Comparison of Resistance and Sham Training of Expiratory Muscles on Pulmonary Functions in Patients with Spinal Cord Injury: An Interventional Study
Abstract
Respiratory complications are major sources of morbidity and mortality in spinal cord injury (SCI). Improvement in expiratory muscle strength may be associated with improved cough and clearance of secretions. So that expiratory muscle training are advised in SCI cases to improve expiratory muscle strength. This study was conducted to compare the effect of Resistance and Sham training on pulmonary function test in spinal cord injury cases. It was found the mean value of all the parameters of PFT of Sham training was found to increase from baseline to 1st and 2nd follow up. This difference was found significant in all the parameters of PFT at 2nd follow up, but FEV1 and PIFR of 1st follow up (p value < 0.05) only. Likewise, it is also observed that the mean value of all the parameters of PFT of test group was found to increase from baseline to 1st and 2nd follow up. This difference was found highly significant (p value <0.001) in all the parameters of PFT at 1st and 2nd follow up. So it can be concluded that however both the type of training improve PFTs but the improvement of high resistance training was significantly more than they were for sham training.
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Introduction
Respiratory complication are major sources of morbidity and mortality in both the acute and chronic phases of spinal cord injury (SCI)1,2,3,4 with an incidence of 36% to 83%. In patients with tetraplegia, weakness of the accessory muscles of breathing along with decreased lung and chest wall compliance severely decrease respiratory efficiency. Weak inspiratory muscles impair the ability of the patient with tetraplegia to take a deep breath, causing atelectasis and a higher risk of developing pneumonia.2 Weakness of expiratory muscles impairs the ability of the patient with tetraplegia to cough and successfully clear respiratory secretions.2 This also predisposes patients with tetraplegia to developing atelectasis, pneumonia, and ultimately an increased risk of early mortality.3
The degree of respiratory dysfunction is related to the extent and level of the neurological injury in such a way that high cervical and thoracic injuries are at the highest risk. The degree of expiratory muscle weakness can be assessed by using spirometry. Recent large cross-sectional studies evaluating pulmonary function in SCI have shown that force vital capacity (FVC) and force expiratory volume in 1 sec (FEV1), as measures of maximum inspiration, decrease linearly with higher levels of SCI, and are worst with high cervical tetraplegia. 1,5,6
Conclusion
It can be concluded that from present study that expiratory resistance breathing exercises using a simple handheld breathing training device have the potential to improve most of the measures of ventilatory function in people with tetraplegia. Sham training, which used a substantially lower level of resistance, also resulted in some improvements in pulmonary function. However, the improvement of high resistance training was significantly more than they were for sham training. The systematic repeated use of a simple respiratory muscle training device training has the potential to increase the strength of respiratory muscle, more so in PIFR, PEFR and CPEFR of pulmonary function. This may reduce the occurrence of respiratory complications related morbidity and improve outcomes.