness, mechanics and movement supplement traditionally employed spirometry and methods to evaluate gas exchange. These include recording postural change in vital capacity, respiratory pressures (mouth and sniff), electromyography and ultrasound evaluation of diaphragmatic thickness and excursions. In this review, we highlight key aspects of the pathophysiology of these conditions as they impact the patient and describe measures to evaluate respiratory dysfunction. We discuss potential areas of physiologic investigation in the evaluation of respiratory aspects of these disorders.
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An HJ, Park SJ. Effects of Cervical Spine Mobilization on Respiratory Function and Cervical Angles of Stroke Patients: A Pilot Study. Healthcare (Basel) 2021; 9:healthcare9040377. [PMID: 33805494 PMCID: PMC8066151 DOI: 10.3390/healthcare9040377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
The forward head posture (FHP) of stroke patients has a negative impact on respiratory function. Cervical spine mobilization is a manual therapy technique that used to prevent and treat FHP and respiratory function. This pilot study investigated whether cervical spine mobilization can effectively improve outcomes following FHP and respiratory function of stroke patients. Twenty-four patients participated in our assessor-blinded randomized controlled trial. All the participants received neurodevelopmental treatments (gait training and trunk rehabilitation). The experimental group additionally received 15-min sessions of cervical spine mobilization three times per week for 4 weeks. The control group received cervical spine sham mobilization during the same period. For the cervical angles, the cranial vertebral angle (CVA) and cranial rotation angle (CRA) were measured. A respiratory function test was performed to measure the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and chest circumferences (upper and lower chest sizes). Except for MIP, there was no significant difference between the experimental group and the control group. The CVA and CRA were significantly increased in the experimental group only. Cervical spine mobilization improved cervical angles and inspiratory function of the stroke patients in this study. However, a comparative study with a larger number of patients is needed to confirm this finding from our pilot study, which had a small sample size.
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Affiliation(s)
- Ho Jung An
- Department of Physical Therapy, Dongnam Health University, 50, Cheoncheon-ro 74beon-gil, Jangan-gu, Suwon-si, Gyeonggi-do 16328, Korea;
| | - Shin Jun Park
- Department of Physical Therapy, Suwon Women’s University, 1098, Juseok-ro, Bongdam-eup, Hwaseong-si, Gyeonggi-do 18333, Korea
- Correspondence: ; Tel.: +82-31-290-8998; Fax: 82-31-290-8959
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Wang J, Li G, Ding S, Yu L, Wang Y, Qiao L, Wu Q, Ni W, Fan H, Zheng Q, Zhang Y, Li H. Liuzijue qigong versus traditional breathing training for patients with post-stroke dysarthria complicated by abnormal respiratory control: Results of a single-center randomized controlled trial. Clin Rehabil 2021; 35:999-1010. [PMID: 33517744 PMCID: PMC8193589 DOI: 10.1177/0269215521992473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of the study was to investigate whether liuzijue qigong could improve the ability of respiratory control and comprehensive speech in patients with stroke dysarthria. Design: A randomized controlled trial. Setting: The research was carried out in the department of rehabilitation. Participants: Altogether, a total of 98 stroke patients with dysarthria participated in the study. Interventions: Patients were randomly divided into two groups (the experimental group: basic articulation + liuzijue qigong, 48 patients or the control group: basic articulation + traditional breathing training, 50 patients). All therapies were conducted once a day, five times a week for three weeks. Main measures: Primary outcome measure: Speech breathing level of the modified Frenchay Dysarthria Assessment. Secondary outcome measures: the modified Frenchay Dysarthria Assessment, maximum phonation time, maximal counting ability, /s/, /z/, s/z ratio, and the loudness level. All outcome measures were assessed twice (at baseline and after three weeks). Results: At three weeks, There were significant difference between the two groups in the change of speech breathing level (81% vs 66%, P = 0.011), the modified Frenchay Dysarthria Assessment (5.54 (4.68–6.40) vs 3.66 (2.92–4.40), P = 0.001), maximum phonation time (5.55 (4.92–6.18) vs 3.01(2.31–3.71), P < 0.01), maximal counting ability (3.08(2.45–3.71) vs 2.10 (1.53–2.67), P = 0.018), and /s/ (3.08 (2.39–3.78) vs 1.87 (1.23–2.51), P = 0.004), while no significant differences were found in the change of /z/ (3.08 (2.31–3.86) vs 2.10 (1.5–2.64), P = 0.08), s/z ratio (1.26 (0.96–1.55) vs 1.03 (0.97–1.09), P = 0.714), and the change of loudness level (69% vs 60%, P = 0.562). Conclusions: Liuzijue qigong, combined with basic articulation training, could improve the respiratory control ability, as well as the comprehensive speech ability of stroke patients with dysarthria. Trial registration: ChiCTR-INR-16010215.
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Affiliation(s)
- Jie Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China.,School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Gaiyan Li
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Shanshan Ding
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Long Yu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yan Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Lei Qiao
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Qilin Wu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Weidong Ni
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Hang Fan
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Qianyun Zheng
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Hongli Li
- Department of Rehabilitation, Shanghai Shenyuan Rehabilitation Hospital, Shanghai, China
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Wang C, Yu L, Yang J, Wang RW, Zheng YN, Zhang Y. Effectiveness of LiuZiJue Qigong versus traditional core stability training for poststroke patients complicated with abnormal trunk postural control: study protocol for a single-center randomized controlled trial. Trials 2020; 21:254. [PMID: 32164792 PMCID: PMC7068967 DOI: 10.1186/s13063-020-4117-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trunk function in stroke patients with hemiplegia is associated with respiration and core stability and is also found to be associated with balance and postural control and activities of daily living. LiuZiJue Qigong (LQG) is a traditional Chinese method of fitness based on breath pronunciation. The purpose of this study is to compare the clinical efficacy of LQG and traditional core stability training in the treatment of stroke patients with abnormal trunk posture. This protocol is written according to the SPIRIT 2013 statement. METHODS/DESIGN This study is a single-center randomized controlled trial in which 160 stroke patients are randomly divided into a study group and a control group. Patients in the study group will receive LQG combined with conventional rehabilitation therapy, and patients in the control group will receive traditional core stability training combined with conventional rehabilitation therapy. All treatments will be done for 45 min/day, five times per week, for 2 weeks. The primary outcome (Trunk Impairment Scale) and secondary outcomes (Berg Balance Scale, Fugl-Meyer Assessment, Modified Barthel Index, Maximum Phonation Time, Dynamic and Static balance testing, and thickness and the mobile degrees of diaphragm) will be measured at baseline, 2 weeks, and the end of the rehabilitation course. DISCUSSION The aim purpose of this research study is to compare the clinical efficacy of LQG and traditional core stability exercise in the treatment of stroke patients with abnormal trunk posture. TRIAL REGISTRATION Chinese Clinical Trial Register, ChiCTR1800014864. Registered on 24 November 2018.
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Affiliation(s)
- Chen Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China.,School of Kinesiology, Shanghai University of Sport, No. 200 Hengren Road, Yangpu District, Shanghai, 200438, People's Republic of China
| | - Long Yu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China
| | - Jian Yang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China
| | - Ren Wei Wang
- School of Kinesiology, Shanghai University of Sport, No. 200 Hengren Road, Yangpu District, Shanghai, 200438, People's Republic of China
| | - Ya Nan Zheng
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China.,School of Kinesiology, Shanghai University of Sport, No. 200 Hengren Road, Yangpu District, Shanghai, 200438, People's Republic of China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China.
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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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Katz S, Arish N, Rokach A, Zaltzman Y, Marcus EL. The effect of body position on pulmonary function: a systematic review. BMC Pulm Med 2018; 18:159. [PMID: 30305051 PMCID: PMC6180369 DOI: 10.1186/s12890-018-0723-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 09/17/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pulmonary function tests (PFTs) are routinely performed in the upright position due to measurement devices and patient comfort. This systematic review investigated the influence of body position on lung function in healthy persons and specific patient groups. METHODS A search to identify English-language papers published from 1/1998-12/2017 was conducted using MEDLINE and Google Scholar with key words: body position, lung function, lung mechanics, lung volume, position change, positioning, posture, pulmonary function testing, sitting, standing, supine, ventilation, and ventilatory change. Studies that were quasi-experimental, pre-post intervention; compared ≥2 positions, including sitting or standing; and assessed lung function in non-mechanically ventilated subjects aged ≥18 years were included. Primary outcome measures were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC, FEV1/FVC), vital capacity (VC), functional residual capacity (FRC), maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), peak expiratory flow (PEF), total lung capacity (TLC), residual volume (RV), and diffusing capacity of the lungs for carbon monoxide (DLCO). Standing, sitting, supine, and right- and left-side lying positions were studied. RESULTS Forty-three studies met inclusion criteria. The study populations included healthy subjects (29 studies), lung disease (nine), heart disease (four), spinal cord injury (SCI, seven), neuromuscular diseases (three), and obesity (four). In most studies involving healthy subjects or patients with lung, heart, neuromuscular disease, or obesity, FEV1, FVC, FRC, PEmax, PImax, and/or PEF values were higher in more erect positions. For subjects with tetraplegic SCI, FVC and FEV1 were higher in supine vs. sitting. In healthy subjects, DLCO was higher in the supine vs. sitting, and in sitting vs. side-lying positions. In patients with chronic heart failure, the effect of position on DLCO varied. CONCLUSIONS Body position influences the results of PFTs, but the optimal position and magnitude of the benefit varies between study populations. PFTs are routinely performed in the sitting position. We recommend the supine position should be considered in addition to sitting for PFTs in patients with SCI and neuromuscular disease. When treating patients with heart, lung, SCI, neuromuscular disease, or obesity, one should take into consideration that pulmonary physiology and function are influenced by body position.
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Affiliation(s)
- Shikma Katz
- Chronic Ventilator-Dependent Division, Herzog Medical Center, POB 3900, Jerusalem, Israel
- 0000 0004 1937 0511grid.7489.2Recanati School for Community Health Professions, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Nissim Arish
- Pulmonary Institute, Shaare Zedek Medical Center, POB 3235, Jerusalem, Israel
- 0000 0004 1937 0538grid.9619.7Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel
| | - Ariel Rokach
- Pulmonary Institute, Shaare Zedek Medical Center, POB 3235, Jerusalem, Israel
- 0000 0004 1937 0538grid.9619.7Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel
| | - Yacov Zaltzman
- Chronic Ventilator-Dependent Division, Herzog Medical Center, POB 3900, Jerusalem, Israel
| | - Esther-Lee Marcus
- Chronic Ventilator-Dependent Division, Herzog Medical Center, POB 3900, Jerusalem, Israel
- 0000 0004 1937 0538grid.9619.7Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel
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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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Reduced cardiorespiratory fitness after stroke: biological consequences and exercise-induced adaptations. Stroke Res Treat 2011; 2012:959120. [PMID: 21876848 PMCID: PMC3159380 DOI: 10.1155/2012/959120] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 06/27/2011] [Indexed: 01/08/2023] Open
Abstract
Evidence from several studies consistently shows decline in cardiorespiratory (CR) fitness and physical function after disabling stroke. The broader implications of such a decline to general health may be partially understood through negative poststroke physiologic adaptations such as unilateral muscle fiber type shifts, impaired hemodynamic function, and decrements in systemic metabolic status. These physiologic changes also interrelate with reductions in activities of daily living (ADLs), community ambulation, and exercise tolerance, causing a perpetual cycle of worsening disability and deteriorating health. Fortunately, initial evidence suggests that stroke participants retain the capacity to adapt physiologically to an exercise training stimulus. However, despite this evidence, exercise as a therapeutic intervention continues to be clinically underutilized in the general stroke population. Far more research is needed to fully comprehend the consequences of and remedies for CR fitness impairments after stroke. The purpose of this brief review is to describe some of what is currently known about the physiological consequences of CR fitness decline after stroke. Additionally, there is an overview of the evidence supporting exercise interventions for improving CR fitness, and associated aspects of general health in this population.
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Kim K, Fell DW, Lee JH. Feedback Respiratory Training to Enhance Chest Expansion and Pulmonary Function in Chronic Stroke: A Double-Blind, Randomized Controlled Study. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.75] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyoung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University
| | - Dennis W. Fell
- Department of Physical Therapy, University of South Alabama
| | - Jeon Hyeong Lee
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University
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12
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Schilero GJ, Spungen AM, Bauman WA, Radulovic M, Lesser M. Pulmonary function and spinal cord injury. Respir Physiol Neurobiol 2009; 166:129-41. [PMID: 19442929 DOI: 10.1016/j.resp.2009.04.002] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 03/31/2009] [Accepted: 04/01/2009] [Indexed: 11/30/2022]
Abstract
Injury to the cervical and upper thoracic spinal cord disrupts function of inspiratory and expiratory muscles, as reflected by reduction in spirometric and lung volume parameters and static mouth pressures. In association, subjects with tetraplegia have decreased chest wall and lung compliance, increased abdominal wall compliance, and rib cage stiffness with paradoxical chest wall movements, all of which contribute to an increase in the work of breathing. Expiratory muscle function is more compromised than inspiratory muscle function among subjects with tetraplegia and high paraplegia, which can result in ineffective cough and propensity to mucus retention and atelectasis. Subjects with tetraplegia also demonstrate heightened vagal activity with reduction in baseline airway caliber, findings attributed to loss of sympathetic innervation to the lungs. Significant increase in airway caliber following inhalation of ipratropium bromide, an anticholinergic agent, suggests that reduction in airway caliber is not due to acquired airway fibrosis stemming from repeated infections or to abnormal hysteresis secondary to chronic inability of subjects to inhale to predicted total lung capacity. Reduced baseline airway caliber possibly explains why subjects with tetraplegia exhibit airway hyperresponsiveness to methacholine and ultrasonically nebulized distilled water. While it has been well demonstrated that bilateral phrenic nerve pacing or stimulation through intramuscular diaphragmatic electrodes improves inspiratory muscle function, it remains unclear if inspiratory muscle training improves pulmonary function. Recent findings suggest that expiratory muscle training, electrical stimulation of expiratory muscles and administration of a long-acting beta(2)-agonist (salmeterol) improve physiological parameters and cough. It is unknown if baseline bronchoconstriction in tetraplegia contributes to respiratory symptoms, of if the chronic administration of a bronchodilator reduces the work of breathing and/or improves respiratory symptoms. Less is known regarding the benefits of treatment of obstructive sleep apnea, despite evidence indicating that the prevalence of this condition in persons with tetraplegia is far greater than that encountered in able-bodied individuals.
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Affiliation(s)
- Gregory J Schilero
- Rehabilitation Research and Development Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. Peters VA Medical Center, Bronx, NY 10468, USA.
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MacKay-Lyons MJ, Howlett J. Exercise capacity and cardiovascular adaptations to aerobic training early after stroke. Top Stroke Rehabil 2005; 12:31-44. [PMID: 15735999 DOI: 10.1310/rdqm-jtgl-whaa-xybw] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinicians are becoming increasingly interested in the use of aerobic training to enhance functional outcomes after stroke. Several studies have demonstrated the effectiveness of training among individuals in the chronic poststroke period. However, there is limited information on the response to training in earlier stages of recovery. The purpose of this article is to review what is known regarding the capacity of people early after stroke (<4 months) to respond to the physiological demands of exercise (exercise capacity) as well as their ability to make long-term cardiovascular adaptations to aerobic exercise. There is evidence that exercise capacity, as measured by peak oxygen consumption on maximal exercise tests, is reduced in this population. There is also evidence, albeit limited, that exercise trainability soon after stroke can be both feasible and safe, if appropriate screening and monitoring are used. Moreover, there are early indications that activity-level functions such as walking speed, mobility, and balance may be enhanced through such programs. Further research is necessary to elucidate the most appropriate timing and design of fitness programs for people early after stroke.
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Britton D, Goldstein B, Jones-Redmond J, Esselman P. Baclofen pump intervention for spasticity affecting pulmonary function. J Spinal Cord Med 2005; 28:343-7. [PMID: 16396387 PMCID: PMC1864906 DOI: 10.1080/10790268.2005.11753832] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Muscle spasticity may adversely affect pulmonary function after spinal cord injury (SCI). However, there is limited information regarding the treatment of spasticity as a determinant of pulmonary function. This study presents the case of a man with C4 tetraplegia who had severe spasticity and difficulty weaning from ventilatory support. METHODS Case presentation. RESULTS Severe spasticity likely contributed to respiratory compromise in this patient. Successful and rapid weaning from the ventilator occurred within 3 weeks of baclofen pump placement. CONCLUSIONS Randomized clinical trials among SCI patients with significant spasticity are needed to determine whether intervention with a baclofen pump facilitates earlier ventilatory weaning.
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Affiliation(s)
- Deanna Britton
- Speech-Language Pathology Clinical Specialist, Harborview Medical Center, 325 Ninth Avenue, Box 359819, Seattle, WA 98104, USA.
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Affiliation(s)
- S Narain
- University of Durban-Westville, Durban, 4000, South Africa
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Baydur A, Adkins RH, Milic-Emili J. Lung mechanics in individuals with spinal cord injury: effects of injury level and posture. J Appl Physiol (1985) 2001; 90:405-11. [PMID: 11160035 DOI: 10.1152/jappl.2001.90.2.405] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Individuals with spinal cord injury (SCI) exhibit reduced lung volumes and flow rates as a result of respiratory muscle weakness. These features have not, however, been investigated in relation to the combined effects of injury level and posture. Changes in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV(1)), FEV(1)/FVC, forced expiratory flow at 50% vital capacity (FEF(50)), inspiratory capacity (IC), and expiratory reserve volume (ERV) were assessed by injury level in the seated and supine positions in 74 individuals with SCI. The main findings were 1) FVC, FEV(1), and IC increased with descending SCI level down to T(10), below which they tended to level off; 2) supine values of FVC and FEV(1) tended to be larger in the supine compared with the seated posture down to injury level T(1), caudad to which they were less than when seated; 3) IC increased proportionately more down to injury level L(1), below which it declined slightly and plateaued; 4) ERV was measurable even at high cervical injuries, was generally smaller in the supine position, reached peak values in both positions at T(10) injury level, and then rapidly declined at lower levels; 5) when subjects were separated according to current, former, and never smokers, only formerly smoking paraplegic individuals demonstrated spirometric values significantly less than paraplegic individuals who never smoked. Changes in spirometric measurements in SCI are dependent on injury level and posture. These findings support the concept that the increase in vital capacity in supine position is related to the effect of gravity on abdominal contents and increase in IC.
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Affiliation(s)
- A Baydur
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles 90033, USA.
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Abstract
Respiratory problems are a major cause of death in the acute and chronic phases of cervical spinal cord injury (CSCI); CSCI paralyzes the intercostal and abdominal muscles, reducing ability to cough and clear secretions. Impaired cough due to neuromuscular disorders can be assessed with the maximum expiratory pressure (MEP). This study consists of two experiments with CSCI patients. In the first, MEP measurements were recorded with the following maneuvers performed: (1) spontaneous cough attempts, (2) manually assisted cough, and (3) cough attempts with functional electrical stimulation (FES) applied to the abdominal wall. In the second, spontaneous cough attempts and cough attempts with a portable FES unit were recorded. These CSCI patients were found to have a greatly reduced MEP when they coughed spontaneously. Either FES-assisted or manually assisted coughing increased the MEP in all patients studied. By increasing the MEP, abdominal muscle FES could enhance cough in quadriplegics.
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Affiliation(s)
- S H Linder
- Spinal Cord Injury Service, VA Medical Center, Palo Alto, Calif
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Biering-Sørensen F, Lehmann Knudsen J, Schmidt A, Bundgaard A, Christensen I. Effect of respiratory training with a mouth-nose-mask in tetraplegics. PARAPLEGIA 1991; 29:113-9. [PMID: 2023775 DOI: 10.1038/sc.1991.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ten tetraplegics, 8 males and 2 females, with a median age of 32 years participated in a scheduled 6 weeks training programme with a respiratory muscle training mouth-nose-mask (RMT-mask) with a fixed expiratory and an increasing inspiratory resistance set by the tetraplegic in accordance to his/her increasing ability during the training period. During the 6 weeks the tetraplegics required to use the RMT-mask for 15 minutes three times a day. Before and after each training session they measured peak flow (PEF). Lung volumes, ventilatory and diffusion capacity were measured before and after the 6 weeks training period. The training resulted only in a significant change in the PEF, which increased with 11% from 371 l/min before to 412 l/min in average after the 6 weeks of training (p less than 0.025). This statistically significant increase was confirmed by the measurements of PEF performed by the tetraplegics themselves during the training period. In addition there was an increase in PEF from before to immediately after each 15 minutes training session, this trend reached statistically significance (p less than 0.025) in the third '2 weeks period'. These results might indicate a possibility of improving the tetraplegics ability to cough by use of a simple RMT-mask, which in turn might prevent certain lung complications including pneumonia, and atelectasia.
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Annoni JM, Ackermann D, Kesselring J. Respiratory function in chronic hemiplegia. INTERNATIONAL DISABILITY STUDIES 1990; 12:78-80. [PMID: 2254236 DOI: 10.3109/03790799009166256] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Dynamic spirometry was examined in 23 non-smoking hemiplegic patients after the acute phase. The decrease of slow inspiratory forced capacity is related to motor impairment and does not vary with time. The forced inspiratory and expiratory vital capacities are similar to the slow inspiratory vital capacity in the first 6 months of the disease, but significantly decrease later independent of the motor impairment. The peak expiratory flow is highly variable but is clearly decreased, and is related to motor impairment. These results point to a restrictive respiratory syndrome due to mechanical limitation of thorax excursions caused by weakness, hypotonicity, and incoordination of the trunk musculature. The importance of long-term physiotherapy of the trunk is emphasized.
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Affiliation(s)
- J M Annoni
- Rehabilitation Centre, Valens, Switzerland
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Weingarden SI, Belen JG. Alternative approach to the respiratory management of the high cervical spinal cord injury patient. INTERNATIONAL DISABILITY STUDIES 1987; 9:132-3. [PMID: 3429397 DOI: 10.3109/03790798709166342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Haas F, Axen K, Pineda H. Aerobic capacity in spinal cord injured people. CENTRAL NERVOUS SYSTEM TRAUMA : JOURNAL OF THE AMERICAN PARALYSIS ASSOCIATION 1986; 3:77-91. [PMID: 3524869 DOI: 10.1089/cns.1986.3.77] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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