The effect of lung volume expansion in tetraplegia

Respiratory muscle training for tetraplegic patients: A literature review

This paper reviews the evidence concerning the effectiveness of respiratory muscle training for tetraplegic patients. While respiratory muscle strength/endurance and/or pulmonary function have been shown to improve after inspiratory muscle training, a lack of controlled studies means it is not possible to exclude spontaneous recovery from being responsible for the improvements seen. It is not known if inspiratory muscle training improves quality of life or decreases morbidity. There are limited data which suggest that, for ventilator dependent tetraplegics, strengthening the muscles of the neck and upper thorax may improve vital capacity and allow limited ventilator-free time. The effectiveness of other techniques such as glossopharyngeal breathing, expiratory muscle training and exercise as methods of improving respiratory muscle strength/endurance is unknown.

The effect of intermittent positive pressure breathing on lung volumes in acute quadriparesis

Resting tidal volume and vital capacity were measured daily in 5 patients with acute quadriparesis during the first 7 to 10 days of their hospitalisation. On admission, vital capacity was significantly reduced to 26% of the predicted value (p less than 0.001). This increased significantly over the study period to 33% of the predicted value (p less than 0.02). Expiratory flow rates, measured on one occasion during the study period, showed similar decrements. Tidal volume and vital capacity were also measured immediately following administration of intermittent positive pressure breathing (IPPB). Although the lung volume achieved during IPPB was significantly higher than resting values of tidal volume and vital capacity (p less than 0.001), tidal volume returned to baseline values as soon as IPPB was ceased. Vital capacity remained significantly higher than baseline values at this stage (p less than 0.02), although the mean increase in vital capacity immediately following IPPB was only 43 mls. Acute quadriparesis is associated with a severe ventilatory impairment which includes a reduced vital capacity and expiratory flow rates. IPPB has a positive effect on lung volume whilst it is being administered. Immediately following treatment, this effect does not appear to be sustained at a level which would be considered clinically significant.