Breathing patterns during breathing exercises in persons with tetraplegia

Abstract

Study design: Cross-sectional, observational, controlled study. Objectives: To survey breathing patterns during breathing at rest, ordinary deep breathing (DB), positive expiratory pressure (PEP) and inspiratory resistance-positive expiratory pressure (IR-PEP) among individuals with a cervical spinal cord lesion (SCL) compared with able-bodied controls. Setting: Sahlgrenska University Hospital, Go¨teborg, Sweden. Method: Participants consisted of 20 persons with a complete SCL at the C5-C8 level (at least 1 year postinjury) and 20 matched, able-bodied controls. Breathing patterns and static lung volumes were measured using a body plethysmograph. Results: Compared to the controls, breathing patterns at rest among the people with tetraplegia were characterised by a decreased tidal volume, stable respiratory rate and total cycle duration resulting in decreased mean inspiratory and expiratory flow, and alveolar ventilation. All volume and flow parameters increased except respiratory rate, which decreased during DB and PEP. During IR-PEP, tidal volume increased less compared to PEP, and combined with a decreased respiratory rate the alveolar ventilation was lower than during breathing at rest. The functional residual capacity increased during PEP and IR-PEP in people with tetraplegia. Conclusion: DB exercises with or without resistance during expiration or the whole breathing cycle affect the breathing pattern in persons with tetraplegia. DB was superior in increasing volumes and flow. PEP and IR-PEP increased FRC but IR-PEP decreased volumes and flows. However, large interindividual differences in the SCL group indicate the need for caution in generalising the results.

Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient

“…Patients who undertook deep breathing exercises, with or without resistance (PEP alone and PEP with inspiratory resistance), significantly increased TLC, VC and RV, but not FRC, compared with a control group 310. Interestingly, inspiratory and expiratory flow, alveolar ventilation, respiratory rate and V T were found to be highest in the deep breathing without resistance group.…”

Effects of overground locomotor training on the ventilatory response to volitional treadmill walking in individuals with incomplete spinal cord injury: a pilot study

“…23 Pulmonary responses, as measured by V E , during both acute submaximal and maximal exercise in individuals with SCI have demonstrated values similar to 32 or lower than 30 those in adults without SCI. However, analyses of V E using data from pre-determined time points that have been averaged may yield skewed descriptions of pulmonary function in SCI as this analytic approach has a limited ability to detect changes in V E resulting from the high degree of V E variability found throughout the first few minutes of exercise.…”

A comparison study of two breathing exercise techniques in tetraplegics

“…The vital capacity approximates their inspiratory capacity. The work of breathing is increased and the diaphragm is prone to fatigue particularly in patients with high cervical cord lesion [16].…”