A case for inspiratory muscle training in SCI: potential role as a preventative tool in infectious respiratory diseases like COVID-19

Abstract

Introduction Respiratory complications (RC) are a leading cause of death after spinal cord injury (SCI) due to compromised immune function and respiratory muscle weakness. Thus, individuals with SCI are at high risk of developing COVID-19 related RC. Results of a SCI clinical trial showed a supervised respiratory muscle training (RMT) program decreased risk of developing RC. The feasibility of conducting unsupervised RMT is not well documented. Four publications (n = 117) were identified in which unsupervised RMT was performed. Significant improvements in respiratory outcomes were reported in two studies: Maximal Inspiratory and Expiratory Pressure (MIP40% and MEP25%, respectively), Peak Expiratory Flow (PEF9%), seated and supine Forced Vital Capacity (FVC23% and 26%, respectively), and Peak Cough Flow (28%). This review and case report will attempt to show that an inspiratory muscle training (IMT) home exercise program (HEP) is feasible and may prepare the respiratory system for RC associated with COVID-19 in patients with SCI. Case presentation A 23-year-old with tetraplegia (P1), history of mechanical ventilation, and hospitalization for RC, completed 27 IMT HEP sessions in one month. MIP and sustained MIP (SMIP) increased from baseline by 28% and 26.5%, respectively. Expiratory volumes and rates also improved (FVC, FEV1, and PEF: 11.7%, 8.3%, and 14.2%, respectively). Discussion The effects of COVID-19 on patients with SCI remains inconclusive, but recent literature and the results of this case suggest that unsupervised IMT is feasible and may limit the severity of RC in patients with SCI who contract COVID-19.

Adherence to and impact of home-based high-intensity IMT in people with spinal cord injury: a pilot study

“… One participant had an acute urinary tract infection [ 35 ] at Follow-up 1 (F1) and his data were not included in the analyses. Both participants who dropped out of the study, one during IMT Phase 1 and the other during IMT Phase 2, cited personal reasons relating to the COVID-19 pandemic.…”

“…A home-based RMT program, targeting RF and balance, may bypass obstacles encountered when people with SCI seek care. However, the program adherence of a person with SCI completing unsupervised RMT is not well documented [ 31 – 35 ]. Recent studies implementing unsupervised RMT in people with SCI only intermittently reported RF outcomes and none mentioned balance [ 35 ], warranting a more thorough investigation of the impact of unsupervised IMT on RF and FSB.…”

Low Intensity Respiratory Muscle Training in COVID-19 Patients after Invasive Mechanical Ventilation: A Retrospective Case-Series Study

“…According to RMT intervention on other conditions, such as heart failure [ 59 , 60 ] or common pathologies suffered in an ICU [ 33 ], future clinical trials should compare low versus high intensity RMT on respiratory muscle strength in these patients who suffered from IMV in an ICU. In addition, a novel study suggested that RMT was feasible and could reduce respiratory complications in neurological patients with COVID-19, claiming the necessity of further studies in this research line [ 61 ].…”

Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease

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“…with the highest resistance to inspiration and expiration). [56][57][58][59][60] Advance Therapy # 1…”