Effect of respiratory therapy on pulmonary functions in children with cerebral palsy: a systematic review

Abstract

Background Children with cerebral palsy (CP) are at risk for respiratory dysfunction. Early initiation of pulmonary rehabilitation in addition to conventional physical therapy may result in improvement and maintenance of chest mobility and respiratory function. However, empirical support for respiratory therapy is limited. The aim of the review was to assess the evidence of the effectiveness of respiratory therapy on pulmonary functions in children with CP. Methods Four electronic databases (PubMed, Cochrane Library, Physiotherapy Evidence Database (PEDro), and Google Scholar) were searched till December 2019 using predefined terms by two independent reviewers. Randomized controlled trials published in English were included if they met the following criteria: population—children with different types of CP of both sex, aged up to 18 years; intervention—respiratory therapy; outcomes—pulmonary functions. Eight studies with 235 participants only met the inclusion criteria and were included in this review. Predefined data were tabulated using American Academy for Cerebral Palsy and Developmental Medicine by two reviewers and verified by a third reviewer. Methodological quality was assessed using rating system of quality assessment and PEDro scale; also, levels of evidence adopted from modified Sacket’s scale were used for each outcome. Results The quality of studies ranged from excellent (one study) to good (five studies) and fair (two studies). The results showed level 1 (six studies) and level 2 (two studies) on modified Sacket’s scale for level of evidence. Lack of allocation concealment and blinding was the major risk of bias in the included studies. Conclusions Meta-analysis revealed significant difference in the improvement of vital capacity, peak expiratory flow, and forced expiratory volume at 1 s in favor of the study groups. However, there is a need for high-quality studies to draw a clear conclusion.

Addition of respiratory exercises to conventional rehabilitation for children and adolescents with cerebral palsy: a systematic review and meta-analysis

“…In general, the studies have a great variation in relation to the number of sessions and session time. We observed that the optimal level of intensity in intervention programs for CP is not clear [13].…”

“…Pulmonary rehabilitation in children with chronic lung diseases has been extensively studied and points out protocols with respiratory exercises aimed at chest mobility and abdominal muscle strengthening, which lead to improved chest expansion and increased lower thoracic mobility, thus suggesting better diaphragmatic work and increased quality of life and exercise capacity [7][8][9][10][11]. Some of these exercises were also proposed for children with CP [12,13]. However, available rehabilitation strategies to target the respiratory functioning of the population with CP are not addressed in the literature; protocols are not standardized, and there is no consensus on the optimal training modalities.…”

“…Aerobic exercises are commonly performed over a long period of time with light to moderate intensity (e.g., running and cycling), limiting their application. Alternatively, respiratory exercises are increasingly regarded as an essential part of the overall physiotherapy in the management of CP and can be defined as techniques with or without the use of mechanical devices that encourage inspiration (e.g., incentive spirometer) and expiration [e.g., positive expiratory pressure (PEP)] [12,13].…”

“…Respiratory training has been proven to be a safe and effective behavioral intervention for the prevention and rehabilitation of chronic conditions, in which, despite presenting different pathophysiology from CP, also have restrictive mechanisms [9][10][11]. However, evidence to date is scarce about the effectiveness of respiratory exercises in the population with CP [13]. In view of the above, this systematic review and meta-analysis aimed to analyze published randomized controlled clinical trials (RCTs) that investigated the effect of the addition of respiratory exercises to conventional rehabilitation on pulmonary function, functional capacity, respiratory muscle strength, gross motor function and quality of life in children and adolescents with CP.…”

Respiratory System Impairments in Children with Cerebral Palsy: Outpatient Surveillance, Diagnosis, and Treatment

“…Curvature, rotation, and shortening of the spine result in thoracic cage deformity 9,62 . A deformed thoracic cage causes reduced lung volume, decreased lung compliance, increased stiffness of the chest wall, reduced force of the respiratory muscles, and increased mechanical dysfunction of the diaphragm.…”