The value of the CoughAssist® in the daily lives of children with neuromuscular disorders: Experiences of families, children and physiotherapists

Mechanically assisted cough strategies: user perspectives and cough flows in children with neurodisability

Background

Mechanical insufflation-exsufflation (MI-E) is used to augment cough in children with neurodisability. We aimed to determine the user comfort and cough flows during three MI-E strategies, and to predict factors associated with improved comfort and cough flows.

Methods

This multicentre, crossover trial was done at four regional hospitals in Norway. Children with neurodisability using MI-E long term via mask were enrolled. In randomised order, they tested three MI-E setting strategies (in-/exsufflation pressure (cmH2O)/in (In)- versus exsufflation (Ex) time): 1) "A-symmetric" (±50/In=Ex); 2) "B-asymmetric" (+25- +30)/-40, In>Ex); and 3) "C-personalised", as set by their therapist. The primary outcomes were user-reported comfort on a visual analogue scale (VAS) (0=maximum comfort) and peak cough flows (PCF) (L·min-1) measured by a pneumotachograph in the MI-E circuit.

Results

We recruited 74 children median (IQR) age 8.1 (4.4-13.8) years, range 0.6-17.9, and analysed 218 MI-E sequences. The mean±sd VAS comfort scores were 4.7±2.96, 2.9±2.44 and 3.2±2.46 for strategies A, B and C, respectively (A versus B and C, p<0.001). The mean±sd PCF registered during strategies A, B and C were 203±46.87, 166±46.05 and 171±49.74 L·min-1, respectively (A versus B and C, p<0.001). Using low inspiratory flow predicted improved comfort. Age and unassisted cough flows increased exsufflation flows.

Conclusions

An asymmetric or personalised MI-E strategy resulted in better comfort scores, but lower PCF than a symmetric approach utilising high pressures. All three strategies generated cough flows above therapeutic thresholds and were rated as slightly to moderately uncomfortable.

A systematic review of how adherence to caregiver facilitated therapeutic activities for children are assessed and reported in published research

This systematic review assessed four measurement properties of measures (instruments) used by researchers to assess adherence to caregiver facilitated therapeutic activities (CFTA) for children in published research. The measurement properties considered in this systematic review were dyadic considerations, interpretability, reliability, and validity of the instruments used to assess adherence or compliance. Two databases (http://www.pubmed.gov and EMBASE) were searched for studies that reported adherence or compliance to CFTA prescribed by physiotherapists or occupational therapists or speech and language therapists. Papers included in this review were those that studied children less than 18 years old and or their primary caregivers. Data were extracted by the authors using a data extraction table adapted from the work of Bollen and colleagues (2014) and by rating the measurement properties of the adherence measures identified based on predefined rating criteria (see supplementary file and Table 1 respectively). The authors relied only on the published research articles and any associated published supplementary files/data. None of the 40 adherence instruments identified wholly fulfilled all the criteria of the four measurement properties assessed. The results of this systematic review show that the measures used by researchers for assessing adherence to CFTA generally lack validity, reliability, and dyadic considerations.