Cough augmentation in amyotrophic lateral sclerosis

Mustfa, Naveed; Aiello, Marina; Lyall, Rebecca; Nikoletou, Dimitra; Olivieri, Dario; Leigh, P. Nigel; Davidson, A. C.; Polkey, Michael I.; Moxham, John

doi:10.1212/01.wnl.0000092018.56823.02

Cited by 87 publications

(72 citation statements)

References 8 publications

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“…Although inspiratory muscle weakness appears to be the primary determinant of both ventilatory failure and respiratory symptoms in neuromuscular disease, the expiratory muscles are also of clinical interest as weakness predisposes to impaired cough and subsequent increased risk of lower respiratory tract infection, a common cause of morbidity and mortality. There is growing evidence that cough augmentation techniques may benefit patients with expiratory muscle weakness [90]. The nonvolitional assessment of expiratory muscles is attractive given that the best established volitional test (PE,max) commonly underestimates strength [64].…”

Section: Neuromuscular Diseasementioning

confidence: 99%

Magnetic stimulation for the measurement of respiratory and skeletal muscle function

Man¹

2004

Eur Respir J

118

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Respiratory and skeletal muscle function is of interest in many areas of pulmonary and critical care medicine. The capacity of the respiratory muscle pump to respond to the load imposed by disease is the basis of an understanding of ventilatory failure. Over the last four decades, considerable progress has been made in quantifying the capacity of the respiratory muscles, in terms of strength, endurance and fatigue. With the development of magnetic stimulation, it has recently become possible to nonvolitionally assess the respiratory muscles in a clinically acceptable way. This is of particular interest in the investigation of patients receiving critical care, those with neuromuscular disease, and in children where volitional efforts are either not possible or likely to be sub-maximal. Furthermore, the adaptation of these techniques to quantify the strength of peripheral muscles, such as the quadriceps, has allowed the effects of muscle training or rehabilitation, uninfluenced by learning effect, to be assessed. This article focuses on the physiological basis of magnetic nerve stimulation, and reviews how the technique has been applied to measure muscle strength and fatigue, with particular emphasis upon the diaphragm. The translation of magnetic stimulation into a clinical tool is described, and how it may be of diagnostic, prognostic and therapeutic value in several areas of pulmonary medicine. In particular, the use of magnetic stimulation in neuromuscular disease, the intensive care setting, chronic obstructive pulmonary disease and paediatrics will be discussed. The nonvolitional assessment of skeletal musclesFor routine muscle strength measurements, the force generated from a maximum voluntary contraction (MVC) is often used. However volitional, effort-dependent manoeuvres for measuring strength are not always suitable for patients as the ability to perform a true MVC relies upon subject motivation and cooperation. This is particularly so in patients on intensive care units (ICU), children, patients with cognitive difficulties, and those patients prevented from performing a true MVC by pain (for example, following surgery). However, even in well-motivated subjects, sub-maximal muscle activation is common in routine clinical practice [1]. As volitional manoeuvres are influenced by a learning effect, the value of MVC is also limited in studies of training or rehabilitation. Consequently, there has been a need for nonvolitional methods to assess muscle strength. Skeletal muscle physiologySkeletal muscle is controlled by electrical impulses conducted by motor neurones that lead to the release of acetylcholine from the motor end plate, thus depolarising the muscle cell membrane. The force generated by muscle contraction is dependent upon a number of factors, including the number of muscle fibres stimulated, muscle length at the time of stimulation and the frequency of stimulation. The force-frequency curve of a muscle is of particular relevance in the understanding of nonvolitional techniques to asse...

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Section: Neuromuscular Diseasementioning

confidence: 99%

Magnetic stimulation for the measurement of respiratory and skeletal muscle function

Man¹

2004

Eur Respir J

118

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“…It involves the application of cycling positive and negative pressure to the airway, facilitating an effective cough and adequate secretion clearance. Studies examining its home-based clinical effectiveness demonstrate that it is safe and well tolerated [2][3][4] ; creates an increased peak cough flow 2,[5][6][7][8] ; results in reduced hospital stay 9 ; and when used as part of a wider home management protocol involving other therapies, such as noninvasive ventilation, achieves reduced rates of pneumonia and hospital stay. 5,6,10,11 However, there have been comparatively few studies examining the broader impact of home-based MI-E on children and their families.…”

Section: Introductionmentioning

confidence: 99%

Lifestyle Implications of Home Mechanical Insufflation-Exsufflation for Children With Neuromuscular Disease and Their Families

Moran¹,

Spittle

Delany

2014

Respir Care

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BACKGROUND: Mechanical insufflation-exsufflation (MI-E) is increasingly used in the home management of children with neuromuscular disease. Research to date has focused on the effect of MI-E on physical health. The aim of this study was to qualitatively investigate the impact of home MI-E on the child and family's lifestyle. METHODS: Eight parents and 3 children participated in semistructured interviews. RESULTS: Five themes emerged from parent interviews demonstrating: (1) lifestyle implications, (2) parents becoming experts, (3) parents developing a sense of control over their child's condition, (4) an element of extra care, and (5) impacts on the parent-child relationship. Developing themes from the child interviews showed them adjusting to and then relying on the device. Home MI-E medicalized the home, but the overall lifestyle impact was positive. CONCLUSIONS: Although involving a small number of subjects, this study demonstrated a mixture of opposing impacts of home MI-E on lifestyle, both enabling and disabling, which need to be considered when introducing home MI-E. The positive impacts included greater ability to manage the child's health, including avoidance of hospital admissions. Negative impacts were greatest for those parents who were sole operators of the device, including a frequently disrupted lifestyle.

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“…Table 2 Studies relating to improvement of cough effectiveness (17) compared combinations of MIE, manual assisted cough (MAC) and breath stacking in people with ALS and other neurodegenerative conditions, using PCF as an outcome. For patients with ALS (n = 73, (16,17)), MIE was more effective than MAC in those patients without bulbar involvement and who are stable. MIE was not effective in those with bulbar dysfunction and those with little lung function impairment.…”

Section: The Problem Of Retained Secretionsmentioning

confidence: 91%

“…MIE was not effective in those with bulbar dysfunction and those with little lung function impairment. The specific issue of bulbar involvement highlights the importance of impaired cough due to upper airway weakness which may not be overcome by these interventions (16). In people with other neurodegenerative conditions, Bach (14) found MIE more effective than MAC with breath stacking; cough with insufflations and unassisted cough.…”

Section: The Problem Of Retained Secretionsmentioning

confidence: 99%

Management of respiratory problems in people with neurodegenerative conditions: a narrative review

2012

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Cough augmentation in amyotrophic lateral sclerosis

Cited by 87 publications

References 8 publications

Magnetic stimulation for the measurement of respiratory and skeletal muscle function

Magnetic stimulation for the measurement of respiratory and skeletal muscle function

Lifestyle Implications of Home Mechanical Insufflation-Exsufflation for Children With Neuromuscular Disease and Their Families

Management of respiratory problems in people with neurodegenerative conditions: a narrative review

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