Mechanically assisted coughing (MAC) is an airway clearance method in which the thorax/abdomen is compressed in synchronization with mechanical insufflation-exsufflation (MI-E). MAC can be performed with manual assistance at the upper thorax (MAC-UT), lower thorax (MAC-LT), and upper thorax + abdomen (MAC-UT/A). This study aimed to determine the most effective approach under different conditions (air stacking or tracheostomy) in patients with neuromuscular disorders (NMDs). Methods: The study included 34 patients with NMDs. The patients were categorized into air stacking group (n= 15), no air stacking group (n=9), and tracheostomy/tracheostomy positive-pressure ventilation (TPPV) group (n=10). Results: In each group, the cough peak flow (CPF) at 75% of the forced vital capacity (!75), !50,!25, and!10 were investigated during the approaches. In the air stacking group, the CPF was higher with MAC-UT, MAC-LT, and MAC-UT/A than with MI-E (p < 0.05). Additionally, !75 was higher with MAC-LT and MAC-UT/A than with MI-E (p < 0.05 and p < 0.01, respectively). In the no air stacking group, !75 was higher with MAC-UT/A than with MI-E (p < 0.05). In the tracheotomy/TPPV group, there were no significant differences. Conclusions: MAC approaches, especially MAC-LT and MAC-UT/A, are preferred in air stacking patients. However, in tracheostomy/TPPV patients, the CPF might not increase with MAC.

MI-E + assisted CPF was the highest. The CPF measured with the peak flow meter suggested underestimation.

INTRODUCTION: Gait asymmetry can become very pronounced in patients who have suffered a stroke. The impairment of trunk function in some stroke patients can restrict thorax mobility and cause respiratory muscle weakness. Trunk and neck dysfunction are believed to affect the gait in stroke patients. OBJECTIVE: This study aimed to investigate the relationship between gait asymmetry and respiratory function in stroke patients by measuring the step time and trunk acceleration. METHODS: This study employed a cross-sectional design. Thirty stroke patients participated in this study. The symmetry index (SI) and Lissajous index (LI) were used to evaluate asymmetry during walking. The respiratory function and respiratory muscle strength were evaluated by spirometry. We examined the relation between SI or LI and the respiratory function/respiratory muscle strength in patients with stroke. RE-SULTS: The results of our analysis demonstrated that the SI was significantly correlated with the inspiratory and expiratory muscle strength and the LI was significantly correlated with the percentage of the predicted vital capacity (respectively, r = −0.386, r = −0.392, r = −0.446; p < 0.05). CONCLUSION: The present study is the first to indicate a relationship between gait asymmetry and respiratory function in stroke patients.

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Mechanical insufflation-exsufflation (MI-E) significantly improved atelectasis of the right medial lobe, lower lobe and lower left lobe, and thoracic compliance (Cdyn) in a subject with severe motor and intellectual disabilities (SMID). [Participant and Methods] The subject was a 30-year-old with SMID. Ventilator management under tracheotomy for quadriplegia, scoliosis with Cobb angle 92.8°, and passive right lateral decubitus posture was incomplete. Postural drainage + MI-E was performed for atelectasis of the right middle lobe and the lower lobe. Due to the severity of scoliosis, insufficient postural drainage + MI-E was performed on the lower left lobe. [Results] Atelectasis of the middle and lower lobes of the right lung disappeared, but partial atelectasis of the left lower lobe did not improve. Cdyn improved significantly after 6 weeks of intervention. [Conclusion] Insufficient postural drainage did not improve atelectasis. It took one month to improve Cdyn.